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Evaluation of the Initial General Ward Early Warning Score and ICU Admission, Hospital Length of Stay and Mortality.

West J Emerg Med 2021 Sep 2;22(5):1131-1138. Epub 2021 Sep 2.

Gelderse Vallei Hospital, Department of Intensive Care Medicine, Ede, The Netherlands.

Introduction: Despite widespread implementation of the Early Warning Score (EWS) in hospitals, its effect on patient outcomes remains mostly unknown. We aimed to evaluate associations between the initial EWS and in-hospital mortality, intensive care unit (ICU) admission, and hospital length of stay (LOS).

Methods: We performed a retrospective cohort study of adult patients admitted to a general hospital ward between July 1, 2014-December 31, 2017. Read More

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September 2021

Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults: A Systematic Review.

JAMA Netw Open 2021 Sep 1;4(9):e2126456. Epub 2021 Sep 1.

CDC COVID-19 Response, Division of Emergency Operations, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia.

Importance: Multisystem inflammatory syndrome in adults (MIS-A) has not been well described. Improved diagnosis and treatment of MIS-A might mitigate COVID-19 morbidity and mortality.

Objective: To summarize the descriptive epidemiology and clinical characteristics of MIS-A. Read More

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September 2021

Patients' perception of medical communication and their needs during the stay in the intensive care unit.

Rev Bras Ter Intensiva 2021 Sep 20. Epub 2021 Sep 20.

Curso de Medicina, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil.

Objective: To understand the perception of patients about medical communication as well as their needs during hospitalization in the intensive care unit.

Methods: This study was cross-sectional descriptive and qualitative exploratory including 103 patients admitted to or recently discharged from the intensive care units of four hospitals in Greater Florianópolis, Santa Catarina state, Brazil. The patients' sociodemographic and clinical variables were studied, as were the score they gave to the quality of medical communication through the Quality of Communication Questionnaire and their spontaneous comments with reflections or justifications for the scores given, and their responses on how they felt and what complementary help they would have liked to receive. Read More

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September 2021

Epidemiology of Candidemia in Children over 7 Years in a Medical Center in Turkey.

Microbiol Spectr 2021 Sep 22:e0045321. Epub 2021 Sep 22.

Department of Clinical Microbiology and Infectious Disease, Health Sciences University, İzmir Tepecik Training and Research Hospital, İzmir, Turkey.

The aims of the study were to describe species in children with candidemia, to determine the changing epidemiology of candidemia over time in our tertiary care hospital, and to examine the demographic and clinical characteristics of patients with candidemia caused by parapsilosis and nonparapsilosis spp. From 2012 to 2018, we identified a total of 126 cases of candidemia. The most commonly isolated sp. Read More

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September 2021

Psychological symptoms in difficult-to-sedate critical care survivors.

Nurs Crit Care 2021 Sep 21. Epub 2021 Sep 21.

Medical Trasplant Coordinator, University Hospital Vall d'Hebron, Barcelona, Spain.

Background: Critical care survivors often experience symptoms of anxiety, depression, or post-traumatic stress disorder (PTSD).

Aims: To determine the prevalence and severity of psychological symptoms during the first 6 months after discharge from the intensive care unit (ICU) and to evaluate its association with patients who are difficult to sedate during admission.

Design: Descriptive, prospective analysis of psychological symptoms in survivors from medicosurgical ICU over a 2-year period. Read More

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September 2021

[Project to Reduce Cases of Drug-Resistant Strain Colonization in the Intensive Care Unit Using a Chlorhexidine Gluconate Bath].

Hu Li Za Zhi 2021 Oct;68(5):74-82

PhD, RN, Head Nurse, Department of Nursing, National Taiwan University Hospital, Taiwan, ROC.

Background: Drug-resistant strains of bacteria are associated with severe consequences such as bacteremia, shock, and death, and increase hospital stay durations and medical health expenses. Therefore, reducing the spread of drug-resistant strains is a priority concern.

Purpose: This project was developed to reduce the number of colonization cases of drug-resistant strains and subsequently increase the quality of care provided in our intensive care unit. Read More

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October 2021

Utility of the ROX Index in Predicting Intubation for Patients With COVID-19-Related Hypoxemic Respiratory Failure Receiving High-Flow Nasal Therapy: Retrospective Cohort Study.

JMIRx Med 2021 Jul-Sep;2(3):e29062. Epub 2021 Aug 27.

Department of Thoracic Medicine and Surgery Temple University Hospital Philadelphia, PA United States.

Background: The use of high-flow nasal therapy (HFNT) to treat COVID-19 pneumonia has been greatly debated around the world due to concerns about increased health care worker transmission and delays in invasive mechanical ventilation (IMV). Herein, we analyzed the utility of the noninvasive ROX (ratio of oxygen saturation) index to predict the need for and timing of IMV.

Objective: This study aimed to assess whether the ROX index can be a useful score to predict intubation and IMV in patients receiving HFNT as treatment for COVID-19-related hypoxemic respiratory failure. Read More

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Outcome, demography and resource utilization in ICU Patients with delirium and malignancy.

Sci Rep 2021 Sep 21;11(1):18756. Epub 2021 Sep 21.

Cardio-Surgical Intensive Care Unit, Institute of Anesthesiology, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.

Delirium in the general intensive care unit (ICU) population is common, associated with adverse outcomes and well studied. However, knowledge on delirium in the increasing number of ICU patients with malignancy is scarce. The aim was to assess the frequency of delirium and its impact on resource utilizations and outcomes in ICU patients with malignancy. Read More

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September 2021

Epidemiology and Outcomes of ARDS After Pediatric Trauma.

Respir Care 2021 Sep 21. Epub 2021 Sep 21.

University Medical Center Utrecht, Utrecht, The Netherlands.

Background: Results of recent studies suggest that the incidence and mortality of ARDS may be higher than previously thought in pediatric trauma patients. We conducted a systematic review of the literature on incidence, risk factors, prognostic factors, and outcomes of ARDS after pediatric trauma in the ICU.

Methods: Medical literature databases were searched up to April 2020. Read More

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September 2021

Health outcomes after the implementation of multidisciplinary clinical guidelines for the care of hip fractures.

Rev Clin Esp (Barc) 2021 Sep 18. Epub 2021 Sep 18.

Servicio de Geriatría, Hospital Germans Trias i Pujol, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.

Background And Objectives: This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures.

Materials And Methods: This work is a pre- and post-intervention prospective study in the Orthogeriatrics Unit of a second-level hospital after implementing multidisciplinary clinical guidelines for hip fracture care. We analyzed patients' baseline characteristics and the variations observed in care provided and in outcome variables in the two periods studied (June 2015-May 2016 and June 2016-May 2017). Read More

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September 2021

Effects of Glucocorticoids on Postoperative Delirium in Adult Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis.

Clin Ther 2021 Sep 18. Epub 2021 Sep 18.

Department of Thoracic and Cardiovascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing China. Electronic address:

Purpose: Delirium is a common neurologic complication after cardiac surgery and is associated with a poor prognosis. Several studies have explored the effects of glucocorticoids on postoperative delirium (POD). However, conclusion have been inconsistent. Read More

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September 2021

Herpesviridae in critically ill hematology patients: HHV-6 is associated with worse clinical outcome.

J Crit Care 2021 Sep 18;66:138-145. Epub 2021 Sep 18.

Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, 232 boulevard de Sainte Marguerite, 13009 Marseille, France. Electronic address:

Purpose: Although viral infections are frequent among patients with hematological malignancies (HM), data about herpesviridae in critically ill hematology patients are scarce. We aimed at determining the impact of herpesviridae reactivation/infection in this population.

Material And Methods: We performed a single center retrospective study including all consecutive adult hematology patients admitted to our comprehensive cancer center ICU on a 6-year period. Read More

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September 2021

Factors associated with a persistent delirium in the intensive care unit: A retrospective cohort study.

J Crit Care 2021 Sep 18;66:132-137. Epub 2021 Sep 18.

Department of Intensive Care, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address:

Purpose: To explore differences between ICU patients with persistent delirium (PD), non-persistent delirium (NPD) and no delirium (ND), and to determine factors associated with PD.

Materials And Methods: Retrospective cohort study including all ICU adults admitted for ≥12 h (January 2015-February 2020), assessable for delirium and followed during their entire hospitalization. PD was defined as ≥14 days of delirium. Read More

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September 2021

Intrapleural use of urokinase and DNase in pleural infections managed with repeated thoracentesis: A comparative cohort study.

PLoS One 2021 21;16(9):e0257339. Epub 2021 Sep 21.

Department of Respiratory Diseases, Rennes University Hospital, Rennes, France.

Introduction: Evacuation of infected fluid in pleural infections is essential. To date, the use of an intrapleural fibrinolytic agent such as urokinase and DNase has not yet been assessed in infections managed by repeated therapeutic thoracentesis (RTT).

Methods: We performed a retrospective comparative study of two successive cohorts of consecutive patients with pleural infections from 2001 to 2018. Read More

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September 2021

Inpatient Outcomes Following a Return Visit to the Emergency Department: A Nationwide Cohort Study.

West J Emerg Med 2021 Aug 30;22(5):1124-1130. Epub 2021 Aug 30.

National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan.

Introduction: Emergency department (ED) revisits are traditionally used to measure potential lapses in emergency care. However, recent studies on in-hospital outcomes following ED revisits have begun to challenge this notion. We aimed to examine inpatient outcomes and resource use among patients who were hospitalized following a return visit to the ED using a national database. Read More

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Effect of Probiotics on Incident Ventilator-Associated Pneumonia in Critically Ill Patients: A Randomized Clinical Trial.

JAMA 2021 Sep;326(11):1024-1033

Université de Sherbrooke, Sherbrooke, Canada.

Importance: Growing interest in microbial dysbiosis during critical illness has raised questions about the therapeutic potential of microbiome modification with probiotics. Prior randomized trials in this population suggest that probiotics reduce infection, particularly ventilator-associated pneumonia (VAP), although probiotic-associated infections have also been reported.

Objective: To evaluate the effect of Lactobacillus rhamnosus GG on preventing VAP, additional infections, and other clinically important outcomes in the intensive care unit (ICU). Read More

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September 2021

The role of immature platelet count and immature platelet fraction in determining the need for transfusion in patients undergoing CABG.

Cardiovasc J Afr 2021 Sep 20;32:1-5. Epub 2021 Sep 20.

Okmeydani Training and Research Hospital, Istanbul, Turkey.

Background: Platelet dysfunction has been shown to play a role in postoperative bleeding, however it is not clear whether immature platelets (IP) can induce appropriate homeostasis to prevent excessive bleeding in patients undergoing coronary artery bypass grafting (CABG). The aim of this study was to evaluate the postoperative change in IP count (IPC), IP fraction (IPF) and mean platelet volume (MPV), and to examine their relationship with postoperative bleeding and blood transfusion.

Methods: One hundred and forty-nine consecutive patients undergoing elective CABG were included in this prospective study. Read More

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September 2021

Intercostal Cryo Nerve Block in Minimally Invasive Cardiac Surgery: The Prospective Randomized FROST Trial.

Pain Ther 2021 Sep 20. Epub 2021 Sep 20.

United Heart and Vascular Institute-Allina, Saint Paul, MN, USA.

Introduction: Intercostal cryo nerve block has been shown to enhance pulmonary function recovery and pain management in post-thoracotomy procedures. However, its benefit have never been demonstrated in minimal invasive thoracotomy heart valve surgery (Mini-HVS). The purpose of the study was to determine whether intraoperative intercostal cryo nerve block in conjunction with standard of care (collectively referred to hereafter as CryoNB) provided superior analgesic efficacy in patients undergoing Mini-HVS compared to standard-of-care (SOC). Read More

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September 2021

Effect of a multidisciplinary Severe Immunotherapy Complications Service on outcomes for patients receiving immune checkpoint inhibitor therapy for cancer.

J Immunother Cancer 2021 Sep;9(9)

Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

Background: In 2017, Massachusetts General Hospital implemented the Severe Immunotherapy Complications (SIC) Service, a multidisciplinary care team for patients hospitalized with immune-related adverse events (irAEs), a unique spectrum of toxicities associated with immune checkpoint inhibitors (ICIs). This study's objectives were to evaluate the intervention's (1) effect on patient outcomes and healthcare utilization, and (2) ability to collect biological samples via a central infrastructure, in order to study the mechanisms responsible for irAEs.

Methods: A hospital database was used to identify patients who received ICIs for a malignancy and were hospitalized with severe irAEs, before (April 2, 2016-October 3, 2017) and after (October 3, 2017-October 24, 2018) SIC Service initiation. Read More

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September 2021

'Stay at home …': exploring the impact of the COVID-19 public health response on sexual behaviour and health service use among men who have sex with men: findings from a large online survey in the UK.

Sex Transm Infect 2021 Sep 20. Epub 2021 Sep 20.

UCL Institute for Global Health, University College London, London, UK.

Objectives: The first UK national lockdown began on 23 March 2020, in response to the COVID-19 pandemic, and led to reduced STI/HIV service provision in the UK. We investigated sexual behaviour, use and need for sexual healthcare during the pandemic.

Methods: Participants (N=2018), including men (cis/transgender), transwomen and gender-diverse people reporting sex with another man (cis/transgender) or non-binary person assigned male at birth, completed an online cross-sectional survey (23 June 2020-14 July 2020), in response to adverts on social media and dating apps. Read More

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September 2021

Anterolateral minithoracotomy versus median sternotomy for the surgical treatment of atrial septal defects: a meta-analysis and systematic review.

J Cardiothorac Surg 2021 Sep 20;16(1):266. Epub 2021 Sep 20.

Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.

Background: To compare the short-term safety and efficacy of right anterolateral minithoracotomy (ALMT) and median sternotomy (MS) for the surgical treatment of atrial septal defects (ASDs).

Methods: The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for comparative studies focusing on surgical repair of ASDs via ALMT or MS published up to the end of April 27, 2020. We used random-effect or fixed-effect models to obtain pooled estimates. Read More

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September 2021

The management of tetanus in adults in an intensive care unit in Southern Vietnam.

Wellcome Open Res 2021 31;6:107. Epub 2021 Aug 31.

Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.

Tetanus remains common in many low- and middle-income countries (LMICs) yet the evidence base guiding management of this disease is extremely limited, particularly with respect to contemporary management options. Sharing knowledge about practice may facilitate improvement in outcomes elsewhere. : We describe clinical interventions and outcomes of 180 adult patients ≥16 years-old with tetanus enrolled in prospective observational studies at a specialist infectious diseases hospital in Southern Vietnam. Read More

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The Effect of Betamethasone Dosing Interval on Perinatal Outcomes: 12 Hours or 24 Hours Apart.

Am J Perinatol 2021 Sep 20. Epub 2021 Sep 20.

Department of Obstetrics and Gynecology, Istanbul Medipol University, Istanbul, Turkey.

Objective:  Antenatal steroids are commonly used to stimulate fetal lung maturation, particularly in pregnancies at risk of early preterm labor. This study aimed to compare the effects of administering betamethasone at a 12- versus 24-hour interval on perinatal outcomes.

Study Design:  This retrospective study included 423 early preterm births from 26 to 33 weeks of gestation. Read More

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September 2021

Early intravenous nitroglycerin use in prehospital setting and in the emergency department to treat patients with acute heart failure: Insights from the EAHFE Spanish registry.

Int J Cardiol 2021 Sep 17. Epub 2021 Sep 17.

Momentum Research, Inc., Durham, NC, USA; INSERM U-942 (Biotherapy in the critically ill), Paris, France.

Background And Objective: Although recommended for the treatment of acute heart failure (AHF), the use of intravenous (IV) nitroglycerin (NTG) is supported by scarce and contradicting evidence. In the current analysis, we have assessed the impact of IV NTG administration by EMS or in emergency department (ED) on outcomes of AHF patients.

Methods: We analyze AHF patients included by 45 hospitals that were delivered to ED by EMS. Read More

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September 2021

A Phase II Cluster-Crossover Randomized Trial of Fentanyl vs. Morphine for Analgosedation in Mechanically Ventilated Patients.

Am J Respir Crit Care Med 2021 Sep 20. Epub 2021 Sep 20.

Austin Health, 3805, Intensive Care, Heidelberg, Victoria, Australia.

Rationale: The continuous infusion of fentanyl or morphine is often prescribed to assist with analgesia and sedation (analgosedation) during mechanical ventilation.

Objectives: To compare the effect of fentanyl vs. morphine on patient-centered outcomes in ventilated patients. Read More

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September 2021

Impact of diabetic hyperglycemia on clinical outcomes in patients with diabetes mellitus following traumatic brain injury.

Turk Neurosurg 2021 Mar 29. Epub 2021 Mar 29.

Chang Gung Medical College and University, Chang Gung Memorial Hospital at Linkou, Department of Neurosurgery, Taiwan.

Aim: Diabetes mellitus (DM) is known to induce negative systemic effects in patients with trauma. However, data on the association between DM and isolated traumatic brain injury (TBI) is limited, especially in the Asian population. This study aimed to identify the effect of patients with DM with TBI in Taiwan. Read More

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Monitoring postoperative lung recovery using electrical impedance tomography in post anesthesia care unit: an observational study.

J Clin Monit Comput 2021 Sep 20. Epub 2021 Sep 20.

Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany.

With electrical impedance tomography (EIT) recruitment and de-recruitment phenomena can be quantified and monitored at bedside. The aim was to examine the feasibility of EIT with respect to monitor atelectasis formation and resolution in the post anesthesia care unit (PACU). In this observational study, 107 postoperative patients were investigated regarding the presence and recovery of atelectasis described by the EIT-derived parameters Global Inhomogeneity Index (GI Index), tidal impedance variation (TIV), and the changes in end-expiratory lung impedance (ΔEELI). Read More

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September 2021

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital.

Clin Pediatr (Phila) 2021 Sep 18:99228211047242. Epub 2021 Sep 18.

East Carolina University, Greenville, NC, USA.

Objective: To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge.

Methods: We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children's hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. Read More

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September 2021

Effects of an earplug placement intervention on sleep quality in patients in a medical intensive care unit: A randomized controlled trial.

Int J Nurs Pract 2021 Sep 19:e13016. Epub 2021 Sep 19.

Department of Nursing, Tzu Chi University, Hualien, Taiwan.

Aims: This study aimed to evaluate the effects of an intervention involving earplug placement during nocturnal sleep in non-ventilated intensive care unit patients.

Methods: A randomized controlled trial was conducted in 107 adult patients between January 2017 and December 2018. Participants in the intervention group (n = 55) slept with earplugs between 10 pm and 7 am on the second night of their intensive care unit stay. Read More

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September 2021

In-Hospital Outcomes of Acute Kidney Injury After Pediatric Cardiac Surgery: A Meta-Analysis.

Front Pediatr 2021 3;9:733744. Epub 2021 Sep 3.

Department of Pediatric Nephrology, University Hospitals of Leuven, Leuven, Belgium.

Cardiac surgery-associated acute kidney injury (CS-AKI) is associated with increased morbidity and mortality in both adults and children. This study aimed to investigate the in-hospital outcomes of CS-AKI in the pediatric population. PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for studies published by August 2020. Read More

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September 2021