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https://www.readbyqxmd.com/read/27922495/toxic-and-endocrine-myopathies
#1
Hans D Katzberg, Charles D Kassardjian
PURPOSE OF REVIEW: This article discusses the clinical features, pathophysiology, and management of toxic and endocrine myopathies. RECENT FINDINGS: Early detection and expeditious correction of metabolic disturbances in endocrinopathies such as Cushing syndrome, thyroid and parathyroid diseases, and acromegaly can minimize and prevent neurologic complications including myopathy. Recently proposed mechanisms of injury in patients with critical illness myopathy include inhibition of protein synthesis, mitochondrial dysfunction, disruption of the ubiquitin-proteasome system, oxidative stress, and disruption of intramuscular calcium homeostasis, which can cause a myosin-loss myopathy...
December 2016: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/27907964/critical-care-neurology-perspective-on-delirium
#2
Matthew B Maas, Andrew M Naidech
The evidence linking delirium to poor outcomes after critical illness is compelling, including higher mortality, prolonged mechanical ventilation, longer length of intensive care unit stay, and long-term cognitive impairments. The attitude toward delirium in the neurologic community is shifting away from viewing it as an unmodifiable, inevitable consequence of severe illness to treating it is as a neurologic emergency, akin to seizures or encephalitis. Delirium, like other manifestations of critical illness encephalopathy, is an organ dysfunction syndrome...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27904628/validation-of-critical-care-pain-observation-tool-in-patients-hospitalized-in-surgical-wards
#3
Malihe Rafiei, Ahmad Ghadami, Alireza Irajpour, Avat Feizi
BACKGROUND: Application of a reliable and authentic behavioral tool for measuring patients' pain, hospitalized in intensive care units who are not able to establish relationship, is needed severely. Therefore, this study is conducted with the aim of validating Critical Care Pain Observation Tool (CPOT) in patients hospitalized in surgical wards. MATERIALS AND METHODS: CPOT was first translated into Persian and was psychometrically measured in terms of content. RESULTS: It should be noted that the content validity of CPOT was approved by panel of specialists...
September 2016: Iranian Journal of Nursing and Midwifery Research
https://www.readbyqxmd.com/read/27902388/the-exploration-of-risk-factors-of-concurrent-bacteremia-among-critically-ill-patients-with-severe-dengue
#4
Chin-Ming Chen, Khee-Siang Chan, Kuo-Chen Cheng, Willy Chou, Hui-Chun Chao, Chiu-Yin Yeh, Wen-Liang Yu
We investigated the clinical features of intensive care unit (ICU) patients with a concomitant severe dengue infection and bacteremia to identify risk factors for this comorbidity. The records of all ICU dengue patients admitted during a July 31-November 31, 2015 were reviewed. Patients with "concurrent bacteremia" (positive bacterial blood culture within 72 hours of ICU admission) were identified. ICU admission was required for 142 patients; 22 (15.5%) had concurrent bacteremia. Streptococcus spp. was the most common pathogen, then Escherichia coli, and then Staphylococcus spp...
November 7, 2016: Journal of Medical Microbiology
https://www.readbyqxmd.com/read/27867308/effect-of-n-methyl-d-aspartate-receptor-antagonist-dextromethorphan-on-opioid-analgesia-in-pediatric-intensive-care-unit
#5
Mohammed Naeem, Hala Al Alem, Ali Al Shehri, Majed Al-Jeraisy
Objective. Pain control is an essential goal in the management of critical children. Narcotics are the mainstay for pain control. Patients frequently need escalating doses of narcotics. In such cases an adjunctive therapy may be beneficial. Dextromethorphan (DM) is NMDA receptor antagonist and may prevent tolerance to narcotics; however, its definitive role is still unclear. We sought whether dextromethorphan addition could decrease the requirements of fentanyl to control pain in critical children. Design. Double-blind, randomized control trial (RCT)...
2016: Pain Research & Management: the Journal of the Canadian Pain Society
https://www.readbyqxmd.com/read/27849239/importance-of-the-use-of-protocols-for-the-management-of-analgesia-and-sedation-in-pediatric-intensive-care-unit
#6
Emiliana Motta, Michele Luglio, Artur Figueiredo Delgado, Werther Brunow de Carvalho
Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols...
September 2016: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/27833752/accuracy-of-critical-care-pain-observation-tool-and-behavioral-pain-scale-to-assess-pain-in-critically-ill-conscious-and-unconscious-patients-prospective-observational-study
#7
Paolo Severgnini, Paolo Pelosi, Elena Contino, Elisa Serafinelli, Raffaele Novario, Maurizio Chiaranda
BACKGROUND: Critically ill patients admitted to intensive care unit (ICU) may suffer from different painful stimuli, but the assessment of pain is difficult because most of them are almost sedated and unable to self-report. Thus, it is important to optimize evaluation of pain in these patients. The main aim of this study was to compare two commonly used scales for pain evaluation: Critical Care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS), in both conscious and unconscious patients...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/27821384/the-effectiveness-of-hand-massage-on-pain-in-critically-ill-patients-after-cardiac-surgery-a-randomized-controlled-trial-protocol
#8
Madalina Boitor, Géraldine Martorella, Andréa Maria Laizner, Christine Maheu, Céline Gélinas
BACKGROUND: Postoperative pain is common in the intensive care unit despite the administration of analgesia. Some trials suggest that massage can be effective at reducing postoperative pain in acute care units; however, its effects on pain relief in the intensive care unit and when pain severity is highest remain unknown. OBJECTIVE: The objective is to evaluate the effectiveness of hand massage on the pain intensity (primary outcome), unpleasantness and interference, muscle tension, anxiety, and vital signs of critically ill patients after cardiac surgery...
November 7, 2016: JMIR Research Protocols
https://www.readbyqxmd.com/read/27808460/patient-reported-health-status-during-pediatric-cancer-treatment
#9
Sarah Dobrozsi, Ke Yan, Raymond Hoffmann, Julie Panepinto
BACKGROUND: Changes in patient function and factors affecting pediatric patients with cancer during treatment are largely unknown. The purpose of this study was to measure patient-reported outcomes (PROs) in children during the initial 6 months of therapy to characterize function and explore factors associated with function including type of cancer, intensity of therapy, age, and gender. PROCEDURE: We conducted a prospective cohort study of children aged 5-21 newly diagnosed with cancer...
November 3, 2016: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/27777355/analgesia-in-the-surgical-intensive-care-unit
#10
REVIEW
Eric Ehieli, Suraj Yalamuri, Charles S Brudney, Srinivas Pyati
Critically ill patients are a heterogeneous group with diverse comorbidities and physiological derangements. The management of pain in the critically ill population is emerging as a standard of care in the intensive care unit (ICU). Pain control of critically ill patients in the ICU presents numerous challenges to intensivists. Inconsistencies in pain assessment, analgesic prescription and variation in monitoring sedation and analgesia result in suboptimal pain management. Inadequate pain control can have deleterious effects on several organ systems in critically ill patients...
October 24, 2016: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/27756590/the-challenges-of-providing-effective-pain-management-for-children-in-the-pediatric-intensive-care-unit
#11
Ahmad Ismail
Providing effective pain management is necessary for all patients in the intensive care unit (ICU). Because of developmental considerations, caring for children may provide additional challenges. The purpose of this literature review is to describe key challenges in providing effective pain management in pediatric intensive care units (PICUs), with the aim of bringing about a better understanding by health care providers caring for children. Challenges of providing effective pain management in the PICU can be categorized into four levels...
October 15, 2016: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/27753844/ed-02-1-acute-aortic-syndrome
#12
Jae-Kwan Song
The successful clinical introduction of various non-invasive imaging modalities has contributed to the establishment of 'acute aortic syndrome', a relatively new clinical syndrome incorporating several disease entities with similar clinical features (at the time of clinical presentation). Aortic dissection (AD) with intimal flap and two aortic channels (true and false lumens) is the most important disease entity in acute aortic syndrome. Clinical characteristics of AD have been established, with standardized treatment strategies depending on the affected site of the aorta...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27704172/improvement-of-postoperative-pain-control-processes-and-outcomes-in-veterans-of-a-surgical-intensive-care-unit
#13
Melissa S D'Andrea, P Marco Fisichella
BACKGROUND: Postoperative pain remains undertreated in critically ill patients. We hypothesized that the adequacy of pain control in our Surgical Intensive Care Unit (SICU) was above the reported average of 71 % in the literature and that the introduction of the critical care pain observation tool (CPOT) could improve it. We used a Lean Six Sigma methodology to improve our processes and quantify our improvement. PATIENTS AND METHODS: We retrospectively review 713 consecutive veterans admitted to our SICU...
October 4, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27697569/performance-of-consultative-palliative-care-model-in-achieving-quality-metrics-in-the-icu
#14
Nicholas G Wysham, Michael J Hochman, Steven P Wolf, Christopher E Cox, Arif H Kamal
CONTEXT: Quality metrics for intensive care unit (ICU)-based palliative care have been proposed but it is unknown how consultative palliative care can contribute to performance on these measures. OBJECTIVES: Assess adherence to proposed quality metrics of intensive care unit (ICU)-based palliative care by palliative care specialists. METHODS: Surrogates for 9/14 patient-level quality metrics were assessed in all patients who received an initial palliative care specialist consult while in an ICU from 10/26/2012 to 1/16/2015 in the Global Palliative Care Quality Alliance, a nationwide palliative care quality registry...
September 30, 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/27685422/a-systematic-review-of-observational-pain-assessment-instruments-for-use-with-nonverbal-intubated-critically-ill-adult-patients-in-the-emergency-department-an-assessment-of-their-suitability-and-psychometric-properties
#15
Wayne Varndell, Margaret Fry, Doug Elliott
AIM: This systematic review examined the psychometric properties and suitability of the available observational pain instruments for potential use with nonverbal critically ill adult patients in the emergency department. BACKGROUND: In the emergency department assessing pain in critically ill patients is challenging, especially those unable to communicate the presence of pain. Critically ill patients are commonly unable to verbally communicate pain due to altered oral communication (e...
September 29, 2016: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/27665572/evaluation-of-perfusion-index-as-a-tool-for-pain-assessment-in-critically-ill-patients
#16
Ahmed Hasanin, Sabah Abdel Raouf Mohamed, Akram El-Adawy
Pain is a common and undertreated problem in critically ill patients. Pain assessment in critically ill patients is challenging and relies on complex scoring systems. The aim of this work was to find out the possible role of the perfusion index (PI) measured by a pulse oximeter (Masimo Radical 7; Masimo Corp., Irvine, CA, USA) in pain assessment in critically ill patients. A prospective observational study was carried out on 87 sedated non-intubated patients in a surgical intensive care unit. In addition to routine monitoring, a Masimo pulse oximeter probe was used for PI measurement...
September 24, 2016: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/27661020/the-effectiveness-of-complementary-manual-therapies-for-pregnancy-related-back-and-pelvic-pain-a-systematic-review-with-meta-analysis
#17
Helen Hall, Holger Cramer, Tobias Sundberg, Lesley Ward, Jon Adams, Craig Moore, David Sibbritt, Romy Lauche
BACKGROUND: Low back pain and pelvic girth pain are common in pregnancy and women commonly utilize complementary manual therapies such as massage, spinal manipulation, chiropractic, and osteopathy to manage their symptoms. OBJECTIVE: The aim of this systematically review was to critically appraise and synthesize the best available evidence regarding the effectiveness of manual therapies for managing pregnancy-related low back and pelvic pain. METHODS: Seven databases were searched from their inception until April 2015 for randomized controlled trials...
September 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27644010/impact-of-an-analgesia-based-sedation-protocol-on-mechanically-ventilated-patients-in-a-medical-intensive-care-unit
#18
Andrew C Faust, Pearl Rajan, Lyndsay A Sheperd, Carlos A Alvarez, Phyllis McCorstin, Rebecca L Doebele
BACKGROUND: Recent attention to adverse effects of intensive care unit (ICU) sedation has led to the use of strategies that target a "lighter" depth of sedation. Among these strategies are "analgosedation" protocols, which prioritize pain management and preferentially use IV opioids before administration of continuously infused sedatives such as propofol or midazolam. We hypothesized that using an analgosedation protocol would result in a shorter duration of mechanical ventilation than a protocol with greater emphasis on IV sedatives METHODS: : We conducted a retrospective study comparing the duration of mechanical ventilation before and after implementation of an analgosedation protocol in a 24-bed medical ICU...
October 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27643004/ed-02-1-acute-aortic-syndrome
#19
Jae-Kwan Song
The successful clinical introduction of various non-invasive imaging modalities has contributed to the establishment of 'acute aortic syndrome', a relatively new clinical syndrome incorporating several disease entities with similar clinical features (at the time of clinical presentation). Aortic dissection (AD) with intimal flap and two aortic channels (true and false lumens) is the most important disease entity in acute aortic syndrome. Clinical characteristics of AD have been established, with standardized treatment strategies depending on the affected site of the aorta...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27590592/psychometric-validation-of-the-behavioral-indicators-of-pain-scale-for-the-assessment-of-pain-in-mechanically-ventilated-and-unable-to-self-report-critical-care-patients
#20
I Latorre-Marco, M Acevedo-Nuevo, M Solís-Muñoz, L Hernández-Sánchez, C López-López, M M Sánchez-Sánchez, M Wojtysiak-Wojcicka, J de Las Pozas-Abril, G Robleda-Font, M J Frade-Mera, R De Blas-García, C Górgolas-Ortiz, J De la Figuera-Bayón, C Cavia-García
OBJECTIVE: To assess the psychometric properties of the behavioral indicators of pain scale (ESCID) when applied to a wide range of medical and surgical critical patients. DESIGN: A multicentre, prospective observational study was designed to validate a scale measuring instrument. SETTING: Twenty Intensive Care Units of 14 hospitals belonging to the Spanish National Health System. PARTICIPANTS: A total of 286 mechanically ventilated, unable to self-report critically ill medical and surgical adult patients...
August 30, 2016: Medicina Intensiva
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