Novel Approaches to the Treatment of Sepsis Syndrome

2008 ◽  
Vol 21 (5) ◽  
pp. 371-379
Author(s):  
Jennifer K. Clayton ◽  
Jessica A. Starr
Keyword(s):  
Treatment Options ◽  
Activated Protein C ◽  
Immunoglobulin Therapy ◽  
The United States ◽  
Sepsis Syndrome ◽  
Preclinical Study ◽  
Health Care Facilities ◽  
Standards Of Care ◽  
Reductase Inhibitors ◽  
Coa Reductase

Sepsis, severe sepsis, and septic shock are common diagnoses in intensive care units worldwide. In the United States, it is estimated that 750 000 cases of sepsis occur annually. This rate is expected to climb, with an additional 1 million cases per year expected by 2020. These infection-induced inflammatory syndromes ultimately lead to organ dysfunction, and a significantly high mortality rate. Recently, advances in knowledge of sepsis syndrome have led to progress in identifying potential treatment options beyond our current standards of care. Many health care facilities have implemented protocols to guide clinicians to use such standards: early goal-directed therapy and activated protein C therapy in qualifying patients. Nonetheless, debate continues to confuse identification of patient populations in whom corticosteroid therapy should be recommended. While the data describing studies of novel treatment approaches has been controversial in some cases, there have been promising results observed in others. Here we review several treatments that have recently gained attention in the medical literature: HMG-CoA reductase inhibitors (statins), selenium therapy, immunoglobulin therapy, and several agents currently in preclinical study.

scholarly journals State Preparedness for Crisis Standards of Care in the United States: Implications for Emergency Management

2020 ◽  
pp. 1-3
Author(s):  
Annie E. Ingram ◽  
Attila J. Hertelendy ◽  
Michael S. Molloy ◽  
Gregory R. Ciottone
Keyword(s):  
United States ◽  
Health Care ◽  
Hurricane Katrina ◽  
Local Level ◽  
The United States ◽  
Health Care Facilities ◽  
Legal Responsibility ◽  
Standards Of Care ◽  
Clear Understanding ◽  
State And Local

Abstract State governments and hospital facilities are often unprepared to handle a complex medical crisis, despite a moral and ethical obligation to be prepared for disaster. The 2019 novel coronavirus disease (COVID-19) has drawn attention to the lack of state guidance on how hospitals should provide care in a crisis. When the resources available are insufficient to treat the current patient load, crisis standards of care (CSC) are implemented to provide care to the population in an ethical manner, while maintaining an ability to handle the surge. This Editorial aims to raise awareness concerning a lack of preparedness that calls for immediate correction at the state and local level. Analysis of state guidelines for implementation of CSC demonstrates a lack of preparedness, as only five states in the US have appropriately completed necessary plans, despite a clear understanding of the danger. States have a legal responsibility to regulate the medical care within their borders. Failure of hospital facilities to properly prepare for disasters is not a new issue; Hurricane Katrina (2005) demonstrated a lack of planning and coordination. Improving disaster health care readiness in the United States requires states to create new policy and legislative directives for the health care facilities within their respective jurisdictions. Hospitals should have clear directives to prepare for disasters as part of a “duty to care” and to ensure that the necessary planning and supplies are available to their employees.

Making a Case for Acute Ischemic Stroke

2010 ◽  
Vol 23 (5) ◽  
pp. 387-397 ◽  
Author(s):  
Kathleen A. Baldwin ◽  
Stacey L. McCoy
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Treatment Options ◽  
Heart Association ◽  
Signs And Symptoms ◽  
The United States ◽  
Standards Of Care ◽  
Hospital Transport ◽  
Reperfusion Strategy

Stroke is the third leading cause of death in the United States and the number one cause of adult long-term disability. Disability in stroke survivors includes hemiparesis, aphasia, inability to walk without assistance, dependence on others for activities of daily living, depression, and institutionalization. Immediate recognition of acute ischemic stroke (AIS) signs and symptoms is required because many treatment options are time sensitive. Hospital transport via activation of 911 and emergency medical services (EMSs) removes delays to urgent diagnosis and intervention. Intravenous (IV) recombinant tissue plasminogen (rt-PA) is a time-sensitive reperfusion strategy. The American Heart Association (AHA) and American Stroke Association (ASA) recently revised recommendations that the time window for IV rt-PA be expanded from 3 hours to 4.5 hours after symptom onset in patients with mild to moderate stroke. Supportive therapies include crystalloid IV solutions, adequate oxygenation, and normothermia. Best rest is desired along with oxygen supplementation. Avoidance of fever is paramount since fever can contribute to negative outcomes. It is the purpose of this article to review risk factors, stroke symptoms, epidemiology, and current drug therapy of AIS. Standards of care will be reviewed.

General perspectives for the treatment of atherosclerosis

2020 ◽  
Vol 17 ◽  
Author(s):  
Hayrettin Ozan Gülcan ◽  
Ilkay Erdogan Orhan
Keyword(s):  
Treatment Options ◽  
Single Agent ◽  
Cholesterol Acyl Transferase ◽  
Synthetic Compounds ◽  
Bile Acid Sequestrants ◽  
Reductase Inhibitors ◽  
Current Review ◽  
Hmg Coa Reductase Inhibitors ◽  
Coa Reductase

: Atherosclerosis, a cardiovascular disease, is at the top of the list among the diseases leading to death. Although the biochemical and pathophysiological cascades involved within the development of atherosclerosis have been identified clearly, its nature is quite complex to be treated with a single agent targeting a pathway. Therefore, many natural and synthetic compounds have been suggested for the treatment of the disease. Majority of the drugs employed target one of the single components of the pathological outcomes, resulting in many times less effective and long-term treatments. In most cases, treatment options prevent further worsening of the symptoms rather than a radical treatment. Consequently, the current review has been prepared to focus on the validated and non-validated targets of atherosclerosis as well as the alternative treatment options such as hydroxymethyl glutaryl coenzyme A (HMG-CoA) reductase inhibitors, acyl-CoA cholesterol acyl transferase (ACAT) inhibitors, lipoprotein lipase stimulants, bile acid sequestrants, and some antioxidants. Related to the topic, both synthetic compounds designed employing medicinal chemistry skills and natural molecules becoming more popular in drug development are scrutinized in this mini review.

The Older Cancer Patient

2021 ◽  
pp. 663-670
Author(s):  
Barbara A. Given ◽  
Charles W. Given
Keyword(s):  
Treatment Options ◽  
The United States ◽  
Incidence Rates ◽  
Standards Of Care ◽  
Patient Centered ◽  
Curative Intent ◽  
Manage Care ◽  
Older Cancer Patients ◽  
Receive Treatment ◽  
Chronic Health Problems

Approximately one-third of all persons reaching the age of 70 will receive a cancer diagnosis. By 2022, there will be 18 million cancer survivors in the United States, and approximately 63% will be 65 or older. Among the population 65 and older, cancer is the second leading cause of death. These increasing incidence rates combined with longer survival will place new demands on the cancer delivery system. The single largest payers for healthcare, Medicare and Medicaid, will experience increased stress as immunologic and other costly therapies become the standards of care. It is important to understand how to manage care for older persons with cancer, many of whom may already be dealing with other chronic health problems. Factors beyond chronological age must be considered when care decisions are made. Given the increased life expectancy resulting from improved treatment of cancer, as well as management of other chronic diseases, cancer and aging are important areas of concern for the future of healthcare. Older patients, even those with few or no comorbid conditions, are less likely to receive treatment with a curative intent. Older cancer patients face the challenge of finding individualized, patient-centered cancer care that considers how physiological, social, psychological, and, more recently, economic parameters interact with treatment options to attain outcomes that manage the disease while preserving quality of life. This chapter discusses these parameters as they pertain to cancer and cancer treatment in the older individual.

Community Planning for Pandemic Influenza: Lessons From the VA Health Care System

2008 ◽  
Vol 2 (4) ◽  
pp. 251-257 ◽  
Author(s):  
Nicole Lurie ◽  
David J. Dausey ◽  
Troy Knighton ◽  
Melinda Moore ◽  
Sarah Zakowski ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care System ◽  
Pandemic Influenza ◽  
Community Planning ◽  
The United States ◽  
Health Care Facilities ◽  
Standards Of Care ◽  
Va Health Care System ◽  
Care System

ABSTRACTBackground: Coordination and communication among community partners—including health departments, emergency management agencies, and hospitals—are essential for effective pandemic influenza planning and response. As the nation’s largest integrated health care system, the US Department of Veterans Affairs (VA) could be a key component of community planning.Purpose: To identify issues relevant to VA–community pandemic influenza preparedness.Methods: As part of a VA–community planning process, we developed and pilot-tested a series of tabletop exercises for use throughout the VA system. These included exercises for facilities, regions (Veterans Integrated Service Networks), and the VA Central Office. In each, VA and community participants, including representatives from local health care facilities and public health agencies, were presented with a 3-step scenario about an unfolding pandemic and were required to discuss issues and make decisions about how the situation would be handled. We report the lessons learned from these pilot tests.Results: Existing communication and coordination for pandemic influenza between VA health care system representatives and local and regional emergency planners are limited. Areas identified that would benefit from better collaborative planning include response coordination, resource sharing, uneven resource distribution, surge capacity, standards of care, workforce policies, and communication with the public.Conclusions: The VA health system and communities throughout the United States have limited understanding of one another’s plans and needs in the event of a pandemic. Proactive joint VA–community planning and coordination—including exercises, followed by deliberate actions to address the issues that arise—will likely improve pandemic influenza preparedness and will be mutually beneficial. Most of the issues identified are not unique to VA, but are applicable to all integrated care systems. (Disaster Med Public Health Preparedness. 2008;2:251–257)

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