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Critical patients

Maya L Henry, Stephanie M Grasso
Speech-language pathologists play a crucial role in the assessment and treatment of individuals with primary progressive aphasia (PPA). The speech-language evaluation is a critical aspect of the diagnostic and rehabilitative process, informing differential diagnosis as well as intervention planning and monitoring of cognitive-linguistic status over time. The evaluation should include a thorough case history and interview and a detailed assessment of speech-language and cognitive functions, with tasks designed to detect core and associated deficits outlined in current diagnostic criteria...
July 2018: Seminars in Speech and Language
Bethany A Matus, Kayla M Bridges, John V Logomarsino
BACKGROUND: Individualized feeding care plans and safe handling of milk (human or formula) are critical in promoting growth, immune function, and neurodevelopment in the preterm infant. Feeding errors and disruptions or limitations to feeding processes in the neonatal intensive care unit (NICU) are associated with negative safety events. Feeding errors include contamination of milk and delivery of incorrect or expired milk and may result in adverse gastrointestinal illnesses. PURPOSE: The purpose of this review was to evaluate the effect(s) of centralized milk preparation, use of trained technicians, use of bar code-scanning software, and collaboration between registered dietitians and registered nurses on feeding safety in the NICU...
June 21, 2018: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Pierre Lemarie, Solenne Husser Vidal, Soizic Gergaud, Xavier Verger, Emmanuel Rineau, Jerome Berton, Elsa Parot-Schinkel, Jean-François Hamel, Sigismond Lasocki
BACKGROUND: Although continuous renal replacement therapy (CRRT) is common, unplanned interruptions (UI) often limit its usefulness. In many units, nurses are responsible for CRRT management. We hypothesized that a nurse training program based on high-fidelity simulation would reduce the rate of interrupted sessions. METHODS: We performed a 2-phase (training and evaluation), randomized, single-center, open study: During the training phase, intensive care unit nurses underwent a 6-hour training program and were randomized to receive (intervention) or not (control) an additional high-fidelity simulation training (6 hours)...
June 20, 2018: Anesthesia and Analgesia
Jonathan Wagner, Piergiuseppe Agostoni, Ross Arena, Romualdo Belardinelli, Daniel Dumitrescu, Alfred Hager, Jonathan Myers, Rainer Rauramaa, Marshall Riley, Tim Takken, Arno Schmidt-Trucksäss
Heart failure with reduced ejection fraction (HFrEF) is common in the developed world and results in significant morbidity and mortality. Accurate risk assessment methods and prognostic variables are therefore needed to guide clinical decision making for medical therapy and surgical interventions with the ultimate goal of decreasing risk and improving health outcomes. The purpose of this review is to examine the role of cardiopulmonary exercise testing (CPET) and its most commonly used ventilatory gas exchange variables for the purpose of risk stratification and management of HFrEF...
May 22, 2018: American Heart Journal
Shenshen Li, James A Blumenthal, Chuan Shi, Danielle Millican, Xian Li, Xin Du, Anushka Patel, Pei Gao, Elizabeth Delong, Pallab K Maulik, Runlin Gao, Xin Yu, Yangfeng Wu
Depression and acute coronary syndromes (ACS) are both common public health challenges. Patients with ACS often develop depression, which in turn adversely affects prognosis. Low-cost, sustainable, and effective service models that integrate depression care into the management of ACS patients to reduce depression and improve ACS outcomes are critically needed. Integrating Depression Care in ACS patients in Low Resource Hospitals in China (I-CARE) is a multicenter, randomized controlled trial to evaluate the efficacy of an 11-month integrated care (IC) intervention compared to usual care (UC) in management of ACS patients...
May 21, 2018: American Heart Journal
Heather Allewelt, Mahsa Taskindoust, Jesse Troy, Kristin Page, Susan Wood, Suhag Parikh, Vinod K Prasad, Joanne Kurtzberg
Allogeneic hematopoietic stem cell transplantation (HSCT) can retard the progression of early infantile Krabbe disease (EIKD). Superior outcomes are achieved if HSCT is performed prior to the onset of symptoms, however little information is available about the long-term outcomes in surviving patients. We now describe functional outcomes in pre-symptomatic infants who underwent HSCT for EIKD at ≤2 months of life. Records of the 19 patients who underwent HSCT for EIKD at ≤2 months of age from 1996-2010 were reviewed...
June 19, 2018: Biology of Blood and Marrow Transplantation
In-Sung Song, Yu Jeong Jeong, Seung Hun Jeong, Hyoung Kyu Kim, Nam-Chul Ha, MyungGeun Shin, Kyung Soo Ko, Byoung Doo Rhee, Sungbo Shim, Sung-Wuk Jang, Jin Han
Multiple myeloma (MM) is a neoplastic plasma cell disorder with high disease recurrence rates. Novel therapeutic approaches capable of improving outcomes in patients with MM are urgently required. The AKT signalling plays a critical regulatory role in MM pathophysiology, including survival, proliferation, metabolism, and has emerged as a key therapeutic target. Here, we identified a novel AKT inhibitor, HS1793, and defined its mechanism of action and clinical significance in MM. HS1793 disrupted the interaction between AKT and heat shock protein 90, resulting in protein phosphatase 2A-modulated phosphorylated-AKT (p-AKT) reduction...
June 19, 2018: Cancer Letters
Jessica Keim-Malpass, Kyle B Enfield, James Forrest Calland, Douglas E Lake, Matthew T Clark
Predictive analytics monitoring that informs clinicians of the risk for failed extubation would help minimize both the duration of mechanical ventilation and the risk of emergency re-intubation in ICU patients. We hypothesized that dynamic monitoring of cardiorespiratory data, vital signs, and lab test results would add information to standard clinical risk factors. To develop predictive analytic models for patients who failed extubation in critical care settings in an academic medical center using standard and novel risk factors...
June 22, 2018: Physiological Measurement
George Vasquez-Rios, Hani Alkhankan, Boutros Peter Sawaya, Javier A Neyra
INTRODUCTION: Methanol intoxication is an infrequent cause of poisoning in the United Sates. It can present with prominent stroke-like features and acute kidney injury. Despite the life-threatening nature of this condition, it is poorly identified by clinicians. We aim to present a case of rapidly progressive mental decline and renal involvement, discuss a diagnostic work-up and provide a critical review on therapeutic strategies. CASE PRESENTATION: A 24-year-old patient presented to the emergency department with acute encephalopathy and diffuse muscular rigidity...
June 22, 2018: Clinical Nephrology
Ariel Tankus, Anat Mirelman, Nir Giladi, Itzhak Fried, Jeffrey M Hausdorff
OBJECTIVE The ability to modulate the pace of movement is a critical factor in the smooth operation of the motor system. The authors recently described distinct and overlapping representations of movement kinematics in the subthalamic nucleus (STN), but it is still unclear how movement pace is modulated according to the demands of the task at the neuronal level in this area. The goal of this study was to clarify how different movement paces are being controlled by neurons in the STN. METHODS The authors performed direct recording of the electrical activity of single neurons in the STN of neurosurgical patients with Parkinson's disease undergoing implantation of a deep brain stimulator under local anesthesia while the patients performed repetitive foot and hand movements intraoperatively at multiple paces...
June 22, 2018: Journal of Neurosurgery
Randall B Graham, Mathew Cotton, Antoun Koht, Tyler R Koski
Various complications of prone positioning in spine surgery have been described in the literature. Patients in the prone position for extended periods are subject to neurological deficits and/or loss of intraoperative signals due to compression neuropathies, but positioning-related spinal deficits are rare in the thoracolumbar deformity population. The authors present a case of severe kyphoscoliotic deformity with critical thoracolumbar stenosis in which, during the use of a hinged open frame in the prone position, complete loss of intraoperative neural monitoring signals occurred while the frame was flexed into kyphosis to facilitate exposure and instrumentation placement...
June 22, 2018: Journal of Neurosurgery. Spine
Andrés R Pérez-Riera, Raimundo Barbosa-Barros, Marianne P C de Rezende Barbosa, Rodrigo Daminello-Raimundo, Luiz C de Abreu, Kjell Nikus
In left bundle branch block (LBBB), the ventricles are activated in a sequential manner with alterations in left ventricular mechanics, perfusion, and workload resulting in cardiac remodeling. Underlying molecular, cellular, and interstitial changes manifest clinically as changes in size, mass, geometry, and function of the heart. Cardiac remodeling is associated with progressive ventricular dysfunction, arrhythmias, and impaired prognosis. Clinical and diagnostic notions about LBBB have evolved from a simple electrocardiographic alteration to a critically important finding affecting diagnostic and clinical management of many patients...
June 22, 2018: Annals of Noninvasive Electrocardiology
Li-Na Wang, Xin-Qing Zhu, Xi-Shuang Song, Yong Xu
Recently, long noncoding RNAs have emerged as new gene regulators and prognostic markers in several cancers, including renal cell carcinoma (RCC). Here, we focused on the long noncoding RNA lung cancer associated transcript 1 (LUCAT1) based on clear cell RCC (ccRCC) the cancer genome atlas (TCGA) data. However, whether aberrant expression of LUCAT1 in ccRCC is correlated with malignancy, metastasis or prognosis has not been elucidated. In the current study, we found that the expression of LUCAT1 was upregulated in ccRCC tissues and cancer cell lines...
June 22, 2018: Journal of Cellular Biochemistry
Julia Lühnen, Ingrid Mühlhauser, Anke Steckelberg
BACKGROUND: The patient's consent to a medical procedure must be preceded by a pre-procedure discussion with the physician that is documented on a standardized form. Evidence suggests that these forms lack information that would be relevant for an informed decision. METHODS: We carried out a systematic literature search up to February 2017 for evidence on the quality and efficacy of informed consent forms. The definition of criteria for the evaluation of meta-information, content, and presentation were derived from current guidelines for evidence-based health information...
June 1, 2018: Deutsches Ärzteblatt International
Scott K Ferguson, Katherine Redinius, Ayla Yalamanoglu, Julie W Harral, Jin Hyen Baek, David Pak, Zoe Loomis, Daniel Hassel, Paul Eigenberger, Eva Grayck, Rachelle Nuss, Kathryn Hassell, Kurt R Stenmark, Paul W Buehler, David C Irwin
KEY POINTS SUMMARY: Sickle cell disease (SCD) results in cardiopulmonary dysfunction, which may be exacerbated by prolonged exposure to environmental hypoxia. It is currently unknown if exposure to mild and moderate altitude exacerbates SCD associated cardiopulmonary and systemic complications. Three months of exposure to mild (1609 meters) and moderate (2438) altitude increased rates of hemolysis and right ventricular systolic pressures in mice with SCD when compared to healthy wild-type cohorts and SCD mice at sea level...
June 21, 2018: Journal of Physiology
Jing-Ya Kuang, Yu-Feng Guo, Ying Chen, Jun Wang, Jiang-Jie Duan, Xiao-Li He, Lin Li, Shi-Cang Yu, Xiu-Wu Bian
Although the deregulation of epidermal growth factor receptor (EGFR) is one of the most common molecular mechanisms of glioblastoma (GBM) pathogenesis, the efficacy of anti-EGFR therapy is limited. Additionally, response to anti-EGFR therapy is not solely dependent on EGFR expression and is more promising in patients with reduced activity of EGFR downstream signaling pathways. Thus, there is considerable interest in identifying the compensatory regulatory factors of the EGFR signaling pathway to improve the efficacy of anti-EGFR therapies for GBM...
June 21, 2018: Cancer Science
V Fischer, M Haffner-Luntzer, M Amling, A Ignatius
Calcium and vitamin D are essential for maintaining bone health. Therefore, deficiencies in calcium and vitamin D are major risk factors for osteoporosis development. Because sufficient amounts of calcium are also required for fracture-callus mineralisation, compromised bone repair that is frequently observed in osteoporotic patients might be attributed to calcium and vitamin D deficiencies. Consequently, calcium and vitamin D supplementation represents a potential strategy for treating compromised fracture healing in osteoporotic patients...
June 22, 2018: European Cells & Materials
Trushil Shah, Shanshan Qin, Mona Vashi, Dan N Predescu, Niranjan Jeganathan, Cristina Bardita, Balaji Ganesh, Salvatore diBartolo, Louis F Fogg, Robert A Balk, Sanda A Predescu
BACKGROUND: Pulmonary endothelial cells' (ECs) injury and apoptotic death are necessary and sufficient for the pathogenesis of the acute respiratory distress syndrome (ARDS), regardless of epithelial damage. Interaction of dysfunctional ECs with circulatory extracellular vesicles (EVs) holds therapeutic promise in ARDS. However, the presence in the blood of long-term ARDS survivors of EVs with a distinct phenotype compared to the EVs of non-surviving patients is not reported. With a multidisciplinary translational approach, we studied EVs from the blood of 33 patients with moderate-to-severe ARDS...
June 22, 2018: Clinical and Translational Medicine
Philippe Vignon, Benjamin Pegot, François Dalmay, Vanessa Jean-Michel, Simon Bocher, Erwan L'her, Jérôme Cros, Gwenaël Prat
PURPOSE: To assess the impact of computerized transthoracic echocardiography (TTE) simulation on the learning curve to achieve competency in basic critical care echocardiography (CCE). METHODS: In this prospective bicenter study, noncardiologist residents novice in ultrasound followed either a previously validated training program with adjunctive computerized simulation on a mannequin (two 3 h-sessions; Vimedix simulator, CAE Healthcare) (interventional group; n = 12) or solely the same training program (control group; n = 12)...
June 21, 2018: Intensive Care Medicine
Gregory Cook, Sonali Patel, Rachael Williams, Juvonda Hodge, Walter Ingram, Rita Gayed
Fulminant hepatic failure secondary to herpes simplex virus (HSV) is a rare complication that is associated with high mortality. Here, we describe the case of a critically ill patient with severe burns and inhalation injury who developed severe coagulopathy during her hospital stay, which was later found to be caused by HSV hepatitis. In addition, we review the current literature on HSV hepatitis. Only three prior reports document liver involvement of HSV in patients with burn. Clinical symptoms, diagnostic factors, and management of HSV hepatitis in patients with burn are presented...
December 5, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
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