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https://www.readbyqxmd.com/read/28449529/do-hospitals-need-oncological-critical-care-units
#1
EDITORIAL
Abby Koch, William Checkley
Since the inception of critical care as a formal discipline in the late 1950s, we have seen rapid specialization to many types of intensive care units (ICUs) to accommodate evolving life support technologies and novel therapies in various disciplines of medicine. Indeed, the field has expanded such that specialized ICUs currently exist to address critical care problems in medicine, cardiology, neurology and neurosurgery, trauma, burns, organ transplant and cardiothoracic surgeries. Specialization does not only need new infrastructure, but also training and staffing of health care providers, ancillary staff, and development and implementation of processes of care...
March 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28449296/frailty-index-intensive-care-unit-complications-in-head-and-neck-oncologic-regional-and-free-flap-reconstruction
#2
Nicholas B Abt, Yanjun Xie, Sidharth V Puram, Jeremy D Richmon, Mark A Varvares
BACKGROUND: Head and neck extirpations requiring reconstruction are challenging surgeries with high postoperative complication risk. METHODS: Regional and free flap reconstructions of head and neck defects were collected from the 2006-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The modified frailty index was made of 15 variables, with increasing index scores indicative of frailer patients. Intensive care unit (ICU)-level complications were defined by Clavien-Dindo classification IV and analyzed with multivariable logistic regression...
April 27, 2017: Head & Neck
https://www.readbyqxmd.com/read/28443269/epidemiology-and-risk-assessment-of-pediatric-venous-thromboembolism
#3
REVIEW
Arash Mahajerin, Stacy E Croteau
The incidence of diagnosed venous thromboembolism (VTE) has been increasing concurrent with advances in technology and medical care that enhance our ability to treat pediatric patients with critical illness or complex multiorgan system dysfunction. Although the overall incidence of VTE is estimated at 0.07-0.49 per 10,000 children, higher rates are observed in specific populations including hospitalized children, those with central venous catheters (CVCs) or patients convalescing from a major surgery. While the absolute number of pediatric VTE events may seem trivial compared to adults, the increasing incidence, associated with increased mortality and morbidity, the availability of novel therapies, and the impact on the cost of care have made investigation of VTE risk factors and prevention strategies a high priority...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28441255/european-society-of-gynaecological-oncology-guidelines-for-the-management-of-patients-with-vulvar-cancer
#4
Maaike H M Oonk, François Planchamp, Peter Baldwin, Mariusz Bidzinski, Mats Brännström, Fabio Landoni, Sven Mahner, Umesh Mahantshetty, Mansoor Mirza, Cordula Petersen, Denis Querleu, Sigrid Regauer, Lukas Rob, Roman Rouzier, Elena Ulrikh, Jacobus van der Velden, Ignace Vergote, Linn Woelber, Ate G J van der Zee
OBJECTIVE: The aim of this study was to develop clinically relevant and evidence-based guidelines as part of European Society of Gynaecological Oncology's mission to improve the quality of care for women with gynecologic cancers across Europe. METHODS: The European Society of Gynaecological Oncology Council nominated an international development group made of practicing clinicians who provide care to patients with vulvar cancer and have demonstrated leadership and interest in the management of patients with vulvar cancer (18 experts across Europe)...
May 2017: International Journal of Gynecological Cancer
https://www.readbyqxmd.com/read/28439646/critical-care-admission-following-elective-surgery-was-not-associated-with-survival-benefit-prospective-analysis-of-data-from-27-countries
#5
Brennan C Kahan, Desponia Koulenti, Kostoula Arvaniti, Vanessa Beavis, Douglas Campbell, Matthew Chan, Rui Moreno, Rupert M Pearse
PURPOSE: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. METHODS: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality...
April 25, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28437809/reactive-rather-than-proactive-diabetes-management-in-the-perioperative-period
#6
Inge Hommel, Petra J van Gurp, Alfons A den Broeder, Hub Wollersheim, Femke Atsma, Marlies E J L Hulscher, Cees J Tack
As perioperative hyperglycemia is associated with poor postoperative patient outcomes, clinical guidelines provide recommendations for optimal perioperative glucose control. It is unclear to what extent recommended glucose levels are met in daily practice, and little is known about factors that influence these levels. We describe blood glucose levels throughout the hospital care pathway in 375 non-critically ill patients with diabetes who underwent major surgery (abdominal, cardiac, or orthopedic) in 6 hospitals, examine determinants of these levels including adherence to 9 quality indicators for optimal perioperative diabetes care, and perform qualitative interviews to identify barriers for optimal care...
April 24, 2017: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
https://www.readbyqxmd.com/read/28437207/persistent-delirium-in-chronic-critical-illness-as-a-prodrome-syndrome-before-death
#7
Anna DeForest, Craig D Blinderman
BACKGROUND: Chronic critical illness (CCI) patients have poor functional outcomes, high risk of mortality, and significant sequelae, including delirium and cognitive dysfunction. The prognostic significance of persistent delirium in patients with CCI has not been well described. OBJECTIVE: We report a case of a patient with CCI following major cardiac surgery who was hemodynamically stable following a long course in the cardiothoracic intensive care unit (CTICU), but had persistent and unremitting delirium...
February 21, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28435744/diagnosis-of-spinal-epidural-abscess-a-case-report-and-literature-review
#8
Chidinma Chima-Melton, Michelle Pearl, Marni Scheiner
INTRODUCTION: Spinal epidural abscess (SEA) is a rare but serious cause of back pain in the critical care setting. It occurs most commonly in adults in their fifth and sixth decades of life. Risk factors include diabetes mellitus, alcoholism, AIDS or other immunocompromised states, cancer, intravenous drug use, trauma and spinal surgery. The clinical presentation can be non-specific but the classical triad includes back pain, fever and neurological deficits. Magnetic resonance imaging (MRI) with gadolinium is the diagnostic imaging modality of choice...
2017: Spinal Cord Series and Cases
https://www.readbyqxmd.com/read/28427793/contribution-of-health-care-factors-to-the-burden-of-skin-disease-in-the-united-states
#9
Henry W Lim, Scott A B Collins, Jack S Resneck, Jean L Bolognia, Julie A Hodge, Thomas A Rohrer, Marta J Van Beek, David J Margolis, Arthur J Sober, Martin A Weinstock, David R Nerenz, Wendy Smith Begolka, Jose V Moyano
The American Academy of Dermatology has developed an up-to-date national Burden of Skin Disease Report on the impact of skin disease on patients and on the US population. In this second of 3 manuscripts, data are presented on specific health care dimensions that contribute to the overall burden of skin disease. Through the use of data derived from medical claims in 2013 for 24 skin disease categories, these results indicate that skin disease health care is delivered most frequently to the aging US population, who are afflicted with more skin diseases than other age groups...
April 17, 2017: Journal of the American Academy of Dermatology
https://www.readbyqxmd.com/read/28422408/prevention-of-the-osmotic-demyelination-syndrome-after-liver-transplantation-a-multidisciplinary-perspective
#10
J F Crismale, K A Meliambro, S DeMaria, D B Bronster, S Florman, T D Schiano
The osmotic demyelination syndrome (ODS) is a serious neurologic condition that occurs in the setting of rapid correction of hyponatremia. It presents with protean manifestations, from encephalopathy to the "locked-in" syndrome. ODS can complicate liver transplantation (LT), and its incidence may increase with the inclusion of serum sodium as a factor in the Model for End-Stage Liver Disease score. A comprehensive understanding of risk factors for the development of ODS in the setting of LT, along with recommendations to mitigate the risk of ODS, are necessary...
April 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28420470/-explore-objective-clinical-variables-for-detecting-delirium-in-icu-patients-a-prospective-case-control-study
#11
Xiaojiang Liu, Jie Lyu, Youzhong An
OBJECTIVE: The aim of this case-control study is to explore clinical objective variables for diagnosing delirium of intensive care unit (ICU) patients. METHODS: According to the method of prospective case-control study, critical adult postoperative patients who were transferred to ICU of Peking University People's Hospital from October 2015 to May 2016 and needed mechanical ventilation were included. After evaluating the Richmond agitation sedation scale score (RASS), the patients whose score were -2 or greater were sorted into two groups, delirium and non-delirium, according to the confusion assessment method for the ICU (CAM-ICU)...
April 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28419788/the-italian-stallions-of-cli-value-care-delivery
#12
EDITORIAL
Gary M Ansel, Michael R Jaff
Critical Limb ischemia with long segment occlusive disease typically reserved for surgery can be treated with a high degree of success in expert centers via an endovascular approach Nitinol woven stents appear to have high patency with proper deployment in all PAD groups Increased early expense that is associated with decreased re-intervention can be cost effective.
April 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28411706/report-of-the-society-for-vascular-surgery-and-the-american-venous-forum-on-the-july-20-2016-meeting-of-the-medicare-evidence-development-and-coverage-advisory-committee-panel-on-lower-extremity-chronic-venous-disease
#13
Peter Gloviczki, Michael C Dalsing, Peter Henke, Brajesh K Lal, Thomas F O'Donnell, Cynthia K Shortell, Ying Huang, Jovan Markovic, Thomas W Wakefield
On July 20, 2016, a Medicare Evidence Development and Coverage Advisory Committee panel assessed the benefits and risks of currently used lower extremity chronic venous disease (CVD) treatments and their effects on health outcome of the American adult population. The main purpose of the meeting was to advise the Centers for Medicare & Medicaid Services on coverage determination for interventions used for treatment of CVD. A systematic review of the Agency for Healthcare Research and Quality was presented, followed by lectures of invited experts and a public hearing of representatives of professional societies and the industry...
May 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28406108/specialty-preferences-and-motivating-factors-a-national-survey-on-medical-students-from-five-uae-medical-schools
#14
Mahera Abdulrahman, Maryam Makki, Sami Shaaban, Maryam Al Shamsi, Manda Venkatramana, Nabil Sulaiman, Manal M Sami, Dima K Abdelmannan, AbdulJabbar M A Salih, Laila AlShaer
BACKGROUND: Workforce planning is critical for being able to deliver appropriate health service and thus is relevant to medical education. It is, therefore, important to understand medical students' future specialty choices and the factors that influence them. This study was conducted to identify, explore, and analyze the factors influencing specialty preferences among medical students of the United Arab Emirates (UAE). METHODS: A multiyear, multicenter survey of medical student career choice was conducted with all five UAE medical schools...
September 2016: Education for Health: Change in Training & Practice
https://www.readbyqxmd.com/read/28404468/assessing-the-impact-of-a-program-for-late-surgical-intervention-in-early-blind-children
#15
A Kalia, T Gandhi, G Chatterjee, P Swami, H Dhillon, S Bi, N Chauhan, S D Gupta, P Sharma, S Sood, S Ganesh, U Mathur, P Sinha
OBJECTIVE: Many blind children in the developing world are unable to obtain timely treatment due to lack of financial and medical resources. Can public health programs that identify and treat such children several years after the onset of blindness enhance their quality of life? The notion that visual development is subject to an early 'critical period' argues against this possibility. However, there are inadequate empirical data from humans on this issue. To address this need, we examined the quality of life of children living in India and who were treated for early-onset blindness (before one year of age), due to cataracts or corneal opacities...
May 2017: Public Health
https://www.readbyqxmd.com/read/28400464/utilisation-of-radiology-rotations-in-acgme-accredited-general-surgery-programmes
#16
Joseph J Eid, Francisco Igor Macedo, Vijay K Mittal
BACKGROUND: General surgery (GS) residents are often required to provide immediate preliminary interpretations of radiological images, especially in critical situations. It is unclear whether residents in Accreditation Council for Graduate Medical Education-accredited GS programmes receive sufficient radiological training to deliver adequate patient care. OBJECTIVES: Determine the utilisation of radiology rotations (RR) during GS residency. METHODS: Between February and March 2015, a pilot voluntary 19-item survey was electronically distributed to GS programme directors (PDs) regarding the availability and value of a RR during GS training...
April 11, 2017: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/28399882/liver-necrosis-shortly-after-pancreaticoduodenectomy-with-resection-of-the-replaced-left-hepatic-artery
#17
Michihiro Yamamoto, Masazumi Zaima, Hidekazu Yamamoto, Hideki Harada, Junichiro Kawamura, Masahiro Yamada, Tekefumi Yazawa, Junya Kawasoe
BACKGROUND: Surgeons, in general, underestimate the replaced left hepatic artery (rLHA) that arises from the left gastric artery (LGA), compared with the replaced right hepatic artery (rRHA), especially in standard gastric cancer surgery. During pancreaticoduodenectomy (PD), preservation of the rRHA arising from the superior mesenteric artery (SMA) is widely accepted to prevent critical postoperative complications, such as liver necrosis, bile duct ischemia, and biliary anastomotic leakage...
April 11, 2017: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28399033/european-society-of-gynaecological-oncology-guidelines-for-the-management-of-patients-with-vulvar-cancer
#18
Maaike H M Oonk, François Planchamp, Peter Baldwin, Mariusz Bidzinski, Mats Brännström, Fabio Landoni, Sven Mahner, Umesh Mahantshetty, Mansoor Mirza, Cordula Petersen, Denis Querleu, Sigrid Regauer, Lukas Rob, Roman Rouzier, Elena Ulrikh, Jacobus van der Velden, Ignace Vergote, Linn Woelber, Ate G J van der Zee
OBJECTIVE: The aim of this study was to develop clinically relevant and evidence-based guidelines as part of European Society of Gynaecological Oncology's mission to improve the quality of care for women with gynecologic cancers across Europe. METHODS: The European Society of Gynaecological Oncology Council nominated an international development group made of practicing clinicians who provide care to patients with vulvar cancer and have demonstrated leadership and interest in the management of patients with vulvar cancer (18 experts across Europe)...
April 8, 2017: International Journal of Gynecological Cancer
https://www.readbyqxmd.com/read/28393340/-development-of-the-oral-assessment-scale-for-post-operational-patients-with-oral-cancer
#19
Yi-Chen Lee, Ya-Chuan Hsu, Hui-Ying Chiang
BACKGROUND: Current oral assessment scales are designed to assess the severity of oral health in cancer patients who have undergone radiotherapy or chemotherapy. Currently, no scale is available that assesses the overall oral health situation of patients. However, this type of scale is critical for guiding nursing staff to understand the oral status of postoperative patients and for facilitating the development of patient-centered oral nursing treatments. PURPOSE: To develop the oral assessment scale for post-operational patients with oral cancer (OASPOCa) and establish its psychometric properties...
April 2017: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/28392713/a-case-report-on-the-treatment-of-complex-chronic-pain-and-opioid-dependence-by-a-multidisciplinary-transitional-pain-service-using-the-act-matrix-and-buprenorphine-naloxone
#20
Aliza Z Weinrib, Lindsay C Burns, Alex Mu, Muhammad Abid Azam, Salima Sj Ladak, Karen McRae, Rita Katznelson, Saam Azargive, Cieran Tran, Joel Katz, Hance Clarke
In an era of growing concern about opioid prescribing, the postsurgical period remains a critical window with the risk of significant opioid dose escalation, particularly in patients with a history of chronic pain and presurgical opioid use. The purpose of this case report is to describe the multidisciplinary care of a complex, postsurgical pain patient by an innovative transitional pain service (TPS). A 59-year-old male with complex chronic pain, as well as escalating long-term opioid use, presented with a bleeding duodenal ulcer requiring emergency surgery...
2017: Journal of Pain Research
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