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https://www.readbyqxmd.com/read/28820545/assessment-and-management-of-acute-severe-mitral-regurgitation-in-the-intensive-care-unit
#1
Marina Leitman, Vladimir Tyomkin, Ehud Raanani, Ram Sharony, Ludmila Tzatskin, Eli Peleg, Alex Blatt, Zvi Vered
BACKGROUND: Acute severe mitral regurgitation (MR) is a serious medical condition. Whilst clear guidelines exist regarding the management of chronic MR, acute severe MR is usually treated on an individual basis. Currently, few data exist regarding acute MR in the era of primary coronary interventions (PCI). The present study included patients admitted to the Department of Cardiology during recent years with acute severe MR of different etiologies, and an analysis of these data in the light of previous investigations...
March 2017: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/28820040/effect-of-interhospital-icu-relocation-on-patient-physiology-and-clinical-outcomes
#2
David R Janz, Yasin A Khan, Jennifer L Mooney, Matthew W Semler, Todd W Rice, Jessica L Johnson, Bennett P deBoisblanc
Relocation of large numbers of critically ill patients between hospitals is sometimes necessary and the risks associated with relocation may be high. In the setting of adherence to an interhospital intensive care unit (ICU) relocation protocol, we aimed to determine whether the interhospital relocation of all ICU patients in a single day is associated with changes in vital signs, device removal, and worse clinical outcomes. We conducted a prospective, observational, cohort study of all critically ill adults admitted to a tertiary medical center's ICUs on the day of a planned hospital relocation and exposed to interhospital ICU relocation compared with unexposed critically ill adults...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28819204/prognostic-factors-and-outcomes-of-unplanned-extubation
#3
Chien-Ming Chao, Mei-I Sung, Kuo-Chen Cheng, Chih-Cheng Lai, Khee-Siang Chan, Ai-Chin Cheng, Shu-Chen Hsing, Chin-Ming Chen
This study investigated the prognostic factors and outcomes of unplanned extubation (UE) in patients in a medical center's 6 intensive care units (ICUs) and calculated their mortality risk. We retrospectively reviewed the medical records of all adult patients in Chi Mei Medical Center who underwent UE between 2009 and 2015. During the study period, there were 305 episodes of UE in 295 ICU patients (men: 199 [67.5%]; mean age: 65.7 years; age range: 18-94 years). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 16...
August 17, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28818213/the-natural-history-and-outcomes-of-line-associated-upper-extremity-deep-venous-thromboses-in-critically-ill-patients
#4
Joshua Underhill, Matthew A Sherman, Ryan Howard, Anthony Hage, Andrea Obi, Lena Napolitano, Dawn M Coleman
OBJECTIVE: Anticoagulation remains the standard of care for line-associated upper extremity deep venous thrombosis (UEDVT). This treatment carries the risk of hemorrhagic complications, possibly more so in surgical patients. Considering the low-risk profile of UEDVT-which is associated with fewer, less severe pulmonary emboli than lower extremity deep venous thrombosis-current UEDVT treatment guidelines may be overly aggressive. The goal of this study was to review outcomes of line-associated UEDVT in critically ill patients and to define the efficacy of current treatment protocols in pulmonary embolism (PE) prevention while avoiding hemorrhagic complications...
September 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28817481/incorporating-dynamic-assessment-of-fluid-responsiveness-into-goal-directed-therapy-a-systematic-review-and-meta-analysis
#5
Joseph M Bednarczyk, Jason A Fridfinnson, Anand Kumar, Laurie Blanchard, Rasheda Rabbani, Dean Bell, Duane Funk, Alexis F Turgeon, Ahmed M Abou-Setta, Ryan Zarychanski
OBJECTIVE: Dynamic tests of fluid responsiveness have been developed and investigated in clinical trials of goal-directed therapy. The impact of this approach on clinically relevant outcomes is unknown. We performed a systematic review and meta-analysis to evaluate whether fluid therapy guided by dynamic assessment of fluid responsiveness compared with standard care improves clinically relevant outcomes in adults admitted to the ICU. DATA SOURCES: Randomized controlled trials from MEDLINE, EMBASE, CENTRAL, clinicaltrials...
September 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28817359/developing-the-storyline-for-an-advance-care-planning-video-for-surgery-patients-patient-centered-outcomes-research-engagement-from-stakeholder-summit-to-state-fair
#6
Rebecca A Aslakson, Anne L R Schuster, Thomas J Lynch, Matthew J Weiss, Lydia Gregg, Judith Miller, Sarina R Isenberg, Norah L Crossnohere, Alison M Conca-Cheng, Angelo E Volandes, Thomas J Smith, John F P Bridges
BACKGROUND: Patient-centered outcomes research (PCOR) methods and social learning theory (SLT) require intensive interaction between researchers and stakeholders. Advance care planning (ACP) is valuable before major surgery, but a systematic review found no extant perioperative ACP tools. Consequently, PCOR methods and SLT can inform the development of an ACP educational video for patients and families preparing for major surgery. OBJECTIVE: The objective is to develop and test acceptability of an ACP video storyline...
August 17, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28816063/acute-cardiovascular-care-association-position-paper-on-intensive-cardiovascular-care-units-an-update-on-their-definition-structure-organisation-and-function
#7
Eric Bonnefoy-Cudraz, Hector Bueno, Gianni Casella, Elia De Maria, Donna Fitzsimons, Sigrun Halvorsen, Christian Hassager, Zaza Iakobishvili, Ahmed Magdy, Toomas Marandi, Jorge Mimoso, Alexander Parkhomenko, Susana Price, Richard Rokyta, Francois Roubille, Pranas Serpytis, Avi Shimony, Janina Stepinska, Diana Tint, Elina Trendafilova, Marco Tubaro, Christiaan Vrints, David Walker, Doron Zahger, Endre Zima, Robert Zuckerman, Maddalena Lettino
Acute cardiovascular care has progressed considerably since the last position paper was published 10 years ago. It is now a well-defined, complex field with demanding multidisciplinary teamworking. The Acute Cardiovascular Care Association has provided this update of the 2005 position paper on acute cardiovascular care organisation, using a multinational working group. The patient population has changed, and intensive cardiovascular care units now manage a large range of conditions from those simply requiring specialised monitoring, to critical cardiovascular diseases with associated multi-organ failure...
August 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28816042/rapid-and-reliable-detection-of-alkaline-phosphatase-by-a-hot-spots-amplification-strategy-based-on-well-controlled-assembly-on-single-nanoparticle
#8
Yi Zeng, Jia-Qiang Ren, Shaokai Wang, Jiaming Mai, Bing Qu, Yan Zhang, Ai-Guo Shen, Jiming Hu
The first appeal of clinical assay is always accurate and rapid. For alkaline phosphatase (ALP) monitoring in medical treatment, a rapid, reliable surface-enhanced Raman scattering (SERS) test kit is designed based on a "hot spots" amplification strategy. Consisting of alkyne-tagged Au nanoparticles (NPs), Ag+, and enzyme substrate, the packaged test kit can achieve one-step clinical assay of ALP in human serum within several minutes, while the operation is simple as it directly inputs the sample into the test kit...
August 17, 2017: ACS Applied Materials & Interfaces
https://www.readbyqxmd.com/read/28815564/target-temperature-34-vs-36%C3%A2-c-after-out-of-hospital-cardiac-arrest-a-retrospective-observational-study
#9
L Arvidsson, S Lindgren, L Martinell, S Lundin, C Rylander
BACKGROUND: Intensive care for comatose survivors of cardiac arrest includes targeted temperature management (TTM) to attenuate cerebral reperfusion injury. A recent multi-center clinical trial did not show any difference in mortality or neurological outcome between TTM targeting 33°C or 36°C after out-of-hospital-cardiac-arrest (OHCA). In our institution, the TTM target was changed accordingly from 34 to 36°C. The aim of this retrospective study was to analyze if this change had affected patient outcome...
August 16, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28814898/reducing-rectal-injury-in-men-receiving-prostate-cancer-radiation-therapy-current-perspectives
#10
REVIEW
Nicholas A Serrano, Noah S Kalman, Mitchell S Anscher
Dose escalation is now the standard of care for the treatment of prostate cancer with radiation therapy. However, the rectum tends to be the dose-limiting structure when treating prostate cancer, given its close proximity. Early and late toxicities can occur when the rectum receives large doses of radiation therapy. New technologies allow for prevention of these toxicities. In this review, we examine the evidence that supports various dose constraints employed to prevent these rectal injuries from occurring...
2017: Cancer Management and Research
https://www.readbyqxmd.com/read/28814257/discharge-interventions-and-modifiable-risk-factors-for-preventing-hospital-readmissions-in-children-with-medical-complexity
#11
John Stephens, Kelly S Kimple, Michael J Steiner, Jay G Berry
BACKGROUND: Concerns about the costs and quality of hospital care have led to increased interest in hospital readmissions in children. Children with medical complexity account for high proportions of inpatient utilization and have a higher risk of hospital readmission. OBJECTIVE: To identify studies of discharge interventions to prevent hospital readmissions in children with medical complexity. METHODS: We conducted a search to identify studies of discharge interventions...
August 16, 2017: Reviews on Recent Clinical Trials
https://www.readbyqxmd.com/read/28814150/nitrous-oxide-labor-analgesia-and-pain-relief-memory-in-breastfeeding-women
#12
Vincenzo Zanardo, Francesca Volpe, Matteo Parotto, Lara Giiberti, Alessia Selmin, Gianluca Straface
OBJECTIVE: The use of labor pain relief medications is a controversial issue that has engendered heated discussions among health care professionals about safety, interference with birthing, and breastfeeding. METHODS: This is a case-control study with 62 puerperae treated with nitrous oxide and 124 control women (ratio 1:2), matched for age, gestational age, parity, delivery route, labor augmentation, and spinal regional analgesia. We tested anhedonia, anxiety, and depression symptoms at hospital discharge by The Edinburgh Postnatal Depression Scale (EPDS), and the intensity of nitrous oxide labor pain relief and satisfaction memory by a retrospective Visual Analog Scale (VAS, 0-10 Numeric Rating Scale) at a set cut off time of 3 months of a child's age...
August 16, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28813449/influenza-virus-infections-among-patients-attending-emergency-department-according-to-main-reason-to-presenting-to-ed-a-3-year-prospective-observational-study-during-seasonal-epidemic-periods
#13
Enrique Casalino, Stephanie Antoniol, Nadhira Fidouh, Christophe Choquet, Jean-Christophe Lucet, Xavier Duval, Benoit Visseaux, Laurent Pereira
OBJECTIVE: The role of influenza virus in patients presenting at ED during seasonal-epidemic periods has not previously been specified. Our objective was to determine its frequency according to clinical presentation. METHODS: This is a prospective observational study conducted during three-consecutive seasonal Influenza epidemics (2013-2015), including patients presenting i) community-acquired pneumonia (CAP); ii) severe acute symptoms (SAS): respiratory failure (RF), hemodynamic failure (HF), cardiac failure (CF), and miscellaneous symptoms (M); iii) symptoms suggesting influenza (PSSI)...
2017: PloS One
https://www.readbyqxmd.com/read/28813433/diabetes-risks-and-outcomes-in-chronic-obstructive-pulmonary-disease-patients-two-nationwide-population-based-retrospective-cohort-studies
#14
Chao-Shun Lin, Chih-Chung Liu, Chun-Chieh Yeh, Yi-Cheng Chang, Chi-Li Chung, Hsin-Long Lane, Chun-Chuan Shih, Ta-Liang Chen, Chien-Chang Liao
OBJECTIVE: The relationship between chronic obstructive pulmonary disease (COPD) and diabetes remains incompletely understood. This study evaluated diabetes risk and post-diabetes outcomes in COPD patients with and without exacerbations. METHODS: We identified 4671 adults newly diagnosed with COPD exacerbations and 9342 adults newly diagnosed with COPD without exacerbations during 2000-2008 using Taiwan's National Health Insurance Research Database. A comparison cohort of 18684 adults without COPD, matched by age and sex, was randomly selected from the same dataset for the control group...
2017: PloS One
https://www.readbyqxmd.com/read/28811766/prognostic-factors-determining-morbidity-and-mortality-in-organophosphate-poisoning
#15
Ayca Acikalin, Nezihat Rana Dişel, Selcuk Matyar, Ahmet Sebe, Zeynep Kekec, Yuksel Gokel, Emre Karakoc
OBJECTIVE: Our aim in this retrospective study was to determine the factors affecting poor prognosis and mortality of organophosphate (OP) poisoning by reviewing patient data. We also reviewed present knowledge to make conclusions on certain longstanding debates in light of the literature. METHODS: In this retrospective descriptive study, patients who were admitted to and hospitalized in the emergency department (ED) or intensive care unit (ICU) of a university hospital with the diagnosis of OP poisoning between December 2010 and December 2015 were evaluated...
May 2017: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/28811051/patient-blood-management-in-the-intensive-care-unit
#16
REVIEW
Aryeh Shander, Mazyar Javidroozi, Gregg Lobel
Patient Blood Management underscores a fundamental shift from a product-centered approach to a patient-centric approach through timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss in an effort to improve patient outcome. In this concept, allogeneic blood transfusion is not viewed as the treatment of default for anemic patients, but one among many treatment modalities that should be weighed based on its merits-potentials risks and benefits-for the individual patient in the context of other alternatives...
July 31, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/28810984/impact-of-a-7-day-field-training-on-oral-health-condition-in-japan-ground-self-defense-force-personnel
#17
Koji Yamashita, Takeshi Nishiyama, Emi Nagata, Atik Ramadhani, Miki Kawada-Matsuo, Hitoshi Komatsuzawa, Takahiko Oho
INTRODUCTION: In the Japan Ground Self-Defense Force (JGSDF), personnel periodically perform intensive training that mimics the conditions seen in battle and during natural disasters. Military training involves intensive, stressful conditions, and changes in immune responses have been found in personnel following training. Good oral condition is important for military personnel to fulfill their duties; however, they have difficulty performing daily oral care under training conditions...
July 2017: Military Medicine
https://www.readbyqxmd.com/read/28810817/struggles-over-antibiotics-physicians-stance-taking-toward-a-nonconforming-policy-in-an-intensive-care-unit
#18
Letizia Caronia, Marzia Saglietti
One of the most pressing contemporary health care challenges consists in rethinking antibiotic use to contrast the increase of multidrug resistant bacteria. Drawing on an ethnographic fieldwork in an Intensive Care Unit that adopts a nonconforming policy of antibiotic stewardship, this article analyzes doctor-doctor interaction concerning infectious disease diagnosis and antibiotic treatment. By analyzing examples of medical decision-making from a corpus of video-recorded morning briefings, we focus on physicians' stance-taking toward the ward's nonconforming policy and illustrate how it is contingently situated along a continuum from strong commitment to overt resistance...
August 1, 2017: Qualitative Health Research
https://www.readbyqxmd.com/read/28810280/-dual-antiplatelet-therapy-in-the-perioperative-period-to%C3%A2-continue-or-discontinue-treatment
#19
Jürgen Koscielny, Christian von Heymann, Uwe Zeymer, Jochen Cremer, Michael Spannagl, Joachim Labenz, Evangelos Giannitsis, Franz Goss
Background For secondary prevention of acute coronary syndrome, guidelines recommend dual antiplatelet therapy (DAPT) with acetylsalicylic acid and a P2Y12 receptor antagonist such as clopidogrel, prasugrel or ticagrelor for a period of 12 months. Often, uncertainty exists with respect to surgical or diagnostic procedures in these high-risk patients: can the DAPT be continued without interruption? If not, what is the recommended withdrawal strategy? What should be considered for the perioperative management? Methods An interdisciplinary group of experienced experts in the fields of cardiology, cardiac surgery, gastroenterology, anaesthesiology, intensive care and haemostaseology developed recommendations relevant to daily clinical practice based on the current scientific evidence...
August 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28810207/intermediate-care-to-intensive-care-triage-a-quality-improvement-project-to-reduce-mortality
#20
David N Hager, Pranav Chandrashekar, Robert W Bradsher, Ali M Abdel-Halim, Souvik Chatterjee, Melinda Sawyer, Roy G Brower, Dale M Needham
PURPOSE: Medical patients whose care needs exceed what is feasible on a general ward, but who do not clearly require critical care, may be admitted to an intermediate care unit (IMCU). Some IMCU patients deteriorate and require medical intensive care unit (MICU) admission. In 2012, staff in the Johns Hopkins IMCU expressed concern that patient acuity and the threshold for MICU admission were too high. Further, shared triage decision-making between residents and supervising physicians did not consistently occur...
August 3, 2017: Journal of Critical Care
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