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https://www.readbyqxmd.com/read/29454226/dysphagia-and-laryngeal-pathology-in-post-surgical-cardiothoracic-patients
#1
Anna Miles, Naomi McLellan, Rochelle Machan, David Vokes, Alexandra Hunting, Mary McFarlane, Jennifer Holmes, Kelly Lynn
PURPOSE: Cardiothoracic surgery is known to result in dysphagia and laryngeal injury. While prevalence has been explored, extent, trajectory and longevity of symptoms are poorly understood. This retrospective, observational study explored dysphagia and laryngeal injury in patients following cardiothoracic surgery referred for instrumental swallowing assessment. METHODS: Clinical notes and endoscopic recordings of 106 patients (age range 18-87yrs; mean 63yrs; SD 15yrs) (including 190 endoscopes) at one large tertiary centre were reviewed by two speech-language pathologists and a laryngologist...
February 9, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29438815/new-onset-squamous-cell-carcinoma-in-previous-split-thickness-skin-graft-donor-site
#2
Vincent J Noori, Kanika Trehan, Alisa Savetamal, Damien W Carter
INTRODUCTION: Marjolin' s ulcer, an aggressive ulcerating squamous cell carcinoma, is a well-known phenomenon that occurs in chronically inflamed or scarred tissue; however, squamous cell carcinoma arising in the acute setting after tissue trauma - specifically autograft donor harvest sites for burns - is a rare, but notable event. METHODS: This case series describes three instances of squamous cell carcinoma diagnosed in split-thickness skin graft donor sites in the immediate post-operative period...
February 10, 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29431292/chikungunya-a-rheumatologist-s-perspective
#3
REVIEW
Shefali Khanna Sharma, Sanjay Jain
Chikungunya (CHIK), a viral infection, is transmitted by Aedes mosquitoes. It is characterized by a phase of acute infection, which is sometimes followed by chronic rheumatisim in the form of arthralgia or myalgia that can last for months and even years. Several studies have been conducted to understand the mechanisms underlying inflammation associated with CHIK infection, persistence of viruses in monocytes-macrophages, and their relationship to the chronic symptoms. Chronic arthritis is one of the serious complications of CHIK infection, which is characterized by swelling and acute pain that poorly responds to treatment with analgesics...
February 12, 2018: International Journal of Rheumatic Diseases
https://www.readbyqxmd.com/read/29430976/loteprednol-etabonate-for-inflammatory-conditions-of-the-anterior-segment-of-the-eye-twenty-years-of-clinical-experience-with-a-retrometabolically-designed-corticosteroid
#4
Timothy L Comstock, John D Sheppard
Topical corticosteroids are an important pharmacotherapy for the management of various inflammatory conditions affecting the anterior segment of the eye. However, medications in this class are associated with well-known risks including increased intraocular pressure (IOP) and development of cataracts. The topical corticosteroid loteprednol etabonate (LE) was developed with the specific intention of minimizing these side effects. Areas Covered: The focus of this review is to examine published efficacy and safety data for LE, a drug engineered to undergo rapid metabolism to inactive metabolites with the goal of improved safety...
February 10, 2018: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/29429033/implementing-a-fracture-liaison-service-open-model-of-care-utilizing-a-cloud-based-tool
#5
S L Greenspan, A Singer, K Vujevich, B Marchand, D A Thompson, Y-J Hsu, D Vaidya, L S Stern, D Zeldow, D B Lee, S Karp, R Recker
PURPOSE: Although half of women and one-quarter of men aged 50 and older will sustain an acute low-trauma fracture, less than a quarter receive appropriate secondary fracture prevention. The goal of this quality improvement demonstration project was to implement a Fracture Liaison Service (FLS) focused on secondary prevention of an osteoporotic fracture in three open health care systems aided by a cloud-based tool. METHODS: The pre-post study design examined the proportion of men and women over age 50 who received appropriate assessment (bone mineral density, vitamin D levels) and treatment (calcium/vitamin D, pharmacologic therapy) in the six months following a recently diagnosed fracture...
February 10, 2018: Osteoporosis International
https://www.readbyqxmd.com/read/29416466/exacerbation-of-chronic-pain-after-dental-extractions-in-a-patient-with-post-treatment-lyme-disease-syndrome
#6
Stephanie Lim, Sakura Kinjo
A subset of patients who had Lyme disease experience postinfectious signs or symptoms called post-treatment Lyme disease syndrome (PTLDS). PTLDS is a chronic condition including pain in joints and muscles, neurological symptoms including demyelinating diseases, peripheral neuropathy, headaches, sleep disturbances, fatigue, and cardiac conditions. We report a case of difficult acute pain management in a patient with PTLDS who underwent dental extractions and required admission to an intensive care unit for pain control...
January 2018: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29415760/mobile-critical-care-recovery-program-m-ccrp-for-acute-respiratory-failure-survivors-study-protocol-for-a-randomized-controlled-trial
#7
Sikandar Khan, Ashok Biju, Sophia Wang, Sujuan Gao, Omar Irfan, Amanda Harrawood, Stephanie Martinez, Emily Brewer, Anthony Perkins, Frederick W Unverzagt, Sue Lasiter, Ben Zarzaur, Omar Rahman, Malaz Boustani, Babar Khan
BACKGROUND: Patients admitted to intensive care units (ICU) with acute respiratory failure (ARF) face chronic complications that can impede return to normal daily function. A mobile, collaborative critical care model may enhance the recovery of ARF survivors. METHODS: The Mobile Critical Care Recovery Program (m-CCRP) study is a two arm, randomized clinical trial. We will randomize 620 patients admitted to the ICU with acute respiratory failure requiring mechanical ventilation in a 1:1 ratio to one of two arms (310 patients per arm) - m-CCRP intervention versus attention control...
February 7, 2018: Trials
https://www.readbyqxmd.com/read/29406365/acute-pain-assessment-in-sedated-patients-in-the-post-anesthesia-care-unit
#8
Sherily Pereira-Morales, Carmen Mabel Arroyo-Novoa, Annete Wysocki, Lucille Sanzero Eller
CONTEXT: Acute postoperative pain remains inadequately assessed and managed. A valid instrument that assesses acute pain in sedated Post-Anesthesia Care Unit (PACU) patients is needed. OBJECTIVES: Two behavioral pain assessment instruments, the Non-Verbal Pain Scale Revised (NVPS-R) and Critical Care Pain Observation Tool (CPOT), were used to determine if these instruments adequately assess acute pain in the PACU. METHODS: A crossover study design was used...
February 5, 2018: Clinical Journal of Pain
https://www.readbyqxmd.com/read/29404365/acute-right-ventricular-failure-after-orthotopic-liver-transplantation
#9
Rohan M Goswami, Rami N Khouzam
The interdependence between the heart and liver in maintaining hemodynamic stability during the perioperative period of either orthotopic heart (OHT) or liver (OLT) transplantation is important. The pre-transplant hemodynamic changes that occur in patients with end-stage liver disease (ESLD) can include decreased systemic vascular resistance, poor ventricular response to stress and increased cardiac output (CO). Concomitant pulmonary disorders are often present in ESLD. Portopulmonary hypertension (PoPHTN) is an important marker for increased mortality in liver transplant patients...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29401336/cavh-in-the-combat-environment-a-case-report-and-lessons-learned-in-southern-afghanistan
#10
Jacob Glaser, Joseph Zeman, Stephen Noble, Nathanial Fernandez
Background: Acute kidney injury is a common complication of both civilian and military trauma. The lack of dedicated resources restrict dialysis in the forward setting. We report a case of a combat polytrauma and renal failure, using continuous arteriovenous hemofiltration to clear uremia and remove volume, allowing for ventilator liberation and safe disposition. Materials and Methods: The patient presented with traumatic lower extremity injuries and abdominal wounds and developed acute post-traumatic renal failure...
January 1, 2018: Military Medicine
https://www.readbyqxmd.com/read/29397583/post-stroke-hypertension-control-and-receipt-of-health-care-services-among-veterans
#11
Dhanashri D Kohok, Jason J Sico, Fitsum Baye, Laura Myers, Jessica Coffing, Masoor Kamalesh, Dawn M Bravata
Many ischemic stroke patients do not achieve goal blood pressure (BP < 140/90 mm Hg). To identify barriers to post-stroke hypertension management, we examined healthcare utilization and BP control in the year after index ischemic stroke admission. This retrospective cohort study included patients admitted for acute ischemic stroke to a VA hospital in fiscal year 2011 and who were discharged with a BP ≥ 140/90 mm Hg. One-year post-discharge, BP trajectories, utilization of primary care, specialty and ancillary services were studied...
February 4, 2018: Journal of Clinical Hypertension
https://www.readbyqxmd.com/read/29397127/high-flow-nasal-oxygen-therapy-in-intensive-care-and-anaesthesia
#12
REVIEW
T Renda, A Corrado, G Iskandar, G Pelaia, K Abdalla, P Navalesi
Oxygen therapy is first-line treatment for hypoxaemic acute respiratory failure (ARF). High-flow nasal oxygen therapy (HFNO) represents an alternative to conventional oxygen therapy. HFNO provides humidified, titrated oxygen therapy matching or even exceeding the patients' inspiratory demand. The application of HFNO is becoming widespread in Intensive Care Units (ICUs), favoured by increasing evidence based on numerous studies supporting its efficacy. The mechanisms of action and physiological effects of HFNO are not yet fully understood...
January 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29394453/exercise-based-cardiac-rehabilitation-for-adults-with-stable-angina
#13
REVIEW
Linda Long, Lindsey Anderson, Alice M Dewhirst, Jingzhou He, Charlene Bridges, Manish Gandhi, Rod S Taylor
BACKGROUND: A previous Cochrane review has shown that exercise-based cardiac rehabilitation (CR) can benefit myocardial infarction and post-revascularisation patients. However, the impact on stable angina remains unclear and guidance is inconsistent. Whilst recommended in the guidelines of American College of Cardiology/American Heart Association and the European Society of Cardiology, in the UK the National Institute for Health and Care Excellence (NICE) states that there is "no evidence to suggest that CR is clinically or cost-effective for managing stable angina"...
February 2, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29393824/strategic-review-process-for-an-accountable-care-organization-and-emerging-accountable-care-best-practices
#14
Sarah J Conway, Sarah Himmelrich, Scott A Feeser, John A Flynn, Steven J Kravet, Jennifer Bailey, Lindsay C Hebert, Susan H Donovan, Sarah G Kachur, Patricia M C Brown, William A Baumgartner, Scott A Berkowitz
Accountable Care Organizations (ACOs), like other care entities, must be strategic about which initiatives they support in the quest for higher value. This article reviews the current strategic planning process for the Johns Hopkins Medicine Alliance for Patients (JMAP), a Medicare Shared Savings Program Track 1 ACO. It reviews the 3 focus areas for the 2017 strategic review process - (1) optimizing care coordination for complex, at-risk patients, (2) post-acute care, and (3) specialty care integration - reviewing cost savings and quality improvement opportunities, associated best practices from the literature, and opportunities to leverage and advance existing ACO and health system efforts in each area...
February 2, 2018: Population Health Management
https://www.readbyqxmd.com/read/29392549/acute-fissuration-of-a-giant-splenic-artery-aneurysm-detected-by-point-of-care-ultrasound-case-report
#15
Philippe Le Conte, David Trewick, Philippe Pes, Eric Frampas, Eric Batard
BACKGROUND: Epigastric pain is frequent in Emergency Medicine and remains a challenging situation. Besides benign etiologies such as gastritis or uncomplicated cholelithiasis, it could reveal myocardial infarction or vascular disease. Point-of-care ultrasound (POCUS) could be performed in such situation. CASE PRESENTATION: A healthy 66-year-old man with no previous medical history was admitted to the Emergency Department for a rapid onset epigastric pain. He reported taking non-steroidal anti-inflammatories for 1 week prior to admission...
February 1, 2018: Critical Ultrasound Journal
https://www.readbyqxmd.com/read/29388370/the-role-of-continuous-renal-replacement-therapy-in-the-management-of-acute-kidney-injury-associated-with-sinusoidal-obstruction-syndrome-following-hematopoietic-cell-transplantation
#16
Rupesh Raina, Ghada A Abusin, Prashant Vijayaraghavan, Jeffery J Auletta, Linda Cabral, Hasan Hashem, Beth A Vogt, Kenneth R Cooke, Rolla F Abu-Arja
Maintaining fluid balance, pre- and post-MA-HCT is essential and usually requires frequent administration of diuretics. Hepatic sinusoidal obstructive syndrome is potentially life-threatening, especially when associated with AKI and MOF. This study describes six patients who developed AKI-associated SOS and diuretic-resistant FO who subsequently underwent CRRT using standardized management guidelines for fluid balance post-HCT. Retrospective chart review was done for HCT patients between September 2011 and October 2013 at a tertiary care children's hospital...
February 1, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29387523/undiagnosed-chicken-meat-aspiration-as-a-cause-of-difficult-to-ventilate-in-a-boy-with-traumatic-brain-injury
#17
Nazhan Afeef Mohd Ariff, Mohd Zulfakar Mazlan, Mohd Erham Mat Hassan, Praveena A/P Seevaunnamtum, Wan Fadzlina Wan Muhd Shukeri, Nik Abdullah Nik Mohamad, Shamsul Kamalrujan Hassan, Kamaruddin Jaalam, Mohamad Hasyizan Hassan, Sanihah Che Omar, Chandran Nadarajan, Irfan Mohamad
Introduction: Bronchoscopy is a commonly used procedure in the context of aspiration in the Intensive Care Unit setting. Despite its ability to remove mucus plug and undigested gastric contents, aspiration of gastric content into the trachea is one of the most feared complications among anesthesiologist. Discussion: The scenario is made worst if the aspiration causes acute hypoxemic respiratory failure immediately post intubation. However, in the event of desaturation, the quick decision to proceed with bronchoscopy is a challenging task to the anesthesiologist without knowing the causes...
2018: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/29387471/subscapularis-tendon-tears-management-and-arthroscopic-repair
#18
Brett A Lenart, Jonathan B Ticker
Tears of the subscapularis tendon have been under-recognised until recently. Therefore, a high index of suspicion is essential for diagnosis.A directed physical examination, including the lift-off, belly-press and increased passive external rotation can help identify tears of the subscapularis.All planes on MR imaging should be carefully evaluated to identify tears of the subscapularis, retraction, atrophy and biceps pathology.Due to the tendency of the tendon to retract medially, acute and traumatic full-thickness tears should be repaired...
December 2017: EFORT Open Reviews
https://www.readbyqxmd.com/read/29387465/predictors-of-post-discharge-mortality-among-patients-hospitalized-for-acute-heart-failure
#19
Ovidiu Chioncel, Sean P Collins, Stephen J Greene, Peter S Pang, Andrew P Ambrosy, Elena-Laura Antohi, Muthiah Vaduganathan, Javed Butler, Mihai Gheorghiade
Acute Heart Failure (AHF) is a " multi-event disease" and hospitalisation is a critical event in the clinical course of HF. Despite relatively rapid relief of symptoms, hospitalisation for AHF is followed by an increased risk of death and re-hospitalisation. In AHF, risk stratification from clinically available data is increasingly important in evaluating long-term prognosis. From the perspective of patients, information on the risk of mortality and re-hospitalisation would be helpful in providing patients with insight into their disease...
November 2017: Cardiac Failure Review
https://www.readbyqxmd.com/read/29375630/youths-experiences-of-school-re-integration-following-psychiatric-hospitalization
#20
Michèle Preyde, Shrenik Parekh, John Heintzman
Objective: The purpose of this study was to report youths' experiences of school re-integration post-discharge from psychiatric hospital. No reports of school reintegration from the patient perspective could be located; hence, a second objective was to explore school-related and clinical factors associated with youth who reported an unfavourable school re-integration experiences. Methods: Patients were recruited while in hospital for acute psychiatric care. They provided informed consent to be contacted post discharge regarding their perceptions of their school reintegration experience...
January 2018: Journal of the Canadian Academy of Child and Adolescent Psychiatry
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