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Acute/Critical Care Surgery

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https://www.readbyqxmd.com/read/28420470/-explore-objective-clinical-variables-for-detecting-delirium-in-icu-patients-a-prospective-case-control-study
#1
Xiaojiang Liu, Jie Lyu, Youzhong An
OBJECTIVE: The aim of this case-control study is to explore clinical objective variables for diagnosing delirium of intensive care unit (ICU) patients. METHODS: According to the method of prospective case-control study, critical adult postoperative patients who were transferred to ICU of Peking University People's Hospital from October 2015 to May 2016 and needed mechanical ventilation were included. After evaluating the Richmond agitation sedation scale score (RASS), the patients whose score were -2 or greater were sorted into two groups, delirium and non-delirium, according to the confusion assessment method for the ICU (CAM-ICU)...
April 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28400464/utilisation-of-radiology-rotations-in-acgme-accredited-general-surgery-programmes
#2
Joseph J Eid, Francisco Igor Macedo, Vijay K Mittal
BACKGROUND: General surgery (GS) residents are often required to provide immediate preliminary interpretations of radiological images, especially in critical situations. It is unclear whether residents in Accreditation Council for Graduate Medical Education-accredited GS programmes receive sufficient radiological training to deliver adequate patient care. OBJECTIVES: Determine the utilisation of radiology rotations (RR) during GS residency. METHODS: Between February and March 2015, a pilot voluntary 19-item survey was electronically distributed to GS programme directors (PDs) regarding the availability and value of a RR during GS training...
April 11, 2017: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/28386273/acute-colonic-pseudo-obstruction-with-feeding-intolerance-in-critically-ill-patients-a-study-according-to-gut-wall-analysis
#3
Chenyan Zhao, Tingbin Xie, Jun Li, Minhua Cheng, Jialiang Shi, Tao Gao, Fengchan Xi, Juanhong Shen, Chun Cao, Wenkui Yu
Objective. To compare the differences between acute colonic pseudo-obstruction (ACPO) with and without acute gut wall thickening. Methods. ACPO patients with feeding tolerance were divided into ACPO with no obvious gut wall thickening (ACPO-NT) group and ACPO with obvious acute gut wall thickening (ACPO-T) group according to computed tomography and abdominal radiographs. Patients' condition, responses to supportive measures, pharmacologic therapy, endoscopic decompression, and surgeries and outcomes were compared...
2017: Gastroenterology Research and Practice
https://www.readbyqxmd.com/read/28380006/rapid-tissue-regeneration-induced-by-intracellular-atp-delivery-a-preliminary-mechanistic-study
#4
Harshini Sarojini, Adrian T Billeter, Sarah Eichenberger, Devin Druen, Rebecca Barnett, Sarah A Gardner, Norman J Galbraith, Hiram C Polk, Sufan Chien
We have reported a new phenomenon in acute wound healing following the use of intracellular ATP delivery-extremely rapid tissue regeneration, which starts less than 24 h after surgery, and is accompanied by massive macrophage trafficking, in situ proliferation, and direct collagen production. This unusual process bypasses the formation of the traditional provisional extracellular matrix and significantly shortens the wound healing process. Although macrophages/monocytes are known to play a critical role in the initiation and progression of wound healing, their in situ proliferation and direct collagen production in wound healing have never been reported previously...
2017: PloS One
https://www.readbyqxmd.com/read/28329734/elevated-mif-2-levels-predict-mortality-in-critically-ill-patients
#5
Julia Pohl, Ulrike B Hendgen-Cotta, Pia Stock, Peter Luedike, Tienush Rassaf
PURPOSE: D-dopachrome tautomerase (MIF-2 or DDT) is a member of the macrophage migration inhibitory factor (MIF) superfamily and a close structural homolog to MIF. Circulating MIF-2 has been described to be elevated in patients suffering from sepsis, severe burn injury and after surgery. We sought to evaluate the prognostic value of MIF-2 in critically ill patients. METHODS: A total of 72 patients were studied upon admission to the medical intensive care unit (ICU)...
March 16, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28328684/eastern-association-for-the-surgery-of-trauma-society-of-trauma-nurses-advanced-practitioner-position-paper-optimizing-the-integration-of-advanced-practitioners-in-trauma-and-critical-care
#6
Jonathan Messing, Jasmine Garces-King, Dennis Taylor, Jonathan Van Horn, Babak Sarani, A Britton Christmas
Nurse Practitioners and Physician Assistants, collectively known as advanced practitioners (APs), enhance the provision of care for the acutely injured patient. Despite their prevalence, institutions employ, train, and utilize these providers with significant variability. The Eastern Association for the Surgery of Trauma (EAST), the Society of Trauma Nurses (STN), and the American Association of Surgical Physicians Assistants (AASPA) acknowledge the value of APs and support their utilization in the management of injured and critically ill patients...
March 21, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28316318/synchronous-open-heart-surgery-and-laparoscopic-cholecystectomy-an-observational-case-study-with-28-patients
#7
Mustafa Bilge Erdogan, Mehmet Kaplan, Hakki Kazaz, Bulent Salman
Acute cholecystitis (AC) may be a severe problem and may increase the mortality rate and hospital stay in patients who undergo open heart surgery (OHS), due to its aggressive course; therefore, AC should be treated as soon as possible. We aimed to present data on our synchronous cardiac and laparoscopic cholecystectomy (LC) operations performed for AC complicating patients with cardiac disease and who were waiting to undergo OHS. Between January 2008 and September 2014, we performed 2773 OHSs in Medical Park Gaziantep Hospital...
March 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28296663/acute-decompensation-in-pediatric-cardiac-patients-outcomes-after-rapid-response-events
#8
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/28251509/indications-of-surgery-in-infective-endocarditis
#9
REVIEW
Aref A Bin Abdulhak, Imad M Tleyjeh
PURPOSE OF THE REVIEW: Infective endocarditis (IE) is a serious disease with significant morbidity and mortality. Valve surgery is fundamental in the standard of care of selected IE patients. Indeed, valve surgery can be a lifesaving procedure in critically ill endocarditis patients. Our goal from this review is to discuss the indications of surgery in IE population and international cardiac societies' guideline recommendations. RECENT FINDINGS: Though IE is an uncommon disease, its incidence is noted to be on rise in some parts of the world, and the disease is expected to continue to be a major health problem...
March 2017: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/28241749/development-and-validation-of-a-score-for-evaluating-comprehensive-stroke-care-capabilities-j-aspect-study
#10
Akiko Kada, Kunihiro Nishimura, Jyoji Nakagawara, Kuniaki Ogasawara, Junichi Ono, Yoshiaki Shiokawa, Toru Aruga, Shigeru Miyachi, Izumi Nagata, Kazunori Toyoda, Shinya Matsuda, Akifumi Suzuki, Hiroharu Kataoka, Fumiaki Nakamura, Satoru Kamitani, Koji Iihara
BACKGROUND: Although the Brain Attack Coalition recommended establishing centers of comprehensive care for stroke and cerebrovascular disease patients, a scoring system for such centers was lacking. We created and validated a comprehensive stroke center (CSC) score, adapted to Japanese circumstances. METHODS: Of the selected 1369 certified training institutions in Japan, 749 completed an acute stroke care capabilities survey. Hospital performance was determined using a 25-item score, evaluating 5 subcategories: personnel, diagnostic techniques, specific expertise, infrastructure, and education...
February 28, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28224107/risk-factors-for-mortality-in-postoperative-peritonitis-in-critically-ill-patients
#11
Yoann Launey, Benjamin Duteurtre, Raphaëlle Larmet, Nicolas Nesseler, Audrey Tawa, Yannick Mallédant, Philippe Seguin
AIM: To identify the risk factors for mortality in intensive care patients with postoperative peritonitis (POP). METHODS: This was a retrospective analysis using a prospective database that includes all patients hospitalized in a surgical intensive care unit for POP from September 2006 to August 2011. The data collected included demographics, comorbidities, postoperative severity parameters, bacteriological findings, adequacy of antimicrobial therapy and surgical treatments...
February 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28222811/recurring-septic-shock-in-a-patient-with-blunt-abdominal-and-pelvic-trauma-how-mandatory-is-source-control-surgery-a-case-report
#12
Antonella Frattari, Giustino Parruti, Rocco Erasmo, Luigi Guerra, Ennio Polilli, Rosamaria Zocaro, Giuliano Iervese, Paolo Fazii, Tullio Spina
BACKGROUND: In critically ill patients with colonization/infection of multidrug-resistant organisms, source control surgery is one of the major determinants of clinical success. In more complex cases, the use of different tools for sepsis management may allow survival until complete source control. CASE PRESENTATION: A 42-year-old white man presented with traumatic hemorrhagic shock. Unstable pelvic fractures led to emergency stabilization surgery. Fever ensued with diarrhea, followed by septic shock...
February 22, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28202833/-emergency-decompressive-craniotomy-in-the-emergency-room-was-effective-in-severe-acute-subdural-hematoma-treatment-two-case-reports
#13
Naoto Shiomi, Tadashi Echigo, Hideki Oka, Masahiro Nozawa, Michiko Okada, Shiho Hiraizumi, Fumitaka Kato, Hirokazu Koseki, Yoichi Hashimoto, Akihiko Hino
The outcome of severe acute subdural hematoma is unfavorable. In particular, patients with levels of consciousness of Glasgow Coma Scale(GCS)3 or 4 tend to be refractory to treatment. Decompressive craniotomy should be promptly performed to remove hematoma. However, if an operating room is not immediately available, emergency burr hole surgery is sometimes performed in the emergency room(primary care room)prior to craniotomy. A previous study has reported that the interval from injury to surgery influences the outcome of severe acute subdural hematoma...
February 2017: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/28190602/prevention-of-acute-kidney-injury-in-intensive-care-units
#14
S Mas-Font, J Ros-Martinez, C Pérez-Calvo, P Villa-Díaz, S Aldunate-Calvo, E Moreno-Clari
Acute kidney injury (AKI) is a growing concern in Intensive Care Units. The advanced age of our patients, with the increase in associated morbidity and the complexity of the treatments provided favor the development of AKI. Since no effective treatment for AKI is available, all efforts are aimed at prevention and early detection of the disorder in order to establish secondary preventive measures to impede AKI progression. In critical patients, the most frequent causes are sepsis and situations that result in renal hypoperfusion; preventive measures are therefore directed at securing hydration and correct hemodynamics through fluid perfusion and the use of inotropic or vasoactive drugs, according to the underlying disease condition...
March 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28190429/the-scope-of-neurology-of-critical-illness
#15
REVIEW
E F M Wijdicks
Critical illness increases the probability of a neurologic complication. There are many reasons to consult a neurologist in a critically ill patient and most often it is altered alertness with no intuitive plausible explanation. Other common clinical neurologic problems facing the intensive care specialist and consulting neurologist in everyday decisions are coma following prolonged cardiovascular surgery, newly perceived motor asymmetry, seizures or other abnormal movements, and generalized muscle weakness...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187026/an-algorithmic-approach-to-the-suspected-septic-wrist
#16
Jeffrey R Claiborne, Leslie G Branch, Michael Reynolds, Anthony J Defranzo
An acutely painful, erythematous wrist can be due to a variety of pathologic processes, including crystalline arthropathy, infection, trauma, osteoarthritis, and systemic disease. The broad differential diagnosis of the inflamed wrist and nonspecific clinical findings make accurate diagnosis challenging. There is no published clinical or laboratory criterion that reliably differentiates septic wrist arthritis from a sterile inflammatory arthropathy. For septic joint patients, long-term results are notably poorer in patients with a delay in treatment, therefore establishing evidenced-based guidelines deserves attention...
February 10, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28160951/an-interprofessional-team-approach-to-decreasing-surgical-site-infection-after-coronary-artery-bypass-graft-surgery
#17
REVIEW
Nicole J Jones, Chloe D Villavaso
The incidence of surgical site infections (SSIs) has a significant negative impact on health care. SSIs are associated with increased mortality, cost, readmissions, and prolonged length of stay. Although recent data show a 17% decrease in the incidence of SSIs among acute care hospitals in the United States, mortality related to SSIs remains clinically significant. The interprofessional team is a critical structure in evaluating surgical practices and outcomes and new evidence-based practices to direct education, interventions, and communication of SSI prevention strategies...
March 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28151799/survival-healthcare-utilization-and-end-of-life-care-among-older-adults-with-malignancy-associated-bowel-obstruction-comparative-study-of-surgery-venting-gastrostomy-or-medical-management
#18
Elizabeth J Lilley, John W Scott, Joel E Goldberg, Christy E Cauley, Jennifer S Temel, Andrew S Epstein, Stuart R Lipsitz, Brittany L Smalls, Adil H Haider, Angela M Bader, Joel S Weissman, Zara Cooper
OBJECTIVE: To compare survival, readmissions, and end-of-life care after palliative procedures compared with medical management for malignancy-associated bowel obstruction (MBO). BACKGROUND: MBO is a late complication of intra-abdominal malignancy for which surgeons are frequently consulted. Decisions about palliative treatments, which include medical management, surgery, or venting gastrostomy tube (VGT), are hampered by the paucity of outcomes data relevant to patients approaching the end of life...
February 1, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28146230/a-framework-to-improve-surgeon-communication-in-high-stakes-surgical-decisions-best-case-worst-case
#19
Lauren J Taylor, Michael J Nabozny, Nicole M Steffens, Jennifer L Tucholka, Karen J Brasel, Sara K Johnson, Amy Zelenski, Paul J Rathouz, Qianqian Zhao, Kristine L Kwekkeboom, Toby C Campbell, Margaret L Schwarze
Importance: Although many older adults prefer to avoid burdensome interventions with limited ability to preserve their functional status, aggressive treatments, including surgery, are common near the end of life. Shared decision making is critical to achieve value-concordant treatment decisions and minimize unwanted care. However, communication in the acute inpatient setting is challenging. Objective: To evaluate the proof of concept of an intervention to teach surgeons to use the Best Case/Worst Case framework as a strategy to change surgeon communication and promote shared decision making during high-stakes surgical decisions...
February 1, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28144059/epidemiological-profile-of-acute-respiratory-distress-syndrome-patients-a-tertiary-care-experience
#20
Rahul Magazine, Shobitha Rao, Bharti Chogtu, Ramkumar Venkateswaran, Hameed Aboobackar Shahul, Umesh Goneppanavar
BACKGROUND: Acute respiratory distress syndrome (ARDS) is seen in critically ill patients. Its etiological spectrum in India is expected to be different from that seen in western countries due to the high prevalence of tropical infections. AIM: To study the epidemiological profile of ARDS patients. SETTING: A tertiary care hospital in Karnataka, India. MATERIALS AND METHODS: Retrospective analysis of 150 out of the 169 ARDS patients diagnosed during 2010-2012...
January 2017: Lung India: Official Organ of Indian Chest Society
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