11 research outputs found

    Resuscitation Endpoints in Traumatic Shock: A Focused Review with Emphasis on Point-of-Care Approaches

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    Trauma resuscitation is a blend of art and science, with the traumatologist at the helm of a large, multidisciplinary team, making split-second decisions and overseeing various parallel processes. Despite tremendous progress over the past few decades, the ā€œartā€ component continues to play a large part in the overall trauma resuscitation process, with the ā€œscienceā€ part slowly but steadily increasing its footprint as a determinant of processes and decisions. Thus, it becomes critical for all clinicians to be able to recognize the evidence-based factors which can be most valuable in guiding trauma resuscitations. This chapter serves as an overview of the current clinical findings, resuscitative endpoints, imaging techniques, and physiologic indices that are most helpful in order to promptly recognize and treat traumatic shock as well as projecting forward to look at novel techniques and biomarkers. Though a single universal marker that accurately and consistently identifies traumatic shock has yet to be discovered, certain factors discussed, such as lactate and base deficit, have been proven to be much more reliable than others

    Adverse Events during Intrahospital Transfers: Focus on Patient Safety

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    Intrahospital transport of patients constitutes an integral part of care delivery in the complex environment of modern hospitals. In general, the more complicated and acute the patientā€™s condition is, the more likely he or she will require both scheduled and unscheduled trips. The purpose of this chapter is to highlight the potential adverse events associated with intrahospital transfers (IHTs), to discuss the interdepartmental handoff process when patients travel within the walls of a single institution, and finally to provide strategies to prevent adverse events from occurring during the IHT process. A comprehensive literature review, covering some of the most recent developments in this area, has been included in this manuscript. Aspects unique to this presentation include sections dedicated to risk assessment, commonly seen patterns of transfers and complications, as well as the inclusion of family communication as a core component of the process. The overall goal of providers and patient safety champions should be the achievement of ā€œzero incidenceā€ rate of IHT-related events. We hope that this chapter provides a small, but significant, step in the right direction

    Diagnosis and management of chronic lung disease in deployed military personnel

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    Military personnel are a unique group of individuals referred to the pulmonary physician for evaluation. Despite accession standards that limit entrance into the military for individuals with various pre-existing lung diseases, the most common disorders found in the general population such as asthma and chronic obstructive pulmonary disease remain frequently diagnosed. Military personnel generally tend to be a more physically fit population who are required to exercise on a regular basis and as such may have earlier presentations of disease than their civilian counterparts. Exertional dyspnea is a common complaint; establishing a diagnosis may be challenging given the subtle nature of symptoms and lack of specificity with pulmonary function testing. The conflicts over the past 10 years in Iraq and Afghanistan have also given rise to new challenges for deployed military. Various respiratory hazards in the deployed environment include suspended geologic dusts, burn pits, vehicle exhaust emissions, industrial air pollution, and isolated exposure incidents and may give rise to both acute respiratory symptoms and chronic lung disease. In the evaluation of deployed military personnel, establishing the presence of actual pulmonary disease and the relationship of existing disease to deployment is an ongoing issue to both military and civilian physicians. This paper reviews the current evidence for chronic lung disease in the deployed military population and addresses any differences in diagnosis and management

    Early results of fecal microbial transplantation protocol implementation at a community-based university hospital

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    Introduction: Clostridium difficile (CD) is a serious and increasingly prevalent healthcare-associated infection. The pathogenesis of CD infection (CDI) involves the acquisition of CD with a concurrent disruption of the native gut flora. Antibiotics are a major risk although other contributing factors have also been identified. Clinical management combines discontinuation of the offending antibiotic, initiation of CD-specific antibiotic therapy, probiotic agent use, fecal microbiota transplantation (FMT), and surgery as the ā€œlast resortā€ option. The aim of this study is to review short-term clinical results following the implementation of FMT protocol (FMTP) at our community-based university hospital. Methods: After obtaining Institutional Review Board and Infection Control Committee approvals, we implemented an institution-wide FMTP for patients diagnosed with CDI. Prospective tracking of all patients receiving FMT between July 1, 2015, and February 1, 2017, was conducted using REDCapā„¢ electronic data capture system. According to the FMTP, indications for FMT included (a) three or more CDI recurrences, (b) two or more hospital admissions with severe CDI, or (c) first episode of complicated CDI (CCDI). Risk factors for initial infection and for treatment failure were assessed. Patients were followed for at least 3 months to monitor for cure/failure, relapse, and side effects. Frozen 250 mL FMT samples were acquired from OpenBiome (Somerville, MA, USA). After 4 h of thawing, the liquid suspension was applied using colonoscopy, beginning with terminal ileum and proceeding distally toward mid-transverse colon. Monitored clinical parameters included disease severity (Hines VA CDI Severity Score or HVCSS), concomitant medications, number of FMT treatments, non-FMT therapies, cure rates, and mortality. Descriptive statistics were utilized to outline the study results. Results: A total of 35 patients (mean age 58.5 years, 69% female) were analyzed, with FMT-attributable primary cure achieved in 30/35 (86%) cases. Within this subgroup, 2/30 (6.7%) patients recurred and were subsequently cured with long-term oral vancomycin. Among five primary FMT failures (14% total sample), 3 (60%) achieved medical cure with long-term oral vancomycin therapy and 2 (40%) required colectomy. For the seven patients who either failed FMT or recurred, long-term vancomycin therapy was curative in all but two cases. For patients with severe CDI (HVCSS ā‰„3), primary and overall cure rates were 6/10 (60%) and 8/10 (80%), respectively. Patients with CCDI (n = 4) had higher HVCSS (4 vs. 3) and a mortality of 25%. Characteristics of patients who failed initial FMT included older age (70 vs. 57 years), female sex (80% vs. 67%), severe CDI (80% vs. 13%), and active opioid use during the initial infection (60% vs. 37%) and at the time of FMT (60% vs. 27%). The most commonly reported side effect of FMT was loose stools. Conclusions: This pilot study supports the efficacy and safety of FMT administration for CDI in the setting of a community-based university hospital. Following FMTP implementation, primary (86%) and overall (94%) nonsurgical cure rates were similar to those reported in other studies. The potential role of opioids as a modulator of CDI warrants further clinical investigation

    A rare low-spin CoIV^{IV}Bis(Ī²\beta-silyldiamide) with high thermal stability

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    Attempted preparation of a chelated CoIV^{IV} Ī²\beta-silylamide resulted in the unprecedented disproportionation to Co0^{0} and a spirocyclic cobalt(IV) bis(Ī²\beta-silyldiamide): [Co[(Nt^{t}Bu)2_2SiMe2_2]2_2] (1). Compoundā€…1 exhibited a room-temperature magnetic moment of 1.8ā€…B.M. and a solid-state axial EPR spectrum diagnostic of a rare S=1/2 configuration for tetrahedral CoIV^{IV}. Ab initio semicanonical coupled-cluster calculations (DLPNO-CCSD(T)) revealed the doublet state was clearly preferred (āˆ’27ā€…kcalā€‰molāˆ’1^{āˆ’1}) over higher spin configurations only for the bulky tert-butyl-substituted analogue. Unlike other CoIV^{IV} complexes, 1 had remarkable thermal stability, and was demonstrated to form a stable self-limiting monolayer in preliminary atomic layer deposition (ALD) surface saturation experiments. The ease of synthesis and high stability make 1 an attractive starting point to investigate otherwise inaccessible CoIV^{IV} intermediates and for synthesizing new materials
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