Database : MEDLINE
Search on : medicine [Words]
References found : 1907445 [refine]
Displaying: 1 .. 10   in format [Detailed]

page 1 of 190745 go to page                         

  1 / 1907445 MEDLINE  
              next record last record
select
to print
Photocopy
Full text

[PMID]: 25267200
[Au] Autor:Diesel JC; Eckhardt CL; Day NL; Brooks MM; Arslanian SA; Bodnar LM
[Ad] Address:Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA....
[Ti] Title:Is gestational weight gain associated with offspring obesity at 36 months?
[So] Source:Pediatr Obes;10(4):305-10, 2015 Aug.
[Is] ISSN:2047-6310
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVE: We examined the association between gestational weight gain (GWG) and offspring obesity at age 36 months. METHODS: Mother-infant dyads (n = 609) were followed from a first study visit (mean [standard deviation]: 18.8 [2.7] weeks gestation) to 36 months postpartum. Total GWG over the entire pregnancy was defined as excessive or non-excessive according to the 2009 Institute of Medicine guidelines. Four mutually exclusive categories of excessive or non-excessive GWG across early (conception to first study visit) and late (first study visit to delivery) pregnancy defined GWG pattern. Body mass index (BMI) z-scores ≥95th percentile of the 2000 Centers for Disease Control (CDC) references defined offspring obesity at 36 months. Multivariable log-binomial models adjusted for pre-pregnancy BMI and breastfeeding were used to estimate the association between GWG and childhood obesity risk. RESULTS: Nearly half of the women had total excessive GWG. Of these, 46% gained excessively during both early and late pregnancy while 22% gained excessively early and non-excessively late, and the remaining 32% gained non-excess weight early and excessively later. Thirteen per cent of all children were obese at 36 months. Excessive total GWG was associated with more than twice the risk of child obesity (adjusted risk ratio [95% confidence interval]: 2.20 [1.35, 3.61]) compared with overall non-excessive GWG. Compared with a pattern of non-excessive GWG in both early and late pregnancy, excessive GWG in both periods was associated with an increased risk of obesity (2.39 [1.13, 5.08]). CONCLUSIONS: Excessive GWG is a potentially modifiable factor that may influence obesity development in early childhood.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1507
[Cu] Class update date: 150718
[Lr] Last revision date:150718
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1111/ijpo.262

  2 / 1907445 MEDLINE  
              first record previous record next record last record
select
to print
Photocopy
Full text

[PMID]: 25666844
[Au] Autor:Lai PS; Hang JQ; Valeri L; Zhang FY; Zheng BY; Mehta AJ; Shi J; Su L; Brown D; Eisen EA; Christiani DC
[Ad] Address:Massachusetts General Hospital, Boston, Massachusetts, USA Harvard School of Public Health, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA....
[Ti] Title:Endotoxin and gender modify lung function recovery after occupational organic dust exposure: a 30-year study.
[So] Source:Occup Environ Med;72(8):546-52, 2015 Aug.
[Is] ISSN:1470-7926
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVES: The purpose of this study is to determine the trajectory of lung function change after exposure cessation to occupational organic dust exposure, and to identify factors that modify improvement. METHODS: The Shanghai Textile Worker Study is a longitudinal study of 447 cotton workers exposed to endotoxin-containing dust and 472 silk workers exposed to non-endotoxin-containing dust. Spirometry was performed at 5-year intervals. Air sampling was performed to estimate individual cumulative exposures. The effect of work cessation on forced expiratory volume in 1 s (FEV1) was modelled using generalised additive mixed effects models to identify the trajectory of FEV1 recovery. Linear mixed effects models incorporating interaction terms were used to identify modifiers of FEV1 recovery. Loss to follow-up was accounted for with inverse probability of censoring weights. RESULTS: 74.2% of the original cohort still alive participated in 2011. Generalised additive mixed models identified a non-linear improvement in FEV1 for all workers after exposure cessation, with no plateau noted 25 years after retirement. Linear mixed effects models incorporating interaction terms identified prior endotoxin exposure (p=0.01) and male gender (p=0.002) as risk factors for impaired FEV1 improvement after exposure cessation. After adjusting for gender, smoking delayed the onset of FEV1 gain but did not affect the overall magnitude of change. CONCLUSIONS: Lung function improvement after cessation of exposure to organic dust is sustained. Endotoxin exposure and male gender are risk factors for less FEV1 improvement.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1507
[Cu] Class update date: 150718
[Lr] Last revision date:150718
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1136/oemed-2014-102579

  3 / 1907445 MEDLINE  
              first record previous record next record last record
select
to print
Photocopy
Full text

[PMID]: 26181256
[Au] Autor:Beltran H; Eng K; Mosquera JM; Sigaras A; Romanel A; Rennert H; Kossai M; Pauli C; Faltas B; Fontugne J; Park K; Banfelder J; Prandi D; Madhukar N; Zhang T; Padilla J; Greco N; McNary TJ; Herrscher E; Wilkes D; MacDonald TY; Xue H; Vacic V; Emde AK; Oschwald D; Tan AY; Chen Z; Collins C; Gleave ME; Wang Y; Chakravarty D; Schiffman M; Kim R; Campagne F; Robinson BD; Nanus DM; Tagawa ST; Xiang JZ; Smogorzewska A; Demichelis F; Rickman DS; Sboner A; Elemento O; Rubin MA
[Ad] Address:Institute for Precision Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York2Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, New York3Department of Medicine, Weill Cornell Medical....
[Ti] Title:Whole-Exome Sequencing of Metastatic Cancer and Biomarkers of Treatment Response.
[So] Source:JAMA Oncol;1(4):466-74, 2015 Jul 1.
[Is] ISSN:2374-2445
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:IMPORTANCE: Understanding molecular mechanisms of response and resistance to anticancer therapies requires prospective patient follow-up and clinical and functional validation of both common and low-frequency mutations. We describe a whole-exome sequencing (WES) precision medicine trial focused on patients with advanced cancer. OBJECTIVE: To understand how WES data affect therapeutic decision making in patients with advanced cancer and to identify novel biomarkers of response. DESIGN, SETTING, AND PATIENTS: Patients with metastatic and treatment-resistant cancer were prospectively enrolled at a single academic center for paired metastatic tumor and normal tissue WES during a 19-month period (February 2013 through September 2014). A comprehensive computational pipeline was used to detect point mutations, indels, and copy number alterations. Mutations were categorized as category 1, 2, or 3 on the basis of actionability; clinical reports were generated and discussed in precision tumor board. Patients were observed for 7 to 25 months for correlation of molecular information with clinical response. MAIN OUTCOMES AND MEASURES: Feasibility, use of WES for decision making, and identification of novel biomarkers. RESULTS: A total of 154 tumor-normal pairs from 97 patients with a range of metastatic cancers were sequenced, with a mean coverage of 95X and 16 somatic alterations detected per patient. In total, 16 mutations were category 1 (targeted therapy available), 98 were category 2 (biologically relevant), and 1474 were category 3 (unknown significance). Overall, WES provided informative results in 91 cases (94%), including alterations for which there is an approved drug, there are therapies in clinical or preclinical development, or they are considered drivers and potentially actionable (category 1-2); however, treatment was guided in only 5 patients (5%) on the basis of these recommendations because of access to clinical trials and/or off-label use of drugs. Among unexpected findings, a patient with prostate cancer with exceptional response to treatment was identified who harbored a somatic hemizygous deletion of the DNA repair gene FANCA and putative partial loss of function of the second allele through germline missense variant. Follow-up experiments established that loss of FANCA function was associated with platinum hypersensitivity both in vitro and in patient-derived xenografts, thus providing biologic rationale and functional evidence for his extreme clinical response. CONCLUSIONS AND RELEVANCE: The majority of advanced, treatment-resistant tumors across tumor types harbor biologically informative alterations. The establishment of a clinical trial for WES of metastatic tumors with prospective follow-up of patients can help identify candidate predictive biomarkers of response.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1507
[Cu] Class update date: 150718
[Lr] Last revision date:150718
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1001/jamaoncol.2015.1313

  4 / 1907445 MEDLINE  
              first record previous record next record last record
select
to print
Photocopy
Full text

[PMID]: 24650248
[Au] Autor:Witham MD; Frost H; McMurdo M; Donnan PT; McGilchrist M
[Ad] Address:Medical Research Institute, University of Dundee , Dundee , UK .
[Ti] Title:Construction of a linked health and social care database resource - lessons on process, content and culture.
[So] Source:Inform Health Soc Care;40(3):229-39, 2015 Sep.
[Is] ISSN:1753-8165
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Combining routinely collected health and social care data on older people is essential to advance both service delivery and research for this client group. Little data is available on how to combine health and social care data; this article provides an overview of a successful data linkage process and discusses potential barriers to executing such projects. METHODS AND RESULTS: We successfully obtained and linked data on older people within Dundee from three sources: Dundee Social Work Department database (30 000 individuals aged 65 years and over), healthcare data held on NHS Tayside patients by the Health Informatics Centre (400 000 individuals), Dundee, and the Dundee of Medicine for the Elderly rehabilitation database (4300 individuals). Data were linked, anonymized and transferred to a Safe Haven environment to ensuring confidentiality and strict access control. Challenges were faced around workflows, culture and documentation. Exploiting the resultant data set raises further challenges centered on database documentation, understanding the way data were collected, dealing with missing data, data validity and collection at different time periods. CONCLUSION: Routinely collected health and social care data sets can be linked, but significant process barriers must be overcome to allow successful linkage and integration of data and its full exploitation.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1507
[Cu] Class update date: 150718
[Lr] Last revision date:150718
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.3109/17538157.2014.892491

  5 / 1907445 MEDLINE  
              first record previous record next record last record
select
to print
Photocopy
Full text

[PMID]: 25978337
[Au] Autor:Naidech AM; Beaumont JL; Berman M; Francis B; Liotta E; Maas MB; Prabhakaran S; Holl J; Cella D
[Ad] Address:1Department of Neurology, Northwestern University, Chicago, IL. 2Departent of Medical Social Sciences, Northwestern University, Chicago, IL. 3Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, IL.
[Ti] Title:Dichotomous "Good Outcome" Indicates Mobility More Than Cognitive or Social Quality of Life.
[So] Source:Crit Care Med;43(8):1654-9, 2015 Aug.
[Is] ISSN:1530-0293
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Worthwhile interventions for intracerebral hemorrhage or subarachnoid hemorrhage generally hinge on whether they improve the odds of good outcome. Although good outcome is correlated with mobility, correlations with other domains of health-related quality of life, such as cognitive function and social functioning, are not well described. We tested the hypothesis that good outcome is more closely associated with mobility than other domains. DESIGN: We defined "good outcome" as 0 through 3 (independent ambulation or better) versus 4 through 5 (dependent) on the modified Rankin Scale at 1, 3, and 12 months. We simultaneously assessed the modified Rankin Scale and health-related quality of life using web-based computer adaptive testing in the domains of mobility, cognitive function (executive function and general concerns), and satisfaction with social roles and activities. We compared the area under the curve between different health-related quality of life domains. SETTING: Neurologic ICU with web-based follow-up. PATIENTS: One hundred fourteen patients with subarachnoid hemorrhage or intracerebral hemorrhage. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: We longitudinally followed 114 survivors with data at 1 month, 62 patients at 3 months, and 58 patients at 12 months. At 1 month, area under the curve was highest for mobility (0.957; 95% CI, 0.904-0.98), higher than cognitive function-general concerns (0.819; 95% CI, 0.715-0.888; p = 0.003 compared with mobility), satisfaction with social roles and activities (0.85; 95% CI, 0.753-0.911; p = 0.01 compared with mobility), and cognitive function-executive function (0.879; 95% CI, 0.782-0.935; p = 0.058 compared with mobility). Optimal specificity and sensitivity for receiver operating characteristic analysis were approximately 1.5 SD below the U.S. population mean. CONCLUSIONS: Health-related quality of life assessments reliably distinguished between good and poor outcomes as determined by the modified Rankin Scale. Good outcome indicated health-related quality of life about 1.5 SD below the U.S. population mean. Associations were weaker for cognitive function and social function than mobility.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1507
[Cu] Class update date: 150718
[Lr] Last revision date:150718
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1097/CCM.0000000000001082

  6 / 1907445 MEDLINE  
              first record previous record next record last record
select
to print
Photocopy
Full text

[PMID]: 25962083
[Au] Autor:Wong HR; Cvijanovich NZ; Anas N; Allen GL; Thomas NJ; Bigham MT; Weiss SL; Fitzgerald J; Checchia PA; Meyer K; Shanley TP; Quasney M; Hall M; Gedeit R; Freishtat RJ; Nowak J; Raj SS; Gertz S; Dawson E; Howard K; Harmon K; Lahni P; Frank E; Hart KW; Lindsell CJ
[Ad] Address:1Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center and Cincinnati Children's Research Foundation, Cincinnati, OH. 2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH. 3Division of Critical Care Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, CA. 4Division of Critical Care Medicine, Children's Hospital of Orange County, Orange, CA. 5Division of Critical Care Medicine, Children's Mercy Hospital, Kansas City, MO. 6Division of Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, PA. 7Division of Critical Care Medicine, Akron Children's Hospital, Akron, OH. 8Division of Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 9Division of Critical Care Medicine, Texas Children's Hospital, Houston, TX. 10Division of Critical Care Medicine, Miami Children's Hospital, Miami, FL. 11Division of Critical Care Medicine, CS Mott Children's Hospital at the University of Michigan, Ann Arbor, MI. 12Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH. 13Division of Critical Care Medicine, Children's Hospital of Wisconsin, Milwaukee, WI. 14Division of Critical Care Medicine, Children's National Medical Center, Washington, DC. 15Division of Critical Care Medicine, Children's Hospital and Clinics of Minnesota, Minneapolis, MN. 16Division of Critical Care Medicine, Riley Hospital for Children, Indianapolis, IN. 17Division of Critical Care Medicine, Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, NJ. 18Division of Critical Care Medicine, The University of Chicago Comer Children's Hospital, Chicago, IL. 19Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.
[Ti] Title:A Multibiomarker-Based Model for Estimating the Risk of Septic Acute Kidney Injury.
[So] Source:Crit Care Med;43(8):1646-53, 2015 Aug.
[Is] ISSN:1530-0293
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: The development of acute kidney injury in patients with sepsis is associated with worse outcomes. Identifying those at risk for septic acute kidney injury could help to inform clinical decision making. We derived and tested a multibiomarker-based model to estimate the risk of septic acute kidney injury in children with septic shock. DESIGN: Candidate serum protein septic acute kidney injury biomarkers were identified from previous transcriptomic studies. Model derivation involved measuring these biomarkers in serum samples from 241 subjects with septic shock obtained during the first 24 hours of admission and then using a Classification and Regression Tree approach to estimate the probability of septic acute kidney injury 3 days after the onset of septic shock, defined as at least two-fold increase from baseline serum creatinine. The model was then tested in a separate cohort of 200 subjects. SETTING: Multiple PICUs in the United States. INTERVENTIONS: None other than standard care. MEASUREMENTS AND MAIN RESULTS: The decision tree included a first-level decision node based on day 1 septic acute kidney injury status and five subsequent biomarker-based decision nodes. The area under the curve for the tree was 0.95 (CI95, 0.91-0.99), with a sensitivity of 93% and a specificity of 88%. The tree was superior to day 1 septic acute kidney injury status alone for estimating day 3 septic acute kidney injury risk. In the test cohort, the tree had an area under the curve of 0.83 (0.72-0.95), with a sensitivity of 85% and a specificity of 77% and was also superior to day 1 septic acute kidney injury status alone for estimating day 3 septic acute kidney injury risk. CONCLUSIONS: We have derived and tested a model to estimate the risk of septic acute kidney injury on day 3 of septic shock using a novel panel of biomarkers. The model had very good performance in a test cohort and has test characteristics supporting clinical utility and further prospective evaluation.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1507
[Cu] Class update date: 150718
[Lr] Last revision date:150718
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1097/CCM.0000000000001079

  7 / 1907445 MEDLINE  
              first record previous record next record last record
select
to print
Photocopy
Full text

[PMID]: 25962082
[Au] Autor:Rhee C; Murphy MV; Li L; Platt R; Klompas M; Centers for Disease Control and Prevention Prevention Epicenters Program
[Ad] Address:1Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. 2Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.
[Ti] Title:Lactate Testing in Suspected Sepsis: Trends and Predictors of Failure to Measure Levels.
[So] Source:Crit Care Med;43(8):1669-76, 2015 Aug.
[Is] ISSN:1530-0293
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Serum lactate monitoring is central to risk stratification and management of sepsis and is now part of a potential quality measure. We examined 11-year trends in lactate testing and predictors of failure to measure lactates in patients with severe sepsis. DESIGN: Retrospective cohort study. SETTING: Two U.S. academic hospitals. PATIENTS: Adult patients admitted from 2003 to 2013. INTERVENTIONS: Annual rates of lactate measurement were assessed in patients who had blood cultures ordered and patients with severe sepsis, as defined by concomitant International Classification of Diseases, Ninth Revision codes for infection and organ dysfunction. The approximate time of suspected sepsis was determined by the first blood culture order with concurrent antibiotic initiation. Multivariate analysis was performed to identify predictors of failure to measure lactates in severe sepsis cases in 2013. MEASUREMENTS AND MAIN RESULTS: Among hospitalizations with blood culture orders, rates of lactate measurement increased from 11% in 2003 to 48% in 2013 (p < 0.001 for linear trend). Rates of repeat lactate measurement within 6 hours after lactate levels greater than or equal to 4.0 mmol/L increased from 23% to 69% (p < 0.001). Patients were progressively less likely to be on vasopressors at the time of first lactate measurement (49% in 2003 vs 21% in 2013; p < 0.001). Despite these trends, lactates were measured at the time of suspected sepsis in only 65% of patients with severe sepsis in 2013. On multivariate analysis, hospital-onset sepsis and hospitalization on a nonmedical service were significant predictors of failure to measure lactates (adjusted odds ratio, 7.56; 95% CI, 6.31-9.06 and adjusted odds ratio, 2.08; 95% CI, 1.76-2.24, respectively). CONCLUSIONS: Lactate testing has increased dramatically over time and is being extended to patients without overt shock. However, rates of serial lactate testing are still suboptimal, and lactates are not being measured in many patients with severe sepsis. Hospital-onset sepsis and nonmedical units may be high-yield targets for quality improvement initiatives.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1507
[Cu] Class update date: 150718
[Lr] Last revision date:150718
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1097/CCM.0000000000001087

  8 / 1907445 MEDLINE  
              first record previous record next record last record
select
to print
Photocopy
Full text

[PMID]: 25867906
[Au] Autor:Semler MW; Weavind L; Hooper MH; Rice TW; Gowda SS; Nadas A; Song Y; Martin JB; Bernard GR; Wheeler AP
[Ad] Address:1Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN. 2Division of Anesthesiology Critical Care Medicine, Vanderbilt University, Nashville, TN. 3Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA. 4Division of Critical Care, Christian Medical College Hospital, Vellore, Tamil Nadu, India. 5Institute for Software Integrated Systems, Vanderbilt University School of Engineering, Nashville, TN. 6Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN. 7Department of Internal Medicine, Meharry Medical College, Nashville, TN.
[Ti] Title:An Electronic Tool for the Evaluation and Treatment of Sepsis in the ICU: A Randomized Controlled Trial.
[So] Source:Crit Care Med;43(8):1595-602, 2015 Aug.
[Is] ISSN:1530-0293
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: To determine whether addition of an electronic sepsis evaluation and management tool to electronic sepsis alerting improves compliance with treatment guidelines and clinical outcomes in septic ICU patients. DESIGN: A pragmatic randomized trial. SETTING: Medical and surgical ICUs of an academic, tertiary care medical center. PATIENTS: Four hundred and seven patients admitted during a 4-month period to the medical or surgical ICU with a diagnosis of sepsis established at the time of admission or in response to an electronic sepsis alert. INTERVENTIONS: Patients were randomized to usual care or the availability of an electronic tool capable of importing, synthesizing, and displaying sepsis-related data from the medical record, using logic rules to offer individualized evaluations of sepsis severity and response to therapy, informing users about evidence-based guidelines, and facilitating rapid order entry. MEASUREMENTS AND MAIN RESULTS: There was no difference between the electronic tool (218 patients) and usual care (189 patients) with regard to the primary outcome of time to completion of all indicated Surviving Sepsis Campaign 6-hour Sepsis Resuscitation Bundle elements (hazard ratio, 1.98; 95% CI, 0.75-5.20; p = 0.159) or time to completion of each element individually. ICU mortality, ICU-free days, and ventilator-free days did not differ between intervention and control. Providers used the tool to enter orders in only 28% of available cases. CONCLUSIONS: A comprehensive electronic sepsis evaluation and management tool is feasible and safe but did not influence guideline compliance or clinical outcomes, perhaps due to low utilization.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1507
[Cu] Class update date: 150718
[Lr] Last revision date:150718
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1097/CCM.0000000000001020

  9 / 1907445 MEDLINE  
              first record previous record next record last record
select
to print
Photocopy
Full text

[PMID]: 25867905
[Au] Autor:Creutzfeldt CJ; Engelberg RA; Healey L; Cheever CS; Becker KJ; Holloway RG; Curtis JR
[Ad] Address:1Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA. 2Department of Pulmonary and Critical Care, University of Washington, Seattle, WA. 3Department of Neurocritical Care, University of Washington, Seattle, WA. 4Department of Neurology, University of Rochester, Rochester, NY.
[Ti] Title:Palliative Care Needs in the Neuro-ICU.
[So] Source:Crit Care Med;43(8):1677-84, 2015 Aug.
[Is] ISSN:1530-0293
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Patients admitted to the neurological or neurosurgical ICU are likely to have palliative care needs. The goals of this project are to encourage the ICU team to identify palliative care needs for patients and their families and potential ways to meet those needs. DESIGN: Quality improvement project using a parallel-group prospective cohort design. SETTING: Single neuro-ICU at a large, academic medical center. PATIENTS: All patients admitted to the neuro-ICU from September 1, 2013, to November 30, 2013. INTERVENTIONS: We developed a palliative care needs screening tool consisting of four questions: 1) Does the patient have distressing physical or psychological symptoms? 2) Are there specific support needs for patient or family? 3) Are treatment options matched with patient-centered goals? 4) Are there disagreements among teams and family? We implemented this daily screening tool on morning rounds for one of two neurocritical care services that alternate admitting days to a single neuro-ICU. We examined prevalence and nature of palliative care needs and actions to address those needs, comparing the services with and without screening. MEASUREMENTS AND MAIN RESULTS: Over the 3-month period, 130 patients were admitted to the service with screening and 132 patients to the service without screening. The two groups did not differ with regard to age, gender, Glasgow Coma Scale, or diagnosis. Palliative care needs were identified in 62% of screened patients (80/130). Needs were mainly social support (53%) and establishing goals of care (28%). Screening was associated with more documented family conferences (p = 0.019) and a trend toward more palliative care consultations (p = 0.056). CONCLUSIONS: We developed a brief palliative care needs screening tool that identified palliative care needs for 62% neuro-ICU patients. This tool was associated with actions to meet these needs, potentially improving care for patients and their families.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1507
[Cu] Class update date: 150718
[Lr] Last revision date:150718
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1097/CCM.0000000000001018

  10 / 1907445 MEDLINE  
              first record previous record
select
to print
Photocopy
Full text

[PMID]: 25860203
[Au] Autor:Stroud MH; Sanders RC; Moss MM; Sullivan JE; Prodhan P; Melguizo-Castro M; Nick T
[Ad] Address:1Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR. 2Section of Critical Care Medicine, Department of Pediatrics, University of Louisville, Louisville, KY. 3Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
[Ti] Title:Goal-Directed Resuscitative Interventions During Pediatric Interfacility Transport.
[So] Source:Crit Care Med;43(8):1692-8, 2015 Aug.
[Is] ISSN:1530-0293
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: This article reports results of the first National Institutes of Health-funded prospective interfacility transport study to determine the effect of goal-directed therapy administered by a specialized pediatric team to critically ill children with the systemic inflammatory response syndrome. We hypothesized that goal-directed therapy during interfacility transport would decrease hospital length of stay, prevent multiple organ dysfunction, and reduce subsequent ICU interventions. DESIGN: Before-and-after intervention trial. SETTING: During interfacility transport of critically ill patients by a specialized pediatric transport team, back to a tertiary care children's hospital. PATIENTS: Before-and-after intervention trial. DESIGN: Interfacility pediatric transport patients, age 1 month to 17 years, with systemic inflammatory response syndrome. INTERVENTIONS: Prospective data were collected on all pediatric interfacility transport patients with systemic inflammatory response syndrome transported by the Angel One Transport team at Arkansas Children's Hospital. A 10-month data collection period was followed by institution of a goal-directed resuscitation protocol. Data were subsequently collected for 10 additional months followed by comparison of pre- and postintervention groups. All transport personnel underwent training with didactics and high-fidelity simulation until mastery with goal-directed resuscitation was achieved. MEASUREMENTS AND MAIN RESULTS: All transport patients were screened for systemic inflammatory response syndrome using established variables and 235 (123 preintervention and 112 postintervention) were enrolled. Univariate analysis revealed shorter hospital stay (11 15 d vs 7 10 d; p = 0.02) and fewer required therapeutic ICU interventions in the postintervention group (Therapeutic Intervention Scoring System-28 Scores, 19.4 6.8 vs 17.3 6.6; p = 0.04). ICU stay and prevalence of organ dysfunction were not statistically different. Multivariable analysis showed a 1.6-day (95% CI, 1.3-2.03; p = 0.02) decrease in hospital stay in the postintervention group. CONCLUSIONS: This study suggests that goal-directed therapy administered by a specialized pediatric transport team has the potential to impact the outcomes of critically ill children. Findings from this study should be confirmed across multiple institutions, but have the potential to impact the clinical outcomes of critically ill children with systemic inflammatory response syndrome.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1507
[Cu] Class update date: 150718
[Lr] Last revision date:150718
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1097/CCM.0000000000001021


page 1 of 190745 go to page                         
   


Refine the search
  Database : MEDLINE Advanced form   

    Search in field  
1  
2
3
 
           



Search engine: iAH v2.6 powered by WWWISIS

BIREME/PAHO/WHO - Latin American and Caribbean Center on Health Sciences Information