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Critical care pharmacology

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https://www.readbyqxmd.com/read/29653128/serotonin-specific-lesions-of-the-dorsal-raphe-disrupt-maternal-aggression-and-caregiving-in-postpartum-rats
#1
M Allie Holschbach, Erika V Vitale, Joseph S Lonstein
The behavioral modifications associated with early motherhood, including high aggression, caring for young, and low anxiety are all affected by acute pharmacological manipulation of serotonin signaling. However, the effects on these behaviors of permanently disrupting serotonin signaling at one of its primary sources, the dorsal raphe (DR), have not been examined in detail. To address this, serotonin-specific lesions centered on the dorsomedial DR (DRdm; subregion most implicated in emotional behaviors) were induced at mid-pregnancy (day 15) or early postpartum (day 2) in rats using a saporin-conjugated neurotoxin targeting the serotonin transporter (Anti-SERT-SAP)...
April 10, 2018: Behavioural Brain Research
https://www.readbyqxmd.com/read/29652744/clinical-pearls-part-3-anaesthetic-management-of-abnormally-invasive-placentation
#2
Vinod Patil, Gamunu Ratnayake, Galina Fastovets, D S Wijayatilake
PURPOSE OF REVIEW: Abnormal placentation is a clinical condition seen increasingly in the pregnant population. It is associated with significant morbidity and mortality, which may be mitigated through robust multidisciplinary care for these patients. The role of maternal critical care for these patients has largely been ignored in the literature. RECENT FINDINGS: Advances in pharmacological management of bleeding with recent publications of large multicentre trials in addition to new technologies in the management of massive obstetric haemorrhage (MOH) have revolutionized the management of abnormal placentation...
April 12, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29651626/current-topics-in-the-management-of-acute-traumatic-spinal-cord-injury
#3
Christopher D Shank, Beverly C Walters, Mark N Hadley
Acute traumatic spinal cord injury (SCI) affects more than 250,000 people in the USA, with approximately 17,000 new cases each year. It continues to be one of the most significant causes of trauma-related morbidity and mortality. Despite the introduction of primary injury prevention education and vehicle safety devices, such as airbags and passive restraint systems, traumatic SCI continues to have a substantial impact on the healthcare system. Over the last three decades, there have been considerable advancements in the management of patients with traumatic SCI...
April 12, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29627355/contemporary-reviews-in-critical-care-medicine-atrial-fibrillation-in-the-intensive-care-unit
#4
REVIEW
Nicholas A Bosch, Jonathan Cimini, Allan J Walkey
Atrial fibrillation (AF) is the most common arrhythmia encountered in the intensive care unit. Pre-existing AF is highly prevalent among older patients with chronic conditions who are at risk for critical illness, while new-onset AF can be triggered by accelerated atrial remodeling and arrhythmogenic triggers encountered during critical illness. The acute loss of atrial systole and onset of rapid ventricular rates that characterize new-onset AF often lead to decreased cardiac output and hemodynamic compromise...
April 5, 2018: Chest
https://www.readbyqxmd.com/read/29599453/functional-cyclophilin-d-moderates-platelet-adhesion-but-enhances-the-lytic-resistance-of-fibrin
#5
Imre Varjú, Veronika Judit Farkas, László Kőhidai, László Szabó, Ádám Zoltán Farkas, Lívia Polgár, Christos Chinopoulos, Krasimir Kolev
In the course of thrombosis, platelets are exposed to a variety of activating stimuli classified as 'strong' (e.g. thrombin and collagen) or 'mild' (e.g. ADP). In response, activated platelets adhere to injured vasculature, aggregate, and stabilise the three-dimensional fibrin scaffold of the expanding thrombus. Since 'strong' stimuli also induce opening of the mitochondrial permeability transition pore (MPTP) in platelets, the MPTP-enhancer Cyclophilin D (CypD) has been suggested as a critical pharmacological target to influence thrombosis...
March 29, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29580965/designing-a-nurse-delivered-delirium-bundle-what-intensive-care-unit-staff-survivors-and-their-families-think
#6
Leona Bannon, Jennifer McGaughey, Mike Clarke, Daniel F McAuley, Bronagh Blackwood
BACKGROUND: Implementation of quality improvement interventions can be enhanced by exploring the perspectives of those who will deliver and receive them. We designed a non-pharmacological bundle for delirium management for a feasibility trial, and we sought to obtain the views of intensive care unit (ICU) staff, survivors, and families on the barriers and facilitators to its implementation. OBJECTIVE: The objective of this study is to determine the barriers and facilitators to a multicomponent bundle for delirium management in critically ill patients comprising (1) education and family participation, (2) sedation minimisation and pain, agitation, and delirium protocol, (3) early mobilisation, and (4) environmental interventions for sleep, orientation, communication, and cognitive stimulation...
March 23, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29538048/lymphatic-dysfunction-in-critical-illness
#7
Edmund Burke, Sanjeev A Datar
PURPOSE OF REVIEW: The essential role of the lymphatic system in fluid homeostasis, nutrient transport, and immune trafficking is well recognized; however, there is limited understanding of the mechanisms that regulate lymphatic function, particularly in the setting of critical illness. The lymphatics likely affect disease severity and progression in every condition, from severe systemic inflammatory states to respiratory failure. Here, we review structural and functional disorders of the lymphatic system, both congenital and acquired, as they relate to care of the pediatric patient in the intensive care setting, including novel areas of research into medical and procedural therapeutic interventions...
March 13, 2018: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29500124/management-of-the-critically-ill-adult-with-congenital-heart-disease
#8
REVIEW
Wolf B Kratzert, Eva K Boyd, Johanna C Schwarzenberger
Survival of adults with congenital heart disease (CHD) has improved significantly over the last 2 decades, leading to an increase in hospital and intensive care unit (ICU) admissions of these patients. Whereas most of the ICU admissions in the past were related to perioperative management, the incidence of medical emergencies from long-term sequelae of palliative or corrective surgical treatment of these patients is rising. Intensivists now are confronted with patients who not only have complex anatomy after congenital cardiac surgery, but also complex pathophysiology due to decades of living with abnormal cardiac anatomy and diseases of advanced age...
November 16, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29497299/human-factors-evaluation-of-a-novel-digital-medicine-system-in-psychiatry
#9
Timothy Peters-Strickland, Ainslie Hatch, Anke Adenwala, Katie Atkinson, Benjamin Bartfeld
Background: The digital medicine system (DMS), a drug-device combination developed for patients with serious mental illness, integrates adherence measurement with pharmacologic treatment by embedding an ingestible sensor in a pill, allowing for information sharing among patients, health care providers (HCPs), and caregivers via a mobile interface. Studies conducted during the DMS development process aimed to minimize cognitive burden and use-related risks and demonstrated effective use of the technology...
2018: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/29496709/residual-neuromuscular-blockade-in-the-critical-care-setting
#10
Nicole Stawicki, Patty Gessner
Residual neuromuscular blockade is a widespread challenge for providers in the acute care setting that, if left unrecognized or untreated, places patients at higher risk for morbidity and mortality. The condition is estimated to occur in 26% to 88% of patients undergoing general anesthesia. The role of the advanced practice nurse in the acute care setting is to facilitate a safe recovery process by identifying early signs of deterioration and supporting the patient until full muscular strength has returned...
2018: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/29473523/drug-induced-qt-interval-prolongation-in-the-intensive-care-unit
#11
Cecilia Villa Etchegoyen, Guillermo Alberto Keller, Sebastian Mrad, Sixuan Cheng, Guillermo DiGirolamo
Drug-induced QT interval prolongation is the most frequent cause of Long QT syndrome (LQTS) in the clinical practice. This electrophysiological entity, produced by an extended duration of the myocardial repolarization and reflected as a prolonged QT interval in the superficial electrocardiogram (EKG), increases the risk of polymorphic ventricular tachycardia (Torsades de Pointes) appearance and sudden death. Certain antiarrhythmic drugs such as amiodarone, sotalol, quinidine, procainamide, verapamil and diltiazem are known as drugs that, due to their mechanism of action, prolong the QT interval, demanding constant monitorization...
February 23, 2018: Current Clinical Pharmacology
https://www.readbyqxmd.com/read/29447230/propofol-induces-a-metabolic-switch-to-glycolysis-and-cell-death-in-a-mitochondrial-electron-transport-chain-dependent-manner
#12
Chisato Sumi, Akihisa Okamoto, Hiromasa Tanaka, Kenichiro Nishi, Munenori Kusunoki, Tomohiro Shoji, Takeo Uba, Yoshiyuki Matsuo, Takehiko Adachi, Jun-Ichi Hayashi, Keizo Takenaga, Kiichi Hirota
The intravenous anesthetic propofol (2,6-diisopropylphenol) has been used for the induction and maintenance of anesthesia and sedation in critical patient care. However, the rare but severe complication propofol infusion syndrome (PRIS) can occur, especially in patients receiving high doses of propofol for prolonged periods. In vivo and in vitro evidence suggests that the propofol toxicity is related to the impaired mitochondrial function. However, underlying molecular mechanisms remain unknown. Therefore, we investigated effects of propofol on cell metabolism and death using a series of established cell lines of various origins, including neurons, myocytes, and trans-mitochondrial cybrids, with defined mitochondrial DNA deficits...
2018: PloS One
https://www.readbyqxmd.com/read/29438178/treatment-of-pancreatic-cancer-with-intravenous-vitamin-c-a-case-report
#13
Jeanne A Drisko, Oscar K Serrano, Lisa R Spruce, Qi Chen, Mark Levine
Pancreatic ductal adenocarcinoma (PDA) has a dismal prognosis and is often discovered at an advanced stage with few therapeutic options. Current conventional regimens for PDA are associated with significant morbidity, decreased quality of life, and a considerable financial burden. As a result, some patients turn to integrative medicine therapies as an alternate option after a diagnosis of PDA. Intravenous pharmacologic ascorbic acid (PAA) is one such treatment. The use of PAA has been passionately debated for many years, but more recent rigorous scientific research has shown that there are significant blood concentration differences when ascorbic acid is given parenterally when compared to oral dosing...
February 12, 2018: Anti-cancer Drugs
https://www.readbyqxmd.com/read/29431016/assessment-and-management-of-constipation-for-patients-receiving-palliative-care-in-specialist-palliative-care-settings-a-systematic-review-of-the-literature
#14
Deborah Hl Muldrew, Felicity Hasson, Emma Carduff, Mike Clarke, Jo Coast, Anne Finucane, Lisa Graham, Philip Larkin, Noleen K McCorry, Paul Slater, Max Watson, Eileen Wright, Sonja McIlfatrick
BACKGROUND: Constipation is an important issue for patients receiving palliative care within specialist palliative care settings. Questions and ambiguity, however, persist about international best practice and management. AIM: To synthesise the current evidence base on the assessment and management of constipation for palliative care patients within a specialist palliative care setting. DESIGN: This is a systematic review. DATA SOURCES: MEDLINE, Embase, CINAHL, Scopus and Cochrane databases were systematically searched in April 2017 for empirical studies, written in English, on the assessment and management of constipation in specialist palliative care settings, published between 2007 and 2017...
February 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29430446/models-of-disuse-muscle-atrophy-therapeutic-implications-in-critically-ill-patients
#15
REVIEW
Esther Barreiro
Skeletal muscle weakness is common in the intensive care units (ICU). Approximately 50% of patients under mechanical ventilation for more than 7 days show signs of ICU-acquired muscle weakness. In these patients, muscle weakness may be the result of axonal polyneuropathy, myopathy or a combination of both. The commonest risk factors in patients with ICU-acquired weakness (AW) are the severity and duration of the systemic inflammatory response, duration of the stay in the ICU and of mechanical ventilation, hyperglycemia, hypoalbuminemia, parenteral nutrition, and administration of corticosteroids and of neuromuscular blocking agents...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29413076/application-of-the-seips-model-to-analyze-medication-safety-in-a-crisis-residential-center
#16
Maria L Steele, Brenda Talley, Karen H Frith
PURPOSE: Medication safety and error reduction has been studied in acute and long-term care settings, but little research is found in the literature regarding mental health settings. Because mental health settings are complex, medication administration is vulnerable to a variety of errors from transcription to administration. The purpose of this study was to analyze critical factors related to a mental health work system structure and processes that threaten safe medication administration practices...
February 2018: Archives of Psychiatric Nursing
https://www.readbyqxmd.com/read/29411991/patient-pathway-the-ideal-approach
#17
Lynsey Corless, Iain Brew
Hepatic encephalopathy (HE) can be a devastating complication of cirrhosis, affecting patients and their families. Multidisciplinary community and specialist teams must work together with patients and their families to recognise HE, identify and treat problems early, and minimise time spent unwell or in hospital. Primary care provides an ideal setting for patient education and reinforcement of the salient points on self-care. In the acute setting, the use of care pathways can ensure that the critical aspects of pharmacological, dietetic and supportive care are offered in a timely fashion to reduce morbidity and mortality...
February 7, 2018: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/29406129/a-decision-making-tool-to-prescribe-knee-orthoses-in-daily-practice-for-patients-with-osteoarthritis
#18
Emmanuel Coudeyre, Christelle Nguyen, Aurore Chabaud, Bruno Pereira, Johann Beaudreuil, Jean-Marie Coudreuse, Philippe Deat, Frédéric Sailhan, Alain Lorenzo, François Rannou
OBJECTIVE: To develop a decision-making tool (DMT) to facilitate the prescription of knee orthoses for patients with osteoarthritis (OA) in daily practice. METHODS: A steering committee gathered a multidisciplinary task force experienced in OA management/clinical research. Two members performed a literature review with qualitative analysis of the highest-quality randomized controlled trials and practice guidelines to confirm evidence concerning knee orthosis for OA...
February 2, 2018: Annals of Physical and Rehabilitation Medicine
https://www.readbyqxmd.com/read/29405771/biomarker-definitions-and-their-applications
#19
Robert M Califf
Biomarkers are critical to the rational development of medical therapeutics, but significant confusion persists regarding fundamental definitions and concepts involved in their use in research and clinical practice, particularly in the fields of chronic disease and nutrition. Clarification of the definitions of different biomarkers and a better understanding of their appropriate application could result in substantial benefits. This review examines biomarker definitions recently established by the U.S. Food and Drug Administration and the National Institutes of Health as part of their joint Biomarkers, EndpointS, and other Tools (BEST) resource...
February 2018: Experimental Biology and Medicine
https://www.readbyqxmd.com/read/29401625/novel-half-life-extended-anti-mif-nanobodies-protect-against-endotoxic-shock
#20
Amanda Sparkes, Patrick De Baetselier, Lea Brys, Inês Cabrito, Yann G-J Sterckx, Steve Schoonooghe, Serge Muyldermans, Geert Raes, Richard Bucala, Peter Vanlandschoot, Jo A Van Ginderachter, Benoît Stijlemans
Sepsis-leading to septic shock-is the leading cause of death in intensive care units. The systemic inflammatory response to infection, which is initiated by activated myeloid cells, plays a key role in the lethal outcome. Macrophage migration inhibitory factor (MIF) is an upstream immunoregulatory mediator, released by myeloid cells, that underlies a common genetic susceptibility to different infections and septic shock. Accordingly, strategies that are aimed at inhibiting the action of MIF have therapeutic potential...
January 25, 2018: FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology
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