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Roozbeh Nikooie, Karin J Neufeld, Esther S Oh, Lisa M Wilson, Allen Zhang, Karen A Robinson, Dale M Needham
Background: Delirium is common in hospitalized patients and is associated with worse outcomes. Antipsychotics are commonly used; however, the associated benefits and harms are unclear. Purpose: To conduct a systematic review evaluating the benefits and harms of antipsychotics to treat delirium in adults. Data Sources: PubMed, Embase, CENTRAL, CINAHL, and PsycINFO from inception to July 2019 without language restrictions. Study Selection: Randomized controlled trials (RCTs) of antipsychotic versus placebo or another antipsychotic, and prospective observational studies reporting harms...
September 3, 2019: Annals of Internal Medicine
Stefanie Schüpke, Franz-Josef Neumann, Maurizio Menichelli, Katharina Mayer, Isabell Bernlochner, Jochen Wöhrle, Gert Richardt, Christoph Liebetrau, Bernhard Witzenbichler, David Antoniucci, Ibrahim Akin, Lorenz Bott-Flügel, Marcus Fischer, Ulf Landmesser, Hugo A Katus, Dirk Sibbing, Melchior Seyfarth, Marion Janisch, Duino Boncompagni, Raphaela Hilz, Wolfgang Rottbauer, Rainer Okrojek, Helge Möllmann, Willibald Hochholzer, Angela Migliorini, Salvatore Cassese, Pasquale Mollo, Erion Xhepa, Sebastian Kufner, Axel Strehle, Stefan Leggewie, Abdelhakim Allali, Gjin Ndrepepa, Helmut Schühlen, Dominick J Angiolillo, Christian W Hamm, Alexander Hapfelmeier, Ralph Tölg, Dietmar Trenk, Heribert Schunkert, Karl-Ludwig Laugwitz, Adnan Kastrati
BACKGROUND: The relative merits of ticagrelor as compared with prasugrel in patients with acute coronary syndromes for whom invasive evaluation is planned are uncertain. METHODS: In this multicenter, randomized, open-label trial, we randomly assigned patients who presented with acute coronary syndromes and for whom invasive evaluation was planned to receive either ticagrelor or prasugrel. The primary end point was the composite of death, myocardial infarction, or stroke at 1 year...
September 1, 2019: New England Journal of Medicine
Fellype Carvalho Barreto, Daniela Veit Barreto, Ziad A Massy, Tilman B Drüeke
Hyperphosphatemia is a common complication in patients with chronic kidney disease (CKD), particularly in those requiring renal replacement therapy. The importance of controlling serum phosphate has long been recognized based on observational epidemiological studies that linked increased phosphate levels to adverse outcomes and higher mortality risk. Experimental data further supported the role of phosphate in the development of bone and cardiovascular diseases. Recent advances in our understanding of the mechanisms involved in phosphate homeostasis have made it clear that the serum phosphate concentration depends on a complex interplay among the kidneys, intestinal tract, and bone, and is tightly regulated by a complex endocrine system...
August 2019: KI Reports
Todd H Baron, Christopher J DiMaio, Andrew Y Wang, Katherine A Morgan
DESCRIPTION: The purpose of this AGA Institute Clinical Practice Update is to review the available evidence and expert recommendations regarding the clinical care of patients with pancreatic necrosis and to offer concise best practice advice for the optimal management of patients with this highly morbid condition. METHODS: This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology...
August 31, 2019: Gastroenterology
Burkhard Tümmler
Infections with Pseudomonas aeruginosa have been marked with the highest priority for surveillance and epidemiological research on the basis of parameters such as incidence, case fatality rates, chronicity of illness, available options for prevention and treatment, health-care utilization, and societal impact. P. aeruginosa is one of the six ESKAPE pathogens that are the major cause of nosocomial infections and are a global threat because of their capacity to become increasingly resistant to all available antibiotics...
2019: F1000Research
Gabriel Wardi, Jessica Brice, Matthew Correia, Dennis Liu, Michael Self, Christopher Tainter
The role of lactic acid and its conjugate base, lactate, has evolved during the past decade in the care of patients in the emergency department (ED). A recent national sepsis quality measure has led to increased use of serum lactate in the ED, but many causes for hyperlactatemia exist outside of sepsis. We provide a review of the biology of lactate production and metabolism, the many causes of hyperlactatemia, and evidence on its use as a marker in prognosis and resuscitation. Additionally, we review the evolving role of lactate in sepsis care...
August 29, 2019: Annals of Emergency Medicine
Michael C Sklar, Michael E Detsky
PURPOSE OF REVIEW: To describe techniques to facilitate safe intubation in critically ill patients. RECENT FINDINGS: Despite advances in the treatment of critically ill patients, endotracheal intubation remains a high-risk procedure associated with complications that can lead to appreciable morbidity and mortality. In addition to the usual anatomical factors that can predict a difficult intubation, incorporating pathophysiological considerations and crisis resource management may enhance safety and mitigate risk...
September 3, 2019: Current Opinion in Critical Care
Nichola Cooper, Waleed Ghanima
New England Journal of Medicine, Volume 381, Issue 10, Page 945-955, September 2019.
September 5, 2019: New England Journal of Medicine
Michael R Rudnick, Amanda K Leonberg-Yoo, Harold I Litt, Raphael M Cohen, Susan Hilton, Peter P Reese
Contrast-induced nephropathy (CIN) has long been observed in both experimental and clinical studies. However, recent observational studies have questioned the prevalence and severity of CIN following intravenous contrast exposure. Initial studies of acute kidney injury following intravenous contrast were limited by the absence of control groups or contained control groups that did not adjust for additional acute kidney injury risk factors, including prevalent chronic kidney disease, as well as accepted prophylactic strategies...
August 28, 2019: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Hilary P Grocott
No abstract text is available yet for this article.
September 4, 2019: Anesthesia and Analgesia
Rohan S Wijesurendra, Barbara Casadei
Atrial fibrillation (AF) is the most common sustained arrhythmia, currently affecting over 33 million individuals worldwide, and its prevalence is expected to more than double over the next 40 years. AF is associated with a twofold increase in premature mortality, and important major adverse cardiovascular events such as heart failure, severe stroke and myocardial infarction. Significant effort has been made over a number of years to define the underlying cellular, molecular and electrophysiological changes that predispose to the induction and maintenance of AF in patients...
August 23, 2019: Heart
Benoit Guery, Tatiana Galperine, Frédéric Barbut
Clostridioides difficile (formerly Clostridium ) is a major cause of healthcare associated diarrhea, and is increasingly present in the community. Historically, C difficile infection was considered easy to diagnose and treat. Over the past two decades, however, diagnostic techniques have changed in line with a greater understanding of the physiopathology of C difficile infection and the use of new therapeutic molecules. The evolution of diagnosis showed there was an important under- and misdiagnosis of C difficile infection, emphasizing the importance of algorithms recommended by European and North American infectious diseases societies to obtain a reliable diagnosis...
August 20, 2019: BMJ: British Medical Journal
Andrew P DeFilippis, Andrew R Chapman, Nicholas L Mills, James A de Lemos, Armin Arbab-Zadeh, L Kristin Newby, David A Morrow
While coronary thrombus overlying a disrupted atherosclerotic plaque has long been considered the hallmark and the primary therapeutic target for acute myocardial infarction (MI), multiple other mechanisms are now known to cause or contribute to MI. It is further recognized that a myocardial infarction (MI) is just one of many types of acute myocardial injury. The Fourth Universal Definition of Myocardial Infarction (UDMI) provides a taxonomy for acute myocardial injury, including five subtypes of MI and non-ischemic myocardial injury...
August 16, 2019: Circulation
Casey A Cable, Seyed Amirhossein Razavi, John D Roback, David J Murphy
OBJECTIVES: To critically assess available high-level clinical studies regarding RBC transfusion strategies, with a focus on hemoglobin transfusion thresholds in the ICU. DATA SOURCES: Source data were obtained from a PubMed literature review. STUDY SELECTION: English language studies addressing RBC transfusions in the ICU with a focus on the most recent relevant studies. DATA EXTRACTION: Relevant studies were reviewed and the following aspects of each study were identified, abstracted, and analyzed: study design, methods, results, and implications for critical care practice...
August 23, 2019: Critical Care Medicine
Andrea Ganna, Karin J H Verweij, Michel G Nivard, Robert Maier, Robbee Wedow, Alexander S Busch, Abdel Abdellaoui, Shengru Guo, J Fah Sathirapongsasuti, Paul Lichtenstein, Sebastian Lundström, Niklas Långström, Adam Auton, Kathleen Mullan Harris, Gary W Beecham, Eden R Martin, Alan R Sanders, John R B Perry, Benjamin M Neale, Brendan P Zietsch
Twin and family studies have shown that same-sex sexual behavior is partly genetically influenced, but previous searches for specific genes involved have been underpowered. We performed a genome-wide association study (GWAS) on 477,522 individuals, revealing five loci significantly associated with same-sex sexual behavior. In aggregate, all tested genetic variants accounted for 8 to 25% of variation in same-sex sexual behavior, only partially overlapped between males and females, and do not allow meaningful prediction of an individual's sexual behavior...
August 30, 2019: Science
Ryan M Brown, Li Wang, Taylor D Coston, Nathan I Krishnan, Jonathan D Casey, Jonathan P Wanderer, Jesse M Ehrenfeld, Daniel W Byrne, Joanna L Stollings, Edward D Siew, Gordon R Bernard, Wesley H Self, Todd W Rice, Matthew W Semler
RATIONALE: Administration of intravenous crystalloid solutions is a fundamental therapy for sepsis, but the effect of crystalloid composition on patient outcomes remains unknown. OBJECTIVES: To compare the effect of balanced crystalloids versus saline on 30-day in-hospital mortality among critically ill adults with sepsis. METHODS: Secondary analysis of patients from the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) admitted to the medical intensive care unit with an ICD-10-CM code for sepsis, using multivariable regression to control for potential confounders...
August 27, 2019: American Journal of Respiratory and Critical Care Medicine
R Louise Rushworth, David J Torpy, Henrik Falhammar
New England Journal of Medicine, Volume 381, Issue 9, Page 852-861, August 2019.
August 29, 2019: New England Journal of Medicine
Marc Mendelson, Andrew M Morris, Karin Thursky, Céline Pulcini
BACKGROUND: Antimicrobial stewardship (AMS) describes a coherent set of actions that ensure optimal use of antimicrobials to improve patient outcomes, while limiting risk of adverse events (including antimicrobial resistance [AMR]). Introduction of AMS programmes in hospitals is part of most national action plans to mitigate AMR, yet the optimal components and actions of such a programme remain undetermined. OBJECTIVES: To describe how health care professionals can start an antimicrobial stewardship programme in their hospital, the components of such a programme, and the evidence base for its implementation...
August 21, 2019: Clinical Microbiology and Infection
Lai Yin Law, D Sean Riminton, MaiAnh Nguyen, Michael H Barnett, Stephen W Reddel, Todd A Hardy
The presentation of a patient with brainstem symptoms and signs invokes a number of common and less common differential diagnoses, and accurate diagnosis can be challenging. We review the major immune-mediated and inflammatory syndromes that can affect the brainstem including multiple sclerosis, neuromyelitis optica spectrum disorder, neuro-Behçet disease, chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids, neurosarcoidosis, Susac syndrome, and the histiocytic disorders...
August 27, 2019: Neurology
Sadudee Peerapornratana, Carlos L Manrique-Caballero, Hernando Gómez, John A Kellum
Sepsis-associated acute kidney injury (S-AKI) is a frequent complication of the critically ill patient and is associated with unacceptable morbidity and mortality. Prevention of S-AKI is difficult because by the time patients seek medical attention, most have already developed acute kidney injury. Thus, early recognition is crucial to provide supportive treatment and limit further insults. Current diagnostic criteria for acute kidney injury has limited early detection; however, novel biomarkers of kidney stress and damage have been recently validated for risk prediction and early diagnosis of acute kidney injury in the setting of sepsis...
June 7, 2019: Kidney International
2019-09-09 00:24:58
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