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Morales-Avalos R, Torres-González EM, Padilla-Medina JR, Monllau JC. ACL anatomy: Is there still something to learn? Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00071-7. [PMID: 38508380 DOI: 10.1016/j.recot.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The different bony and soft tissue reference points and the micro and macroscopic structures of the knee continue to be the object of focused study and analysis. Upon reviewing the most recent literature, we saw the wide spectrum of studies that seek to define the different anatomical aspects of the anterior cruciate ligament (ACL). PURPOSE The purpose of this paper is to review the most recent publications on the ACL and its morphology in which its microscopic composition and macroscopic anatomy are addressed. RESULTS The ACL consists of typeI (90%) and typeIII (10%) collagen matrix. Its length ranges from 27 to 38mm and its width from 10 to 12mm. The ACL cross-section area measures an average of 44mm2, and its shape resembles that of an hourglass or a bow tie. ACL bundles have been defined as anteromedial, intermediate, and posterolateral. Femoral and tibial footprints were seen to present a high degree of variability in shape and size. Furthermore, the blood supply is given by the medial genicular artery and innervation by the tibial nerve branches. Additionally, the ACL functionally prevents anterior translation of the tibia and stabilizes against the internal rotation of the tibia and valgus angulation of the knee. CONCLUSIONS There is great variability in the anatomy of the ACL as well as its attachment sites. At the same time, the shape and size of its footprint has become a factor in determining individualized ACL reconstruction. The persistence of morphological variability in the aging of the ACL and important aspects of surgical planning and decision making with respect to anatomical risk factors suggest that further studies are called for.
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Affiliation(s)
- R Morales-Avalos
- Departamento de Fisiología, Facultad de Medicina, Universidad Autónoma de Nuevo León (UANL), Monterrey, Nuevo León, México; Departamento de Cirugía Ortopédica, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | - E M Torres-González
- Departamento de Cirugía Ortopédica y Traumatología, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León (UANL), Monterrey, Nuevo León, México; Departamento de Cirugía Ortopédica, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - J R Padilla-Medina
- Departamento de Cirugía Ortopédica y Traumatología, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León (UANL), Monterrey, Nuevo León, México; Departamento de Cirugía Ortopédica, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - J C Monllau
- ICATKnee (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, España; Departamento de Cirugía Ortopédica, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
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Kirmaier A, Kubiak J, Mahler L, Qian X, Wu L, Ono Y, Riedel S, Medline A, Yang X, Elamin S, Afdhal N, Arnaout R. Case report and mini-review: Sarcina ventriculi in the stomach of an 80-year-old female. Diagn Microbiol Infect Dis 2024; 108:116137. [PMID: 38134822 DOI: 10.1016/j.diagmicrobio.2023.116137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023]
Abstract
Sarcina ventriculi, also known as Zymosarcina ventriculi and, incorrectly, as Clostridium ventriculi, is rarely encountered in clinical settings. A patient with a complicated gastrointestinal (GI) history, who was acutely presenting with small-bowel obstruction, was found to be colonized by S. ventriculi. The distinctive morphology of this species, with large Gram-variable cocci (up to 3 µm) arranged in two-by-two cuboid clusters reaching up to 20 µm, was key in identifying this bacterium in a stomach biopsy specimen. Sarcina ventriculi appears to be ubiquitously found in nature, and related bacterial species can cause GI-related disease in various animals. Clinical manifestations in humans are broad and often related to other underlying comorbidities. Isolation of S. ventriculi in the laboratory requires anaerobic culture on select media but its absence from standard MALDI-TOF databases complicates identification. Susceptibility data do not exist, so empiric treatment is the only option for this rare pathogen.
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Affiliation(s)
- Andrea Kirmaier
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeffrey Kubiak
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lily Mahler
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Xia Qian
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Leo Wu
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Yuho Ono
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stefan Riedel
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Alexandra Medline
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Xiao Yang
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sami Elamin
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Beth, Israel Deaconess Medical Center, Boston, MA, USA
| | - Nezam Afdhal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Beth, Israel Deaconess Medical Center, Boston, MA, USA
| | - Ramy Arnaout
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Leroy G, Boettcher P, Joly F, Looft C, Baumung R. Multifunctionality and provision of ecosystem services by livestock species and breeds at global level. Animal 2024; 18:101048. [PMID: 38160592 DOI: 10.1016/j.animal.2023.101048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Beyond providing food, livestock species are linked to a wide range of uses and ecosystem services (ESs). Based on information reported by 41 countries on 3 361 national breed populations to the Domestic Animal Diversity Information System of the Food and Agriculture Organization of the United Nations, we investigated how factors such as species, region, breed adaptedness, or management system associate with the recognition of provision of a set of 52 ESs. Among species, a greater number of cultural ESs were reported for horses (2.47 for horses vs 0.75 on average across all species), while the major ruminant species (cattle, goats and sheep) were on average associated with more provisioning ESs (2.99 vs 2.39), and more regulating and maintenance ESs (1.86 vs 1.32). Compared to European breeds, African livestock contribute more provisioning ES (3.95 vs 1.88). Native breeds and, to a lesser extent, locally adapted breeds, were linked to more ESs than were exotic breeds (5.97 and 4.10 vs 2.90, respectively), regardless of the ES category considered. The total number of ES reported was greater for breeds primarily kept under Back Yard/Farm Yard and extensive management systems than in other production environments. Different "bundles" of ES were identified in relation to the interdependence among themselves, or according to species or regional specificities. Overall, our results highlight that native and locally adapted breeds, which tend to be raised in less specialized production systems than exotic breeds, are reported to play multiple roles contributing to rural community livelihoods and environmental sustainability of food systems.
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Affiliation(s)
- G Leroy
- Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153 Roma, Italy.
| | - P Boettcher
- Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153 Roma, Italy
| | - F Joly
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR Herbivores, 63122 Saint-Genès-Champanelle, France
| | - C Looft
- Neubrandenburg University of Applied Sciences, Brodaer Str. 2, Neubrandenburg, Germany
| | - R Baumung
- Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, 00153 Roma, Italy
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Eppling J, Nickel R. A Team Approach to Bundle Compliance. Crit Care Nurs Clin North Am 2023; 35:495-504. [PMID: 37838421 DOI: 10.1016/j.cnc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Hospitals are always looking to improve the quality of patient care and avoid hospital-acquired conditions such as ventilator-associated pneumonia (VAP). Currently, there are no set standards regarding interventions to prevent VAP, and there is not a single element that has a direct impact on VAP prevention. By creating an interprofessional team to work together, the quality improvement project was able to evaluate current practice compared with evidence-based practice in the literature to develop a critical care VAP bundle practice, which demonstrated improvement in compliance.
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Affiliation(s)
- Joseph Eppling
- Louisiana State University Health Science Center School of Nursing, 1900 Gravier Street, New Orleans, LA 70112, USA.
| | - Rachel Nickel
- University Medical Center New Orleans, 2000 Canal Street, New Orleans, LA 70118, USA
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5
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Morales-Avalos R, Torres-González EM, Padilla-Medina JR, Monllau JC. ACL anatomy: Is there still something to learn? Rev Esp Cir Ortop Traumatol (Engl Ed) 2023:S1888-4415(23)00070-X. [PMID: 36787832 DOI: 10.1016/j.recot.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The different bony and soft tissue reference points and the micro and macroscopic structures of the knee continue to be the object of focused study and analysis. Upon reviewing the most recent literature, we saw the wide spectrum of studies that seek to define the different anatomical aspects of the anterior cruciate ligament (ACL). PURPOSE The purpose of this paper is to review the most recent publications on the ACL and its morphology in which its microscopic composition and macroscopic anatomy are addressed. RESULTS The ACL consists of type I (90%) and type III (10%) collagen matrix. Its length ranges from 27 to 38mm and its width from 10 to 12mm. The ACL cross-section area measures an average of 44mm2, and its shape resembles that of an hourglass or a bow tie. ACL bundles have been defined as anteromedial, intermediate, and posterolateral. Femoral and tibial footprints were seen to present a high degree of variability in shape and size. Furthermore, the blood supply is given by the medial genicular artery and innervation by the tibial nerve branches. Additionally, the ACL functionally prevents anterior translation of the tibia and stabilizes against the internal rotation of the tibia and valgus angulation of the knee. CONCLUSIONS There is great variability in the anatomy of the ACL as well as its attachment sites. At the same time, the shape and size of its footprint has become a factor in determining individualized ACL reconstruction. The persistence of morphological variability in the aging of the ACL and important aspects of surgical planning and decision making with respect to anatomical risk factors suggest that further studies are called for.
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Affiliation(s)
- R Morales-Avalos
- Physiology Department, Faculty of Medicine, Universidad Autónoma de Nuevo León (U.A.N.L), Monterrey, Mexico; Department of Orthopedic Surgery, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - E M Torres-González
- Department of Orthopedic Surgery and Traumatology, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León (U.A.N.L), Monterrey, Mexico; Department of Orthopedic Surgery, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - J R Padilla-Medina
- Department of Orthopedic Surgery and Traumatology, Faculty of Medicine and University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León (U.A.N.L), Monterrey, Mexico; Department of Orthopedic Surgery, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - J C Monllau
- ICATKnee (ICATME), Hospital Universitari Dexeus, Universitat Autónoma de Barcelona, Barcelona, Spain; Department of Orthopedic Surgery, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
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Gallart E, Delicado M, Nuvials X. [Update of the recommendations of the Bacteraemia Zero Project]. Enferm Intensiva 2022; 33:S31-S39. [PMID: 35911623 PMCID: PMC9315357 DOI: 10.1016/j.enfi.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
El proyecto Bacteriemia Zero (BZ) fue el primero de los Proyectos Zero que se implementó en las Unidades de Cuidados Intensivos (UCI), consiguiendo una disminución de las tasas de infección relacionadas con catéter por debajo de las recomendadas por los estándares de calidad de las sociedades científicas. A raíz de la pandemia causada por el SARS-CoV-2 en las UCI, se ha observado un incremento importante de estas tasas de infección. El incremento de las tasas de infección y la necesidad de incorporar en la práctica clínica la mejor evidencia disponible, justifica la necesidad de actualizar las recomendaciones del proyecto BZ. Se constituyó un grupo de trabajo formado por miembros de las diferentes sociedades científicas que consideró que el paquete de medidas obligatorias del proyecto no debía modificarse debido a su eficacia demostrada y decidió incorporar, después de su revisión, las siguientes medidas opcionales: uso de catéteres impregnados con antimicrobianos, uso de apósitos impregnados con clorhexidina, uso de tapones con solución antiséptica en los conectores e higiene corporal diaria con clorhexidina.
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Affiliation(s)
- E Gallart
- Unidad de Cuidados Intensivos, Hospital Universitari Vall d'Hebron, Grupo de Investigación Multidisciplinar de Enfermería, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - M Delicado
- Organización Sanitaria Integrada Bilbao-Basurto Basurto, España
| | - X Nuvials
- Servicio de Medicina Intensiva, Hospital Universitari Vall d'Hebron, Grupo de Investigación SODIR, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España
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Sun X, Yang P, Tao Y, Bian H. Improving ecosystem services supply provides insights for sustainable landscape planning: A case study in Beijing, China. Sci Total Environ 2022; 802:149849. [PMID: 34455273 DOI: 10.1016/j.scitotenv.2021.149849] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
Promoting land use planning through ecosystem service (ES) protection is a crucial approach for maintaining landscape sustainability. Identifying ES bundles to serve landscape functional zoning can provide a new perspective for sustainable land use planning. Taking the Beijing metropolitan region as a study area, we quantitatively assessed the spatiotemporal distributions of multiple ESs, from 1980 to 2017, based on land use changes. By combining ES patterns and comprehensive ecosystem service (CES), distinct ES bundles were identified through the clustering method. Based on the ES bundles, landscape functional zones were then established. We further developed improved land use scenarios to conserve ESs in selected towns of different functional zones by exploring dominant factors influencing ESs. Results showed that most of ESs decreased due to the expansion of developed lands. According to the classification of ES bundles, Beijing can be classified into three landscape functional zones at town level: the ecological conservation region (ECR), food production region (FPR), and urban development region (UDR). For each landscape functional zone, the town with the greatest decline in CES value was selected. Associated with the influencing factors of ESs, local land use patterns, and ecological protection policies, corresponding multi-step improved land use scenarios were designed. These scenarios were demonstrated to be effective in conserving ESs in the selected towns: (1) the agricultural expansion scenario, which enhanced food provision services in the ECR; (2) the forest conservation scenario, which enhanced habitat and recreational services in the FPR; and (3) the developed land optimization scenario, which enhanced a range of regulating services in the UDR. Overall, this study used landscape functional zoning as a nexus to connect ES patterns and land use management. The optimized land use strategies can provide references for conserving ESs and enhancing landscape sustainability in Beijing and other similar metropolitan areas worldwide.
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Affiliation(s)
- Xiao Sun
- Key Laboratory of Agricultural Remote Sensing (AGRIRS), Ministry of Agriculture and Rural Affairs/Institute of Agricultural Resources and Regional Planning, Chinese Academy of Agricultural Sciences, Beijing 100081, China.
| | - Peng Yang
- Key Laboratory of Agricultural Remote Sensing (AGRIRS), Ministry of Agriculture and Rural Affairs/Institute of Agricultural Resources and Regional Planning, Chinese Academy of Agricultural Sciences, Beijing 100081, China.
| | - Yu Tao
- College of Land Management, Nanjing Agricultural University, Nanjing 210095, China.
| | - Hongyan Bian
- State Cultivation Base of Eco-agriculture for Southwest Mountainous Land, Chongqing Key Laboratory of Karst Environment, School of Geographical Sciences, Southwest University, Chongqing 400715, China
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Abstract
This article provides an overview of the history of the sepsis definitions as well as an overview of the current understanding of the pathogenesis of sepsis. The evolution of the treatment bundles is also presented.
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Affiliation(s)
- Michael H Ackerman
- Masters in Healthcare Innovation Program, The Ohio State University, Columbus, OH, USA.
| | - Thomas Ahrens
- Viven Health, 006 Woodbridge Creek Court, St Louis, MO 63129, USA
| | - Justin Kelly
- OSU Wexner Medical Center - The James, 460 West 10th Avenue, Room C1138, Columbus, OH, 43210, USA
| | - Anne Pontillo
- Nursing Education Department, James Cancer Hospital Solove Research Institute, 660 Ackerman Road, 5th Floor/Room 574, Columbus, OH 43202, USA
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Rosselli Del Turco E, Bartoletti M, Dahl A, Cervera C, Pericàs JM. How do I manage a patient with enterococcal bacteraemia? Clin Microbiol Infect 2021; 27:364-71. [PMID: 33152537 DOI: 10.1016/j.cmi.2020.10.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Enterococcal bacteraemia (EB) is common, particularly in the nosocomial setting, and its management poses a challenge for clinicians and microbiologists. OBJECTIVES The aim was to summarize the more relevant features of EB and to provide a practical state-of-the-art on the topics that more directly affect its management. SOURCES Pubmed articles from inception to 31 May 2020. CONTENT The following topics are covered: epidemiological, clinical and microbiological characteristics and factors associated with prognosis of EB; diagnosis and work-up, including the use of echocardiography to rule out endocarditis; antibiotic management with special focus on antimicrobial resistance and complicated EB; and the role of infectious disease consultation and the use of bundles in EB. In addition, three clinical vignettes are presented to illustrate the practical application of the guidance provided, and major gaps in the current evidence supporting EB management are discussed. IMPLICATIONS EB is associated with large burdens of morbidity and mortality, particularly among fragile and immunosuppressed patients presenting complicated bacteraemia due to multidrug-resistant enterococci. Most cases of EB are caused by Enterococcus faecalis, followed by E. faecium. EB often presents as polymicrobial bacteraemia. Rapidly identifying patients at risk of EB is crucial for timely application of diagnostic techniques and empiric therapy. Early alert systems and rapid diagnostic techniques, such as matrix-assisted desorption ionization-time of flight mass spectrometry, especially if used together with infectious disease consultation within bundles, appear to improve management and prognosis of EB. Echocardiography is also key in the work-up of EB and should probably be more extensively used, although its exact indications in EB are still debated. Multidisciplinary approaches are warranted due to the complexity and severity of EB.
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Gallaher J, Charles A. An invited commentary on "Impact of a bundle on surgical infections after hip arthroplasty. A cohort study in Italy" [Int. J. Surg. (2020) Epub ahead of print] The reality of bundles in a resource-limited environment. Int J Surg 2020; 83:156. [PMID: 32987209 DOI: 10.1016/j.ijsu.2020.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, UNC School of Medicine, 4006 Burnett Womack Building, CB 7228, USA.
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, UNC School of Medicine, 4006 Burnett Womack Building, CB 7228, USA
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Qiu R, Qi Y, Wan X. An event-related potential study of consumers' responses to food bundles. Appetite 2020; 147:104538. [PMID: 31775014 DOI: 10.1016/j.appet.2019.104538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 11/26/2022]
Abstract
We conducted two event-related potentials (ERP) experiments to investigate consumers' responses to different types of food bundles. In Experiment 1, the participants were instructed to indicate their wanting of a three-yogurt bundle when their neural activity was recorded. The results of self-report wanting scores revealed that the participants wanted bundles consisting of their favorite yogurt products more than those of disliked products. Such a difference in self-report scores was also indexed by the N2 in frontal brain and the P1 in the left hemisphere. By contrast, bundles consisting of three different yogurt products elicited a smaller amplitude of the N2 than bundles consisting of two favorite products and one disliked product, but these two types of bundles received comparable wanting scores. Moreover, we asked the participants in Experiment 2 to perform a visual discrimination task on these bundles, and did not found these effects on the N2 or the P1. Collectively, these results revealed neural activities underlying consumers' responses to food rewards, and demonstrated the role of individuals' variety-seeking tendency in wanting process.
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Affiliation(s)
- Ruyi Qiu
- Department of Psychology, Tsinghua University, China
| | - Yuxuan Qi
- Department of Psychology, Tsinghua University, China
| | - Xiaoang Wan
- Department of Psychology, Tsinghua University, China.
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12
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Abstract
Maternal morbidity and mortality is on the rise in the United States. Several local, state, and nationwide organizations have worked toward reducing maternal mortality by improving patient safety. Early warning systems unique to the obstetric population have been developed to provide early intervention and to prevent patients from decompensating. Patient care bundles, supported by the American College of Obstetricians and Gynecologists, as well as The Council on Patient Safety, provide a standardized approach to obstetric care. Monitoring outcomes through root cause analysis is key to improving patient safety and outcomes.
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13
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Moore WR, Vermuelen A, Taylor R, Kihara D, Wahome E. Improving 3-Hour Sepsis Bundled Care Outcomes: Implementation of a Nurse-Driven Sepsis Protocol in the Emergency Department. J Emerg Nurs 2019; 45:690-8. [PMID: 31235077 DOI: 10.1016/j.jen.2019.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 11/24/2022]
Abstract
PROBLEM Sepsis, a life-threatening condition, can rapidly progress to death. The Hospital Inpatient Quality Reporting program has implemented bundled care metrics for sepsis care, but timely completion of these interventions is challenging. Best-practice interventions could improve patient outcomes and reimbursement. The purpose of this project was to improve the timeliness of sepsis recognition and implementation of bundled care interventions in the emergency department. METHODS This evidence-based practice improvement project implemented a Detect, Act, Reassess, Titrate (DART)-based nursing protocol embedded within a checklist communication tool in the emergency department of a tertiary level-2 trauma center. Data comparisons between preintervention and post-DART protocol/checklist implementation included compliance with the individual Inpatient Quality Reporting 3-hour bundled elements, number of hospital days, and time to screen. Staff also completed a survey designed to assess their satisfaction with the DART algorithm/checklist. The Pearson χ2 test was used to assess bundled-care intervention variables. Wilcoxon rank sum tests were used to explore hospitalization outcomes. Staff satisfaction survey results were summarized. RESULTS Improvement was statistically significant for lactate levels, blood cultures, and early antibiotic administration in the intervention period compared with baseline. Time to screen, ED length of stay, and number of hospital days improved between baseline and the intervention period, with an average number of hospital days decreasing by 2.5 days. Compliance with all Inpatient Quality Reporting metrics increased from 30% to 80%. DISCUSSION When the nurse-driven protocol and communication tool were implemented, compliance with time-sensitive sepsis bundled interventions improved significantly. The outcomes suggest nurse-driven protocols can improve sepsis outcomes.
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Martin-Loeches I, Guia MC, Vallecoccia MS, Suarez D, Ibarz M, Irazabal M, Ferrer R, Artigas A. Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study. Ann Intensive Care 2019; 9:26. [PMID: 30715638 PMCID: PMC6362175 DOI: 10.1186/s13613-019-0495-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background Age has been traditionally considered a risk factor for mortality in elderly patients admitted to intensive care units. The aim of this prospective, observational, multicenter cohort study is to determine the risk factors for mortality in elderly and very elderly critically ill patients with sepsis. Results A total of 1490 patients with ≥ 65 years of age were included in the study; most of them 1231 (82.6%) had a cardiovascular failure. The mean age (± SD) was 74.5 (± 5.6) years, and 876 (58.8%) were male. The patients were divided into two cohorts: (1) elderly: 65–79 years and (2) very elderly: ≥ 80 years. The overall hospital mortality was 48.8% (n = 727) and was significantly higher in very elderly compared to elderly patients (54.2% vs. 47.4%; p = 0.02). Factors independently associated with mortality were APACHE II score of the disease, patient location at sepsis diagnosis, development of acute kidney injury, and thrombocytopenia in the group of elderly patients. On the other hand, in the group of very elderly patients, predictors of hospital mortality were age, APACHE II score, and prompt adherence of the resuscitation bundle. Conclusion This prospective multicenter study found that patients aged 80 or over had higher hospital mortality compared to patients between 65 and 79 years. Age was found to be an independent risk factor only in the very elderly group, and prompt therapy provided within the first 6 h of resuscitation was associated with a reduction in hospital mortality in the very elderly patients.
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Affiliation(s)
- Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital/Trinity College Dublin TCD, James's St, Ushers, Dublin, D03 VX82, Ireland. .,Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain. .,University of Barcelona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES CB06/06/0028), Barcelona, Spain.
| | - Maria Consuelo Guia
- Critical care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Maria Sole Vallecoccia
- Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital/Trinity College Dublin TCD, James's St, Ushers, Dublin, D03 VX82, Ireland.,Department of Intensive Care and Anaesthesiology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A.Gemelli, Rome, Italy
| | - David Suarez
- Critical care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Mercedes Ibarz
- Servicio de Medicina Intensiva, Hospitales Universitarios Sagrado Corazon y General de Cataluña, Barcelona, Spain
| | - Marian Irazabal
- Servicio de Medicina Intensiva, Hospitales Universitarios Sagrado Corazon y General de Cataluña, Barcelona, Spain
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Shock Organ Dysfunction and Resuscitation Research Group, Vall d' Hebron Research Institute, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Antonio Artigas
- Critical care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain.,Servicio de Medicina Intensiva, Hospitales Universitarios Sagrado Corazon y General de Cataluña, Barcelona, Spain
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15
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Álvarez-Lerma F, Sánchez García M. "The multimodal approach for ventilator-associated pneumonia prevention"-requirements for nationwide implementation. Ann Transl Med 2018; 6:420. [PMID: 30581828 PMCID: PMC6275409 DOI: 10.21037/atm.2018.08.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/17/2018] [Indexed: 01/06/2023]
Abstract
The multimodal approach for ventilator-associated pneumonia (VAP) prevention has been shown to be a successful strategy in reducing VAP rates in many intensive care units (ICU) in some countries. The simultaneous application of several measures or "bundles" to reduce VAP rates has achieved a higher impact than the progressive implementation of the individual interventions. The ultimate objective of recommendation bundles is their integration in the culture of routine healthcare of the staff in charge of ventilated patients for accomplished rates to persist over time. The noteworthy elements of this new strategy include the selection of the individual recommendations of the bundle, education of care workers (HCW) in the culture of patient safety, audit of compliance with the recommendations, commitment of the hospital management to support implementation, nomination and empowerment of local leaders of the projects in ICUs, both physicians and nurses, and the continuous collection of VAP episodes. The implementation of this new strategy is not an easy task, as both its inherent strength and important barriers to its application have become evident, which need to be overcome for maximal reduction of VAP rates.
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Affiliation(s)
- Francisco Álvarez-Lerma
- Service of Intensive Care Medicine, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M. Sánchez García
- Department of Critical Care, Hospital Clínico San Carlos, Madrid, Spain
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Alp E, Cookson B, Erdem H, Rello J; Survey Group. Infection control bundles in intensive care: an international cross-sectional survey in low- and middle-income countries. J Hosp Infect 2019; 101:248-56. [PMID: 30036635 DOI: 10.1016/j.jhin.2018.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/13/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND In low- and middle-income countries (LMICs), the burden of healthcare-associated infections (HCAIs) is not known due to a lack of national surveillance systems, standardized infection definitions, and paucity of infection prevention and control (IPC) organizations and legal infrastructure. AIM To determine the status of IPC bundle practice and the most frequent interventional variables in LMICs. METHODS A questionnaire was emailed to Infectious Diseases International Research Initiative (ID-IRI) Group Members and dedicated IPC doctors working in LMICs to examine self-reported practices/policies regarding IPC bundles. Responding country incomes were classified by World Bank definitions into low, middle, and high. Comparison of LMIC results was then made to a control group of high-income countries (HICs). FINDINGS This survey reports practices from one low-income country (LIC), 16 middle-income countries (MICs) (13 European), compared to eight high-income countries (HICs). Eighteen (95%) MICs had an IPC committee in their hospital, 12 (63.2%) had an annual agreed programme and produced an HCAI report. Annual agreed programmes (87.5% vs 63.2%, respectively) and an annual HCAI report (75.0% vs 63.2%, respectively) were more common in HICs than MICs. All HICs had at least one invasive device-related surveillance programme. Seven (37%) MICs had no invasive device-related surveillance programme, six (32%) had no ventilator-associated pneumonia prevention bundles, seven (37%) had no catheter-associated urinary tract infection prevention bundles, and five (27%) had no central line-associated bloodstream infection prevention bundles. CONCLUSION LMICs need to develop their own bundles with low-cost and high-level-of-evidence variables adapted to the limited resources, with further validation in reducing infection rates.
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Wang H, Tong H, Liu H, Wang Y, Wang R, Gao H, Yu P, Lv Y, Chen S, Wang G, Liu M, Li Y, Yu K, Wang C. Effectiveness of antimicrobial-coated central venous catheters for preventing catheter-related blood-stream infections with the implementation of bundles: a systematic review and network meta-analysis. Ann Intensive Care 2018; 8:71. [PMID: 29904809 PMCID: PMC6002334 DOI: 10.1186/s13613-018-0416-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 06/01/2018] [Indexed: 11/29/2022] Open
Abstract
Background Catheter-related blood-stream infections (CRBSIs) are the most common complication when using central venous catheters (CVCs). Whether coating CVCs under bundles could further reduce the incidence of CRBSIs is unclear. We aimed to assess the effectiveness of implementing the use of bundles with antimicrobial-coated CVCs for preventing catheter-related blood-stream infections. Methods In this systematic review and network meta-analyses, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library in addition to the EMBASE, MEDLINE, CINAHL, and Web of Science databases for studies published before July 2017. The primary outcome was the rate of CRBSIs per 1000 catheter-days, and the secondary outcome was the incidence of catheter colonization. Results Twenty-three studies revealed significant differences in the rate of CRBSIs per 1000 catheter-days between antimicrobial-impregnated and standard CVCs (RR 0.70, 95% CI 0.53–0.91, p = 0.008). Thirty-three trials were included containing 10,464 patients who received one of four types of CVCs. Compared with a standard catheter, chlorhexidine/silver sulfadiazine- and antibiotic-coated catheters were associated with lower numbers of CRBSIs per 1000 catheter-days (ORs and 95% CrIs: 0.64 (0.40–0.955) and 0.53 (0.25–0.95), respectively) and a lower incidence of catheter colonization (ORs and 95% CrIs: 0.44 (0.34–0.56) and 0.30 (0.20–0.46), respectively). Conclusions Outcomes are superior for catheters impregnated with chlorhexidine/silver sulfadiazine or other antibiotics than for standard catheters in preventing CRBSIs and catheter colonization under bundles. Compared with silver ion-impregnated CVCs, chlorhexidine/silver sulfadiazine antiseptic catheters resulted in fewer cases of microbial colonization of the catheter but did not reduce CRBSIs. Electronic supplementary material The online version of this article (10.1186/s13613-018-0416-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hongliang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongshuang Tong
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Haitao Liu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yao Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Ruitao Wang
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hong Gao
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Pulin Yu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yanji Lv
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Shuangshuang Chen
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Guiyue Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Miao Liu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yuhang Li
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Kaijiang Yu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China.
| | - Changsong Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China.
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18
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Wu F, Zhou X. Fluid resuscitation in pre-hospital patients with septic shock: One size does not fit all. Am J Emerg Med 2019; 37:168-9. [PMID: 29861366 DOI: 10.1016/j.ajem.2018.05.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 05/25/2018] [Indexed: 11/23/2022] Open
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Biasucci DG, Pittiruti M, Taddei A, Picconi E, Pizza A, Celentano D, Piastra M, Scoppettuolo G, Conti G. Targeting zero catheter-related bloodstream infections in pediatric intensive care unit: a retrospective matched case-control study. J Vasc Access 2018; 19:119-24. [PMID: 29148002 DOI: 10.5301/jva.5000797] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the effectiveness and safety of a new three-component 'bundle' for insertion and management of centrally inserted central catheters (CICCs), designed to minimize catheter-related bloodstream infections (CRBSIs) in critically ill children. METHODS Our 'bundle' has three components: insertion, management, and education. Insertion and management recommendations include: skin antisepsis with 2% chlorhexidine; maximal barrier precautions; ultrasound-guided venipuncture; tunneling of the catheter when a long indwelling time is expected; glue on the exit site; sutureless securement; use of transparent dressing; chlorhexidine sponge dressing on the 7th day; neutral displacement needle-free connectors. All CICCs were inserted by appropriately trained physicians proficient in a standardized simulation training program. RESULTS We compared CRBSI rate per 1000 catheters-days of CICCs inserted before adoption of our new bundle with that of CICCs inserted after implementation of the bundle. CICCs inserted after adoption of the bundle remained in place for a mean of 2.2 days longer than those inserted before. We found a drop in CRBSI rate to 10%, from 15 per 1000 catheters-days to 1.5. CONCLUSIONS Our data suggest that a bundle aimed at minimizing CR-BSI in critically ill children should incorporate four practices: (1) ultrasound guidance, which minimizes contamination by reducing the number of attempts and possible break-down of aseptic technique; (2) tunneling the catheter to obtain exit site in the infra-clavicular area with reduced bacterial colonization; (3) glue, which seals and protects the exit site; (4) simulation-based education of the staff.
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Ruiz-Tovar J, Llavero C, Morales V, Gamallo C. Effect of the application of a bundle of three measures (intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples) on the surgical site infection after elective laparoscopic colorectal cancer surgery. Surg Endosc 2018; 32:3495-501. [PMID: 29349539 DOI: 10.1007/s00464-018-6069-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Surgical site infection (SSI) prevention bundles include the simultaneous use of different measures, which individually have demonstrated an effect on prevention of SSI. The implementation of bundles can yield superior results to the implementation of individual measures. The aim of this study was to address the effect of the application of a bundle including intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples, on the surgical site infection after elective laparoscopic colorectal cancer surgery. METHODS A prospective, randomized study was performed, including patients with diagnosis of colorectal neoplasms and plans to undergo an elective laparoscopic surgery. The patients were randomized into two groups: those patients following standard bundles (Group 1) and those ones following the experimental bundle with three additional measures, added to the standard bundle. Incisional and organ space SSI were investigated. The study was assessor-blinded. RESULTS A total of 198 patients were included in the study, 99 in each group. The incisional SSI rate was 16% in Group 1 and 2% in Group 2 [p = 0.007; RR = 5.6; CI 95% (1.4-17.8)]. The organ-space SSI rate was 4% in Group 1 and 0% in Group 2 [p = 0.039; RR = 1.7; CI 95% (1.1-11.6)]. Median hospital stay was 5.5 days in Group 1 and 4 days in Group 2 (p = 0.028). CONCLUSIONS The addition of intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples, to a standard bundle of SSI prevention, reduces the incisional and organ-space SSI and consequently the hospital stay, after elective laparoscopic colorectal cancer surgery (ClinicalTrials.gov Identifier: NCT03081962).
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21
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Machado FR, Ferreira EM, Schippers P, de Paula IC, Saes LSV, de Oliveira FI, Tuma P, Nogueira Filho W, Piza F, Guare S, Mangini C, Guth GZ, Azevedo LCP, Freitas FGR, do Amaral JLG, Mansur NS, Salomão R. Implementation of sepsis bundles in public hospitals in Brazil: a prospective study with heterogeneous results. Crit Care 2017; 21:268. [PMID: 29089025 PMCID: PMC5664817 DOI: 10.1186/s13054-017-1858-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 10/05/2017] [Indexed: 01/21/2023]
Abstract
Background Public hospitals in emerging countries pose a challenge to quality improvement initiatives in sepsis. Our objective was to evaluate the results of a quality improvement initiative in sepsis in a network of public institutions and to assess potential differences between institutions that did or did not achieve a reduction in mortality. Methods We conducted a prospective study of patients with sepsis or septic shock. We collected baseline data on compliance with the Surviving Sepsis Campaign 6-h bundles and mortality. Afterward, we initiated a multifaceted quality improvement initiative for patients with sepsis or septic shock in all hospital sectors. The primary outcome was hospital mortality over time. The secondary outcomes were the time to sepsis diagnosis and compliance with the entire 6-h bundles throughout the intervention. We defined successful institutions as those where the mortality rates decreased significantly over time, using a logistic regression model. We analyzed differences over time in the secondary outcomes by comparing the successful institutions with the nonsuccessful ones. We assessed the predictors of in-hospital mortality using logistic regression models. All tests were two-sided, and a p value less than 0.05 indicated statistical significance. Results We included 3435 patients from the emergency departments (50.7%), wards (34.1%), and intensive care units (15.2%) of 9 institutions. Throughout the intervention, there was an overall reduction in the risk of death, in the proportion of septic shock, and the time to sepsis diagnosis, as well as an improvement in compliance with the 6-h bundle. The time to sepsis diagnosis, but not the compliance with bundles, was associated with a reduction in the risk of death. However, there was a significant reduction in mortality in only two institutions. The reduction in the time to sepsis diagnosis was greater in the successful institutions. By contrast, the nonsuccessful sites had a greater increase in compliance with the 6-h bundle. Conclusions Quality improvement initiatives reduced sepsis mortality in public Brazilian institutions, although not in all of them. Early recognition seems to be a more relevant factor than compliance with the 6-h bundle. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1858-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Flavia Ribeiro Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil. .,Latin American Sepsis Institute, São Paulo, SP, Brazil. .,Latin American Sepsis Institute, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715 - 6° andar, Vila Clementino, 04024-002, São Paulo, SP, Brazil.
| | | | | | | | | | | | - Paula Tuma
- Sociedade Paulista para o Desenvolvimento da Medicina (SPDM), São Paulo, SP, Brazil
| | | | - Felipe Piza
- Sociedade Paulista para o Desenvolvimento da Medicina (SPDM), São Paulo, SP, Brazil
| | - Sandra Guare
- Sociedade Paulista para o Desenvolvimento da Medicina (SPDM), São Paulo, SP, Brazil
| | - Cláudia Mangini
- Sociedade Paulista para o Desenvolvimento da Medicina (SPDM), São Paulo, SP, Brazil
| | | | | | - Flavio Geraldo Resende Freitas
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil.,Latin American Sepsis Institute, São Paulo, SP, Brazil
| | - Jose Luiz Gomes do Amaral
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, SP, Brazil.,Latin American Sepsis Institute, São Paulo, SP, Brazil.,Sociedade Paulista para o Desenvolvimento da Medicina (SPDM), São Paulo, SP, Brazil
| | | | - Reinaldo Salomão
- Latin American Sepsis Institute, São Paulo, SP, Brazil.,Infectious Disease Department, Federal University of São Paulo, São Paulo, SP, Brazil
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Le Conte P, Thibergien S, Obellianne JB, Montassier E, Potel G, Roy PM, Batard E. Recognition and treatment of severe sepsis in the emergency department: retrospective study in two French teaching hospitals. BMC Emerg Med 2017; 17:27. [PMID: 28854874 PMCID: PMC5575926 DOI: 10.1186/s12873-017-0133-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/29/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Sepsis management in the Emergency Department remains a daily challenge. The Surviving Sepsis Campaign (SSC) has released three-hour bundle. The implementation of these bundles in European Emergency Departments remains poorly described. The main objective was to assess the compliance with the Severe Sepsis Campaign 3-h bundle (blood culture, lactate dosage, first dose of antibiotics and 30 ml/kg fluid challenge). Secondary objectives were the analysis of the delay of severe sepsis recognition and description of the population. METHODS In accordance with STROBE statement, we performed a retrospective study in two French University Hospital Emergency Departments from February to August 2015. Patients admitted during the study period were screened using the electronic files of the hospital databases. Patient's files were reviewed and included in the study if they met severe sepsis criteria. Demographics, comorbities, treatments were recorded. Delays from admission to severe sepsis diagnosis, fluid loading onset and antibiotics administration were calculated. RESULTS One hundred thirty patients were included (76 men, mean age 71 ± 14 years). Blood culture, lactate dosage, antibiotics and 30 ml/kg fluid loading were performed within 3 hours in % [95% confidence interval] 100% [96-100%], 62% [54-70%], 49% [41-58%] and 19% [13-27%], respectively. 25 patients out of 130 (19% [13-27%]) fulfilled each criteria of the 3-h bundle. The mean fluid loading volume was 18 ± 11 ml/kg. Mean delay between presentation and severe sepsis diagnosis was 200 ± 263 min, from diagnosis to fluid challenge and first antibiotic dose, 10 ± 27 min and 20 ± 55 min, respectively. CONCLUSION Compliance with SSC 3-h bundle and delay between admission and sepsis recognition have to be improved. If confirmed by other studies, an improvement program might be deployed.
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Affiliation(s)
| | | | | | | | - Gilles Potel
- Service des urgences, CHU de Nantes, 44035 Nantes cedex 01, France
| | | | - Eric Batard
- Service des urgences, CHU de Nantes, 44035 Nantes cedex 01, France
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Garyfallidis E, Côté MA, Rheault F, Sidhu J, Hau J, Petit L, Fortin D, Cunanne S, Descoteaux M. Recognition of white matter bundles using local and global streamline-based registration and clustering. Neuroimage 2017; 170:283-295. [PMID: 28712994 DOI: 10.1016/j.neuroimage.2017.07.015] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 06/06/2017] [Accepted: 07/10/2017] [Indexed: 11/17/2022] Open
Abstract
Virtual dissection of diffusion MRI tractograms is cumbersome and needs extensive knowledge of white matter anatomy. This virtual dissection often requires several inclusion and exclusion regions-of-interest that make it a process that is very hard to reproduce across experts. Having automated tools that can extract white matter bundles for tract-based studies of large numbers of people is of great interest for neuroscience and neurosurgical planning. The purpose of our proposed method, named RecoBundles, is to segment white matter bundles and make virtual dissection easier to perform. This can help explore large tractograms from multiple persons directly in their native space. RecoBundles leverages latest state-of-the-art streamline-based registration and clustering to recognize and extract bundles using prior bundle models. RecoBundles uses bundle models as shape priors for detecting similar streamlines and bundles in tractograms. RecoBundles is 100% streamline-based, is efficient to work with millions of streamlines and, most importantly, is robust and adaptive to incomplete data and bundles with missing components. It is also robust to pathological brains with tumors and deformations. We evaluated our results using multiple bundles and showed that RecoBundles is in good agreement with the neuroanatomical experts and generally produced more dense bundles. Across all the different experiments reported in this paper, RecoBundles was able to identify the core parts of the bundles, independently from tractography type (deterministic or probabilistic) or size. Thus, RecoBundles can be a valuable method for exploring tractograms and facilitating tractometry studies.
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Affiliation(s)
- Eleftherios Garyfallidis
- Department of Intelligent Systems Engineering, School of Informatics and Computing, Indiana University, Bloomington, USA.
| | - Marc-Alexandre Côté
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, Université de Sherbrooke, Sherbrooke, Canada
| | - Francois Rheault
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, Université de Sherbrooke, Sherbrooke, Canada
| | - Jasmeen Sidhu
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, Université de Sherbrooke, Sherbrooke, Canada
| | - Janice Hau
- Brain Development Imaging Lab (BDIL), Department of Psychology, San Diego State University, USA; Groupe d' Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR5293, CNRS, CEA Université de Bordeaux, Bordeaux, France
| | - Laurent Petit
- Groupe d' Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR5293, CNRS, CEA Université de Bordeaux, Bordeaux, France
| | - David Fortin
- Division of Neurosurgery and Neuro-Oncology, Faculty of Medicine and Health Science, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Stephen Cunanne
- Research Center on Aging and Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, Université de Sherbrooke, Sherbrooke, Canada
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Zhang B, Cheng CK, Qu TB, Hai Y, Lin Y, Pan J, Wang ZW, Wen L. Partial versus Intact Posterior Cruciate Ligament-retaining Total Knee Arthroplasty: A Comparative Study of Early Clinical Outcomes. Orthop Surg 2017; 8:331-7. [PMID: 27627716 DOI: 10.1111/os.12269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 05/24/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Whether the entire posterior cruciate ligament (PCL) should be retained during cruciate-retaining total knee arthroplasty (CR TKA) is controversial. The goal of this study was to compare the early clinical outcomes of partial versus intact PCL-retaining TKA. METHODS Ninety-two patients who had undergone unilateral CR TKA from March 2012 to June 2013 were enrolled in this study. Forty-six of these patients were randomly selected to undergo intact PCL-retaining TKA (intact group), whereas the remaining 46 patients underwent tibial osteotomy together with anterolateral bundle and bone island resection (partial group). All operations were performed by a senior orthopedic surgeon and the PCL was released to some extent in both groups. After TKA, active and passive flexion and extension exercises of the knee and lower limb strength exercises were maintained until at least 3 months after surgery. Before surgery and 6, 12, and 24 months after surgery, range of motion, Knee Society Clinical Rating System scores (including clinical and functional scores of the knee) and maximum anteroposterior (AP) displacement of the knee at 30° and 90° of knee flexion were evaluated in both groups. RESULTS Fourteen patients were rejected from the final analysis because of loss to follow-up or development of complications. Thus, 40 patients from the partial group and 38 from the intact group were followed up for 24-41 months (mean 32.8 months). Knee functional scores were significantly higher in the intact than in the partial group (88.1 vs. 84.8 points) 24 months after surgery There were no significant differences in range of motion or knee clinical scores between the two groups at any time point. However, 12 and 24 months after surgery, the mean maximum AP displacement of the knee in 90° knee flexion was significantly greater in the partial than in the intact group (12 months: 6.3 vs. 5.7 mm; 24 months: 7.0 vs. 6.2 mm). CONCLUSION Double-bundle PCL plays an important role in maintaining knee stability; the entire PCL should therefore be retained during CR TKA.
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Affiliation(s)
- Bo Zhang
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Cheng-Kung Cheng
- Department of Biological Science and Medical Engineering, International Research Center for Implantable and Interventional Medical Devices, Beihang University, Beijing, China.,Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Tie-Bing Qu
- Department of Joint Functional Reconstruction, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China.
| | - Yong Hai
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Yuan Lin
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiang Pan
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhi-Wei Wang
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Liang Wen
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Benetatos P, Jho Y. Bundling in semiflexible polymers: A theoretical overview. Adv Colloid Interface Sci 2016; 232:114-126. [PMID: 26813628 DOI: 10.1016/j.cis.2016.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 12/07/2015] [Accepted: 01/02/2016] [Indexed: 01/07/2023]
Abstract
Supramolecular assemblies of polymers are key modules to sustain the structure of cells and their function. The main elements of these assemblies are charged semiflexible polymers (polyelectrolytes) generally interacting via a long(er)-range repulsion and a short(er)-range attraction. The most common supramolecular structure formed by these polymers is the bundle. In the present paper, we critically review some recent theoretical and computational advances on the problem of bundle formation, and point a few promising directions for future work.
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Affiliation(s)
- Panayotis Benetatos
- Department of Physics, Kyungpook National University, 80 Daehakro, Bukgu, Daegu, 702-701, South Korea
| | - YongSeok Jho
- Asia Pacific Center for Theoretical Physics, Pohang, Gyeongbuk, 790-784, South Korea; Department of Physics, Pohang University of Science and Technology, 790-784, South Korea.
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Rello J, Leblebicioglu H; members of ESGCIP. Sepsis and septic shock in low-income and middle-income countries: need for a different paradigm. Int J Infect Dis 2016; 48:120-2. [PMID: 27117201 DOI: 10.1016/j.ijid.2016.04.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 12/29/2022] Open
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Abstract
The medical literature demonstrates that inadequate hospital protocols or the lack of consistent protocols for diagnosis, management, consultation, and/or referral can lead to confusion and unnecessary variation in patient care. Incongruities in clinical settings have been repeatedly shown to compromise quality of patient outcomes. Accordingly, the development and adoption of standardized protocols as the best practice for addressing incidence of adverse events remains a top priority in health care quality and safety initiatives. Among the 127 hospital facilities that provide inpatient obstetrical care in New York State, adoption and uptake of standardized care management plans is sporadic at best. In 2001, to target the incidence of severe maternal outcomes and enhance the state of maternal health in New York, the American Congress of Obstetricians and Gynecologists (ACOG) District II and the New York State Department of Health developed the Safe Motherhood Initiative. Today, the Initiative demonstrates that maternal care outcomes are well served through an organized culture of obstetric safety. ACOG District II assists hospitals to optimize their delivery of obstetric care via three toolkits containing standardized protocols for the diagnosis, prevention, and management of the leading causes of maternal mortality and morbidity: hemorrhage, hypertension, and pulmonary embolus.
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Affiliation(s)
- Anna Burgansky
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York-Presbyterian/Lawrence Hospital, New York, NY
| | - Donna Montalto
- American Congress of Obstetricians and Gynecologists, District II, 100 Great Oaks Boulevard, Suite 109, Albany, NY 12203
| | - Norain A Siddiqui
- American Congress of Obstetricians and Gynecologists, District II, 100 Great Oaks Boulevard, Suite 109, Albany, NY 12203.
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Abstract
Intensive care units provide a wide range of care to patients with serious or life-threatening conditions. This care provides excellent state-of-the-art interventions, often concentrated on meeting national health priorities and performance measures. Overall patient care and the resultant outcomes in the intensive care unit are superb. However, one area that needs improvement is the provision of high-quality palliative care (PC) and end-of-life care. Many providers and administrators now realize implementing PC in the critical care setting is vital to optimal patient outcomes. PC improves patient and family satisfaction and quality of life, reduces length of stay and 30-day readmission rates, and patients can live longer with PC.
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Affiliation(s)
- Tonja M Hartjes
- Adult Gerontology Acute Care Nurse Practitioner Program, University of Florida, College of Nursing, 1225 Center Drive, PO Box 100187, Gainesville, FL 32610-0187, USA.
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Garyfallidis E, Ocegueda O, Wassermann D, Descoteaux M. Robust and efficient linear registration of white-matter fascicles in the space of streamlines. Neuroimage 2015; 117:124-40. [PMID: 25987367 DOI: 10.1016/j.neuroimage.2015.05.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 04/03/2015] [Accepted: 05/07/2015] [Indexed: 02/06/2023] Open
Abstract
The neuroscientific community today is very much interested in analyzing specific white matter bundles like the arcuate fasciculus, the corticospinal tract, or the recently discovered Aslant tract to study sex differences, lateralization and many other connectivity applications. For this reason, experts spend time manually segmenting these fascicles and bundles using streamlines obtained from diffusion MRI tractography. However, to date, there are very few computational tools available to register these fascicles directly so that they can be analyzed and their differences quantified across populations. In this paper, we introduce a novel, robust and efficient framework to align bundles of streamlines directly in the space of streamlines. We call this framework Streamline-based Linear Registration. We first show that this method can be used successfully to align individual bundles as well as whole brain streamlines. Additionally, if used as a piecewise linear registration across many bundles, we show that our novel method systematically provides higher overlap (Jaccard indices) than state-of-the-art nonlinear image-based registration in the white matter. We also show how our novel method can be used to create bundle-specific atlases in a straightforward manner and we give an example of a probabilistic atlas construction of the optic radiation. In summary, Streamline-based Linear Registration provides a solid registration framework for creating new methods to study the white matter and perform group-level tractometry analysis.
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Yokoe M, Takada T, Mayumi T, Yoshida M, Isaji S, Wada K, Itoi T, Sata N, Gabata T, Igarashi H, Kataoka K, Hirota M, Kadoya M, Kitamura N, Kimura Y, Kiriyama S, Shirai K, Hattori T, Takeda K, Takeyama Y, Hirota M, Sekimoto M, Shikata S, Arata S, Hirata K. Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015. J Hepatobiliary Pancreat Sci 2015; 22:405-32. [PMID: 25973947 DOI: 10.1002/jhbp.259] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/10/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Japanese (JPN) guidelines for the management of acute pancreatitis were published in 2006. The severity assessment criteria for acute pancreatitis were later revised by the Japanese Ministry of Health, Labour and Welfare (MHLW) in 2008, leading to their publication as the JPN Guidelines 2010. Following the 2012 revision of the Atlanta Classifications of Acute Pancreatitis, in which the classifications of regional complications of pancreatitis were revised, the development of a minimally invasive method for local complications of pancreatitis spread, and emerging evidence was gathered and revised into the JPN Guidelines. METHODS A comprehensive evaluation was carried out on the evidence for epidemiology, diagnosis, severity, treatment, post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and clinical indicators, based on the concepts of the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). With the graded recommendations, where the evidence was unclear, Meta-Analysis team for JPN Guidelines 2015 conducted an additional new meta-analysis, the results of which were included in the guidelines. RESULTS Thirty-nine questions were prepared in 17 subject areas, for which 43 recommendations were made. The 17 subject areas were: Diagnosis, Diagnostic imaging, Etiology, Severity assessment, Transfer indication, Fluid therapy, Nasogastric tube, Pain control, Antibiotics prophylaxis, Protease inhibitor, Nutritional support, Intensive care, management of Biliary Pancreatitis, management of Abdominal Compartment Syndrome, Interventions for the local complications, Post-ERCP pancreatitis and Clinical Indicator (Pancreatitis Bundles 2015). Meta-analysis was conducted in the following four subject areas based on randomized controlled trials: (1) prophylactic antibiotics use; (2) prophylactic pancreatic stent placement for the prevention of post-ERCP pancreatitis; (3) prophylactic non-steroidal anti-inflammatory drugs (NSAIDs) for the prevention of post-ERCP pancreatitis; and (4) peritoneal lavage. Using the results of the meta-analysis, recommendations were graded to create useful information. In addition, a mobile application was developed, which made it possible to diagnose, assess severity and check pancreatitis bundles. CONCLUSIONS The JPN Guidelines 2015 were prepared using the most up-to-date methods, and including the latest recommended medical treatments, and we are confident that this will make them easy for many clinicians to use, and will provide a useful tool in the decision-making process for the treatment of patients, and optimal medical support. The free mobile application and calculator for the JPN Guidelines 2015 is available via http://www.jshbps.jp/en/guideline/jpn-guideline2015.html.
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Affiliation(s)
- Masamichi Yokoe
- General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, KitaKyushu, Japan
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Chemotherapy Research Institute, International University of Health and Welfare, Ichikawa, Japan
| | - Shuji Isaji
- Hepatobiliary Pancreatic & Transplant Surgery Mie University Graduate School of Medicine, Mie, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University, School of Medical Science, Kanazawa, Japan
| | - Hisato Igarashi
- Clinical Education Center, Kyushu University Hospital, Fukuoka, Japan
| | - Keisho Kataoka
- Otsu Municipal Hospital, Shiga.,Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiko Hirota
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Masumi Kadoya
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Kisarazu, Chiba, Japan
| | - Yasutoshi Kimura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kunihiro Shirai
- Department of Emergency and Critical Care Medicine, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Takayuki Hattori
- Department of Radiology, Tokyo Metropolitan Health and Medical Treatment Corporation, Ohkubo Hospital, Tokyo, Japan
| | - Kazunori Takeda
- Department of Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kinki University Faculty of Medicine, Osaka, Japan
| | - Morihisa Hirota
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Miho Sekimoto
- The University of Tokyo Graduate School of Public Policy, Health Policy Unit, Tokyo
| | - Satoru Shikata
- Department of Family Medicine, Mie Prefectural Ichishi Hospital, Mie, Japan
| | - Shinju Arata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Koichi Hirata
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
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Chahoud J, Semaan A, Almoosa KF. Ventilator-associated events prevention, learning lessons from the past: A systematic review. Heart Lung 2015; 44:251-9. [PMID: 25686517 DOI: 10.1016/j.hrtlng.2015.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Preventing Ventilator-associated events (VAE) is a major challenge. Strictly monitoring for ventilator-associated pneumonia (VAP) is not sufficient to ensure positive outcomes. Therefore, the surveillance definition was updated and a change to the broader VAE was advocated. OBJECTIVE This paper summarizes the scientific efforts assessing VAP preventive bundles and the recent transition in surveillance methods. METHODS We conducted a systematic review to identify lessons from past clinical studies assessing VAP prevention bundles. We then performed a thorough literature review on the recent VAE surveillance algorithm, highlighting its advantages and limitations. CONCLUSION VAP prevention bundles have historically proven their efficacy and the introduction of the new VAE definition aimed at refining and objectivizing surveillance methods. Randomized controlled trials remain vital to determine the effect of VAE prevention on patient outcomes. We recommend expanding beyond limited VAP prevention strategies towards VAE prevention bundles.
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Affiliation(s)
| | - Adele Semaan
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | - Khalid F Almoosa
- Department of Internal Medicine, School of Medicine, University of Texas Health Science Center, Houston, TX, USA; Transplant Surgery ICU, Memorial Hermann Hospital TMC, Houston, TX, USA.
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Bruce HR, Maiden J, Fedullo PF, Kim SC. Impact of nurse-initiated ED sepsis protocol on compliance with sepsis bundles, time to initial antibiotic administration, and in-hospital mortality. J Emerg Nurs 2015; 41:130-7. [PMID: 25612516 DOI: 10.1016/j.jen.2014.12.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Emergency nurses play a key role in the initial triage and care of patients with potentially life-threatening illnesses. The aims of this study were to (1) evaluate the impact of a nurse-initiated ED sepsis protocol on time to initial antibiotic administration, (2) ascertain compliance with 3-hour Surviving Sepsis Campaign (SSC) targets, and (3) identify predictors of in-hospital sepsis mortality. METHODS A retrospective chart review investigated all adult patients-admitted through either of 2 academic tertiary medical center emergency departments-who were discharged with a diagnosis of severe sepsis or septic shock (N = 195). Pre- and post-protocol implementation data examined both compliance with 3-hour SSC bundle targets and patient outcomes. Multivariate logistic regression analysis identified predictors of in-hospital mortality. RESULTS Serum lactate measurement (83.9% vs 98.7%, P = .003) and median time to initial antibiotic administration (135 minutes vs 108 minutes, P = .021) improved significantly after protocol implementation. However, one quarter of antibiotic administration times still exceeded the 3-hour target. Significant predictors of in-hospital mortality were respiratory dysfunction, central nervous system dysfunction, urinary tract infection, vasopressor administration, and patient body weight (P < .05). There were no in-hospital mortality rate differences between the pre- and post-protocol implementation groups. DISCUSSION Compliance with serum lactate measurement and blood culture collection goals approached 100% in the post-protocol group. However, compliance with medical interventions requiring multiple health care-provider involvement (ie, antibiotic and fluid administration) remained suboptimal. Efforts focused on multidisciplinary bundle elements are necessary to achieve full compliance with SSC targets.
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Kulikova S, Hertz-Pannier L, Dehaene-Lambertz G, Buzmakov A, Poupon C, Dubois J. Multi-parametric evaluation of the white matter maturation. Brain Struct Funct 2014; 220:3657-72. [PMID: 25183543 PMCID: PMC4575699 DOI: 10.1007/s00429-014-0881-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 08/18/2014] [Indexed: 12/18/2022]
Abstract
In vivo evaluation of the brain white matter maturation is still a challenging task with no existing gold standards. In this article we propose an original approach to evaluate the early maturation of the white matter bundles, which is based on comparison of infant and adult groups using the Mahalanobis distance computed from four complementary MRI parameters: quantitative qT1 and qT2 relaxation times, longitudinal λ║ and transverse λ⊥ diffusivities from diffusion tensor imaging. Such multi-parametric approach is expected to better describe maturational asynchrony than conventional univariate approaches because it takes into account complementary dependencies of the parameters on different maturational processes, notably the decrease in water content and the myelination. Our approach was tested on 17 healthy infants (aged 3- to 21-week old) for 18 different bundles. It finely confirmed maturational asynchrony across the bundles: the spino-thalamic tract, the optic radiations, the cortico-spinal tract and the fornix have the most advanced maturation, while the superior longitudinal and arcuate fasciculi, the anterior limb of the internal capsule and the external capsule have the most delayed maturation. Furthermore, this approach was more reliable than univariate approaches as it revealed more maturational relationships between the bundles and did not violate a priori assumptions on the temporal order of the bundle maturation. Mahalanobis distances decreased exponentially with age in all bundles, with the only difference between them explained by different onsets of maturation. Estimation of these relative delays confirmed that the most dramatic changes occur during the first post-natal year.
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Affiliation(s)
- S Kulikova
- UMR 1129 NeuroSpin/UNIACT, INSERM-CEA, Gif-sur-Yvette, France
| | - L Hertz-Pannier
- UMR 1129 NeuroSpin/UNIACT, INSERM-CEA, Gif-sur-Yvette, France. .,CEA/SAC/DSV/I2BM/NeuroSpin, Bât 145, point courrier 156, 91191, Gif-sur-Yvette, France.
| | | | - A Buzmakov
- LORIA, CNRS-Inria Nancy Grand Est-Université de Lorraine, Nancy, France
| | - C Poupon
- NeuroSpin/UNIRS CEA-Saclay, Gif-sur-Yvette, France
| | - J Dubois
- UMR 992 NeuroSpin/UNICOG INSERM-CEA, Gif-sur-Yvette, France
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Zachariah P, Furuya EY, Edwards J, Dick A, Liu H, Herzig CT, Pogorzelska-Maziarz M, Stone PW, Saiman L. Compliance with prevention practices and their association with central line-associated bloodstream infections in neonatal intensive care units. Am J Infect Control 2014; 42:847-51. [PMID: 25087136 DOI: 10.1016/j.ajic.2014.04.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/23/2014] [Accepted: 04/23/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bundles and checklists have been shown to decrease the rates of central line-associated bloodstream infections (CLABSIs), but implementation of these practices and association with CLABSI rates have not been described nationally. We describe implementation and levels of compliance with preventive practices in a sample of US neonatal intensive care units (NICUs) and assess their association with CLABSI rates. METHODS An online survey assessing infection prevention practices was sent to hospitals participating in National Healthcare Safety Network CLABSI surveillance in October 2011. Participating hospitals permitted access to their NICU CLABSI rates. Multivariable regressions were used to test the association between compliance with NICU-specific CLABSI prevention practices and corresponding CLABSI rates. RESULTS Overall, 190 level II/III and level III NICUs participated. The majority of NICUs had written policies (84%-93%) and monitored compliance with bundles and checklists (88%-91%). Reporting ≥95% compliance for any of the practices ranged from 50%-63%. Reporting of ≥95% compliance with insertion checklist and assessment of daily line necessity were significantly associated with lower CLABSI rates (P < .05). CONCLUSIONS Most of the NICUs in this national sample have instituted CLABSI prevention policies and monitor compliance, although reporting compliance ≥95% was suboptimal. Reporting ≥95% compliance with select CLABSI prevention practices was associated with lower CLABSI rates. Future studies should focus on identifying and improving compliance with effective CLABSI prevention practices in neonates.
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Abstract
Networks and bundles comprised of F-actin and myosin II generate contractile forces used to drive morphogenic processes in both muscle and nonmuscle cells. To elucidate the minimal requirements for contractility and the mechanisms underlying their contractility, model systems reconstituted from a known set of purified proteins in vitro are needed. Here, we describe two experimental protocols our lab has developed to reconstitute 1D bundles and quasi-2D networks of actomyosin that are amenable to quantitative biophysical measurement. These assays have enabled our discovery of the mechanisms of contractility in disordered actomyosin assemblies and of a mechanical feedback between contraction and F-actin severing.
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Affiliation(s)
- Michael Murrell
- Departments of Biomedical Engineering and Materials Science and Engineering, University of Wisconsin, Madison, Wisconsin, USA
| | - Todd Thoresen
- Department of Physics, Institute for Biophysical Dynamics, University of Chicago, Chicago, Illinois, USA; James Franck Institute, University of Chicago, Chicago, Illinois, USA
| | - Margaret Gardel
- Department of Physics, Institute for Biophysical Dynamics, University of Chicago, Chicago, Illinois, USA; James Franck Institute, University of Chicago, Chicago, Illinois, USA.
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Komzák M, Hart R, Okál F, Safi A. AM bundle controls the anterior-posterior and rotational stability to a greater extent than the PL bundle - a cadaver study. Knee 2013; 20:551-5. [PMID: 23647795 DOI: 10.1016/j.knee.2013.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 03/14/2013] [Accepted: 03/31/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the influence of both bundles of the anterior cruciate ligament (ACL) on knee stability, anterior-posterior translation (APT) and internal (IR) and external (ER) rotation in cadaveric knees using a computer navigation system. METHODS The APT, IR, and ER of the knees were recorded in the intact condition, the anterolateral bundle (AM) or the posterolateral bundle (PL) deficit condition and in the ACL-deficient condition. The KT-1000 arthrometer was used for APT evaluation. The measurement of rotational movements was done using a rollimeter. All tests were performed at 30°, 60° and 90° of flexion. RESULTS At 30° of flexion: In the intact knee APT was 5.8mm, IR 12.1°, ER 10.1°. After the AM was cut, the APT increased to 9.1mm, IR to 13.9° and ER to 12.6°. After the PL was cut, the APT was 6.4mm, IR 13.1° and ER 10.6°. After the AM and PL were cut, the APT was 10.8mm, IR 15.7° and the ER was 12.9° on average. CONCLUSIONS The AM has a greater impact on the APT than the PL in all knee joint flexion angles. The PL does not resist the rotational stability more than the AM. The rotational stability is better controlled by both bundles of ACL as compared to one bundle of the ACL. CLINICAL RELEVANCE This study acknowledges the fact that the both bundles of the ACL are importants for AP and rotational stability of the knee joint.
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Affiliation(s)
- Martin Komzák
- Department of Orthopaedic and Traumatologic Surgery, Hospital Znojmo, MUDr. Jana Jánského 11, Znojmo, 669 02, Czech Republic.
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Abstract
Recent evidence from publications describing the success of interventions to control hospital meticillin-resistant Staphylococcus aureus (MRSA), often in the endemic setting, is reviewed. Overall, there is cautious ground for optimism that MRSA can be controlled in a cost-effective manner by employing a bundle approach, the mainstay of which is widespread admission screening to inform patient-specific control measures.
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Affiliation(s)
- Ian M Gould
- Department of Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK.
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