Curēus
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Objectives While penicillin allergies are commonly reported, their cross-reactivity with beta-lactam antibiotics is minimal. First-line treatment of gonorrheal infections includes a cephalosporin. In emergency department (ED) environments, physicians must consider these potential allergies when selecting antibiotics for a patient with symptoms concerning for sexually transmitted infection (STI). ⋯ Conclusions Patients with penicillin allergies represent a recurring challenge for ED physicians when faced with antibiotic selection for STI symptoms concerning for gonorrheal infection. Those with penicillin allergies are significantly less likely to receive a cephalosporin antibiotic, though these remain the only universally accepted treatment for gonorrheal infections. These findings highlight the significant need for further physician and public education on allergies and antibiotic selection.
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Background Palliative care (PC) has a positive effect on symptom burden, quality of life, psychosocial communication, prognostic understanding, mood, and quality of care at the end of life of patients with advanced cancer. Objectives To investigate the timing of the first palliative consultation and referral of advanced cancer patients to the palliative care service and their determinants at King Faisal Specialist Hospital and Research Center (KFSHRC), Jeddah, Saudi Arabia. Subjects and methods A retrospective cohort study was conducted at KFSHRC. ⋯ Conclusion In a considerable proportion of terminal cancer patients, palliative care was consulted late, and the timing of palliative care referral was too late/much too late among most of those consulted palliative care. Length of survival was higher among patients who reported early PC consultation and who with ideal referral time to PC services than others. Therefore, future considerations to facilitate early integration of palliative care in cancer patients are highly recommended through mainly improving staff education in communication skills and palliative care approach.
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Background The Connecticut Orthopaedic Institute (COI) conceptualized a Pivot Plan during an elective surgery moratorium at the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic with the goal of planning and executing orthopedic procedures safely. With the resumption of elective surgeries and the continued planning of surgical recovery over the months (and possibly years) to follow, facilities must brace themselves for repeat waves of COVID-19. Thereby, herein we share the Pivot Plan, its implementation process, evaluation of patient safety, and program performance during a pandemic. ⋯ Conclusion The COI Pivot Plan was successfully implemented at two different hospitals offering elective orthopaedic surgeries to a varied patient population. The precautions taken by COI were effective in controlling the spread of the SARS-CoV-2 virus while returning to elective orthopaedic surgery. Furthermore, data collected before and after the onset of the COVID-19 pandemic indicated that program performance and quality improved.
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Optimum timing is crucial to avoid negative outcomes of weaning. We aimed to investigate predictive values of diaphragmatic thickening fraction (DTF), diaphragmatic excursion (DE), and anterolateral lung ultrasound (LUS) scores in extubation success and compare with rapid shallow breathing index (RSBI) in patients extubated under traditional parameters. ⋯ Investigating the lung and diaphragm via ultrasound provides real-time information to increase extubation success. Cut-off values of 64 for RSBI, 27.5 for DTF, 1.3 cm for the DE, and 6.5 for LUS scores were obtained, respectively, and PPVs of all sonographic parameters were found over 90%. We consider that sonographic evaluations accompanied by an RSBI will increase extubation success in the weaning process.
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Case Reports
A Case of Failure of EkoSonic™ Endovascular System in the Treatment of Submassive Pulmonary Embolism.
Submassive pulmonary embolism (SPE) is characterized by the presence of right ventricular (RV) strain as visualized on echocardiogram or CT scan with brain natriuretic peptide (BNP) and/or troponin elevation. The condition accounts for 20-25% of all pulmonary embolism (PE) cases. In cases of SPE, catheter-directed thrombolysis (CDT) is generally considered in the presence of severe hypoxemia, worsening RV dysfunction, patients with increasing tachycardia and elevated troponins, free-floating thrombus in the right atrium or RV, and presence of extensive clot burden. EkoSonic™ Endovascular System (EKOS; Boston Scientific, Marlborough, MA) has been successfully used to treat cases of PE even where systemic thrombolytic therapy has failed. ⋯ He was diagnosed with coronavirus disease 2019 (COVID-19) pneumonia during the hospitalization and had a delayed EKOS procedure with minimal improvement in oxygenation and clot burden. He subsequently underwent half-dose systemic thrombolytic therapy with complete resolution of his symptoms. Given our success with half-dose systemic therapy, we propose that it may be considered as a "rescue therapy" in cases where EKOS fails to deliver results.