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Goal-directed therapy

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https://www.readbyqxmd.com/read/27922870/quality-and-safety-in-health-care-part-xx-goal-directed-fluid-therapy-and-the-universal-protocol
#1
Jay A Harolds
There have been numerous initiatives to improve quality and safety in surgery. Goal-directed fluid therapy and a quality bundle for emergency laparotomy surgery are two of them. The establishment of a Universal Protocol to prevent the wrong procedure, the wrong patient having a procedure, or the wrong site for a procedure is an important safeguard for patients.
December 3, 2016: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/27920568/reduced-butyrylcholinesterase-activity-is-an-early-indicator-of-trauma-induced-acute-systemic-inflammatory-response
#2
Aleksandar R Zivkovic, Jochen Bender, Thorsten Brenner, Stefan Hofer, Karsten Schmidt
PURPOSE: Early diagnosis of systemic inflammatory response syndrome is fundamentally important for an effective and a goal-directed therapy. Various inflammation biomarkers have been used in clinical and experimental practice. However, a definitive diagnostic tool for an early detection of systemic inflammation remains to be identified. Acetylcholine (Ach) has been shown to play an important role in the inflammatory response. Serum cholinesterase (butyrylcholinesterase [BChE]) is the major Ach hydrolyzing enzyme in blood...
2016: Journal of Inflammation Research
https://www.readbyqxmd.com/read/27919350/identification-and-characterization-of-severe-familial-hypercholesterolemia-in-patients-presenting-for-cardiac-catheterization
#3
Barak Zafrir, Chen Shapira, Gil Lavie, David A Halon, Moshe Y Flugelman
BACKGROUND: Patients with severe familial hypercholesterolemia (FH) are often unrecognized despite typical presentation. The introduction of PCSK9 inhibitors opens new therapeutic options and emphasizes the need for identification of severe FH patients. OBJECTIVES: The objective was identification, characterization, and management of severe FH patients by screening of cardiac catheterization (CC) database. METHODS: Retrospective analysis of CC database from 2002 to mid-2015 was performed for low-density lipoprotein cholesterol (LDL-C) ≥130 mg/dL (n = 2383)...
November 2016: Journal of Clinical Lipidology
https://www.readbyqxmd.com/read/27916041/-progress-of-perioperative-goal-directed-fluid-therapy-on-prognosis-of-patients
#4
J Zhao, Y H Yu
Fluid therapy is an important part of perioperative period, also one of the most controversial issues. Having reviewed the relevant research in recent years as well as the large-scale meta-analysis, the perioperative goal-directed fluid therapy has been discussed from the aspects of evaluating indicators, new methods and latest progress, and the impact on the prognosis. It manifests that the development of goal-directed fluid therapy makes a better prognosis than traditional fluid therapy, therefore it has also became an important perioperative treatment strategy...
December 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/27914655/crohn-s-disease
#5
REVIEW
Joana Torres, Saurabh Mehandru, Jean-Frédéric Colombel, Laurent Peyrin-Biroulet
Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract, with increasing incidence worldwide. Crohn's disease might result from a complex interplay between genetic susceptibility, environmental factors, and altered gut microbiota, leading to dysregulated innate and adaptive immune responses. The typical clinical scenario is a young patient presenting with abdominal pain, chronic diarrhoea, weight loss, and fatigue. Assessment of disease extent and of prognostic factors for complications is paramount to guide therapeutic decisions...
November 30, 2016: Lancet
https://www.readbyqxmd.com/read/27913120/gene-delivery-nanoparticles-to-modulate-angiogenesis
#6
REVIEW
Jayoung Kim, Adam C Mirando, Aleksander S Popel, Jordan J Green
Angiogenesis is naturally balanced by many pro- and anti-angiogenic factors while an imbalance of these factors leads to aberrant angiogenesis, which is closely associated with many diseases. Gene therapy has become a promising strategy for the treatment of such a disordered state through the introduction of exogenous nucleic acids that express or silence the target agents, thereby engineering neovascularization in both directions. Numerous non-viral gene delivery nanoparticles have been investigated towards this goal, but their clinical translation has been hampered by issues associated with safety, delivery efficiency, and therapeutic effect...
November 29, 2016: Advanced Drug Delivery Reviews
https://www.readbyqxmd.com/read/27908328/the-new-usual-care
#7
REVIEW
Jared Radbel, Daniel Boutsikaris
Recent literature continues to refine which components of the early goal-directed therapy (EGDT) algorithm are necessary. Given it utilizes central venous pressure, continuous central venous oxygen saturation, routine blood transfusions, and inotropic medications, this algorithm can be timely, invasive, costly, and potentially harmful. New trials highlight early recognition, early fluid resuscitation, appropriate antibiotic treatment, source control, and the application of a multidisciplinary evidence-based approach as essential components of current sepsis management...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27906057/the-hiv-treatment-cascade-and-care-continuum-updates-goals-and-recommendations-for-the-future
#8
REVIEW
Emma Sophia Kay, D Scott Batey, Michael J Mugavero
The HIV care continuum is a framework that models the dynamic stages of HIV care. The continuum consists of five main steps, which, at the population level, are depicted cross-sectionally as the HIV treatment cascade. These steps include diagnosis, linkage to care (LTC), retention in care (RiC), adherence to antiretroviral therapy (ART), and viral suppression. Although the HIV treatment cascade is represented as a linear, unidirectional framework, persons living with HIV (PLWH) often experience the care continuum in a less streamlined fashion, skip steps altogether, or even exit the continuum for a period of time and regress to an earlier stage...
November 8, 2016: AIDS Research and Therapy
https://www.readbyqxmd.com/read/27905217/to-crispr-and-beyond-the-evolution-of-genome-editing-in-stem-cells
#9
Kuang-Yui Chen, Paul S Knoepfler
The goal of editing the genomes of stem cells to generate model organisms and cell lines for genetic and biological studies has been pursued for decades. There is also exciting potential for future clinical impact in humans. While recent, rapid advances in targeted nuclease technologies have led to unprecedented accessibility and ease of gene editing, biology has benefited from past directed gene modification via homologous recombination, gene traps and other transgenic methodologies. Here we review the history of genome editing in stem cells (including via zinc finger nucleases, transcription activator-like effector nucleases and CRISPR-Cas9), discuss recent developments leading to the implementation of stem cell gene therapies in clinical trials and consider the prospects for future advances in this rapidly evolving field...
December 2016: Regenerative Medicine
https://www.readbyqxmd.com/read/27894494/optimal-fluid-therapy-for-traumatic-hemorrhagic-shock
#10
REVIEW
Ronald Chang, John B Holcomb
The resuscitation of traumatic hemorrhagic shock has undergone a paradigm shift in the last 20 years with the advent of damage control resuscitation (DCR). Major principles of DCR include minimization of crystalloid, permissive hypotension, transfusion of a balanced ratio of blood products, and goal-directed correction of coagulopathy. In particular, plasma has replaced crystalloid as the primary means for volume expansion for traumatic hemorrhagic shock. Predicting which patient will require DCR by prompt and accurate activation of a massive transfusion protocol, however, remains a challenge...
January 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/27889413/molecular-diagnosis-of-bloodstream-infections-in-onco-haematology-patients-with-pcr-esi-ms-technology
#11
Elena Jordana-Lluch, Belén Rivaya, Clara Marcó, Montserrat Giménez, Ma Dolores Quesada, Agustín Escobedo, Montserrat Batlle, Elisa Martró, Vicente Ausina
OBJECTIVES: Onco-haematological patients are prone to develop infections, and antibiotic prophylaxis may lead to negative blood cultures. Thus, the microbiological diagnosis and subsequent administration of a targeted antimicrobial therapy is often difficult. The goal of this study was to evaluate the usefulness of IRIDICA (PCR/ESI-MS technology) for the molecular diagnosis of bloodstream infections in this patient group. METHODS: A total of 463 whole blood specimens from different sepsis episodes in 429 patients were analysed using the PCR/ESI-MS platform, comparing the results with those of blood culture and other clinically relevant information...
November 23, 2016: Journal of Infection
https://www.readbyqxmd.com/read/27886576/the-effect-of-early-goal-directed-therapy-for-treatment-of-severe-sepsis-or-septic-shock-a-systemic-review-and-meta-analysis
#12
Sun-Kyung Park, Su Rin Shin, Min Hur, Won Ho Kim, Eun-Ah Oh, Soo Hee Lee
PURPOSE: To assess the effects of early goal-directed therapy (EGDT) on reducing mortality compared with conventional management of severe sepsis or septic shock. MATERIALS AND METHODS: We included a systemic review, using the Medline and EMBASE. Seventeen randomized trials with 5765 patients comparing EGDT with usual care were included. RESULTS: There were no significant differences in mortality between EGDT and control groups (relative risk [RR], 0...
October 30, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27883947/social-cognitive-predictors-of-treatment-outcome-in-cannabis-dependence
#13
Matthew J Gullo, Marya Matveeva, Gerald F X Feeney, Ross McD Young, Jason P Connor
BACKGROUND: Drug-related outcomes expectancies and refusal self-efficacy are core components of Social Cognitive Theory. Both predict treatment outcome in alcohol use disorders. Few studies have reported expectancies and refusal self-efficacy in cannabis dependence. None have examined both, although both constructs are key targets in Cognitive-Behavioural Therapy (CBT). This study tests the predictive role of expectancies and refusal self-efficacy in treatment outcome for cannabis dependence...
November 4, 2016: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/27881113/psychotherapy-integration-under-scrutiny-investigating-the-impact-of-integrating-emotion-focused-components-into-a-cbt-based-approach-a-study-protocol-of-a-randomized-controlled-trial
#14
Anna Babl, Martin Grosse Holtforth, Sara Heer, Mu Lin, Annabarbara Stähli, Dominique Holstein, Martina Belz, Yvonne Egenolf, Eveline Frischknecht, Fabian Ramseyer, Daniel Regli, Emma Schmied, Christoph Flückiger, Jeannette Brodbeck, Thomas Berger, Franz Caspar
BACKGROUND: This currently recruiting randomized controlled trial investigates the effects of integrating components of Emotion-Focused Therapy (EFT) into Psychological Therapy (PT), an integrative form of cognitive-behavioral therapy in a manner that is directly mirroring common integrative practice in the sense of assimilative integration. Aims of the study are to understand how both, an existing therapy approach as well as the elements to be integrated, are affected by the integration and to clarify the role of emotional processing as a mediator of therapy outcome...
November 24, 2016: BMC Psychiatry
https://www.readbyqxmd.com/read/27879074/s1-guidelines-on-the-diagnosis-and-treatment-of-scabies-short-version
#15
Cord Sunderkötter, Hermann Feldmeier, Regina Fölster-Holst, Bertram Geisel, Sabine Klinke-Rehbein, Alexander Nast, Sandra Philipp, Bernhardt Sachs, Julia Stingl, Johanna Stoevesandt, Henning Hamm
The goals of this German guideline are the improvement of diagnosis and therapy of scabies, the implementation of a coordinated action in outbreaks of scabies, and the control of this infestation in large migration or refugee flows.Sarcoptes scabiei var. hominis is transmitted by direct skin-to-skin contact of sufficient duration. The infectivity of female mites when removed from patients does not exceed 48 hours at room temperature (21°C) and relative humidity of 40-80%. The risk of infection rises proportionally to the number of mites on the skin and is particularly high in crusted scabies...
November 2016: Journal der Deutschen Dermatologischen Gesellschaft, Journal of the German Society of Dermatology: JDDG
https://www.readbyqxmd.com/read/27876325/does-early-goal-directed-therapy-decrease-mortality-compared-with-standard-care-in-patients-with-septic-shock
#16
Michael E Winters, Robert Sherwin, Gary M Vilke, Gabriel Wardi
BACKGROUND: Current international guidelines for the treatment of patients with severe sepsis and septic shock recommend that patients receive targeted care to various physiologic endpoints, thereby optimizing tissue perfusion and oxygenation. These recommendations are primarily derived from a protocol published >15 years ago, which was viewed by many as complex and was therefore not widely adopted. Instead, many emergency physicians focused on the administration of early antibiotics, source control, aggressive fluid resuscitation, vasoactive medications as needed to maintain mean arterial blood pressure, and careful monitoring of these patients...
November 19, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27867284/ekosonic-thrombolysis-as-a-therapeutic-adjunct-in-venous-occlusive-disease
#17
D S Zaghlool, R W Franz, J Jenkins
The use of ultrasound waves in conjunction with local thrombolysis may accelerate clot resolution and serve as an important therapeutic adjunct in the treatment of venous occlusive disease. Our goal was to provide a larger sample population over a 5-year period to evaluate our experience with the EkoSonic endovascular system (EKOS, EKOS Corporation, Bothell, WA). We suspected that ultrasound-accelerated thrombolysis (UAT) using EKOS would provide excellent thrombolysis and midterm patency rates with minimal thrombolytic complications...
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/27864889/goal-directed-treatment-for-osteoporosis-a-progress-report-from-the-asbmr-nof-working-group-on-goal-directed-treatment-for-osteoporosis
#18
REVIEW
Steven R Cummings, Felicia Cosman, Michael E Lewiecki, John T Schousboe, Douglas Bauer, Dennis Black, Thomas Brown, Angela M Cheung, Kathleen Cody, Cyrus Cooper, Adolfo Diez-Perez, Richard Eastell, Peyman Hadji, Takayuki Hosoi, Suzanne Jan De Beur, Risa Kagan, Douglas P Kiel, Ian Reid, Daniel H Solomon, Susan Randall
The American Society for Bone and Mineral Research and the United States National Osteoporosis Foundation (NOF) formed a working group to develop principles of goal-directed treatment and identify gaps that need to be filled to implement this approach. With goal-directed treatment, a treatment goal would first be established choice of treatment determined by the probability of achieving that goal. Goals of treatment would be freedom from fracture, a T-score > -2.5, which is above the NOF threshold for initiating treatment, or achievement of an estimated risk level below the threshold for initiating treatment...
November 19, 2016: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
https://www.readbyqxmd.com/read/27864822/caregiver-directed-home-based-intensive-bimanual-training-in-young-children-with-unilateral-spastic-cerebral-palsy-a-randomized-trial
#19
Claudio L Ferre, Marina Brandão, Bhavini Surana, Ashley P Dew, Noelle G Moreau, Andrew M Gordon
AIM: To examine the efficacy of caregiver-directed, home-based intensive bimanual training in children with unilateral spastic cerebral palsy (USCP) using a randomized control trial. METHOD: Twenty-four children (ages 2y 6mo-10y 1mo; 10 males, 14 females) performed home-based activities directed by a caregiver for 2 hours per day, 5 days per week, for 9 weeks (total=90h). Cohorts of children were age-matched into groups and randomized to receive home-based hand-arm bimanual intensive therapy (H-HABIT; n=12) or lower-limb functional intensive training (LIFT-control; n=12)...
November 19, 2016: Developmental Medicine and Child Neurology
https://www.readbyqxmd.com/read/27863914/cultural-aspects-and-mythologies-surrounding-menstruation-and-abnormal-uterine-bleeding
#20
REVIEW
Delfin A Tan, Rohana Haththotuwa, Ian S Fraser
The objective of this chapter is to present an overview of how menstruation, a normal bodily function, was and is perceived in various ethnic groups and cultures in the world, from ancient mythology, historical, or traditional practices to contemporary belief systems. Mythical tales about menstruation abound in the legends and prehistory of ancient cultures. These tales characterize menstrual blood variously as sacred, a gift from the gods, or a punishment for sin, but it is almost always magical and powerful...
October 26, 2016: Best Practice & Research. Clinical Obstetrics & Gynaecology
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