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[PMID]:29396713
[Au] Autor:Kiladjian JJ; Guglielmelli P; Griesshammer M; Saydam G; Masszi T; Durrant S; Passamonti F; Jones M; Zhen H; Li J; Gadbaw B; Perez Ronco J; Khan M; Verstovsek S
[Ad] Endereço:Centre d'Investigations Cliniques (CIC1427), Hôpital Saint-Louis, AP-HP, INSERM, CLIP2 "Saint-Louis - Paris Nord," Early Phase Research Center, Université Paris Diderot, 1, Avenue Claude Vellefaux, 75010, Paris, France. jean-jacques.kiladjian@aphp.fr.
[Ti] Título:Efficacy and safety of ruxolitinib after and versus interferon use in the RESPONSE studies.
[So] Source:Ann Hematol;97(4):617-627, 2018 Apr.
[Is] ISSN:1432-0584
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Ruxolitinib was well tolerated and superior to best available therapy (including interferon [IFN]) in controlling hematocrit without phlebotomy eligibility, normalizing blood counts, and improving polycythemia vera-related symptoms in the Study of Efficacy and Safety in Polycythemia Vera Subjects Who Are Resistant to or Intolerant of Hydroxyurea: JAK Inhibitor INC424 (INCB018424) Tablets Versus Best Available Care (RESPONSE) studies. This ad hoc analysis focuses on ruxolitinib in relation to IFN in the RESPONSE studies, with attention on the following: (1) safety and efficacy of ruxolitinib and best available therapy in patients who received IFN before study randomization, (2) safety and efficacy of IFN during randomized treatment in best available therapy arm, and (3) use of ruxolitinib after crossover from best available therapy in IFN-treated patients. IFN exposure before randomization had little effect on the efficacy or safety of ruxolitinib. In the randomized treatment arms, ruxolitinib was superior to IFN in efficacy [hematocrit control (RESPONSE = 60% of ruxolitinib vs 23% of IFN patients; RESPONSE-2 = 62% of ruxolitinib vs 15% of IFN patients)] and was tolerated better in hydroxyurea-resistant or hydroxyurea-intolerant patients. After crossing over to receive ruxolitinib, patients who had initially received IFN and did not respond had improved hematologic and spleen responses (62% of patients at any time after crossover) and an overall reduction in phlebotomy procedures. Rates and incidences of the most common adverse events decreased after crossover to ruxolitinib, except for infections (primarily grade 1 or 2). These data suggest that ruxolitinib is efficacious and well tolerated in patients who were previously treated with IFN. The RESPONSE (NCT01243944) and RESPONSE-2 (NCT02038036) studies were registered at clinicaltrials.gov .
[Mh] Termos MeSH primário: Antineoplásicos/uso terapêutico
Interferons/uso terapêutico
Janus Quinases/antagonistas & inibidores
Policitemia Vera/tratamento farmacológico
Inibidores de Proteínas Quinases/uso terapêutico
Pirazóis/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Idoso
Antineoplásicos/efeitos adversos
Sangria/efeitos adversos
Terapia Combinada/efeitos adversos
Estudos Cross-Over
Monitoramento de Medicamentos
Resistência a Múltiplos Medicamentos
Resistência a Medicamentos Antineoplásicos
Feminino
Seres Humanos
Hidroxiureia/efeitos adversos
Hidroxiureia/uso terapêutico
Interferons/efeitos adversos
Janus Quinases/metabolismo
Masculino
Meia-Idade
Policitemia Vera/metabolismo
Policitemia Vera/fisiopatologia
Policitemia Vera/terapia
Padrões de Prática Médica
Inibidores de Proteínas Quinases/efeitos adversos
Pirazóis/efeitos adversos
Reprodutibilidade dos Testes
Esplenomegalia/etiologia
Esplenomegalia/prevenção & controle
[Pt] Tipo de publicação:CLINICAL TRIAL; CLINICAL TRIAL, PHASE III; COMPARATIVE STUDY; EQUIVALENCE TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antineoplastic Agents); 0 (INCB018424); 0 (Protein Kinase Inhibitors); 0 (Pyrazoles); 9008-11-1 (Interferons); EC 2.7.10.2 (Janus Kinases); X6Q56QN5QC (Hydroxyurea)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180204
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1007/s00277-017-3225-1


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[PMID]:29381721
[Au] Autor:von Babo M; Chmiel C; Müggler SA; Rakusa J; Schuppli C; Meier P; Fischler M; Urner M
[Ad] Endereço:Department of Internal Medicine, Waid City Hospital, Zurich, Switzerland.
[Ti] Título:Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland.
[So] Source:PLoS One;13(1):e0191752, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. METHODS: In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. RESULTS: 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women). 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI) did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients. CONCLUSION: This study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.
[Mh] Termos MeSH primário: Transfusão de Sangue/utilização
Medicina Geral
Hospitais de Ensino/organização & administração
Padrões de Prática Médica
[Mh] Termos MeSH secundário: Estudos Transversais
Seres Humanos
Medicina Interna
Suíça
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180131
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191752


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[PMID]:29305630
[Au] Autor:Ben Lakhal R; Ghedira H; Bellaaj H; Ben Youssef Y; Menif S; Manai Z; Bedoui M; Lakhal A; M'Sadek F; Elloumi M; Khélif A; Ben Romdhane N; Laatiri MA; Ben Othmen T; Meddeb B
[Ad] Endereço:Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia. raihane.benlakhal@gmail.com.
[Ti] Título:Chronic myeloid leukemia patients in Tunisia: epidemiology and outcome in the imatinib era (a multicentric experience).
[So] Source:Ann Hematol;97(4):597-604, 2018 Apr.
[Is] ISSN:1432-0584
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Data are limited in developing countries regarding the clinicopathologic features and response to therapy of chronic myeloid leukemia (CML) in the era of imatinib (IM). The objective of this study is to report on the clinicoepidemiologic features of CML in Tunisia, to evaluate the long-term outcome of patients in chronic (CP) or accelerated phase (AP) treated with IM 400 mg daily as frontline therapy, and to determine imatinib's efficacy and safety. From October 2002 to December 2014, 410 CML patients were treated with IM in six Tunisian departments of hematology. Response (hematologic, cytogenetic, and molecular responses) and outcome-overall survival (OS), event-free survival (EFS), and progression-free survival (PFS)-were evaluated. The following prognostic factors were analyzed for their impact on the European leukemia net (ELN) response, OS, EFS, and PFS at 5 years: age, sex, leukocyte count, Sokal score, European Treatment and Outcome Study (EUTOS) score, CML phase, time to starting IM, and impact of adverse events. The median age was 45 years (3-85 years). Two hundred ten (51.2%) patients were male. Splenomegaly was present in 322 of the 410 (79%). Additional cytogenetic abnormalities were encountered in 25 (6.3%) patients. At diagnosis, 379 (92.4%) patients were in CP, 31 (7.6%) were in AP. The Sokal risk was low in 87 (22.5%), intermediate in 138 (35.7%), and high in 164 patients (41.9%). The EUTOS risk was low in 217 (74%), and high in 77 (26%) patients. The rates of cumulative complete cytogenetic response (CCyR), major molecular response (MMR), and molecular response 4/5 log (MR4.5) in CP/AP-CML patients were 72, 68.4, and 46.4%, respectively. The median time to reach CCyR, MMR, and MR4.5 was 6 months (3-51), 18 months (3-72), and 24 months (3-100), respectively. According to the ELN criteria, optimal, suboptimal response, and failure were noted in 206 (51.8%), 61 (15.3%), and 125 (31.4%) patients, respectively. Five-year event-free survival (EFS), progression-free survival (PFS), and overall survival (OS) were 81, 90, and 90%, respectively. By multivariate analysis, AP, high EUTOS risk, and baseline WBC ≥ 150G/l remained independent predictive factors of non-optimal response to IM. The adverse events (AE) of IM were moderate and tolerable. With the caveats that the monitoring of the disease was not optimal, response rates were similar to those reported in previous studies. It is clear to us that improvements should be made in treatment of AP-CML and high Sokal risk group of CP-CML. The frontline use of second-generation tyrosine kinase inhibitor (TKI) is expected to improve the results of the first-line treatment of these high-risk Tunisian patients, but cost and accessibility of this therapy remain the problems in developing countries.
[Mh] Termos MeSH primário: Antineoplásicos/uso terapêutico
Mesilato de Imatinib/uso terapêutico
Leucemia Mieloide de Fase Acelerada/tratamento farmacológico
Leucemia Mieloide de Fase Crônica/tratamento farmacológico
Inibidores de Proteínas Quinases/uso terapêutico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Antineoplásicos/efeitos adversos
Criança
Pré-Escolar
Feminino
Seguimentos
Seres Humanos
Mesilato de Imatinib/efeitos adversos
Leucemia Mieloide de Fase Acelerada/diagnóstico
Leucemia Mieloide de Fase Acelerada/epidemiologia
Leucemia Mieloide de Fase Acelerada/patologia
Leucemia Mieloide de Fase Crônica/diagnóstico
Leucemia Mieloide de Fase Crônica/epidemiologia
Leucemia Mieloide de Fase Crônica/patologia
Masculino
Meia-Idade
Padrões de Prática Médica
Prognóstico
Inibidores de Proteínas Quinases/efeitos adversos
Estudos Retrospectivos
Esplenomegalia/etiologia
Esplenomegalia/patologia
Esplenomegalia/prevenção & controle
Análise de Sobrevida
Carga Tumoral/efeitos dos fármacos
Tunísia/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Antineoplastic Agents); 0 (Protein Kinase Inhibitors); 8A1O1M485B (Imatinib Mesylate)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180107
[St] Status:MEDLINE
[do] DOI:10.1007/s00277-017-3224-2


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[PMID]:29364822
[Au] Autor:Keim RG
[Ad] Endereço:Senior Editor, Journal of Clinical Orthodontics.
[Ti] Título:Anticipating the puck.
[So] Source:J Clin Orthod;51(12):772, 2017 Dec.
[Is] ISSN:0022-3875
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Padrões de Prática Médica
Inquéritos e Questionários
[Mh] Termos MeSH secundário: Seres Humanos
Ortodontia
Publicações Periódicas como Assunto
Estados Unidos
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE


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[PMID]:29215335
[Au] Autor:Djordjevic ZM; Folic MM; Jankovic SM
[Ad] Endereço:Clinic of Control Hospital Infections, Kragujevac Centre Clinical, Kragujevac, Serbia.
[Ti] Título:Previous Antibiotic Exposure and Antimicrobial Resistance Patterns of spp. and aeruginosa Isolated from Patients with Nosocomial Infections.
[So] Source:Balkan Med J;34(6):527-533, 2017 12 01.
[Is] ISSN:2146-3131
[Cp] País de publicação:Turkey
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The alarming spread of antibiotic-resistant bacteria causing healthcare-associated infections has been extensively reported in recent medical literature. AIMS: To compare trends in antimicrobial consumption and development of resistance among isolates of spp. and that cause hospital infections. STUDY DESIGN: Cross-sectional study. METHODS: A study was conducted in a tertiary healthcare institution in central Serbia, during the 7-year period between January 2009 and December 2015. The incidence rate of infections caused by or , as well as their resistance density to commonly used antibiotics, were calculated. Utilization of antibiotics was expressed as the number of defined daily doses per 1000 patient-days. RESULTS: A statistically significant increase in resistance density in 2015 compared to the first year of observation was noted for , but not for , to third-generation cephalosporins (p=0.008), aminoglycosides (p=0.005), carbapenems (p=0.003), piperacillin/tazobactam (p=0.025), ampicillin/sulbactam (p=0.009) and tigecycline (p=0.048). CONCLUSION: Our study showed that there is an association between the resistance density of spp. and utilization of carbapenems, tigecycline and aminoglycosides. A multifaceted intervention is needed to decrease the incidence rate of and hospital infections, as well as their resistance density to available antibiotics.
[Mh] Termos MeSH primário: Infecções por Acinetobacter/microbiologia
Acinetobacter/efeitos dos fármacos
Antibacterianos/uso terapêutico
Infecção Hospitalar/tratamento farmacológico
Infecção Hospitalar/microbiologia
Farmacorresistência Bacteriana/efeitos dos fármacos
Infecções por Pseudomonas/microbiologia
Pseudomonas aeruginosa/efeitos dos fármacos
[Mh] Termos MeSH secundário: Acinetobacter/isolamento & purificação
Infecções por Acinetobacter/tratamento farmacológico
Adulto
Estudos Transversais
Seres Humanos
Testes de Sensibilidade Microbiana
Padrões de Prática Médica/estatística & dados numéricos
Infecções por Pseudomonas/tratamento farmacológico
Pseudomonas aeruginosa/isolamento & purificação
Sérvia/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.4274/balkanmedj.2016.1844


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[PMID]:28460016
[Au] Autor:Kathirvel S; Tripathy JP; Tun ZM; Patro BK; Singh T; Bhalla A; Devnani M; Wilkinson E
[Ad] Endereço:Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
[Ti] Título:Physicians' compliance with the National Drug Policy on Malaria in a tertiary teaching hospital, India, from 2010 to 2015: a mixed method study.
[So] Source:Trans R Soc Trop Med Hyg;111(2):62-70, 2017 02 01.
[Is] ISSN:1878-3503
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background: National drug policies are formulated to encourage rational use of drugs and to reduce drug resistance. This study assessed physicians' compliance with the National Drug Policy on Malaria at a tertiary care hospital in north India. Methods: This mixed method study extracted data from adult malaria inpatient records of the hospital from 2010-2015, and assessed drug supply at pharmacies. Physicians' practices and perspectives were explored by in-depth interviews. Compliance was assessed by severity, type of species and pregnancy status. Thematic analysis was done for the qualitative data. Results: A total of 247 case files were reviewed. Vivax malaria (41.0%) was more common than falciparum malaria (37.2%). The majority (90.8%) of cases were severe malaria. Overall compliance for use of schizonticidal drug was 73.0% in severe malaria and was only 9.5% in uncomplicated malaria. Compliance for use of gametocidal drug (primaquine) was 15.3%. Schizonticidal drugs were available in all pharmacies except the public one. Primaquine was available in only one. The main themes emerging in the thematic network analysis were physicians' misconceptions, physician-related factors, and hospital-related and drug access factors. Conclusions: The degree of compliance for severe malaria treatment was reasonably good but low for radical cure. Raising knowledge and awareness among health care providers, by using written treatment protocols and continuing medical education would improve compliance.
[Mh] Termos MeSH primário: Antimaláricos/uso terapêutico
Fidelidade a Diretrizes/estatística & dados numéricos
Malária/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Antimaláricos/provisão & distribuição
Atitude do Pessoal de Saúde
Feminino
Hospitais de Ensino/estatística & dados numéricos
Seres Humanos
Índia
Masculino
Meia-Idade
Farmácias/estatística & dados numéricos
Padrões de Prática Médica
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antimalarials)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1093/trstmh/trx020


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[PMID]:29343479
[Au] Autor:Brat GA; Agniel D; Beam A; Yorkgitis B; Bicket M; Homer M; Fox KP; Knecht DB; McMahill-Walraven CN; Palmer N; Kohane I
[Ad] Endereço:Department of Biomedical Informatics, Harvard Medical School, Countway Library, Boston, MA 02215, USA gbrat@bidmc.harvard.edu.
[Ti] Título:Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study.
[So] Source:BMJ;360:j5790, 2018 01 17.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To quantify the effects of varying opioid prescribing patterns after surgery on dependence, overdose, or abuse in an opioid naive population. DESIGN: Retrospective cohort study. SETTING: Surgical claims from a linked medical and pharmacy administrative database of 37 651 619 commercially insured patients between 2008 and 2016. PARTICIPANTS: 1 015 116 opioid naive patients undergoing surgery. MAIN OUTCOME MEASURES: Use of oral opioids after discharge as defined by refills and total dosage and duration of use. The primary outcome was a composite of misuse identified by a diagnostic code for opioid dependence, abuse, or overdose. RESULTS: 568 612 (56.0%) patients received postoperative opioids, and a code for abuse was identified for 5906 patients (0.6%, 183 per 100 000 person years). Total duration of opioid use was the strongest predictor of misuse, with each refill and additional week of opioid use associated with an adjusted increase in the rate of misuse of 44.0% (95% confidence interval 40.8% to 47.2%, P<0.001), and 19.9% increase in hazard (18.5% to 21.4%, P<0.001), respectively. CONCLUSIONS: Each refill and week of opioid prescription is associated with a large increase in opioid misuse among opioid naive patients. The data from this study suggest that duration of the prescription rather than dosage is more strongly associated with ultimate misuse in the early postsurgical period. The analysis quantifies the association of prescribing choices on opioid misuse and identifies levers for possible impact.
[Mh] Termos MeSH primário: Analgésicos Opioides/uso terapêutico
Overdose de Drogas/epidemiologia
Transtornos Relacionados ao Uso de Opioides/epidemiologia
Dor Pós-Operatória/tratamento farmacológico
Uso Excessivo de Medicamentos Prescritos/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Bases de Dados Factuais
Esquema de Medicação
Feminino
Seres Humanos
Masculino
Meia-Idade
Padrões de Prática Médica/estatística & dados numéricos
Estudos Retrospectivos
Fatores de Risco
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180119
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5790


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[PMID]:29240467
[Au] Autor:Schultz K; Ewbank ML; Pandit HG
[Ad] Endereço:Medical Student, Indiana University School of Medicine, Indianapolis, USA.
[Ti] Título:Changing practice for hip arthroplasty and its implications.
[So] Source:Br J Nurs;26(22):1238-1244, 2017 Dec 14.
[Is] ISSN:0966-0461
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:This overview provides insight into changes in clinical practice and the implications for nursing staff and clinicians who are involved in the management of patients undergoing primary total hip arthroplasty. The review highlights commonly used surgical approaches, their advantages, their associated risks and how to manage complications if they occur.
[Mh] Termos MeSH primário: Artroplastia de Quadril/métodos
Padrões de Prática Médica/tendências
[Mh] Termos MeSH secundário: Artroplastia de Quadril/efeitos adversos
Seres Humanos
Enfermagem Ortopédica
Complicações Pós-Operatórias/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.12968/bjon.2017.26.22.1238


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[PMID]:29293195
[Au] Autor:Hadaway L
[Ad] Endereço:Lynn Hadaway Associates, Inc, Milner, Georgia. Lynn Hadaway, MEd, RN-BC, CRNI®, is president of Lynn Hadaway Associates, Inc, and has more than 40 years' experience as an infusion nurse, educator, and consultant. She holds a master's degree in education, as well as certification in professional staff development and infusion nursing. She has published extensively on infusion topics in numerous journals.
[Ti] Título:Stopcocks for Infusion Therapy: Evidence and Experience.
[So] Source:J Infus Nurs;41(1):24-34, 2018 Jan/Feb.
[Is] ISSN:1539-0667
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Stopcocks have been used for decades to deliver infusion therapy in patients of all ages and in all health care settings. During the past 20 years, a growing number of studies have validated concern about the risk of the open lumen allowing intraluminal contamination. Additional studies highlight fluid flow dynamics associated with stopcocks. This integrative literature review and clinician practice survey analyzes the published evidence and reports of actual practices with stopcocks, and raises issues about practice changes that could reduce these risks.
[Mh] Termos MeSH primário: Contaminação de Equipamentos/prevenção & controle
Infusões Intravenosas/métodos
Padrões de Prática Médica
[Mh] Termos MeSH secundário: Administração Intravenosa/efeitos adversos
Infecção Hospitalar/microbiologia
Infecção Hospitalar/prevenção & controle
Seres Humanos
Infusões Intravenosas/efeitos adversos
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE
[do] DOI:10.1097/NAN.0000000000000258


  10 / 50482 MEDLINE  
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[PMID]:29428042
[Au] Autor:Hafiz S; Zubowicz EA; Abouassaly C; Ricotta JJ; Sava JA
[Ti] Título:Extremity Vascular Injury Management: Good Outcomes Using Selective Referral to Vascular Surgeons.
[So] Source:Am Surg;84(1):140-143, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Revascularization after extremity vascular injury has long been considered an important skill among trauma surgeons. Increasingly, some trauma surgeons defer vascular repair in response to training or practice patterns. This study was designed to document results of extremity revascularization surgery to evaluate trauma surgeon outcomes and judicious referral of more complex injuries to vascular surgeons (VAS). The trauma registry of an urban level I trauma center was used to identify all patients from 2003 to 2013 who underwent an early (<24 hours) procedure for urgent management of acute injury to extremity vessels. Patients were managed by trauma (TRA) versus VAS based on the practice pattern of the on-call trauma surgeon. Injury and outcome variables were recorded. Of 115 patients, 84 patients were revascularized by trauma and 31 vascular surgeries. There was no difference in complication rates or frequency of any type of complication associated with repairs performed by VAS or TRA. There were similar rates between the two groups for patients with multiple injuries, such as venous, bone or tendon, and nerve injury to the affected extremity. One VAS patient and two TRA patients developed compartment syndrome. In appropriately selected patients, trauma surgeons achieve good outcomes after revascularization of injured extremities.
[Mh] Termos MeSH primário: Extremidade Inferior/irrigação sanguínea
Seleção de Pacientes
Extremidade Superior/irrigação sanguínea
Lesões do Sistema Vascular/diagnóstico
Lesões do Sistema Vascular/cirurgia
Ferimentos Penetrantes/diagnóstico
Ferimentos Penetrantes/cirurgia
[Mh] Termos MeSH secundário: Adulto
Síndromes Compartimentais/prevenção & controle
Feminino
Seres Humanos
Tempo de Internação
Masculino
Meia-Idade
Padrões de Prática Médica
Estudos Retrospectivos
Fatores de Risco
Fatores de Tempo
Centros de Traumatologia
Índices de Gravidade do Trauma
Resultado do Tratamento
Procedimentos Cirúrgicos Vasculares
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE



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