6 research outputs found
Going Viral—RSV as the Neglected Adult Respiratory Virus
No full textHuman respiratory syncytial virus (RSV) is increasingly recognized as a significant viral pathogen in adults with acute respiratory illness, particularly in the elderly, the immunocompromised, and those with underlying cardiopulmonary disease. Although long acknowledged as one of the most common causes of upper respiratory tract infections (URI) in children since its discovery in 1956, the true burden of disease in adults is likely significantly under-recognized. The emerging evidence of RSV as a driver of morbidity and mortality in elderly and immunocompromised patients has sparked advances in vaccine development and renewed interest in quantifying the true burden of disease. This review attempts to summarize the findings of the most recent evidence investigating the burden of RSV related disease in adults and to highlight where future research is needed
An Interdisciplinary Approach to Combat Obesity in the Galapagos
No full textGalapagos Background Total Population (2010) = 25,1241 Largest city = Puerto Ayora (Santa Cruz) Average monthly income in Galapagos = 251.70/month2 Booming tourism industry contributes to rapid population growth3
4 of 18 main islands (\u3e1km2) open for human residence (Santa Cruz, Isabela, San Cristobal, Floreana
The Financial Dialogue in the Development of Medical Treatment Plans
No full textAs patients face increasingly high out-of-pocket costs and difficulties navigating the healthcare system, failing to discuss available treatment options in financial terms can lead to grave consequences for patients. Medical bills are responsible for the majority of bankruptcies in the United States. Given the severe financial implications of medical bills, it is imperative that patients become more involved in discussions of their treatment plans and become aware of the costs of their decisions up front. Counseling about costs ensures that physicians avoid placing a debilitating financial burden on patients and maintain adherence to the ethical principle of non-maleficence. Various studies have shown that physicians lack proper education in health economics, which makes navigation of this aspect of healthcare daunting. Finding a place for teaching economics and health policy has been difficult given the necessity to deliver a voluminous amount of scientific content during medical education. Nevertheless, physicians function as part of a healthcare industry that is not immune from the economic principles that govern commerce in any other service business. We suggest incorporation of customer service techniques from other business settings into the traditional practice of humanistic medicine in order to facilitate cost discussion and improve patient understanding. A physician’s job is to educate the patient about potential plans of action to solve his/her problem, and costs represent key pieces of information for optimizing treatment plans. In the end, it is the patient who is entitled to decide what is best, or, in other words, the customer is always right
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Ultrasonography of a Helical Left Common Carotid Artery
No full textCase Presentation: An 83-year-old woman was admitted to the intensive care unit for septic shock at which point an internal jugular central venous line was placed. The patient’s common carotid artery was visualized in an atypical location, lateral to the internal jugular vein. Further inspection revealed the common carotid artery travelling in a rotational trajectory around the internal jugular vein.Discussion: For at least two decades, point-of-care ultrasound has become the standard of care for placing central venous lines. This surprising anatomical orientation is rare and cautions physicians to fully explore a patient’s anatomy prior to placing central lines
Improving Outcomes in Nosocomial Pneumonia: Recent Evidence and More Challenges
No full textNosocomial pneumonia (NP) represents a leading nosocomial infection and results in substantial morbidity and cost. Over the last several years, the evidence has evolved which directs our approach to NP. Specifically, the definition of NP and classification of its various subtypes has expanded to capture nuances among various phenotypes of this syndrome. For example, segregating those with hospital-acquired pneumonia (HAP) based on whether they subsequently require mechanical ventilation has been shown to be important. Likewise, newer data indicate the true economic cost of NP and underscore the diverse range of pathogens that can cause NP. Moreover, multidrug-resistant (MDR) bacteria have become a major threat in NP. Fortunately, newer simple preventive strategies have been tested and found to be effective at reducing the incidence of NP. Should prevention fail, a range of new antibiotics have been formally studied in NP and found to be effective. Some of these novel agents have relatively broad ranges of activity and are in vitro active against select MDR organisms. Others, however, are narrower in spectrum and directed against specific problem bacteria. In short, the literature in the field of NP has progressed rapidly, and clinicians require a clear appreciation of these changes so as to improve patient outcomes
Critically Ill Adults With Coronavirus Disease 2019 in New Orleans and Care With an Evidence-Based Protocol
No full textBackground: Characteristics of critically ill adults with coronavirus disease 2019 (COVID-19) in an academic safety net hospital and the effect of evidence-based practices in these patients are unknown. Research Question: What are the outcomes of critically ill adults with COVID-19 admitted to a network of hospitals in New Orleans, Louisiana, and what is an evidence-based protocol for care associated with improved outcomes? Study Design and Methods: In this multi-center, retrospective, observational cohort study of ICUs in four hospitals in New Orleans, Louisiana, we collected data on adults admitted to an ICU and tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 9, 2020 and April 14, 2020. The exposure of interest was admission to an ICU that implemented an evidence-based protocol for COVID-19 care. The primary outcome was ventilator-free days. Results: The initial 147 patients admitted to any ICU and tested positive for SARS-CoV-2 constituted the cohort for this study. In the entire network, exposure to an evidence-based protocol was associated with more ventilator-free days (25 days; 0-28) compared with non-protocolized ICUs (0 days; 0-23, P =.005), including in adjusted analyses (P =.02). Twenty patients (37%) admitted to protocolized ICUs died compared with 51 (56%; P =.02) in non-protocolized ICUs. Among 82 patients admitted to the academic safety net hospital\u27s ICUs, the median number of ventilator-free days was 22 (interquartile range, 0-27) and mortality rate was 39%. Interpretation: Care of critically ill COVID-19 patients with an evidence-based protocol is associated with increased time alive and free of invasive mechanical ventilation. In-hospital survival occurred in most critically ill adults with COVID-19 admitted to an academic safety net hospital\u27s ICUs despite a high rate of comorbidities
