Articles: cations.
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Multiple organ dysfunction syndrome (MODS) is associated with poor outcomes for trauma patients. Different forms of MODS may exist and have different consequences. The ability to distinguish them clinically may have implications for prognosis and treatment. We wished to study whether prolonged MODS (PRMODS) could be observed as a distinct clinical entity to early resolving MODS (ERMODS) in critically injured patients. ⋯ PRMODS appears common, a distinct clinical entity and associated with worse patient outcomes. PRMODS may represent an important endpoint for studies evaluating outcomes following trauma.
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Clin J Am Soc Nephrol · Oct 2016
Randomized Controlled TrialEffect of Patiromer on Urinary Ion Excretion in Healthy Adults.
Patiromer is a nonabsorbed potassium-binding polymer that uses calcium as the counterexchange ion. The calcium released with potassium binding has the potential to be absorbed or bind phosphate. Because binding is not specific for potassium, patiromer can bind other cations. Here, we evaluate the effect of patiromer on urine ion excretion in healthy adults, which reflects gastrointestinal ion absorption. ⋯ In healthy adults, patiromer reduces urine potassium, urine sodium, urine magnesium, and urine phosphate, while modestly increasing urine calcium. Compared with divided dosing, administration of patiromer once daily provides equivalent reductions in urine potassium, urine sodium, and urine magnesium, with less effect on urine calcium and urine phosphate.
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Internet and software-based platforms (e-learning) have gained popularity as teaching tools in medical education. Despite widespread use, there is limited evidence to support their effectiveness for surgical training. This study sought to evaluate the effectiveness of e-learning as a teaching tool compared with no intervention and other methods of surgical training. ⋯ Despite significant heterogeneity amongst platforms, e-learning is at least as effective as other methods of training.
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Multicenter Study Observational Study
Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes.
Vascular surgical care has changed dramatically in recent years with little knowledge of the impact of system failures on patient safety. The primary aim of this multicentre observational study was to define the landscape of surgical system failures, errors and inefficiency (collectively termed failures) in aortic surgery. Secondary aims were to investigate determinants of these failures and their relationship with patient outcomes. ⋯ Failure in aortic procedures is frequently caused by issues with team-working and equipment, and is associated with patient harm. Multidisciplinary team training, effective use of technology and new-device accreditation may improve patient outcomes.
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Comparative Study Observational Study
Timing of Pharmacologic Venous Thromboembolism Prophylaxis in Severe Traumatic Brain Injury: a Propensity-Matched Cohort Study.
Patients with severe traumatic brain injury (sTBI) are at high risk for developing venous thromboembolism (VTE). Nonetheless, pharmacologic VTE prophylaxis is often delayed out of concern for precipitating extension of intracranial hemorrhage (ICH). The purpose of this study was to compare the effectiveness of early vs late VTE prophylaxis in patients with sTBI, and to characterize the risk of subsequent ICH-related complication. ⋯ In this observational study of patients with sTBI, early initiation of VTE prophylaxis was associated with decreased risk of pulmonary embolism and deep vein thrombosis, but no increase in risk of late neurosurgical intervention or death. Early prophylaxis may be safe and should be the goal for each patient in the context of appropriate risk stratification.