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[PMID]: 25695147
[Au] Autor:Schuetz P; Aujesky D; Müller C; Müller B
[Ad] Address:Medical University Clinic of the Medical Faculty University of Basel, Kantonsspital Aarau, Switzerland....
[Ti] Title:Biomarker-guided personalised emergency medicine for all - hope for another hype?
[So] Source:Swiss Med Wkly;145:w14079, 2015.
[Is] ISSN:1424-3997
[Cp] Country of publication:Switzerland
[La] Language:eng
[Ab] Abstract:Polymorbid patients, diverse diagnostic and therapeutic options, more complex hospital structures, financial incentives, benchmarking, as well as perceptional and societal changes put pressure on medical doctors, specifically if medical errors surface. This is particularly true for the emergency department setting, where patients face delayed or erroneous initial diagnostic or therapeutic measures and costly hospital stays due to sub-optimal triage. A "biomarker" is any laboratory tool with the potential better to detect and characterise diseases, to simplify complex clinical algorithms and to improve clinical problem solving in routine care. They must be embedded in clinical algorithms to complement and not replace basic medical skills. Unselected ordering of laboratory tests and shortcomings in test performance and interpretation contribute to diagnostic errors. Test results may be ambiguous with false positive or false negative results and generate unnecessary harm and costs. Laboratory tests should only be ordered, if results have clinical consequences. In studies, we must move beyond the observational reporting and meta-analysing of diagnostic accuracies for biomarkers. Instead, specific cut-off ranges should be proposed and intervention studies conducted to prove outcome relevant impacts on patient care. The focus of this review is to exemplify the appropriate use of selected laboratory tests in the emergency setting for which randomised-controlled intervention studies have proven clinical benefit. Herein, we focus on initial patient triage and allocation of treatment opportunities in patients with cardiorespiratory diseases in the emergency department. The following five biomarkers will be discussed: proadrenomedullin for prognostic triage assessment and site-of-care decisions, cardiac troponin for acute myocardial infarction, natriuretic peptides for acute heart failure, D-dimers for venous thromboembolism, C-reactive protein as a marker of inflammation, and procalcitonin for antibiotic stewardship in infections of the respiratory tract and sepsis. For these markers we provide an overview on physiopathology, historical evolution of evidence, strengths and limitations for a rational implementation into clinical algorithms. We critically discuss results from key intervention trials that led to their use in clinical routine and potential future indications. The rational for the use of all these biomarkers, first, tackle diagnostic ambiguity and consecutive defensive medicine, second, delayed and sub-optimal therapeutic decisions, and third, prognostic uncertainty with misguided triage and site-of-care decisions all contributing to the waste of our limited health care resources. A multifaceted approach for a more targeted management of medical patients from emergency admission to discharge including biomarkers, will translate into better resource use, shorter length of hospital stay, reduced overall costs, improved patients satisfaction and outcomes in terms of mortality and re-hospitalisation. Hopefully, the concepts outlined in this review will help the reader to improve their diagnostic skills and become more parsimonious laboratory test requesters.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1502
[Js] Journal subset:IM
[St] Status:In-Data-Review

  2 / 89874 MEDLINE  
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[PMID]: 25695387
[Au] Autor:Valdés-Ferrer SI
[Ad] Address:Elmezzi School of Molecular Medicine and the Laboratory of Biomedical Science, Feinstein Institute for Medical Research, Manhasset, NY.
[Ti] Title:Clinical Forum: The challenges of long-term sepsis survivors: when surviving is just the beginning.
[So] Source:Rev Invest Clin;66(5):439-49, 2014 Sep-Oct.
[Is] ISSN:0034-8376
[Cp] Country of publication:Mexico
[La] Language:eng
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1502
[Js] Journal subset:IM
[St] Status:In-Data-Review

  3 / 89874 MEDLINE  
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SciELO Chile full text

[PMID]: 25697247
[Au] Autor:Mena N P; León Del P J; Sandino P D; Ralmolfo B P; Sabatelli D; Llanos M A; Milet L B
[Ti] Title:Evacuación del meconiointestinal para mejorar tolerancia alimentaria en prematuro de muy bajo peso (protocolo Emita). [Meconium evacuation to improve feeding tolerance in very low birth weight preterm infants (Emita Protocol)].
[So] Source:Rev Chil Pediatr;85(3):304-11, 2014 Jun.
[Is] ISSN:0717-6228
[Cp] Country of publication:Chile
[La] Language:spa
[Ab] Abstract:INTRODUCTION: It has been reported that feeding tolerance in preterm infants is associated with an early passage of meconium. Prospective, randomized or historical control studies that stimulate meconium evacuation have reported varied results. This study was intented to evaluate the use of enemas to speed up meconium evacuation, facilitating feeding tolerance. PATIENTS AND METHOD: A controlled multicenter randomized trial that evaluated the use of physiological saline enemas with glycerol (0.8 ml glycerol + 3 ml saline or 1 ml glycerol + 5 ml saline depending on babies weighing less or more than 800 g at birth, respectively) versus simulation. This procedure was performed in the first 96 hours of life in infants with birth weight between 500 and 1,250 g. Maternal (preterm delivery, clinical chorioamnionitis, gestational hypertension, administration of magnesium sulfate and prenatal corticosteroids, fetal Doppler altered, type of delivery, gender, weight and gestational age, assessment of Apgar and need for assisted ventilation and oxygenotherapy) and nutritional history (age when feeding volumes of 100 ml/kg/day and full enteral feeding were reached, age to remove meconium, number of days on parenteral nutrition, weight at 28 days, weekly volumes of breast milk and preterm formula) were described. RESULTS: No significant differences were obtained regarding the age to reach full enteral intake or 100 ml/kg/day were found among the 101 patients in the study. Also, no differences in the following secondary variables are observed: number of episodes of late sepsis with or without positive blood culture, hyperbilirubinemia, necrotizing enterocolitis and intraventricular hemorrhage. CONCLUSIONS: The routine use of saline enemas and glycerin in this study does not alter the enteral feeding tolerance in very low birth weight preterm infants.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1502
[Js] Journal subset:IM
[St] Status:In-Data-Review

  4 / 89874 MEDLINE  
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SciELO Chile full text

[PMID]: 25697246
[Au] Autor:Folatre B I; Kuschel B C; Marín H F
[Ti] Title:Transfusiones de glóbulos rojos en recién nacidos de muy bajo peso de nacimiento. [Red blood cell transfusions in very low birth weight newborns].
[So] Source:Rev Chil Pediatr;85(3):298-303, 2014 Jun.
[Is] ISSN:0717-6228
[Cp] Country of publication:Chile
[La] Language:spa
[Ab] Abstract:INTRODUCTION: It has been reported that 80% of very low birth weight infants (VLBWI) are receiving packed red blood cell transfusions (PRBCtr), and in 90% of cases, the indication is the replacement of the blood collected. The existence of guidelines for transfusion practices has had a great impact on the decline in the number of transfusions. The aim of this paper is to describe the characteristics of VLBW infants who are packed red blood cell transfusion receptors. PATIENTS AND METHODS: This is a descriptive cross-sectional study, which included the medical records of all VLBW newborns older than 72 hours, released from the Neonatology department of the Hospital Valdivia Base, between 2005 and 2006. Birth weight, gestational age, pulmonary surfactant, hyaline membrane, mechanical ventilation, bronchopulmonary dysplasia, sepsis and packed red blood cell transfusions were evaluated. Guidelines for packed red cell transfusions were used at the Hospital. RESULTS: 93 newborns were evaluated and 62 of them were transfused (66.7%); they received 2.1 ± 0.9 PRBC transfusion and the exposure to different donors was 2.1 ± 0.9. The VLBW infants susceptible to be PRBCtr receptor were those younger than 30 weeks' gestational age, weighing less than 1,250 g and with respiratory failure, mechanical ventilation and sepsis. CONCLUSION: The observed percentages of transfused infants with very low birth weight, median PRBCtr and exposure to different donors can be attributed to the existence of guidelines for neonatal transfusion practices and a team of highly experienced neonatologists.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1502
[Js] Journal subset:IM
[St] Status:In-Data-Review

  5 / 89874 MEDLINE  
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[PMID]: 24817321
[Au] Autor:Arul GS; Sonka BJ; Lundy JB; Rickard RF; Jeffery SL
[Ad] Address:212 Field Hospital, Sheffield, UK....
[Ti] Title:Management of complex abdominal wall defects associated with penetrating abdominal trauma.
[So] Source:J R Army Med Corps;161(1):46-52, 2015 Mar.
[Is] ISSN:0035-8665
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:INTRODUCTION: The paradigm of Damage Control Surgery (DCS) has radically improved the management of abdominal trauma, but less well described are the options for managing the abdominal wall itself in an austere environment. This article describes a series of patients with complex abdominal wall problems managed at the UK-led Role 3 Medical Treatment Facility (MTF) in Camp Bastion, Afghanistan. METHOD: Contemporaneous review of a series of patients with complex abdominal wall injuries who presented to the Role 3 MTF between July and November 2012. RESULTS: Five patients with penetrating abdominal trauma associated with significant damage to the abdominal wall were included. All patients were managed using DCS principles, leaving the abdominal wall open at the end of the first procedure. Subsequent management of the abdominal wall was determined by a multidisciplinary team of general and plastic surgeons, intensivists and specialist nurses. The principles of management identified included minimising tissue loss on initial laparotomy by joining adjacent wounds and marginal debridement of dead tissue; contraction of the abdominal wall was minimised by using topical negative pressure dressing and dermal-holding sutures. Definitive closure was timed to allow oedema to settle and sepsis to be controlled. Closure techniques include delayed primary closure with traction sutures, components separation, and mesh closure with skin grafting. DISCUSSION: A daily multidisciplinary team discussion was invaluable for optimal decision making regarding the most appropriate means of abdominal closure. Dermal-holding sutures were particularly useful in preventing myostatic contraction of the abdominal wall. A simple flow chart was developed to aid decision making in these patients. This flow chart may prove especially useful in a resource-limited environment in which returning months or years later for closure of a large ventral hernia may not be possible.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1502
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1136/jramc-2014-000276

  6 / 89874 MEDLINE  
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[PMID]: 25699115
[Au] Autor:Karadag MA; Cecen K; Demir A; Bagcioglu M; Kocaaslan R; Kadioglu TC
[Ad] Address:Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey....
[Ti] Title:Gastrointestinal complications of laparoscopic/robot-assisted urologic surgery and a review of the literature.
[So] Source:J Clin Med Res;7(4):203-10, 2015 Apr.
[Is] ISSN:1918-3003
[Cp] Country of publication:Canada
[La] Language:eng
[Ab] Abstract:Gastrointestinal injuries that occur during or after laparoscopic and robot-assisted surgery are serious side effects that affect patient outcome. In this review, we attempt to highlight the identification, incidence and management of gastrointestinal and visceral complications of laparoscopic and robot-assisted surgery. A search of Medline and PubMed databases was performed using the following terms: gastrointestinal complications of laparoscopy, laparoscopic, kidney and robotic surgery. A total of 1,072 papers related to the subject were analyzed. Forty-six of these papers were included in the present review. These papers reported high numbers of participants and had a high level of evidence. Gastrointestinal complications during laparoscopic and robot-assisted surgery are rare, but similar, and can occur at any time between access and closure. Despite their infrequency, these complications can result in mortality. The early recognition and management of gastrointestinal complications is very important. Unrecognized or delayed identification of gastrointestinal complications may cause sepsis and death.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1502
[Da] Date of entry for processing:150220
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.14740/jocmr2090w

  7 / 89874 MEDLINE  
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[PMID]: 25608572
[Au] Autor:Kahlberg A; Melissano G; Tshomba Y; Leopardi M; Chiesa R
[Ad] Address:Department of Vascular Surgery San Raffaele Scientific Institute, Vita­Salute University School of Medicine, Milan, Italy - kahlberg.andrea@hsr.it.
[Ti] Title:Strategies to treat thoracic aortitis and infected aortic grafts.
[So] Source:J Cardiovasc Surg (Torino);56(2):269-80, 2015 Apr.
[Is] ISSN:0021-9509
[Cp] Country of publication:Italy
[La] Language:eng
[Ab] Abstract:Infectious thoracic aortitis is a rare disease, especially since the incidence of syphilis and tuberculosis has dropped in western countries. However, the risk to develop an infectious aortitis and subsequent mycotic aneurysm formation is still present, particularly in case of associated endocarditis, sepsis, and in immunosuppressive disorders. Moreover, the number of surgical and endovascular thoracic aortic repairs is continuously increasing, and infective graft complications are observed more frequently. Several etiopathogenetic factors may play a role in thoracic aortic and prosthetic infections, including hematogenous seeding, local bacterial translocation, and iatrogenous contamination. Also, fistulization of the esophagus or the bronchial tree is commonly associated with these diseases, and it represents a critical event requiring a multidisciplinary management. Knowledge on underlying micro-organisms, antibiotic efficacy, risk factors, and prevention strategies has a key role in the management of this spectrum of infectious diseases involving the thoracic aorta. When the diagnosis of a mycotic aneurysm or a prosthetic graft infection is established, treatment is demanding, often including a number of surgical options. Patients are usually severely compromised by sepsis, and in most cases they are considered unfit for surgery for general clinical conditions or local concerns. Thus, results of different therapeutic strategies for infectious diseases of the thoracic aorta are still burdened with very high morbidity and mortality. In this manuscript, we review the literature regarding the main issues related to thoracic infectious aortitis and aortic graft infections, and we report our personal series of patients surgically treated at our institution for these conditions from 1993 to 2014.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1502
[Js] Journal subset:IM
[St] Status:In-Data-Review

  8 / 89874 MEDLINE  
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[PMID]: 24650942
[Au] Autor:Khan SK; Rushton SP; Shields DW; Corsar KG; Refaie R; Gray AC; Deehan DJ
[Ad] Address:Royal Victoria Infirmary, Newcastle upon Tyne University Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom. Electronic address: Sameer.khan@doctors.net.uk....
[Ti] Title:The risk of cardiorespiratory deaths persists beyond 30 days after proximal femoral fracture surgery.
[So] Source:Injury;46(2):358-62, 2015 Feb.
[Is] ISSN:1879-0267
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:INTRODUCTION: 30-day mortality is routinely used to assess proximal femoral fracture care, though patients might remain at risk for poor outcome for longer. This work has examined the survivorship out to one year of a consecutive series of patients admitted for proximal femoral fracture to a single institution. We wished to quantify the temporal impact of fracture upon mortality, and also the influence of patient age, gender, surgical delay and length of stay on mortality from both cardiorespiratory and non-cardiorespiratory causes. PATIENTS AND METHODS: Data were analysed for 561 consecutive patients with 565 fragility type proximal femoral fractures treated surgically at our trauma unit. Dates and causes of death were obtained from death certificates and also linked to data from the Office of National Statistics. Mortality rates and causes were collated for two time periods: day 0-30, and day 31-365. RESULTS: Cumulative incidence analysis showed that mortality due to cardiorespiratory causes (pneumonia, myocardial infarction, cardiac failure) rose steeply to around 100 days after surgery and then flattened reaching approximately 12% by 1 year. Mortality from non-cardiorespiratory causes (kidney failure, stroke, sepsis etc.) was more progressive, but with a rate half of that of cardiorespiratory causes. Progressive modelling of mortality risks revealed that cardiorespiratory deaths were associated with advancing age and male gender (p<0.001 for both), but the effect of age declined after 100 days. Non-cardiorespiratory deaths were not time-dependent. CONCLUSION: We believe this analysis extends our understanding of the temporal impact of proximal femoral fracture and its surgical management upon outcome beyond the previously accepted standard (30 days) and supports the use of a new, more relevant timescale for this high risk group of patients. It also highlights the need for planning and continuing physiotherapy, respiratory exercises and other chest-protective measures from 31 to 100 days.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1502
[Js] Journal subset:IM
[St] Status:In-Data-Review

  9 / 89874 MEDLINE  
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[PMID]: 25695167
[Au] Autor:Harrison M; Collins CD
[Ad] Address:1Department of Pharmacy Services,St. Joseph Mercy Health System,Ann Arbor,Michigan.
[Ti] Title:Is procalcitonin-guided antimicrobial use cost-effective in adult patients with suspected bacterial infection and sepsis?
[So] Source:Infect Control Hosp Epidemiol;36(3):265-72, 2015 Mar.
[Is] ISSN:1559-6834
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE Procalcitonin has emerged as a promising biomarker of bacterial infection. Published literature demonstrates that use of procalcitonin testing and an associated treatment pathway reduces duration of antibiotic therapy without impacting mortality. The objective of this study was to determine the financial impact of utilizing a procalcitonin-guided treatment algorithm in hospitalized patients with sepsis. DESIGN Cost-minimization and cost-utility analysis. PATIENTS Hypothetical cohort of adult ICU patients with suspected bacterial infection and sepsis. METHODS Utilizing published clinical and economic data, a decision analytic model was developed from the U.S. hospital perspective. Effectiveness and utility measures were defined using cost-per-clinical episode and cost per quality-adjusted life years (QALYs). Upper and lower sensitivity ranges were determined for all inputs. Univariate and probabilistic sensitivity analyses assessed the robustness of our model and variables. Incremental cost-effectiveness ratios (ICERs) were calculated and compared to predetermined willingness-to-pay thresholds. RESULTS Base-case results predicted the use of a procalcitonin-guided treatment algorithm dominated standard care with improved quality (0.0002 QALYs) and decreased overall treatment costs ($65). The model was sensitive to a number of key variables that had the potential to impact results, including algorithm adherence (<42.3%), number and cost of procalcitonin tests ordered (≥9 and >$46), days of antimicrobial reduction (<1.6 d), incidence of nephrotoxicity and rate of nephrotoxicity reduction. CONCLUSION The combination of procalcitonin testing with an evidence-based treatment algorithm may improve patients' quality of life while decreasing costs in ICU patients with suspected bacterial infection and sepsis; however, results were highly dependent on a number of variables and assumptions. Infect Control Hosp Epidemiol 2014;00(0): 1-8.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1502
[Js] Journal subset:IM; N
[St] Status:In-Data-Review
[do] DOI:10.1017/ice.2014.60

  10 / 89874 MEDLINE  
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[PMID]: 25699046
[Au] Autor:Stolla M; Refaai MA; Heal JM; Spinelli SL; Garraud O; Phipps RP; Blumberg N
[Ad] Address:Department of Pathology and Laboratory Medicine, School of Medicine and Dentistry, University of Rochester Medical Center , Rochester, NY , USA....
[Ti] Title:Platelet transfusion - the new immunology of an old therapy.
[So] Source:Front Immunol;6:28, 2015.
[Is] ISSN:1664-3224
[Cp] Country of publication:Switzerland
[La] Language:eng
[Ab] Abstract:Platelet transfusion has been a vital therapeutic approach in patients with hematologic malignancies for close to half a century. Randomized trials show that prophylactic platelet transfusions mitigate bleeding in patients with acute myeloid leukemia. However, even with prophylactic transfusions, as many as 75% of patients, experience hemorrhage. While platelet transfusion efficacy is modest, questions and concerns have arisen about the risks of platelet transfusion therapy. The acknowledged serious risks of platelet transfusion include viral transmission, bacterial sepsis, and acute lung injury. Less serious adverse effects include allergic and non-hemolytic febrile reactions. Rare hemolytic reactions have occurred due to a common policy of transfusing without regard to ABO type. In the last decade or so, new concerns have arisen; platelet-derived lipids are implicated in transfusion-related acute lung injury after transfusion. With the recognition that platelets are immune cells came the discoveries that supernatant IL-6, IL-27 sCD40L, and OX40L are closely linked to febrile reactions and sCD40L with acute lung injury. Platelet transfusions are pro-inflammatory, and may be pro-thrombotic. Anti-A and anti-B can bind to incompatible recipient or donor platelets and soluble antigens, impair hemostasis and thus increase bleeding. Finally, stored platelet supernatants contain biological mediators such as VEGF and TGF-ß1 that may compromise the host versus tumor response. This is particularly of concern in patients receiving many platelet transfusions, as for acute leukemia. New evidence suggests that removing stored supernatant will improve clinical outcomes. This new view of platelets as pro-inflammatory and immunomodulatory agents suggests that innovative approaches to improving platelet storage and pre-transfusion manipulations to reduce toxicity could substantially improve the efficacy and safety of this long-employed therapy.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1502
[Da] Date of entry for processing:150220
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.3389/fimmu.2015.00028


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