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https://www.readbyqxmd.com/read/28089154/pre-hospital-electrocardiogram-triage-with-telemedicine-near-halves-time-to-treatment-in-stemi-a-meta-analysis-and-meta-regression-analysis-of-non-randomized-studies
#1
REVIEW
Natale Daniele Brunetti, Luisa De Gennaro, Michele Correale, Francesco Santoro, Pasquale Caldarola, Antonio Gaglione, Matteo Di Biase
BACKGROUND: A shorter time to treatment has been shown to be associated with lower mortality rates in acute myocardial infarction (AMI). Several strategies have been adopted with the aim to reduce any delay in diagnosis of AMI: pre-hospital triage with telemedicine is one of such strategies. We therefore aimed to measure the real effect of pre-hospital triage with telemedicine in case of AMI in a meta-analysis study. METHODS: We performed a meta-analysis of non-randomized studies with the aim to quantify the exact reduction of time to treatment achieved by pre-hospital triage with telemedicine...
January 8, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28062332/psychosocial-concerns-in-the-postoperative-oncology-patient
#2
REVIEW
Elizabeth Ercolano
OBJECTIVES: To describe psychosocial concerns associated with the postoperative cancer patient and to discuss current psychosocial evidence-based approaches to manage these psychosocial concerns. DATA SOURCES: Published peer-reviewed literature. CONCLUSION: The postoperative phase of cancer care may be associated with a range of overlapping acute and chronic psychosocial concerns related to the surgery itself, the cancer diagnosis, and the need for ongoing cancer treatments...
January 3, 2017: Seminars in Oncology Nursing
https://www.readbyqxmd.com/read/28059860/diagnosis-and-treatment-of-upper-airway-oedema-caused-by-acute-angio-oedema-in-the-emergency-department-a-french-consensus-statement
#3
Bernard Floccard, Nicolas Javaud, Alban Deroux, Isabelle Boccon-Gibod, Olivier Fain, Stéphanie Amarger, Claire Blanchard-Delaunay, Pierre Y Jeandel, Nicolas Marmion, Yann Ollivier, Pauline Pralong, Stéphane Gayet, Aurélie Du-Thanh, Fabien Pelletier, Laurent Sailler, Philip Robinson, David Launay, Laurence Bouillet
Angio-oedema is a transitory, localized, noninflammatory oedema of subcutaneous tissue or mucous. When the oedema affects the mouth, lips, tongue or larynx, it can result in fatal asphyxiation in the absence of specific treatment. Oedema secondary to plasma extravasation is usually mediated by either histamine or bradykinin. As laboratory tests are not available in an emergency setting, the implicated mediator cannot be readily determined. The challenge for the emergency physician is to determine the aetiological type, evaluate severity and initiate adapted treatment by means of a structured approach...
January 4, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28053053/acute-on-chronic-liver-failure-an-update
#4
REVIEW
Ruben Hernaez, Elsa Solà, Richard Moreau, Pere Ginès
Acute-on-chronic liver failure (ACLF) is a syndrome characterised by acute decompensation of chronic liver disease associated with organ failures and high short-term mortality. Alcohol and chronic viral hepatitis are the most common underlying liver diseases. Up to 40%-50% of the cases of ACLF have no identifiable trigger; in the remaining patients, sepsis, active alcoholism and relapse of chronic viral hepatitis are the most common reported precipitating factors. An excessive systemic inflammatory response seems to play a crucial role in the development of ACLF...
January 4, 2017: Gut
https://www.readbyqxmd.com/read/28050223/geriatric-homelessness-association-with-emergency-department-utilization
#5
Ana Hategan, Daniel Tisi, Mariam Abdurrahman, James A Bourgeois
BACKGROUND: Homeless adults frequently use emergency departments (EDs), yet previous studies investigating ED utilization by the older segment received little attention. This study sought to characterize older homeless adults who utilized local urban EDs. METHODS: ED encounters at three hospitals in Hamilton (Ont.) were analyzed, and demographic and clinical characteristics of the older homeless (age > 50) vs. younger counterparts (age ≤ 50) were compared during a 24-month period...
December 2016: Canadian Geriatrics Journal: CGJ
https://www.readbyqxmd.com/read/28034476/defining-cases-of-severe-pediatric-diarrhea-for-an-efficacy-trial-of-an-enterotoxigenic-escherichia-coli-etec-vaccine-report-on-an-international-workshop-washington-dc-march-2016
#6
Thomas F Wierzba, Alexandra Bourgis
Enterotoxigenic Escherichia coli (ETEC) causes severe acute watery diarrhea. No ETEC vaccine is available but candidates are in development, including ETVAX, an oral, whole-cell inactivated vaccine. ETVAX is being tested in a descending-age trial in Bangladesh. If found safe and immunogenic, investigators may test it for efficacy in children. Like oral rotavirus vaccines, we expect that ETVAX will be most effective at decreasing the incidence of moderate-to-severe ETEC episodes. Thus, for an efficacy trial outcome, it will be necessary to triage patients into moderate-to-severe versus mild disease...
December 26, 2016: Vaccine
https://www.readbyqxmd.com/read/28033032/dynamic-and-personalized-risk-forecast-in-step-down-units-implications-for-monitoring-paradigms
#7
Lujie Chen, Ogundele Olufunmilayo, Gilles Clermont, Marilyn Hravnak, Michael R Pinsky, Artur W Dubrawski
RATIONALE: Cardiorespiratory insufficiency (CRI) is a term applied to the manifestations of loss of normal cardiorespiratory reserve and portends a bad outcome. CRI occurs commonly in hospitalized patients, but its risk escalation patterns are unexplored. OBJECTIVES: To describe the dynamic and personal character of CRI risk evolution observed through continuous vital sign monitoring of individual Step-Down Unit patients. METHODS: Using a machine learning model, we estimated risk trends for CRI (defined as exceedance of vital sign stability thresholds) for each of 1,971 admissions (1,880 unique patients) to a 24-bed adult surgical-trauma step-down unit at an urban teaching hospital in Pittsburgh, Pennsylvania using continuously-recorded vital signs from standard bedside monitors...
December 29, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28031190/risk-factors-for-death-in-children-during-inpatient-treatment-of-severe-acute-malnutrition-a-prospective-cohort-study
#8
Maren Jh Rytter, Esther Babirekere-Iriso, Hanifa Namusoke, Vibeke B Christensen, Kim F Michaelsen, Christian Ritz, Charlotte G Mortensen, Ezekiel Mupere, Henrik Friis
BACKGROUND: Children who receive in-hospital treatment of severe acute malnutrition often have high mortality rates, and the reasons are not well understood. OBJECTIVE: We assessed risk factors for death in children who were treated for malnutrition in a hospital. DESIGN: In a prospective observational study of 120 children who were receiving in-hospital treatment of severe acute malnutrition in Uganda with therapeutic formulas F-75 and F-100, we collected data on symptoms, clinical findings, plasma markers of refeeding syndrome (electrolytes and phosphate), and acute phase reactants, and recorded the nutritional therapy given in hospital...
December 28, 2016: American Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28030519/incorporating-a-computerized-cognitive-battery-into-the-emergency-department-care-of-pediatric-mild-traumatic-brain-injuries-is-it-feasible
#9
Aneesh M Khetani, Brian L Brooks, Angelo Mikrogianakis, Karen M Barlow
OBJECTIVES: The use of computers to test cognitive function acutely after a concussion is becoming increasingly popular, especially after sport-related concussion. Although commonly performed in the community, it is not yet performed routinely in the emergency department (ED), where most injured children present. The challenges of performing computerized cognitive testing (CCT) in a busy ED are considerable. The aim of this study was to evaluate the feasibility of CCT in the pediatric ED after concussion...
December 28, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28007319/nasal-flaring-as-a-clinical-sign-of-respiratory-acidosis-in-patients-with-dyspnea
#10
José Gregorio Zorrilla-Riveiro, Anna Arnau-Bartés, Ramón Rafat-Sellarés, Dolors García-Pérez, Arantxa Mas-Serra, Rafael Fernández-Fernández
OBJECTIVE: To determine whether the presence of nasal flaring is a clinical sign of respiratory acidosis in patients attending emergency departments for acute dyspnea. METHODS: Single-center, prospective, observational study of patients aged over 15 requiring urgent attention for dyspnea, classified as level II or III according to the Andorran Triage Program and who underwent arterial blood gas test on arrival at the emergency department. The presence of nasal flaring was evaluated by two observers...
December 10, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27999514/hemorrhagic-stroke-resulting-from-venous-malformation-at-20-weeks-of-pregnancy
#11
Nicole D Ulrich, Elizabeth R Lapeyre, Robert C Moore
BACKGROUND: Stroke in the pregnant patient is not a common occurrence. Despite its relative rarity, stroke during pregnancy is associated with high morbidity and mortality for both mother and infant. We report the case of a patient who experienced a hemorrhagic stroke during pregnancy because of venous cavernoma. CASE REPORT: A 34-year-old patient, gravida 5 para 1-0-3-1, presented to labor and delivery triage at 21 weeks, 0 days' gestation with the concern of sudden-onset right-sided facial, arm, and leg numbness and weakness...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27986846/hospital-transfer-associated-with-increased-mortality-after-endovascular-revascularization-for-acute-ischemic-stroke
#12
Lorenzo Rinaldo, Waleed Brinjikji, Brandon A McCutcheon, Mohamad Bydon, Harry Cloft, David F Kallmes, Alejandro A Rabinstein
BACKGROUND: Patients with an acute ischemic stroke (AIS) due to large vessel occlusion often require transfer to an endovascular center for treatment. OBJECTIVE: To assess the effect of hospital transfer on outcomes after endovascular revascularization. METHODS: Outcomes of endovascular revascularization were compared between directly admitted and transferred patients using data from a national database and our own institution. RESULTS: 118 institutions within the database reported outcomes of 8533 inpatient admissions for endovascular treatment of AIS...
December 16, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27978944/bleeding-events-before-coronary-angiography-in-patients-with-non-st-segment-elevation-acute%C3%A2-coronary-syndrome
#13
Björn Redfors, Ajay J Kirtane, Stuart J Pocock, Girma Minalu Ayele, Efthymios N Deliargyris, Roxana Mehran, Gregg W Stone, Philippe Généreux
BACKGROUND: Upstream administration of antithrombotic drugs to patients with non-ST-segment elevation acute coronary syndromes before coronary angiography is a common practice despite an incomplete understanding of the risks and benefits. OBJECTIVES: The authors analyzed the incidence of bleeding and ischemic events occurring before angiography and assessed their association with antithrombotic drugs and mortality risk. METHODS: All patients from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial with planned angiography after enrollment were included...
December 20, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27974670/the-syntax-score-does-not-predict-risk-of-adverse-events-in-patients-with-non-st-elevation-acute-coronary-syndrome-who-undergo-coronary-artery-bypass-graft-surgery
#14
Björn Redfors, Chun-Hui He, Tullio Palmerini, Adriano Caixeta, Gennaro Giustino, Girma Minalu Ayele, Ajay J Kirtane, Roxana Mehran, Gregg W Stone, Philippe Généreux
OBJECTIVES: We tested the ability of the SYNTAX score (SS) to predict 1-year adverse outcomes for patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS) who undergo coronary artery bypass graft (CABG) surgery. BACKGROUND: The SS effectively risk stratifies patients who undergo percutaneous coronary intervention, but not patients with stable coronary disease who undergo CABG. METHODS: We calculated the SS for 457 patients with NSTE-ACS in the angiographic substudy of the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial who underwent CABG...
December 15, 2016: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/27974505/metabolomic-screening-using-esi-ft-ms-identifies-potential-radiation-responsive-molecules-in-mouse-urine
#15
Daisuke Iizuka, Susumu Yoshioka, Hidehiko Kawai, Shunsuke Izumi, Fumio Suzuki, Kenji Kamiya
The demand for establishment of high-throughput biodosimetric methods is increasing. Our aim in this study was to identify low-molecular-weight urinary radiation-responsive molecules using electrospray ionization Fourier transform mass spectrometry (ESI-FT MS), and our final goal was to develop a sensitive biodosimetry technique that can be applied in the early triage of a radiation emergency medical system. We identified nine metabolites by statistical comparison of mouse urine before and 8 h after irradiation...
December 14, 2016: Journal of Radiation Research
https://www.readbyqxmd.com/read/27940752/improving-guideline-based-care-of-acute-asthma-in-a-pediatric-emergency-department
#16
Matthew P Gray, Grant E Keeney, Michael J Grahl, Marc H Gorelick, Christopher D Spahr
BACKGROUND AND OBJECTIVE: Rapid repetitive administration of short-acting β-agonists (SABA) is the most effective means of reducing acute airflow obstruction in asthma. Little evidence exists that assesses process measures (ie, timeliness) and outcomes for asthma. We used quality improvement (QI) methods to improve emergency department care in accordance with national guidelines including timely SABA administration and use of asthma severity scores. METHODS: The Model for Improvement was used and interventions were targeted at 4 key drivers: knowledge, engagement, decision support, and workflow enhancement...
November 2016: Pediatrics
https://www.readbyqxmd.com/read/27926536/a-minimal-titration-model-of-the-mammalian-dynamical-heat-shock-response
#17
Aude Sivéry, Emmanuel Courtade, Quentin Thommen
Environmental stress, such as oxidative or heat stress, induces the activation of the heat shock response (HSR) and leads to an increase in the heat shock proteins (HSPs) level. These HSPs act as molecular chaperones to maintain cellular proteostasis. Controlled by highly intricate regulatory mechanisms, having stress-induced activation and feedback regulations with multiple partners, the HSR is still incompletely understood. In this context, we propose a minimal molecular model for the gene regulatory network of the HSR that reproduces quantitatively different heat shock experiments both on heat shock factor 1 (HSF1) and HSPs activities...
December 7, 2016: Physical Biology
https://www.readbyqxmd.com/read/27914145/differential-cell-count-and-crp-level-in-blood-as-predictors-for-middle-east-respiratory-syndrome-coronavirus-infection-in-acute-febrile-patients-during-nosocomial-outbreak
#18
Ga Eun Park, Cheol In Kang, Jae Hoon Ko, Sun Young Cho, Young Eun Ha, Yae Jean Kim, Kyong Ran Peck, Jae Hoon Song, Doo Ryeon Chung
A case-control study was performed to identify clinical predictors for Middle East respiratory syndrome coronavirus (MERS-CoV) infection among patients with acute febrile illness during the nosocomial outbreak. Patients with MERS-CoV were more likely to have monocytosis with normal white blood cell (WBC) count and lower C-reactive protein (CRP) level. Simple laboratory data such as complete blood counts (CBC) with differential count could be a useful marker for the prediction of MERS and triage at the initial presentation of acute febrile patients in outbreak setting...
January 2017: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/27907140/detection-of-acute-radiation-sickness-a-feasibility-study-in-non-human-primates-circulating-mirnas-for-triage-in-radiological-events
#19
Naresh Menon, Claude J Rogers, Agnes I Lukaszewicz, James Axtelle, Marshleen Yadav, Feifei Song, Arnab Chakravarti, Naduparambil K Jacob
Development of biomarkers capable of estimating absorbed dose is critical for effective triage of affected individuals after radiological events. Levels of cell-free circulating miRNAs in plasma were compared for dose-response analysis in non-human primates (NHP) exposed to lethal (6.5 Gy) and sub-lethal (1 and 3 Gy) doses over a 7 day period. The doses and test time points were selected to mimic triage needs in the event of a mass casualty radiological event. Changes in miRNA abundance in irradiated animals were compared to a non-irradiated cohort and a cohort experiencing acute inflammation response from exposure to lipopolysaccharide (LPS)...
2016: PloS One
https://www.readbyqxmd.com/read/27903076/the-potential-of-optimizing-prehospital-triage-of-patients-with-suspected-acute-myocardial-infarction-using-high-sensitivity-cardiac-troponin-t-and-copeptin
#20
Carsten Stengaard, Jacob T Sørensen, Søren A Ladefoged, Jens F Lassen, Martin B Rasmussen, Claus Kjær Pedersen, Antoine Ayer, Hans Erik Bøtker, Christian J Terkelsen, Kristian Thygesen
PURPOSE: In patients with a suspected acute myocardial infarction (AMI), to evaluate the potential for early triage based on measurement of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin in blood samples collected in the prehospital phase. MATERIALS AND METHODS: In this retrospective study, we measured hs-cTnT and copeptin in blood samples collected in the ambulance form 962 patients with suspected AMI. The diagnostic accuracy was estimated by receiver-operating characteristic (ROC) curve area under the curve (AUC) for both biomarkers and a combined model...
December 12, 2016: Biomarkers: Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals
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