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https://www.readbyqxmd.com/read/29311623/basal-p53-expression-is-indispensable-for-mesenchymal-stem-cell-integrity
#1
Siddaraju V Boregowda, Veena Krishnappa, Jacqueline Strivelli, Christopher L Haga, Cori N Booker, Donald G Phinney
Marrow-resident mesenchymal stem cells (MSCs) serve as a functional component of the perivascular niche that regulates hematopoiesis. They also represent the main source of bone formed in adult bone marrow, and their bifurcation to osteoblast and adipocyte lineages plays a key role in skeletal homeostasis and aging. Although the tumor suppressor p53 also functions in bone organogenesis, homeostasis, and neoplasia, its role in MSCs remains poorly described. Herein, we examined the normal physiological role of p53 in primary MSCs cultured under physiologic oxygen levels...
January 8, 2018: Cell Death and Differentiation
https://www.readbyqxmd.com/read/29302597/ethical-challenges-involved-in-obtaining-consent-for-research-from-patients-hospitalized-in-the-intensive-care-unit
#2
Fiona Ecarnot, Jean-Pierre Quenot, Guillaume Besch, Gaël Piton
Clinical research remains a vital contributor to medical knowledge, and is an established and integral part of the practice of medicine worldwide. Respect for patient autonomy and ethical principles dictate that informed consent must be obtained from subjects before they can be enrolled into clinical research, yet these conditions may be difficult to apply in real practice in the intensive care unit (ICU). A number of factors serve to complexify the consent process in critically ill patients, notably decisional incapacity of the patient due to illness or sedation...
December 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29260613/documentation-of-crucial-information-relating-to-critically-ill-patients
#3
Alexandria Bear, Elizabeth Thiel
BACKGROUND: Medical decision-making has evolved to the modern model of shared decision-making among patients, surrogate decision-makers, and medical providers. As such, informed consent discussions with critically ill patients often should include larger discussions relating to values and goals of care. Documentation of care options and prognosis serves as an important component of electronic communication relating to patient preferences among care providers. OBJECTIVE: This retrospective chart review study sought to evaluate the prevalence of documentation of critical data, care options, prognosis, and medical plan, within primary team and palliative care consult team documentation...
January 1, 2017: Journal of Palliative Care
https://www.readbyqxmd.com/read/29121600/use-of-surrogate-indicators-for-the-evaluation-of-potential-health-risks-due-to-poor-urban-water-quality-a-bayesian-network-approach
#4
Buddhi Wijesiri, Kaveh Deilami, James McGree, Ashantha Goonetilleke
Urban water pollution poses risks of waterborne infectious diseases. Therefore, in order to improve urban liveability, effective pollution mitigation strategies are required underpinned by predictions generated using water quality models. However, the lack of reliability in current modelling practices detrimentally impacts planning and management decision making. This research study adopted a novel approach in the form of Bayesian Networks to model urban water quality to better investigate the factors that influence risks to human health...
November 6, 2017: Environmental Pollution
https://www.readbyqxmd.com/read/29117010/assessing-the-methodological-quality-of-glaucoma-clinical-practice-guidelines-and-their-recommendations-on-microinvasive-glaucoma-surgery-a-systematic-review
#5
Evan Michaelov, James J Armstrong, Mary Nguyen, Bridget Instrum, Tracey Lam, James Denstedt, Cindy M L Hutnik
INTRODUCTION: Clinical practice guidelines (CPG) are regarded by many as critical communications providing guidance within specific medical fields. Over a decade ago, the first microinvasive glaucoma surgical procedures (MIGS) were introduced. Since then, a number of these novel intraocular pressure (IOP) controlling surgical options have been approved worldwide. Governing bodies and healthcare administration often utilize CPGs when considering funding for newer technologies. This highlights the importance of well-written, accurate and up-to-date CPGs in the rapidly evolving field of MIGS...
November 7, 2017: Journal of Glaucoma
https://www.readbyqxmd.com/read/29099239/physician-approaches-to-conflict-with-families-surrounding-end-of-life-decision-making-in-the-icu-a-qualitative-study
#6
Hashim M Mehter, Jessica B McCannon, Jack A Clark, Renda Soylemez Wiener
RATIONALE: Families of critically ill patients are often asked to make difficult decisions to pursue, withhold or withdraw aggressive care or resuscitative measures, exercising "substituted judgment" from the imagined standpoint of the patient. Conflict may arise between intensive care unit (ICU) physicians and family members regarding the optimal course of care. OBJECTIVES: To characterize how ICU physicians approach and manage conflict with surrogates regarding end-of-life decision-making...
November 3, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28993286/spirit-trial-a-phase-iii-pragmatic-trial-of-an-advance-care-planning-intervention-in-esrd
#7
Mi-Kyung Song, Mark L Unruh, Amita Manatunga, Laura C Plantinga, Janice Lea, Manisha Jhamb, Abhijit V Kshirsagar, Sandra E Ward
Advance care planning (ACP) is a central tenet of dialysis care, but the vast majority of dialysis patients report never engaging in ACP discussions with their care providers. Over the last decade, we have developed and iteratively tested SPIRIT (Sharing Patient's Illness Representation to Increase Trust), a theory-based, patient- and family-centered advance care planning intervention. SPIRIT is a six-step, two-session, face-to-face intervention to promote cognitive and emotional preparation for end-of-life decision making for patients with ESRD and their surrogates...
October 6, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28972523/shared-decision-making-interventions-theoretical-and-empirical-evidence-with-implications-for-health-literacy
#8
Dawn Stacey, Sophie Hill, Kirsten McCaffery, Laura Boland, Krystina B Lewis, Lidia Horvat
Basic health literacy is required for making health decisions. The aim of this chapter is to discuss the use of shared decision making interventions for supporting patient involvement in making health decisions. The chapter provides a definition of shared decision making and discusses the link between shared decision making and the three levels of health literacy: functional, communicative/interactive, and critical. The Interprofessional Shared Decision Making Model is used to identify the various players involved: the patient, the family/surrogate/significant others, decision coach, and health care professionals...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28966921/echocardiographic-evaluation-of-hemodynamics-in-neonates-and-children
#9
REVIEW
Yogen Singh
Hemodynamic instability and inadequate cardiac performance are common in critically ill children. The clinical assessment of hemodynamic status is reliant upon physical examination supported by the clinical signs such as heart rate, blood pressure, capillary refill time, and measurement of the urine output and serum lactate. Unfortunately, all of these parameters are surrogate markers of cardiovascular well-being and they provide limited direct information regarding the adequacy of blood flow and tissue perfusion...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28915184/wide-disagreement-between-alternative-assessments-of-premorbid-physical-activity-subjective-patient-and-surrogate-reports-and-objective-smartphone-data
#10
Samuel Gluck, Matthew J Summers, Thomas P Goddard, Alice Andrawos, Natalie C Smith, Kylie Lange, Theodore J Iwashyna, Adam M Deane
OBJECTIVES: Surrogate-decision maker and patient self-reported estimates of the distances walked prior to acute illness are subjective and may be imprecise. It may be possible to extract objective data from a patient's smartphone, specifically, step and global position system data, to quantify physical activity. The objectives were to 1) assess the agreement between surrogate-decision maker and patient self-reported estimates of distance and time walked prior to resting and daily step-count and 2) determine the feasibility of extracting premorbid physical activity (step and global position system) data from critically ill patients...
October 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28892669/development-of-a-prediction-model-for-long-term-quality-of-life-in-critically-ill-patients
#11
Sandra Oeyen, Karel Vermeulen, Dominique Benoit, Lieven Annemans, Johan Decruyenaere
PURPOSE: We developed a prediction model for quality of life (QOL) 1 year after intensive care unit (ICU) discharge based upon data available at the first ICU day to improve decision-making. METHODS: The database of a 1-year prospective study concerning long-term outcome and QOL (assessed by EuroQol-5D) in critically ill adult patients consecutively admitted to the ICU of a university hospital was used. Cases with missing data were excluded. Utility indices at baseline (UIb) and at 1 year (UI1y) were surrogates for QOL...
September 6, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28846992/improving-research-enrollment-of-severe-burn-patients
#12
Anne M Lachiewicz, Felicia N Williams, Shannon S Carson, Jessica M Trexler, Carrie A Nielsen, David van Duin, David J Weber, Shannon D Williams, Samuel W Jones, Bruce A Cairns
Enrolling severely burn injured patients into prospective research studies poses specific challenges to investigators. The authors describe their experience of recruiting adults with ≥20% TBSA burns or inhalation injury admitted to a single academic burn unit into observational research with minimally invasive specimen collection. The authors outline iterative changes that they made to their recruitment processes in response to perceived weaknesses leading to delays in enrollment. The primary outcome was the change in days to consent for enrolled patients or cessation of recruitment for nonenrolled patients before and after the interventional modifications...
September 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/28805132/evaluation-of-the-decisional-fatigue-scale-among-surrogate-decision-makers-of-the-critically-ill
#13
Ronald L Hickman, Grant A Pignatiello, Sadia Tahir
Intense emotional distress and impaired information processing have been implicated in reducing a surrogate decision maker's ability to formulate informed health care decisions for a critically ill patient. The heightened intensity of negative emotions, mental effort, and impaired judgment is consistent with the manifestation of decision fatigue. The aim of this article is to describe the validity and reliability of the Decision Fatigue Scale (DFS) among surrogate decision makers of the critically ill. A convenience sample of 101 surrogate decision makers were administered the DFS and a battery of psychosocial instruments at two time points...
August 1, 2017: Western Journal of Nursing Research
https://www.readbyqxmd.com/read/28753647/incorporating-seascape-connectivity-in-conservation-prioritisation
#14
Rebecca Weeks
In conservation prioritisation, it is often implicit that representation targets for individual habitat types act as surrogates for the species that inhabit them. Yet for many commercially and ecologically important coral reef fish species, connectivity among different habitats in a seascape may be more important than any single habitat alone. Approaches to conservation prioritisation that consider seascape connectivity are thus warranted. I demonstrate an approach that can be implemented within a relatively data-poor context, using widely available conservation planning software...
2017: PloS One
https://www.readbyqxmd.com/read/28685395/what-families-need-and-physicians-deliver-contrasting-communication-preferences-between-surrogate-decision-makers-and-physicians-during-outcome-prognostication-in-critically-ill-tbi-patients
#15
Thomas Quinn, Jesse Moskowitz, Muhammad W Khan, Lori Shutter, Robert Goldberg, Nananda Col, Kathleen M Mazor, Susanne Muehlschlegel
BACKGROUND: Surrogate decision-makers ("surrogates") and physicians of incapacitated patients have different views of prognosis and how it should be communicated, but this has not been investigated in neurocritically ill patients. We examined surrogates' communication preferences and physicians' practices during the outcome prognostication for critically ill traumatic brain injury (ciTBI) patients in two level-1 trauma centers and seven academic medical centers in the USA. METHODS: We used qualitative content analysis and descriptive statistics of transcribed interviews to identify themes in surrogates (n = 16) and physicians (n = 20)...
October 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28682835/technologic-distractions-part-1-summary-of-approaches-to-manage-alert-quantity-with-intent-to-reduce-alert-fatigue-and-suggestions-for-alert-fatigue-metrics
#16
REVIEW
Sandra L Kane-Gill, Michael F O'Connor, Jeffrey M Rothschild, Nicholas M Selby, Barbara McLean, Christopher P Bonafide, Maria M Cvach, Xiao Hu, Avinash Konkani, Michele M Pelter, Bradford D Winters
OBJECTIVE: To provide ICU clinicians with evidence-based guidance on tested interventions that reduce or prevent alert fatigue within clinical decision support systems. DESIGN: Systematic review of PubMed, Embase, SCOPUS, and CINAHL for relevant literature from 1966 to February 2017. PATIENTS: Focus on critically ill patients and included evaluations in other patient care settings, as well. INTERVENTIONS: Identified interventions designed to reduce or prevent alert fatigue within clinical decision support systems...
September 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28549520/-taking-over-somebody-s-life-experiences-of-surrogate-decision-makers-in-the-surgical-intensive-care-unit
#17
Elizabeth J Lilley, Megan A Morris, Nicholas Sadovnikoff, Jamahal M Luxford, Navin R Changoor, Anna Bystricky, Angela M Bader, Zara Cooper
BACKGROUND: Impaired capacity of patients necessitates the use of surrogates to make decisions on behalf of patients. Little is known about surrogate decision-making in the surgical intensive care unit, where the decline to critical illness is often unexpected. We sought to explore surrogate experiences with decision-making in the surgical intensive care unit. METHODS: This qualitative study was performed at 2 surgical intensive care units at a single, tertiary, academic hospital Surrogate decision-makers who had made a major medical decision for a patient in the surgical intensive care unit were identified and enrolled prospectively...
August 2017: Surgery
https://www.readbyqxmd.com/read/28528347/discriminative-accuracy-of-physician-and-nurse-predictions-for-survival-and-functional-outcomes-6-months-after-an-icu-admission
#18
Michael E Detsky, Michael O Harhay, Dominique F Bayard, Aaron M Delman, Anna E Buehler, Saida A Kent, Isabella V Ciuffetelli, Elizabeth Cooney, Nicole B Gabler, Sarah J Ratcliffe, Mark E Mikkelsen, Scott D Halpern
Importance: Predictions of long-term survival and functional outcomes influence decision making for critically ill patients, yet little is known regarding their accuracy. Objective: To determine the discriminative accuracy of intensive care unit (ICU) physicians and nurses in predicting 6-month patient mortality and morbidity, including ambulation, toileting, and cognition. Design, Setting, and Participants: Prospective cohort study conducted in 5 ICUs in 3 hospitals in Philadelphia, Pennsylvania, and enrolling patients who spent at least 3 days in the ICU from October 2013 until May 2014 and required mechanical ventilation, vasopressors, or both...
June 6, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28497934/cerebral-autoregulation-monitoring-in-acute-traumatic-brain-injury-what-s-the-evidence
#19
Leanne A Calviello, Joseph Donnelly, Frederick A Zeiler, Eric P Thelin, Peter Smielewski, Marek Czosnyka
Cerebral autoregulation is conceptualized as a vascular self-regulatory mechanism within the brain. Controlled by elusive relationships between various biophysical processes, it functions to protect the brain against potential damages caused by sudden changes in cerebral perfusion pressures and flow. Following events such as traumatic brain injuries (TBI), autoregulation may be compromised, potentially leading to an unfavorable outcome. In spite of its complexity, autoregulation has been able to be quantified non-invasively within the neuro-critical care setting with the aid of transcranial Doppler...
August 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28473002/surrogate-prediction-of-quality-of-life-and-desire-for-treatment-a-guess-of-a-guess
#20
Scott Snyder, Halima Amjad
In conditions, such as dementia, stroke, or critical illness, clinicians often rely on substituted judgment through a surrogate to assist in medical decision making. Surrogates may face tough decisions regarding whether to pursue or forego surgery, tube feeding, and cardiopulmonary resuscitation. Surrogates often have little confidence in their decision (Majesko et al., 2012), though substituted judgment relies on the surrogate to determine the decision that the patient would have made. Prior studies suggest that surrogates predict patient preferences with only 68% accuracy (Shalowitz et al...
May 5, 2017: International Psychogeriatrics
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