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Critical care pharmacology

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https://www.readbyqxmd.com/read/28190445/management-of-neurologic-complications-of-coagulopathies
#1
J D Vanderwerf, M A Kumar
Coagulopathy is common in intensive care units (ICUs). Many physiologic derangements lead to dysfunctional hemostasis; these may be either congenital or acquired. The most devastating outcome of coagulopathy in the critically ill is major bleeding, defined by transfusion requirement, hemodynamic instability, or intracranial hemorrhage. ICU coagulopathy often poses complex management dilemmas, as bleeding risk must be tempered with thrombotic potential. Coagulopathy associated with intracranial hemorrhage bears directly on prognosis and outcome...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28173638/valproate-protein-binding-is-highly-variable-in-icu-patients-and-not-predicted-by-total-serum-concentrations-a-case-series-and-literature-review
#2
Richard R Riker, David J Gagnon, Colman Hatton, Teresa May, David B Seder, Katie Stokem, Gilles L Fraser
STUDY OBJECTIVE: The free fraction of valproate (the pharmacologically active moiety, normally 5-10%) may vary significantly in critically ill patients, but this topic is understudied, with only 4 prior ICU case reports. The objective of this study was to evaluate the range of valproate plasma protein binding in ICU patients. DESIGN: Observational study of consecutive ICU patients. SETTING: Neurocritical and medical critical care services in a non-university academic medical center...
February 7, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28167634/management-of-patients-on-non-vitamin-k-antagonist-oral-anticoagulants-in-the-acute-care-and-periprocedural-setting-a-scientific-statement-from-the-american-heart-association
#3
Amish N Raval, Joaquin E Cigarroa, Mina K Chung, Larry J Diaz-Sandoval, Deborah Diercks, Jonathan P Piccini, Hee Soo Jung, Jeffrey B Washam, Babu G Welch, Allyson R Zazulia, Sean P Collins
Non-vitamin K oral anticoagulants (NOACs) are now widely used as alternatives to warfarin for stroke prevention in atrial fibrillation and management of venous thromboembolism. In clinical practice, there is still widespread uncertainty on how to manage patients on NOACs who bleed or who are at risk for bleeding. Clinical trial data related to NOAC reversal for bleeding and perioperative management are sparse, and recommendations are largely derived from expert opinion. Knowledge of time of last ingestion of the NOAC and renal function is critical to managing these patients given that laboratory measurement is challenging because of the lack of commercially available assays in the United States...
February 6, 2017: Circulation
https://www.readbyqxmd.com/read/28096485/murine-cytomegalovirus-deubiquitinase-regulates-viral-chemokine-levels-to-control-inflammation-and-pathogenesis
#4
Adam T Hilterbrand, Daniel R Boutz, Edward M Marcotte, Jason W Upton
: Maintaining control over inflammatory processes represents a paradox for viral pathogens. Although many viruses induce host inflammatory responses to facilitate infection, control is necessary to avoid overactivation. One way is through the manipulation of proinflammatory chemokine levels, both host and viral. Murine cytomegalovirus (MCMV), a model betaherpesvirus, encodes a viral C-C chemokine, MCK2, which promotes host inflammatory responses and incorporates into virions to facilitate viral dissemination...
January 17, 2017: MBio
https://www.readbyqxmd.com/read/28093813/nerolidol-protects-against-lps-induced-acute-kidney-injury-via-inhibiting-tlr4-nf-%C3%AE%C2%BAb-signaling
#5
Lu Zhang, Dandan Sun, Yan Bao, Yan Shi, Yan Cui, Minghao Guo
Acute kidney injury (AKI) is a critical care syndrome, resulting in acute reduction of renal function and up to 22% mortality of hospitalized patients. Nerolidol is a major component in several essential oils that possesses various pharmacological properties. The present study aimed to investigate the potential effect of nerolidol on lipopolysaccharide (LPS)-induced AKI. Nerolidol dose-dependently reduced the pathological injuries of kidney induced by LPS in rats. Nerolidol significantly decreased the levels of blood urea nitrogen and creatinine in LPS-treated rats in a dose-dependent manner...
January 17, 2017: Phytotherapy Research: PTR
https://www.readbyqxmd.com/read/28074823/pharmacological-update-new-drugs-in-cardiac-practice-a-critical-appraisal
#6
REVIEW
Rohan Magoon, Arindam Choudhury, Vishwas Malik, Ridhima Sharma, Poonam Malhotra Kapoor
Cardiac practice involves the application of a range of pharmacological therapies. An anesthesiologist needs to keep pace with the rampant drug developments in the field of cardiovascular medicine for appropriate management in both perioperative and intensive care set-up, to strengthen his/her role as a perioperative physician in practice. The article reviews the changing trends and the future perspectives in major classes of cardiovascular medicine.
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28068863/an-exploratory-study-investigating-the-multidimensional-factors-impacting-the-health-and-well-being-of-young-adults-with-cerebral-palsy
#7
Susan E Sienko
BACKGROUND: For young adults with cerebral palsy, changes in psychological and social development, in conjunction with the progression of musculoskeletal deformities and the onset of secondary conditions, make the transition to adulthood a difficult developmental phase. Preliminary evidence shows that many of the physical impairments reported in adults with cerebral palsy begin during late adolescence; however, there is little information about prevalence of impairments and the combined role impairments, psychological and social factors have on the health and well-being of young adults with cerebral palsy...
January 9, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/28051841/a-review-of-a-national-training-initiative-to-increase-provider-use-of-mat-to-address-the-opioid-epidemic
#8
REVIEW
Frances R Levin, Adam Bisaga, Maria A Sullivan, Arthur Robin Williams, Kathryn Cates-Wessel
BACKGROUND AND OBJECTIVES: The Providers' Clinical Support System for Medication Assisted Treatment (PCSS-MAT) initiative focuses on training and mentoring health professionals in the treatment of opioid use disorders (OUD) using pharmacological strategies. Led by the American Academy of Addiction Psychiatry (AAAP), PCSS-MAT is a consortium representing four of the five national professional organizations authorized by DATA 2,000-AAAP, American Osteopathic Academy of Addiction Medicine, American Psychiatric Association, and American Society of Addiction Medicine...
December 2016: American Journal on Addictions
https://www.readbyqxmd.com/read/28028552/venous-thromboembolic-events-in-critically-ill-traumatic-brain-injury-patients
#9
Markus B Skrifvars, Michael Bailey, Jeffrey Presneill, Craig French, Alistair Nichol, Lorraine Little, Jacques Duranteau, Olivier Huet, Samir Haddad, Yaseen Arabi, Colin McArthur, D James Cooper, Rinaldo Bellomo
PURPOSE: To estimate the prevalence, risk factors, prophylactic treatment and impact on mortality for venous thromboembolism (VTE) in patients with moderate to severe traumatic brain injury (TBI) treated in the intensive care unit. METHODS: A post hoc analysis of the erythropoietin in traumatic brain injury (EPO-TBI) trial that included twice-weekly lower limb ultrasound screening. Venous thrombotic events were defined as ultrasound-proven proximal deep venous thrombosis (DVT) or clinically detected pulmonary embolism (PE)...
December 27, 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/28024557/acute-right-ventricle-failure-in-the-intensive-care-unit-assessment-and-management
#10
REVIEW
Carmen Hrymak, Johann Strumpher, Eric Jacobsohn
Caring for the critically ill patient with acute right ventricle (RV) failure is a diagnostic and management challenge. A thorough understanding of normal RV anatomy and physiology is essential to manage RV failure. Despite the fact that the RV is essentially a volume chamber that ejects into a low-pressure system, the left ventricle contributes significantly to RV function through maintenance of the transseptal gradient (TSG). Preserving systemic mean arterial pressure maintains the TSG and RV perfusion. Various pathological states cause acute RV failure by decreasing the TSG and RV perfusion and/or increasing pulmonary vascular resistance...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28002134/neuroplasticity-and-amblyopia-vision-at-the-balance-point
#11
Vijay K Tailor, D Samuel Schwarzkopf, Annegret H Dahlmann-Noor
PURPOSE OF REVIEW: New insights into triggers and brakes of plasticity in the visual system are being translated into new treatment approaches which may improve outcomes not only in children, but also in adults. RECENT FINDINGS: Visual experience-driven plasticity is greatest in early childhood, triggered by maturation of inhibitory interneurons which facilitate strengthening of synchronous synaptic connections, and inactivation of others. Normal binocular development leads to progressive refinement of monocular visual acuity, stereoacuity and fusion of images from both eyes...
December 20, 2016: Current Opinion in Neurology
https://www.readbyqxmd.com/read/28002122/neuroplasticity-and-amblyopia-vision-at-the-balance-point
#12
Vijay K Tailor, D Samuel Schwarzkopf, Annegret H Dahlmann-Noor
PURPOSE OF REVIEW: New insights into triggers and brakes of plasticity in the visual system are being translated into new treatment approaches which may improve outcomes not only in children, but also in adults. RECENT FINDINGS: Visual experience-driven plasticity is greatest in early childhood, triggered by maturation of inhibitory interneurons which facilitate strengthening of synchronous synaptic connections, and inactivation of others. Normal binocular development leads to progressive refinement of monocular visual acuity, stereoacuity and fusion of images from both eyes...
February 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/27977530/a-survey-assessment-of-perceived-importance-and-methods-of-maintenance-of-critical-procedural-skills-in-pediatric-emergency-medicine
#13
Matthew R Mittiga, Michael R FitzGerald, Benjamin T Kerrey
OBJECTIVE: The aim of this study was to delineate pediatric emergency medicine provider opinions regarding the importance of, and to ascertain existing processes by which practitioners maintain, the following critical procedural skills: oral endotracheal intubation, intraosseous line placement, pharmacologic and electrical cardioversion, tube thoracostomy, and defibrillation. METHODS: A customized survey was administered to all members of the Listserv for the American Academy of Pediatrics Section on Emergency Medicine...
December 12, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27975107/pediatricians-as-psychiatrists
#14
Edward S Traisman
The overall health of children and teenagers is dependent on their physical and psychological health. As pediatricians, it is important to enquire about the mental health of children and adolescents at the well-child visit. Screening for depression and attention-deficit/hyperactivity disorder is an important component of that visit. Understanding these disorders and the long-term effects on both the child and family as well as managing psychotherapeutic and pharmacological treatments are now becoming a critical part of pediatric care for children and adolescents...
December 1, 2016: Pediatric Annals
https://www.readbyqxmd.com/read/27965560/ketamine-50-years-of-modulating-the-mind
#15
REVIEW
Linda Li, Phillip E Vlisides
Ketamine was introduced into clinical practice in the 1960s and continues to be both clinically useful and scientifically fascinating. With considerably diverse molecular targets and neurophysiological properties, ketamine's effects on the central nervous system remain incompletely understood. Investigators have leveraged the unique characteristics of ketamine to explore the invariant, fundamental mechanisms of anesthetic action. Emerging evidence indicates that ketamine-mediated anesthesia may occur via disruption of corticocortical information transfer in a frontal-to-parietal ("top down") distribution...
2016: Frontiers in Human Neuroscience
https://www.readbyqxmd.com/read/27932214/a-regional-assessment-of-chemicals-of-concern-in-surface-waters-of-four-midwestern-united-states-national-parks
#16
Sarah M Elliott, David D VanderMeulen
Anthropogenic chemicals and their potential for adverse biological effects raise concern for aquatic ecosystem health in protected areas. During 2013-15, surface waters of four Midwestern United States national parks were sampled and analyzed for wastewater indicators, pharmaceuticals, personal care products, and pesticides. More chemicals and higher concentrations were detected at the two parks with greater urban influences (Mississippi National River and Recreation Area and Indiana Dunes National Lakeshore) than at the two more remote parks (Apostle Islands National Lakeshore and Isle Royale National Park)...
February 1, 2017: Science of the Total Environment
https://www.readbyqxmd.com/read/27925423/the-johns-hopkins-venous-thromboembolism-collaborative-multidisciplinary-team-approach-to-achieve-perfect-prophylaxis
#17
REVIEW
Michael B Streiff, Brandyn D Lau, Deborah B Hobson, Peggy S Kraus, Kenneth M Shermock, Dauryne L Shaffer, Victor O Popoola, Jonathan K Aboagye, Norma A Farrow, Paula J Horn, Hasan M Shihab, Peter J Pronovost, Elliott R Haut
Venous thromboembolism (VTE) is an important cause of preventable harm in hospitalized patients. The critical steps in delivery of optimal VTE prevention care include (1) assessment of VTE and bleeding risk for each patient, (2) prescription of risk-appropriate VTE prophylaxis, (3) administration of risk-appropriate VTE prophylaxis in a patient-centered manner, and (4) continuously monitoring outcomes to identify new opportunities for learning and performance improvement. To ensure that every hospitalized patient receives VTE prophylaxis consistent with their individual risk level and personal care preferences, we organized a multidisciplinary task force, the Johns Hopkins VTE Collaborative...
December 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/27923397/pharmacological-interventions-for-delirium-in-intensive-care-patients-a-protocol-for-an-overview-of-reviews
#18
Marija Barbateskovic, Laura Krone Larsen, Marie Oxenbøll-Collet, Janus Christian Jakobsen, Anders Perner, Jørn Wetterslev
BACKGROUND: The prevalence of delirium in intensive care unit (ICU) patients is high. Delirium has been associated with morbidity and mortality including more ventilator days, longer ICU stay, increased long-term mortality and cognitive impairment. Thus, the burden of delirium for patients, relatives and societies is considerable. Today, reviews of randomised clinical trials are produced in large scales sometimes making it difficult to get an overview of the available evidence. A preliminary search identified several reviews investigating the effects of pharmacological interventions for the management and prevention of delirium in ICU patients...
December 7, 2016: Systematic Reviews
https://www.readbyqxmd.com/read/27907964/critical-care-neurology-perspective-on-delirium
#19
Matthew B Maas, Andrew M Naidech
The evidence linking delirium to poor outcomes after critical illness is compelling, including higher mortality, prolonged mechanical ventilation, longer length of intensive care unit stay, and long-term cognitive impairments. The attitude toward delirium in the neurologic community is shifting away from viewing it as an unmodifiable, inevitable consequence of severe illness to treating it is as a neurologic emergency, akin to seizures or encephalitis. Delirium, like other manifestations of critical illness encephalopathy, is an organ dysfunction syndrome...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27898136/pharmacological-approaches-for-the-management-of-persistent-pain-in-older-adults-what-nurses-need-to-know
#20
Fabio Guerriero, Ruth Bolier, Janet H Van Cleave, M Cary Reid
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.4 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo...
December 1, 2016: Journal of Gerontological Nursing
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