102 research outputs found
Association of left ventricular longitudinal strain with central venous oxygen saturation and serum lactate in patients with early severe sepsis and septic shock
Syftet med denna studie Àr att synliggöra pedagogers syn pÄ förÀldrasamverkan i förskolan. Vi har Àven intresserat oss pÄ samverkan mellan pedagogerna och förÀldrar med annat modersmÄl Àn svenska. VÄr studie grundar sig pÄ observationer kring bemötande av förÀldrar pÄ förskolan. Vi undersökte hur pedagogerna sÄg pÄ förÀldrasamverkan och hur de arbetar kring samverkan med förÀldrar, för att kunna fÄ en bredare syn i vÄr studie om hur samverkan fungerar pÄ de aktuella förskolorna. Som metod anvÀnde vi kvalitativ intervju dÄ detta lÀmpade sig vÀl för oss för att vi skulle kunna fÄ en bredare syn om hur samverkan fungerar pÄ de aktuella förskolorna. Intervjuer ger mer exakta svar och det underlÀttar för oss som intervjuar att stÀlla följdfrÄgor. Resultatet visar att samverkan med förÀldrar har ökat i förskolan och blivit en stor del av verksamheten. Pedagogerna försöker engagera sig mycket i arbetet med förÀldrasamverkan och letar efter möjligheter för att skapa en bra kommunikation med förÀldrar som har annat modersmÄl Àn svenska. Resultaten visar Àven att pedagogerna menar att oavsett om förÀldrarna behÀrskar det svenska sprÄket eller inte sÄ anstrÀnger de sig för att visa förÀldrarna att de Àr viktiga i verksamheten
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The peripheral blood transcriptome in septic cardiomyopathy: an observational, pilot study.
BACKGROUND:Septic cardiomyopathy (SCM) is common in sepsis and associated with increased morbidity and mortality. Left ventricular global longitudinal strain (LV GLS), measured by speckle tracking echocardiography, allows improved identification of impaired cardiac contractility. The peripheral blood transcriptome may be an important window into SCM pathophysiology. We therefore studied the peripheral blood transcriptome and LV GLS in a prospective cohort of patients with sepsis. RESULTS:In this single-center observational pilot study, we enrolled adult patients (age >â18) with sepsis within 48âh of admission to the ICU. SCM was defined as LV GLS >â-â17% based on echocardiograms performed within 72âh of admission. We enrolled 27 patients, 24 of whom had high-quality RNA results; 18 (75%) of 24 had SCM. The group was 50% female and had a median (IQR) age of 59.5 (48.5-67.0) years and admission APACHE II score of 21.0 (16.0-32.3). Forty-six percent had septic shock. After filtering for low-expression and non-coding genes, 15,418 protein coding genes were expressed and 73 had significantly different expression between patients with vs. without SCM. In patients with SCM, 43 genes were upregulated and 30 were downregulated. Pathway analysis identified enrichment in type 1 interferon signaling (adjusted pâ<â10-5). CONCLUSIONS:In this hypothesis-generating study, SCM was associated with upregulation of genes in the type 1 interferon signaling pathway. Interferons are cytokines that stimulate the innate and adaptive immune response and are implicated in the early proinflammatory and delayed immunosuppression phases of sepsis. While type 1 interferons have not been implicated previously in SCM, interferon therapy (for viral hepatitis and Kaposi sarcoma) has been associated with reversible cardiomyopathy, perhaps suggesting a role for interferon signaling in SCM
Therapeutic Use of Bacteriophage and Antibiotic Formulations for the Treatment of Antibiotic Resistant Acinetobacter Baumannii
Gemstone Team LYTICWidespread use of antibiotics has enriched global bacteria populations for strains
possessing antibiotic resistance (AR) genes. Proliferation of AR genes and mechanisms
have resulted in numerous multidrug resistant (MDR) infections for which there are no
effective treatments. Acinetobacter baumannii is a major cause of hospital acquired
(nosocomial) infections and is associated with outbreaks of MDR infections. Virulent
bacteriophages (phages) present a way to remedy bacterial infections, while also having
built-in mechanisms to circumvent resistance. This proposed study aims to develop a
phage therapeutic targeting antibiotic resistant A. baumannii. The phages chosen for the
final formulation exhibited high bactericidal activity and were able to infect several
strains of A. baumannii from a provided library. Additionally, the phage-antibiotic
synergy (PAS) effect was investigated in formulations with sub-lethal doses of ampicillin
and chloramphenicol. The effectiveness of the phage therapeutic at different multiplicity
of infections (MOI) and antibiotic concentrations were assessed relative to standard antibiotic doses. Well-plate studies suggest that higher MOI and antibiotic concentrations
resulted in the greatest initial bactericidal effects, longest time to develop resistance, and
lowest overall bacteria concentration. In future formulation studies, we would like to
expand and optimize the current phage-antibiotic formulation and explore cocktail
effects, whereby the formulation consists of a mixture of different phages that increases
selective pressure
Early High-Dose Vitamin D3 for Critically Ill, Vitamin D-Deficient Patients
BACKGROUND: Vitamin D deficiency is a common, potentially reversible contributor to morbidity and mortality among critically ill patients. The potential benefits of vitamin D supplementation in acute critical illness require further study.
METHODS: We conducted a randomized, double-blind, placebo-controlled, phase 3 trial of early vitamin D3 supplementation in critically ill, vitamin D-deficient patients who were at high risk for death. Randomization occurred within 12 hours after the decision to admit the patient to an intensive care unit. Eligible patients received a single enteral dose of 540,000 IU of vitamin D3 or matched placebo. The primary end point was 90-day all-cause, all-location mortality.
RESULTS: A total of 1360 patients were found to be vitamin D-deficient during point-of-care screening and underwent randomization. Of these patients, 1078 had baseline vitamin D deficiency (25-hydroxyvitamin D level,[50 nmol per liter]) confirmed by subsequent testing and were included in the primary analysis population. The mean day 3 level of 25-hydroxyvitamin D was 46.9±23.2 ng per milliliter (117±58 nmol per liter) in the vitamin D group and 11.4±5.6 ng per milliliter (28±14 nmol per liter) in the placebo group (difference, 35.5 ng per milliliter; 95% confidence interval [CI], 31.5 to 39.6). The 90-day mortality was 23.5% in the vitamin D group (125 of 531 patients) and 20.6% in the placebo group (109 of 528 patients) (difference, 2.9 percentage points; 95% CI, -2.1 to 7.9; Pâ=â0.26). There were no clinically important differences between the groups with respect to secondary clinical, physiological, or safety end points. The severity of vitamin D deficiency at baseline did not affect the association between the treatment assignment and mortality.
CONCLUSIONS: Early administration of high-dose enteral vitamin D3 did not provide an advantage over placebo with respect to 90-day mortality or other, nonfatal outcomes among critically ill, vitamin D-deficient patients.
METHODS: We conducted a randomized, double-blind, placebo-controlled, phase 3 trial of early vitamin D3 supplementation in critically ill, vitamin D-deficient patients who were at high risk for death. Randomization occurred within 12 hours after the decision to admit the patient to an intensive care unit. Eligible patients received a single enteral dose of 540,000 IU of vitamin D3 or matched placebo. The primary end point was 90-day all-cause, all-location mortality
Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study
Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ℠0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe
Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials
An amendment to this paper has been published and can be accessed via the original article
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