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https://www.readbyqxmd.com/read/27920416/re-evaluating-the-inhibition-of-stress-erosions-revise-a-protocol-for-pilot-randomized-controlled-trial
#1
Waleed Alhazzani, Gordon Guyatt, John C Marshall, Richard Hall, John Muscedere, Francois Lauzier, Lehana Thabane, Mohammed Alshahrani, Shane W English, Yaseen M Arabi, Adam M Deane, Tim Karachi, Bram Rochwerg, Simon Finfer, Nick Daneman, Nicole Zytaruk, Diane Heel-Ansdell, Deborah Cook, On Behalf Of
INTRODUCTION: Clinicians routinely administer stress ulcer prophylaxis to mechanically ventilated patients in the intensive care unit (ICU), most commonly prescribing proton pump inhibitors (PPIs). However, the incidence of gastrointestinal (GI) bleeding from stress ulceration is low and recent observational studies suggest these agents may increase infections. Therefore, a large randomized clinical trial (RCT) is needed to inform modern practice. The aim of this multicenter pilot trial is to determine the feasibility of performing a large RCT to investigate the efficacy and safety of withholding intravenous pantoprazole...
November 2016: Annals of Saudi Medicine
https://www.readbyqxmd.com/read/27916222/acute-amiodarone-pulmonary-toxicity-after-surgical-procedures
#2
REVIEW
Jirapat Teerakanok, Pakpoom Tantrachoti, Phumpattra Chariyawong, Kenneth Nugent
Amiodarone can cause toxicity in several organs, including amiodarone-induced pulmonary toxicity which is a subacute or chronic complication. Amiodarone-induced acute respiratory distress syndrome (ARDS) in postoperative patients is a rare acute complication. The PubMed and Google Scholar databases were searched. Seven retrospective and prospective case series and 10 case reports of amiodarone-induced postoperative ARDS were reviewed. All patients received amiodarone chronically or during the perioperative period...
December 2016: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/27916176/functional-assessment-and-transplantation-of-the-donor-heart-after-circulatory-death
#3
Simon J Messer, Richard G Axell, Simon Colah, Paul A White, Marian Ryan, Aravinda A Page, Barbora Parizkova, Kamen Valchanov, Christopher W White, Darren H Freed, Euan Ashley, John Dunning, Martin Goddard, Jayan Parameshwar, Christopher J Watson, Thomas Krieg, Ayyaz Ali, Steven Tsui, Stephen R Large
BACKGROUND: After a severe shortage of brain-dead donors, the demand for heart transplantation has never been greater. In an attempt to increase organ supply, abdominal and lung transplant programs have turned to the donation after circulatory-determined death (DCD) donor. However, because heart function cannot be assessed after circulatory death, DCD heart transplantation was deemed high risk and never adopted routinely. We report a novel method of functional assessment of the DCD heart resulting in a successful clinical program...
December 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27911487/external-inspection-of-compliance-with-standards-for-improved-healthcare-outcomes
#4
REVIEW
Gerd Flodgren, Daniela C Gonçalves-Bradley, Marie-Pascale Pomey
BACKGROUND: Inspection systems are used in healthcare to promote quality improvements (i.e. to achieve changes in organisational structures or processes, healthcare provider behaviour and patient outcomes). These systems are based on the assumption that externally promoted adherence to evidence-based standards (through inspection/assessment) will result in higher quality of healthcare. However, the benefits of external inspection in terms of organisational-, provider- and patient-level outcomes are not clear...
December 2, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27911381/a-novel-approach-for-the-administration-of-medications-and-fluids-in-emergency-scenarios-and-settings
#5
Akilesh Honasoge, Neal Lyons, Kathleen Hesse, Braden Parker, Robert Mokszycki, Kelly Wesselhoff, Rolla Sweis, Erik B Kulstad
The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or intraosseous routes, but in many patients, particularly in the emergency or critical care settings, these routes are often unavailable or time-consuming to access. A novel device is now available that offers an easy route for administration of medications or fluids via rectal mucosal absorption (also referred to as proctoclysis in the case of fluid administration and subsequent absorption)...
November 9, 2016: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/27908501/prospective-evaluation-of-surgical-palliative-care-immersion-training-for-general-surgery-residents
#6
Mustafa Raoof, Lisa O'Neill, Leigh Neumayer, Mindy Fain, Robert Krouse
BACKGROUND: Palliative care competencies in surgical training are recognized to improve the care of surgical patients with advanced or life-threatening illnesses. Formal programs to teach these competencies are lacking. The study aims to assess the feasibility and utility of a unique surgical palliative care immersion training program. STUDY DESIGN: A half-day Surgical Palliative Care Immersion Training (SPCIT) was developed using the American College of Surgeon's manual titled "Surgical Palliative Care: A Resident's Guide" as a framework...
November 27, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27907965/movement-disorders-in-the-intensive-care-unit
#7
Sara M Schaefer, Rezvan Rostami, David M Greer
Movement disorders are common; yet to those without subspecialty experience they can be difficult to recognize, categorize, and manage. Although most frequently encountered in an outpatient setting, patients with movement disorders are commonly hospitalized and often admitted to the intensive care unit, leading to possible confusion about their proper care. In addition, movement disorders can arise in critical care settings for several reasons, including medication side effects, substance withdrawal, or development of a new syndrome...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907936/early-treatment-for-neonatal-abstinence-syndrome-a-palliative-approach
#8
Jennifer Hudson, Rachel Mayo, Lori Dickes, Liwei Chen, Windsor Westbrook Sherrill, Julie Summey, Bradley Dalton, Kindal Dankovich
Objective To describe medical, safety, and health care utilization outcomes associated with an early treatment model for neonatal opioid withdrawal. Study Design This is a retrospective review of 117 opioid-exposed infants born in a large regional hospital and treated in the level I nursery with methadone initiated within 48 hours of birth. Results For this cohort, mean length of stay was 8.3 days. Hospital safety events were infrequent; there were no medication errors or deaths. Within 30 days of discharge, 14% of infants visited the emergency department; 7% were readmitted...
December 1, 2016: American Journal of Perinatology
https://www.readbyqxmd.com/read/27906935/long-term-prednisolone-in-post-stroke-complex-regional-pain-syndrome
#9
Jayantee Kalita, Usha Misra, Ajit Kumar, Sanjeev K Bhoi
BACKGROUND: There is no study on the long-term use of prednisolone in post-stroke complex regional pain syndrome-1 (CRPS1). OBJECTIVE: To evaluate the efficacy and safety of long-term low dose prednisolone in post-stroke CRPS-I. STUDY DESIGN: Open-labeled randomized controlled trial. SETTING: Tertiary care teaching institute. METHODS: Seventy-seven out of 396 (19.4%) patients with stroke had CRPS-1 and 58 met the inclusion criteria...
November 2016: Pain Physician
https://www.readbyqxmd.com/read/27905916/study-protocol-a-dose-escalating-phase-2-study-of-oral-lisdexamfetamine-in-adults-with-methamphetamine-dependence
#10
Nadine Ezard, Adrian Dunlop, Brendan Clifford, Raimondo Bruno, Andrew Carr, Alexandra Bissaker, Nicholas Lintzeris
BACKGROUND: The treatment of methamphetamine dependence is a continuing global health problem. Agonist type pharmacotherapies have been used successfully to treat opioid and nicotine dependence and are being studied for the treatment of methamphetamine dependence. One potential candidate is lisdexamfetamine, a pro-drug for dexamphetamine, which has a longer lasting therapeutic action with a lowered abuse potential. The purpose of this study is to determine the safety of lisdexamfetamine in this population at doses higher than those currently approved for attention deficit hyperactivity disorder or binge eating disorder...
December 1, 2016: BMC Psychiatry
https://www.readbyqxmd.com/read/27894601/treatment-rationale-and-study-design-for-the-relay-study-a-multicenter-randomized-double-blind-study-of-erlotinib-with-ramucirumab-or-placebo-in-patients-with-epidermal-growth-factor-receptor-mutation-positive-metastatic-non-small-cell-lung-cancer
#11
Edward B Garon, Martin Reck, Luis Paz-Ares, Santiago Ponce, Jesus Corral Jaime, Oscar Juan, Ernest Nadal, Pablo Lee, Rita Dalal, Jingyi Liu, Shuang He, Joseph Treat, Kazuhiko Nakagawa
INTRODUCTION: We present the treatment rationale and study design for the RELAY study (NCT02411448 ). This phase Ib/III study will assess safety, tolerability, and efficacy of the combination of ramucirumab with erlotinib in previously untreated stage IV non-small-cell lung cancer patients with an activating epidermal growth factor receptor (EGFR) mutation. PATIENTS AND METHODS: The study is being conducted in approximately 120 sites in North America, Europe, and Asia and is currently open for enrollment...
June 8, 2016: Clinical Lung Cancer
https://www.readbyqxmd.com/read/27893594/sexually-transmitted-disease-program-evolution-in-response-to-changes-in-the-public-health-environment-a-massachusetts-example
#12
Marion W Carter, Katherine K Hsu, Penny S Loosier, Brandy L Peterson Maddox, Sonal R Doshi, Karen Kroeger, Kevin Cranston
BACKGROUND: In 2008, the line item supporting sexually transmitted disease (STD) services in the Massachusetts state budget was cut as a result of budget shortfalls. Shortly thereafter, direct provision of STD clinical services supported by the Massachusetts Department of Public Health (MDPH) was suspended. Massachusetts Department of Public Health requested an initial assessment of its internal response and impact in 2010. A follow-up assessment occurred in September 2013. METHODS: In 2010 and 2013, 39 and 46 staff, respectively, from MDPH and from clinical partner agencies, were interviewed about changes in the role of the MDPH, partnerships, STD services, challenges, and recommendations...
November 2016: Sexually Transmitted Diseases
https://www.readbyqxmd.com/read/27891229/nicotine-replacement-therapy-for-agitation-and-delirium-management-in-the-intensive-care-unit-a-systematic-review-of-the-literature
#13
Melanie Kowalski, Andrew A Udy, Hayden J McRobbie, Michael J Dooley
BACKGROUND: Active smokers are prevalent within the intensive care setting and place a significant burden on healthcare systems. Nicotine withdrawal due to forced abstinence on admission may contribute to increased agitation and delirium in this patient group. The aim of this systematic review was to determine whether management of nicotine withdrawal, with nicotine replacement therapy (NRT), reduces agitation and delirium in critically ill patients admitted to the intensive care unit (ICU)...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/27891024/palliative-care-and-the-indian-neurologist
#14
REVIEW
Roop Gursahani
End-of-life care is an integral part of neurology practice, and neuropalliative medicine is an emerging neurology subspeciality. This begins with serious illness communication as a protocol-based process that depends on an evaluation of patient autonomy and accurate prognostication. Communication needs vary between chronic, life-limiting neurologic illnesses and acute brain injury. In an ideal situation, the patient's wishes are spelled out in advance care plans and living wills, and surrogates have only limited choices for implementation...
October 2016: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/27889726/prolonged-infusion-of-dexmedetomidine-in-critically-ill-children
#15
Cinara Andreolio, Jefferson Pedro Piva, Elisa Baldasso, Roberta Ferlini, Rafaela Piccoli
OBJECTIVE: To describe main indications, doses, length of infusion and side effects related to dexmedetomidine infusion. METHODS: Observational and retrospective study evaluating dexmedetomidine use in pediatric intensive care unit. RESULTS: 77 children received dexmedetomidine infusion longer than 6 hours for mechanical ventilation weaning (32.5%), post- neurosurgery and post-upper airway surgery (24.7%), non-invasive ventilation (13%), refractory tachycardia (6...
November 15, 2016: Indian Pediatrics
https://www.readbyqxmd.com/read/27888715/making-a-case-for-controlled-organ-donation-after-cardiac-death-the-story-of-italy-s-first-experience
#16
Marco Vergano, Emma Magavern, Francesca Baroncelli, Valeria Frisenda, Alessia Fonsato, Diego Artusio, Carlo Alberto Castioni, Maria Elena De Piero, Massimo Abelli, Elena Ticozzelli, Sergio Livigni
Donation after circulatory death (DCD) is a valuable option for the procurement of organs for transplantation. In Italy, organ procurement after controlled DCD is legally and ethically conceivable within the current legislative framework. However, although formal impediments do not exist, the health care team is faced with many obstacles that may hinder the implementation of such programs. We report the case of Italy's first controlled DCD, specifically discussing the role of the patient's family in the shared decision-making process...
November 5, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27888427/taiwanese-medical-students-narratives-of-intercultural-professionalism-dilemmas-exploring-tensions-between-western-medicine-and-taiwanese-culture
#17
Ming-Jung Ho, Katherine Gosselin, Madawa Chandratilake, Lynn V Monrouxe, Charlotte E Rees
In an era of globalization, cultural competence is necessary for the provision of quality healthcare. Although this topic has been well explored in non-Western cultures within Western contexts, the authors explore how Taiwanese medical students trained in Western medicine address intercultural professionalism dilemmas related to tensions between Western medicine and Taiwanese culture. A narrative interview method was employed with 64 Taiwanese medical students to collect narratives of professionalism dilemmas...
November 26, 2016: Advances in Health Sciences Education: Theory and Practice
https://www.readbyqxmd.com/read/27887032/provider-perception-of-pharmacy-services-in-the-patient-centered-medical-home
#18
Nicole P Albanese, Alyssa M Pignato, Scott V Monte
BACKGROUND: Despite the positive data on clinical outcomes, cost savings, and provider experience, no study has surveyed providers to evaluate what pharmacy services they find to be worthwhile. OBJECTIVE: To determine what clinical, cost/access, and educational pharmacy services providers in a patient-centered medical home (PCMH) consider worthwhile and the perceived barriers to successful pharmacist incorporation. METHODS: A cross-sectional online survey was distributed to primary care physicians, nurse practitioners, and physician assistants in a PCMH physician group...
November 24, 2016: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/27881701/externally-visible-thrombus-partially-predicts-internal-thrombus-deposition-in-extracorporeal-membrane-oxygenators
#19
Charles F Evans, Tieluo Li, Vikas Mishra, Diana L Pratt, Isa S K Mohammed, Zachary N Kon, Bartley P Griffith
AIM: We sought to quantify the location and volume of thrombus in used hollow-fiber membrane oxygenators and correlate the volume of thrombus with patient demographics, flow characteristics and anticoagulation parameters. METHODS: Hollow-fiber membrane oxygenators (Quadrox D, Maquet, Rastatt, Germany) were collected after clinical use in ECMO circuits and divided into sections. Each section was digitally imaged and analyzed using ImageJ software. The location and total volume (cm(3)) of thrombus was calculated for different sections...
November 22, 2016: Perfusion
https://www.readbyqxmd.com/read/27879954/comparison-of-terminal-extubation-and-terminal-weaning-as-mechanical-ventilation-withdrawal-in-icu-patients
#20
Damien Thellier, Pierre Y Delannoy, Olivier Robineau, Agnès Meybeck, Nicolas Boussekey, Arnaud Chiche, Olivier Leroy, Hugues Georges
BACKGROUND: Terminal extubation (TE) is applied in some intensive care unit (ICU) patients when a decision of withdrawal of mechanical ventilation is decided. Other units prefer terminal weaning (TW) with no removal of the endotracheal tube. We report our experience with these two procedures. METHODS: We conducted a retrospective study analyzing patients deceased in our ICU after a decision of life sustained therapy (LST) during the year 2013. TE was proposed to family members for patients presenting with two medical conditions: lack of vasoactive drugs (VAD) and SaO2 > 95% with a FIO2 < 50%...
November 23, 2016: Minerva Anestesiologica
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