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Critical Incident Response

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https://www.readbyqxmd.com/read/28746528/simple-motor-tasks-independently-predict-extubation-failure-in-critically-ill-neurological-patients
#1
Fernanda Machado Kutchak, Marcelo de Mello Rieder, Josué Almeida Victorino, Carla Meneguzzi, Karla Poersch, Luiz Alberto Forgiarini, Marino Muxfeldt Bianchin
Objective: To evaluate the usefulness of simple motor tasks such as hand grasping and tongue protrusion as predictors of extubation failure in critically ill neurological patients. Methods: This was a prospective cohort study conducted in the neurological ICU of a tertiary care hospital in the city of Porto Alegre, Brazil. Adult patients who had been intubated for neurological reasons and were eligible for weaning were included in the study. The ability of patients to perform simple motor tasks such as hand grasping and tongue protrusion was evaluated as a predictor of extubation failure...
May 2017: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
https://www.readbyqxmd.com/read/28746084/epidemiology-and-location-of-primary-retrieval-missions-in-a-scottish-aeromedical-service
#2
Gregg Neagle, Lisa Curatolo, John Ferris, Mike Donald, Stephen Hearns, Alasdair R Corfield
INTRODUCTION: Prehospital critical care teams comprising an appropriately trained physician and paramedic or nurse have been associated with improved outcomes in selected trauma patients. These teams are a scarce and expensive resource, especially when delivered by rotary air assets. The optimal tasking of prehospital critical care teams is therefore vital and remains a subject of debate. Emergency Medical Retrieval Service (EMRS) provides a prehospital critical care response team to incidents over a large area of Scotland either by air or by road...
July 25, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28743332/-clinical-significance-of-early-immunological-paralysis-in-patients-with-severe-h1n1-influenza-a
#3
Yongbing Qian, Hui Xie, Rui Tian, Jian Lu, Wei Jin, Ruilan Wang
OBJECTIVE: To analysis the immunological characteristics of patients with severe H1N1 influenza A, and to provide theoretical basis for predicting the prognosis of the disease. METHODS: A retrospective analysis was conducted. The clinical data of 15 patients diagnosed with severe H1N1 influenza A and admitted to Shanghai General Hospital of Nanjing Medical University from October 2015 to December 2016 were collected. All the patients were divided into survival and death groups according to 28-day survival...
July 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28742690/do-surgeons-react-a-retrospective-analysis-of-surgeons-response-to-harassment-of-a-colleague-during-simulated-operating-theatre-scenarios
#4
Hannah Gostlow, Camila Vega Vega, Nicholas Marlow, Wendy Babidge, Guy Maddern
OBJECTIVE: To assess and report on surgeons' ability to identify and manage incidences of harassment. BACKGROUND: The Royal Australasian College of Surgeons is committed to driving out discrimination, bullying, harassment, and sexual harassment from surgical training and practice, through changing the culture of the workplace. To eradicate these behaviors, it is first critical to understand how the current workforce responds to these actions. METHODS: A retrospective analysis of video data of an operating theatre simulation was conducted to identify how surgeons, from a range of experience levels, react to instances of harassment...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28729329/fluids-in-sepsis-and-septic-shock-fissh-protocol-for-a-pilot-randomised-controlled-trial
#5
Bram Rochwerg, Tina Millen, Peggy Austin, Michelle Zeller, Frédérick D'Aragon, Roman Jaeschke, Marie-Hélène Masse, Sangeeta Mehta, Francois Lamontagne, Maureen Meade, Gordon Guyatt, Deborah J Cook
INTRODUCTION: Observational evidence suggests physiological benefits and lower mortality with lower chloride solutions; however, 0.9% saline remains the most widely used fluid worldwide. Given uncertainty regarding the association of lower chloride on mortality, it is unlikely that practice will change without direct randomised clinical trial (RCT) evidence. This pilot RCT will investigate the feasibility of a large-scale trial directly comparing low chloride with high chloride fluids in patients with septic shock...
July 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28719264/the-human-microbiome-in-the-fight-against-tuberculosis
#6
Madeleine R Wood, Elaine A Yu, Saurabh Mehta
AbstractThe human microbiome is an intriguing potentially modifiable risk factor in our arsenal against Mycobacterium tuberculosis, the leading infectious disease killer globally. Previous studies have shown associations between the human microbiome and pulmonary disease states; however, etiological links between the microbiome and tuberculosis (TB) infection or disease remain unclear. Immunomodulatory roles of the microbiome may prove to be a critical asset in the host response against TB, including in preventing TB infection, reducing progression from latency, mitigating disease severity, and lowering the incidence of drug resistance and coinfections...
June 2017: American Journal of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/28716785/imbuing-medical-professionalism-in-relation-to-safety-a-study-protocol-for-a-mixed-methods-intervention-focused-on-trialling-an-embedded-learning-approach-that-centres-on-the-use-of-a-custom-designed-board-game
#7
Marie Ward, Eilish McAuliffe, Éidín Ní Shé, Ann Duffy, Una Geary, Una Cunningham, Catherine Holland, Nick McDonald, Karen Egan, Christian Korpos
INTRODUCTION: Healthcare organisations have a responsibility for ensuring that the governance of workplace settings creates a culture that supports good professional practice. Encouraging such a culture needs to start from an understanding of the factors that make it difficult for health professionals to raise issues of concern in relation to patient safety. The focus of this study is to determine whether a customised education intervention, developed as part of the study, with interns and senior house officers (SHOs) can imbue a culture of medical professionalism in relation to patient safety and support junior doctors to raise issues of concern, while shaping a culture of responsiveness and learning...
July 17, 2017: BMJ Open
https://www.readbyqxmd.com/read/28715416/signatures-of-inflammation-and-impending-multiple-organ-dysfunction-in-the-hyperacute-phase-of-trauma-a-prospective-cohort-study
#8
Claudia P Cabrera, Joanna Manson, Joanna M Shepherd, Hew D Torrance, David Watson, M Paula Longhi, Mimoza Hoti, Minal B Patel, Michael O'Dwyer, Sussan Nourshargh, Daniel J Pennington, Michael R Barnes, Karim Brohi
BACKGROUND: Severe trauma induces a widespread response of the immune system. This "genomic storm" can lead to poor outcomes, including Multiple Organ Dysfunction Syndrome (MODS). MODS carries a high mortality and morbidity rate and adversely affects long-term health outcomes. Contemporary management of MODS is entirely supportive, and no specific therapeutics have been shown to be effective in reducing incidence or severity. The pathogenesis of MODS remains unclear, and several models are proposed, such as excessive inflammation, a second-hit insult, or an imbalance between pro- and anti-inflammatory pathways...
July 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28711179/immediate-birth-an-analysis-of-women-and-their-babies-undergoing-time-critical-birth-in-a-tertiary-referral-obstetric-hospital
#9
M H Warren, J Kamania, A T Dennis
BACKGROUND: At our institution, the emergency obstetric 'code green' activates the system for immediate birth, usually by caesarean section. This study aimed to determine the incidence of immediate birth, indications, modes of anaesthesia, and short-term neonatal and maternal outcomes. METHOD: A review was performed for all women at the Royal Women's Hospital, Parkville, Australia who underwent immediate birth over a two-year period: January 1, 2013 to December 31, 2014...
June 16, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28706906/mesothelioma-recent-highlights
#10
REVIEW
Michele Carbone, Haining Yang
Recent discoveries have elucidated some of the mechanisms responsible for the development of mesothelioma. These discoveries are: (I) the critical role of chronic inflammation in promoting mesothelioma growth, driven by the release of high mobility group box protein-1 (HMGB1) following asbestos deposition in tissues and its potential role as a biomarker to identify asbestos exposed individuals and mesothelioma patients; (II) the discovery that inherited heterozygous germline mutations of the deubiquitylase BRCA-associated protein 1 (BAP1) cause a high incidence of mesothelioma in some families; and that (III) germline BAP1 mutations lower the threshold of asbestos required to cause mesothelioma in mice, evidence of gene X environment interaction...
June 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28697259/behavioral-counseling-to-promote-a-healthful-diet-and-physical-activity-for-cardiovascular-disease-prevention-in-adults-without-known-cardiovascular-disease-risk-factors-updated-evidence-report-and-systematic-review-for-the-us-preventive-services-task-force
#11
REVIEW
Carrie D Patnode, Corrine V Evans, Caitlyn A Senger, Nadia Redmond, Jennifer S Lin
Importance: Unhealthful dietary patterns, low levels of physical activity, and high sedentary time increase the risk of cardiovascular disease. Objective: To systematically review the evidence on the benefits and harms of behavioral counseling for the primary prevention of cardiovascular disease in adults without known cardiovascular risk factors to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, and PsycINFO for studies published in the English language between January 1, 2013, and May 25, 2016, and ongoing surveillance in targeted publications through March 24, 2017...
July 11, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28688909/are-we-making-an-impact-with-incident-learning-systems-analysis-of-quality-improvement-interventions-using-total-body-irradiation-as-a-model-system
#12
Aileen Kim, Eric Ford, Matthew Spraker, Jing Zeng, Ralph Ermoian, Loucille Jordan, Gabrielle Kane, Matthew Nyflot
PURPOSE: Despite increasing interest in incident learning systems (ILS) to improve safety and quality in radiation oncology, little is known about interventions developed in response to safety data. We used total body irradiation (TBI) as a model system to study the effectiveness of interventions from our institutional ILS. METHODS AND MATERIALS: Near-miss event reports specific to TBI were identified from a departmental ILS from March 2012 to December 2015. The near-miss risk index was rated at multidisciplinary review from 0 (no potential harm) to 4 (critical potential harm)...
June 6, 2017: Practical Radiation Oncology
https://www.readbyqxmd.com/read/28686681/kir-and-their-hla-class-i-ligands-two-more-pieces-towards-completing-the-puzzle-of-chronic-rejection-and-graft-loss-in-kidney-transplantation
#13
Roberto Littera, Gianbenedetto Piredda, Davide Argiolas, Sara Lai, Elena Congeddu, Paola Ragatzu, Maurizio Melis, Elisabetta Carta, Maria Benigna Michittu, Donatella Valentini, Luisella Cappai, Rita Porcella, Francesco Alba, Maria Serra, Valentina Loi, Roberta Maddi, Sandro Orrù, Giorgio La Nasa, Giovanni Caocci, Roberto Cusano, Marcella Arras, Mauro Frongia, Antonello Pani, Carlo Carcassi
BACKGROUND: Kidney transplantation is a life-saving treatment for patients with end-stage renal disease. However, despite progress in surgical techniques and patient management, immunological rejection continues to have a negative impact on graft function and overall survival. Incompatibility between donors and recipients for human leukocyte antigens (HLA) of the major histocompatibility complex (MHC) generates a series of complex cellular and humoral immune response mechanisms that are largely responsible for rejection and loss of graft function...
2017: PloS One
https://www.readbyqxmd.com/read/28676934/type-i-interferon-pathway-in-neuroinflammation-and-neurodegeneration-focus-on-alzheimer-s-disease
#14
REVIEW
Juliet M Taylor, Zachery Moore, Myles R Minter, Peter J Crack
Past research in Alzheimer's disease (AD) has largely been driven by the amyloid hypothesis; the accompanying neuroinflammation seen in AD has been assumed to be consequential and not disease modifying or causative. However, recent data from both clinical and preclinical studies have established that the immune-driven neuroinflammation contributes to AD pathology. Key evidence for the involvement of neuroinflammation in AD includes enhanced microglial and astroglial activation in the brains of AD patients, increased pro-inflammatory cytokine burden in AD brains, and epidemiological evidence that chronic non-steroidal anti-inflammatory drug use prior to disease onset leads to a lower incidence of AD...
July 4, 2017: Journal of Neural Transmission
https://www.readbyqxmd.com/read/28676492/local-emergency-medical-response-after-a-terrorist-attack-in-norway-a-qualitative-study
#15
Aleidis S Brandrud, Michael Bretthauer, Guttorm Brattebø, May Jb Pedersen, Kent Håpnes, Karin Møller, Trond Bjorge, Bjørnar Nyen, Lars Strauman, Ada Schreiner, Gro S Haldorsen, Maria Bergli, Eugene Nelson, Tamara S Morgan, Per Hjortdahl
INTRODUCTION: On 22 July 2011, Norway suffered a devastating terrorist attack targeting a political youth camp on a remote island. Within a few hours, 35 injured terrorist victims were admitted to the local Ringerike community hospital. All victims survived. The local emergency medical service (EMS), despite limited resources, was evaluated by three external bodies as successful in handling this crisis. This study investigates the determinants for the success of that EMS as a model for quality improvement in healthcare...
July 4, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28673371/mass-fatality-incident-preparedness-among-faith-based-organizations
#16
Qi Zhi, Jacqueline A Merrill, Robyn R Gershon
Introduction Members of faith-based organizations (FBOs) are in a unique position to provide support and services to their local communities during disasters. Because of their close community ties and well-established trust, they can play an especially critical role in helping communities heal in the aftermath of a mass-fatality incident (MFI). Faith-based organizations are considered an important disaster resource and partner under the National Response Plan (NRP) and National Response Framework; however, their level of preparedness and response capabilities with respect to MFIs has never been evaluated...
July 4, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28668823/desmoid-tumors-in-familial-adenomatous-polyposis
#17
REVIEW
Maria Laura DE Marchis, Francesco Tonelli, Davide Quaresmini, Domenica Lovero, David Della-Morte, Franco Silvestris, Fiorella Guadagni, Raffaele Palmirotta
Familial adenomatous polyposis (FAP) is a cancer syndrome caused by a germline mutation in the adenomatous polyposis coli (APC) gene. It is characterized by the presence of hundreds of colonic polyps, which have a high tendency to undergo malignant transformation. Among associated lesions in FAP, desmoid tumors represent a common possible life-threatening condition that requires special attention. They are rare tumors occurring with a particularly high incidence in FAP, especially after surgery. In agreement with Knudson's 'two-hit' theory, the inactivation of the residual APC gene in FAP is a critical step in the development of both colorectal cancer and desmoids...
July 2017: Anticancer Research
https://www.readbyqxmd.com/read/28666312/antithrombin-iii-administration-for-portal-vein-thrombosis-in-patients-with-liver-disease-a-randomized-double-blind-controlled-trial
#18
Hisashi Hidaka, Shigehiro Kokubu, Takahiro Sato, Shinji Katsushima, Namiki Izumi, Takumi Igura, Shingo Asahara, Kazuo Notsumata, Yukio Osaki, Keiji Tsuji, Hirofumi Kawanaka, Tomohiko Akahoshi, Shozo Hirota, Shoichi Matsutani
AIM: Portal vein thrombosis (PVT) is one of the most critical disorders in liver disease patients. These patients have the imbalance of coagulation and coagulation inhibition resulting from decreased levels of coagulation inhibitory factors, such as protein C, protein S, and antithrombin III (AT-III). We designed this randomized, double-blind, placebo-controlled trial comparing the safety and efficacy of AT-III administration for PVT in patients with those who received no treatment. METHODS: Eligible patients were diagnosed with the association of thrombus, without tumor thrombus, thrombus in more than 50% of the cross-sectional lumen of the portal vein...
June 30, 2017: Hepatology Research: the Official Journal of the Japan Society of Hepatology
https://www.readbyqxmd.com/read/28656364/the-critical-role-of-macrophages-in-the-pathogenesis-of-hidradenitis-suppurativa
#19
REVIEW
Ahmed Shah, Raed Alhusayen, Saeid Amini-Nik
INTRODUCTION: Hidradenitis suppurativa (HS) is a painful chronic inflammatory disease with a prevalence between 1 and 4% of general population. The pathogenesis of HS long eluded scientists, but growing evidence suggests that it is a consequence of inflammatory dysregulation. FINDINGS: Recent studies suggest that dysregulated immune response to skin flora and overexpression of inflammatory cytokines leads to chronic skin inflammation seen in HS. Macrophages are the most numerous inflammatory cells found in HS infiltrates and release numerous pro-inflammatory cytokines such as IL-23, and IL-1β and TNF-α, exacerbating the inflammation and contributing to the pathogenesis of HS...
June 27, 2017: Inflammation Research: Official Journal of the European Histamine Research Society ... [et Al.]
https://www.readbyqxmd.com/read/28655354/perioperative-systemic-steroid-for-rapid-recovery-in-total-knee-and-hip-arthroplasty-a-systematic-review-and-meta-analysis-of-randomized-trials
#20
REVIEW
Chen Yue, Rong Wei, Youwen Liu
BACKGROUND: Perioperative systemic steroid administration for rapid recovery in total knee and hip arthroplasty (TKA/THA) is an important and controversial topic. We conducted this systematic review and meta-analysis to evaluate the overall benefits and harms of perioperative systemic steroid in patients undergoing TKA and THA. METHODS: A comprehensive search was performed on PubMed, OVID, and Web of Science databases, and a systematic approach was carried out starting from the PRISMA recommendations...
June 27, 2017: Journal of Orthopaedic Surgery and Research
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