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Critical care transfer

Shireen Meher, Anna Cuthbert, Jamie J Kirkham, Paula Williamson, Edgardo Abalos, Nasreen Aflaifel, Zulfiqar A Bhutta, Alina Bishop, Jennifer Blum, Peter Collins, Declan Devane, Anne-Sophie Ducloy-Bouthors, Bukola Fawole, A Metin Gülmezoglu, Kathryn Gutteridge, Gill Gyte, Caroline S E Homer, Shuba Mallaiah, Jeffrey M Smith, Andrew D Weeks, Zarko Alfirevic
OBJECTIVE: To develop core outcome sets (COS) for studies evaluating interventions for (1) prevention and (2) treatment of PPH, and recommendations on how to report the COS. DESIGN: A two-round Delphi survey and face-to-face meeting. POPULATION: Health care professionals and women's representatives. METHODS: Outcomes were identified from systematic reviews of PPH studies and stakeholder consultation. Participants scored each outcome in the Delphi on a Likert scale between 1 (not important) and 9 (critically important)...
June 19, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
Mithun Chakravarthy, Masaki Tsukashita, Srinivas Murali
Cardiogenic shock is a clinical syndrome characterized by low cardiac output and sustained tissue hypoperfusion resulting in end-organ dysfunction and death. In-hospital mortality rates range from 50% to 60%. Urgent diagnosis, timely transfer to a tertiary or quaternary medical facility with critical care management capabilities and multidisciplinary shock teams is a must to increase survival. Aggressive, hemodynamically guided medical management with careful monitoring of clinical and hemodynamic parameters with timely use of appropriate mechanical circulatory support devices is often necessary...
July 2018: Critical Care Clinics
Jennifer L Moore, Kirsten Potter, Kathleen Blankshain, Sandra L Kaplan, Linda C OʼDwyer, Jane E Sullivan
BACKGROUND: Use of outcome measures (OMs) in adult neurologic physical therapy is essential for monitoring changes in a patient's status over time, quantifying observations and patient-reported function, enhancing communication, and increasing the efficiency of patient care. OMs also provide a mechanism to compare patient and organizational outcomes, examine intervention effectiveness, and generate new knowledge. This clinical practice guideline (CPG) examined the literature related to OMs of balance, gait, transfers, and patient-stated goals to identify a core set of OMs for use across adults with neurologic conditions and practice settings...
June 12, 2018: Journal of Neurologic Physical Therapy: JNPT
Jessica R Philpott, Jacob A Kurowski
Transitional care for patients with IBD focuses on efforts to successfully transfer care from pediatric to adult providers while encouraging the assumption of health care responsibility. As 25% of patients will be diagnosed with IBD before the age of 18 years, many will undergo this process. Efforts to enhance this process have included transition clinics and other means to improve patient comfort with transition and develop the skill of health care self-management. Currently, most pediatric practitioners provide transition care with informal education and emphasize independence without formal programs...
June 11, 2018: Inflammatory Bowel Diseases
Manoj Abraham, Arvind Badhey, Shirley Hu, Sameep Kadakia, J K Rasamny, Augustine Moscatello, Yadranko Ducic
Head and neck patients undergoing microvascular reconstruction are at high risk for thromboembolism. While the prevention of thromboembolism has become an essential aspect of care, within the field of microsurgery, concern for anastomotic complications have hindered the creation of an accepted regimen. The aim of this review was to evaluate the risks and benefits of prophylactic agents for thromboprophylaxis. A literature search was conducted in MEDLINE, Cochrane Library, and PubMed/NCBI databases. Articles discussing thromboprophylaxis in otolaryngology, head and neck surgery, or microvascular reconstruction were considered in the review from the past 30 years...
June 2018: Craniomaxillofacial Trauma & Reconstruction
Behzad Nasseri, Neda Soleimani, Navid Rabiee, Alireza Kalbasi, Mahdi Karimi, Michael R Hamblin
The rapid diagnosis of pathogens is crucial in the early stages of treatment of diseases where the choice of the correct drug can be critical. Although conventional cell culture-based techniques have been widely utilized in clinical applications, newly introduced optical-based, microfluidic chips are becoming attractive. The advantages of the novel methods compared to the conventional techniques comprise more rapid diagnosis, lower consumption of patient sample and valuable reagents, easy application, and high reproducibility in the detection of pathogens...
May 29, 2018: Biosensors & Bioelectronics
Adam J Singer, Merry Taylor, Deborah LeBlanc, Kristen Meyers, Karol Perez, Henry C Thode, Jesse M Pines
BACKGROUND: Core laboratory testing may increase length of stay and delay care. OBJECTIVES: We compared length of emergency department (ED) care in patients receiving point-of-care testing (POCT) at triage vs. traditional core laboratory testing. METHODS: We conducted a prospective, case-controlled trial of adult patients with prespecified conditions requiring laboratory testing and had POCT performed by a nurse after triage for: a basic metabolic panel, troponin I, lactate, INR (i-STAT System), urinalysis (Beckman Coulter Icon), or urine pregnancy test...
June 7, 2018: Journal of Emergency Medicine
Jane Seymour, David Clark
Background : The Liverpool Care Pathway for the Dying Patient ('the LCP') was an integrated care pathway (ICP) recommended by successive governments in England and Wales to improve end-of-life care, using insights from hospice and palliative care. It was discontinued in 2014 following mounting criticism and a national review.  The ensuing debate among clinicians polarised between 'blaming' of the LCP and regret at its removal. Employing the concept of 'boundary objects', we aimed to address three questions: 1) why and how did the LCP come to prominence as a vehicle of policy and practice 2) what factors contributed to its demise? 3) what immediate implications and lessons resulted from its withdrawal? Methods : We use primary and secondary sources in the public domain to assemble a critical and historical review...
2018: Wellcome Open Research
Tsung-Ying Chen
Good medical leadership is the key to building high-quality healthcare. However, in the development of medical careers, the teaching of leadership has traditionally not equaled that of technical and academic competencies. As a result of changes in personal standards, the quality of medical leadership has led to variations between different organizations, as well as occasional catastrophic failure in the standard of care provided for patients. Leaders in the medical profession have called for reform in healthcare in response to challenges in the system and improvements in public health...
April 2018: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
Rachel Zayas
Critical care transport began in the 1970s as a response to the growing need to be able to transport critically ill and injured patients to tertiary care centers for higher levels of care or specialized treatments. Patients in critical condition now are transported great distances to receive potentially lifesaving treatment and interventions. Modes of critical care transport include ambulances, helicopters, and airplanes. Critical care transport teams consist of highly skilled paramedics, registered nurses, respiratory therapists, nurse practitioners, and physicians...
2018: AACN Advanced Critical Care
Samuel Aronson, Lawrence Babb, Darren Ames, Richard A Gibbs, Eric Venner, John J Connelly, Keith Marsolo, Chunhua Weng, Marc S Williams, Andrea L Hartzler, Wayne H Liang, James D Ralston, Emily Beth Devine, Shawn Murphy, Christopher G Chute, Pedro J Caraballo, Iftikhar J Kullo, Robert R Freimuth, Luke V Rasmussen, Firas H Wehbe, Josh F Peterson, Jamie R Robinson, Ken Wiley, Casey Overby Taylor
The eMERGE Network is establishing methods for electronic transmittal of patient genetic test results from laboratories to healthcare providers across organizational boundaries. We surveyed the capabilities and needs of different network participants, established a common transfer format, and implemented transfer mechanisms based on this format. The interfaces we created are examples of the connectivity that must be instantiated before electronic genetic and genomic clinical decision support can be effectively built at the point of care...
May 31, 2018: Journal of the American Medical Informatics Association: JAMIA
Russ S Kotwal, Amanda M Staudt, Edward L Mazuchowski, Jennifer M Gurney, Stacy A Shackelford, Frank K Butler, Zsolt T Stockinger, John B Holcomb, Shawn C Nessen, Elizabeth A Mann-Salinas
BACKGROUND: Timely and optimal care can reduce mortality among critically injured combat casualties. US military Role 2 surgical teams were deployed to forward positions in Afghanistan on behalf of the battlefield trauma system. They received prehospital casualties, provided early damage control resuscitation and surgery, and rapidly transferred casualties to Role 3 hospitals for definitive care. A database was developed to capture Role 2 data. METHODS: A retrospective review and descriptive analysis was conducted of battle-injured casualties transported to US Role 2 surgical facilities in Afghanistan from February 2008 to September 2014...
May 30, 2018: Journal of Trauma and Acute Care Surgery
Sharon L Oetker-Black, Tammie Davis
AIM: This study's purpose is to psychometrically evaluate the Mock Code Self-Efficacy Scale. This tool was developed to measure senior baccalaureate nursing students' level of self-efficacy as it pertains to mock codes. BACKGROUND: Cardiopulmonary resuscitation is an essential component of nursing education. METHOD: The Mock Code Self-Efficacy Scale was analyzed for item characteristics, face validity, content validity, reliability, and dimensionality in a sample of senior-level nursing students (n = 153) enrolled in a critical care nursing course...
May 25, 2018: Nursing Education Perspectives
S Zullino, T Simoncini
SSRIs are the first choice for the treatment of mood disorders during pregnancy and lactation. Despite the known side effects, the benefits/risks balance suggests their use. Hypertensive disorders of pregnancy (HDP) and Intrauterine growth restriction (IUGR) are the main vascular effects of these drugs, with mechanisms that involves endothelial dysfunction in feto-placental system. These data are supported by animal models, even if preliminary findings are not yet adequately supported by molecular and clinical data...
May 24, 2018: Vascular Pharmacology
Bengt Klarin, Anders Larsson, Göran Molin, Bengt Jeppsson
Recultured Lactobacillus plantarum 299v-like strains were tested regarding antibiotic susceptibility, and no decrease was detected. Antibiotics are frequently used to treat patients in intensive care units (ICUs) and are associated with a significant risk of selection of resistant bacterial strains. In particular, it is possible that genetic transfer of antibiotic resistance to the resident gastrointestinal flora, as well as to administered probiotics, may be increased in the ICU setting. The aim of the present investigation was to detect possible changes in antimicrobial susceptibility in reisolates of the probiotic strain Lactobacillus plantarum 299v (Lp299v) given to antibiotic treated, critically ill patients...
May 24, 2018: MicrobiologyOpen
Kewan A Hamid, Mohamed A Mohamed, Anas Salih
Acute appendicitis is a grave and life-threatening condition in children, accounting for one to two cases per 10,000 in children less than four years' old. Prompt diagnosis and management are imperative to prevent serious complications, such as abscess formation, perforation, bowel obstruction, peritonitis, and sepsis. In young children, however, the diagnosis of this condition is challenging. The delayed utilization of imaging may further delay the diagnosis due to concerns of exposure to ionizing radiation...
March 19, 2018: Curēus
Li Wenliang, Aaron R Seitz
Understanding visual perceptual learning (VPL) has become increasingly more challenging as new phenomena are discovered with novel stimuli and training paradigms. While existing models aid our knowledge of critical aspects of VPL, the connections shown by these models between behavioral learning and plasticity across different brain areas are typically superficial. Most models explain VPL as readout from simple perceptual representations to decision areas and are not easily adaptable to explain new findings...
May 23, 2018: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Haitao Wu, Wang Sun, Junrong Shen, David W Rooney, Zhenhua Wang, Kening Sun
The oxygen reduction reaction (ORR) and oxygen evolution reaction (OER) are both fundamental and essential processes for various energy conversion and storage systems. The kinetics of ORR and OER play a critical role in their energy efficiency and practicality. Here, flower-like ultrathin Co3O4 nanosheets synthesized through a facile solvothermal technique were studied as a bifunctional catalyst for both water splitting and non-aqueous Li-O2 batteries. Due to the novel structure and highly active {110} and {100} exposed facets, which can effectively facilitate mass transfer and enhance catalytic capability, Co3O4 nanosheets exhibit better stability and higher ORR/OER activity than Co3O4 nanoparticles, Co3O4 bulks, Pt/C, and RuO2 in alkaline solution...
May 23, 2018: Nanoscale
Christopher Wei Guang Ho, Shi-Hui Yang, Chu Hui Wong, Si Jack Chong
INTRODUCTION: Although an uncommon form of admission to a burns centre, the deep, penetrating nature of noxious currents mean that electrical burns have the most catastrophic consequences of all burn injuries. Understanding the physics of electricity is crucial to explaining the mechanisms of tissue damage and organ failure in electrical injuries which necessitate special management above and beyond that of regular thermal burns. PRESENTATION OF CASE: We present a young man who suffered significant occupation-related electrical burns that was complicated by compartment syndrome, rhabdomyolysis and acute kidney injury...
May 16, 2018: International Journal of Surgery Case Reports
Juan C Rojas, Kyle A Carey, Dana P Edelson, Laura R Venable, Michael D Howell, Matthew M Churpek
RATIONALE: Patients transferred from the intensive care unit (ICU) to the wards who are later readmitted to the ICU have increased length of stay, healthcare expenditure, and mortality compared to those who are never readmitted. Improving risk-stratification for patients transferred to the wards could have important benefits for critically ill hospitalized patients. OBJECTIVE: We aimed to use a machine-learning technique to derive and validate an ICU readmission prediction model with variables available in the electronic health record (EHR) in real-time and compare it to previously published algorithms...
May 22, 2018: Annals of the American Thoracic Society
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