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https://www.readbyqxmd.com/read/28328691/factors-associated-with-discharge-home-after-transfer-to-a-pediatric-emergency-department
#1
Erin R Peebles, Michael R Miller, Tim P Lynch, Janice A Tijssen
OBJECTIVES: The transfer of children from community emergency departments (EDs) to tertiary care pediatric EDs for investigations, interventions, or a second opinion is common. In order to improve health care system efficiency, we must have a better understanding of this population and identify areas for education and capacity building. METHODS: We conducted a retrospective chart review of all patients (aged 0-17 years) who were transferred from community ED to a pediatric ED from November 2013 to November 2014...
March 21, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28314625/transthyretin-concentrations-in-acute-stroke-patients-predict-convalescent-rehabilitation
#2
Naofumi Isono, Yuki Imamura, Keiko Ohmura, Norihide Ueda, Shinji Kawabata, Motomasa Furuse, Toshihiko Kuroiwa
OBJECTIVE: For stroke patients, intensive nutritional management is an important and effective component of inpatient rehabilitation. Accordingly, acute care hospitals must detect and prevent malnutrition at an early stage. Blood transthyretin levels are widely used as a nutritional monitoring index in critically ill patients. Here, we had analyzed the relationship between the transthyretin levels during the acute phase and Functional Independence Measure in stroke patients undergoing convalescent rehabilitation...
March 14, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28296663/acute-decompensation-in-pediatric-cardiac-patients-outcomes-after-rapid-response-events
#3
Aarti C Bavare, Kimia S Rafie, Patricia X Bastero, Joseph L Hagan, Paul A Checchia
OBJECTIVE: We studied rapid response events after acute clinical instability outside ICU settings in pediatric cardiac patients. Our objective was to describe the characteristics and outcomes after rapid response events in this high-risk cohort and elucidate the cardiac conditions and risk factors associated with worse outcomes. DESIGN: A retrospective single-center study was carried out over a 3-year period from July 2011 to June 2014. SETTING: Referral high-volume pediatric cardiac center located within a tertiary academic pediatric hospital...
March 14, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28292743/-the-score-matters-wide-variations-in-predictive-performance-of-18-paediatric-track-and-trigger-systems
#4
Susan M Chapman, Jo Wray, Kate Oulton, Christina Pagel, Samiran Ray, Mark J Peters
OBJECTIVE: To compare the predictive performance of 18 paediatric early warning systems (PEWS) in predicting critical deterioration. DESIGN: Retrospective case-controlled study. PEWS values were calculated from existing clinical data, and the area under the receiver operator characteristic curve (AUROC) compared. SETTING: UK tertiary referral children's hospital. PATIENTS: Patients without a 'do not attempt resuscitation' order admitted between 1 January 2011 and 31 December 2012...
March 14, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28289791/-predictors-of-cognitive-outcome-in-ventilated-early-rehabilitation-patients
#5
M-D Heidler, L Bidu, H Völler, A Salzwedel
BACKGROUND: After weaning failure, patients who are transferred from intensive care units to early rehabilitation centers (ERC) not only suffer from motor deficits but also from cognitive deficits. It is still uncertain which patient factors have an impact on cognitive outcome at the end of early rehabilitation. OBJECTIVE: Investigation of predictors of cognitive performance for initially ventilated early rehabilitation patients. METHODS: A total of 301 patients (mean age 68...
March 13, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28288599/clinical-use-of-computational-modeling-for-surgical-planning-of-arteriovenous-fistula-for-hemodialysis
#6
Michela Bozzetto, Stefano Rota, Valentina Vigo, Francesco Casucci, Carlo Lomonte, Walter Morale, Massimo Senatore, Luigi Tazza, Massimo Lodi, Giuseppe Remuzzi, Andrea Remuzzi
BACKGROUND: Autogenous arteriovenous fistula (AVF) is the best vascular access (VA) for hemodialysis, but its creation is still a critical procedure. Physical examination, vascular mapping and doppler ultrasound (DUS) evaluation are recommended for AVF planning, but they can not provide direct indication on AVF outcome. We recently developed and validated in a clinical trial a patient-specific computational model to predict pre-operatively the blood flow volume (BFV) in AVF for different surgical configuration on the basis of demographic, clinical and DUS data...
March 14, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28285881/finite-element-analysis-of-the-amputated-lower-limb-a-systematic-review-and-recommendations
#7
REVIEW
A S Dickinson, J W Steer, P R Worsley
The care and rehabilitation of individuals after lower limb amputation presents a substantial and growing socioeconomic challenge. Clinical outcome is closely linked to successful functional rehabilitation with a prosthetic limb, which depends upon comfortable prosthetic limb - residual limb load transfer. Despite early interest in the 1980s, the amputated limb has received considerably less attention in computational biomechanical analysis than other subjects, such as arthroplasty. This systematic literature review investigates the state of the art in residual limb finite element analysis published since 2000...
March 9, 2017: Medical Engineering & Physics
https://www.readbyqxmd.com/read/28283324/early-mobilization-why-what-for-and-how
#8
A R Miranda Rocha, B P Martinez, V Z Maldaner da Silva, L A Forgiarini Junior
Early mobilization strategies in the intensive care unit may result in the prevention and reduction of polyneuromyopathy in the critical patient, improved quality of life, shortened ICU and hospital stay, and lesser mortality during hospitalization. However, it is well known that factors such as the protocol used, the population included in the studies, the timing of the strategy, the severity of the patients and different barriers directly influence the outcomes. This study examines the main protocols described in the literature and their associated results...
March 7, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28280845/-function-of-prosthesis-components-in-lower-limb-amputees-with-bone-anchored-percutaneous-implants-biomechanical-aspects
#9
S Blumentritt
BACKGROUND: Bone anchorage of an artificial limb has been proven to be an alternative intervention for amputees when prosthesis use is seriously reduced because of stump problems. Little is known about how prosthesis components interact with bone and joints and which potential the optimum use provides with respect to quality of treatment of leg amputees. OBJECTIVE: Does osseointegration influence the motor activity of residual limbs differently compared with socket prostheses? How should prosthesis components be aligned? What type of prosthetic knee joints should be preferred in transfemoral amputees? MATERIAL AND METHODS: Transfer of biomechanical knowledge of socket prosthetics to bone-anchored prostheses...
March 9, 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/28271093/uterine-sarcoma-with-ambiguous-histomorphology-a-case-report
#10
Eirwen M Miller, Yumei Fu, Ruben Barrera Vera, Gary L Goldberg, Rouzan G Karabakhtsian
BACKGROUND: Leiomyosarcomas (LMS) and endometrial stromal sarcomas (ESS) may display overlapping histomorphology, which may challenge diagnostic accuracy. Since LMS and ESS have vastly different clinical behavior and adjuvant therapy recommendations, accurate diagnosis is critical. CASE: We present the case of an 83-year-old female with postmenopausal bleeding who underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy for clinically atypical appearing leiomyomata...
May 2017: Gynecologic Oncology Reports
https://www.readbyqxmd.com/read/28267682/a-retrospective-descriptive-comparative-study-to-identify-patient-variables-that-contribute-to-the-development-of-deep-tissue-injury-among-patients-in-intensive-care-units
#11
Holly Kirkland-Kyhn, Oleg Teleten, Machelle Wilson
Deep tissue injury (DTI) may develop in critically ill patients despite implementation of preventive interventions. A retrospective, descriptive study was conducted in a 620-bed, level 1 trauma, academic medical center with 7 adult intensive care units ([ICUs] cardiac surgery, trauma surgery, burn surgery, med-surgery, neurosurgery, medical, and transfer) among patients treated from January 1, 2010 to January 1, 2015. All patients 18 years of age or older that developed a sacral DTI that evolved into a Stage 3, Stage 4, or unstageable hospital-acquired pressure ulcers (HAPU) in the ICU were included...
February 2017: Ostomy/wound Management
https://www.readbyqxmd.com/read/28265471/public-medical-preparedness-at-the-swiss-wrestling-and-alpine-games-2013-descriptive-analysis-of-1-533-patients-treated-at-the-largest-3-day-sporting-event-in-switzerland
#12
Simone Hostettler-Blunier, Nora Müller, Tobias Haltmeier, Andreas Hosner, Heinz Bähler, Frank Neff, Daniel Baumberger, Aristomenis Exadaktylos, Beat Schnüriger
Introduction. Medical preparedness at mass gatherings is challenging, as little is known about the optimal planning. Most studies and case reports are based on mass casualty incidents, so the results cannot be extrapolated to mass gatherings. Aim of this study was to evaluate the preclinical medical structure and the frequency of specific injuries and medical emergencies during the event. Methods. Retrospective analysis of a prospectively collected database. Three on-site medical assistance points were set up, completed by mobile teams, and coordinated by an on-site operational management team...
2017: Emergency Medicine International
https://www.readbyqxmd.com/read/28257538/multidisciplinary-approach-to-complicated-pregnancy
#13
Josip Andelo Borovac, Josko Bozic, Tina Ticinovic Kurir, Nikola Zaja, Kresimir Kolic, Vedran Hrboka
A nulliparous pregnant woman in her mid-20s and in the 32nd week of gestation presented to the emergency department with severe headache and vomiting. She had an uneventful medical history; however, the physical examination upon hospital admission revealed a hypertensive emergency, papilledema, and 2+ dipstick proteinuria. Upon establishing the diagnosis of preeclampsia, aggressive therapy with corticosteroids, antihypertensive medication, and seizure prophylaxis was initiated. Hemodynamic stability was achieved within 24 hours and the patient remained in the observation unit located within the gynecology clinic...
March 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28253527/the-pursuit-of-value-in-musculoskeletal-imaging-policy-and-clinical-practice-intersect
#14
Paul Harkey, Richard Duszak
Rapidly rising health care costs coupled with variability in pricing and patient service have led to intense public scrutiny and pressure for health care providers to demonstrate value. Recent changes in legislation and payment models have intensified a shift from volume-based to value-based care, transferring risk from payers to providers. The American College of Radiology's Imaging 3.0 initiative encourages radiologists to become leaders in this changing health care landscape, helping to redefine value relative to health outcomes that matter to patients...
February 2017: Seminars in Musculoskeletal Radiology
https://www.readbyqxmd.com/read/28244212/integrated-major-haemorrhage-management-in-the-retrieval-setting-damage-control-resuscitation-from-referral-to-receiving-facility
#15
Julian D Wijesuriya, Sean Keogh
Major haemorrhage is a leading cause of death in critically ill or injured patients requiring medical retrieval and presents significant clinical and logistic challenges irrespective of patient location, primary pathophysiology or mode of transport. It is essential that all care providers involved in the retrieval patient pathway, including referring hospitals, ambulance services, retrieval teams and tertiary receiving centres, adopt a common approach to the management of this complex patient group through the use of retrieval-specific, integrated protocols...
February 28, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28243767/practical-considerations-for-investigation-of-protein-conformational-dynamics-by-15-n-r-1%C3%AF-relaxation-dispersion
#16
Erik Walinda, Daichi Morimoto, Masahiro Shirakawa, Kenji Sugase
It is becoming increasingly apparent that proteins are not static entities and that their function often critically depends on accurate sampling of multiple conformational states in aqueous solution. Accordingly, the development of methods to study conformational states in proteins beyond their ground-state structure ("excited states") has crucial biophysical importance. Here we investigate experimental schemes for optimally probing chemical exchange processes in proteins on the micro- to millisecond timescale by (15)N R 1ρ relaxation dispersion...
February 28, 2017: Journal of Biomolecular NMR
https://www.readbyqxmd.com/read/28241941/an-analysis-of-messages-sent-between-nurses-and-physicians-in-deteriorating-internal-medicine-patients-to-help-identify-issues-in-failures-to-rescue
#17
Hannah J Wong, Rachel Bierbrier, Philip Ma, Sherman Quan, Sannie Lai, Robert C Wu
OBJECTIVE: To evaluate in patients who deteriorate and require transfer to the intensive care unit (ICU), how many have a critical text message communicating deterioration and what is the quality of this message? Is message quality, message response or the timeliness of rapid response team (RRT) activation related to death? METHODS: We conducted a retrospective chart review of all ICU transfers from General Internal Medicine (GIM) wards from January 2012 until August 2014...
April 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28236388/mechanical-ventilation-education-and-transition-of-critical-care-nurses-into-practice
#18
REVIEW
Sandra Goldsworthy
A foundational skill for critical care nurses caring for mechanically ventilated patients. This paper describes challenges and opportunities in preparing nurses to transition into the intensive care environment. Hospitals invest significant funding in educational programs for new critical care nurses so that they can transition effectively into the critical care environment. Simulation has been shown to impact self-efficacy and performance. This paper describes the integration of mechanical ventilation education into a case-based simulation program and the results of a study measuring self-efficacy and transfer of learning before and after the implementation of a simulation intervention...
December 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28231398/living-with-melanoma-%C3%A2-for-a-day-a-phenomenological-analysis-of-medical-students-simulated-experiences
#19
M Corr, G Roulston, N King, T Dornan, C Blease, G J Gormley
BACKGROUND: Despite the rising incidence of melanoma, medical students have progressively fewer opportunities to encounter patients with this important condition. Curricula tend to attach the greatest value to intellectual forms of learning. Compared to intellectual learning, however, experiential learning affords students deep insights about a condition. Doctors who experience ill health are more empathic towards patients. However opportunities to learn about cancer experientially are limited...
February 23, 2017: British Journal of Dermatology
https://www.readbyqxmd.com/read/28228127/a-review-of-enhanced-paramedic-roles-during-and-after-hospital-handover-of-stroke-myocardial-infarction-and-trauma-patients
#20
Darren Flynn, Richard Francis, Shannon Robalino, Joanne Lally, Helen Snooks, Helen Rodgers, Graham McClelland, Gary A Ford, Christopher Price
BACKGROUND: Ambulance paramedics play a critical role expediting patient access to emergency treatments. Standardised handover communication frameworks have led to improvements in accuracy and speed of information transfer but their impact upon time-critical scenarios is unclear. Patient outcomes might be improved by paramedics staying for a limited time after handover to assist with shared patient care. We aimed to categorize and synthesise data from studies describing development/extension of the ambulance-based paramedic role during and after handover for time-critical conditions (trauma, stroke and myocardial infarction)...
February 23, 2017: BMC Emergency Medicine
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