Sonali Advani, MBBS
- Assistant Professor of Medicine
https://medicine.duke.edu/faculty/sonali-advani-mbbs
Multidisciplinary rounds have been shown to improve efficiency blood pressure medication joint pain buy torsemide 20mg overnight delivery, outcome heart attack 51 buy 20mg torsemide with amex, and reduce the cost of 16 Physical Therapist Occupational Therapist Clinical Dietitian Speech Therapist Social Worker care blood pressure hypertension buy generic torsemide 20mg line. These models utilize large databases of patient information that compare outcomes among similar groups of critically ill patients arrhythmia pac cheap torsemide 20mg otc. Halpern N, Pastores S: Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Critical care medicine beds, use occupancy, and costs in the United States: A methodological review. Thompson D, Hamilton D, Cadenhead C, et al: Guidelines for intensive care unit design. Nighttime intensivist staffing, mortality, and limits on life support: A retrospective cohort study. Kerlin M, Small D, Cooney E, et al: A randomized trial of nighttime physician staffing in the intensive care unit. Needleman J, Buerhaus P, Pankratz S, et al: Nurse staffing and inpatient hospital mortality. Curtis J, Cook D, Wall R, et al: Intensive care unit quality improvement: A "how-to" guide for the interdisciplinary team. A care bundle refers to the use of a limited set of evidencebased interventions consistently applied to a specific clinical situation b. Consistent use of care bundles have not conclusively demonstrated improved patient outcomes d. A care bundle exists for the placement and care of an indwelling urinary catheter 3. Has not been demonstrated to appreciably reduce the incidence of medical errors 4. The National Patient Safety Foundation defines safety as "avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the processes of health care. Patient safety emphasizes harm prevention by creating resilient systems that work in non-routine operating conditions. Quality improvement, on the other hand, is often framed in terms of its success, which explains the abundance of information on quality initiatives relative to that of safety data. A few health care systems have successfully adopted these strategies, while other attempts have been unsuccessful, generating controversy over their usefulness. High hazard industries, such as commercial air travel, nuclear power, and naval aviation, are another area from which safety concepts have been adopted. Many of these organizations are able to deliver consistently high performance in situations that have a low tolerance for error. Leape and Berwick posited that the culture of medicine is one of the biggest impediments to patient safety progress. Crit Care 2011; 15:314 22 individual performance and a commitment to research contributed to significant advances in modern medicine. Surviving Sepsis Campaign) has improved efficiency, reduced costs, and decreased complications. Enacting a comparable policy would cost little, place minimal burden on nursing staff, and potentially save countless lives. Thus, the key to improved outcomes will involve better integration of the current technology. Incremental biomedical advancement pales in comparison to the conceivable harm reduction buoyed by a culture supporting multidisciplinary communication and quality improvement at every level. Progress is slow, but cultivating a highly collaborative working environment with safety and quality as the top priority will bring us closer to the ultimate goal of zero patient harm. Institute of Medicine: Crossing the Quality Chasm: A New Health System for the 21st Century.
If left untreated arrhythmia names buy 10mg torsemide free shipping, these patients have a poor prognosis with a median survival of 4-21 months hypertension prognosis discount torsemide 20mg mastercard, a three-year survival rate of three percent blood pressure levels chart quality 20mg torsemide, and virtually no five-year survival prehypertension home remedies generic 10 mg torsemide with amex. Traditional external whole-beam radiation therapy is of limited use for patients diagnosed with liver cancer, as the liver can only tolerate 30 to 35 Grays (Gy) before radiation-induced disease occurs. This low radiation dosage is non-tumoricidal and may not improve patient mortality. Researchers have recently taken advantage of this knowledge by attempting to deliver Yttrium-90 radiation microspheres directly into liver tumors. By selectively infusing radioactive material into the left, right or common hepatic artery, a concentrated dosage of radiation can be delivered directly into the tumor bed, while conserving the normal liver tissue that surrounds the tumor. The size of the microspheres causes them to become entrapped within the tumor vasculature and retained within the tumor. Access to the hepatic artery may be accomplished via a percutaneous femoral or gastroduodenal arterial catheter or a porta-cath that is radiologically guided into the liver. The total radioactivity required by a patient will be dependent on the extent and presentation of the tumor tissue. Yttrium-90 is a beta emitter which decays to stable zirconium-90, to which hepatic tumors and healthy liver tissue are sensitive. Sir-Spheres are infused over a 10-minute period to provide an average radiation dose of 200 to 300 Gy to the tumor with an average of 15-50 Gy to the normal liver parenchyma. These microspheres are injected via the hepatic artery, under direct monitoring, into either the right or left lobe of the liver. They are not biodegradable and should not redistribute to other organs of the body. Patients typically receive only two treatments to each lobe of the liver, given at approximately two-month intervals. No studies have been done on the safety and effectiveness of this device in pregnant women, nursing mothers or children. Radiation pneumonitis has been seen in patients receiving doses of yttrium-90 greater than 30 Grays (Gy) in a single treatment with vascular abnormalities, bleeding diathesis, or portal vein thrombosis thus making catheterization of the hepatic artery a contraindication with severe liver dysfunction, pulmonary insufficiency, or any prior intrahepatic chemotherapy; or who are currently pregnant or nursing Patients with severe underlying liver diseases are not candidates for this type of therapy. The patients within this study had cancer that was non-responsive to polychemotherapy and/or local therapy. Two additional patients showed stable findings, while one additional patient showed progressive disease. The researchers concluded that additional studies are needed to determine if this therapy should be used as a stand-alone or as an adjunct to other treatments. After determining the best treatment combination then long-term survival for these patients may be improved. Patients with extrahepatic disease were also enrolled if the liver was the primary site of tumor origin. This study involved the use of a mixed population, and two varying treatment protocols. The Page 3of12 Coverage Position Number: 0081 researchers concluded that additional studies are needed to stratify exactly which patients these therapies may be appropriate for use with, as it may be useful for treatment in patients who have exhausted chemotherapeutic options. The systemic chemolytic agents used were fluorouracil and leucovorin delivered for five consecutive days and repeated at four week intervals. Prior to the administration of the microspheres, these patients were given an injection of Angiotension 2, with the Sir-Spheres being injected after a 30-second delay. This post-treatment scan was read by a radiologist who was blinded to the treatment that the patient had received. Ten patients were recorded as having a partial response in the combined therapy group with a median progression of their disease occurring at 18. The researchers reported that there are limited conclusions that can be determined from this study. Not all patients returned for follow-up scanning or continued rounds of chemotherapy. These results were documented through the analysis of four explanted livers previously treated with yttrium-90 microspheres. Tumor vasculature plays an important part in the delivery of microsphere therapy; tumoricidal doses of radiation must be patient specific to protect the viability of the surrounding normal liver tissue. The differences, between these microsphere agents, is the amount of radiation delivered per microsphere. During micosphere therapy it is vital that lung shunting is kept at a minimum of 30 Gy or below, to prevent radiation pneumonitis.
Epidemiological data show that radiation can increase plaque vulnerability and chance of rupture blood pressure chart bhf buy torsemide 10mg cheap, but the mechanisms behind this acceleration are not understood blood pressure difference in arms purchase 20 mg torsemide with mastercard. The study of radiation and mechanics together may help to improve long-term cardiovascular outcomes in cancer patients blood pressure lowering medications trusted torsemide 10 mg, but it is difficult to control for the contributions of radiation and mechanics together blood pressure normal limit buy 10mg torsemide with mastercard. To test the responses of the hydrogel co-culture, samples were irradiated with 0 or 2 Gy of 137Cs -rays. In conclusion, a hydrogel-based co-culture model of atherosclerotic plaque was successfully created in a manner mimicking the spatial orientation of stable atherosclerotic plaques that might be caused to progress and destabilize by thoracic radiation. Future work with the model developed will focus on incorporating it into force-generating bioreactors to study how altered mechanics and radiation can intersect to increase plaque vulnerability and rupture in patients treated with thoracic radiation. Deletion of the miR379/410 cluster in mice confers a partial perinatal lethal phenotype wherein a significant proportion of newborn pups die after birth due to liver-related issues, and the surviving ones present with anxiety-related behaviors. The result is a feedback cycle of refining the vulnerable parts of the prediction models and identifying the right intervention strategy to diagnose future patients. In practice, however, we often find the provision of gold-standard labels from clinical data sources to be noisy and incomplete. Clinically measurements such as blood tests and imaging are sampled at sparse intervals, and small fluctuations in certain features frequently lead to unstable performance in the resulting models. Many studies have profiled cell states across the immune compartment in melanoma in the context of immunotherapy. However, an integrated and comprehensive understanding of response to therapy requires incorporation of all components of the tumor microenvironment, including a defined role of the non-immune components. Analysis of transcriptomic changes after immunotherapy demonstrate fibroblast reprogramming from a growth and survival, pro-tumor state to a pro-inflammatory,cell-recruiting state. These results implicate fibroblasts as important immune modulators in melanoma and as underexplored and promising therapeutic targets for influencing immune infiltration, immunotherapy success, and improved outcomes in the treatment of melanoma. Tortelli Candida colonization is associated with vaginal community state type in women of reproductive age Brett Tortelli1,2, Justin Fay1, Amanda Lewis3 1 onization more effectively than L. Candida is a common member of the vaginal microbial community and can frequently colonize asymptomatically. However, different relationships between vaginal Candida and bacteria have been reported. Determining the relationship between Candida and bacteria in the vagina remains important to understanding the role of vaginal microbiota in reproductive health. Mayo Clinic Medical Scientist Training Program, Neuroscience Program, 2Department of Neurology, 3Translational Neuroimmunology Lab. Vaginal swabs were used to characterize bacterial communities and Candida colonization. Of the 255 women in our analysis, an approximately equal number of black (47%) and white (53%) women were evaluated and forty-two (16%) were vaginally colonized with Candida. Despite the availability of dozens of therapeutics targeting neuronal electrophysiology, approximately of patients do not achieve adequate seizure control. Individuals with medically refractory epilepsy suffer from serious consequences associated with ongoing seizures, including progressive decline in cognitive function and increased risk of sudden unexplained death. In recent years a growing body of evidence has demonstrated an important role of neuroinflammation in the pathogenesis of epilepsy. Increased inflammation and loss of inhibitory neural tone is also associated with poor outcomes in behavioral tests of hippocampal function. Cancer, then, can be thought of as a wound that never heals, especially given that patients suffering from chronic wounds have increased risk of developing cancer. In addition to postoperative quality of life, insufficient postoperative pain therapy may have a negative effect on perioperative morbidity and mortality (Shipton and Tait 2005). Pain increases risks for pulmonary and cardiovascular complications and acute organ dysfunction (Joshi and Ogunnaike 2005). Ideally, analgesic strategies should be designed based on patient characteristics and surgical factors. Identification of predictive factors for postoperative pain would allow targeting of high risk patients, and facilitate early intervention.
Discount torsemide 10mg with mastercard. Braun ActivScan™ 9 - Upper arm blood pressure monitor.
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