Mcnultyburke7618
Ultrasonography is an essential imaging modality in the critical care population and has been increasingly utilized to check gastric residual volume . Various studies have shown that intensive care unit nurses untrained in ultrasound can easily be trained in its accurate interpretation. learn more We prospectively analyzed nurse-performed repeated measurements of gastric residual volume and nasogastric tube positioning via an ultrasound technique in the intensive care unit.
This was a single-center, cross-sectional prospective study. Four intensive care unit nurses, evenly divided into two groups (teams A and B), underwent four hours of formal ultrasound training by three critical care staff physicians. The trained nurses provided bedside ultrasound assessments of gastric residual volume and nasogastric tube positioning which were compared to a standard protocol of syringe aspiration.
Ninety patients were recruited to the study. Four measurements per patient were performed, for a total of 360 assessments. The ultrctice for intensive care unit nurses.Women with hereditary breast cancer are at increased risk of second primary cancers in the ipsilateral and contralateral breast. The level of risk varies with mutation and age at first breast cancer diagnosis. These factors as well as life expectancy should be considered when selecting the surgical approach.Despite marked progress in outcomes for women with early stage breast cancer, unmet challenges persist. link2 These include accounting for the cohort of tumors that do not have favorable clinical outcomes related to tumor heterogeneity, particularly the variation within the subset of ER positive breast cancer; better treatments for subsets where existing therapies are not fully effective; and the development of biomarkers to predict response or need for ongoing treatment. Beyond these tumor-related factors, there is persistent need for focus on improving the patient's experience of treatment - avoiding unnecessary therapy, and providing better supportive care so as to minimize side effects and social and economic disruption caused by treatment. For clinical investigators, the improved prognosis for early stage breast cancer has meant that large sample sizes of subjects are needed for prospective clinical trials with cancer outcome endpoints. link3 As a consequence, the scale of clinical research enterprises has become enormous, too often unsupportable without industry or government resources. Finally, as breast cancer is a global health concern, there is an urgent need to assure that screening and treatment are available to women around the world so that the progress achieved in developed countries can reach billions of women everyone on earth.
Awareness of the value of aquatic exercise (AE) in the postoperative rehabilitation has increased, and several inherent advantages of AE, such as adjustment of both resistance and muscle strengthening parameters makes good rationale for its inclusion in postoperative rehabilitation. This study aimed to determine and compare the benefits of AE and land-based exercise (LBE) on pain, functionality, and quality of life after arthroscopic partial meniscectomy (APM).
This randomized controlled study included 30 middle-aged (35-50), physically active patients who were randomized into LBE (n=15) and AE (n=15) groups after APM for a degenerative meniscal tear. Visual analogue scale (VAS), Short Form-36 (SF-36), single-leg hop test and Lysholm questionnaire scores in addition to isokinetic muscle strength values were evaluated at baseline, at fourth week immediately after cessation of exercise program and at eighth week follow-up visits. The exercise sessions were conducted in 1-h sessions per day, three days a week for a total of four weeks.
Significant improvement was observed in the VAS, single-leg hop test, Lysholm questionnaire, and most of SF-36 subscale scores in both groups at both fourth and eighth follow-ups. Isokinetic dynamometer revealed significant improvement in the peak torque values for extension at angular velocities of 60° and 180° at both follow-ups in the AE group. LBE group showed significant improvement in the peak torque value for extension only at an angular velocity of 60° only at fourth week follow-up. There was no significant difference between groups for any of these parameters at any of the follow-ups.
Both AE and LBE programs had significantly improved pain, function, isokinetic muscle strength, and quality of life in patients after APM. Either type of exercise is essential as part of the rehabilitation protocol for good clinical outcomes after APM and should not be neglected (level II).
NCT04925726.
NCT04925726.
Factors related to postoperative mechanical failure after long fusion with lower instrumented vertebra (LIV) at L5 have not been well investigated. Elucidating such factors may allow us to perform alternatives to spinopelvic fusion for adult spinal deformity (ASD) cases. We investigated the incidence and risk factors of LIV failure in patients with ASD who underwent surgical treatment of long corrective fusion until the L5 vertebrae.
Between 2009 and 2018, 52 patients who underwent corrective fusions to L5 were followed-up for at least one-year. We evaluated the associated patient factors for LIV failure which include loosening of the pedicle screw of LIV, fracture of LIV, distal junctional kyphosis (DJK).
The mean age of the participants was 71.2±7.59 (range, 44-84). LIV failure occurred in 20 patients (38.5%), and 6 patients (11.5%) underwent secondary surgery for caudal segments. The mean pelvic incidence (PI) was 52.5±9.8 in the failure group versus 45.3±11.4 in non-failure group (P=0.02) and pelvic tilt (PT) was 39.1±9.0 versus 32.4±13.0. There were no significant differences in sex, age, body mass index, number of levels fused, and other radiographic data. Logistic regression analysis that included T1 pelvic angle, PT, PI - postoperative LL and PI also identified PI as the only significant determinant of LIV failure (OR=1.07, P=0.034). Receiver operating characteristic analysis demonstrated that a PI over 50.0° was associated with LIV failure (sensitivity 63%, specificity 70%, AUC 0.694).
LIV failure was frequently observed after long corrective fusion for patients with ASD. High PI was found to be a significant risk factor for the LIV failure.
LIV failure was frequently observed after long corrective fusion for patients with ASD. High PI was found to be a significant risk factor for the LIV failure.
Endotracheal suction is an invasive airway clearance technique used in mechanically ventilated children. This article outlines the methods used to develop appropriate use criteria for endotracheal suction interventions in mechanically ventilated paediatric patients.
The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop paediatric appropriate use criteria. This included the following sequential phases of defining scope and key terms, a literature review and synthesis, expert multidisciplinary panel selection, case scenario development, and appropriateness ratings by an interdisciplinary expert panel over two rounds. The panel comprised experts in the fields of paediatric and neonatal intensive care, respiratory medicine, infectious diseases, critical care nursing, implementation science, retrieval medicine, and education. Case scenarios were developed iteratively by interdisciplinary experts and derived from common applications or anticipated intervention uses, as well as from current clinical practice guidelines and results of studies examining interventions efficacy and safety. Scenarios were rated on a scale of 1 (harm outweighs benefit) to 9 (benefit outweighs harm), to define appropriate use (median 7 to 9), uncertain use (median 4 to 6), and inappropriate use (median 1 to 3) of endotracheal suction interventions. Scenarios were than classified as a level of appropriateness.
The RAND Corporation/University of California, Los Angeles Appropriateness Method provides a thorough and transparent method to inform development of the first appropriate use criteria for endotracheal suction interventions in paediatric patients.
The RAND Corporation/University of California, Los Angeles Appropriateness Method provides a thorough and transparent method to inform development of the first appropriate use criteria for endotracheal suction interventions in paediatric patients.
Moving average is the continuously updated arithmetic mean of the pressure injury (PI) risk score values measured with the COMHON Index (Conscious level, Mobility, Hemodynamics, Oxygenation, Nutrition).
The objective of this study was to validate the moving average as a method to measure the level of risk of PI.
This is a cohort study of adult patients admitted for a duration of more than 24h in an intensive care unit (ICU) of a tertiary-level university hospital, between June 1, 2018, and December 31, 2019. The risk of PI was obtained with the COMHON Index, and its 3-day moving average was used to monitor the risk of PI. To assess the predictive ability of the moving average score, a receiver operating characteristic curve analysis was performed, obtaining the area under the curve, and the Youden Index to determine the optimal cut-off point of the PI risk moving average score using the COMHON Index.
A total of 1335 patients (94.6% of admissions) were included, and 82 developed PI (cumulative incidence of 6.1%) in the 18 months of the study. The highest incidence of PI was in the sacrum (49%) followed by the heel (17.6%). The median age was 65 (54-73) years, and the median length of stay was 3.8 (1.9-9) days. The moving average score had an area under the receiver operating characteristic curve of 87% (95% confidence interval 85%-89%), with a cut-off point of the moving average score ≥11, and the negative predictive value was 99.6%.
The moving average score combined with a validated scale is a useful method to predict potential PI of patients admitted to the ICU. Its use is suggested for decision-making during the implementation of the care plan related to the prevention of PI in patients admitted to the ICU.
The moving average score combined with a validated scale is a useful method to predict potential PI of patients admitted to the ICU. Its use is suggested for decision-making during the implementation of the care plan related to the prevention of PI in patients admitted to the ICU.Nonalcoholic fatty liver disease (NAFLD) is a common and emerging liver disease in adults, paralleling the epidemic of obesity and diabetes, and leading to worrisome events (hepatocellular carcinoma and end-stage liver disease). In the last years, mounting evidence added insights about epidemiology, natural history, diagnosis and lifestyle-based or drug treatment of NAFLD. In this rapidly evolving scenario, members of the Associazione Italiana per lo Studio del Fegato (AISF), the Società Italiana di Diabetologia (SID) and the Società Italiana dell'Obesità (SIO) reviewed current knowledge on NAFLD. The quality of the published evidence is graded, and practical recommendations are made following the rules and the methodology suggested in Italy by the Centro Nazionale per l'Eccellenza delle cure (CNEC) and Istituto Superiore di Sanità (ISS). Whenever possible, recommendations are placed within the context the Italian Healthcare system, with reference to specific experience and local diagnostic and management resources.
