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Critical Care*

Maryam Rouhi, Christine Stirling, Jenifer Ayton, Elaine Peta Crisp
INTRODUCTION: Women within the first 12 months after birth often do not seek professional help for post-childbirth morbidities. This systematic review uses the Behavioural Model of Health Services Use (BMSHU) to assess the barriers and facilitators to women's help-seeking from health professionals during the first twelve months after childbirth. METHOD: A qualitative meta-aggregation was used for the review. Systematic searching of Medline via Ovid, CINAHL, EMBASE and Web of Science revealed an initial 691 papers, of which 48 were reviewed...
February 8, 2019: Midwifery
Christopher F Janowak, Suresh K Agarwal, Ben L Zarzaur
BACKGROUND: We previously demonstrated that unidentified aliased patients, John Doe's (DOEs), are one of the highest risk and most medically fragile populations of injured patients. Aliasing can result in misplaced information and confusion that must be overcome by health care professionals. DOE alias use is institutionally dependent and not uniform, which may lead to significant variation in perception of confusion and error. We sought to determine if health care practitioners experience confusion that may result in compromised care when caring for injured DOE patients...
February 14, 2019: Journal of Surgical Research
Madeleine Taylor, Shaukat Khan, Molly Stapleton, Jianmin Wang, Jing Chen, Robert Wynn, Hiromasa Yabe, Yasutsugu Chinen, Jaap Jan Boelens, Robert W Mason, Francyne Kubaski, Dafne D G Horovitz, Anneliese L Barth, Marta Serafini, Maria Ester Bernardo, Hironori Kobayashi, Kenji E Orii, Yasuyuki Suzuki, Tadao Orii, Shunji Tomatsu
Allogenic hematopoietic stem cell transplantation (HSCT) has been shown to be a treatment option for a selected group of patients with mucopolysaccharidoses (MPS) (MPS I, II, IVA, VI, and VII). Early diagnosis and timely referral to an expert in MPS are critical, followed by a complete examination and evaluation with a multidisciplinary team, including a transplant physician. Treatment recommendations for MPS are based on multiple factors such as biological, sociological, and financial effects. These include type of MPS, clinical severity, prognosis, present clinical signs and symptoms (disease stage), age at onset, the rate of progression, family significances and expectations, financial burdens, feasibility, availability, risks and benefits with available therapies such as HSCT, enzyme replacement therapy (ERT), surgical interventions, and other supportive care...
February 14, 2019: Biology of Blood and Marrow Transplantation
Charles N Bernstein, Charles Burchill, Laura E Targownik, Harminder Singh, Leslie L Roos
BACKGROUND & AIMS: We performed a population-based study to determine whether there was an increased risk of inflammatory bowel diseases (IBD) in persons with critical events at birth and within 1 year of age. METHODS: We collected data from the University of Manitoba IBD Epidemiology Database, which contains records on all Manitobans diagnosed with IBD from 1984 through 2010 and matched controls. From 1970 individuals' records can be linked with those of their mothers, so we were able to identify siblings...
February 14, 2019: Gastroenterology
Joshua R Vest, Nir Menachemi, Shaun J Grannis, Jennifer L Ferrell, Suranga N Kasthurirathne, Ying Zhang, Yan Tong, Paul K Halverson
INTRODUCTION: Social determinants of health are critical drivers of health status and cost, but are infrequently screened or addressed in primary care settings. Systematic approaches to identifying individuals with unmet social determinants needs could better support practice workflows and linkages of patients to services. A pilot study examined the effect of a risk-stratification tool on referrals to services that address social determinants in an urban safety-net population. METHODS: An intervention that risk stratified patients according to the need for wraparound was evaluated in a stepped wedge design (i...
February 14, 2019: American Journal of Preventive Medicine
Gang Li, Peng Jia, Jian Zhao, Xingdan Wu, Yan Duan, Dong Liu, Ting Wang, Bin Liu
INTRODUCTION: We aimed to assess the performance of red blood cell distribution width (RDW), C-reactive protein (CRP) or the combination of both to predict clinical outcomes in pediatric non-cardiovascular critical illness. MATERIALS AND METHODS: We analyzed 404 pediatric non-cardiovascular critically ill patients admitted to pediatric intensive care unit (PICU). Potential predictors were identified using multivariable logistic regression. We also calculated the power of RDW and CRP additive to pediatric critical illness score (PCIS) to predict mortality with calculation of C-index value, integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices...
January 23, 2019: American Journal of Emergency Medicine
Turki Turki, Jason T L Wang
Predicting the response, or sensitivity, of a clinical drug to a specific cancer type is an important research problem. By predicting the clinical drug response correctly, clinicians are able to understand patient-to-patient differences in drug sensitivity outcomes, which in turn results in lesser time spent and lower cost associated with identifying effective drug candidates. Although technological advances in high-throughput drug screening in cells led to the generation of a substantial amount of relevant data, the analysis of such data would be a challenging task...
January 3, 2019: Computers in Biology and Medicine
Madeleine C Strach, Thiru Prasanna, Youlia M Kirova, Severine Alran, Sandra O'Toole, Jane M Beith, Philip Poortmans, Catriona M McNeil, Susan Carroll
Modern breast cancer care is a complex multidisciplinary undertaking in which the integrated function of multiple constituent parts is critical, and where changes to one therapeutic component may profoundly influence the delivery and outcomes of another. Oncoplastic and reconstructive breast surgery has evolved in the era of longer survival rates for women with breast cancer and aims to enhance oncological and cosmetic outcomes. However, concurrently there has been an expansion in the indications for post-mastectomy radiation therapy (Abdulkarim et al...
February 2019: Critical Reviews in Oncology/hematology
Dania Fischer, Holger Neb, Suma Choorapoikayil, Kai Zacharowski, Patrick Meybohm
Although blood transfusions have been used for more than 100 years and their potential to save lives is indisputable, there is still limited data on medium- and long-term outcomes after hemotherapy. Until recently, red blood cell transfusions represented the most commonly employed treatment for cancer anemia. As transfusions have been related to worse patient outcome in oncologic surgery, preventive strategies and alternative treatment approaches in the perioperative setting are warranted. This review aims to evaluate the evidence concerning the impact of transfusion on the course of malignant diseases with a focus on oncologic surgery and to provide a bundle of measures to improve patient care...
February 2019: Critical Reviews in Oncology/hematology
David G Leach, Simon Young, Jeffrey D Hartgerink
Macroscale biomaterials, such as preformed implantable scaffolds and injectable soft materials, possess powerful synergies with anti-cancer immunotherapies. Immunotherapies on their own typically have poor delivery properties, and often require repeated high-dose injections that result in serious off-tumor effects and/or limited efficacy. Rationally designed biomaterials allow for discrete localization and controlled release of immunotherapeutic agents, and have been shown in a large number of applications to improve outcomes in the treatment of cancers via immunotherapy...
February 13, 2019: Acta Biomaterialia
Karen E Kun, Aleny Couto, Kebba Jobarteh, Rose Zulliger, Elpidia Pedro, Inacio Malimane, Andrew Auld, Marisa Meldonian
The Community Antiretroviral (ARV) Therapy Support Group (CASG) program aims to address low retention rates in Mozambique's HIV treatment program and the absorptive capacity of the country's health facilities. CASG provides patients with the opportunity to form groups, whose members provide peer support and collect ARV medications on a rotating basis for one another. Based on the promising results in one province, a multi-site level evaluation followed. We report on qualitative findings from this evaluation from the patient perspective on the role of social relationships (as facilitated through CASG) in conferring time, financial, educational and psychosocial benefits that contribute to improved patient retention...
February 15, 2019: AIDS and Behavior
Anat Yerushalmy-Feler, Jacqueline Padlipsky, Shlomi Cohen
PURPOSE OF REVIEW: Cytomegalovirus (CMV) colitis is a relatively common end-organ infectious complication in immunocompromised hosts which negatively affects clinical outcomes. This paper presents the contemporary approaches to the diagnosis and management of CMV colitis and discusses some of the controversies of this condition, focusing on methods of diagnosis. RECENT FINDINGS: While certain risk factors for CMV colitis are well recognized, the clinical as well as endoscopic features of this condition are nonspecific...
February 15, 2019: Current Infectious Disease Reports
Lawrence D Frank, Jennifer L Kuntz, James E Chapman, Eric H Fox, John F Dickerson, Richard T Meenan, Brian E Saelens, Deborah R Young, Janne Boone-Heinonen, Stephen P Fortmann
BACKGROUND: The health impacts of community design have been studied extensively over the past two decades. In particular, public transportation use is associated with more walking between transit stops and shops, work, home and other destinations. Change in transit access has been linked with physical activity and obesity but seldom to health outcomes and associated costs, especially within a causal framework. Health related fiscal impacts of transit investment should be a key consideration in major transit investment decisions...
February 15, 2019: BMC Public Health
Lorene M Nelson, Mitchell T Wallin, Ruth Ann Marrie, W J Culpepper, Annette Langer-Gould, Jon Campbell, Stephen Buka, Helen Tremlett, Gary Cutter, Wendy Kaye, Laurie Wagner, Nicholas G Larocca
OBJECTIVE: Considerable gaps exist in knowledge regarding the prevalence of neurologic diseases, such as multiple sclerosis (MS), in the United States. Therefore, the MS Prevalence Working Group sought to review and evaluate alternative methods for obtaining a scientifically valid estimate of national MS prevalence in the current health care era. METHODS: We carried out a strengths, weaknesses, opportunities, and threats (SWOT) analysis for 3 approaches to estimate MS prevalence: population-based MS registries, national probability health surveys, and analysis of administrative health claims databases...
February 15, 2019: Neurology
Kathryn Polak, Sydney Kelpin, Mishka Terplan
Substance use during pregnancy is common, costly and associated with maternal and newborn health consequences. Assessment of substance use should be integrated into prenatal care. Substance use identification methods include patient interview, screening instruments, and biological testing. In this review, we critically evaluate screening and testing for substance use during pregnancy, highlighting the benefits and barriers of integrated assessment into prenatal care. We also discuss the limitations and negative consequences that should be considered when implementing screening and/or testing procedures...
February 5, 2019: Seminars in Fetal & Neonatal Medicine
Zerrin Defne Dundar, Sedat Kocak, Abdullah Sadik Girisgin
INTRODUCTION: In this study, we aimed to investigate the prognostic power of the first lactate level measured in the emergency department (ED), National Early Warning Score (NEWS), and NEWS-lactate (NEWS-L) on ED admission in critically ill geriatric patients. METHODS: This retrospective observational study was conducted in the ED of a university hospital. Consecutive patients ≥65 years of age admitted to our ED between July 1, 2017, and December 31, 2017, and transferred to the intensive care unit after the ED follow-up period were included in the study...
February 7, 2019: American Journal of Emergency Medicine
Benjamin Thomas, Emre Gazyakan, Florian Falkner, Volker J Schmidt, Christoph Hirche, Ulrich Kneser, Amir K Bigdeli
BACKGROUND: Though technically feasible, free tissue transfer carries the risk of perioperative morbidity and mortality in elderly patients. To minimize the operative treatment time and complication rates, we choose the rectus abdominis muscle (RAM) flap. METHODS: Between 2012 and 2017, 34 patients (mean age: 74±7 years, range: 65-89 years) with comorbidities underwent defect reconstruction with a free RAM flap. Recipient-sites were: lower extremity (65%), trunk (18%), upper extremity (12%), and head and neck (6%)...
January 11, 2019: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Katharina Mattishent, Menaka Thavarajah, Ashnish Sinha, Adam Peel, Matthias Egger, Joseph Solomkin, Stijn de Jonge, Asad Latif, Sean Berenholtz, Benedetta Allegranzi, Yoon Kong Loke
BACKGROUND: Evidence-based guidelines from the World Health Organization (WHO) have recommended a high (80%) fraction of inspired oxygen (FiO2 ) to reduce surgical site infection in adult surgical patients undergoing general anaesthesia with tracheal intubation. However, there is ongoing debate over the safety of high FiO2 . We performed a systematic review to define the relative risk of clinically relevant adverse events (AE) associated with high FiO2 . METHODS: We reviewed potentially relevant articles from the WHO review supporting the recommendation, including an updated (July 2018) search of EMBASE and PubMed for randomised and non-randomised controlled studies reporting AE in surgical patients receiving 80% FiO2 compared with 30-35% FiO2 ...
March 2019: British Journal of Anaesthesia
Christopher J Nolan, Marc Prentki
While few dispute the existence of the metabolic syndrome as a clustering of factors indicative of poor metabolic health, its utility above that of its individual components in the clinical care of individual patients is questioned. This is likely a consequence of the failure of clinicians and scientists to agree on a unifying mechanism to explain the metabolic syndrome. Insulin resistance has most commonly been proposed for this role and is generally considered to be a root causative factor for not only metabolic syndrome but also for its associated conditions of non-alcoholic fatty liver disease (NAFLD), polycystic ovary syndrome (PCOS), obesity-related type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD)...
February 15, 2019: Diabetes & Vascular Disease Research
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
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