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Early Goal Direct Therapy

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https://www.readbyqxmd.com/read/29747290/-the-relationship-between-arterial-blood-lactate-clearance-prognosis-and-myocardial-damage-in-patients-with-septic-shock-after-early-goal-directed-therapy
#1
X L Shang, D W Liu, X T Wang, H W He, H M Zhang, L X Su, P Pan
Objective: To evaluate the prognostic value of arterial blood lactate clearance based on central venous oxygen saturation and perfusion index in patients with septic shock related myocardial injury after early goal-directed therapy. Methods: One hundred and fifty-seven patients with septic shock after early resuscitation were enrolled from August 2013 to July 2016 in ICU at Peking Union Medical College Hospital. Parameters indicating early resuscitation included central venous pressure (CVP) 8-12 mmHg (1 mmHg=0...
May 1, 2018: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/29732181/optimising-drug-dosing-in-patients-receiving-extracorporeal-membrane-oxygenation
#2
REVIEW
Vesa Cheng, Mohd-Hafiz Abdul-Aziz, Jason A Roberts, Kiran Shekar
Optimal pharmacological management during extracorporeal membrane oxygenation (ECMO) involves more than administering drugs to reverse underlying disease. ECMO is a complex therapy that should be administered in a goal-directed manner to achieve therapeutic endpoints that allow reversal of disease and ECMO wean, minimisation of complications (treatment of complications when they do occur), early interruption of sedation and rehabilitation, maximising patient comfort and minimising risks of delirium. ECMO can alter both the pharmacokinetics (PK) and pharmacodynamics (PD) of administered drugs and our understanding of these alterations is still evolving...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29726720/bioactive-mushroom-polysaccharides-as-antitumor-an-overview
#3
Urja Pandya, Umesh Dhuldhaj, Nirmal S Sahay
Immuno-therapies are gaining more importance to treat certain forms of cancer. The goal of therapies is to enhance person's own IgG, IgA, IgM, IgD, IgE and macrophages to combat with neoplastic cells hence the effectiveness of the immune system. Since, early civilization mushrooms are considered as potent food as well as medicine. Mushrooms are well known for their bioactive compounds such as chizophyllan, lentinan, grifolan, PSP (polysaccharide-peptide complex) and PSK (polysaccharide-protein complex) which are considered as medicines against melignancy...
May 4, 2018: Natural Product Research
https://www.readbyqxmd.com/read/29687277/early-goal-directed-therapy-using-a-physiological-holistic-view-the-andromeda-shock-a-randomized-controlled-trial
#4
Glenn Hernández, Alexandre Biasi Cavalcanti, Gustavo Ospina-Tascón, Fernando Godinho Zampieri, Arnaldo Dubin, F Javier Hurtado, Gilberto Friedman, Ricardo Castro, Leyla Alegría, Maurizio Cecconi, Jean-Louis Teboul, Jan Bakker
BACKGROUND: Septic shock is a highly lethal condition. Early recognition of tissue hypoperfusion and its reversion are key factors for limiting progression to multiple organ dysfunction and death. Lactate-targeted resuscitation is the gold-standard under current guidelines, although it has several pitfalls including that non-hypoxic sources of lactate might predominate in an unknown proportion of patients. Peripheral perfusion-targeted resuscitation might provide a real-time response to increases in flow that could lead to a more timely decision to stop resuscitation, thus avoiding fluid overload and the risks of over-resuscitation...
April 23, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29678619/effect-of-goal-directed-fluid-therapy-on-early-cognitive-function-in-elderly-patients-with-spinal-stenosis
#5
Na Zhang, Min Liang, Dan-Dan Zhang, Yi-Rong Xiao, Yan-Zhen Li, You-Guang Gao, Hong-da Cai, Xian-Zhong Lin, Cai-Zhu Lin, Kai Zeng, Xiao-Dan Wu
PURPOSE: To explore effect of goal-directed fluid therapy (GDFT) on early cognitive function in elderly patients with spinal stenosis. METHODS: 83 elderly patients with spinal stenosis were randomly classified into two groups: control group (n = 40) and GDFT group (n = 43). The Montreal Cognitive Assessment (MoCA) score, IL-6 and S100β levels, hemodynamic parameters, cerebral oxygen saturation (rSO2 ), arterial lactic acid values, output of surgery, operation time and cases of hypotension, intraoperative complications within 7 days were recorded for all patients...
April 17, 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29656977/liposomal-bupivacaine-vs-plain-bupivacaine-in-periarticular-injection-for-control-of-pain-and-early-motion-in-total-knee-arthroplasty-a-randomized-prospective-study
#6
Jason P Zlotnicki, Brian R Hamlin, Anton Y Plakseychuk, Timothy J Levison, Scott D Rothenberger, Kenneth L Urish
BACKGROUND: The use of multimodal pain regimens has been shown to be an effective technique for the treatment of postoperative pain after total knee arthroplasty. Periarticular injections, of both short-acting and long-acting anesthetics, have emerged as an additional method of providing significant improvement in postoperative pain relief. The purpose of this study is to compare the efficacy of periarticular injection using long-acting vs short-acting preparations. METHODS: A randomized, prospective study of 80 consecutive patients was performed comparing liposomal bupivacaine vs plain bupivacaine periarticular injection...
March 16, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29643247/the-pathway-to-establishing-hiv-latency-is-critical-to-how-latency-is-maintained-and-reversed
#7
Simin D Rezaei, Hao K Lu, J Judy Chang, Ajantha Rhodes, Sharon R Lewin, Paul U Cameron
HIV infection requires lifelong antiretroviral therapy because of the persistence of latently infected CD4+ T cells. Induction of viral expression from latently infected cells occurs following T cell receptor (TCR) activation but not all latently infected cells respond to TCR stimulation. We compared two models of latently infected cells using an enhanced green fluorescent protein (EGFP) reporter virus to infect CCL19 treated resting CD4+ (rCD4) T cells (pre-activation latency) or activated CD4+ T cells that returned to a resting state (post-activation latency)...
April 11, 2018: Journal of Virology
https://www.readbyqxmd.com/read/29627424/asthma-across-the-lifespan-time-for-a-paradigm-shift
#8
Stanley J Szefler
We have a unique opportunity to significantly reduce the worldwide burden of asthma in children and impact respiratory outcomes in adults. However, this will require a paradigm shift that is directed at altering the natural history of asthma, reducing asthma exacerbations and preventing long-term adverse outcomes of childhood asthma. Attention should continue to be directed toward minimizing risk as well as impairment with a goal to achieve optimal control. Based on several NIH studies conducted over the last 10 years we now have the tools necessary to accomplish this goal...
April 5, 2018: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/29617940/intraosseous-versus-intravenous-access-in-pediatric-septic-shock-patients-admitted-to-alexandria-university-pediatric-intensive-care-unit
#9
Ahmed A El-Nawawy, Omneya M Omar, Mona Khalil
The cornerstone of emergency management of sepsis is early, goal-directed therapy. The purpose of this study was to evaluate the effect of intraosseous (IO) vs. intravenous (IV) access for resuscitation of patients with septic shock admitted to pediatric intensive care unit. This prospective interventional randomized clinical trial study was conducted on 60 patients with septic shock who need rapid administration of fluids and drugs; 30 cases were randomly chosen for IO vascular access, while the other 30 were selected for IV access...
April 1, 2018: Journal of Tropical Pediatrics
https://www.readbyqxmd.com/read/29607704/perceived-barriers-to-goals-of-care-discussions-with-patients-with-advanced-cancer-and-their-families-in-the-ambulatory-setting-a-multicenter-survey-of-oncologists
#10
Josee-Lyne Ethier, Thivaher Paramsothy, John J You, Robert Fowler, Sonal Gandhi
BACKGROUND: Earlier goals of care (GOC) discussions in patients with advanced cancer are associated with less aggressive end-of-life care including decreased use of medical technologies. Unfortunately, conversations often occur late in the disease trajectory when patients are acutely unwell. Here, we evaluate practitioner perspectives of patient, family, physician, and external barriers to early GOC discussions in the ambulatory oncology setting. METHODS: A previously published survey to assess barriers to GOC discussions among clinicians on inpatient medical wards was modified for the ambulatory oncology setting and distributed to oncologists from 12 centers in Ontario, Canada...
January 1, 2018: Journal of Palliative Care
https://www.readbyqxmd.com/read/29572615/precision-medicine-for-crc-patients-in-the-veteran-population-state-of-the-art-challenges-and-research-directions
#11
REVIEW
Shyam S Mohapatra, Surinder K Batra, Srinivas Bharadwaj, Michael Bouvet, Bard Cosman, Ajay Goel, Wilma Jogunoori, Michael J Kelley, Lopa Mishra, Bibhuti Mishra, Subhra Mohapatra, Bhaumik Patel, Joseph R Pisegna, Jean-Pierre Raufman, Shuyun Rao, Hemant Roy, Maren Scheuner, Satish Singh, Gitanjali Vidyarthi, Jon White
Colorectal cancer (CRC) accounts for ~9% of all cancers in the Veteran population, a fact which has focused a great deal of the attention of the VA's research and development efforts. A field-based meeting of CRC experts was convened to discuss both challenges and opportunities in precision medicine for CRC. This group, designated as the VA Colorectal Cancer Cell-genomics Consortium (VA4C), discussed advances in CRC biology, biomarkers, and imaging for early detection and prevention. There was also a discussion of precision treatment involving fluorescence-guided surgery, targeted chemotherapies and immunotherapies, and personalized cancer treatment approaches...
March 23, 2018: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29564123/trends-in-the-epidemiology-of-purple-urine-bag-syndrome-a-systematic-review
#12
Hsiu-Wu Yang, Yu-Jang Su
Purple urine bag syndrome (PUBS) is rarely observed in clinical practice. The present study aimed to identify the epidemiological trends in PUBS in recent decades. A search of PubMed articles published between 1980 October and 2016 August was conducted, in which 106 articles (174 cases) described PUBS. Of these cases, 58 cases were excluded: 14 cases without mention of gender, 4 cases without description of age, 37 cases without mention of white blood cell (WBC) count, shock status, fever status or description of etiology, and 3 cases without information on mortality...
March 2018: Biomedical Reports
https://www.readbyqxmd.com/read/29546038/using-survival-analysis-to-understand-patterns-of-sustainment-within-a-system-driven-implementation-of-multiple-evidence-based-practices-for-children-s-mental-health-services
#13
Lauren Brookman-Frazee, Chanel Zhan, Nicole Stadnick, David Sommerfeld, Scott Roesch, Gregory A Aarons, Debbie Innes-Gomberg, Lillian Bando, Anna S Lau
Evidence-based practice (EBP) implementation requires substantial resources in workforce training; yet, failure to achieve long-term sustainment can result in poor return on investment. There is limited research on EBP sustainment in mental health services long after implementation. This study examined therapists' continued vs. discontinued practice delivery based on administrative claims for reimbursement for six EBPs [Cognitive Behavioral Interventions for Trauma in Schools (CBITS), Child-Parent Psychotherapy, Managing and Adapting Practices (MAP), Seeking Safety (SS), Trauma-Focused Cognitive Behavior Therapy (TF-CBT), and Positive Parenting Program] adopted in a system-driven implementation effort in public mental health services for children...
2018: Frontiers in Public Health
https://www.readbyqxmd.com/read/29542349/endothelial-dysfunction-and-menopause-is-exercise-an-effective-countermeasure
#14
S Witkowski, C Serviente
Cardiovascular disease is the leading cause of death in women. There is a dramatic rise in risk factors for cardiovascular disease during the menopausal transition that is independent of aging. Endothelial dysfunction is an early hallmark of developing cardiovascular disease and has been shown to increase across the stages of menopause. Exercise is considered one of the most effective lifestyle therapies to maintain and improve endothelial function. However, accumulating evidence suggests that exercise does not have the same benefit on endothelial function in menopausal women as it does in other populations, and factors associated with menopause likely influence the endothelial responsiveness to exercise...
March 15, 2018: Climacteric: the Journal of the International Menopause Society
https://www.readbyqxmd.com/read/29519292/-evaluation-of-platelet-function-in-critically-ill-patients-and-its-clinical-significance
#15
Hepeng Fu, Yuxiang Zhang
Platelets play a pivotal role in the thromboembolic, inflammatory, and immunomodulatory process. The alteration of platelet quality often affects the treatment and prognosis of critically ill patients, and has a significant correlation with mortality. With the further research on the function of the platelet, it is found that the abnormal platelet quality can present during the early stage of the illness of the critically ill patients. In order to evaluate the alterations of the platelet quality more accurately, the further studies of platelet parameters, including platelet counts (PLT), platelet hematocrit (PCT), platelet large cell ratio (PLCR), mean platelet volume (MPV), platelet distribution width (PDW), immature platelet fraction (IPF) and so on, are still be the focus of current researches in the field of critical illness...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29514697/cardiac-output-optimisation-following-liver-transplant-colt-trial-study-protocol-for-a-feasibility-randomised-controlled-trial
#16
Farid Froghi, Rahul Koti, Kurinchi Gurusamy, Susan Mallett, Douglas Thorburn, Linda Selves, Sarah James, Jeshika Singh, Manuel Pinto, Christine Eastgate, Margaret McNeil, Helder Filipe, Fatima Jichi, Nick Schofield, Daniel Martin, Brian Davidson
BACKGROUND: Patients with liver cirrhosis undergoing liver transplantation have a hyperdynamic circulation which persists into the early postoperative period making accurate assessment of fluid requirements challenging. Goal-directed fluid therapy (GDFT) has been shown to reduce morbidity and mortality in a number of surgery settings. The impact of GDFT in patients undergoing liver transplantation is unknown. A feasibility trial was designed to determine patient and clinician support for recruitment into a randomised controlled trial of GDFT following liver transplantation, adherence to a GDFT protocol, participant withdrawal, and to determine appropriate endpoints for a subsequent larger trial to evaluate the efficacy of GDFT in patients undergoing liver transplantation...
March 7, 2018: Trials
https://www.readbyqxmd.com/read/29496373/major-publications-in-the-critical-care-pharmacotherapy-literature-january-december-2017
#17
REVIEW
Drayton A Hammond, Laura Baumgartner, Craig Cooper, Elisabeth Donahey, Serena A Harris, Jessica M Mercer, Mandy Morris, Mona K Patel, Angela M Plewa-Rusiecki, Alia A Poore, Ryan Szaniawski, Deanna Horner
PURPOSE: To summarize selected meta-analyses and trials related to critical care pharmacotherapy published in 2017. The Critical Care Pharmacotherapy Literature Update (CCPLU) Group screened 32 journals monthly for impactful articles and reviewed 115 during 2017. Two meta-analyses and eight original research trials were reviewed here from those included in the monthly CCPLU. Meta-analyses on early, goal-directed therapy for septic shock and statin therapy for acute respiratory distress syndrome were summarized...
June 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29495219/-central-venous-arterial-carbon-dioxide-tension-to-arterial-central-venous-oxygen-content-ratio-combined-with-lactate-clearance-rate-as-early-resuscitation-goals-of-septic-shock
#18
X H Gao, P J Li, W Cao
Objective: To investigate the prognostic significance of central venous-arterial carbon dioxide tension to arterial-venous oxygen content ratio (Pcv-aCO(2)/Ca-cvO(2)) combined with lactate clearance rate (LCR) as early resuscitation goals of septic shock. Methods: One hundred and forty-five septic shock patients admitted to Second Department of Critical Care Medicine of Lanzhou University Second Hospital from March 2013 to May 2017 were enrolled in this study.All septic shock patients received an initial resuscitation therapy according to early goal-directed therapy...
February 13, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29490168/antioxidant-defense-and-protection-against-cardiac-arrhythmias-lessons-from-a-mammalian-hibernator-the-woodchuck
#19
Zhenghang Zhao, Raymond K Kudej, Hairuo Wen, Nadezhda Fefelova, Lin Yan, Dorothy E Vatner, Stephen F Vatner, Lai-Hua Xie
Hibernating animals show resistance to hypothermia-induced cardiac arrhythmias. However, it is not clear whether and how mammalian hibernators are resistant to ischemia-induced arrhythmias. The goal of this investigation was to determine the susceptibility of woodchucks ( Marmota monax) to arrhythmias and their mechanisms after coronary artery occlusion at the same room temperature in both winter, the time for hibernation, and summer, when they do not hibernate. By monitoring telemetric electrocardiograms, we found significantly higher arrhythmia scores, calculated as the severity of arrhythmias, with incidence of ventricular tachycardia, ventricular fibrillation, and thus sudden cardiac death (SCD) in woodchucks in summer than they had in winter...
February 28, 2018: FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology
https://www.readbyqxmd.com/read/29469034/early-successes-in-an-open-access-provincially-funded-hepatitis-c-treatment-program-in-prince-edward-island
#20
Jordan W Francheville, Robin Rankin, Jeremy Beck, Connie Hoare, Stefanie Materniak, Greg German, Lisa Barrett, Natalie Bunimov-Wall, Daniel Smyth
INTRODUCTION: The availability of curative hepatitis C therapies has created an opportunity to improve treatment delivery and access. Local providers, government, industry, and community groups in Prince Edward Island developed an innovative province-wide care model. Our goal was to describe the first year of program implementation. MATERIAL AND METHODS: Using a communitybased prospective observational study design, all chronic hepatitis C referrals received from April 2015 to April 2016 were recorded in a database...
February 13, 2018: Annals of Hepatology
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