2009 Nov - Arrhythmias and increased neuro-endocrine stress response during physicians' night shifts: a randomized cross-over trial.

Rauchenzauner M, Ernst F, Hintringer F, Ulmer H, Ebenbichler CF, Kasseroler MT, et al.; Eur Heart J. 2009 Nov;30(21):2606-13.
AIMS: To evaluate the effects of a 24 h (h) physicians on-call duty (OCD) ('night shift') on 24 h electrocardiogram (ECG), heart rate variability, blood pressure (BP), and various biochemical serum and urine 'stress markers' compared with a 'regular' day at work.

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2009 Dec - Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study.

Donaldson LJ, Rutter PD, Ellis BM, Greaves FEC, Mytton OT, Pebody RG, et al.; BMJ. 2009;339:b5213.
The research finds: i) the current estimated case fatality rate, using an estimate of symptomatic cases in the community as the denominator, is lower than previous estimates; ii) in the current pandemic children have experienced the highest attack rate and the lowest case fatality rates, while older people are much less susceptible but are more likely to die when affected.

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2009 Dec - Use of colour-coded labels for intravenous high-risk medications and lines to improve patient safety.

Porat N, Bitan Y, Shefi D, Donchin Y, Rozenbaum H.; Qual Saf Health Care. 2009 Dec;18(6):505-9.
PROBLEM: Labelling of high-risk drug infusions and lines is a well-recognised safety strategy to prevent medication errors. Although hospital wards characterised by multiple high-risk drug infusions use different types of labelling, little is known about the contribution of a colour-coded label (CCL) to patient safety.

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2009 Dec - Molar Pregnancy-induced Thyroid Storm

Moskovitz JB, Bond MC.; J Emerg Med. 2009 Dec 1.
Background: Molar pregnancy is a rare form of pregnancy, affecting approximately 1 in 1000 pregnancies in the United States. Hyperthyroidism is a rare complication of molar pregnancy; thyroid storm occurs even less frequently.

Objectives: To discuss a rare cause of thyroid storm in a woman of reproductive age.

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2009 Oct - Efficacy and Safety of Dopamine versus Norepinephrine in the Management of Septic Shock.

Patel GP, Grahe JS, Sperry M, Singla S, Elpern E, Lateef O, Balk RA.; Shock. 2009 Oct 21.
BACKGROUND:: The optimum septic shock vasopressor support strategy is currently debated. This study was performed to evaluate the efficacy and safety of norepinephrine and dopamine as the initial vasopressor in septic shock patients who were managed with a specific treatment protocol.

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2009 Nov - Safety, effectiveness, and practicality of endovascular therapy within the first 3 hours of acute ischemic stroke onset.

Mathews MS, Sharma J, Snyder KV, Natarajan SK, Siddiqui AH, Hopkins LN, Levy EI.; Neurosurgery. 2009 Nov;65(5):860-5
OBJECTIVE: This study assesses the safety, effectiveness, and practicality of endovascular therapy for ischemic stroke within the first 3 hours of symptom onset.

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2009 Oct - Atrial natriuretic peptide for preventing and treating acute kidney injury.

Nigwekar SU, Navaneethan SD, Parikh CR, Hix JK.; Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006028.
BACKGROUND: Acute kidney injury (AKI) is common in hospitalised patients and is associated with significant morbidity and mortality. Despite recent advances, outcomes have not substantially changed in the last four decades. Atrial natriuretic peptide (ANP) has shown promise in animal studies, however randomised controlled trials (RCTs) have shown inconsistent clinical benefits.

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2009 Oct - Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial.

Stiell IG, Clement CM, Grimshaw J, Brison RJ, Rowe BH, Schull MJ, Lee JS, Brehaut J, McKnight RD, Eisenhauer MA, Dreyer J, Letovsky E, Rutledge T, MacPhail I, Ross S, Shah A, Perry JJ, Holroyd BR, Ip U, Lesiuk H, Wells GA.; BMJ. 2009 Oct 29;339:b4146.
OBJECTIVE: To evaluate the effectiveness of an active strategy to implement the validated Canadian C-Spine Rule into multiple emergency departments.

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2009 Nov - Predictors of adopting therapeutic hypothermia for post-cardiac arrest patients among Canadian emergency and critical care physicians.

Bigham BL, Dainty KN, Scales DC, Morrison LJ, Brooks SC.; Resuscitation. 2009 Nov 12.
Therapeutic hypothermia improves outcomes in resuscitated cardiac arrest patients, but prior application rates are less than 30%. We sought to evaluate self-reported physician adoption, predictors of adoption, and barriers to use among Canadian emergency and critical care physicians.

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2009 Dec - Hepatocellular integrity after parenteral nutrition: comparison of a fish-oil-containing lipid emulsion with an olive-soybean oil-based lipid emulsion.

Piper SN, Schade I, Beschmann RB, Maleck WH, Boldt J, Röhm KD.; Eur J Anaesthesiol. 2009 Dec;26(12):1076-82.
BACKGROUND AND OBJECTIVE: Parenteral nutrition including lipids might be associated with liver disease. The cause leading to parenteral nutrition-related liver dysfunction remains largely unknown but is likely to be multifactorial. The study was performed to assess the effects of a lipid emulsion based on soybean oil, medium-chain triglycerides, olive and fish oil (SMOFlipid20%) compared with a lipid emulsion based on olive and soybean oil on hepatic integrity.

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2009 Nov - Acute lower GI bleeding for the acute care surgeon: current diagnosis and management [Review]

Lee J, Costantini TW, Coimbra R.; Scand J Surg. 2009;98(3):135-142.
Lower gastrointestinal bleeding is a common cause for hospital admission that results in sig-nificant morbidity and mortality. After initial resuscitation of the patient, the diagnosis and treatment of lower gastrointestinal bleeding remains a challenge for acute care surgeons. Iden-tifying the source of bleeding can be difficult since many patients bleed intermittently or stop bleeding spontaneously.

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2009 Nov - Statins in the Management of Patients with Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Kramer AH, Fletcher JJ.; Neurocrit Care. 2009 Nov 17.
Background: Delayed ischemic neurological deficits (DINDs) contribute to morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). Based on promising preliminary reports, some clinicians routinely administer statins to prevent DINDs.

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2009 Sep - The bacterial challenge: time to react.

European Centre for Disease Prevention and Control

This document reports on the gap between bacterial resistance in the European Union and the availability of new treatments against multidrug-resistance bacteria.

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2009 Nov - Perioperative management of warfarin and antiplatelet therapy

Jaffer AK.; Cleve Clin J Med. 2009 Nov;76 Suppl 4:S37-44.
Perioperative management of patients on warfarin or antiplatelet therapy involves assessing and balancing individual risks for thromboembolism and bleeding. Discontinuing anticoagulant and antiplatelet therapy is usually necessary for major surgery but increases the risk of thrombotic events. Bridge therapy, the temporary perioperative substitution of low-molecular-weight heparin or unfractionated heparin in place of warfarin, is an effective means of reducing the risk of thromboembolism but may increase the risk of bleeding.

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2009 Nov - Perioperative fluid management: Progress despite lingering controversies

MARK A. HAMILTON; Cleveland Clinic Journal of Medicine 2009; 76(Suppl 4):S28-S31
Perioperative fluid management remains controversial. Nevertheless, its optimization is essential to reducing the risk of postoperative complications, which have been shown to profoundly affect patients’ short- and long-term outcomes. Current evidence favors a “flow-guided” approach to perioperative fluid administration, which uses variables such as stroke volume and cardiac output as the basis for guiding fluid requirements.

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2009 Nov - Cardiac risk stratification for noncardiac surgery: update from the American College of Cardiology/American Heart Association 2007 guidelines.

Fleisher LA; American College of Cardiology/American Heart Association.; Cleve Clin J Med. 2009 Nov;76 Suppl 4:S9-15.
The American College of Cardiology and American Heart Association updated their joint guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery in 2007. The guidelines recommend preoperative cardiac testing only when the results may influence patient management. They specify four high-risk conditions for which evaluation and preoperative treatment are needed: unstable coronary syndromes, decompensated heart failure, significant cardiac arrhythmias, and severe valvular disease.

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2009 Sep - Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation.

Christenson J, Andrusiek D, Everson-Stewart S, Kudenchuk P, Hostler D, Powell J, Callaway CW, Bishop D, Vaillancourt C, Davis D, Aufderheide TP, Idris A, Stouffer JA, Stiell I, Berg R; Resuscitation Outcomes Consortium Investigators.; Circulation. 2009 Sep 29;120(13):1241-7. Epub 2009 Sep 14.
BACKGROUND: Quality cardiopulmonary resuscitation contributes to cardiac arrest survival. The proportion of time in which chest compressions are performed in each minute of cardiopulmonary resuscitation is an important modifiable aspect of quality cardiopulmonary resuscitation. We sought to estimate the effect of an increasing proportion of time spent performing chest compressions during cardiac arrest on survival to hospital discharge in patients with out-of-hospital ventricular fibrillation or pulseless ventricular tachycardia.

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2008 Sep - European trial of free light chain removal by extended haemodialysis in cast nephropathy (EuLITE): A randomised control trial.

Hutchison CA, Cook M, Heyne N, Weisel K, Billingham L, Bradwell A, Cockwell P. European trial of free light chain removal by extended haemodialysis in cast nephropathy (EuLITE): A randomised control trial. Trials. 2008 Sep 28;9:55.

Figure. The Gambro HCO 1100 (a high cut-off protein permeable membrane which offers significantly higher permeability for substances in the molecular weight range 15 to 45 kDa) as used in ICU, Pamela Youde Nethersole Eastern Hospital, Hong Kong
ABSTRACT: BACKGROUND: Renal failure is a frequent complication of multiple myeloma and when severe is associated with a greatly increased morbidity and mortality. The principal cause of severe renal failure is cast nephropathy, a direct consequence of high concentrations of monoclonal free light chains (FLCs) in patients' sera. FLC removal by extended haemodialysis, using a high cut-off dialyser, has recently been described as a novel therapeutic option.

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2009 Nov 3 - Review: Systematic Review: Sodium Bicarbonate Treatment Regimens for the Prevention of Contrast-Induced Nephropathy

Sophia Zoungas, MD, PhD; Toshiharu Ninomiya, MD, PhD; Rachel Huxley, DPhil; Alan Cass, MD, PhD; Meg Jardine, MD, PhD; Martin Gallagher, MD; Anushka Patel, MD, PhD; Ali Vasheghani-Farahani, MD; Gelareh Sadigh, MD; and Vlado Perkovic, MD, PhD. Annals Int Med, November 3, 2009, vol. 151 no. 9 631-638

Figure. Chemical structure of sodium bicarbonate
Background: Intravenous sodium bicarbonate has been proposed to reduce the risk for contrast-induced nephropathy (CIN).

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2009 Aug - Anaesthetic management under field conditions after the 12 May 2008 earthquake in Wenchuan, China.

Jiang J, Xu H, Liu H, Yuan H, Wang C, Ye J.; Injury. 2009 Aug 18.
OBJECTIVE: To summarise our experiences of anaesthetic management under field conditions after the Wenchuan earthquake, China, on 12 May 2008.

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