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James Rotenberg, Bruce Kinosian, Peter Boling, George Taler
The Independence at Home (IAH) Demonstration Year 2 results confirmed that the first-year savings were 10 times as great as those of the pioneer accountable care organizations during their initial 2 years. We update projected savings from nationwide conversion of the IAH demonstration, incorporating Year 2 results and improving attribution of IAH-qualified (IAH-Q) Medicare beneficiaries to home-based primary care (HBPC) practices. Applying IAH qualifying criteria to beneficiaries in the Medicare 5% claims file, the effect of expanding HBPC to the 2...
February 23, 2018: Journal of the American Geriatrics Society
Alison D McNeilly, Rory J McCrimmon
Hypoglycaemia remains the most common metabolic adverse effect of insulin and sulfonylurea therapy in diabetes. Repeated exposure to hypoglycaemia leads to a change in the symptom complex that characterises hypoglycaemia, culminating in a clinical phenomenon referred to as impaired awareness of hypoglycaemia (IAH). IAH effects approximately 20-25% of people with type 1 diabetes and increases the risk of severe hypoglycaemia. This review focuses on the mechanisms that are responsible for the much higher frequency of hypoglycaemia in people with diabetes compared with those without, and subsequently how repeated exposure to hypoglycaemia leads to the development of IAH...
February 7, 2018: Diabetologia
H Hatle, M R Bjørgaas, T B Rø, S E Olsen, B O Åsvold
AIMS: To investigate fear of hypoglycaemia (FoH) in relation to hypoglycaemia awareness, history of severe hypoglycaemia (SH) and hypoglycaemia symptoms in adults with Type 1 diabetes. METHODS: Questionnaire-based cross-sectional survey. We assessed FoH with the Hypoglycaemia Fear Survey-II Worry subscale, hypoglycaemia awareness status with the Gold score, and used the Edinburgh Hypoglycaemia Scale to grade the presence and intensity of hypoglycaemia symptoms. All these measures have previously been validated for research application...
February 2, 2018: Diabetes Research and Clinical Practice
Natasa Kovac, Mladen Peric
BACKGROUND AND OBJECTIVE: Liver function assessment in patients with intra-abdominal hypertension (IAH) after major abdominal surgery is complex and often confounding. Elevated intra-abdominal pressure (IAP) often occurs after major abdominal surgery, and is associated with decreased abdominal blood flow and organ dysfunction, and it could cause abdominal compartment syndrome (ACS), which is a life-threatening condition. Plasma disappearance rate (PDR) of indocyanine green (ICG) and ICG retention rate after 15 min (R15) were used to evaluate liver function and as a prognostic parameter after major abdominal surgery...
February 28, 2018: Current Medical Research and Opinion
Wei-Chao Liao, Yan-Hong Chen, Hang-Yang Li, Ting-Ting Wang, Peng Lan, Kong-Han Pan, Hui-Qing Ge, Qiang-Min Xie, Jian-Cang Zhou
Objective This study aimed to examine the mechanism of diaphragmatic dysfunction in sepsis due to severe acute pancreatitis (SAP) with intra-abdominal hypertension (IAH) in a rat model. Methods The rats were assigned at random to four groups: (1) control (n = 5), (2) SAP (n = 5), (3) SAP+IAH (n = 5), and (4) SAP+IAH+SS-31 (n = 5). Length and force output of the diaphragm were analysed in vivo. Histopathological examinations were performed by haematoxylin-eosin. Oxidative stress levels related to protease in diaphragmatic mitochondria were detected with a colorimetric technique...
January 1, 2018: Journal of International Medical Research
Ester Párraga Ros, Laura Correa-Martín, Francisco M Sánchez-Margallo, Irma Eugenia Candanosa-Aranda, Manu L N G Malbrain, Robert Wise, Rafael Latorre, Octavio López Albors, Gregorio Castellanos
BACKGROUND: A mechanical intestinal obstruction (MIO) can generate intraabdominal hypertension (IAH) that is life threatening. The intestines are very sensitive to IAH since the low splanchnic perfusion causes intestinal hypoxia, local acidosis and bacterial translocations. This may lead to acute intestinal distress syndrome (AIDS). The identification of intestinal injuries during IAH and its correlation with clinical parameters as the abdominal perfusion pressure (APP), the gastric intramucosal pH (pHi) and lactic acid (Lc) are still unknown...
2018: PloS One
Yuan Li, Jianan Ren, Xiuwen Wu, Jieshou Li
Some patients with intra-abdominal infection (IAI) may develop intra-abdominal hypertension (IAH) during treatment. The present study investigated the impact of IAI combined with IAH on the intestinal mucosal barrier in a rabbit model. Forty-eight New Zealand white rabbits were randomly divided into four groups: (i) IAI and IAH; (ii) IAI alone; (iii) IAH alone; and (iv) Control group. IAI model: cecal ligation and puncture for 48 h; IAH model: raised intra-abdominal pressure (IAP) of 20 mmHg for 4 h. Pathological changes in intestinal mucosa were confirmed by light and scanning electron microscopy...
February 28, 2018: Bioscience Reports
Bruno M Pereira, Renato G Pereira, Robert Wise, Gavin Sugrue, Tanya L Zakrison, Alcir E Dorigatti, Rossano K Fiorelli, Manu L N G Malbrain
BACKGROUND: Intra-abdominal hypertension is a common complication in critically ill patients. Recently the Abdominal Compartment Society (WSACS) developed a medical management algorithm with a stepwise approach according to the evolution of the intra-abdominal pressure and aiming to keep IAP ≤ 15 mm Hg. With the increased use of ultrasound as a bedside modality in both emergency and critical care patients, we hypothesized that ultrasound could be used as an adjuvant point-of-care tool during IAH management...
2017: Anaesthesiology Intensive Therapy
Vincent Dupont, Alexandre Debrumetz, Alain Wynckel, Philippe Rieu
Intra-abdominal hypertension (IAH) is a frequent and serious condition affecting critical care patients. IAH diagnostic needs intravesical pressure (IVP) measurement which is recommended for monitoring patients presenting IAH risk factors. IVP monitoring is probably insufficient in daily practice. This could be explained by lack of knowledge about IAH physiopathology, which leads to absence of therapeutic target. Acute kidney injury (AKI) is the earliest and most described organ dysfunction associated with IAH...
November 23, 2017: Néphrologie & Thérapeutique
Gavin Sugrue, Manu L N G Malbrain, Bruno Pereira, Robert Wise, Michael Sugrue
Intra-abdominal hypertension (IAH) is common in critically ill patients. Diagnosis is based on measurement of intra-abdominal pressure, most commonly via the bladder. Modern imaging techniques with plain radiographs, computed tomography and magnetic resonance can help establish the diagnosis and also guide treatment. In 2013 the Abdominal Compartment Society (WSACS) published updated consensus definitions and recommendations for management of IAH and abdominal compartment syndrome (ACS). This review will give a concise overview of the important role radiographic imaging plays within these management guidelines...
November 24, 2017: Anaesthesiology Intensive Therapy
Maria Concepcion C Cabatan, Lenin C Grajo
OBJECTIVE: This study is a pilot implementation of an Internationalization at Home (IaH) teaching and learning collaboration to enhance intercultural learning and understanding of concepts of occupation in two cohorts of occupational science and occupational therapy students from the Philippines and the United States. METHOD: In this collective case study, 149 students (Cohort 1, n = 65; Cohort 2, n = 84) participated. The collaboration included virtual conversations among students, faculty presentations, reflective assignments, and completion of an anonymous online survey...
November 2017: American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association
Ronald Mbiine, Rose Alenyo, Olive Kobusingye, Job Kuteesa, Cephas Nakanwagi, Hervé Monka Lekuya, Olivia Kituuka, Moses Galukande
BACKGROUND: Severe burns have been shown to be a risk factor for developing intra-abdominal hypertension (IAH). Fluid resuscitation practices used in burns management further predispose patients to intra-abdominal hypertension. The mortality associated with IAH in severe burns is estimated to be more than 74.5% once organ dysfunction occurs. Despite 95% of all burns occurring in Low and Middle income countries (LMIC), there is paucity of published data on this topic in sub-Saharan Africa...
2017: International Journal of Burns and Trauma
Adrian Regli, Bart Leon De Keulenaer, Annamaria Palermo, Peter Vernon van Heerden
PURPOSE: Intra-abdominal hypertension (IAH) is associated with impaired respiratory function. Animal data suggest that positive end-expiratory pressure (PEEP) levels adjusted to intra-abdominal pressure (IAP) levels may counteract IAH-induced respiratory dysfunction. In this pilot study, our aim was to assess whether PEEP adjusted for IAP can be applied safely in patients with IAH. MATERIALS AND METHODS: We included patients on mechanical ventilation and with IAH...
October 16, 2017: Journal of Critical Care
Cornelis A J van Beers, Martine G Caris, J Hans DeVries, Erik H Serné
AIMS: We aimed to re-assess the previously shown but recently disputed association between HbA1c and severe hypoglycemia. METHODS: 52 Patients with T1D and IAH participated in an earlier reported randomized, crossover trial with two 16-week intervention periods comparing continuous glucose monitoring (CGM) with self-monitoring of blood glucose (SMBG). In this previous study, time spent in normoglycemia (the primary outcome), was improved by 9.6% (p<0.0001). We performed post-hoc analyses using a zero-inflated Poisson regression model to assess the relationship between severe hypoglycemia and HbA1c, glucose variability and duration of diabetes...
September 18, 2017: Journal of Diabetes and its Complications
Petr Bednarik, Amir A Moheet, Heidi Grohn, Anjali F Kumar, Lynn E Eberly, Elizabeth R Seaquist, Silvia Mangia
In this study, we retrospectively analyzed the anatomical MRI data acquired from 52 subjects with type 1 diabetes (26M/26F, 36 ± 11 years old, A1C = 7.2 ± 0.9%) and 50 age, sex and BMI frequency-matched non-diabetic controls (25M/25F, 36 ± 14 years old). The T1D group was further sub-divided based on whether subjects had normal, impaired, or indeterminate awareness of hypoglycemia (n = 31, 20, and 1, respectively). Our goals were to test whether the gray matter (GM) volumes of selected brain regions were associated with diabetes status as well as with the status of hypoglycemia awareness...
2017: Frontiers in Neuroscience
Hui-Ting Yang, Song-Song Zou, Li-Juan Zhai, Yao Wang, Fu-Miao Zhang, Li-Guo An, Gui-Wen Yang
Numerous bacteria are harbored in the animal digestive tract and are impacted by several factors. Intestinal microbiota homeostasis is critical for maintaining the health of an organism. However, how pathogen invasion affects the microbiota composition has not been fully clarified. The mechanisms for preventing invasion by pathogenic microorganisms are yet to be elucidated. Zebrafish is a useful model for developmental biology, and studies in this organism have gradually become focused on intestinal immunity...
December 2017: Fish & Shellfish Immunology
Evita C Wiegers, Hanne M Rooijackers, Cees J Tack, Hans J M M Groenewoud, Arend Heerschap, Bastiaan E de Galan, Marinette van der Graaf
Since altered brain lactate handling has been implicated in the development of impaired awareness of hypoglycemia (IAH) in type 1 diabetes, the capacity to transport lactate into the brain during hypoglycemia may be relevant in its pathogenesis. High-intensity interval training (HIIT) increases plasma lactate levels. We compared the effect of HIIT-induced hyperlacticacidemia on brain lactate during hypoglycemia between 1 ) patients with type 1 diabetes and IAH, 2 ) patients with type 1 diabetes and normal awareness of hypoglycemia, and 3 ) healthy participants without diabetes ( n = 6 per group)...
December 2017: Diabetes
William Kirke Rogers, Luis Garcia
Abdominal compartment syndrome (ACS) is the end point of a process whereby massive interstitial swelling in the abdomen or rapid development of a space-filling lesion in the abdomen (such as ascites or a hematoma) leads to pathologically increased pressure. This results in so-called intraabdominal hypertension (IAH), causing decreased perfusion of the kidneys and abdominal viscera and possible difficulties with ventilation and maintenance of cardiac output. These effects contribute to a cascade of ischemia and multiple organ dysfunction with high mortality...
August 2, 2017: Chest
Tatsumi Moriya, Kazuki Omura, Madoka Matsubara, Yuki Yoshida, Kei Hayama, Motoshi Ouchi
OBJECTIVE: This study investigated the association between renal histology, as assessed by morphometric analysis using light (LM) and electron (EM) microscopy, and changes in urinary albumin excretion (UAE) and glomerular filtration rate (GFR) in Japanese people with type 2 diabetes in the early stages of diabetic nephropathy. RESEARCH DESIGN AND METHODS: We performed percutaneous renal biopsies in 29 patients with type 2 diabetes (22 men, mean ± SD age 49 ± 10 years and GFR 119 ± 27 mL/min/1...
August 3, 2017: Diabetes Care
G Raghavendra Prasad, J V Subba Rao, Amtul Aziz, T M Rashmi
INTRODUCTION: Abdomen, a closed compartment, is prone to raised intra-abdominal pressure (IAP) in the postoperative period. After a critical value of ≥ 15 cm of water, IAP produces abdominal compartment syndrome (ACS). ACS leads to reduced venous return, reduced cardiac output, and domino effect of organ dysfunction, leading to death. Hence, it is the need of hour to monitor IAP to pick up intra-abdominal hypertension (IAH) and ACS. This routine facilitates early institution of treatment measures...
July 2017: Journal of Indian Association of Pediatric Surgeons
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