Key Peculiarities of Protein-energy Metabolism and Nutrtional Status Impairment of Cerebral ICU Patients during Early Rehabilitation Period in Specialized Medical Center

OBJECTIVE: The study goal was to compare endoscopically guided middle meatal cultures with cultures of antral lavage aspirate in intensive care unit (ICU) patients with sinusitis. METHODS: Prospective study of febrile ICU patients seen for sinusitis at a tertiary medical center. RESULTS: Of 31 antral lavages performed in 18 patients, 19 lavages yielded purulent or mucopurulent aspirate. Endoscopically guided middle meatal cultures yielded the same pathogen, as did cultures of the lavage aspirate in 4 (21%) of these 19 cases. The antral lavage was negative (absence of purulent/mucopurulent aspirate) in 12 cases, and of those, 5 (42%) of the 12 middle meatal cultures showed no growth (sensitivity = 21%, specificity = 58%, χ2-1.52, P = 0.218). CONCLUSION: Endoscopically guided middle meatal cultures did not correlate well with cultures from the antral lavage aspirate in febrile ICU patients evaluated for sinusitis.

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Non-protein energy intake during total parenteral nutrition: effect on protein turnover and energy metabolism

Clinical Nutrition ◽

10.1016/s0261-5614(06)80011-7 ◽

1995 ◽

Vol 14 (1) ◽

pp. 47-49 ◽

Cited By ~ 7

Author(s):

A. Pierro ◽

M.O. Jones ◽

P.J. Garlick ◽

M.A. McNurlan ◽

S.C. Donnell ◽

...

Keyword(s):

Energy Metabolism ◽

Parenteral Nutrition ◽

Total Parenteral Nutrition ◽

Energy Intake ◽

Protein Turnover ◽

Protein Energy

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2424. Shedding of Viable Clostridiodes difficile in Patients Admitted to a Medical Intensive Care Unit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2102 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S837-S838

Author(s):

Vincent B Young ◽

Micah Keidan ◽

Rachel D Yelin ◽

Thelma E Dangana ◽

Pamela B Bell ◽

...

Keyword(s):

Intensive Care ◽

Medical Center ◽

Academic Medical Center ◽

Secondary Analysis ◽

Icu Patients ◽

Specific Pcr ◽

Patient Admissions ◽

Academic Medical ◽

Healthcare Associated ◽

Record Review

Abstract Background Hospitalized patients are at risk of colonization with a range of healthcare-associated bacterial pathogens, including C. difficile. In patients admitted to intensive care units (ICUs), in whom C. difficile infection (CDI) is associated with increased morbidity and mortality. To understand the risk for acquisition of C. difficile and development of CDI, we monitored ICU patients daily for shedding of C. difficile by culture. Methods We conducted a secondary analysis of daily rectal/fecal swab samples collected from medical ICU patients of a 720-bed academic medical center in Chicago, IL. Selective culture for C. difficile was performed on swab samples from patients who had 2 or more samples obtained using selective media. Confirmation of putative C. difficile isolates was done by specific PCR assays for the 16S rRNA-encoding gene and the toxin genes tcdA, tcdB, cdtA and cdtB. Clinical testing for CDI was performed using the Xpert® C. difficile PCR assay (Cepheid). Clinical and demographic metadata were collected at bedside and by electronic medical record review. Results Culture was attempted on 2106 swab samples from 451 patients (486 ICU admissions) (Figure 1). A mean of 4.33 samples was obtained from each patient. C. difficile was isolated from 211 (10%) samples from 79 patients (Table 1). The first sample was positive by culture for 48 (9.9%) of patient admissions to the ICU. 31 (6.4%) patients who were initially negative by culture had a subsequent sample from which C. difficile was isolated. Persistence of culture-positivity varied from patient to patient (Figure 2). Of 80 patients who were tested for CDI based on physician suspicion, 12 patients had a positive Cepheid PCR test; 9 had diarrhea and were treated for CDI. Conclusion Surveillance for shedding of C. difficile by daily culture reveals that patients admitted to the ICU can shed the pathogen intermittently without attributable disease. This can be in the form patients who are admitted carrying the organism as well as those who appear to acquire the organism during their stay. It is unclear whether patient or microbiome factors underlie the differences seen in patterns of shedding. Furthermore, intermittent shedding may reflect multiple episodes of exposure to C. difficile spores and asymptomatic shedding without stable colonization. Disclosures All authors: No reported disclosures.

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Impact of Changes in Urine Culture Ordering Practice on Antimicrobial Utilization in Intensive Care Units at an Academic Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.334 ◽

2016 ◽

Vol 37 (4) ◽

pp. 448-454 ◽

Cited By ~ 15

Author(s):

Mohamed Sarg ◽

Greer E. Waldrop ◽

Mona A. Beier ◽

Emily L. Heil ◽

Kerri A. Thom ◽

...

Keyword(s):

Intensive Care ◽

Urine Culture ◽

Medical Center ◽

Academic Medical Center ◽

Intervention Group ◽

Antimicrobial Use ◽

Post Intervention ◽

Icu Patients ◽

Antimicrobial Utilization ◽

Academic Medical

OBJECTIVETo assess antimicrobial utilization before and after a change in urine culture ordering practice in adult intensive care units (ICUs) whereby urine cultures were only performed when pyuria was detected.DESIGNQuasi-experimental studySETTINGA 700-bed academic medical centerPATIENTSPatients admitted to any adult ICUMETHODSAggregate data for all adult ICUs were obtained for population-level antimicrobial use (days of therapy [DOT]), urine cultures performed, and bacteriuria, all measured per 1,000 patient days before the intervention (January–December 2012) and after the intervention (January–December 2013). These data were compared using interrupted time series negative binomial regression. Randomly selected patient charts from the population of adult ICU patients with orders for urine culture in the presence of indwelling or recently removed urinary catheters were reviewed for demographic, clinical, and antimicrobial use characteristics, and pre- and post-intervention data were compared.RESULTSStatistically significant reductions were observed in aggregate monthly rates of urine cultures performed and bacteriuria detected but not in DOT. At the patient level, compared with the pre-intervention group (n=250), in the post-intervention group (n=250), fewer patients started a new antimicrobial therapy based on urine culture results (23% vs 41%, P=.002), but no difference in the mean total DOT was observed.CONCLUSIONA change in urine-culture ordering practice was associated with a decrease in the percentage of patients starting a new antimicrobial therapy based on the index urine-culture order but not in total duration of antimicrobial use in adult ICUs. Other drivers of antimicrobial use in ICU patients need to be evaluated by antimicrobial stewardship teams.Infect. Control Hosp. Epidemiol. 2016;37(4):448–454

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Protein Energy Metabolism in Chronic Kidney Disease

Chronic Renal Disease ◽

10.1016/b978-0-12-815876-0.00016-4 ◽

2020 ◽

pp. 225-248

Author(s):

Manuel T. Velasquez ◽

Sarah C. Andrews ◽

Dominic S. Raj

Keyword(s):

Chronic Kidney Disease ◽

Energy Metabolism ◽

Kidney Disease ◽

Protein Energy

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Selection of Treatment Techniques for Lower Extremity Varicose Vein Disease

Galician Medical Journal ◽

10.21802/gmj.2016.3.36 ◽

2016 ◽

Vol 23 (3) ◽

Author(s):

Vasyl Mykhailovych Krysa ◽

Bohdan Vasylovych Krysa

Keyword(s):

Varicose Vein ◽

Medical Center ◽

Laser Coagulation ◽

Treatment Technique ◽

Treatment Techniques ◽

Clinical Observations ◽

Vascular Ultrasonography ◽

Rehabilitation Period ◽

Short Time ◽

Vein Disease

The article deals with available literature analysis, as well as authors’ own clinical observations concerning treatment of varicose vein disease. The article presents traditional surgery and endovascular methods of treatment and emphasizes that no technique has been recognized as universally applicable. The issue of reducing postoperative trauma, as well as shortening hospitalization and rehabilitation periods remains topical. Vein removal or any other way of excluding it from blood circulation has to be aimed only at areas with abnormalities in the area with venous reflux confirmed by ultrasonography. Such approach enables preserving autograft, indispensable in cardiovascular surgery. Nowadays, classical combined phlebectomy is replaced by endovascular techniques. The reason is that it is less traumatic, has a good aesthetic effect and a shorter rehabilitation period. Laser coagulation proves to become a priority trend in treating varicose vein disease, as an instrument of so-called “office surgery” when patients can leave the medical center on their own and proceed with their usual activities in a short time. All known treatment techniques should not be considered as rivals. Combination of various treatment techniques with consideration to their peculiarities makes it possible to achieve better clinic results than when aiming at a single technique. The main criterion to choose a treatment technique is preoperative vascular ultrasonography, which determines anatomic and morphological peculiarities of varicose vein disease, special features of hemodynamic disorders and helps select an optimal treatment option.

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Characterization and clinical course of 1000 patients with COVID-19 in New York: retrospective case series

10.1101/2020.04.20.20072116 ◽

2020 ◽

Cited By ~ 15

Author(s):

Michael G Argenziano ◽

Samuel L Bruce ◽

Cody L Slater ◽

Jonathan R Tiao ◽

Matthew R Baldwin ◽

...

Keyword(s):

New York ◽

Medical Record ◽

Symptom Onset ◽

Clinical Course ◽

Medical Center ◽

Academic Medical Center ◽

Bimodal Distribution ◽

Hospitalized Patients ◽

Icu Patients ◽

Presenting Symptoms

AbstractObjectiveTo characterize patients with coronavirus disease 2019 (COVID-19) in a large New York City (NYC) medical center and describe their clinical course across the emergency department (ED), inpatient wards, and intensive care units (ICUs).DesignRetrospective manual medical record review.SettingNewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), a quaternary care academic medical center in NYC.ParticipantsThe first 1000 consecutive patients with laboratory-confirmed COVID-19.MethodsWe identified the first 1000 consecutive patients with a positive RT-SARS-CoV-2 PCR test who first presented to the ED or were hospitalized at NYP/CUIMC between March 1 and April 5, 2020. Patient data was manually abstracted from the electronic medical record.Main outcome measuresWe describe patient characteristics including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition.ResultsAmong the first 1000 patients, 150 were ED patients, 614 were admitted without requiring ICU-level care, and 236 were admitted or transferred to the ICU. The most common presenting symptoms were cough (73.2%), fever (72.8%), and dyspnea (63.1%). Hospitalized patients, and ICU patients in particular, most commonly had baseline comorbidities including of hypertension, diabetes, and obesity. ICU patients were older, predominantly male (66.9%), and long lengths of stay (median 23 days; IQR 12 to 32 days); 78.0% developed AKI and 35.2% required dialysis. Notably, for patients who required mechanical ventilation, only 4.4% were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at 3-4 and 9 days. As of April 30, 90 patients remained hospitalized and 211 had died in the hospital.ConclusionsHospitalized patients with COVID-19 illness at this medical center faced significant morbidity and mortality, with high rates of AKI, dialysis, and a bimodal distribution in time to intubation from symptom onset.

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Who cares? Perception of loneliness in patients treated for coronary heart disease

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.113 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

M Blakoe ◽

SK Berg ◽

IE Hoejskov ◽

P Palm ◽

C Bernild

Keyword(s):

Social Support ◽

Coronary Heart Disease ◽

Heart Disease ◽

Social Network ◽

Emotional Support ◽

Early Rehabilitation ◽

Critical Event ◽

Emotional Pain ◽

Rehabilitation Period ◽

Insight Into

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): University hospital of Copenhagen, Rigshospitalet research grant Background When patients are treated for Coronary heart disease (CHD), social support is known to be essential for them to adapt mentally and behaviourally to this critical event (1, 2). However, a substantial part of the CHD population experience loneliness in their everyday life, which places them in a vulnerable situation in the early rehabilitation period, as this period is characterized by an increased need for practical, informational and emotional support (3, 4) . Aim To provide insight into the nuances and complexity of loneliness, as well as the impact on health behaviour, in the early rehabilitation period following CHD treatment. Method This qualitative study has a philosophical hermeneutic approach. Patients classified as lonely during hospitalization in a social support questionnaire, were interviewed 8-12 weeks following discharge in either focus group (n = 7) or individual interview (n = 10) sessions. The empirical material was analysed using inductive content analysis. Results The analysis of the data produced three themes: i) A life in loneliness, ii) The changed, but unmet, need for social support, iii) Symmetry and asymmetry in relationships. Each theme contained of three sub-themes. A consistent finding was participants’ experience of shock related to the CHD event and the fundamental uncertainty to which it led, which increased the feeling of loneliness as an emotional pain. Participants experienced loneliness, not in relation to the lack of quantity of social network members, but in relation to the deficient quality of the relationships. In this regard, they described mutual and complimentary mechanisms that impacted how and from whom they could receive adequate social support. Participants described how dyadic relational mechanisms could either promote or limit who they could ask for social support as they experienced a need for reciprocity in the relationship, in order to receive practical and emotional support. Furthermore, a main finding was the participants experience on how loneliness affected their abilities to adapt to the critical event and manage health behavioural changes in the rehabilitation period. Conclusion In patients with coronary heart disease, loneliness is experienced as an emotional pain that negatively influenced the ability to adapt to the critical event and manage health behavioural changes. Participants assessed societal, dyadic and psychological mechanisms to impact their access to support from social network members. Perspective Insight into the patients’ experience of loneliness and the mechanisms mediating loneliness can enhance nursing care practice and inform future social support interventions.

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