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https://www.readbyqxmd.com/read/28430046/an-outpatient-methadone-weaning-program-by-a-neonatal-intensive-care-unit-for-neonatal-abstinence-syndrome
#1
Andrew Lai, Patrick Philpot, Jenny Boucher, Andrew Meyer
Through retrospective chart review, this study described characteristics and length of stay for a cohort of newborns discharged on methadone following an inpatient weaning for neonatal abstinence syndrome (NAS). Data were assessed for all term infants born between January 1, 2010, and December 31, 2014, admitted to the hospital with a co-diagnosis of NAS at discharge, for gestational age, length of stay, days on treatment protocol before discharge, time to once-daily interval methadone dosing, and hospital charges, as well as for categorical characteristics...
April 21, 2017: Population Health Management
https://www.readbyqxmd.com/read/28426544/neonatal-abstinence-syndrome-where-are-we-and-where-do-we-go-from-here
#2
Laura Brandt, Loretta P Finnegan
PURPOSE OF REVIEW: Over the last 15 years the prevalence of neonatal abstinence syndrome (NAS) increased almost five-fold. A considerable diversity seems to prevail in the management of NAS. This review provides an overview of factors affecting the expression and course of NAS, and recent developments in NAS assessment and treatment. RECENT FINDINGS: Apart from different pharmacological and nonpharmacological treatment modalities, maturity of the infant and genetic variations likely are (co)responsible for interpatient variability in NAS severity, despite similar maternal exposure...
April 19, 2017: Current Opinion in Psychiatry
https://www.readbyqxmd.com/read/28419284/laser-thermal-ablation-for-metastases-failing-radiosurgery-a-multicentered-retrospective-study
#3
Tafadzwa L Chaunzwa, Di Deng, Eric C Leuthardt, Stephen B Tatter, Alireda M Mohammadi, Gene H Barnett, Veronica L Chiang
BACKGROUND: Radiosurgical failure following stereotactic radiosurgery for brain metastases can be attributed to tumor regrowth or radiation necrosis. MRI-guided laser thermal ablation (LTA) therapy has emerged as an option for treatment; however, previous literature demonstrates variable results across centers. OBJECTIVE: To assess the outcomes of LTA in the treatment of metastases failing radiosurgery across multiple centers and to determine if any treatment factors are predictive of outcome...
April 13, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28405457/factors-for-improving-reproductive-performance-of-sows-and-herd-productivity-in-commercial-breeding-herds
#4
REVIEW
Yuzo Koketsu, Satomi Tani, Ryosuke Iida
We review critical factors associated with reproductive performance of female breeding pigs, their lifetime performance and herd productivity in commercial herds. The factors include both sow-level and herd-level factors. High risk sow-level groups for decreasing reproductive performance of female pigs are low or high parity, increased outdoor temperature, decreased lactation feed intake, single inseminations, increased lactation length, prolonged weaning-to-first-mating interval, low birth weight or low preweaning growth rate, a few pigs born alive at parity 1, an increased number of stillborn piglets, foster-in or nurse sow practices and low or high age at first-mating...
2017: Porcine Health Management
https://www.readbyqxmd.com/read/28403404/hospital-outcomes-and-long-term-survival-after-referral-to-a-specialized-weaning-unit
#5
M G Davies, T G Quinnell, N S Oscroft, S P Clutterbuck, J M Shneerson, I E Smith
Background.: Prolonged invasive mechanical ventilation (IMV) is a frequent challenge, and an increasing number of patients are transferred from intensive care units to long-term acute care hospitals or specialized weaning units. There are few published data for discharge home rates, use of noninvasive ventilation (NIV), or long-term survival. Methods.: A case-note and database review was conducted of patients admitted to a UK national specialized weaning unit for weaning from IMV between 1992 and 2012...
April 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28402093/extracorporeal-co2-removal-ecco2r-in-critically-ill-patients-a-systematic-review
#6
Fabio S Taccone, Maximilian V Malfertheiner, Fiorenza Ferrari, Matteo DI Nardo, Justyna Swol, Lars M Broman, Leen Vercaemst, Nicholas Barrett, Federico Pappalardo, Jan Belohlavek, Thomas Mueller, Roberto Lorusso, Mirko Belliato
INTRODUCTION: The use of extracorporeal CO2 removal (ECCO2R) is increasingly employed in critically ill patients. However, the clinical evidence supporting its efficacy remains currently poor. EVIDENCE ACQUISITION: A systematic review using MEDLINE via PubMed was performed to identify eligible studies (until 30th September 2016). The amount of CO2 reduction, the effect on the duration of mechanical ventilation and weaning, the impact on patients' outcome and the occurrence of complications were evaluated...
April 11, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28394957/-intestinal-failure-due-to-short-bowel-syndrome-impact-of-a-multidisciplinary-intestinal-rehabilitation-program
#7
María Elena Molina, Felipe Bellolio, Julieta Klaassen, Javier Gómez, Constanza Villalón, Juan Francisco Guerra, Álvaro Zúñiga
BACKGROUND: In patients suffering intestinal failure due to short bowel, the goal of an Intestinal Rehabilitation Program is to optimize and tailor all aspects of clinical management, and eventually, wean patients off lifelong parenteral nutrition. AIM: To report the results of our program in patients suffering intestinal failure. PATIENTS AND METHODS: A registry of all patients referred to the Intestinal Failure unit between January 2009 and December 2015 was constructed...
November 2016: Revista Médica de Chile
https://www.readbyqxmd.com/read/28380189/extracorporeal-respiratory-support-in-adult-patients
#8
Thiago Gomes Romano, Pedro Vitale Mendes, Marcelo Park, Eduardo Leite Vieira Costa
In patients with severe respiratory failure, either hypoxemic or hypercapnic, life support with mechanical ventilation alone can be insufficient to meet their needs, especially if one tries to avoid ventilator settings that can cause injury to the lungs. In those patients, extracorporeal membrane oxygenation (ECMO), which is also very effective in removing carbon dioxide from the blood, can provide life support, allowing the application of protective lung ventilation. In this review article, we aim to explore some of the most relevant aspects of using ECMO for respiratory support...
January 2017: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
https://www.readbyqxmd.com/read/28348897/ace-inhibitor-induced-angioedema-following-cervical-spine-surgery
#9
Faris Hannoodi, Hussam Sabbagh
Angioedema is a well-known side effect of angiotensin converting enzyme inhibitors (ACEi). However, ACE inhibitors induced angioedema after cervical surgery is a rare condition. They result in increased levels of circulating bradykinins. Rare cases of angioedema following local trauma in patients using ACE inhibitors have been published. We present such a case. A 54-year-old Caucasian female with a history significant for hypertension, controlled with lisinopril, was admitted for routine cervical spine surgery...
2017: Case Reports in Cardiology
https://www.readbyqxmd.com/read/28347320/life-threatening-massive-pulmonary-embolism-rescued-by-venoarterial-extracorporeal-membrane-oxygenation
#10
Fillipo Corsi, Guillaume Lebreton, Nicolas Bréchot, Guillaume Hekimian, Ania Nieszkowska, Jean-Louis Trouillet, Charles-Edouard Luyt, Pascal Leprince, Jean Chastre, Alain Combes, Matthieu Schmidt
BACKGROUND: Despite quick implementation of reperfusion therapies, a few patients with high-risk, acute, massive, pulmonary embolism (PE) remain highly hemodynamically unstable. Others have absolute contraindication to receive reperfusion therapies. Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) might lower their right ventricular overload, improve hemodynamic status, and restore tissue oxygenation. METHODS: ECMO-related complications and 90-day mortality were analyzed for 17 highly unstable, ECMO-treated, massive PE patients admitted to a tertiary-care center (2006-2015)...
March 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28343681/ultrasound-evaluation-of-diaphragm-function-and-its-application-in-critical-patients-mechanical-ventilation-and-brachial-plexus-block
#11
F de B de la Quintana Gordon, B Nacarino Alcorta, M Fajardo Pérez
Before diaphragm ultrasonography, assessment of diaphragm function was very difficult due to the complex nature of its exploration. The use of this new technique has shed light on diagnostic problems and treatment with an improvement in final outcomes for critically ill patients, in whom the incidence of diaphragm weakness or dysfunction has been underestimated. Better knowledge of diaphragm function enables us earlier diagnosis by quantification of diaphragm contractile activity or evaluation of functional status after delivery of plexus block anaesthesia, facilitating therapeutic decisions...
March 23, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28333157/consensus-approach-to-nasal-high-flow-therapy-in-neonates
#12
B A Yoder, B Manley, C Collins, K Ives, A Kugelman, A Lavizzari, M McQueen
OBJECTIVE: Nasal high-flow therapy (nHFT) is commonly used for noninvasive respiratory support in the neonatal intensive care unit. Our objective was to determine which aspects of neonatal nHFT have achieved adequate evidence base to support consensus among experienced clinical investigators, and to document areas lacking consensus to promote future investigations. STUDY DESIGN: Prospective, modified Delphi collation of tabular queries related to specific aspects of neonatal nHFT...
March 23, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28329284/contemporary-outcome-of-unplanned-right-ventricular-assist-device-for-severe-right-heart-failure-after-continuous-flow-left-ventricular-assist-device-insertion
#13
Daisuke Yoshioka, Hiroo Takayama, Reshad A Garan, Veli K Topkara, Jiho Han, Paul Kurlansky, Melana Yuzefpolskaya, Paolo C Colombo, Yoshifumi Naka, Koji Takeda
OBJECTIVES: The timely use of a right ventricular assist device (RVAD) becomes necessary for severe right heart failure (RHF) after left ventricular assist device (LVAD) insertion. This study evaluates outcomes in patients who required unplanned RVAD support early after continuous-flow (CF) LVAD insertion. METHODS: We retrospectively reviewed 305 patients who underwent HeartMate II/HeartWare CF-LVAD insertion between 2009 and 2014. Twenty-seven (9%) patients required unplanned RVAD for severe RHF early after LVAD insertion...
March 1, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28328578/sustained-improvements-in-pain-mood-function-and-opioid-use-post-interdisciplinary-pain-rehabilitation-in-patients-weaned-from-high-and-low-dose-chronic-opioid-therapy
#14
Kelly L Huffman, Taylor E Rush, Youran Fan, Giries W Sweis, Brinder Vij, Edward C Covington, Judith Scheman, Manu Mathews
Increased prescribing of opioids for chronic non cancer pain is associated with significant social costs, including overdose and addiction. In this context, there is interest in interdisciplinary chronic pain rehabilitation programs (ICPRP) focusing on self-management and minimizing opioid use. This study examined outcomes of patients weaned from opioids in an ICPRP from 2007-2012. Participants included 413 patients on high dose (HD) chronic opioid therapy (COT; >100mg), 528 on low dose (LD) COT and 516 not on opioids (NO)...
March 21, 2017: Pain
https://www.readbyqxmd.com/read/28315650/retrospective-analysis-of-reproductive-performance-of-pair-bred-compared-with-trio-bred-mice
#15
Katherine Wasson
Federal guidelines provide recommendations regarding the minimum of floor space that should be allotted for breeding laboratory rodents. Mouse mating systems used by a variety of institutions frequently deviate from these recommendations. Regulatory agencies suggest that deviations from established guidelines should be assessed on an institutional basis and recommend periodic review by the local IACUC. Mouse breeding data, collected in a laboratory animal management software program at a single institution, were retrospectively analyzed to determine the effects of 2 breeding schemes on reproductive performance...
March 1, 2017: Journal of the American Association for Laboratory Animal Science: JAALAS
https://www.readbyqxmd.com/read/28281412/early-hybrid-approach-and-enteral-feeding-algorithm-could-reduce-the-incidence-of-necrotising-enterocolitis-in-neonates-with-ductus-dependent-systemic-circulation
#16
Lucia Manuri, Stefano Morelli, Salvatore Agati, Michele B Saitta, Lilia Oreto, Giuseppe Mandraffino, Enrico Iannace, Fiore S Iorio, Paolo Guccione
BACKGROUND: The reported incidence of necrotising enterocolitis in neonates with complex CHD with ductus-dependent systemic circulation ranges from 6.8 to 13% despite surgical treatment; the overall mortality is between 25 and 97%. The incidence of gastrointestinal complications after hybrid palliation for neonates with ductus-dependent systemic circulation still has to be defined, but seems comparable with that following the Norwood procedure. METHODS: We reviewed the incidence of gastrointestinal complications in a series of 42 consecutive neonates with ductus-dependent systemic circulation, who received early hybrid palliation associated with a standardised feeding protocol...
January 2017: Cardiology in the Young
https://www.readbyqxmd.com/read/28272159/outcomes-in-pediatric-autoimmune-hepatitis-and-significance-of-azathioprine-metabolites
#17
Melissa A Sheiko, Shikha S Sundaram, Kelley E Capocelli, Zhaoxing Pan, Annette M McCoy, Cara L Mack
OBJECTIVES: Autoimmune hepatitis (AIH) is a common pediatric liver disease and long-term remission is usually maintained with azathioprine (AZA). There is no consensus on the target range for AZA active metabolite 6-thioguanine (6-TGN) levels in pediatric AIH. The aim of this study was to characterize the outcomes of pediatric patients with AIH and determine correlations between AZA dosing or 6-TGN metabolite levels and biochemical remission. METHODS: A retrospective chart review was performed and data on presentation, laboratories including AZA metabolite levels, medication use and outcomes was collected...
March 7, 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/28260350/morphine-treatment-for-neonatal-abstinence-syndrome-huge-dosing-variability-underscores-the-need-for-a-better-clinical-study-design
#18
Paola Mian, Dick Tibboel, Enno D Wildschut, John N van den Anker, Karel Allegaert
INTRODUCTION: At present, morphine is the most commonly used first-line therapy to treat Neonatal Abstinence Syndrome (NAS). Unfortunately, there is still lack of evidence and consensus to guide pharmacologic therapy for NAS. In this review, we provide an overview on dosing regimens of morphine currently reported to treat NAS, with the aim to stimulate discussion on the need for a standardized dosing through better study design. METHODS: A search strategy was performed in Pubmed to identify studies that provide a dosing regimen used, or advised by a review or guideline for morphine to treat NAS...
March 3, 2017: Minerva Pediatrica
https://www.readbyqxmd.com/read/28240700/factors-influencing-weaning-older-adults-from-mechanical-ventilation-an-integrative-review
#19
REVIEW
Karen V Stieff, Fidelindo Lim, Leon Chen
This study aim was to describe the influences that affect weaning from mechanical ventilation among older adults in the intensive care unit (ICU). Adults older than 65 years comprised only 14.5% of the US population in 2014; however, they accounted up to 45% of all ICU admissions. As this population grows, the number of ICU admissions is expected to increase. One of the most common procedures for hospitalized adults 75 years and older is mechanical ventilation. An integrative review methodology was applied to analyze and synthesize primary research reports...
April 2017: Critical Care Nursing Quarterly
https://www.readbyqxmd.com/read/28236395/nursing-strategies-for-effective-weaning-of-the-critically-ill-mechanically-ventilated-patient
#20
REVIEW
Darian Ward, Paul Fulbrook
The risks imposed by mechanical ventilation can be mitigated by nurses' use of strategies that promote early but appropriate reduction of ventilatory support and timely extubation. Weaning from mechanical ventilation is confounded by the multiple impacts of critical illness on the body's systems. Effective weaning strategies that combine several interventions that optimize weaning readiness and assess readiness to wean, and use a weaning protocol in association with spontaneous breathing trials, are likely to reduce the requirement for mechanical ventilatory support in a timely manner...
December 2016: Critical Care Nursing Clinics of North America
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