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https://www.readbyqxmd.com/read/29779296/the-assessment-and-management-of-chest-pain-in-primary-care-a-focus-on-acute-coronary-syndrome
#1
Richard Thomsett, Louise Cullen
BACKGROUND: Chest pain is a common presentation and diagnosis can be challenging. There are many causes for chest pain, including life-threatening conditions such as acute coronary syndrome (ACS), which can prove difficult to diagnose. OBJECTIVE: This article focuses on diagnosis and early management of patients with possible ACS. Key differentials and essential primary care investigations and management are outlined. Hospital-based risk stratification and management are described, providing an outline of what patients can expect if referred to hospital...
May 2018: Australian journal of general practice
https://www.readbyqxmd.com/read/29779154/the-effect-of-meteorological-conditions-and-air-pollution-on-the-occurrence-of-type-a-and-b-acute-aortic-dissections
#2
Nan Xie, Liqun Zou, Lei Ye
To explore the association of weather conditions and air pollutants with incidence risk of acute aortic dissection (AAD), we included patients who consecutively admitted to the emergency units of our hospital for AAD between Dec. 1, 2013, and Apr. 30, 2017. Their medical records were reviewed. The meteorological data (daily precipitation, minimal and maximal temperatures, mean atmospheric pressure, relative humidity) and air pollutants values [air daily index (AQI), aerodynamic diameter of 2.5 mm or less (PM2...
May 19, 2018: International Journal of Biometeorology
https://www.readbyqxmd.com/read/29778885/effects-of-hyperpolypharmacy-and-potentially-inappropriate-medications-pims-on-functional-decline-in-older-patients-discharged-from-acute-care-hospitals
#3
Paolo Fabbietti, Carmelinda Ruggiero, Federica Sganga, Sergio Fusco, Federica Mammarella, Norma Barbini, Laura Cassetta, Graziano Onder, Andrea Corsonello, Fabrizia Lattanzio, Mirko Di Rosa
AIM: To comparatively investigate the effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients after hospital discharge. METHODS: Our series consisted of 733 patients aged ≥65 consecutively enrolled in a multicenter observational longitudinal study. PIMs were defined on the basis of updated versions of Beers and STOPP criteria. The occurrence of functional decline was defined as the loss of independency in at least 1 basic activity of daily living (BADL) from discharge through 3-month follow-up visit...
May 16, 2018: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/29778845/predictors-of-long-term-mortality-in-status-epilepticus
#4
Somsak Tiamkao, Pawinee Saybungkla, Prapassara Sirikarn, Kittisak Sawanyawisuth
BACKGROUND: There were several studies that have reported on the long-term mortality rate of status epilepticus (SE). However, these studies were conducted mainly in Western countries using small study populations. This study aimed to evaluate predictors for long-term mortality in SE using the Thai national healthcare database. METHODS: This study was conducted using the Thai national Universal Health Coverage (UC) database. The eligibility criteria for this study were that all patients were diagnosed with SE and had been admitted to any hospital between 2005 and 2015...
May 17, 2018: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/29778659/sepsis-3-septic-shock-criteria-and-associated-mortality-among-infected-hospitalized-patients-assessed-by-a-rapid-response-team
#5
Shannon M Fernando, Peter M Reardon, Bram Rochwerg, Nathan I Shapiro, Donald M Yealy, Andrew J E Seely, Jeffrey J Perry, Douglas P Barnaby, Kyle Murphy, Peter Tanuseputro, Kwadwo Kyeremanteng
BACKGROUND: Rapid Response Teams (RRTs) respond to deteriorating hospitalized patients, and help determine subsequent management, including Intensive Care Unit (ICU) admission. In such patients with sepsis and septic shock, the Sepsis-3 clinical criteria have a potential role in detection, risk-stratification, and prognostication, though their accuracy in comparison to the Systemic Inflammatory Response Syndrome (SIRS)-based septic shock criteria are unknown. We sought to evaluate prognostic accuracy of the Sepsis-3 criteria for in-hospital mortality among infected hospitalized patients with acute deterioration...
May 17, 2018: Chest
https://www.readbyqxmd.com/read/29778434/implementation-of-multimodal-infection-control-and-hand-hygiene-strategies-in-acute-care-hospitals-in-greece-a-cross-sectional-benchmarking-survey
#6
Evangelos I Kritsotakis, Eirini Astrinaki, Argyri Messaritaki, Achilleas Gikas
BACKGROUND: In this first attempt to suggest achievable standards for improvement in hospital infection prevention and control (IPC) in Greece, we assessed main IPC structure and process indicators emphasizing hand hygiene. METHODS: Acute-care hospitals across the country participated in a cross-sectional survey by completing the World Health Organization Hand Hygiene Self-assessment Framework (HHSAF) and by providing hospital-level IPC indicators. RESULTS: Seventeen hospitals completed the survey, comprising 14% of the country's public hospitals...
May 16, 2018: American Journal of Infection Control
https://www.readbyqxmd.com/read/29778365/cerebral-microbleeds-and-intracranial-haemorrhage-risk-in-patients-anticoagulated-for-atrial-fibrillation-after-acute-ischaemic-stroke-or-transient-ischaemic-attack-cromis-2-a-multicentre-observational-cohort-study
#7
Duncan Wilson, Gareth Ambler, Clare Shakeshaft, Martin M Brown, Andreas Charidimou, Rustam Al-Shahi Salman, Gregory Y H Lip, Hannah Cohen, Gargi Banerjee, Henry Houlden, Mark J White, Tarek A Yousry, Kirsty Harkness, Enrico Flossmann, Nigel Smyth, Louise J Shaw, Elizabeth Warburton, Keith W Muir, Hans Rolf Jäger, David J Werring
BACKGROUND: Cerebral microbleeds are a potential neuroimaging biomarker of cerebral small vessel diseases that are prone to intracranial bleeding. We aimed to determine whether presence of cerebral microbleeds can identify patients at high risk of symptomatic intracranial haemorrhage when anticoagulated for atrial fibrillation after recent ischaemic stroke or transient ischaemic attack. METHODS: Our observational, multicentre, prospective inception cohort study recruited adults aged 18 years or older from 79 hospitals in the UK and one in the Netherlands with atrial fibrillation and recent acute ischaemic stroke or transient ischaemic attack, treated with a vitamin K antagonist or direct oral anticoagulant, and followed up for 24 months using general practitioner and patient postal questionnaires, telephone interviews, hospital visits, and National Health Service digital data on hospital admissions or death...
June 2018: Lancet Neurology
https://www.readbyqxmd.com/read/29778325/tranexamic-acid-for-hyperacute-primary-intracerebral-haemorrhage-tich-2-an-international-randomised-placebo-controlled-phase-3-superiority-trial
#8
Nikola Sprigg, Katie Flaherty, Jason P Appleton, Rustam Al-Shahi Salman, Daniel Bereczki, Maia Beridze, Hanne Christensen, Alfonso Ciccone, Ronan Collins, Anna Czlonkowska, Robert A Dineen, Lelia Duley, Juan Jose Egea-Guerrero, Timothy J England, Kailash Krishnan, Ann Charlotte Laska, Zhe Kang Law, Serefnur Ozturk, Stuart J Pocock, Ian Roberts, Thompson G Robinson, Christine Roffe, David Seiffge, Polly Scutt, Jegan Thanabalan, David Werring, David Whynes, Philip M Bath
BACKGROUND: Tranexamic acid can prevent death due to bleeding after trauma and post-partum haemorrhage. We aimed to assess whether tranexamic acid reduces haematoma expansion and improves outcome in adults with stroke due to intracerebral haemorrhage. METHODS: We did an international, randomised placebo-controlled trial in adults with intracerebral haemorrhage from acute stroke units at 124 hospital sites in 12 countries. Participants were randomly assigned (1:1) to receive 1 g intravenous tranexamic acid bolus followed by an 8 h infusion of 1 g tranexamic acid or a matching placebo, within 8 h of symptom onset...
May 15, 2018: Lancet
https://www.readbyqxmd.com/read/29778236/challenges-in-implementation-of-institutional-protocols-for-patients-with-acute-coronary-syndrome
#9
REVIEW
Atman P Shah, Sandeep Nathan
The diagnosis of acute coronary syndrome (ACS) encompasses ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation ACS (non-STEMI and unstable angina). In recent years, there have been improvements in the rates of death, cardiogenic shock, and recurrent myocardial infarction in patients with ACS, primarily due to the introduction of new pharmacological and interventional therapies, as well as the introduction of and adherence to new treatment guidelines. However, ACS still represents a considerable public health burden...
April 17, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29778133/study-of-acute-kidney-injury-on-309-hypertensive-inpatients-with-acei-arb-diuretic-treatment
#10
Qiaochao Chen, Shaofang Zhu, Jianjun Liao, Wen He
BACKGROUND: The present study investigated risk factors for acute kidney injury (AKI) in patients found to be hypertensive during hospitalization who were prescribed angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists (ARB) + diuretic combinations, in order to determine which type of diuretic or combination of diuretics used in ACE/ARB-treated patients leads to a higher risk of acute kidney injury. METHOD: Data on basic information, medical history, diagnostic information and medications prescribed were obtained from the patients' medical records...
June 2018: Journal of the National Medical Association
https://www.readbyqxmd.com/read/29777926/epidemiology-of-acute-febrile-illness-in-latin-america
#11
REVIEW
José Moreira, Clarisse S Bressan, Patricia Brasil, Andre M Siqueira
BACKGROUND: The causes of acute febrile illness (AFI) in Latin America (LA) are diverse and its complexity increase as the proportion of fever due to malaria decreases as control and new pathogens emerge in the region. In this context, it is important to shed light over the gaps on the epidemiological characteristics and the geographic range for many AFI aetiologies. AIMS: To review studies on community-acquired fever etiology other than malaria in LA, and to highlight knowledge gaps and challenges needing further investigation...
May 16, 2018: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/29777760/peripheral-intravenous-volume-assessment-piva-for-quantitating-volume-overload-in-patients-hospitalized-with-acute-decompensated-heart-failure-a-pilot-study
#12
Merrick Miles, Bret D Alvis, Kyle Hocking, Franz Baudenbacher, Christy Guth, JoAann Lindenfeld, Colleen Brophy, Susan Eagle
BACKGROUND: To determine the feasibility of Peripheral Intravenous Volume Assessment (PIVA) of venous waveforms for assessing volume overload in patients admitted to the hospital with acute decompensated heart failure (ADHF). METHODS: Venous waveforms were captured from a peripheral intravenous catheter in subjects admitted for ADHF and healthy age-matched controls. Admission PIVA signal, brain natriuretic peptide, and chest radiographic measurements were related to the net volume removed during diuresis...
May 16, 2018: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/29777746/perioperative-and-long-term-all-cause-mortality-in-patients-with-diabetes-who-underwent-a-lower-extremity-amputation
#13
María Eugenia López-Valverde, Javier Aragón-Sánchez, Ana López-de-Andrés, Viviana Guerrero-Cedeño, Rebeca Tejedor-Méndez, Gerardo Víquez-Molina, Rodrigo Jiménez-García
INTRODUCTION: Long-term mortality of patients with diabetes who undergo lower extremity amputation (LEA) has not been reported in Spain. METHODS: The retrospective cohort included all subjects who underwent LEAs from January 1, 2005 to December 31, 2015 in San Jorge Hospital, Huesca, Spain. Live status of every patient up to September 2017 and the date of death were retrieved using the national death index. RESULTS: The series included 203 patients: 116 patients (57...
May 16, 2018: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/29777660/chronic-obstructive-pulmonary-disease-exacerbations-a-need-for-action
#14
Antonio Anzueto, Marc Miravitlles
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, with exacerbations contributing strongly to the overall severity and burden of disease at the individual level. Many patients with COPD are managed predominantly in the primary care setting; therefore, primary care physicians (PCPs) must have awareness and understanding of the causes, effects, and management of exacerbations in COPD. This review offers practical information regarding how exacerbations are defined in the treatment setting, pathogenic and environmental causes, options for exacerbation treatment and prevention, and suggestions for improving care in the clinic...
May 16, 2018: American Journal of Medicine
https://www.readbyqxmd.com/read/29777579/acute-blood-pressure-levels-and-long-term-outcome-in-ischemic-stroke
#15
Johan-Emil Bager, Clara Hjalmarsson, Karin Manhem, Bjorn Andersson
OBJECTIVES: Elevated blood pressure (BP) is common in acute ischemic stroke, but its effect on outcome is not fully understood. We aimed to investigate the association of baseline BP and BP change within the first day after stroke with stroke severity, functional outcome, and mortality. METHODS: Patients admitted to hospital with acute ischemic stroke (IS) from 15 February 2005 through 31 May 2009 were consecutively included. Acute stroke severity and functional outcome at three and twelve months were investigated using multivariate regression analysis; the association between BP and all-cause mortality at one, three, and twelve was investigated by Cox proportional hazard regression and Kaplan-Meier survival curves...
May 18, 2018: Brain and Behavior
https://www.readbyqxmd.com/read/29777559/utility-of-heart-rate-turbulence-and-t-wave-alternans-to-assess-risk-for-re-admission-and-cardiac-death-in-hospitalized-heart-failure-patients
#16
Shinya Yamada, Akiomi Yoshihisa, Yu Sato, Takamasa Sato, Masashi Kamioka, Takashi Kaneshiro, Masayoshi Oikawa, Atsushi Kobayashi, Hitoshi Suzuki, Takafumi Ishida, Yasuchika Takeishi
BACKGROUND: Heart failure (HF) patients have a higher risk of recurrent HF and cardiac death, and electrical remodeling is considered to be an important factor for HF progression. The present study aimed to validate the utility of electrocardiogram and Holter monitoring for the risk stratification of HF patients. METHODS: Our study comprised 215 patients (144 males, mean age 62 years) who had been hospitalized due to acute decompensated HF. Electrocardiogram (QRS duration and QTc interval) and 24-hour Holter monitoring (heart rate variability, heart rate turbulence and T-wave alternans [TWA]) were performed in stable condition before discharge...
May 18, 2018: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/29777456/distal-bowel-re-feeding-in-patients-with-proximal-jejunostomy
#17
Anand Nagar, Siddharth Mehrotra, Amitabh Yadav, Vivek Mangla, Shailendra Lalwani, Naimish Mehta, Samiran Nundy
BACKGROUND: Patients who have a proximal jejunostomy are difficult to manage because of their high stoma output which results in fluid and electrolyte imbalance with repeated hospital admissions and the necessity for expensive parenteral nutrition (PN). There are few reports on the use of re-feeding of the proximal effluents in this situation. METHODS: We here relate our experience with this manoeuvre in 35 patients between Jan 2010 and Feb 2016 who had stomas less than 120 cm away from the duodenojejunal flexure...
May 18, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29777370/analysis-of-genetic-variability-of-respiratory-syncytial-virus-groups-a-and-b-in-kuwait
#18
Nada Madi, Wassim Chehadeh, Mohammed Asadzadeh, Mariam Al-Turab, Anfal Al-Adwani
Respiratory syncytial virus (RSV) is the most frequently identified viral agent in infants, children, and elderly people with acute respiratory tract infections (ARTIs). This study is the only one of its kind in Kuwait, and its purpose was to investigate the genetic variability of the G protein gene in RSV strains prevalent in Kuwait. Respiratory samples were collected from patients with ARTIs in various hospitals in Kuwait and subjected to reverse transcription PCR (RT-PCR) amplifying a fragment of the G gene of RSV...
May 19, 2018: Archives of Virology
https://www.readbyqxmd.com/read/29777350/the-american-association-for-the-surgery-of-trauma-emergency-general-surgery-anatomic-severity-scoring-system-as-a-predictor-of-cost-in-appendicitis
#19
Eric J Finnesgard, Matthew C Hernandez, Johnathon M Aho, Martin D Zielinski
BACKGROUND: The World Society for Emergency Surgery determined that for appendicitis managed with appendectomy, there is a paucity of evidence evaluating costs with respect to disease severity. The American Association for the Surgery of Trauma (AAST) disease severity grading system is valid and generalizable for appendicitis. We aimed to evaluate hospitalization costs incurred by patients with increasing disease severity as defined by the AAST. We hypothesized that increasing disease severity would be associated with greater cost...
May 17, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29777224/progression-of-whole-blood-transcriptional-signatures-from-interferon-induced-to-neutrophil-associated-patterns-in-severe-influenza
#20
Jake Dunning, Simon Blankley, Long T Hoang, Mike Cox, Christine M Graham, Philip L James, Chloe I Bloom, Damien Chaussabel, Jacques Banchereau, Stephen J Brett, Miriam F Moffatt, Anne O'Garra, Peter J M Openshaw
Transcriptional profiles and host-response biomarkers are used increasingly to investigate the severity, subtype and pathogenesis of disease. We now describe whole-blood mRNA signatures and concentrations of local and systemic immunological mediators in 131 adults hospitalized with influenza, from whom extensive clinical and investigational data were obtained by MOSAIC investigators. Signatures reflective of interferon-related antiviral pathways were common up to day 4 of symptoms in patients who did not require mechanical ventilator support; in those who needed mechanical ventilation, an inflammatory, activated-neutrophil and cell-stress or death ('bacterial') pattern was seen, even early in disease...
May 18, 2018: Nature Immunology
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