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https://www.readbyqxmd.com/read/28938253/guidelines-for-the-diagnosis-and-management-of-critical-illness-related-corticosteroid-insufficiency-circi-in-critically-ill-patients-part-i-society-of-critical-care-medicine-sccm-and-european-society-of-intensive-care-medicine-esicm-2017
#1
Djillali Annane, Stephen M Pastores, Bram Rochwerg, Wiebke Arlt, Robert A Balk, Albertus Beishuizen, Josef Briegel, Joseph Carcillo, Mirjam Christ-Crain, Mark S Cooper, Paul E Marik, Gianfranco Umberto Meduri, Keith M Olsen, Sophia C Rodgers, James A Russell, Greet Van den Berghe
OBJECTIVE: To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients. PARTICIPANTS: A multispecialty task force of 16 international experts in critical care medicine, endocrinology, and guideline methods, all of them members of the Society of Critical Care Medicine and/or the European Society of Intensive Care Medicine. DESIGN/METHODS: The recommendations were based on the summarized evidence from the 2008 document in addition to more recent findings from an updated systematic review of relevant studies from 2008 to 2017 and were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology...
September 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28938251/critical-illness-related-corticosteroid-insufficiency-circi-a-narrative-review-from-a-multispecialty-task-force-of-the-society-of-critical-care-medicine-sccm-and-the-european-society-of-intensive-care-medicine-esicm
#2
Djillali Annane, Stephen M Pastores, Wiebke Arlt, Robert A Balk, Albertus Beishuizen, Josef Briegel, Joseph Carcillo, Mirjam Christ-Crain, Mark S Cooper, Paul E Marik, Gianfranco Umberto Meduri, Keith M Olsen, Bram Rochwerg, Sophia C Rodgers, James A Russell, Greet Van den Berghe
OBJECTIVE: To provide a narrative review of the latest concepts and understanding of the pathophysiology of critical illness-related corticosteroid insufficiency (CIRCI). PARTICIPANTS: A multi-specialty task force of international experts in critical care medicine and endocrinology and members of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. DATA SOURCES: Medline, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews...
September 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28936626/the-impact-of-frailty-on-icu-and-30-day-mortality-and-the-level-of-care-in-very-elderly-patients-%C3%A2-%C3%A2-80%C3%A2-years
#3
Hans Flaatten, Dylan W De Lange, Alessandro Morandi, Finn H Andersen, Antonio Artigas, Guido Bertolini, Ariane Boumendil, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Christian Jung, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agwald Öhman, Bernardo Bollen Pinto, Ivo W Soliman, Wojciech Szczeklik, Andreas Valentin, Ximena Watson, Tilemachos Zaferidis, Bertrand Guidet
PURPOSE: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. METHODS: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine...
September 21, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28933807/recognizing-and-managing-adrenal-disorders-in-the-emergency-department-digest
#4
Amy Cutright, Stephen Ducey, Claudia L Barthold, Jeremy Kim
Primary and secondary adrenal insufficiency are underrecognized conditions among emergency department patients, affecting an estimated 10% to 20% of critically ill patients. The signs and symptoms of cortisol deficit can be nonspecific and wide-ranging, and identification and swift treatment with stress-dosing of hydrocortisone is vital to avoid life-threatening adrenal crisis. Laboratory evaluation focuses on identification of electrolyte abnormalities typical of adrenal insufficiency, and while additional testing may depend on the type and severity of symptoms, it should not delay corticosteroid replacement...
September 22, 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28924009/site-specific-regulation-of-p2x7-receptor-function-in-microglia-gates-morphine-analgesic-tolerance
#5
Heather Leduc-Pessah, Nicholas L Weilinger, Churmy Y Fan, Nicole E Burma, Roger J Thompson, Tuan Trang
Tolerance to the analgesic effects of opioids is a major problem in chronic pain management. Microglia are implicated in opioid tolerance, but the core mechanisms regulating their response to opioids remain obscure. By selectively ablating microglia in the spinal cord using a saporin-conjugated antibody to Mac1, we demonstrate a causal role for microglia in the development, but not maintenance, of morphine tolerance in male rats. Increased P2X7 receptor (P2X7R) activity is a cardinal feature of microglial activation, and in this study we found that morphine potentiates P2X7R-mediated Ca(2+) responses in resident spinal microglia acutely isolated from morphine tolerant rats...
September 18, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/28919590/a-study-of-the-discussions-on-psychiatry-of-korea-in-the-1960s-and-1970s-from-mental-hygiene-to-modern-psychiatry
#6
Ji-Yeon Im
This study is to review the emergence of new psychiatrists, scientific rationalization, and popular internalization to reorganize the formation process of modern psychological medicine system. Unlike eugenic psychiatry from the Japanese Colonial Era, the social conditions and contexts forming autonomous system of psychiatry of Korea in the 1960s and 1970s have been concentrated. The discussion approach has been tried to secure two perspectives-treatment and criticism-at the same time and to expand the time and scope of study through the extensive texts such as newspapers, magazines, books, advertisements, and others in the 1960s and 1970s...
August 2017: Ŭi Sahak
https://www.readbyqxmd.com/read/28917221/determining-the-predictive-equation-for-height-from-ulnar-length-in-the-vietnamese-population
#7
Ana Bonell, Nguyen Nguyen Huyen, Vu Dinh Phu, Heiman Wertheim, Behzad Nadjm
BACKGROUND AND OBJECTIVES: Height is an essential measurement in clinical medicine. It allows the calculation of body mass index, ideal body weight, basic energy requirements and tidal volumes. In many patient groups, such as the critically ill, height cannot be measured easily and surrogate anthropometric measures are used. Regression equations estimating height are specific to ethnicity. We aimed to develop the regression equation for Vietnamese men and women to predict height from ulna length and so improve prescription of life-saving treatment in the intensive care units...
2017: Asia Pacific Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28894885/-intensive-care-medicine-survival-and-prospect-of-life
#8
REVIEW
A Valentin
Intensive care medicine has achieved a significant increase in survival rates from critical illness. In addition to short-term outcomes like intensive care unit or hospital mortality, long-term prognosis and prospect of life of intensive care patients have recently become increasingly important. Pure survival is no longer a sole goal of intensive care medicine. The prediction of an intensive care patient's individual course should include the period after intensive care. A relevant proportion of all intensive care patients is affected by physical, psychological, cognitive, and social limitations after discharge from the intensive care unit...
September 11, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28872035/prevalence-and-severity-of-peripheral-arterial-disease-among-patient-with-heel-pressure-ulcer-a-retrospective-study-of-42-patients
#9
Guillaume Tisserand, Nora Zenati, Christophe Seinturier, Sophie Blaise, Gilles Pernod
Heel pressure ulcer is a major complication in elderly hospitalized patients. The association with peripheral arterial disease (PAD) which is also a frequent disease in this population is poorly known. The aim of this study was to assess the prevalence of PAD and critical limb ischemia (CLI) in patients with heel pressure ulcer. Patients referred to the vascular medicine department for heel pressure ulcer from October 2014 to June 2015 were included in the study. The assessment of peripheral arterial disease was made with the results of ankle brachial index and/or doppler ultra sound of lower limb arteries...
September 1, 2017: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
https://www.readbyqxmd.com/read/28864709/early-interventions-for-the-prevention-of-post-traumatic-stress-symptoms-in-survivors-of-critical-illness-protocol-for-a-systematic-review
#10
Lindsey J Glaspey, Michael B Roberts, Anthony Mazzarelli, Stephen Trzeciak, Brian W Roberts
INTRODUCTION: Post-traumatic stress disorder (PTSD) is being increasingly reported among survivors of critical illness and injury. Previous work has demonstrated that PTSD reduces patient quality of life and ability to return to work, as well as increases healthcare costs. As such, identifying interventions aimed at preventing the development of critical illness-related PTSD could have an important public health impact. The objective of this systematic review is to collate the world's literature on early interventions aimed at preventing PTSD among survivors of critical illness...
September 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28860560/effect-of-non-linearity-of-a-predictor-on-the-shape-and-magnitude-of-its-receiver-operating-characteristic-curve-in-predicting-a-binary-outcome
#11
Kwok M Ho
Area under a receiver-operating-characteristic (AUROC) curve is widely used in medicine to summarize the ability of a continuous predictive marker to predict a binary outcome. This study illustrated how a U-shaped or inverted U-shaped continuous predictor would affect the shape and magnitude of its AUROC curve in predicting a binary outcome by comparing the ROC curves of the worst first 24-hour arterial pH values of 9549 consecutive critically ill patients in predicting hospital mortality before and after centering the predictor by its mean or median...
August 31, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28845827/non-conventional-practice-versus-evidence-based-medicine-a-scientific-and-ethical-analysis-of-the-italian-regulation
#12
Sara Patuzzo, Rosagemma Ciliberti
BACKGROUND: The current lack of scientific validation of non-conventional treatments in medicine, whose epistemological foundations lie in scientific evidence and experimentation, raises significant questions regarding the costs and benefits of alternative-treatment forms. Nonetheless, in the last few decades non-conventional treatments have been increasingly recognised by the Italian medical profession, with one regional healthcare administration adopting some non-conventional practices as part of its conventional healthcare services...
August 23, 2017: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/28841235/harms-of-off-label-erythropoiesis-stimulating-agents-for-critically-ill-people
#13
REVIEW
Bita Mesgarpour, Benedikt H Heidinger, Dominik Roth, Susanne Schmitz, Cathal D Walsh, Harald Herkner
BACKGROUND: Anaemia is a common problem experienced by critically-ill people. Treatment with erythropoiesis-stimulating agents (ESAs) has been used as a pharmacologic strategy when the blunted response of endogenous erythropoietin has been reported in critically-ill people. The use of ESAs becomes more important where adverse clinical outcomes of transfusing blood products is a limitation. However, this indication for ESAs is not licensed by regulatory authorities and is called off-label use...
August 25, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28831134/evaluation-of-the-new-chinese-disseminated-intravascular-coagulation-scoring-system-in-critically-ill-patients-a-multicenter-prospective-study
#14
Yingying Wu, Lili Luo, Ting Niu, Yue Han, Ying Feng, Qiulan Ding, Ruibin Huang, Xiaohui Zhang, Jianming Feng, Ming Hou, Jun Peng, Yan Li, Yuhong Zhou, Lei Su, Linhua Yang, Zeping Zhou, Feng Xue, Jian Gu, Tienan Zhu, Xiaomin Wang, Jun Deng, Heng Mei, Yu Hu
Disseminated intravascular coagulation (DIC) is a common life-threatening complication in critically ill patients. The diagnostic scoring systems of DIC enable a more prompt and accurate diagnosis of DIC, such as the International Society on Thrombosis and Haemostasis (ISTH), the Japanese Association for Acute Medicine (JAAM) and the Japanese Ministry of Health and Welfare (JMHW). This study prospectively evaluated the newly proposed Chinese DIC Scoring System (CDSS), which was conducted at 18 centers in China during a one-year period...
August 22, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28828880/critical-reflections-on-a-visit-to-an-inner-city-primary-health-care-clinic-in-rio-de-janeiro
#15
Louis S Jenkins, Marcos A Goldraich
INTRODUCTION: Brazil and South Africa share many sociodemographic and health features that provide many learning opportunities. Brazil's national health system, the Sistema Único de Saúde (SUS) prioritises primary health care since 1994, the year democracy came to South Africa. Two family physicians from these countries met in Rocinha favela in Rio de Janeiro, a densely populated area where poverty, danger, drugs, tuberculosis and mental illness are the focus of the health system.Maria do Socorro Family Clinic: Central to the SUS are the Family Health Teams, consisting of community health workers, nurses, doctors and allied health workers...
July 27, 2017: African Journal of Primary Health Care & Family Medicine
https://www.readbyqxmd.com/read/28814584/examining-self-reported-and-biological-stress-and-near-misses-among-emergency-medicine-residents-a-single-centre-cross-sectional-assessment-in-the-usa
#16
Bengt B Arnetz, Philip Lewalski, Judy Arnetz, Karen Breejen, Karin Przyklenk
OBJECTIVES: To examine the relationship between perceived and biological stress and near misses among Emergency Medicine residents. DESIGN: Self-rated stress and stress biomarkers were assessed in residents in Emergency Medicine before and after a day shift. The supervising physicians and residents reported numbers of near misses. SETTING: The study took place in the Emergency Department of a large trauma 1 centre, located in Detroit, USA...
August 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/28810235/obesity-as-a-conditioning-factor-for-high-altitude-diseases
#17
Rocío San Martin, Julio Brito, Patricia Siques, Fabiola León-Velarde
Obesity, a worldwide epidemic, has become a major health burden because it is usually accompanied by an increased risk for insulin resistance, diabetes, hypertension, cardiovascular diseases, and even some kinds of cancer. It also results in associated increases in healthcare expenditures and labor and economic consequences. There are also other fields of medicine and biology where obesity or being overweight play a major role, such as high-altitude illnesses (acute mountain sickness, hypoxic pulmonary hypertension, and chronic mountain sickness), where an increasing relationship among these two morbid statuses has been demonstrated...
2017: Obesity Facts
https://www.readbyqxmd.com/read/28802938/impulse-control-and-related-disorders-in-parkinson-s-disease
#18
Daniel Weintraub, Daniel O Claassen
Impulse control disorders (ICDs), such as compulsive gambling, buying, sexual, and eating behaviors, are a serious and increasingly recognized complication in Parkinson's disease (PD), occurring in up to 20% of PD patients over the course of their illness. Related behaviors include punding (stereotyped, repetitive, purposeless behaviors), dopamine dysregulation syndrome (DDS) (compulsive medication overuse), and hobbyism (e.g., compulsive internet use, artistic endeavors, and writing). These disorders have a significant impact on quality of life and function, strain interpersonal relationships, and worsen caregiver burden, and are associated with significant psychiatric comorbidity...
2017: International Review of Neurobiology
https://www.readbyqxmd.com/read/28802248/utility-of-rapid-whole-exome-sequencing-in-the-diagnosis-of-neonatal-niemann-pick-disease-type-c-presenting-with-fetal-hydrops-and-liver-failure
#19
Mersedeh Rohanizadegan, Sarah El-Almery, Anne O'Donnell-Luria, Ivana Mihalek, Peggy Chen, Marilyn Sanders, Kristen Leeman, Megan Cho, Christina Hung, Olaf Bodamer
Rapid whole exome sequencing (rWES) is increasingly used in critically ill newborn infants to inform about diagnosis, clinical management and prognosis. Here we report a male newborn infant with hydrops, pancytopenia and acute liver failure who was listed for liver transplantation. Given the acuity of the presentation, the procedure related morbidity and mortality and lack of diagnosis we employed rWES in the proband and both parents with a turn-around time of 10 business days. rWES returned one maternally inherited, likely pathogenic and one paternally inherited, likely pathogenic variant in NPC1 suggestive of a diagnosis of Niemann Pick disease type C (NPC)...
August 11, 2017: Cold Spring Harbor Molecular Case Studies
https://www.readbyqxmd.com/read/28796716/an-intensive-simulation-based-communication-course-for-pediatric-critical-care-medicine-fellows
#20
Erin M Johnson, Melinda F Hamilton, R Scott Watson, Rene Claxton, Michael Barnett, Ann E Thompson, Robert Arnold
OBJECTIVE: Effective communication among providers, families, and patients is essential in critical care but is often inadequate in the PICU. To address the lack of communication education pediatric critical care medicine fellows receive, the Children's Hospital of Pittsburgh PICU developed a simulation-based communication course, Pediatric Critical Care Communication course. Pediatric critical care medicine trainees have limited prior training in communication and will have increased confidence in their communication skills after participating in the Pediatric Critical Care Communication course...
August 2017: Pediatric Critical Care Medicine
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