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Acute and critical care

Mallory S Abate, Laura R Battle, Ashley N Emerson, Jerad M Gardner, Sara C Shalin
CONTEXT.—: Fatal dermatologic diseases and ones with high morbidity can occur in the inpatient setting. In such cases, prompt and accurate assessment of a bedside skin biopsy is required. This may be challenging for many pathologists who are not familiar with the complexity of skin pathology and skin terminology within the fields of dermatopathology and dermatology. OBJECTIVE.—: To provide the pathologist with a practical, up-to-date, and "must-know" reference guide on dermatologic urgencies and emergencies from a real-world perspective, highlighting diagnostic pearls, diagnostic pitfalls, and commonly encountered practice gaps...
February 20, 2019: Archives of Pathology & Laboratory Medicine
Stéphane Gaudry, Jean-Pierre Quenot, Alexandre Hertig, Saber Davide Barbar, David Hajage, Jean-Damien Ricard, Didier Dreyfuss
Acute kidney injury (AKI) affects many intensive care unit patients and is responsible for increased morbidity and mortality. Although life-saving in many situations, renal replacement therapy (RRT) may be associated with complications and the appropriate timing of its initiation is still the subject of intense debate. An early initiation strategy can prevent some metabolic complications whereas a delayed one may allow for renal function recovery in some patients without need for this costly and potentially dangerous technique...
February 20, 2019: American Journal of Respiratory and Critical Care Medicine
Mark P Plummer, Jeroen Hermanides, Adam M Deane
In health, postprandial glycemic excursions are attenuated via stimulation of insulin secretion, suppression of glucagon secretion, and slowing of gastric emptying. The incretin hormones, glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide, are primary modulators of this response. Drugs have recently been developed that exploit the incretin-axis for the management of type 2 diabetes. There is burgeoning interest in the potential of incretin therapies for the management of acute hyperglycemia in the critically ill...
April 2019: Critical Care Clinics
Adam M Blevins, Jennifer N Lashinsky, Craig McCammon, Marin Kollef, Scott Micek, Paul Juang
Critically ill patients are frequently treated with empiric antibiotic therapy including vancomycin and β-Lactams. Recent evidence suggests an increased risk of acute kidney injury (AKI) in patients who received the combination of vancomycin and piperacillin/tazobactam (VPT) compared with patients who received vancomycin alone or vancomycin in combination with cefepime (VC) or meropenem (VM), but most studies have been conducted predominately in the non-critically ill population. A retrospective cohort study including 2492 patients was conducted in the intensive care units of a large university hospital with the primary outcome being the development of any AKI...
February 19, 2019: Antimicrobial Agents and Chemotherapy
Gerald Chi, C Michael Gibson, Arzu Kalayci, Alexander T Cohen, Adrian F Hernandez, Russell D Hull, Farima Kahe, Mehrian Jafarizade, Sadaf Sharfaei, Yuyin Liu, Robert A Harrington, Samuel Z Goldhaber
PURPOSE: To assess the efficacy and safety of betrixaban for venous thromboembolism (VTE) prophylaxis among critically ill patients. METHODS: The APEX trial randomized 7513 acutely ill hospitalized patients to betrixaban for 35-42 days or enoxaparin for 10 ± 4 days. Among those, 703 critically ill patients admitted to the intensive care unit were included in the analysis, and 547 patients who had no severe renal insufficiency or P-glycoprotein inhibitor use were included in the full-dose stratum...
February 18, 2019: Intensive Care Medicine
Elias Wagner, Georg Marckmann, Ralf J Jox
AIMS: In the case of acute brain injury, decision-making uncertainties can arise when both an advance decision to refuse treatment and a prior consent to post-mortem organ donation are present. It is yet unknown how the persons concerned view this potential conflict. The present study aims to investigate how frequent this situation is, whether the persons concerned are aware of the potential conflict and what they would prioritize. METHODS: Semi-quantitative cross-sectional survey of senior citizens of a metropolitan region in Germany using a literature-based questionnaire...
February 18, 2019: Das Gesundheitswesen
Dorothy M Wade, Paul R Mouncey, Alvin Richards-Belle, Jerome Wulff, David A Harrison, M Zia Sadique, Richard D Grieve, Lydia M Emerson, Alexina J Mason, David Aaronovitch, Nicole Als, Chris R Brewin, Sheila E Harvey, David C J Howell, Nicholas Hudson, Monty G Mythen, Deborah Smyth, John Weinman, John Welch, Chris Whitman, Kathryn M Rowan
Importance: A meta-analysis of outcomes during the 6 months after intensive care unit (ICU) discharge indicate a prevalence for clinically important posttraumatic stress disorder (PTSD) symptoms of 25%. Objective: To determine whether a nurse-led preventive, complex psychological intervention, initiated in the ICU, reduces patient-reported PTSD symptom severity at 6 months. Design, Setting, and Participants: A multicenter, parallel-group, cluster-randomized clinical trial with integrated economic and process evaluations conducted in 24 ICUs in the United Kingdom...
February 19, 2019: JAMA: the Journal of the American Medical Association
Wendy Jo Svetanoff, Benjamin Zendejas, Farokh R Demehri, Alex Cuenca, Bharath Nath, C Jason Smithers
Introduction: There are no reported survivors of gastroschisis with complete liver herniation. We describe a case report of two patients, one of whom survived. Case #1: The patient was born with gastroschisis and herniation of the entire liver. Along with silo placement, the abdominal fascia was attached to an external traction system for growth. Complete closure was achieved at 5 months. Due to pulmonary hypoplasia, high-frequency ventilation was required. The patient is doing well, on a home ventilator wean, at 20 months...
2019: Case Reports in Surgery
Soo Jin Na, Taek Kyu Park, Joo Myung Lee, Young Bin Song, Jin-Oh Choi, Joo-Yong Hahn, Jin-Ho Choi, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh, Joong Hyun Ahn, Keumhee C Carriere, Jeong Hoon Yang
BACKGROUND: Data on the association between obesity and mortality in patients who require acute cardiac care are limited, so we investigated the effect of obesity on clinical outcomes in patients admitted to the cardiac intensive care unit (CICU). Methods and Results: We reviewed 2,429 eligible patients admitted to the CICU at Samsung Medical Center between January 2012 and December 2015. After excluding 197 patients with low body mass index (BMI) to adjust for the possibility of frailty, patients were divided into 3 categories: normal BMI (n=822), 18...
February 16, 2019: Circulation Journal: Official Journal of the Japanese Circulation Society
Michael Schreiber, Clemens-Alexander Greim
The rising impact of perioperative sonography is mainly based on mobile high quality ultrasound systems. Relevant bleedings or functional limitations of the abdomen are easy to identify with sonography. The FAST-Concept can be the first access to continue proceedings in ultrasound examination of the abdomen. This paper demonstrates some important ultrasound examinations of the abdomen. The clinical main issues are traumatic and atraumatic bleedings of heart, liver and spleen with haemodynamic instability and functional limitations of abdominal organs like bile cystitis, gastrointestinal passage disability and obstructive uropathy...
February 2019: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Benjamin Vojnar, Martin Zoremba
With focused transthoracic echocardiography (TTE) we rapidly and non-invasively receive up-to-date information on a patient's hemodynamic status. These can subsequently influence our therapy and thus our risk management. Postoperatively, TTE has proved its worth as an examination method in the recovery room and in the intensive care unit to promptly diagnose life-threatening causes of circulatory depression. Acute pathology such as a pericardial tamponade or fulminant pulmonary artery embolism can be detected quickly and thus possibly time-consuming transport to a CT can be avoided...
February 2019: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Anil C Anand, Pankaj Singh
Neurologic dysfunction characterised by Hepatic Encephalopathy (HE) and cerebral oedema are the most dramatic presentations of Acute Liver Failure (ALF) and signify poor outcome. Improved critical care and wider availability of emergency Liver Transplantation (LT) has improved survivability in ALF. In most cases absence of clinically overt encephalopathy after spontaneous recovery from ALF or after LT is thought to indicate complete neurologic recovery. Recent data suggests that neurologic recovery may not always be complete...
January 2019: Journal of Clinical and Experimental Hepatology
Tim Gutierrez, Greg Hambright, Tahir Mustafa, Anthony Cahill, Vaidehi Agrawal, Michael S Truitt
No abstract text is available yet for this article.
January 1, 2019: American Surgeon
Tim Gutierrez, Greg Hambright, Tahir Mustafa, Anthony Cahill, Vaidehi Agrawal, Michael S Truitt
No abstract text is available yet for this article.
January 1, 2019: American Surgeon
Michael R Nahouraii, Colleen H Karvetski, Rita A Brintzenhoff, Gaurav Sachdev, Susan L Evans, Toan T Huynh
Multiprofessional rounds (MPR) represent a mechanism for the coordination of care in critically ill patients. Herein, we examined the impact of MPR on ventilator days (Vent-day), ICU length of stay (LOS), hospital LOS (HLOS), and mortality. A team developed guidelines for MPR, which began in February 2016. Patients admitted between November 2015 and March 2017 with Acute Physiology and Chronic Health Evaluation (APACHE) IV and injury severity scores were included. Outcome data consisted of Vent-day, Vent-day observed/expected ratio (O/E), ICU LOS, ICU LOS O/E, HLOS, HLOS-O/E, and mortality...
January 1, 2019: American Surgeon
Michael H Gold, Julie Biron
INTRODUCTION: Skin rejuvenation procedures have become common with sophisticated technologies with reduced downtime and related risks. Recently, microneedling has been paired with radiofrequency to create Fractional Radiofrequency Microneedling (FRFM) to induce neocollagenesis. Frequently, topical products are applied immediately after the needling. This procedure is known as percutaneous collagen induction therapy (PCIT). Postoperative topical wound care is critical for prompt rapid and safe healing, with moist wound healing deemed of primary importance for fast and correct scarring process...
February 12, 2019: Journal of Cosmetic Dermatology
Timothy R Leclair, Neil Zakai, Janice Y Bunn, Michael Gianni, Daren K Heyland, Sara S Ardren, Renee D Stapleton
BACKGROUND: The utility of vitamin D (VITD) supplementation during critical illness and whether it may alter outcomes, including mortality and ventilator-free days, is unclear. We performed a retrospective cohort study in a generalizable population to investigate this question. METHODS: We included all mechanically ventilated adults admitted to the medical intensive care unit (ICU) service at a tertiary center from 2009 to 2012 who were in the ICU for at least 72 hours...
February 12, 2019: JPEN. Journal of Parenteral and Enteral Nutrition
Han-Tao Li, Chih-Hong Lee, Tony Wu, Mei-Yun Cheng, Wei-En Johnny Tseng, Chun-Wei Chang, Hsiang-Yao Hsieh, Hsing-I Chiang, Chih-Yin Lin, Bao-Luen Chang, Wey-Ran Lin, Siew-Na Lim
BACKGROUND: The incidence of cefepime-induced neurotoxicity (CIN) has been previously underestimated, and there have only been sporadic reports from critical neurological settings. The present study aimed to investigate the potential factors associated with disease development, electroencephalography (EEG) sub-classification, and outcome measures. METHODS: The 10-year medical records of patients who underwent EEG between 2007 and 2016 at a tertiary medical center in Taiwan, and developed encephalopathy after cefepime therapy were retrospectively reviewed...
February 12, 2019: Neurocritical Care
A C Jackson
Rabies is an acute neurological infection of humans and animals, caused by rabies virus and usually transmitted by animal bites. After an incubation period usually lasting weeks or longer, a variety of prodromal symptoms may occur. Encephalitic rabies (80% of cases) is associated with episodes of generalised arousal or hyperexcitability and hydrophobia, in which spasms involve the contraction of inspiratory muscles with swallowing. Paralytic rabies (in 20% of cases) is characterised by progressive lower motor neuron weakness...
August 2018: Revue Scientifique et Technique
Janet E Squires, Ian D Graham, Doris Grinspun, John Lavis, France Légaré, Robert Bell, Stephen Bornstein, Susan E Brien, Mark Dobrow, Megan Greenough, Carole A Estabrooks, Michael Hillmer, Tanya Horsley, Alan Katz, Christina Krause, Wendy Levinson, Adrian Levy, Michelina Mancuso, Alies Maybee, Steve Morgan, Letitia Nadalin Penno, Andrew Neuner, Tamara Rader, Janet Roberts, Gary Teare, Joshua Tepper, Amanda Vandyk, Denise Widmeyer, Michael Wilson, Jeremy M Grimshaw
BACKGROUND: There is increasing recognition in Canada and globally that a substantial proportion of health care delivered is inappropriate as evidenced by (1) harmful and/or ineffective practices being overused, (2) effective clinical practices being underused, and (3) other clinical practices being misused. Inappropriate health care leads to negative patient experiences, poor health outcomes, and inefficient use of scarce health care resources. The purpose of this study is to conduct a systematic review of inappropriate health care in Canada...
February 11, 2019: Systematic Reviews
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