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Voelker, Rebecca. "Lifesaving App for Opioid Users." JAMA 316, no. 17 (November 1, 2016): 1756. http://dx.doi.org/10.1001/jama.2016.15572.
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Wong, Sam. "Lifesaving app alerts first-aiders to emergencies." New Scientist 229, no. 3061 (February 2016): 23. http://dx.doi.org/10.1016/s0262-4079(16)30363-3.
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Donskey, Curtis J. "Never Let a Crisis Go to Waste: Recruiting the Next Generation of Infectious Diseases Physicians." Pathogens and Immunity 2, no. 2 (June 27, 2017): 270. http://dx.doi.org/10.20411/pai.v2i2.197.
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Sometimes infectious diseases can seem to be the least interesting subspecialty of internal medicine. We don’t offer lifesaving or pain-relieving procedures. We offer the same advice over and over again hoping someday it might stick: wash your hands; stop prescribing antibiotics when there is no evidence of infection; and take your flu shot—it really won’t give you the flu. We give advice that some consider expendable. Shouldn’t all physicians be able to prescribe antibiotics with a little help from an online textbook or computer app? On top of all that, we apparently aren’t very stylish. One of my female colleagues recently told me she can pick out all of the male infectious disease physicians at scientific meetings by the standard uniform of ill-fitting khakis and button-down shirts.But a new crisis is always lurking to remind us that infectious diseases can be one of the most interesting and challenging areas of medicine. Emerging infections—often exotic and frightening—grab the attention of everyone from frontline personnel to the news media: Legionnaires’ disease; HIV; West Nile virus; SARS; MERS; chikungunya; Ebola virus; Zika virus; and Mycobacterium chimaera to name just a few. Without warning, common pathogens create havoc when they acquire new resistance mechanisms or virulence factors: multidrug-resistant gram-negative bacilli; Staphylococcus aureus; and Clostridium difficile. Standard procedures such as transrectal biopsy of the prostate and endoscopic retrograde cholangiopancreatography suddenly become risky due to increasing antimicrobial resistance or inadequate methods for device reprocessing.
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Boyd, Andrew Dallas, Chioma Iheanyi Ndukwe, Anandu Dileep, Olivia Frances Everin, Yingwei Yao, Betty Welland, Jerry Field, et al. "Elderly Medication Adherence Intervention Using the My Interventional Drug-Eluting Stent Educational App: Multisite Randomized Feasibility Trial." JMIR mHealth and uHealth 8, no. 6 (June 24, 2020): e15900. http://dx.doi.org/10.2196/15900.
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Background A lifesaving treatment for myocardial infarction is the placement of a stent in a closed or obstructed coronary artery. The largest modifiable risk factor after receiving a stent is medication adherence to Dual AntiPlatelet Therapy, a combination of P2Y12 inhibitors and aspirin. Objective This study aimed to determine the acceptability of a protocol and an intervention using the My Interventional Drug-Eluting Stent Educational App (MyIDEA) and to evaluate medication adherence using the proportion of days covered (PDC) and platelet activation tests in a multisite randomized controlled trial. Methods Potential participants who received a post percutaneous coronary intervention (PCI) procedure with a drug-eluting stent were approached. All patients older than 50 years and who spoke English were recruited. Participants were recruited, baseline demographics were collected, and the Hospital Anxiety and Depression Scale (HADS), Rapid Estimate of Adult Literacy in Medicine-Short Form, Burden-Benefit questionnaire, 36-Item Short Form Health Survey, and PCI knowledge questionnaire were administered. Block randomization was used to randomize participants to either usual care or MyIDEA supplementation. MyIDEA is a personalized educational intervention based on the Kolb experiential learning theory using patient narratives for education. During the visits, participants’ blood was collected to measure platelet suppression from medication. During the second and third encounters, the Morisky medication adherence score and cardiology outcomes were measured. The study was conducted at the University of Illinois Hospital and John H Stroger Jr Cook County Hospital with appropriate ethical approvals. Platelet suppression was measured through aspirin reactive units and P2Y12 reactive units. Medication adherence was measured using the PDC. The analysis team was blinded to the participants’ group membership. The primary outcome was a feasibility analysis of recruitment and retention. Results The mean age of participants was 60.4 years (SD 7.1); the majority of patients were black and non-Hispanic. The majority of patients’ reading levels were seventh grade or above, and they were not very familiar with other electronic devices for information and communication. The number of control subjects was 21, and the number of participants in the interventional arm was 24. The interventional group was able to use MyIDEA in both the hospital and outpatient setting. However, there was no significant difference in platelet suppression or medication adherence between groups. There were also differences between the groups in terms of depression and anxiety, initially, as measured by HADS. No documented adverse event associated with the intervention was found. Conclusions Elderly patients are willing to use tablet devices to be educated about health conditions. Additional studies are required to measure the effectiveness and determine the most suitable timing and location for patient education. Trial Registration ClinicalTrials.gov NCT04439864; https://clinicaltrials.gov/ct2/show/NCT04439864
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Ravi Manne, Snigdha Kantheti and Sneha Kantheti. "Classification of Skin cancer using deep learning, Convolutional Neural Networks - Opportunities and vulnerabilities- A systematic Review." November 2020 6, no. 11 (November 18, 2020): 101–8. http://dx.doi.org/10.46501/ijmtst061118.
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Background: Skin cancer classificationusing convolutional neural networks (CNNs) proved better results in classifying skin lesions compared with dermatologists which is lifesaving in terms of diagnosing. This will help people diagnosetheir cancer on their own by just installing app on mobile devices. It is estimated that 6.3 billion people will use the subscriptions by the end of year 2021[28] for diagnosing their skin cancer. Objective: This study represents review of many research articles on classifying skin lesions using CNNs. With the recent enhancement in machine learning algorithms, misclassification rate of skin lesions has reduced compared to a dermatologist classifying them.In this article we discuss how using CNNs has evolved in successfully classifying skin cancer type, and methods implemented, and the success rate. Even though Deep learning using CNN has advantages compared to a dermatologist, it also has some vulnerabilities, in terms of misclassifying images under some Criteria, and situations. We also discuss about those Vulnerabilities in this review study. Methods: We searched theScienceDirect, PubMed,Elsevier, Web of Science databases and Google Scholar for original research articles that are published. We selected papers that have sufficient data and information regarding their research, and we created a review on their approaches and methods they have used. From the articles we searched online So far no review paper has discussed both opportunities and vulnerabilities that existed in skin cancer classification using deep learning. Conclusions: The improvements in machine learning, Deep learning techniques, can avoid human mistakes that could be possible in misclassifying and diagnosing the disease. We will discuss, how Deep learning using CNN helped us and its vulnerabilities.
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Portis, Mary. "Stop, Drop, & Roll: A Lifesaving Physical Education Lesson." Strategies 12, no. 1 (September 1998): 11–12. http://dx.doi.org/10.1080/08924562.1998.10591364.
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Engler, Kim, Sara Ahmed, David Lessard, Serge Vicente, and Bertrand Lebouché. "Assessing the Content Validity of a New Patient-Reported Measure of Barriers to Antiretroviral Therapy Adherence for Electronic Administration in Routine HIV Care: Proposal for a Web-Based Delphi Study." JMIR Research Protocols 8, no. 8 (August 2, 2019): e12836. http://dx.doi.org/10.2196/12836.
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Background Adherence to lifesaving antiretroviral therapy (ART) for HIV infection remains a challenge for many patients. Routine screening for barriers to ART adherence could help make HIV care more patient-centered and prevent virologic rebound or failure. Our team is currently developing a new HIV-specific patient-reported outcome measure (PROM) of these barriers for use in Canada and France along with a digital app for its electronic administration. In our previous work, we developed the PROM’s multidimensional conceptual framework and generated 100 English items, which have been translated to French. Objective This study aims to use a Web-based Delphi to help validate and select the content of this new HIV-specific PROM, based on the perspective of anglophone and francophone patients and providers in Canada and France. Here, we present the proposal for this Delphi. Methods This modified Delphi will involve a diverse panel of patients (n=32) and providers (n=52) recruited especially from the 9 sites of the PROM development study (site locations in Canada: Montreal, Toronto, Vancouver; in France: Paris, Nantes, Clermont-Ferrand, Saint-Martin, Cayenne). Overall, 2 rounds of Web-based questionnaires will be conducted. The threshold for consensus is set at 60% and will determine which items are carried forward to the second round. Per item, 3 aspects will be rated: importance as a barrier to ART adherence, relevance for HIV care, and clarity. In both rounds, space will be available for free text comments. Overall comprehensiveness will be assessed in the second round. Results This study has undergone a methodological review by experts in patient-oriented research. It has received approval from a research ethics board of the McGill University Health Centre. It is financially supported, in part, by the Canadian Institutes of Health Research’s Strategy for Patient-Oriented Research-Quebec Support Unit (M006). As of May 21, 2019, 15 people living with HIV and 25 providers completed the first round of the Delphi (24 from Canada and 16 from France). Conclusions To our knowledge, this is the first Delphi to seek consensus on the most relevant and clinically actionable barriers to ART adherence, collecting opinions on an extensive list of barriers. Drawing on a relatively large and diverse panel of HIV patients and providers, it essentially engages key stakeholders in decision making about the PROM’s final content, helping to ensure its utility and adoption. International Registered Report Identifier (IRRID) PRR1-10.2196/12836
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Marrone, Chris. "Book Review: Miracle Medicines: Seven Lifesaving Drugs and the People Who Created Them." Annals of Pharmacotherapy 41, no. 7-8 (July 2007): 1322–23. http://dx.doi.org/10.1345/aph.1k107.
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Khanna, Neena, and SunilK Kothiwala. "Mucocutaneous blisters & a mediastinal mass: Lifesaving role of surgery." Indian Journal of Medical Research 142, no. 2 (2015): 227. http://dx.doi.org/10.4103/0971-5916.164276.
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Edler, Jessica R., Lindsey E. Eberman, Leamor Kahanov, Christopher Roman, and Heather Lynne Mata. "Athletic Trainers' Knowledge Regarding Airway Adjuncts." Athletic Training Education Journal 10, no. 2 (April 1, 2015): 164–69. http://dx.doi.org/10.4085/1002164.
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Context Research suggests that knowledge gaps regarding the appropriate use of airway adjuncts exist among various health care practitioners, and that knowledge is especially limited within athletic training. Objective To determine the relationship between perceived knowledge (PK) and actual knowledge (AK) of airway adjunct use and the difference in PK after AK assessment. Design Knowledge assessment. Patients or Other Participants Two thousand athletic trainers received the survey via e-mail; 152 (7.6%) responded. Intervention(s) The AK assessment included 7 items based on the use and implementation of airway adjuncts based on the National Athletic Trainers' Association educational competencies. Perceived knowledge was measured using a well-established PK questionnaire, which also included 1 item to rate likelihood to pursue continuing education (CE). Main Outcome Measure(s) Perceived knowledge was compared pre- and posttest. Our demographic variables assessed how often lifesaving skills were used. We used total scores of the AK assessment to measure AK. We employed dependent t tests to determine the pre- and posttest differences in PK and likelihood to pursue CE. We used a correlation analysis to determine the relationship between PK and AK. We calculated separate analyses of variance to determine differences in AK between the frequencies of lifesaving skill use. Results We identified no significant change (t150 = −0.91, P = .37, 95% confidence interval = −0.17 to 0.06) in likelihood to pursue CE. Greater PK was weakly associated with greater AK (r = 0.36, P < .001). We found a significant difference (F1,145 = 4.63, P = .03, effect size = 0.031, 1 − β = 0.57) between the frequency of use of lifesaving skills and AK. Conclusion We identified a knowledge gap among athletic trainers in the use of airway adjuncts. Although the likelihood to pursue CE score was high, the score did not significantly increase after completing the assessment. Participants who use lifesaving skills more frequently scored higher on the AK assessment, suggesting that the more frequently athletic trainers utilize a skill, the more knowledgeable they are.
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Kelly, Janet, and Emma Welch. "Ethical decision-making regarding infant viability: A discussion." Nursing Ethics 25, no. 7 (December 28, 2016): 897–905. http://dx.doi.org/10.1177/0969733016677869.
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Background: There are no universally agreed rules of healthcare ethics. Ethical decisions and standards tend to be linked to professional codes of practice when dealing with complex issues. Objectives: This paper aims to explore the ethical complexities on who should decide to give infants born on the borderline of viability lifesaving treatment, parents or the healthcare professionals. Method: The paper is a discussion using the principles of ethics, professional codes of practice from the UK, Nursing Midwifery Council and UK legal case law and statute. Healthcare professionals' experiences that influence parental decision are also considered. Findings & Discussion: There are considerable barriers to an effective discussion taking place in an environment where clinical decisions have to be made quickly once the baby is born. This is compounded by the need and respect for parental autonomy and the difficulties they face when making a best interest's decision knowing that this could cause more harm than good for their infant child and balancing any decision they make with quality of life. Conclusion: On deciding whether to give lifesaving treatment born at the borderline of viability, it should be a joint decision between the parents and the neonatal team.
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Randunu, Raniru, Khaled Alawaini, Lee-Anne Huber, Edward Randell, Janet Brunton, and Robert Bertolo. "Intrauterine Growth-Restricted Piglets Are Predisposed to Develop Metabolic Disorders in Adulthood When Fed With Parenteral Nutrition in the Neonatal Period." Current Developments in Nutrition 6, Supplement_1 (June 2022): 703. http://dx.doi.org/10.1093/cdn/nzac061.087.
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Abstract Objectives Total parenteral nutrition (TPN) is lifesaving yet non-normal nutrition regimen during the neonatal period. However, studies have shown that TPN feeding early in life can permanently alter metabolism at later ages. Moreover, intrauterine growth restricted (IUGR) neonates also have a higher risk of developing metabolic diseases (such as obesity and dyslipidemia) in later life. Because a substantial proportion of IUGR neonates receive TPN in early life, we wondered if the metabolic effects of feeding TPN early in life would exacerbate these effects of IUGR? We hypothesized that feeding TPN to IUGR neonates would aggravate the risk of developing obesity and dyslipidemia in adulthood. Methods Sixteen normal weight female piglets (7 d old) were randomized to sow-fed (SF) or early TPN (TPN-CON); 8 (IUGR or runt) piglets were fed TPN as a third group (TPN-IUGR). After 2 weeks of TPN or suckling, all pigs were fed a normal grower diet for 8 mo. At 8 mo, catheters were implanted and in vivo metabolic tests were conducted. Results TPN-IUGR pigs demonstrated catch-up growth by 4 mo, and body weights were not different among groups at 8 mo. The metabolic effects of feeding TPN persisted into adulthood, as indicated by higher postprandial plasma triglycerides (TG) and fasting plasma non-esterified fatty acids (NEFA), compared to SF (P < 0.05). IUGR exacerbated TPN-induced risk for diseases by worsening obesity outcomes with greater subcutaneous fat deposition (P < 0.05) and greater ectopic TG deposition in the liver (P < 0.05) and muscle (P < 0.05). Furthermore, IUGR led to dyslipidemia as indicated by higher cholesterol in fasted plasma LDL (P < 0.05), slower postprandial TG clearance (P < 0.05), higher fasting plasma NEFA (P < 0.001) and higher plasma dimethylglycine (P < 0.05), compared to the TPN-CON. IUGR pigs had greater VLDL secretion, as suggested by higher microsomal transfer protein mRNA (P < 0.05). Early TPN programmed reduced lipogenesis, as indicated by lower fatty acid synthase mRNA (P < 0.05), compared to SF. Conclusions Collectively, these findings conclude that although TPN is a lifesaving measure, feeding TPN to IUGR neonates has long-term metabolic consequences predisposing them to develop metabolic disorders in adulthood. Funding Sources Canadian Institutes of Health Research.
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Jesmin, Shahela, Nishat Anam Borna, Mosammat Nargis Shamima, Iftekhar Md Kudrate E Khuda, and Shahin Mahmuda. "The Hayman Technique: A Simple Method to Treat Postpartum Hemorrhage due to Placenta Praevia." TAJ: Journal of Teachers Association 30, no. 1 (December 3, 2018): 66–69. http://dx.doi.org/10.3329/taj.v30i1.39126.
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Aim: To assess effectiveness of Hayman suture to control postpartum haemorrhage due to placenta praevia during caesarean sectionMethods: It is a cross sectional observational study performed in Rajshahi Medical College Hospital, tertiary level hospital, from January 2016 to December 2016. It included 32 patients with PPH following placenta praevia during elective& emergency caesarean section (C/S). All 32 patients underwent horizontal compression suture (bilateral anteroposterior compression) of lower uterine segment. Vicryl 0 tapercut needle was used. All patients were followed postpartum for evaluation of uterine cavity and menstrual cycles.Results Hayman suture was applied in 32 cases. In 27 cases Hayman suture was the only intervention. Hayman with uterine artery ligation required in 2 cases. In 1 patient along with Hayman B-lynch compression suture was given and 2 patients required total hysterectomy.Conclusion: The quick and simple Hayman technique seems to be effective, safe, lifesaving method in stopping hemorrhage due to placenta praevia.TAJ 2017; 30(1): 66-69
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García, Antonia, Coral Barbas, Rosa Aguilar, and Mario Castro. "Capillary electrophoresis for rapid profiling of organic acidurias." Clinical Chemistry 44, no. 9 (September 1, 1998): 1905–11. http://dx.doi.org/10.1093/clinchem/44.9.1905.
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Abstract Organic acids analysis is a powerful technique in the diagnosis of inborn errors of metabolism. Clinically, patients present with severe symptoms, and early detection and appropriate treatment are often lifesaving. Most of the existing methods are based on gas chromatography in combination with mass spectrometry and require sophisticated equipment and complex sample pretreatment and derivatization. We propose a rapid, simple, and automated capillary electrophoretic method for routine analysis of urine to detect 27 organic acids related to metabolic diseases. With this method, direct measurements are performed on samples after initial centrifugation and dilution, if needed. Separation is performed in pH 6.0 phosphate buffer with methanol added as an organic modifier, −10 kV applied potential, and ultraviolet detection at 200 nm. The assay is completed in <15 min, and alternative separation conditions are proposed in case of overlapping peaks. The developed method allows the identification and quantitation of methylmalonic, pyroglutamic, and glutaric acids in samples of patients with diseases related to these acids.
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Solanki, Vandana, Urmila Singh, Seema Mehrotra, Shuchi Agarwal, and Apala Priyadarshini. "Review of hysterectomies in Department of Obstetrics and Gynaecology at tertiary care hospital in Northern India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 12 (November 26, 2018): 4977. http://dx.doi.org/10.18203/2320-1770.ijrcog20184951.
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Background: With the advancement of newer and conservative approach in the management of many gynaecological conditions, hysterectomy still remains the chief modality of treatment. The aim of this study was to analyze the various indications, clinical profile, and outcome of all the patients who underwent hysterectomy at premier teaching hospital in Northern India.Methods: This study involved all the patients who underwent hysterectomy from 1st Jan 2017 to 31st Dec 2017 in tertiary care hospital India.Results: Out of total 513 hysterectomies, 105 were obstetric and 408 were gynaecological hysterectomies. In obstetric hysterectomies 40% were due to rupture uterus, 38% were due to abnormal placentation. In gynaecological hysterectomies, 75.5 % abdominal & 24.5 % were vaginal.75.7 % were for benign conditions and 24.3% were for malignant conditions. Most common indication was AUB.Conclusions: Hysterectomy is commonly done to improve the quality of life but at the same time in obstetrics emergencies it’s a lifesaving procedure. So, its indications should be clearly evaluated, and patient should be clearly counselled about conservative options, risk and benefits of the procedure.
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Saqlain, Nazish, Nisar Ahmed, Aatika Ahmed, and Sidra Hareem. "BLOOD DONATION;." Professional Medical Journal 24, no. 12 (November 2, 2018): 1806–11. http://dx.doi.org/10.29309/tpmj/2017.24.12.566.
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The participation of women in blood donation process has been scarce equallyin low & high resourced countries. Every year 3.5 million blood donations are collected inPakistan with very little percentage of females donating blood. Objective: The objective of thestudy was to assess the knowledge, attitude and beliefs of female attendants accompanyingthe patients. Study Design: Cross-sectional study. Setting: The Children’s Hospital & Instituteof Child Health, Lahore, regarding blood donation. Period: 1st June to 31st December, 2015.Material & Methods: 306 females of age 16-50 years accompanying a patient in the hospitalwere randomly selected. After taking informed consent, a self-designed questionnaire validatedby Kappa Statistics program was distributed to the participants. Data was analyzed by usingSPSS 22. Results: The mean age of female attendants was 29.57 years. 31.7% had neverreceived any education. Only 12.7% had donated blood before. 93.8% had the idea that ablood transfusion is a lifesaving procedure but only half of them knew the common bloodgroups. 87.3% knew that both males and females can donate blood but 75.5% thought thatmales are better donors than females. There was a lack of knowledge about certain importantfacts including transfusion transmissible infections, donation frequency, duration and volumeof blood collected during a single session. Majority females were of the view that they are toofragile to donate blood and severe and prolonged anemia can develop after donating blood.Conclusion: There is a need to develop effective interventions for the education & motivationof potential female donors towards blood donation in order to increase the donor turnover rate.
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Ewanowski, Kathleen M., Caitlin Bramble, Walter R. Anyan, Irma D. Fleming, Ronda Hopkins, Stephen E. Morris, Callie M. Thompson, and Giavonni M. Lewis. "608 Utilization of Phase-Based Guidelines For Patient Care After Application of Cultured Epithelial Autograft." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S143—S144. http://dx.doi.org/10.1093/jbcr/irac012.236.
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Abstract Introduction Cultured epithelial autografts (CEA) have been clinically utilized since 1981 & can be a lifesaving procedure in patients with extensive full thickness burns. CEA is more susceptible to bacterial contamination & complete graft loss than traditional split-thickness autografts, yet no standard of practice exists for the postoperative care of these grafts to minimize infection & maximize graft take. Prior to 2019, care of CEA patients at our institution was not standardized & instead varied upon the attending surgeon’s practice. With the input of interdisciplinary team members, CEA patient care was standardized via phase-based guidelines (PBGs), leading to improved team communication & improved patient outcomes. Methods PBGs were created via interdisciplinary collaboration among surgeons, APCs, nursing staff, PT/OT, & psychosocial providers. Team members agreed upon 3 facets of patient care: Wound Care/Airing Out, Restrictions/Visitors, & Burn Therapy (Figure 1). As wounds progressed postoperatively, patient phases were advanced, liberalizing them from rigorous infection-prevention techniques to strict unit standards for non-CEA burn patients. In 2019, the utilization of patient-specific CEA care plans ceased in favor of standardized PBGs. A retrospective chart review was conducted on all patients from 2018-2021 who received CEA & survived their injuries. Some patients underwent a single CEA application while others underwent multiple operations. CEA graft take was assessed on all wounds from each surgery. Results CEA was rarely used at our institution. Beginning in 2018, seven patients received CEA & survived their injuries, ranging in age from 4-59 yrs (mean 24) & %TBSA from 38-80 (mean 53) (Table 1). Implementation of PBGs correlated with subjective improvement in team communication & increased mean percentages of CEA graft take from < 35% to >75%. Conclusions PBGs have standardized care for our CEA patients, eliminated communication errors among team members, & increased CEA graft take. Further research is needed to determine efficacy in decreasing infection, antibiotic use, hospital stay length, & mortality in these patients.
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Nogueira, Leticia, Neetu Chawla, Xuesong Han, Ahmedin Jemal, and K. Robin Yabroff. "Colorectal Cancer Care Among Young Adult Patients After the Dependent Coverage Expansion Under the Affordable Care Act." JNCI: Journal of the National Cancer Institute 112, no. 10 (December 19, 2019): 1063–66. http://dx.doi.org/10.1093/jnci/djz235.
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Abstract The effect of the Dependent Coverage Expansion (DCE) under the Affordable Care Act (ACA) on receipt of colorectal cancer treatment has yet to be determined. We identified newly diagnosed DCE–eligible (aged 19–25 years, n = 1924) and DCE–ineligible (aged 27–34 years, n = 8313) colorectal cancer patients from the National Cancer Database from 2007 to 2013. All statistical tests were two-sided. Post-ACA, there was a statistically significant increase in early-stage diagnosis among DCE–eligible (15 percentage point increase, confidence interval = 9.8, 20.2; P < .001), but not DCE–ineligible (P = .09), patients. DCE–eligible patients resected for IIB–IIIC colorectal cancer were more likely to receive timely adjuvant chemotherapy (hazard ratio = 1.34, 95% confidence interval = 1.05 to 1.71; 7.0 days’ decrease in restricted mean time from surgery to chemotherapy, P = .01), with no differences in DCE–ineligible patients (hazard ratio = 1.10, 95% confidence interval = 0.98 to 1.24; 2.1 days’ decrease, P = .41) post-ACA. Our findings highlight the role of the ACA in improving access to potentially lifesaving cancer care, including a shift to early-stage diagnosis and more timely receipt of adjuvant chemotherapy.
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Kruse, Robert L., Melissa Neally, Brian C. Cho, Evan M. Bloch, Parvez M. Lokhandwala, Paul M. Ness, Steven M. Frank, Aaron A. R. Tobian, and Eric A. Gehrie. "Cryoprecipitate Utilization Patterns Observed With a Required Prospective Approval Process vs Electronic Dosing Guidance." American Journal of Clinical Pathology 154, no. 3 (May 23, 2020): 362–68. http://dx.doi.org/10.1093/ajcp/aqaa042.
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Abstract Objectives We evaluated the impact of electronic medical record (EMR)–guided pooled cryoprecipitate dosing vs our previous practice of requiring transfusion medicine (TM) resident approval for every cryoprecipitate transfusion. Methods At our hospital, cryoprecipitate pooled from five donors is dosed for adult patients, while single-donor cryoprecipitate is dosed for pediatric patients (defined as patients <50 kg in weight). EMR-based dosing guidance replaced a previously required TM consultation when cryoprecipitate pools were ordered, but a consultation remained required for single-unit orders. Usage was defined as thawed cryoprecipitate; wastage was defined as cryoprecipitate that expired prior to transfusion. Results In the 6 months prior to intervention, 178 ± 13 doses of pooled cryoprecipitate were used per month vs 187 ± 15 doses after the intervention (P = .68). Wastage of pooled cryoprecipitate increased from 7.7% ± 1.5% to 12.7% ± 1.4% (P = .038). There was no change in wastage of pediatric cryoprecipitate doses during the study period. These trends remained unchanged for a full year postimplementation. Conclusions Electronic dosing guidance resulted in similar cryoprecipitate usage as TM auditing. Increased wastage may result from reduced TM oversight. Product wastage should be balanced against the possibility that real-time audits could delay a lifesaving therapy.
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Asnes, Andrea G., and John M. Leventhal. "Bruising in Infants: An Approach to the Recognition of Child Physical Abuse." Pediatrics In Review 43, no. 7 (July 1, 2022): 361–70. http://dx.doi.org/10.1542/pir.2022-001271.
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Infants (children <12 months of age) are maltreated at more than twice the rate of any other child age group, and infants die because of maltreatment at 3 times the rate of any other age group in childhood. The incidence of hospitalization for serious physical abuse in children also is highest for infants. Successful recognition of medically mild signs of physical abuse in infants, such as certain bruising patterns, can, therefore, lead to lifesaving interventions. The importance of the recognition of medically mild injuries due to physical abuse is underscored by the finding that a high percentage of infants (27.5%) hospitalized with serious physical abuse were found to have previously sustained milder injuries, such as bruising. Clinicians must be aware of patterns of bruising suggestive of abuse to distinguish between infants who have been abused and those who have been accidentally injured. To maximize the likelihood that abused infants will be identified and protected, as well to minimize the likelihood that an accidentally injured infant will be mischaracterized as abused, the application of an evidence-based approach to the evaluation of bruised infants should be applied. A consistent, evidence-based practice in this setting also may reduce the influence of racial and socioeconomic bias and decrease disparities in care.
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Nipanal, Akkamahadevi V., Madhukumar M.H, and Nagappa H. "Analysis of Cerebrospinal Fluid (CSF) – Adenosine Deaminase (ADA) in Meningitis." Journal of Evolution of Medical and Dental Sciences 10, no. 16 (April 19, 2021): 1102–5. http://dx.doi.org/10.14260/jemds/2021/236.
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BACKGROUND Acute infections of the nervous system are generally widespread and cause significant problems in the field medicine and therefore early detection, right decision making, and early initiation of therapy can be lifesaving. Meningitis is the inflammation of the membranes that cover the brain and spinal cord. It is a general clinical problem during infancy and childhood. Delay in differentiating between bacterial, tubercular & viral meningitis and institution of its treatment may have irreparable consequences that lead to significant morbidity & mortality. The present study was conducted to find out the utility of cerebrospinal fluid-adenosine deaminase (CSF-ADA) for the early diagnosis & differentiation of tubercular & viral meningitis in adults. METHODS 50 meningitis patients who met the inclusion criteria were selected. Investigations including complete haemogram, liver function test (LFT), renal function test (RFT), random blood sugar (RBS), serum electrolytes, human immunodeficiency virus (HIV) test, chest x-ray and computed tomography (CT) brain (plain) were done. CSF cytology, biochemistry, gram stain, acid-fast bacteria (AFB) stain & culture were done. These cases were further divided in to two groups based on clinical and CSF laboratory findings as group I: tubercular meningitis, group II: viral meningitis. An estimation of CSF-ADA was done in all patients. RESULTS The mean age of the 50 patients studied was 37.76 + 15.58 years, with the maximum number of patients suffering from tubercular meningitis. The incidence of meningitis was more in males. CSF-adenosine deaminase activity was found to be higher in tubercular meningitis, the mean value was 17.67 ± 8.13 IU / L. CONCLUSIONS Assessment of CSF-ADA will be helpful for early diagnosis and differentiation of tubercular and viral meningitis. This is needed when gold standard investigations for meningitis like smear and / or culture for acid fast bacilli are not available or negative or are time consuming. KEY WORDS CSF-Cerebrospinal Fluid, ADA-Adenosine Deaminase, AFB-Acid Fast Bacilli.
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Schaumann, Nikolaus, Veit Lorenz, Peter Schellongowski, Thomas Staudinger, Gottfried J. Locker, Heinz Burgmann, Branko Pikula, Roland Hofbauer, Ernst Schuster, and Michael Frass. "Evaluation of Seldinger Technique Emergency Cricothyroidotomy versus Standard Surgical Cricothyroidotomy in 200 Cadavers." Anesthesiology 102, no. 1 (January 1, 2005): 7–11. http://dx.doi.org/10.1097/00000542-200501000-00005.
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Background Percutaneous cricothyroidotomy is a lifesaving procedure for airway obstruction in trauma victims who need airway establishment and cannot be intubated or in whom intubation has failed. Methods The purpose of this study was to examine whether there is a training effect using Seldinger technique emergency cricothyroidotomy (group 1; Arndt Emergency Cricothyroidotomy Catheter Set; Cook Critical Care, Bloomington, IN) versus standard surgical cricothyroidotomy (group 2). Twenty emergency physicians performed five cricothyroidotomies with each method in a total of 200 human cadavers, comparing efficacy and safety (speed, success rate, and injuries). Results Seven attempts in group 1 and six in group 2 had to be aborted. Time intervals from the start of the procedure to location of the cricothyroid membrane were not significantly different between the groups. However, time to tracheal puncture (P < 0.01) and time to first ventilation (P < 0.001) were significantly longer in group 2. No time effect could be observed in both groups. The airway was accurately placed into the trachea through the cricothyroid membrane in 88.2% (82 of 93) of the cadavers in group 1 and in 84.0% (79 of 94) in group 2 (not significant). No injuries were observed in group 1, whereas there were six punctures of the thyroid vessels in group 2 (P < 0.05). Conclusions With respect to time needed for the procedure, the participants performed Seldinger technique emergency cricothyroidotomy significantly faster as compared with standard surgical cricothyroidotomy. Even if no training effect had been observed, the authors believe that it is important to train residents in different methods of cricothyroidotomy in cadavers in addition to training in mannequins to achieve a higher level of efficacy in real-life situations. The shorter time to first ventilation and the fact that no injuries could be observed favor the Seldinger technique.
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Michalak, Suzanne M., John D. Rolston, and Michael T. Lawton. "Incidence and Predictors of Complications and Mortality in Cerebrovascular Surgery." Neurosurgery 79, no. 2 (May 11, 2016): 182–93. http://dx.doi.org/10.1227/neu.0000000000001251.
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Abstract BACKGROUND: Cerebrovascular surgery offers potentially lifesaving treatments for intracranial vascular pathology yet bears substantial risks in the form of perioperative complications and mortality. OBJECTIVE: To better characterize the risks associated with cerebrovascular surgery by broadly investigating the incidence of complications, patient-level predictors of complications, and mortality using the National Surgical Quality Improvement Program database, a prospective, audited, national data set. METHODS: All cerebrovascular cases were extracted from the National Surgical Quality Improvement Program with the use of Current Procedural Terminology codes. Complication and mortality rates were analyzed with univariate and multivariate statistical analyses. RESULTS: A total of 1141 cases were analyzed. The rate of complications was nearly twice that of previous estimates: Almost one-third of patients (30.9%) experienced at least 1 complication, which was significantly associated with 30-day mortality (odds ratio, 7.76; 95% confidence interval, 4.27-14.10; P <.001). Emergency surgery was associated with higher mortality rates (15.1%) than nonemergency procedures (2.3%). Significant predictors of complications included preoperative ventilator dependence, emergency surgery, bleeding disorders, diabetes mellitus, and alcohol abuse. Significant predictors of mortality included postoperative coma >24 hours, preoperative or postoperative ventilator dependence, black or Asian race, and stroke. The most common complications were ventilator dependence (64.5% in patients ventilated preoperatively, 8.4% in patients not ventilated preoperatively), bleeding requiring transfusion (10.2%), reoperation within 30 days (9.6%), pneumonia (7.3%), and stroke (7.3%). CONCLUSION: Cerebrovascular surgery is associated with significant risks of morbidity and mortality. Mitigation of these risks requires broader, patient-centered understanding of risk factors and complications specific to cerebrovascular surgery, as presented in this article. These findings pave the way for improving patient safety and outcomes in cerebrovascular surgery.
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Wong, David T., Atul J. Prabhu, Margarita Coloma, Ngozi Imasogie, and Frances F. Chung. "What Is the Minimum Training Required for Successful Cricothyroidotomy?" Anesthesiology 98, no. 2 (February 1, 2003): 349–53. http://dx.doi.org/10.1097/00000542-200302000-00013.
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Background A correctly performed cricothyroidotomy may be lifesaving in a cannot-ventilate, cannot-intubate situation. However, many practicing anesthesiologists do not have experience with cricothyroidotomy. The purpose of this study was to determine the minimum training required to perform cricothyroidotomy in 40 s or less in mannequins. Methods After informed consent, participants were shown a demonstration video and asked to perform 10 consecutive cricothyroidotomy procedures on a mannequin using a preassembled percutaneous dilational cricothyroidotomy set. Each attempt was timed from skin palpation to lung insufflation. Cricothyroidotomy was considered successful if it was performed in 40 s or less, and the cricothyroidotomy time was considered to have plateaued when there were no significant reductions in cricothyroidotomy times in three consecutive attempts. Results One hundred two anesthesiologists participated in the study. There was a significant reduction of cricothyroidotomy times over the 10 attempts (P < 0.0001) and between three consecutive attempts until the fourth attempt (P < 0.03). The cricothyroidotomy times plateaued by the fourth attempt, while the success rate plateaued at the fifth attempt (94, 96, 96, and 96% at the fourth, fifth, sixth, and seventh attempts, respectively). Conclusion Practice on mannequins leads to reductions in cricothyroidotomy times and improvement in success rates. By the fifth attempt, 96% of participants were able to successfully perform the cricothyroidotomy in 40 s or less. While clinical correlates are not known, the authors recommend that providers of emergency airway management be trained on mannequins for at least five attempts or until their cricothyroidotomy time is 40 s or less. The most appropriate retraining intervals have yet to be determined for optimal cricothyroidotomy skill retention.
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Islam, Dr Farhana, Dr Fantasir Md Shibly Al-Amin, Dr Tasia Sultana Rahman, Dr Zereen Mosfeqa Rahman, Md Wasim Mollah, and Md Rabiul Islam. "A Comparative Status of HBsAg, HCV, HIV, TPHA & MP Test Results Among General Blood Donors in a Tertiary Care Hospital in Bangladesh." Scholars Journal of Applied Medical Sciences 9, no. 7 (July 16, 2021): 1180–84. http://dx.doi.org/10.36347/sjams.2021.v09i07.011.
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Background: Today blood transfusion is most frequently used of a life-saving therapeutic procedure in treatment arena. But in some times its becomes revers like life threatening rather than lifesaving. Specially for the blood receivers may have the threat of transfusion transmitted infections (TTIs) because of transmitting virus, bacteria or parasitic, microorganisms through blood transfusion procedures. Specially hepatitis B and C virus, human immunodeficiency virus (HIV) and syphilis (Treponema pallidum) bear the risk of transmission by blood transfusion. For this reason, Hepatitis B surface antigen (HBsAg), anti- Hepatitis C Virus (HCV), anti- human immunodeficiency virus (HIV), syphilis antibody TPHA (Treponema pallidum haemagglutination) and MP (Malarial Parasite) are routinely controlled in all donated blood samples. Aim of the study: The aim of this study was to analyze the status of HBsAg, HCV, HIV, TPHA & MP test results among general blood donors. Methods: This was a comparative observational study which was conducted in the Department of Blood Transfusion Medicine, National Institute of Cancer Research and Hospital(NICRH), Mohakhali, Dhaka, Bangladesh during the period from January 2018 to December 2020. In total 14,625 general blood donors were enrolled as the study population. This study was approved by the ethical committee of the mentioned hospital. Proper written consents were taken from all the participants before starting data collection. A pre-designed questionnaire was used in patent data collection. All data were processed, analyzed and disseminated by MS Office and SPSS version 20 as per need. Result: In this study 70.5% blood donors were male and 29.5% were female. So male was dominating in number and the male vs female ratio was 2.39:1. The highest number of donors were from 18-30 years’ age group which was 67.3%. Then 28.6% and 4.1% donors were from 31-34 years 41-50 years’ age groups respectively Finally, in analyzing the positive .........
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Petrosoniak, Andrew, Jodi Herold, and Karen Woolfrey. "Emergency medicine procedural skills: what are residents missing?" CJEM 15, no. 04 (July 2013): 241–48. http://dx.doi.org/10.2310/8000.2013.130897.
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ABSTRACTObjective:This study sought to establish the current state of procedural skills training in Canadian Royal College emergency medicine (EM) residencies.Methods:A national Web-based survey was administered to residents and program directors of all 13 Canadian-accredited Royal College EM residency programs. Programdirectors rated the importance and experience required for competence of 45 EM procedural skills. EM residents reported their experience and comfort in performing the same procedural skills.Results:Thirteen program directors and 86 residents responded to the survey (response rate of 100% and 37%, respectively). Thirty-two (70%) procedures were considered important by > 70% of program directors, including all resuscitation and lifesaving airway procedures. Four procedures deemed important by program directors, including cricothyroidotomy, pericardiocentesis, posterior nasal pack for epistaxis, and paraphimosis reduction, had never been performed by the majority of senior residents. Program director opinion was used to categorize each procedure based on performance frequency to achieve competence. Overall, procedural experience correlated positively with comfort levels as indicated by residents.Conclusions:We established an updated needs assessment of procedural skills training for Canadian Royal College EM residency programs. This included program director opinion of important procedures and the performance frequency needed to achieve competence. However, we identified several important procedures that were never performed by most senior residents despite program director opinion regarding the experience needed for competence. Further study is required to better define objective measures for resident competence in procedural skills.
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Bloomer, Zachary, Jennifer Teague, and Nicole Vietor. "Ectopic Cushing’s From Metastatic Prostate Cancer." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A757. http://dx.doi.org/10.1210/jendso/bvab048.1539.
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Abstract Objective: Ectopic ACTH production from malignancy is a rare etiology of Cushing’s syndrome. The most common tumors associated with this syndrome include small cell lung cancer, pancreatic neuroendocrine tumors, pheochromoctoma, thymic carcinoma, and bronchial carcinoma. Metastatic prostate cancer does not commonly produce ACTH. Here, we present a rare case of Cushing’s syndrome due to metastatic prostate cancer. Case Report: Patient is a 64 year old man with a 2 year history of castrate-resistant prostate cancer who was admitted for the 2nd time in 1 month for profound weakness and new onset hypokalemia. Initial analysis revealed hypertension with systolic blood pressure in the 150s, potassium in the mid 2s, an ACTH level of >1000pg/mL, and a 24-hr urine cortisol of almost 10,000mcg/24hrs. This was confirmed on repeat analysis. Metyrapone was initiated for treatment of hypercortisolemia and systemic chemotherapy with Cisplatin/Irinotecan was started to treat metastatic prostate cancer. ACTH and 24-hr urine cortisol levels returned to normal within a few weeks of therapy. The patient was able to discontinue Metyrapone following systemic chemotherapy treatment. Subsequent labs following discontinuation of metyrapone confirmed ongoing resolution of hypercortisolemia. Conclusion: This case represents an extremely rare cause of Cushing’s syndrome. Metastatic prostate cancer can rarely produce ACTH and cause clinical Cushing’s syndrome. Ectopic Cushing’s syndrome is often due to very aggressive tumors and is associated with a poor prognosis. Rapid recognition and treatment of this condition can be lifesaving.
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Luharia, Anurag A. "THE MEDICAL PHYSICIST - SCIENTIST BEHIND THE CURTAIN." Journal of Medical pharmaceutical and allied sciences 10, no. 4 (September 15, 2021): 3212–13. http://dx.doi.org/10.22270/jmpas.v10i4.1280.
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Ionizing radiation has validated its existence and effectiveness in modern medicine for both diagnostic and therapeutic use. For the last decade rapid growth in medical radiation application has witnessed in India towards the betterment of mankind, for safe and quality clinical practice, radiation protection and quality assurance. At the end of the 19th century Physics brought paradigm shift in the field of radiation-based medical diagnosis and treatment and giving rise to the modern medical physicist profession and revolutionized the practice of medicine. Medical Physicists are the scientists with Post graduation / PhD degrees, and certified from A.E.R.B as Radiological Safety Officer, deals with utilization of Physics knowledge in developing not only lifesaving tools & technology but also diagnosis and treatments of various medical conditions that help humans live longer and healthier. Medical Physicists are responsible to carry out the commissioning, establishment of entire Radiation facility and get the clearance of statutory compliances form authorities in order to start the clinical practice are also responsible for research, developing and evaluating new analytical techniques, planning and ensuring safe and accurate treatment of patients also provide advice about radiation protection, training and updating healthcare, scientific and technical staff , managing radiotherapy quality assurance program, mathematical modeling ,maintaining equipment ,writing reports, teaching ,laboratory management and administration. Now it’s a time to raise the curtain from the Medical Physics profession and utilize their services up to maximum extent in the field of scientific research, academic, teaching, diagnosis, treatment and safety.
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Selvaperumal, A., G. Thiyagarajan, Thangamani S, Vallalkannan S, and K. Ramaswamy. "Design and performance of subirrigation system in maize (Zea mays) in Kumulur farm, Trichy district, Tamil Nadu, India." Journal of Applied and Natural Science 13, no. 2 (May 9, 2021): 470–75. http://dx.doi.org/10.31018/jans.v13i2.2623.
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Subirrigation system can furnish water to plants. The upward flux and the discharge rate must satisfy the plant’s lifesaving irrigation needs during summer. The experiment was laid out in A-block of Eastern farm, Agricultural Engineering College and Research Institute, Kumulur, Trichy, Tamil Nadu. Subirrigation system spacing was arrived using Moody's equation calculated as 10 m. The experiment was laid out in spilt plot design with three replications. Four drain spacing levels (7.5, 10, 12.5 and 15 m) were the main plot treatments and two levels of depth and diameter of drain pipes (75 cm, 60 cm & 75 mm, 63 mm) were the sub plot treatments. The highest volumetric water content was recorded in 7.5 m spacing + 45 cm soil depth + lower reach (S1T3T1). Capillary rise on water table management system under subirrigation mode was fixed as 33.5 cm and the average deep percolation loss was obtained in 0.3 cm/d at development stage of crop period. The highest maize yield (4.30 t/ha) was obtained in 7.5 m spacing + 60 cm drain depth + 75 mm diameter (S1D3). The highest water use efficiency of (0.86 kg/m3) was recorded in 7.5 m spacing + 60 cm drain depth + 75 mm drain diameter (S1D3). This subirrigation system could furnish water to plants due to upward flux and the same system also functioned efficiently under drainage modes and removed the waterlogging during wet periods.
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Das, Ratan Kumar, K. Trimal Subudhi, and Ranjan Kumar Mohanty. "The rate and indication of caesarean section in a tertiary care teaching hospital eastern India." International Journal of Contemporary Pediatrics 5, no. 5 (August 24, 2018): 1733. http://dx.doi.org/10.18203/2349-3291.ijcp20182963.
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Background: Caesarean section is one of the most widely performed surgical procedures in obstetrics worldwide. It was mainly evolved as a lifesaving procedure for mother and foetus during the difficult delivery. To analyze the rate and indications for C-Section and associated maternal morbidity and mortality were the main objectives of present study.Methods: This retrospective study was conducted over a period of one year from 1st May 2017 to 30th April 2018 at the Department of Pediatrics and OBG, IMS & SUM Medical college and Hospital, Bhubaneswar (Odisha), eastern India. Data of Patients who delivered by C-Section in our hospital during the defined study period was recorded and a statistical analysis of various parameters namely, the caesarean section rates, its indications, the patient’s morbidity and mortality was done.Results: The total numbers of women delivered over the study period were 1619, out of which C-Sections were 574.The overall CS rate was 35.45%. Previous LSCS was the leading indication to the CS rate (29.96%) followed by arrest of labour (13.94%), CPD (11.84%), foetal distress (10.97%), breech presentation (5.74%), oligohydroaminous/IUGR (5.21%), failed induction of labour (5.21%), pregnancy induced hypertension(PIH) (4.87%) and multifetal gestation (3.84%), prematurity (3.31%). 12.01% patients had various complications mainly infection (6.27%) and hemorrhage (3.48%). There was no mortality during this period.Conclusions: Being a tertiary care hospital, a high rate of Caesarean deliveries was observed, Individualization of the indication and careful evaluation, following standardized guidelines, practice of evidenced-based obstetrics and audits in the institution, can help us limit CSR.
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Juneja, Sunil K., Pooja Tandon, and Bhanupriya . "Cesarean scar pregnancy: an upcoming challenge." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 6 (May 26, 2018): 2226. http://dx.doi.org/10.18203/2320-1770.ijrcog20182325.
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Background: Cesarean scar pregnancy (CSP) is a type of ectopic pregnancy implanted in the myometrium at the site of previous cesarean scar. Incidence of cesarean deliveries are increasing globally, leading to rise in incidence of cesarean scar pregnancy. Caesarean scar pregnancies are associated with some life-threatening complications such as scar rupture, haemorrhage, disseminated intravascular coagulation, requiring lifesaving hysterectomy. We present our experience with 11 patients with cesarean scar pregnancy, diagnosed using transvaginal colour doppler ultrasound during 3-year period and treated conservatively to preserve the uterus with successful outcome in all patients.Methods: This was a retrospective study, conducted in the Department of Obstetrics and Gynecology of DMC&H, Ludhiana from January 2015 to December 2017. Out of total deliveries (4278), 3.9% (171/4278) were diagnosed as ectopic pregnancy. 6.43% (11/171) of them were diagnosed as cesarean scar ectopic pregnancy. After counseling, all patients underwent conservative management. Injection methotrexate 50mg was administered intramuscularly and beta- HCG was monitored after 4 days and then weekly till it was <1.Results: 2 patients had an increase in beta HCG levels on day 7 and required second dose of methotraxate. 8 patients required blood transfusion due to excessive bleeding on admission. In 9 patients beta HCG levels reduced to <1 in 7 weeks post first methotraxate dose administration, and in remaining 3 it returned to <1 after 8 weeks . No patient required any surgical intervention.Conclusions: Cesarean scar pregnancy, a type of ectopic pregnancy can be safely managed conservatively if diagnosed early.
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Heymans, Frédéric, Georg Feigl, Stephan Graber, Delphine S. Courvoisier, Kerstin M. Weber, and Pavel Dulguerov. "Emergency Cricothyrotomy Performed by Surgical Airway–naive Medical Personnel." Anesthesiology 125, no. 2 (August 1, 2016): 295–303. http://dx.doi.org/10.1097/aln.0000000000001196.
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Abstract Background When conventional approaches to obtain effective ventilation and return of effective spontaneous breathing fail, surgical airway is the last rescue option. Most physicians have a limited lifetime experience with cricothyrotomy, and it is unclear what method should be taught for this lifesaving procedure. The aim of this study is to compare the performance of medical personnel, naive to surgical airway techniques, in establishing an emergency surgical airway in cadavers using three commonly used cricothyrotomy techniques. Methods Twenty medical students, without previous knowledge of surgical airway techniques, were randomly selected from their class. After training, they performed cricothyrotomy by three techniques (surgical, Melker, and QuickTrach II) in a random order on 60 cadavers with comparable biometrics. The time to complete the procedure, rate of success, and number of complications were recorded. A success was defined as the correct placement of the cannula within the trachea in 3 min. Results The success rates were 95, 55, and 50% for surgical cricothyrotomy, QuickTrach, and Melker, respectively (P = 0.025). The majority of failures were due to cannula misplacement (15 of 20). In successful procedures, the mean procedure time was 94 ± 35 s in the surgical group, 77 ± 34 in the QuickTrach II group, and 149 ± 24 in the Melker group (P < 0.001). Few significant complications were found in successful procedures. No cadaver biometric parameters were correlated with success of the procedure. Conclusion Surgical airway–naive medical personnel establish emergency cricothyrotomy more efficiently and safely with the surgical procedure than with the other two commonly used techniques.
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Bell, Thomas. "NATIONAL ASTHMA ATTACK AUDIT, 1991 TO 1992." Pediatrics 94, no. 2 (August 1, 1994): 257. http://dx.doi.org/10.1542/peds.94.2.257a.
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Purpose of the Study. This study takes the newly developed guidelines for asthma management and compares them to ongoing asthma management in general practice. Methods. A correspondence survey covering 218 general practices in the United Kingdom covered 1775 patients of all ages who had a total of 1805 attacks. Patient characteristics, place of management of attacks, and actual management were compared to recommended guidelines. The physicians from participating practices had attended a special one-half day course on the guidelines, largely derived from the British Thoracic Society and then took part in the survey for three consecutive months. Findings. There is extensive demographic data of interest, including level of care, incidence of hospitalization, age distribution, and other parameters—too lengthy for inclusion in this review. Hospital admissions peaked (16%) in the 0-to 9-and >69-year age ranges. Twenty-nine percent had their own peak flow meters (PPM), and 34% had been issued their own asthma self-management plan. Two deaths were reported—both were moribund upon arrival for treatment. On presentation PFM readings were obtained in 82% and asthma ratings in 97%. After this great start, things began to deteriorate when we examined therapy. Nebulization was given to only 35% of patients, and steroids to 55%. A sizable proportion of patients graded as "breathless and distressed" did not receive the recommended lifesaving antiasthma treatment with nebulization (46%) and steroids (48%). The authors stress that the standards or guidelines derived from hospital care may not necessarily be applicable to general practice. Thirty-five percent of the patients were given antibiotics.
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Haque, Md Rafiqul, Dannish Arefin Biswas, Jesmin Sultana, Tanjina Rahman, Tanzim Anwar, and Tasmina Parveen. "Study of donor deferral during blood donation: A single centre teaching hospital study." Bangladesh Journal of Medical Science 21, no. 3 (May 21, 2022): 645–47. http://dx.doi.org/10.3329/bjms.v21i3.59580.
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Background: Safe blood transfusion can be a crucial lifesaving intervention in many clinical situations.For safe blood products donor selection is the first and foremost measure of blood donation. Objective:Aim of the study to determine the incidence and causes for deferral in blood donors. Materials and Methods: This cross-sectional retrospective study was done at Transfusion medicine department in Delta Medical College and Hospital, Bangladesh during 6 months period. In current study data were extracted from the register book and analyzed. Prospective donors were confidentially interviewed and examined and screened for causes of temporary and permanent deferral of blood donation. Data were presented as charts, table and analyzed with Microsoft Excel. Result: A total of 2215 directed donors were studied,of them, 1555 (73.52%) were male and 560 (26.48%) females. Predominantly blood donors belonged to 31–40 years of age group (38.01%). Out of 2115 directed donors, 423 (20%) were deferred. Deferral was significantly more likely in female. The most common cause for deferralwere history of anemia (27.66%). Other causes were antibiotic & medications, high blood pressure, low blood pressure, frequent donation, Positive HBsAg, HCV markers, suspected addiction, and vaccination. Conclusion: Effective measures are required for documenting the deferred donors and appropriate preventive intervention program should be undertaken for prevalent causes of deferrals, like low Hb, Infections with HBV etc. Anemia is the most prevalent reason of temporary deferral for blood donation in this region of Bangladesh. Other reasons were hypertension, hypotension,suspected addiction, vaccination etc. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 645-647
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Miller, Matthew B., Alison K. Macpherson, and Loriann M. Hynes. "Athletic Therapy Students' Perceptions of High-Fidelity Manikin Simulation: A Pilot Study." Athletic Training Education Journal 13, no. 2 (April 1, 2018): 158–67. http://dx.doi.org/10.4085/1302158.
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Context: Athletic therapy students learn emergency skills through a variety of modes, including students portraying injured athletes and cardiopulmonary resuscitation manikins. Although acceptable and satisfactory forms of teaching, these methods are limited in their ability to create realistic physiological symptoms of injury. Objective: To assess how athletic therapy students perceive their learning needs (LNs) relative to the use of high-fidelity manikin simulation (HFMS) compared with student simulation (SS) in the laboratory setting. Design: Pretest-posttest study design. Setting: Nursing Simulation Centre, Sheridan College, Brampton, Ontario, Canada. Patients or Other Participants: Thirty students from the Bachelor of Applied Health Science (Athletic Therapy) program at Sheridan College in years 2 and 4. Intervention(s): Perceived LNs related to the use of the Laerdal Medical SimMan3G HFMS contrasted with the use of SS for learning to respond to a prescribed emergency scenario. Main Outcome Measure(s): Participants completed questionnaires for both the SS and HFMS environments that consisted of 16 specific LNs spanning the cognitive, psychomotor, and affective domains of learning. Paired t tests and a 2-way analysis of variance were used to analyze the questionnaire data. Results: Participants reported all LNs as being equally important in both environments, but HFMS was identified as a better environment for achieving 13 of the 16 LNs. The mean change from pretesting to posttesting of all LNs in the affective domain improved significantly (P < .05) in the HFMS environment. Year 4 participants deemed HFMS to be a more effective means of learning in the cognitive and psychomotor domains (P < .05). Conclusions: The HFMS experience enhanced athletic therapy students' perceptions of their confidence, base of knowledge, decision-making skills, and overall acute management of critical lifesaving situations. The HMFS environment is a more effective tool for addressing the LNs in the affective domain, which includes skills related to confidence, attitudes, values, and appreciations.
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Alhamid, Mohammed Alabed. "Difficult Laparoscopic Cholecystectomy." Global Journal of Health Science 11, no. 9 (July 22, 2019): 102. http://dx.doi.org/10.5539/gjhs.v11n9p102.
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Laparoscopic cholecystectomy is as much easy procedure as difficult one. Surgeon should consider every case as his first one. Intraoperative complications are common while transformation to open surgery should be always in consideration. Transformation to open cholecystectomy isn't a sign of lack of experience, rather it is a proof of surgeon cleverness and an evidence of professional competence as it could keep our patient away from life-threatening complications in difficult situations.
Predictive factors for difficulty vary from male patient, repeated acute attacks, history of obstructive jaundice, presence of abnormal anatomical or pathological findings, and adhesions.
The aim of this study was to assess some preoperative causes namely by history, clinical examination and, radiological data which can dependably anticipate the odds of troublesome laparoscopic Cholecystectomy or alteration to open Cholecystectomy .1005 patients experienced laparoscopic cholecystectomy 171 of them were difficult cases (10.05%). Transformation rate in our study is within the lower limits and accepted internationally. Dense fibrous adhesion and bleeding are the main causes of transformation. History of acute cholecystitis is separate hazard factor for transformation from laparoscopic to open procedure. Gender and age are also showing increasing rate of transformation.
Results shown bile duct damages may evaded even with nearness of hazard factors as anatomical variations from the of biliary channels, intense cholecystitis, extreme endless fibrosis, affected stones inside Hartmann pocket, and short cystic pipe during laparoscopic cholecystectomy by careful watching and wise decision of transformation whenever surgeon feels risk of major complication in case of proceeding in laparoscopic technique.
Mortality not encountered directly through the procedure or in short post-operative period but as sequel of complicated cases. Authors proposes that change of the laparoscopic cholecystectomy isn't really a disappointment of the specialist, as usually explained, yet is a lifesaving method as delineated by the results of the study. The experience of the operating surgeon assumes an essential function on this subject.
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Zisiadis, Georgios, Carlos Rodrigues, Giusy Pizzirusso, Luis Arroyo-García, Ahmed Osman, and Klas Blomgren. "LTBK-06. Memantine increases dendritic arborization and integration of immature neurons after cranial irradiation." Neuro-Oncology 24, Supplement_1 (June 1, 2022): i192. http://dx.doi.org/10.1093/neuonc/noac079.718.
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Abstract Cranial irradiation (IR) is a cornerstone in the treatment of high-grade pediatric brain tumors. While lifesaving, it is associated with severe sequalae in 50-90 % of the survivors, as they often show disabling cognitive dysfunction, declined IQ, impaired processing speed, anxiety and posttraumatic stress symptoms, resulting in poorer academic accomplishments and social isolation. Memantine (Mem) is a non-competitive NMDA receptor antagonist and a potent enhancer of neural plasticity. It is used in the clinical setting in the treatment of Alzheimer’s disease and dementias and has been shown to enhance cognition in post-IR cancer survivors. Nevertheless, while an improvement in synaptic plasticity has been documented in association to hippocampal neurogenesis, the exact mechanisms underlying Mem’s actions are yet poorly understood. The goal of this project is to further dissect the actions of Mem and identify factors that contribute to hippocampal neurogenesis. To this end, 20-day-old C57BL6/J mice were subjected to a single dose of 7 Gy whole brain irradiation and then supplied with Mem in the drinking water to obtain a steady-state plasma concentration of the drug. Animals were then sacrificed at different time points and the brains harvested for immunohistochemical staining, bulk-RNA sequencing and electrophysiological studies. Sholl analysis of the morphological data of the new-born neurons of Mem treated animals showed a statistically significant increase in coverage area (500µm2 vs. 250µm2, p= <0,0001) and number of dendrites (15 vs. 5, p= <0,0001) compared to non-treated individuals. Preliminary analysis of the electrophysiological responses revealed no changes in the gamma oscillations in Mem treated irradiated mice. The attained results will shed light on the mechanisms of action and take steps towards establishing Mem as a neoadjuvant therapy for children undergoing IR. Ultimately, we aim to ameliorate IR-associated neurocognitive impairment and improve the quality of life of pediatric cancer survivors.
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Annamaraju, Maruti Ram, Subhadra Devi Velichety, Ravindra Kumar Boddeti, and Srihari Rao Battalapalli. "Histological study of normal human suprarenal gland of different age groups." Asian Journal of Medical Sciences 12, no. 4 (April 1, 2021): 110–17. http://dx.doi.org/10.3126/ajms.v12i4.33310.
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Background: Adrenal gland is a lifesaving endocrine gland of the human body. Knowledge of normal microscopic anatomy of the Adrenal gland facilitates Pathologists to correlate and make the differential diagnosis of various adrenal glands associated clinical conditions on histopathological examination.
Aims and Objective: To study histological features of human adrenal gland in the post-natal period at different ages.
Materials and Methods: Present study is conducted with 98 human adrenal glands from 49 unclaimed dead bodies during an autopsy and 22 human adrenal glands from 11 cadavers during routine dissection in S.V Medical College, Tirupati, which were utilized after obtaining consent from the close kith and kin. During the autopsy/dissection, the samples collected were from 2 Years to 64 years of age individuals of both sex with typical external features and divided into three groups. The first group consisted of less than 25 years of age. The second group consists of ages between 26 years to 50 years. The third group included 51 years and above, and all the specimens are processed for histological staining and observed under the microscope.
Results: At 2 years well-developed capsule with large vessels and well-differentiated zones of definitive cortex and medulla were identified. The thick muscular coat of the central vein was identified at 20 years. At 36 years & 45 years, cellular architecture in various zones is very well differentiated. At 65 years, the cortico-medullary demarcation was irregular, and vascularity decreased.
Conclusion: Histological features of pre-pubertal, adult, and old age group sections helps in the understanding of post-natal changes in the growth of the Suprarenal gland and its functions.
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Singhal, Maneesh, Ravikiran Naalla, Aniket Dave, Moumita De, Deepti Gupta, and Shashank Chauhan. "The role of plastic and reconstructive surgeon in trauma care: Perspectives from a Level 1 trauma centre in India." Indian Journal of Plastic Surgery 51, no. 02 (May 2018): 170–76. http://dx.doi.org/10.4103/ijps.ijps_212_17.
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ABSTRACT Background: As the morbidity and mortality due to trauma are ever increasing, there is proportionally growing need of trauma care facilities across the country. In the context of expanding designated trauma care facilities, the role of plastic and reconstructive surgeon needs to be analysed and defined at least at a Level 1 trauma centre. Materials and Methods: We included the patients who were operated under the department of plastic, reconstructive & burns surgery at a Level 1 urban trauma centre between January 2016 and December 2017. We analysed the demographic data and categorised operative data according to anatomical areas and interacting specialties. Results: A total of 1539 procedures were performed under the division of plastic reconstructive and burn surgery. Amongst them, 81% were male, and 19% were female. Mean age was 27.3 years (range: 3–90 years). The anatomical locations treated were upper limb (49%), lower limb (35%), head and neck (8%) and trunk (8%). Interdepartmental cases were 600 and majority of them were in collaboration with orthopaedics (n = 298), general surgery (n = 163), neurosurgery (79) and maxillofacial surgery (60). Conclusion: There is a significant role of plastic surgeon at a Level 1 trauma centre in India. The plastic surgeon's interventions are limb saving and sometimes lifesaving, many at times morbidity of post-traumatic sequelae are either prevented or treated. Along with other core specialties involved in the management of trauma, plastic surgeons play an integral role in a Level 1 trauma centre. The policymakers should take note to augment the number of plastic surgeons at a Level 1 apex trauma centre on par with other specialties, as the workload is heavy and is steadily on an increasing trend.
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Rahman, Chowdhury Md Mushfiqur, Rajat Shuvra Das, Khundkar Alamin Rumi, and Kazi Monisur Rahman. "Comparative Study Between Haemorrhage and Surgical Emphysema as Complication of Emergency Tracheostomy." Journal of Dhaka Medical College 28, no. 2 (January 5, 2021): 159–63. http://dx.doi.org/10.3329/jdmc.v28i2.51151.
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Background: Emergency tracheostomy is the commonest surgical intervention performed as lifesaving procedure by ENT surgeons on patients in emergency room of ENT and ICU. Several operative and postoperative complications have been reported after tracheostomy including fatal hemorrhage. Massive subcutaneous neck emphysema occurred because ventilation started at the time when the hemorrhage was not completely managed and the tracheal tube was not fully secured.
Objective: This study was conducted to compare haemorrhage and surgical emphysema as complication of emergency tracheostomy among patients admitted in Department of ENT and Head-Neck Surgery in Dhaka Medical College & Hospital.
Methods and Materials: This was a Cross Sectional Study conducted in the ENT and Head- Neck Surgery Department, Dhaka Medical College Hospital from July 2015 to June 2016. A total of 90 patients were included who fulfilled the selection criteria. Non probability convenient sampling was used to collect data. Statistical analysis was done by SPSS version 21.
Results: Mean± SD of the study subjects was 49.84±17.4 years with most patients belonged to 40-79 years age group. 28.9% patients had habit of smoking and betel nut chewing. (48.9%) patients suffered from Ca larynx. Out of 90 tracheostomy patients, 40(44.4%) patients had had different complications including haemorrhage (13.3%), surgical emphysema (10%), haemorrhage with surgical emphysema (6.7%), tube blockage (3.3%), wound infection (3.3%) and injury to local tissue (2.2%). Haemorrhage occurs from anterior jugular vein, middle thyroid veins and thyroid gland and included peroperative haemorrhage (7.8%), immediate post- operative haemorrhage, <24 hours, (4.43%) and late post-operative haemorrhage (1.2%).
Conclusion: In this study, haemorrhage followed by surgical emphysema and haemorrhage with surgical emphysema were found as major complications following emergency tracheostomy,
J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 159-163
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Okiror, Samuel, Abraham Mulugeta, Iheoma Onuekwusi, Fiona Braka, Sylvesta Malengemi, John Burton, Rustam Hydarav, et al. "Polio Outbreak Investigation and Response in The Horn of Africa: 2013-2016." Journal of Immunological Sciences Special Issue, no. 2 (April 30, 2021): 14–21. http://dx.doi.org/10.29245/2578-3009/2021/s2.1104.
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Background: There has been civil strife, spanning more than two decades in some countries and recurrent natural disasters in the Horn of Africa (HoA). This has consistently maintained these countries in chronic humanitarian conditions. More important however is the fact that these crises have also denied populations of these countries access to access to lifesaving health services. Children in the difficult terrains and security compromised areas are not given the required immunization services to build their immunity against infectious diseases like the poliovirus. This was the situation in 2013 when the large outbreaks of poliovirus occurred in the HoA. This article reviews the epidemiology, risk, and programme response to what is now famed as the 2013-204 poliovirus outbreaks in the HoA and highlights the challenges that the programme faced in interrupting poliovirus transmission here. Methods: A case of acute flaccid paralysis (AFP) was defined as a child <15 years of age with sudden onset of fever and paralysis. Polio cases were defined as AFP cases with stool specimens positive for WPV. Results: Between 2013 and 2016, when transmission was interrupted 20,266 polio viruses were in the Horn of Africa region. In response to the outbreak, several supplementary immunization activities were conducted with oral polio vaccine (OPV) The trivalent OPV was used initially, followed subsequently by bivalent OPV, and targeting various age groups, including children aged <5 years, children aged <10 years, and individuals of any age. Other response activities were undertaken to supplement the immunization in controlling the outbreak. Some of these activities included the use of various communication strategies to create awareness, sensitize and mobilize the populations against poliovirus transmission. Conclusions: The outbreaks were attributed to the existence of clusters of unvaccinated children due to inaccessibility to them by the health system, caused by poor geographical terrain and conflicts. The key lesson therefore is that the existence of populations with low immunity to infections will necessary constitutes breeding grounds for disease outbreak and of course reservoirs to the vectors. Though brought under reasonable control, the outbreaks indicate that the threat of large polio outbreaks resulting from poliovirus importation will remain constant unless polio transmission is interrupted in the remaining polio-endemic countries of the world.
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Patel, Nayan Kumar, Sunil Kumar Sharma, and Ayan Roy. "A study of etiology, clinical characteristics, electrocardiographic and echocardiographic findings in patients with cardiac tamponade in a tertiary care hospital in Western Odisha." International Journal of Advances in Medicine 7, no. 12 (November 23, 2020): 1865. http://dx.doi.org/10.18203/2349-3933.ijam20205049.
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Background: Cardiac tamponade is a life-threatening condition characterized by elevated intracardiac pressure, limitation of diastolic filling, and reduction of cardiac output and mostly requires urgent therapeutic intervention. Pericardial disease in on the rise attributed to improved survival of malignancy, growing no of cardiac interventions, chronic kidney diseases with dialysis, advent of modern chemo-radiotherapy. Still, there are paucity of data on etiology, clinical characteristics, electrocardiogram (ECG) and echocardiographic features in patients with cardiac tamponade from Odisha. Aim of this study was to emphasize the etiology, clinical characteristics, electrocardiographic and echocardiographic features in patients with cardiac tamponade.Methods: A prospective observational study of 1-year duration was undertaken for patients with cardiac tamponade admitted at VIMSAR, a cardiology unit. Data on etiology, clinical characteristics, Echocardiography, ECG findings were documented. Echo guided pericardiocentesis followed culture, cytological and biochemical analysis done.Results: Most common symptom was dyspnoea (88%), clinical signs were tachypnoea (96%), raised jugular venous pulse (64%), tachycardia (84%), pulsus paradoxus (60%). Classical beck’s triad was seen in 42% cases. X-ray showed cardiomegaly (94%) & pleural effusion (64%). Common ECG findings were sinus tachycardia (84%), low voltage QRS (68%) and electrical alternans (44%). Echocardiography showed 80% and 68% of patients had right atrium collapse and right ventricle collapse respectively. Both inferior vena cava plethora and transmitral flow variation were seen in 88% of cases. 96% had normal left ventricle function. 80% had large effusion. Pericardiocentesis yield was mostly in between 500-1000ml (mean 908 ml) with 72% with haemorrhagic aspirate. All malignancy cases and 76% tubercular cases had haemorrhagic effusion. Most common etiology was tubercular (50%), followed by malignancy (28%). 6% remained idiopathic. chronic kidney disease, systemic lupus erythematosus, post MI intervention, hypothyroid were some of the other causes.Conclusions: Initial assessment with investigation and careful follow-up can yield a causal diagnosis in most cases. Early diagnosis and intervention by pericardiocentesis can be lifesaving.
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Roka-Moiia, Yana, Samuel Miller-Gutierrez, Daniel E. Palomares, Joseph E. Italiano, Jawaad Sheriff, Danny Bluestein, and Marvin J. Slepian. "Platelet Dysfunction During Mechanical Circulatory Support." Arteriosclerosis, Thrombosis, and Vascular Biology 41, no. 4 (April 2021): 1319–36. http://dx.doi.org/10.1161/atvbaha.120.315583.
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Objective: Mechanical circulatory support has emerged as lifesaving therapy for patients with advanced heart failure. However, mechanical circulatory support remains limited by a paradoxical coagulopathy accompanied by both thrombosis and bleeding. While mechanisms of mechanical circulatory support thrombosis are increasingly defined, mechanical circulatory support-related bleeding, as related to shear-mediated alteration of platelet function, remains poorly understood. We tested the hypothesis that platelet exposure to elevated shear stress, while a defined prothrombotic activator of platelets, coordinately induces downregulation of key platelet adhesion receptors GPIb-IX-V, α IIb β 3 , and P-selectin, thus decreasing platelet functional responsiveness to physiological stimuli. Approach and Results: Human gel-filtered platelets were exposed to continuous or pulsatile shear stress in vitro. Surface expression of platelet receptors and platelet-derived microparticle generation were quantified by flow cytometry. Shedding of receptor soluble forms were assessed via ELISA, and platelet aggregation was measured by optical aggregometry. We demonstrate that platelet exposure to elevated shear stress led to a downregulation of GPIb and α IIb β 3 receptors on platelets with a progressive increase in the generation of platelet-derived microparticles expressing elevated levels of α IIb β 3 and GPIb on their surface. No shear-mediated shedding of GPIb and β 3 subunit soluble fragments was detected. Soluble P-selectin was extensively shed from platelets, while surface expression of P-selectin on platelets was not significantly altered by shear. Shear-mediated downregulation of GPIb and α IIb β 3 on platelets was associated with an evident decrease of platelet aggregatory response induced by ADP and TRAP 6 (thrombin receptor activating peptide 6). Conclusions: Our data clearly indicate that accumulation of shear stress, consistent with supraphysiologic conditions characterizing device-supported circulation (1) induces adequate platelet degranulation, yet (2) causes downregulation of primary platelet adhesion receptors via ejection of receptor-enriched platelet-derived microparticles, thus mechanistically limiting platelet activation and the aggregatory response.
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Khattab, Sherif, Souad AlMuthree, Mohamed Bakry, Noha Ibraheem, Omar Alghamdi, Mahassen Khalifa, Ibrahim Alsehli, and Paul McCague. "282. Risk Factors for Mortality in Severe COVID-19 Patients Admitted to the Intensive Care Unit: A Retrospective Single-Center Study in Saudi Arabia." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S246—S247. http://dx.doi.org/10.1093/ofid/ofab466.484.
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Abstract Background The first case of COVID-19 in the Kingdom of Saudi Arabia (KSA) was reported in March 2020. This study aims to describe the overall mortality in the ICU during the COVID-19 pandemic and to determine independent risk factors for overall survival & 29 days mortality. Methods This is a retrospective single-center study; data for adult patients admitted to the ICU with COVID-19 between 1st March 2020 to 31st December 2020 were extracted and reviewed. Overall survival was described using Kaplan-Meier curves with reporting of median overall survival and 29 days survival estimates. Multivariate analysis was performed using Cox proportional hazards model and multivariate logistic regression model. Figure 1. Study flow chart Table 1. Demographic characteristics categorized by Gender Results Eligible subjects were 209 (Figure 1) and subjects demographics are summarized in (Table1). Observed death events were 82 (39.2% of the total cohort), 61% of deaths reached at 2 weeks of ICU stay (n.= 50), median overall survival (OS) was reached at day 23, as shown in (Figure 2). The multivariate Cox proportional hazard regression analysis (Figure 3) showed elevated SOFA score [aHR= 1.10, P < 0.001] and Vasopressors [aHR= 3.23, P= 0.002] as independent risk factors for overall ICU mortality. Independent protective factors were: Systemic corticosteroids use (P= 0.019), Insulin use (P= 0.026) and Liposomal Amphotericin B (LAMB) use (P= 0.019). For mortality at day 29, the multivariate logistic regression model (Figure. 4) showed elevated SOFA score (P= 0.005), any need for ventilation escalation after ICU admission (P= 0.014), Ribavirin use (P=0.016) and Vasopressors use ( P< 0.001) as independent risk factors. Angiotensin-Converting Enzyme inhibitors (ACEi) use was a protective factor (P=0.025). Figure 2. Overall Survival (OS) for patients admitted to the ICU due to COVID-19 - Kaplan Meier (KM) Figure 3. Multivariate Cox proportional hazard regression model for factors associated with overall mortality in patients admitted to the ICU due to COVID-19 Figure 4. Multivariate logistic regression model for factors associated with 29 days mortality in patients admitted to the ICU due to COVID-19 Conclusion SOFA score and vasopressors are independent predictors for overall survival and 29-day mortality in the ICU. The need for ventilation escalation after ICU admission appeared to lead to poor prognosis in regard to 29-day mortality only. Systemic corticosteroids are lifesaving, further studies are required to confirm the observed clinical benefits with insulin, LAMB and ACEi use in the ICU and to investigate any hazardous impact of ribavirin on COVID-19 outcomes. Study limitations Residual confounding of other measured and/or unobserved factors cannot be ruled out. Disclosures Sherif Khattab, BPharm, Gilead Sciences (Employee, Shareholder) Mohamed Bakry, MBBCh, Gilead Sciences (Employee)Roche Pharma (Employee)
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Freeman, S., M. Columbus, T. Nguyen, S. Mal, and J. Yan. "P049: Post-intubation sedation in the emergency department: a survey of national practice patterns." CJEM 21, S1 (May 2019): S80. http://dx.doi.org/10.1017/cem.2019.240.
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Introduction: Endotracheal intubation (ETI) is a lifesaving procedure commonly performed by emergency department (ED) physicians that may lead to patient discomfort or adverse events (e.g., unintended extubation) if sedation is inadequate. No ED-based sedation guidelines currently exist, so individual practice varies widely. This study's objective was to describe the self-reported post-ETI sedation practice of Canadian adult ED physicians. Methods: An anonymous, cross-sectional, web-based survey featuring 7 common ED scenarios requiring ETI was distributed to adult ED physician members of the Canadian Association of Emergency Physicians (CAEP). Scenarios included post-cardiac arrest, hypercapnic and hypoxic respiratory failure, status epilepticus, polytrauma, traumatic brain injury, and toxicology. Participants indicated first and second choice of sedative medication following ETI, as well as bolus vs. infusion administration in each scenario. Data was presented by descriptive statistics. Results: 207 (response rate 16.8%) ED physicians responded to the survey. Emergency medicine training of respondents included CCFP-EM (47.0%), FRCPC (35.8%), and CCFP (13.9%). 51.0% of respondents work primarily in academic/teaching hospitals and 40.4% work in community teaching hospitals. On average, responding physicians report providing care for 4.9 ± 6.8 (mean ± SD) intubated adult patients per month for varying durations (39.2% for 1–2 hours, 27.8% for 2–4 hours, and 22.7% for ≤1 hour). Combining all clinical scenarios, propofol was the most frequently used medication for post-ETI sedation (38.0% of all responses) and was the most frequently used agent except for the post-cardiac arrest, polytrauma, and hypercapnic respiratory failure scenarios. Ketamine was used second most frequently (28.2%), with midazolam being third most common (14.5%). Post-ETI sedation was provided by > 98% of physicians in all situations except the post-cardiac arrest (26.1% indicating no sedation) and toxicology (15.5% indicating no sedation) scenarios. Sedation was provided by infusion in 74.6% of cases and bolus in 25.4%. Conclusion: Significant practice variability with respect to post-ETI sedation exists amongst Canadian emergency physicians. Future quality improvement studies should examine sedation provided in real clinical scenarios with a goal of establishing best sedation practices to improve patient safety and quality of care.
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Inbar, Tsofia, and Eldad J. Dann. "Preoperative Anemia and Blood Transfusion Requirement during Hip Surgery: Synthetic and Real Patient Cohort Data." Blood 134, Supplement_1 (November 13, 2019): 3693. http://dx.doi.org/10.1182/blood-2019-125252.
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Introduction: Blood transfusion (BT), albeit lifesaving, is associated with morbidity, mortality and increased hospitalization length. In the last decade, due to BT-related risks the "patient blood management" (PBM) approach has been introduced to clinical practice. PBM focuses on multidisciplinary and multimodal preventive measures aiming to reduce the need for transfusions and ultimately improve patients' clinical outcomes. The 1st pillar of PBM is optimizing the red blood cell mass. Preoperative anemia is prevalent in approximately 25% of the patients undergoing elective total hip replacement surgery. The indications for BT during orthopedic surgery include excessive bleeding or hemodynamic instability and not the hemoglobin (Hb) level. Several studies have shown that preoperative anemia is a risk factor for postoperative complications. Strategies to minimize BT requirement during surgery have mainly focused on lowering transfusion thresholds. Randomized controlled trials have shown that in most clinical scenarios, a restrictive transfusion threshold (Hb level 7-8g/dL) appears to be non-inferior to the liberal transfusion strategy in terms of blood use, morbidity and mortality. Other strategies have not been fully evaluated. We hypothesize that preoperative anemia may lead to redundant blood product use with its inherent complications during elective orthopedic surgery. Methods: Medical files of patients who underwent hip surgery between 2011-2018 at the Rambam Health Care Campus, a tertiary care center in Northern Israel, were reviewed. Data on patient demographics, clinical findings, comorbidities, surgery type, hospitalization length were retrieved. Patients with available Hb level measurements within 90 days pre-surgery were included in the study. Receiving >1 blood unit was considered a surgery complication and such patients were excluded. We created a synthetic data cohort using MDClone Healthcare Data Sandbox. MDClone is an environment enabling fast data extraction and producing synthetic data for analysis that does not require IRB approval. Upon confirming the feasibility of using the synthetic data and receiving IRB approval, data of real patients were compared with those of the synthetic cohort. To track significant differences group means were analyzed using ANOVA followed by Tukey HSD. Results: During the evaluated period, 976 patients underwent elective hip surgery; 383 were excluded from the analysis due to receipt of >1 blood unit or lack of Hb value. Data on 593 patients [women: n=360 (60%)] were included in the final analysis. During surgery, BT was required in 29 % of patients, with this need being slightly higher among women (31.1% vs. 26.6%; p =NS). Patients receiving BT had a significantly lower mean Hb level than those who did not require it (11.94g/dL versus 12.8g/dL for women and 12.3g/dL vs. 13.8g/dL for men; p <0.001). Hospitalization was longer in transfused patients compared to non-transfused ones (mean 7.5 vs. 6.9 days, p =0.018) and in patients with a low Hb level (female <12, male <13.5) than in those with a high Hb level, irrespective of BT receipt (p <0.00045). Patients with at least one of the following diagnoses were significantly more likely to have a lower preoperative Hb level (p <0.05): diabetes, renal failure, ischemic heart disease. No other factors (e.g., patient's weight, red cell distribution width or blood pressure) were predictive of transfusion need. The probability of transfusion of 1 blood unit was 0.43 in the Hb 11g/dL cohort and 0.15 in Hb 13g/dL cohort (35% reduction). Results of real and synthetic data groups are presented in figures 1A & 1B. All differences in mean values between the two datasets were insignificant (p close to 1). Conclusions: Preoperative anemia in patients undergoing elective hip surgery is a risk factor for BT requirement and longer hospitalization. Diagnosis and management of anemia using timely pre-surgery evaluation may minimize intraoperative BT, particularly in women and patients with comorbidities and may shorten the hospitalization length. Synthetic data provide an accurate prediction of real data results. Disclosures No relevant conflicts of interest to declare.
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Ameri, Zahra Daneshvar, Ali Vafaee, Tahere Sadeghi, Zhila Mirlashari, Djavad Ghoddoosi-Nejad, and Faramarz Kalhor. "Effect of a Comprehensive Total Parenteral Nutrition Training Program on Knowledge and Practice of Nurses in NICU." Global Journal of Health Science 8, no. 10 (February 25, 2016): 135. http://dx.doi.org/10.5539/gjhs.v8n10p135.
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<p><strong>Background: </strong>Parenteral nutrition is a lifesaving therapy for many infants who are unable to tolerate enteral feedings. It fulfils preterm neonates’ needs for growth and development when their sizes or conditions preclude enteral feeding. Virtuous nursing care and close biochemical monitoring are absolutely essential for successful parenteral nutrition therapy. Since poor knowledge in parenteral nutrition can causes severe impairment to neonatal infants, the conduction of this study is essential.</p><p><strong>Aims: </strong>The present study aims to: (1) examine the knowledge and practice of nurses in total parenteral nutrition (TPN); (2) employ training programs for improving knowledge and practice in management of TPN in new-borns.<strong></strong></p><p><strong>Method: </strong>A quasi-experimental study was carried out in Sarem Maternity Hospital in Tehran, Iran. The study population included nurses working in Neonatal Intensive Care Unit (NICU) who were included in the study using headcount census method (n=30). A two-part questionnaire including demographic information; 20 multiple choice questions on the nurses’ knowledge of TPN therapy and 19-item 3-point Likert-type checklist on administration of TPN completed by observing the nurses’ practice. To examine the reliability of the practice part, Cronbach's alpha method was used (α=0.78). Study interventions were mentoring education by the researcher and researcher-developed training manual and educational video and guidelines about neonatal parenteral nutrition. Before and after intervention data were collected and compared using paired t-test.<strong></strong></p><p><strong>Results: </strong>The mean scores of nurses' knowledge before and afterward parenteral nutrition (PN) training program were 11.93±1.91 and 17.56±1.59, respectively. The mean scores of the nurses' practice earlier and after training program were 38.84±2.96 and 40.15±3.02, respectively. Comparing the mean scores of the nurses' familiarity, before and after taking the training course, demonstrated a significant difference (p<0.0001). The knowledge of the nurses in all areas of parenteral nutrition prescription was significantly improved after the employment of mentoring method (p<0.05). Despite an increase in the post-intervention total score, the nurses’ practice, before and after, the intervention was not statistically significant (p<0.05).<strong></strong></p><p><strong>Conclusion: </strong>There is a breach between nursing knowledge and practice in prescribing parenteral nutrition. The gap between knowledge and practice in this area can lead to more morbidity and negative influences on the infant. Therefore, it is required that the gap between knowledge and practice is known as the infant gets less damage.</p>
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Kashfi, Tasmia, ASM Areef Ahsan, and Rozina Sultana. "Frequency and Outcome of Ventilator Associated Pneumonia in an Intensive Care Unit of a Tertiary Care Hospital in Dhaka." Bangladesh Critical Care Journal 10, no. 1 (April 25, 2022): 43–47. http://dx.doi.org/10.3329/bccj.v10i1.59203.
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Background: Intubation and mechanical ventilation are integral parts of critical care management. Though a lifesaving intervention, invasive mechanical ventilation imposes a great risk of nosocomial pneumonia to the patient. Ventilator associated pneumonia rates in an ICU is a predictor of successful infection control strategy. Objectives: objective of the current study was to study the frequency of ventilator associated pneumonia and its outcome in the critical care setting. Methods: This prospective observational cross-sectional study was done in department of critical care medicine of BIRDEM General Hospital for the period of 1st July, 2017 to 30th June, 2018. All consecutive patients who were intubated and mechanically ventilated for a period of at least 48 hours within the study period were evaluated for the selection criteria of the study. The included study participants were followed up daily for signs of development of VAP. Once VAP was suspected pertinent investigations were sent to confirm the diagnosis. Study participants were observed regularly to identify signs of pulmonary infection. The microbiological tests were done in the Department of Microbiology of BIRDEM. Quantitative culture was done (expressed as CFU/ml) and antibiotic sensitivity was done by standard disc diffusion method. A cutoff value of 105 CFU/ml was taken as a positive culture. CPIS score was calculated to diagnose VAP .The study participants were followed up to transfer to step down unit/ward or death to see the outcome. Data were collected in preformed data collection sheet and analyzed by the statistical packages for social sciences (SPSS) software version 22. Results: In this study total 92 patients out of 625 intubated patients during the study period after fulfilling the inclusion criteria were selected as study participants. The mean age of the the participants who developed VAP was 65.05±14.79 years with a range of 27 to 101 years. 62.9% (n=22) were female and 37.1% (n=13) were male. In this study DM, HTN & Renal disease were the most common co-morbidities. Among the 35 VAP positive participants 51.4% (n=18) developed early onset VAP and 48.6% (n=17) developed late onset VAP. Among the VAP positive participants 31.4% were survivors and 68.6% were non-survivors and among the VAP negative participants 68.4% were survivors and 31.6% were non survivors (p=0.001). Conclusion: Frequency of VAP was 5.6% in the study. It was associated with significantly prolonged length of mechanical ventilation and length of ICU stay and high mortality. Bangladesh Crit Care J March 2022; 10 (1): 43-47
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Kashfi, Tasmia, ASM Areef Ahsan, and Rozina Sultana. "Frequency and Outcome of Ventilator Associated Pneumonia in an Intensive Care Unit of a Tertiary Care Hospital in Dhaka." Bangladesh Critical Care Journal 10, no. 1 (April 25, 2022): 43–47. http://dx.doi.org/10.3329/bccj.v10i1.59203.
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Background: Intubation and mechanical ventilation are integral parts of critical care management. Though a lifesaving intervention, invasive mechanical ventilation imposes a great risk of nosocomial pneumonia to the patient. Ventilator associated pneumonia rates in an ICU is a predictor of successful infection control strategy. Objectives: objective of the current study was to study the frequency of ventilator associated pneumonia and its outcome in the critical care setting. Methods: This prospective observational cross-sectional study was done in department of critical care medicine of BIRDEM General Hospital for the period of 1st July, 2017 to 30th June, 2018. All consecutive patients who were intubated and mechanically ventilated for a period of at least 48 hours within the study period were evaluated for the selection criteria of the study. The included study participants were followed up daily for signs of development of VAP. Once VAP was suspected pertinent investigations were sent to confirm the diagnosis. Study participants were observed regularly to identify signs of pulmonary infection. The microbiological tests were done in the Department of Microbiology of BIRDEM. Quantitative culture was done (expressed as CFU/ml) and antibiotic sensitivity was done by standard disc diffusion method. A cutoff value of 105 CFU/ml was taken as a positive culture. CPIS score was calculated to diagnose VAP .The study participants were followed up to transfer to step down unit/ward or death to see the outcome. Data were collected in preformed data collection sheet and analyzed by the statistical packages for social sciences (SPSS) software version 22. Results: In this study total 92 patients out of 625 intubated patients during the study period after fulfilling the inclusion criteria were selected as study participants. The mean age of the the participants who developed VAP was 65.05±14.79 years with a range of 27 to 101 years. 62.9% (n=22) were female and 37.1% (n=13) were male. In this study DM, HTN & Renal disease were the most common co-morbidities. Among the 35 VAP positive participants 51.4% (n=18) developed early onset VAP and 48.6% (n=17) developed late onset VAP. Among the VAP positive participants 31.4% were survivors and 68.6% were non-survivors and among the VAP negative participants 68.4% were survivors and 31.6% were non survivors (p=0.001). Conclusion: Frequency of VAP was 5.6% in the study. It was associated with significantly prolonged length of mechanical ventilation and length of ICU stay and high mortality. Bangladesh Crit Care J March 2022; 10 (1): 43-47
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Yu, Binglan, Liu Han, Patricio A. Leyton, Kenneth D. Bloch, and Warren M. Zapol. "Nitric Oxide Synthase 3 Deficiency Does Not Prevent Inflammatory Adverse Effects Of Transfusing Syngeneic Stored Blood In a Murine Model Of Hemorrhagic Shock." Blood 122, no. 21 (November 15, 2013): 791. http://dx.doi.org/10.1182/blood.v122.21.791.791.
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Abstract Introduction Blood transfusion is a lifesaving treatment for hemorrhagic shock. During storage, red blood cells (RBC) undergo progressive deleterious functional, biochemical and structural alterations, which are collectively termed the “storage lesion”. The association between transfusion of blood stored for more than 14 days and adverse clinical outcomes (increased infection, multi-organ failure and mortality) is controversial. Studying mice with hemorrhagic shock, we recently found that resuscitation with blood stored for prolonged periods (SRBC) was associated with worse outcomes than was resuscitation with fresh blood (FRBC). The mechanisms responsible for the adverse effects associated with transfusion of SRBC are incompletely characterized. However, it is known that transfusion of SRBC increases plasma levels of hemoglobin (Hb), which can scavenge vascular nitric oxide (NO). Intravenous infusion of a solution containing cell-free Hb induces systemic hypertension in wild-type (WT) mice, but not in mice that are congenitally deficient in NO synthase 3 (NOS3-/-). In the present study, we sought to determine if NOS3-/- mice are protected from the adverse effects associated with resuscitation of hemorrhagic shock with SRBC. Methods Leukoreduced, packed RBC from WT C57BL6 mice were stored with 14% CPDA-1 anticoagulant at 4°C for either ≤24 h (FRBC) or 2 weeks (SRBC). Mice, of each genotype that were not subjected to hemorrhagic shock or resuscitation, served as control groups. Anesthetized WT mice and NOS3-/- mice (on a C57BL6 background) were bled to a mean arterial pressure (MAP) of 40 mmHg over 10 min. After 90 min of hemorrhagic shock, mice were resuscitated with FRBC or SRBC. Survival rates for up to 7 days were determined. In addition, blood and tissue samples were collected at 4 h after resuscitation to measure plasma markers of liver and kidney injury, plasma Hb and interleukin 6 (IL-6) levels, tissue IL-6 mRNA levels, and pulmonary myeloperoxidase activity and mRNA levels. All data are expressed as mean±SD. Results Baseline MAP under anesthesia was higher in NOS3-/- mice than in WT mice (111±4 vs 83±5 mmHg; P<0.01). After hemorrhagic shock and resuscitation with either FRBC or SRBC, MAP returned to the respective baseline values in each genotype. Survival rates at one week did not differ between WT or NOS3-/- mice resuscitated with either FRBC or SRBC. In both genotypes, after hemorrhagic shock, resuscitation with FRBC elevated plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities similarly as compared to a control group (P<0.01). Plasma levels of ALT and AST were greater after resuscitation with SRBC than after resuscitation with FRBC in both genotypes at 4 h (P<0.01). Resuscitation with SRBC, but not FRBC, increased plasma blood urea nitrogen and creatinine levels similarly in WT and NOS3-/- mice. Plasma Hb levels were greater in mice resuscitated with SRBC than in those resuscitated with FRBC in both genotypes at 4 h after resuscitation (WT: 202±79 vs 5±2 µM, respectively; NOS3-/-: 240±51 vs 14±3 µM, respectively; P<0.001 for both). At 4 h after resuscitation, plasma IL-6 levels were greater in mice treated with SRBC than in mice treated with FRBC in both genotypes (WT: 0.8±0.1 vs 0.5±0.1 ng/ml, respectively; NOS3-/-: 0.8±0.1 vs 0.4±0.1 ng/ml; P<0.01 for both). In both WT and NOS3-/- mice, IL-6 mRNA levels were greater in the liver, kidney, and spleen after resuscitation with SRBC than after resuscitation with FRBC (P<0.01, all values differ SRBC vs FRBC for both genotypes). Pulmonary myeloperoxidase activity and mRNA levels were greater in both genotypes after resuscitation with SRBC than mice resuscitated with FRBC (P<0.01, all values differ SRBC vs FRBC for both genotypes). Conclusions Survival rate after hemorrhagic shock did not differ in WT and NOS3-/- mice resuscitated with either FRBC or SRBC. Resuscitation with SRBC induced greater tissue injury and a more marked inflammatory response than did resuscitation with FRBC, but there was no difference between the genotypes. Our data suggest that mice with NOS3 deficiency are not protected from the adverse effects associated with resuscitation of hemorrhagic shock with SRBC. These findings suggest that the adverse effects of transfusing blood stored for prolonged periods in mice with hemorrhagic shock are not exclusively attributable to scavenging of NOS3-generated NO by increased plasma Hb levels. Disclosures: No relevant conflicts of interest to declare.