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Common Chronic Conditions Do Not Affect Performance Of Cell Cycle Arrest Biomarkers For Risk Stratification Of Acute Kidney Injury, Michael Heung, Luis Ortega, Lakhmir S. Chawla, Richard G. Wunderink, Wesley H. Self, Jay Koyner, Jing Shi, John A. Kellum 2016 George Washington University

Common Chronic Conditions Do Not Affect Performance Of Cell Cycle Arrest Biomarkers For Risk Stratification Of Acute Kidney Injury, Michael Heung, Luis Ortega, Lakhmir S. Chawla, Richard G. Wunderink, Wesley H. Self, Jay Koyner, Jing Shi, John A. Kellum

Anesthesiology and Critical Care Medicine Faculty Publications

Background Identification of acute kidney injury (AKI) can be challenging in patients with underlying chronic disease, and biomarkers often perform poorly in this population. In this study we examined the performance characteristics of the novel biomarker panel of urinary tissue inhibitor of metalloproteinases-2 (TIMP2) and insulin-like growth factor-binding protein 7 ([IGFBP7]) in patients with a variety of comorbid conditions.

Methods We analyzed data from two multicenter studies of critically ill patients in which [TIMP2]•[IGFBP7] was validated for prediction of Kidney Disease: Improving Global Outcomes (KDIGO) Stage 2 or 3 AKI within 12 h. We constructed receiver operating characteristic (ROC ...


Clinical Adjudication In Acute Kidney Injury Studies: Findings From The Pivotal Timp-2*Igfbp7 Biomarker Study, Kathleen D. Liu, Anitha Vijayan, Mitchell H. Rosner, Jing Shi, Lakhmir S. Chawla, John A. Kellum 2016 George Washington University

Clinical Adjudication In Acute Kidney Injury Studies: Findings From The Pivotal Timp-2*Igfbp7 Biomarker Study, Kathleen D. Liu, Anitha Vijayan, Mitchell H. Rosner, Jing Shi, Lakhmir S. Chawla, John A. Kellum

Anesthesiology and Critical Care Medicine Faculty Publications

Background The NEPROCHECK test (Astute Medical, San Diego, CA, USA) combines urinary tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) to identify patients at high risk for acute kidney injury (AKI). In a US Food and Drug Administration registration trial (NCT01573962), AKI was determined by a three-member clinical adjudication committee. The objectives were to examine agreement among adjudicators as well as between adjudicators and consensus criteria for AKI and to determine the relationship of biomarker concentrations and adjudicator agreement.

Methods Subjects were classified as AKI 3/3, 2/3, 1/3 or 0/3 according ...


Acute Appendicitis: Transcript Profiling Of Blood Identifies Promising Biomarkers And Potential Underlying Processes, Lakhmir S. Chawla, Ian Toma, Danielle L. Davison, Khashayar Vaziri, Juliet Lee, Raymond Lucas, Michael G. Seneff, Aobhinn Nyhan, Timothy A. McCaffrey 2016 George Washington University

Acute Appendicitis: Transcript Profiling Of Blood Identifies Promising Biomarkers And Potential Underlying Processes, Lakhmir S. Chawla, Ian Toma, Danielle L. Davison, Khashayar Vaziri, Juliet Lee, Raymond Lucas, Michael G. Seneff, Aobhinn Nyhan, Timothy A. Mccaffrey

Anesthesiology and Critical Care Medicine Faculty Publications

Background

The diagnosis of acute appendicitis can be surprisingly difficult without computed tomography, which carries significant radiation exposure. Circulating blood cells may carry informative changes in their RNA expression profile that would signal internal infection or inflammation of the appendix.

Methods

Genome-wide expression profiling was applied to whole blood RNA of acute appendicitis patients versus patients with other abdominal disorders, in order to identify biomarkers of appendicitis. From a large cohort of emergency patients, a discovery set of patients with surgically confirmed appendicitis, or abdominal pain from other causes, was identified. RNA from whole blood was profiled by microarrays, and ...


Intra-Abdominal Hypertension And Abdominal Compartment Syndrome, Patrick B. Murphy 2016 The University of Western Ontario

Intra-Abdominal Hypertension And Abdominal Compartment Syndrome, Patrick B. Murphy

Electronic Thesis and Dissertation Repository

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are increasingly recognized in critically ill patients; no non operative treatments exist, and mortality remains high.

The purpose of this thesis was to prospectively characterize the incidence of IAH in a mixed medical-surgical intensive care unit, and to test the potential therapeutic benefit of carbon monoxide (CO) and hydrogen sulphide (H2S) using an animal model of ACS. IAH was diagnosed in 30% of patients on admission; further 15% developed IAH during ICU stay. Incidence of ACS was 3%, with obesity, sepsis, mechanical ventilation and 24-hour fluid balance as independent predictors, also predicting ...


Reducing Phlebotomy-­Induced Blood Loss In The Picu: A Quality Improvement Study, Amanda Johnson, Ariel Hoch, Scot T. Bateman, Stacey L. Valentine 2016 University of Massachusetts Medical School

Reducing Phlebotomy-­Induced Blood Loss In The Picu: A Quality Improvement Study, Amanda Johnson, Ariel Hoch, Scot T. Bateman, Stacey L. Valentine

UMass Center for Clinical and Translational Science Research Retreat

Introduction: Phlebotomy­induced blood loss contributes to development of anemia in critically ill children. Major factors contributing to this include blood overdraw from indwelling catheters and utilization of larger volume containers. We targeted these causes of excessive blood draws to decrease volumes of both the discarded blood and sample sent to the laboratory for standard tests. Methods: Pre and post quality improvement study in a 10­bed pediatric intensive care unit 2014­2015. All patients admitted to PICU during each 2­month study period were eligible for enrollment. Pre-intervention, nurses used standard pediatric tubes (3­3.5mL). A wash­out ...


Facilitating Effective Communication Between First Responders And Older Adults During Fall Incidents: An Educational Intervention, Krystin M. Beeman, Erica L. Berger, Isabel A. Cabezas, Nicole M. Mathews 2016 Dominican University of California

Facilitating Effective Communication Between First Responders And Older Adults During Fall Incidents: An Educational Intervention, Krystin M. Beeman, Erica L. Berger, Isabel A. Cabezas, Nicole M. Mathews

Master's Theses and Capstone Projects

PURPOSE. The purpose of this project was to provide first responders with communication strategies for older adults that may help when responding to fall- related calls. General information was also provided to First Responders on working with older adults with a focus on the aging process, fall risk factors, and communications strategies.

METHODS. A series of educational sessions to first responders at a local fire district were developed and presented by occupational therapy students. Materials were developed by presenters from evidence-based resources and tailored to the target population. Each presentation focused on statistics about older adults, the aging process, fall ...


An Evaluation Of Patient Surveys To Determine Possible Causes Of Hospital Readmissions, Monica Weinberg MS, Matthew McCambridge MD 2016 USF MCOM - LVHN Campus

An Evaluation Of Patient Surveys To Determine Possible Causes Of Hospital Readmissions, Monica Weinberg Ms, Matthew Mccambridge Md

USF-LVHN SELECT

No abstract provided.


Intensive Care In Oncology: Admission And Outcomes In Adult Patients With Cancer, Surya John 2016 University of Central Florida

Intensive Care In Oncology: Admission And Outcomes In Adult Patients With Cancer, Surya John

Honors in the Major Theses

Background: Historically, patients with cancer have been perceived as poor candidates for ICU admission. General ICU admission criteria lists cancer patients as low priority in ICU admission depriving them of the care they rightfully deserve. The purpose of this literary synthesis was to examine ICU admission criteria, risk factors, and outcomes of ICU admission in relation to hematological and solid tumor cancers and discuss ways that practitioners and nurses can educate patients with cancer and their families on appropriateness of ICU care.

Methods: A total of 768 articles were found in a literature search including all literature from 2005 to ...


National Institutes Of Health Stroke Scale (Nihss) And Tissue Plasminogen (Tpa) Education For All Critical Care Nurses, Cheriese Rawlins 2015 Baptist Hospital of Miami

National Institutes Of Health Stroke Scale (Nihss) And Tissue Plasminogen (Tpa) Education For All Critical Care Nurses, Cheriese Rawlins

All Publications

No abstract provided.


Interrater Variability In Identifying Ventilator Associated Pneumonia Using Six Different Definitions, Ahmad Nusair,, Balwinder Singh,, Shifang Ding,, Ognjen Gajic,, Guangxi Li, 2015 Marshall University School of Medicine

Interrater Variability In Identifying Ventilator Associated Pneumonia Using Six Different Definitions, Ahmad Nusair,, Balwinder Singh,, Shifang Ding,, Ognjen Gajic,, Guangxi Li,

Ahmad R. Nusair

Objective There is no widely accepted standard definition for Ventilator Associated Pneumonia (VAP). The reliability of the current definitions in use remains controversial. Our objective was to assess the reliability of six commonly used VAP definitions: The Loose, The Rigorous, The Modified Clinical Pulmonary Infection Score (CPIS), The Canadian Critical Care Trials Group (CCCTG), The International Sepsis Forum Consensus (ISFC) and The Center for Disease Control and Prevention (CDC). Design We examined the electronic health records of all the consecutively admitted adult patients at our institution who received invasive mechanical ventilation (IMV) for ≥ 48 hours, from January 2006 through December ...


Interrater Variability In Identifying Ventilator Associated Pneumonia Using Six Different Definitions#11;, Ahmad Nusair, Balwinder Singh, Ognjen Gajic, Guangxi Li 2015 Marshall University Joan C. Edwards school of Medicine

Interrater Variability In Identifying Ventilator Associated Pneumonia Using Six Different Definitions#11;, Ahmad Nusair, Balwinder Singh, Ognjen Gajic, Guangxi Li

Ahmad R. Nusair

There is no widely accepted standard definition for Ventilator Associated Pneumonia (VAP). The reliability of the current definitions in use remains controversial. Our objective was to assess the reliability of six commonly used VAP definitions: The Loose, The Rigorous, The Modified Clinical Pulmonary Infection Score (CPIS), The Canadian Critical Care Trials Group (CCCTG), The International Sepsis Forum Consensus (ISFC) and The Center for Disease Control and Prevention (CDC).


Alkali Therapy In Lactic Acidosis, Zeid Khitan,, Deepak Malhotra,, Dominic Raj,, Antonios Tzamaloukas,, Joseph Shapiro, 2015 Marshall University Joan C. Edwards School of Medicine

Alkali Therapy In Lactic Acidosis, Zeid Khitan,, Deepak Malhotra,, Dominic Raj,, Antonios Tzamaloukas,, Joseph Shapiro,

Zeid J. Khitan

This report attempts to frame the debate about clinical administration of sodium bicarbonate in the setting of lactic acidosis in terms of simple questions. Specifically, we address why we develop lactic acidosis in some circumstances, how acute lactic acidosis impairs cardiovascular function and why sodium bicarbonate may have deleterious effects which limit its utility. We also attempt to explore treatment alternatives to sodium bicarbonate.


Alkali Therapy In Lactic Acidosis, Zeid Khitan,, Deepak Malhotra,, Dominic Raj,, Antonios Tzamaloukas,, Joseph Shapiro, 2015 Marshall University Joan C. Edwards School of Medicine

Alkali Therapy In Lactic Acidosis, Zeid Khitan,, Deepak Malhotra,, Dominic Raj,, Antonios Tzamaloukas,, Joseph Shapiro,

Joseph I Shapiro MD

This report attempts to frame the debate about clinical administration of sodium bicarbonate in the setting of lactic acidosis in terms of simple questions. Specifically, we address why we develop lactic acidosis in some circumstances, how acute lactic acidosis impairs cardiovascular function and why sodium bicarbonate may have deleterious effects which limit its utility. We also attempt to explore treatment alternatives to sodium bicarbonate.


Alkali Therapy In Lactic Acidosis, Zeid J. Khitan, MD, Deepak Malhotra, MD, Dominic S. Raj, MD, Antonios H. Tzamaloukas, MD, Joseph I. Shapiro, MD 2015 Marshall University Joan C. Edwards School of Medicine

Alkali Therapy In Lactic Acidosis, Zeid J. Khitan, Md, Deepak Malhotra, Md, Dominic S. Raj, Md, Antonios H. Tzamaloukas, Md, Joseph I. Shapiro, Md

Marshall Journal of Medicine

This report attempts to frame the debate about clinical administration of sodium bicarbonate in the setting of lactic acidosis in terms of simple questions. Specifically, we address why we develop lactic acidosis in some circumstances, how acute lactic acidosis impairs cardiovascular function and why sodium bicarbonate may have deleterious effects which limit its utility. We also attempt to explore treatment alternatives to sodium bicarbonate.


Interrater Variability In Identifying Ventilator Associated Pneumonia Using Six Different Definitions, Ahmad Nusair, MD, Balwinder Singh, MD, MS., Shifang Ding, MD, PhD., Ognjen Gajic, MD, Guangxi Li, MD 2015 Marshall University School of Medicine

Interrater Variability In Identifying Ventilator Associated Pneumonia Using Six Different Definitions, Ahmad Nusair, Md, Balwinder Singh, Md, Ms., Shifang Ding, Md, Phd., Ognjen Gajic, Md, Guangxi Li, Md

Marshall Journal of Medicine

Objective

There is no widely accepted standard definition for Ventilator Associated Pneumonia (VAP). The reliability of the current definitions in use remains controversial. Our objective was to assess the reliability of six commonly used VAP definitions: The Loose, The Rigorous, The Modified Clinical Pulmonary Infection Score (CPIS), The Canadian Critical Care Trials Group (CCCTG), The International Sepsis Forum Consensus (ISFC) and The Center for Disease Control and Prevention (CDC).

Design

We examined the electronic health records of all the consecutively admitted adult patients at our institution who received invasive mechanical ventilation (IMV) for ≥ 48 hours, from January 2006 through December ...


Pilot Study Comparing Simulation-Based And Didactic Lecture-Based Critical Care Teaching For Final-Year Medical Students., Orsolya Solymos, Patrick O'Kelly, Criona M Walshe 2015 Royal College of Surgeons in Ireland

Pilot Study Comparing Simulation-Based And Didactic Lecture-Based Critical Care Teaching For Final-Year Medical Students., Orsolya Solymos, Patrick O'Kelly, Criona M Walshe

Anaesthesia and Critical Care Articles

BACKGROUND: Simulation-based medical education has rapidly evolved over the past two decades, despite this, there are few published reports of its use in critical care teaching. We hypothesised that simulation-based teaching of a critical care topic to final-year medical students is superior to lecture-based teaching.

METHODS: Thirty-nine final-year medical students were randomly assigned to either simulation-based or lecture-based teaching in the chosen critical care topic. The study was conducted over a 6-week period. Efficacy of each teaching method was compared through use of multiple choice questionnaires (MCQ) - baseline, post-teaching and 2 week follow-up. Student satisfaction was evaluated by means of ...


The Effect Of Tele-Icu Innovation On Progressive Care Unit Patient Population, Donna L. Armaignac, Carlos Valle, Louis Gidel, Xiaorong Mei, Irfan Zaidi, Leslee Gross, Lisa-Mae Williams, Emir Veledar 2015 Baptist Health South Florida

The Effect Of Tele-Icu Innovation On Progressive Care Unit Patient Population, Donna L. Armaignac, Carlos Valle, Louis Gidel, Xiaorong Mei, Irfan Zaidi, Leslee Gross, Lisa-Mae Williams, Emir Veledar

All Publications

Introduction: Although, Tele-ICU is integrated into 11% of US critical care delivery, Tele-innovation's advanced monitoring, clinical decision-support functions and cognitive affordances have not been examined in PCU. We compared significant well established outcomes and quality measures between PCU standard of care and PCU Tele-intervention, namely, hospital length of stay (LOS), mortality, APACHE IV severity adjusted mortality and MSDRG severity adjusted mortality.

Methods: Data about n = 13, 421 patients from 6 hospitals (Observational Case Control design) from Jan 2012 – Mar 2015 were analyzed. PCU standard of care control n=7047, PCU Tele-intervention n=6374. PCU inclusion time was defined as ...


Myd88 In Lung Resident Cells Governs Airway Inflammatory And Pulmonary Function Responses To Organic Dust Treatment., Jill A. Poole, Todd A. Wyatt, Debra J. Romberger, Elizabeth Staab, Samantha Simet, Stephen J. Reynolds, Joseph H. Sisson, Tammy Kielian 2015 University of Nebraska Medical Center

Myd88 In Lung Resident Cells Governs Airway Inflammatory And Pulmonary Function Responses To Organic Dust Treatment., Jill A. Poole, Todd A. Wyatt, Debra J. Romberger, Elizabeth Staab, Samantha Simet, Stephen J. Reynolds, Joseph H. Sisson, Tammy Kielian

Journal Articles: Pulmonary & Critical Care Med

Inhalation of organic dusts within agriculture environments contributes to the development and/or severity of airway diseases, including asthma and chronic bronchitis. MyD88 KO (knockout) mice are nearly completely protected against the inflammatory and bronchoconstriction effects induced by acute organic dust extract (ODE) treatments. However, the contribution of MyD88 in lung epithelial cell responses remains unclear. In the present study, we first addressed whether ODE-induced changes in epithelial cell responses were MyD88-dependent by quantitating ciliary beat frequency and cell migration following wounding by electric cell-substrate impedance sensing. We demonstrate that the normative ciliary beat slowing response to ODE is delayed ...


Population Attributable Risk Of Unintentional Childhood Poisoning In Karachi Pakistan., Bilal Ahmed, Zafar Fatmi, Amna R Siddiqui 2015 Aga Khan University

Population Attributable Risk Of Unintentional Childhood Poisoning In Karachi Pakistan., Bilal Ahmed, Zafar Fatmi, Amna R Siddiqui

Zafar Fatmi

Background: The percentage of unintentional childhood poisoning cases in a given population attributable to specific risk factors (i.e., the population attributable risk) which can be calculated, determination of such risk factors associated with potentially modifiable risk factors, are necessary to focus on the prevention strategies. Methods: We calculated PARs, using 120 cases with unintentional poisoning and 360 controls in a hospital based matched case- control study. The risk factors were accessibility to hazardous chemicals and medicines due to unsafe storage, child behavior reported as hyperactive, storage of kerosene and petroleum in soft drink bottles, low socioeconomic class, less education ...


Predictors Of Unintentional Poisoning Among Children Under 5 Years Of Age In Karachi: A Matched Case-Control Study, Bilal Ahmed, Zafar Fatmi, Amna R. Siddiqui, Abdul L. Sheikh 2015 Aga Khan University

Predictors Of Unintentional Poisoning Among Children Under 5 Years Of Age In Karachi: A Matched Case-Control Study, Bilal Ahmed, Zafar Fatmi, Amna R. Siddiqui, Abdul L. Sheikh

Zafar Fatmi

Objective: Poisoning is the fourth leading cause of unintentional injury and a common paediatric emergency in children under 5 years of age. The objective of this study was to determine the factors associated with unintentional poisoning among children under 5 years of age presenting to emergency rooms at tertiary care hospitals in Karachi, Pakistan. Setting: Children were recruited from the emergency rooms of the three biggest tertiary care hospitals in Karachi. Design: A matched case-control study was conducted on 120 cases and 360 controls, with matching done on gender and age. Parents were interviewed using a structured questionnaire containing information ...


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