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https://www.readbyqxmd.com/read/27870808/description-and-results-of-a-comprehensive-care-protocol-for-overnight-stay-spine-surgery-in-adults
#1
Drew A Bednar
STUDY DESIGN: This is a prospective cohort study. OBJECTIVE: To define the probability of successful morning-after discharge after adult spine surgery achieved with a standard care protocol as applied to patients with a large variety of common degenerative spine disorders. SUMMARY OF BACKGROUND DATA: Qualifying criteria for ambulatory or overnight-stay adult spine surgery are not well defined in either the spine or anesthesia literature. Most reports simply go to ASA risk classification or surgical technique alternatives and do not present a clearly defined patient care and case management protocol...
November 18, 2016: Spine
https://www.readbyqxmd.com/read/27753508/characteristics-and-clinical-outcomes-of-head-injured-cyclists-with-and-without-helmets-in-urban-and-rural-areas-of-taiwan-a-15%C3%A2-year-study
#2
Chia-Ying Kuo, Hung-Yi Chiou, Jia-Wei Lin, Shin-Han Tsai, Mau-Roung Lin, Yung-Hsiao Chiang, Chien-Min Lin, Shu-Fen Chu, Tsan-Hon Liou, Wen-Ta Chiu
Objective Bicycle riding is increasingly popular in Taiwan, but the number of cyclists injured and cyclists' death rate are both increasing. The aim of this study was to investigate the different characteristics and clinical outcomes of traffic-accident related head injuries to cyclists in urban and rural areas. Methods Records of 812 patients (533 urban and 279 rural) admitted to 27 hospitals in Taipei City and Hualien County as the result of a traumatic head injury while bicycling between 1998 and 2013 were retrieved for study...
October 18, 2016: Traffic Injury Prevention
https://www.readbyqxmd.com/read/27709392/functional-state-of-the-heart-during-spontaneous-nonconvulsive-seizure-activity-at-various-times-of-the-day
#3
M L Mamalyga, L M Mamalyga
Circadian peculiarities of HR regulation and functional capacities of the heart in WAG/Rij rats with genetically determined absence epilepsy are related to spike-wave activity of the brain. The number of spike-wave discharges (SWD) is maximum at night, early morning, and evening time and decreases to minimum at 08.00-16.00. At night, functional capacities of the heart are reduced and stress test at night induces ischemic changes in the myocardium at a lower functional load than in the daytime (low level of SWD activity)...
September 2016: Bulletin of Experimental Biology and Medicine
https://www.readbyqxmd.com/read/27343798/allergic-reaction-to-patent-blue-dye-in-breast-surgery-case-report
#4
Marcius Vinícius M Maranhão, Dyluzia Kelly Amaral da Nóbrega, Carlos Eduardo Caiado Anunciação, Barbara de Alcântara Brito Maia, Paulo Virgílio Dantas Mariano
We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20min after the dye injection, the patient developed hypotension (BP=70×30mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial-like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used...
July 2016: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/27135731/discharge-rounds-implementation-of-a-targeted-intervention-for-improving-patient-throughput-on-an-inpatient-medical-teaching-service
#5
Krisda H Chaiyachati, Andre N Sofair, Jeremy I Schwartz, David Chia
OBJECTIVES: Patient throughput and early discharges are important for decreasing emergency department wait times and creating available beds for new hospital admissions. The educational schedule of internal medicine trainees can interfere with timely discharges, but targeted interventions can help residents meet the hospital's patient flow needs. Our training program instituted daily morning discharge rounds on the inpatient service, requiring each team to prepare potential discharges 1 day ahead and prioritizing these discharges the next day...
May 2016: Southern Medical Journal
https://www.readbyqxmd.com/read/26975590/early-versus-late-parenteral-nutrition-in-critically-ill-children
#6
RANDOMIZED CONTROLLED TRIAL
Tom Fivez, Dorian Kerklaan, Dieter Mesotten, Sascha Verbruggen, Pieter J Wouters, Ilse Vanhorebeek, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Michael P Casaer, Gonzalo Garcia Guerra, Jan Hanot, Ari Joffe, Dick Tibboel, Koen Joosten, Greet Van den Berghe
BACKGROUND: Recent trials have questioned the benefit of early parenteral nutrition in adults. The effect of early parenteral nutrition on clinical outcomes in critically ill children is unclear. METHODS: We conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding parenteral nutrition for 1 week (i.e., providing late parenteral nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early parenteral nutrition...
March 24, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/26925275/spontaneous-uterine-rupture-in-a-preterm-pregnancy-following-myomectomy
#7
Claire Sutton, Prue Standen, Jade Acton, Christopher Griffin
A 44-year-old nulliparous woman was transferred to a tertiary obstetric hospital for investigation of acute onset abdominal pain. She was at gestation of 32 weeks and 2 days with a history of previous laparoscopic fundal myomectomy. An initial bedside ultrasound demonstrated oligohydramnios. Following an episode of increased pain early the following morning, a formal ultrasound diagnosed a uterine rupture with the fetal arm extending through a uterine rent. An uncomplicated classical caesarean section was performed and the neonate was delivered in good condition but with a bruised and oedematous right arm...
2016: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/26786491/keloidal-plaque-in-a-patient-with-pulmonary-tuberculosis-a-rare-morphological-variant-of-tuberculosis-verrucosa-cutis
#8
Sundeep Chowdhry, Urmi Khanna, Paschal D'Souza, Tapan Kumar Dhali
Tuberculosis verrucosa cutis (TVC), also known as warty tuberculosis, anatomist's wart or prosector's wart is characterized by the presence of verrucous plaque-like lesions, resulting from direct inoculation of the causative organism into the skin of a previously infected patient. A 59-year-old man presented with a hyperpigmented plaque on the chest wall which closely mimicked a keloid. He was a case of sputum-positive pulmonary tuberculosis and had repeatedly been applying early morning saliva on the lesion as a part of the indigenous practices for quick healing...
September 2014: International Journal of Mycobacteriology
https://www.readbyqxmd.com/read/26734432/four-simple-ward-based-initiatives-to-reduce-unnecessary-in-hospital-patient-stay-a-quality-improvement-project
#9
Asad Shabbir, Gorav Wali, Alan Steuer
Prolonged hospital stay not only increases financial stress on the National Health Service but also exposes patients to an unnecessarily high risk of adverse ward events. Each day accumulates approximately £225 in bed costs with additional risks of venousthromboembolism, hospital acquired infections, prescription errors, and falls. Despite being medically fit for discharge (MFFD), patients awaiting care packages with prolonged length of stay (LoS) have poorer outcomes and experience increased rates of mortality as a result...
2015: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/26734298/a-reimagined-discharge-lounge-as-a-way-to-an-efficient-discharge-process
#10
Natalia Hernandez, Dinesh John, Joan Mitchell
Faced with inherent inefficiencies built into transfer of a patient from emergency department (ED) to an inpatient bed, we determined that the timely availability of an inpatient bed was essential to improving efficiency and flow. Lack of beds early in the day was a major cause for delays and backup in the ED, which in turn placed the ED at risk for overcrowding and diversion. Review of the discharge process revealed that only 33.4% of discharges were completed prior to noon, and on average took 126 minutes from the time a discharge order was written to the time the patient actually left their inpatient bed...
2014: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/26730085/early-oral-feeding-in-pediatric-intestinal-anastomosis
#11
Mamatha B, Anand Alladi
A prospective nonrandomized study of 31 children aged <16 years over a period of 14 months was conducted to evaluate the effects of early oral feeding (EOF) in children with intestinal anastomosis. Patients undergoing elective or emergency intestinal anastomosis below the ligament of Trietz with no contamination were included while contaminated cases and neonatal atresias were excluded. First feed was the direct oral feed started within 24 h, usually the morning after surgery. Liquid feeds were started initially and increased at 4 hourly increments to appropriate feed for age...
December 2015: Indian Journal of Surgery
https://www.readbyqxmd.com/read/26692893/development-of-automated-postoperative-enteral-nutrition-restricting-feeding-site-inflow-to-match-peristaltic-outflow
#12
Gerald Moss
BACKGROUND: Surgical stress accelerates postoperative metabolism, while simultaneously compromising gut activity. The dysfunction may be worsened by early feeding. These patients are not expected to fully meet their optimum metabolic requirements using current nutritional regimens. For optimum postoperative enteral nutrition, we must automatically match the patients' feeding site inflows to their impaired peristaltic outflows. An essential adjunct is virtually complete exclusion of swallowed air...
2015: Annals of Surgical Innovation and Research
https://www.readbyqxmd.com/read/26527017/-post-partum-guidelines-for-clinical-practice-short-text
#13
REVIEW
M-V Sénat, L Sentilhes, A Battut, D Benhamou, S Bydlowski, A Chantry, X Deffieux, F Diers, M Doret, C Ducroux-Schouwey, F Fuchs, G Gascoin, C Lebot, L Marcellin, G Plu-Bureau, B Raccah-Tebeka, E Simon, G Bréart, L Marpeau
OBJECTIVE: To determine the post-partum management of women and their newborn whatever the mode of delivery. MATERIAL AND METHODS: The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS: Because breastfeeding is associated with a decrease in neonatal morbidity (lower frequency of cardiovascular diseases, infectious, atopic or infantile obesity) (EL2) and an improvement in the cognitive development of children (EL2), exclusive and extended breastfeeding is recommended (grade B) between 4 to 6 months (Professional consensus)...
December 2015: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
https://www.readbyqxmd.com/read/26522504/can-abdominal-surgical-emergencies-be-treated-in-an-ambulatory-setting
#14
REVIEW
L Genser, C Vons
INTRODUCTION: The performance of emergency abdominal surgery in an outpatient setting is increasingly the order of the day in France. This review evaluates the feasibility and reliability of ambulatory surgical treatment of the most common abdominal emergencies: appendectomy for acute appendicitis and cholecystectomy for acute complications of gallstone disease (acute cholecystitis and gallstone pancreatitis). METHODS: This study evaluates surgical procedures performed on an ambulatory basis according to the international definition (admission in the morning, discharge in the evening with a hospital stay of less than 12 hours)...
December 2015: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/26425247/facilitating-early-in-day-discharge-for-multiple-sclerosis-patients-treated-with-intravenous-methylprednisolone-a-quality-improvement-project
#15
John C Probasco, Gina Hawley, Margie Burnett, Lorrie Gibson, Kathryn Carter, Elizabeth Harlow, Holly Russell, Linda Huffman, Jane Adams, Terry Ziegler, Hilary Sporney, Michael Levy, Hans A Puttgen
BACKGROUND AND PURPOSE: Delays in patient hospital discharge affect care value through costs of prolonged length of stay and barriers to patient flow within the hospital. We sought to facilitate early-in-day discharges (EIDDs) without extending length of stay for inpatients with multiple sclerosis admitted for acute exacerbations and treated with intravenous (IV) methylprednisolone. METHODS: We developed a standardized admission order set, a provider checklist, and a patient checklist to better coordinate in-hospital care and discharge planning for patients with multiple sclerosis admitted for IV methylprednisolone treatment...
October 2015: Neurohospitalist
https://www.readbyqxmd.com/read/26423210/adolescent-presentations-with-alcohol-intoxication-to-the-emergency-department-at-joondalup-health-campus-in-2013
#16
Michael T Lovegrove
OBJECTIVE: To document the number of adolescents aged 16 years and under presenting to the ED at Joondalup Health Campus (JHC) with problems related primarily to alcohol intoxication, and document information about these presentations. METHOD: Presentations of adolescents were sourced from the Emergency Department Information System database at JHC. The patient's notes were interrogated for data on presentation and discharge times, means of arrival to the ED, age, gender, arrival Glasgow Coma Score (GCS), location from where the adolescent was brought and blood alcohol levels (BALs), if done...
September 30, 2015: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/26313503/use-of-day-1-early-morning-cortisol-to-predict-the-need-for-glucocorticoid-replacement-after-pituitary-surgery
#17
L N Rao Bondugulapati, Christopher Campbell, Sharmistha Roy Chowdhury, Pablo Goetz, J Stephen Davies, D Aled Rees, Caroline Hayhurst
BACKGROUND: Assessment of adrenal reserve in patients who have undergone pituitary surgery is crucial. However, there is no clear consensus with regards to the type and timing of the test that should be used in the immediate post-operative period. Recently, there has been increased interest in measuring post-operative cortisol levels. We present our data utilising day 1 post-operative early morning cortisol as a tool to assess adrenal reserve in steroid-naive patients. METHODS: A retrospective analysis of endoscopic pituitary surgery undertaken over a 2-year period...
2016: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/26253131/real-time-prediction-of-inpatient-length-of-stay-for-discharge-prioritization
#18
Sean Barnes, Eric Hamrock, Matthew Toerper, Sauleh Siddiqui, Scott Levin
OBJECTIVE: Hospitals are challenged to provide timely patient care while maintaining high resource utilization. This has prompted hospital initiatives to increase patient flow and minimize nonvalue added care time. Real-time demand capacity management (RTDC) is one such initiative whereby clinicians convene each morning to predict patients able to leave the same day and prioritize their remaining tasks for early discharge. Our objective is to automate and improve these discharge predictions by applying supervised machine learning methods to readily available health information...
April 2016: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/26064364/h2-relaxin-expression-and-its-effect-on-clinical-outcomes-in-patients-with-chronic-heart-failure
#19
Juan Xie, Yuan Chen, Liang Li, Shan Zhang
To investigate the expression of H2 Relaxin (H2RLX) in chronic heart failure (CHF) patients and determine whether H2RLX level can predict cardiovascular events in CHF patients within 180 days after discharge. One hundred forty-six patients were selected for examination from July 2012 to January 2014. The CHF group included a total of 115 patients, while the control group comprised a total of 31 patients without CHF. In the early morning on the first day after admission, patients' blood samples were obtained for measuring levels of brain natriuretic peptide (BNP), LDL-cholesterol, haemoglobin, fasting blood glucose, thyroid stimulating hormone, and creatinine clearance rate (Ccr)...
2015: International Journal of Clinical and Experimental Medicine
https://www.readbyqxmd.com/read/25908989/association-of-serum-chloride-concentration-with-outcomes-in-postoperative-critically-ill-patients-a-retrospective-observational-study
#20
Satoshi Kimura, Shinsaku Matsumoto, Nagisa Muto, Tomoko Yamanoi, Tatsuya Higashi, Kosuke Nakamura, Mineo Miyazaki, Moritoki Egi
BACKGROUND: Although chloride is one of the major electrolytes measured routinely in dairy practice, the amount of attention chloride receives in critically ill patients is limited. There are still a few studies reporting the incidence of derangements of chloride and its association with patients' outcomes. Accordingly, we conducted a retrospective study to assess the prevalence of abnormality of serum chloride level in postoperative patients in the intensive care unit on the early phase of surgery and its association with outcome...
2014: Journal of Intensive Care
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