12,827 results match your criteria optimal timing

Medical Leadership: Experiences in the Use of Shared and Parental Leadership to Improve Academic Performance in the Management of a National Plastic Surgery Unit in China.

Plast Reconstr Surg 2021 Oct;148(4):650e-657e

From the Departments of Plastic Surgery and Human Resources, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; and Department of Plastic Surgery, Austin Hospital.

Background: Effective leadership is an integral component for optimal academic performance of surgical units. As one of the leading plastic surgery academic medical centers in China, the authors would like to share their experiences of using the combined parental and shared leadership approach in managing their surgical staff within the department. It has taken into account the essence of Eastern moral philosophies and Western leadership theories. Read More

View Article and Full-Text PDF
October 2021

Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study.

Gut 2021 Sep 21. Epub 2021 Sep 21.

Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

Objective: While it is recommended that patients presenting with acute upper gastrointestinal bleeding (AUGIB) should receive endoscopic intervention within 24 hours, the optimal timing is still uncertain. We aimed to assess whether endoscopy timing postadmission would affect outcomes.

Design: We conducted a retrospective, territory-wide, cohort study with healthcare data from all public hospitals in Hong Kong. Read More

View Article and Full-Text PDF
September 2021

Reversal of direct oral anticoagulants in adult hip fracture patients. A systematic review and meta-analysis.

Injury 2021 Sep 12. Epub 2021 Sep 12.

Professor and Consultant Anaesthetist, Anaesthesia and Critical Care, Division of Clinical Neuroscience, University of Nottingham, UK Department of Anaesthesia, Nottingham University Hospitals, UK. Electronic address:

Background: Increasing numbers of patients are taking Direct Oral Anticoagulants at the time of hip fracture. Evidence is limited on how and if the effects of DOAC's should be reversed before surgical fixation. Wide variations in practice exist. Read More

View Article and Full-Text PDF
September 2021

The use of functional placental magnetic resonance imaging for assessment of the placenta after prolonged preterm rupture of the membranes in vivo: A pilot study.

Acta Obstet Gynecol Scand 2021 Sep 21. Epub 2021 Sep 21.

Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.

Introduction: Preterm prelabor rupture of membranes (PPROM) complicates 3% of pregnancies in the UK. Where delivery does not occur spontaneously, expectant management until 37 weeks of gestation is advocated, unless signs of maternal infection develop. However, clinical presentation of maternal infection can be a late sign and injurious fetal inflammatory responses may already have been activated. Read More

View Article and Full-Text PDF
September 2021

Does timing matter in radiotherapy of hepatocellular carcinoma? An experimental study in mice.

Cancer Med 2021 Sep 20. Epub 2021 Sep 20.

Institute of Anatomy II, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.

This study investigates whether a chronotherapeutic treatment of hepatocellular carcinoma (HCC) may improve treatment efficacy and mitigate side effects on non-tumoral liver (NTL). HCC was induced in Per2::luc mice which were irradiated at four time points of the day. Proliferation and DNA-double strand breaks were analyzed in irradiated and nonirradiated animals by detection of Ki67 and γ-H2AX. Read More

View Article and Full-Text PDF
September 2021

Peak Lag Between Plasma Vasopressin and Urine Aquaporin-2 Following Cardiac Surgery.

Int Heart J 2021 Sep 17. Epub 2021 Sep 17.

Second Department of Internal Medicine, University of Toyama.

Tolvaptan, a vasopressin type-2 receptor antagonist, is utilized to ameliorate fluid retention following cardiac surgery. However, the optimal timing of tolvaptan administration considering novel biomarkers remains unknown. We prospectively included patients who underwent cardiac surgery between 2016 and 2020. Read More

View Article and Full-Text PDF
September 2021

Should Vasopressors Be Started Early in Septic Shock?

Semin Respir Crit Care Med 2021 Oct 20;42(5):683-688. Epub 2021 Sep 20.

Department of Intensive Care Medicine, University of Bern, Bern University Hospital, Bern, Switzerland.

Sepsis can influence blood volume, its distribution, vascular tone, and cardiac function. Persistent hypotension or the need for vasopressors after volume resuscitation is part of the definition of septic shock. Since increased positive fluid balance has been associated with increased morbidity and mortality in sepsis, timing of vasopressors in the treatment of septic shock seems crucial. Read More

View Article and Full-Text PDF
October 2021

Bacterial Urine Profile and Optimal Urine Specimen Collection Timing in Asymptomatic Chronically Catheterized Adults with Spinal Cord Injuries and Disorders.

Am J Infect Control 2021 Sep 17. Epub 2021 Sep 17.

Pathology and Laboratory Medicine Service VA Northeast Ohio Health Care System.

Background: Adults with spinal cord injuries and disorders (SCI/D) require chronic indwelling catheterization which is associated with an increased risk of catheter-associated (CA) adverse events.

Methods: We studied urine samples (culture and urinalysis) from two cohorts of chronically catheterized males with SCI/D. Cohort 1 included 28 participants; three samples per patient were collected (before, after, and seven days after catheter change). Read More

View Article and Full-Text PDF
September 2021

Assessment of the Role and Timing of Glaucoma Surgery in Boston Keratoprosthesis Type 1 Patients.

Am J Ophthalmol 2021 Sep 17. Epub 2021 Sep 17.

Department of Ophthalmology, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet, D.01.2273, Montreal (Quebec) H2 × 3E4, Canada. Electronic address:

Purpose: To determine the role and optimal timing of glaucoma surgery in relation to Boston keratoprosthesis type 1 (KPro) implantation.

Design: Retrospective, comparative, non-randomized clinical study.

Methods: Single-center study of a total of 100 eyes (100 patients) implanted with a KPro between 2008-2017 and diagnosed with glaucoma before or after KPro. Read More

View Article and Full-Text PDF
September 2021

Improving the time to ileostomy closure following an anterior resection for rectal cancer in the UK.

Colorectal Dis 2021 Sep 20. Epub 2021 Sep 20.

Department of Surgery, University Hospital of Wales, Cardiff, UK.

Aim: Delayed closure of ileostomy following an anterior resection for rectal cancer in the UK is common. The aims of this study were i) to investigate the variation in patient pathways between hospitals, ii) identify the key learning points from units with the shortest time to closure iii) develop guidance for a pathway to minimize delay in ileostomy closure.

Method: This was a mixed methods study. Read More

View Article and Full-Text PDF
September 2021

Waning immunity after receipt of Pertussis, Diphtheria, Tetanus and Polio-related vaccines: a systematic review and meta-analysis.

J Infect Dis 2021 Sep 20. Epub 2021 Sep 20.

WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.

DTP-containing (pertussis, diphtheria and tetanus) combined with polio vaccines are recommended by WHO as part of routine immunization programs. The decline of immunity after vaccination has been considered as a possible reason for the re-emergence of vaccine-preventable diseases worldwide. In this study, we evaluated the potential duration of protective immunity of pertussis, diphtheria, tetanus and polio through a systematic review and meta-analysis. Read More

View Article and Full-Text PDF
September 2021

Early Use of Remdesivir in Patients Hospitalized With COVID-19 Improves Clinical Outcomes: A Retrospective Observational Study.

Infect Dis Clin Pract (Baltim Md) 2021 Sep 15;29(5):e282-e286. Epub 2021 Apr 15.

Department of Infectious Disease, Wellstar Cobb Hospital, Marietta.

Background: Remdesivir treatment, like most antiviral drugs, is likely to be most effective when used early in the course of coronavirus disease 2019 (COVID-19). Optimal timing of remdesivir for the treatment of COVID-19 remains unclear.

Objectives: The aim of this study was to determine whether early treatment with remdesivir improves clinical outcomes: length of stay, need for mechanical ventilation, and death. Read More

View Article and Full-Text PDF
September 2021

On timeline of enhancing testing-capacity of COVID-19: A case study via an optimal replacement model.

J Process Control 2021 Sep 12;105:204-213. Epub 2021 Aug 12.

Department of Mathematics and Computer Science, Open University of Sri Lanka, Nawala, Sri Lanka.

Process of enhancing testing-capacity regarding COVID-19 is a topic of interest. This task of enhancing is constrained by socio-economic background of a country either in favorable or unfavorable ways. In this paper, we investigate timing of enhancing testing-capacity as an optimal problem, where the enhancement is quantified via number of tests as an instant measure and recovered portion as a long-term measure. Read More

View Article and Full-Text PDF
September 2021

Evidence around early induction of labor in women of advanced maternal age and those using assisted reproductive technology.

Best Pract Res Clin Obstet Gynaecol 2021 Aug 25. Epub 2021 Aug 25.

Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, UK. Electronic address:

Worldwide, there has been a trend toward later motherhood. Concurrently, the incidence of subfertility has been on the rise, necessitating conception using assisted reproductive technologies (ARTs). These pregnancies are considered high risk due to fetal complications such as antepartum stillbirth and growth restriction and maternal complications such as increase in maternal morbidity and mortality. Read More

View Article and Full-Text PDF

Association of Advanced Airway Insertion Timing and Outcomes After Out-of-Hospital Cardiac Arrest.

Ann Emerg Med 2021 Sep 15. Epub 2021 Sep 15.

Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Study Objective: While often prioritized in the resuscitation of patients with out-of-hospital cardiac arrest, the optimal timing of advanced airway insertion is unknown. We evaluated the association between the timing of advanced airway (laryngeal tube and endotracheal intubation) insertion attempt and survival to hospital discharge in adult out-of-hospital cardiac arrest.

Methods: We performed a secondary analysis of the Pragmatic Airway Resuscitation Trial (PART), a clinical trial comparing the effects of laryngeal tube and endotracheal intubation on outcomes after adult out-of-hospital cardiac arrest. Read More

View Article and Full-Text PDF
September 2021

Tongue-Tie children with a severe Hazelbaker score or difficult breastfeeding greatly benefit from frenotomy or frenuloplasty with/without anaesthesia - First do or do no harm?

J Stomatol Oral Maxillofac Surg 2021 Sep 16. Epub 2021 Sep 16.

Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM, Campus Marburg, Philipps University of Marburg, Marburg, Germany. Electronic address:

Tongue-tie (ankyloglossia) is a relatively common congenital anomaly characterised by an abnormally short lingual frenulum, causing limitation of tongue mobility. There have been immense controversies regarding diagnosis, clinical significance and management of such condition hitherto. Although most tongue-tie babies are asymptomatic without feeding difficulties, operative corrections may be necessary in some cases to improve their breastfeeding. Read More

View Article and Full-Text PDF
September 2021

Optimal timing of venous thromboembolic chemoprophylaxis initiation following blunt solid organ injury: meta-analysis and systematic review.

Eur J Trauma Emerg Surg 2021 Sep 18. Epub 2021 Sep 18.

Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University Of Southern California, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA.

Purpose: The need to prevent venous thromboembolism (VTE) following blunt solid organ injury must be balanced against the concern for exacerbation of hemorrhage. The optimal timing for initiation of VTE chemoprophylaxis is not known. The objective was to determine the safety and efficacy of early (≤ 48 h) VTE chemoprophylaxis initiation following blunt solid organ injury. Read More

View Article and Full-Text PDF
September 2021

Heart health meets cognitive health: evidence on the role of blood pressure.

Lancet Neurol 2021 Oct;20(10):854-867

Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Program, National Institutes of Health, Bethesda, MD, USA.

The enormous societal and financial burden of Alzheimer's disease and related dementias requires the identification of risk factors and pathways to reduce dementia risk. Blood pressure (BP) management and control is one promising area, in which data have been inconclusive. Accumulating evidence over the past 5 years shows the effectiveness of BP management interventions among older individuals at risk, most notably from the SPRINT-MIND trial. Read More

View Article and Full-Text PDF
October 2021

Management strategy for hematological malignancy patients with acute respiratory failure.

Eur J Med Res 2021 Sep 17;26(1):108. Epub 2021 Sep 17.

Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.

Acute respiratory failure (ARF) is still the major cause of intensive care unit (ICU) admission for hematological malignancy (HM) patients although the advance in hematology and supportive care has greatly improved the prognosis. Clinicians have to make decisions whether the HM patients with ARF should be sent to ICU and which ventilation support should be administered. Based on the reported investigations related to management of HM patients with ARF, we propose a selection procedure to manage this population and recommend hematological ICU as the optimal setting to recuse these patients, where hematologists and intensivists can collaborate closely and improve the outcomes. Read More

View Article and Full-Text PDF
September 2021

Ischemic mitral regurgitation: when should one intervene?

Curr Opin Cardiol 2021 Sep 15. Epub 2021 Sep 15.

Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Purpose Of Review: Optimal timing of intervention for ischemic mitral regurgitation remains to be elucidated. This review summarizes the data on the management of ischemic mitral regurgitation, and their implications on current practice and future research.

Recent Findings: Mechanistically, ischemic mitral regurgitation can present as Type I, Type IIIb or mixed Type I and IIIb disease. Read More

View Article and Full-Text PDF
September 2021

Submassive Pulmonary Embolism Complicating Small Bowel Obstruction.

Cureus 2021 Aug 13;13(8):e17162. Epub 2021 Aug 13.

Interventional Cardiology, Loyola University Medical Center, Maywood, USA.

The evaluation of patients with pulmonary embolism (PE) requires a comprehensive approach that assesses physical and laboratory exam findings, interprets varying imaging modalities, and selects appropriate treatment strategies. Comorbidities can complicate treatment and influence physicians to make difficult management decisions. In this case report, we present a patient with a small bowel obstruction complicated by submassive intermediate high-risk PE. Read More

View Article and Full-Text PDF

State of the art: percutaneous tracheostomy in the intensive care unit.

J Thorac Dis 2021 Aug;13(8):5261-5276

Division of Pulmonary & Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA.

Percutaneous tracheostomy is a commonly performed procedure for patients in the intensive care unit (ICU) and offers many benefits, including decreasing ICU length of stay and need for sedation while improving patient comfort, effective communication, and airway clearance. However, there is no consensus on the optimal timing of tracheostomy in ICU patients. Ultrasound (US) and bronchoscopy are useful adjunct tools to optimize procedural performance. Read More

View Article and Full-Text PDF

Patient selection and preoperative evaluation of percutaneous dilation tracheostomy in the intensive care unit.

J Thorac Dis 2021 Aug;13(8):5251-5260

Division of Pulmonary, Critical Care and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.

Percutaneous dilation tracheostomy (PDT) is increasingly performed at the bedside of critically ill patients in the intensive care unit (ICU). PDT is safe overall and has a number of benefits compared to surgical tracheostomy. A tracheostomy tube has numerous advantages compared to an endotracheal tube, including decreased work of breathing, ease of connecting to a mechanical ventilator, improved patient comfort and pulmonary hygiene. Read More

View Article and Full-Text PDF

Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID-19: A multicenter prospective cohort study.

Head Neck 2021 Sep 15. Epub 2021 Sep 15.

Otorhinolaryngology Department, Hospital Clínic de Barcelona, UB, IDIBAPS, Barcelona, Spain.

Background: Optimal timing for tracheotomy for critically ill COVID-19 patients requiring invasive mechanical ventilation (IMV) is not established.

Methods: Multicenter prospective cohort including all COVID-19 patients admitted to intensive care units (ICUs) in 36 hospitals who required tracheotomy during first pandemic wave. With a target emulation trial framework, we studied the causal effects of early (7-10 days) versus late (>10 days) tracheotomy (LT) on time from tracheotomy to weaning, postoperative mortality, and tracheotomy complications. Read More

View Article and Full-Text PDF
September 2021

Relationship Between Timing of Anterior Cruciate Ligament Reconstruction and Chondral Injuries: A Systematic Review and Meta-analysis.

Am J Sports Med 2021 Sep 15:3635465211036141. Epub 2021 Sep 15.

School of Medicine, University of Central Lancashire, Preston, UK.

Background: After anterior cruciate ligament (ACL) injury, the optimal timing of ACL reconstruction and the influence of this timing on chondral damage remain unclear.

Purpose: To assess the effect of timing of ACL reconstruction on the presence of chondral injuries via a systematic review and meta-analysis.

Study Design: Systematic review and meta-analysis; Level of evidence, 4. Read More

View Article and Full-Text PDF
September 2021

COVID-19 Critical Illness: A Data-Driven Review.

Annu Rev Med 2021 Sep 14. Epub 2021 Sep 14.

Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA; email:

The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges in critical care medicine, including extreme demand for intensive care unit (ICU) resources and rapidly evolving understanding of a novel disease. Up to one-third of hospitalized patients with COVID-19 experience critical illness. The most common form of organ failure in COVID-19 critical illness is acute hypoxemic respiratory failure, which clinically presents as acute respiratory distress syndrome (ARDS) in three-quarters of ICU patients. Read More

View Article and Full-Text PDF
September 2021

Stereotactic radiosurgery for craniopharyngiomas.

Acta Neurochir (Wien) 2021 Sep 13. Epub 2021 Sep 13.

Department of Neurological Surgery, University of Virginia Health System, Box 800212, Charlottesville, VA, 22908, USA.

Background: The management of craniopharyngiomas is challenging, usually requiring multidisciplinary care. We evaluated the long-term clinical and radiologic outcomes of Gamma Knife radiosurgery (GKRS) for craniopharyngiomas.

Methods: This retrospective study involved patients managed with GKRS for a craniopharyngioma during the period of 1989 to 2019. Read More

View Article and Full-Text PDF
September 2021

Optimal strategies to screen health care workers for COVID-19 in the US: a cost-effectiveness analysis.

Res Sq 2021 Sep 10. Epub 2021 Sep 10.

Background: Transmission of SARS-CoV-2 in health care facilities poses a challenge against pandemic control. Health care workers (HCWs) have frequent and high-risk interactions with COVID-19 patients. We undertook a cost-effectiveness analysis to determine optimal testing strategies for screening HCWs to inform strategic decision-making in health care settings. Read More

View Article and Full-Text PDF
September 2021

Time to Diagnosis of Acute Complications after Cardiovascular Implantable Electronic Device Insertion and Optimal Timing of Discharge within the First Twenty Four Hours.

Heart Rhythm 2021 Sep 10. Epub 2021 Sep 10.

The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Medical Center, New York, New York. Electronic address:

Background: Over 3 million cardiovascular implantable electronic devices (CIEDs) are implanted annually. There is minimal data regarding the timing of diagnosis of acute complications after implant. It remains unclear if patients can be safely discharged less than 24 hours post implantation. Read More

View Article and Full-Text PDF
September 2021

Timing of adjuvant chemotherapy after limb amputation and effect on outcome in dogs with appendicular osteosarcoma without distant metastases.

J Am Vet Med Assoc 2021 Oct;259(7):749-756

Objective: To determine an optimal time interval between amputation and initiation of adjuvant chemotherapy (TI) in dogs with appendicular osteosarcoma without distant metastases and whether TI was associated with outcome.

Animals: 168 client-owned dogs treated at 9 veterinary oncology centers.

Procedures: Data were collected from the dogs' medical records concerning potential prognostic variables and outcomes. Read More

View Article and Full-Text PDF
October 2021