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991.
A case of electromagnetic interference between HeartMate 3 LVAD and implantable cardioverter defibrillator 
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下载免费PDF全文 Samineh Sehatbakhsh Alexander Kushnir Mohamad Kabach Matthew Kolek Robert Chait Waqas Ghumman 《Pacing and clinical electrophysiology : PACE》2018,41(2):218-220
Implantable cardioverter defibrillators (ICDs) have been shown to have a significant benefit in reducing sudden cardiac death (SCD) in patients with systolic heart failure. Additionally, cardiac devices as a bridge to transplant or destination therapy are often used in patients with end‐stage systolic heart failure. As a result, most patients with left ventricular assist devices (LVADs) also have an ICD. Here, we present an electromagnetic interference (EMI) between HeartMate 3 LVAD and ICD. This issue might be critical for both electrophysiologists and advanced heart failure cardiologists to understand prior to implantation of ICD/LVADs in these patients. 相似文献
992.
Marcalee Alexander Khurram Bashir Craig Alexander Lesley Marson Raymond Rosen 《Archives of physical medicine and rehabilitation》2018,99(2):299-305
Objective
To examine the safety and efficacy of using a clitoral vacuum suction device (CVSD) versus vibratory stimulation (V) to treat orgasmic dysfunction in women with multiple sclerosis (MS) or spinal cord injury (SCI).Design
Randomized clinical trial.Setting
Two academic medical centers.Participants
Women (N=31) including 20 with MS and 11 with SCI.Intervention
A 12-week trial of the use of a CVSD versus V.Main Outcome Measures
Female Sexual Function Inventory (FSFI) and Female Sexual Distress Scale (FSDS).Results
Twenty-three women (18 MS, 5 SCI) completed the study including 13 of 16 randomized to CVSD and 10 of 15 randomized to V. There was a statistically significant increase in total FSFI score (P=.011), desire (P=.009), arousal (P=.009), lubrication (P=.008), orgasm (P=.012), and satisfaction (P=.049), and a significant decrease in distress as measured by FSDS (P=.020) in subjects using the CVSD. In subjects who used V, there was a statistically significant increase in the orgasm subscale of the FSFI (P=.028). Subjects using the CVSD maintained improvements 4 weeks after treatment.Conclusions
CVSD is safe and overall efficacious to treat female neurogenic sexual dysfunction related to MS and SCI. V is also safe and efficacious for female neurogenic orgasmic dysfunction; however, results were limited to the active treatment period. Because of ease of access and cost, clinicians can consider use of V for women with MS or SCI with orgasmic dysfunction. CVSD is recommended for women with multiple sexual dysfunctions or for whom V is ineffective. 相似文献993.
Jon J. Ford Matt C. Richards Luke D. Surkitt Alexander Y.P. Chan Sarah L. Slater Nicholas F. Taylor Andrew J. Hahne 《Archives of physical medicine and rehabilitation》2018,99(12):2504-2512.e12
Objective
To identify predictors for back pain, leg pain, and activity limitation in patients with early persistent low back disorders (LBDs).Design
Prospective inception cohort study.Setting
Primary care private physiotherapy clinics in Melbourne, Australia.Participants
Individuals (N=300) aged 18-65 years with low back and/or referred leg pain of ≥6 weeks and ≤6 months duration.Interventions
Not applicable.Main Outcome Measures
Numeric rating scales for back pain and leg pain as well as the Oswestry Disability Scale.Results
Prognostic factors included sociodemographics, treatment related factors, subjective/physical examination, subgrouping factors, and standardized questionnaires. Univariate analysis followed by generalized estimating equations were used to develop a multivariate prognostic model for back pain, leg pain, and activity limitation. Fifty-eight prognostic factors progressed to the multivariate stage where 15 showed significant (P<.05) associations with at least 1 of the 3 outcomes. There were 5 indicators of positive outcome (2 types of LBD subgroups, paresthesia below waist, walking as an easing factor, and low transversus abdominis tone) and 10 indicators of negative outcome (both parents born overseas, deep leg symptoms, longer sick leave duration, high multifidus tone, clinically determined inflammation, higher back and leg pain severity, lower lifting capacity, lower work capacity, and higher pain drawing percentage coverage). The preliminary model identifying predictors of LBDs explained up to 37% of the variance in outcome.Conclusions
This study evaluated a comprehensive range of prognostic factors reflective of both the biomedical and psychosocial domains of LBDs. The preliminary multivariate model requires further validation before being considered for clinical use. 相似文献994.
Cognitive‐Behavioral Therapy for Insomnia to Reduce Chronic Migraine: A Sequential Bayesian Analysis 下载免费PDF全文
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996.
Use of Ultrasound Contrast Agents in Relation to Percutaneous Interventional Procedures: A Systematic Review and Pictorial Essay 下载免费PDF全文
下载免费PDF全文 Christian Pállson Nolsøe MD PhD Alexander Bjørneboe Nolsøe MD Jeanett Klubien MD Hans‐Christian Pommergaard MD PhD Jacob Rosenberg MD DSc Maria Franca Meloni MD Torben Lorentzen MD PhD 《Journal of ultrasound in medicine》2018,37(6):1305-1324
The aim of this article is to provide an inventory of the use of contrast‐enhanced ultrasound (CEUS) in relation to percutaneous interventional procedures. The article is structured into a systematic literature review followed by a clinical part relating to percutaneous CEUS‐guided procedures. A literature search identified 3109 records. After abstract screening, 55 articles were analyzed and supplemented with pictorial material to explain the techniques. In conclusion, the best‐evidenced indications for CEUS‐guided interventions are biopsy and ablation of inconspicuous or B‐mode–invisible tumors, intraprocedural ablation control and follow‐up, as well as percutaneous transhepatic cholangiography and drainage procedures. 相似文献
997.
Mary S. Jacob Paige Kulie Cameron Benedict Alexander J. Ordoobadi Neal Sikka Erika Steinmetz Melissa L. McCarthy 《The American journal of emergency medicine》2018,36(1):61-65
Objectives
Urine microscopy is a common test performed in emergency departments (EDs). Urine specimens can easily become contaminated by different factors, including the collection method. The midstream clean-catch (MSCC) collection technique is commonly used to reduce urine contamination. The urine culture contamination rate from specimens collected in our ED is 30%. We developed an instructional application (app) to show ED patients how to provide a MSCC urine sample. We hypothesized that ED patients who viewed our instructional app would have significantly lower urine contamination rates compared to patients who did not.Methods
We prospectively enrolled 257 subjects with a urinalysis and/or urine culture test ordered in the ED and asked them to watch our MSCC instructional app. After prospective enrollment was complete, we retrospectively matched each enrolled subject to an ED patient who did not watch the instructional app. Controls were matched to cases based on gender, type of urine specimen provided, ED visit date and shift. Urinalysis and urine culture contamination results were compared between the matched pairs using McNemar's test.Results
The overall urine culture contamination rate of the 514 subjects was 38%. The majority of the matched pairs had a urinalysis (63%) or urinalysis plus urine culture (35%) test done. There were no significant differences in our urine contamination rates between the matched pairs overall or when stratified by gender, by prior knowledge of the clean catch process or by type of urine specimen.Conclusion
We did not see a lower contamination rate for patients who viewed our instructional app compared to patients who did not. It is possible that MSCC is not effective for decreasing urine specimen contamination. 相似文献998.
Joseph B. Miller Alexander Lee Julian P. Suszanski Madison Tustian Jessica Levely Corcoran Steven Moore Lauren Rodriguez Christopher A. Lewandowski 《The American journal of emergency medicine》2018,36(6):1018-1021
Introduction
Retrospective data indicates that dehydration in acute ischemic stroke patients may be common, even though these patients frequently have elevated blood pressure. We sought to evaluate clinical and laboratory measures of intravascular volume status compared to more objective measures using ultrasound measurements of the inferior vena cava (IVC).Methods
This was a prospective observation study of acute ischemic stroke patients in the emergency department. Patients with NIH stroke scale ≥4 within 12?h of symptom onset were included. A trained ultrasonographer performed bi-dimensional imaging of the IVC with passive respiration to determine the percent inspiratory collapse and maximum diameter. We defined low intravascular volume as >50% IVC collapse and a maximal diameter?<?2.1?cm. Analysis was limited to patients with confirmed ischemic stroke.Results
There were 42 patients, of whom 31 had confirmed acute ischemic stroke. The mean age was 65?±?15?years, 52% were female, and 71% were hypertensive. The median NIH stroke scale score was 7 (IQR 5–15). Based on IVC ultrasound, low intravascular volume was present in 63% (95% CI 44–80%) of patients. A higher proportion of hypertensive patients had low intrasvascular volume (72% vs. 33%). There was poor correlation between IVC assessment of intrasvascular volume and blinded clinician assessment or laboratory markers of dehydration.Conclusion
The majority of ED acute ischemic stroke patients in this sample were hypertensive and demonstrated low intravascular volume based on IVC ultrasound. 相似文献999.
Kathy Boutis Jocelyn Gravel Stephen B. Freedman William Craig Ken Tang Carol A. DeMatteo Alexander Sasha Dubrovsky Darcy Beer Emma Burns Gurinder Sangha Roger Zemek 《The Journal of emergency medicine》2018,54(6):757-765
Background
The accurate identification of children with a concussion by emergency physicians is important to initiate appropriate anticipatory guidance and management.Objectives
We compared the frequency of persistent concussion symptoms in children who were provided the diagnosis of concussion by an emergency physician versus those who met Berlin/Zurich international criteria for this diagnosis. We also determined the clinical variables independently associated with a physician-diagnosed concussion.Methods
This was a planned secondary analysis of a prospective, multicenter cohort study. Participants were 5–17 years of age and met the Zurich/Berlin International Consensus Statement criteria for concussion.Results
There were 2946 enrolled children. In those with physician-diagnosed concussion vs. no concussion, the frequency of persistent symptoms was 62.5% vs. 38.8% (p < 0.0001) at 1 week, 46.3% vs. 25.8% (p < 0.0001) at 2 weeks, and 33.0% vs. 23.0% (p < 0.0001) at 4 weeks. Of those meeting international criteria, 2340 (79.4%) were diagnosed with a concussion by an emergency physician and 12 variables were associated with this diagnosis. Five had an odds ratio (OR) > 1.5: older age (13–17 vs. 5–7 years, OR 2.9), longer time to presentation (≥16 vs. <16 h, OR 2.1), nausea (OR 1.7), sport mechanism (OR 1.7), and amnesia (OR 1.6).Conclusions
Relative to international criteria, the more selective assignment of concussion by emergency physicians was associated with a greater frequency of persistent concussion symptoms. In addition, while most children meeting international criteria for concussion were also provided this diagnosis for concussion by an emergency physician, the presence of 5 specific variables made this diagnosis more likely. 相似文献1000.
Ly Thuy Nguyen Kimberly Alexander Patsy Yates 《Journal of pain and symptom management》2018,55(6):1459-1472