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21.
22.
Luis Alfonso Ortíz-Reyes Lilia Castillo-Martínez Arianne Itzel Lupián-Angulo Daniel Dante Yeh Héctor Isaac Rocha-González Aurora Elizabeth Serralde-Zúñiga 《Journal of the Academy of Nutrition and Dietetics》2018,118(1):52-61
Background
Unintentional underfeeding is common in patients receiving enteral nutrition (EN), and is associated with increased risk of malnutrition complications. Protocols for EN in critically ill patients have been shown to enhance adequacy, resulting in better clinical outcomes; however, outside of intensive care unit (ICU) settings, the influence of a protocol for EN is unknown.Objective
To evaluate the efficacy and safety of implementing an EN protocol in a noncritical setting.Design
Randomized controlled clinical trial.Participants and settings
This trial was conducted from 2014 to 2016 in 90 adult hospitalized patients (non-ICU) receiving exclusively EN. Patients with carcinomatosis, ICU admission, or <72 hours of EN were excluded.Intervention
The intervention group received EN according to a protocol, whereas the control group was fed according to standard practice.Main outcome measures
The proportion of patients receiving ≥80% of their caloric target at Day 4 after EN initiation.Statistical analyses performed
Student t test or Wilcoxon rank-sum test were used for continuous variables and the difference between the groups in the time to receipt of the optimal amount of nutrition was analyzed using Kaplan-Meier curves.Results
Forty-five patients were randomized to each group. At Day 4 after EN initiation, 61% of patients in the intervention arm had achieved the primary end point compared with 23% in the control group (P=0.001). In malnourished patients, 63% achieved the primary end point in the intervention group compared with 16% in the control group (P=0.003). The cumulative deficit on Day 4 was lower in the intervention arm compared with the control arm: 2,507 kcal (interquartile range [IQR]=1,262 to 2,908 kcal) vs 3,844 kcal (IQR=2,620 to 4,808 kcal) (P<0.001) and 116 g (IQR=69 to 151 g) vs 191 g (IQR=147 to 244 g) protein (P<0.001), respectively. The rates of gastrointestinal complications were not significantly different between groups.Conclusions
Implementation of an EN protocol outside the ICU significantly improved the delivery of calories and protein when compared with current standard practice without increasing gastrointestinal complications. 相似文献23.
David Ancona-Lezama Lauren A Dalvin Carol L Shields 《Indian journal of ophthalmology》2020,68(11):2356
Retinoblastoma management remains complex, requiring individualized treatment based on International Classification of Retinoblastoma (ICRB) staging, germline mutation status, family psychosocial factors and cultural beliefs, and available institutional resources. For this 2020 retinoblastoma review, PubMed was searched for articles dated as early as 1931, with an emphasis on articles from 1990 to the present day, using keywords of retinoblastoma, chemotherapy, intravenous chemotherapy, chemoreduction, intra-arterial chemotherapy, ophthalmic artery chemosurgery, intravitreal chemotherapy, intracameral chemotherapy, cryotherapy, transpupillary thermotherapy, laser, radiation, external beam radiotherapy, plaque radiotherapy, brachytherapy, and enucleation. We discuss current treatment modalities as used in the year 2020, including intravenous chemotherapy (IVC), intra-arterial chemotherapy (IAC), intravitreal chemotherapy (IvitC), intracameral chemotherapy (IcamC), consolidation therapies (cryotherapy and transpupillary thermotherapy [TTT]), radiation-based therapies (external beam radiotherapy [EBRT] and plaque radiotherapy), and enucleation. Additionally, we present a consensus treatment algorithm based on the agreement of three North American retinoblastoma treatment centers, and encourage further collaboration amongst the world''s most expert retinoblastoma treatment centers in order to develop consensus management plans and continue advancement in the identification and treatment of this childhood cancer. 相似文献
24.
Diabetes is a metabolic disorder comprising of high glucose level in blood over a prolonged period in the body as it is not capable of using it properly. The severe complications associated with diabetes include diabetic ketoacidosis, nonketotic hypersmolar coma, cardiovascular disease, stroke, chronic renal failure, retinal damage and foot ulcers. There is a huge increase in the number of patients with diabetes globally and it is considered a major health problem worldwide. Early diagnosis of diabetes is helpful for treatment and reduces the chance of severe complications associated with it. Machine learning algorithms (such as ANN, SVM, Naive Bayes, PLS-DA and deep learning) and data mining techniques are used for detecting interesting patterns for diagnosing and treatment of disease. Current computational methods for diabetes diagnosis have some limitations and are not tested on different datasets or peoples from different countries which limits the practical use of prediction methods. This paper is an effort to summarize the majority of the literature concerned with machine learning and data mining techniques applied for the prediction of diabetes and associated challenges. This report would be helpful for better prediction of disease and improve in understanding the pattern of diabetes. Consequently, the report would be helpful for treatment and reduce risk of other complications of diabetes. 相似文献
25.
We examined the accuracy of computer-based rhythm interpretation from one electrocardiograph manufacturer (GE Healthcare Technologies MUSE software 005C) in 4297 consecutive recordings in a university hospital setting. Overreading was performed by either of 2 experienced cardiologists, and all disagreements with the initial computer rhythm statement were reviewed by the second cardiologist to achieve physician consensus used as the "gold standard" for rhythm diagnosis. Overall, 13.2% (565/4297) of computer-based rhythm statements required revision, but excluding tracings with pacemakers, the revision rate was 7.8% (307/3954), including 3.8% involving the primary rhythm diagnosis and 3.9% involving definition of ectopic complexes. The false-negative rate for sinus rhythm was only 1.3%, but a computer diagnosis of sinus rhythm was incorrect in 9.9% of other rhythms. The false-negative rate for atrial fibrillation was 9.2%, whereas a computer diagnosis of atrial fibrillation was incorrect in 1.1% of other rhythms, including sinus. Computer diagnosis of paced rhythms remains problematic, and physician overreading to correct computer-based electrocardiogram rhythm diagnoses remains mandatory. 相似文献
26.
Michele M. Pelter Yuan Xu Richard Fidler Ran Xiao David W. Mortara 《Journal of electrocardiology》2018,51(2):288-295
Background
Patients hospitalized for suspected acute coronary syndrome (ACS) are at risk for transient myocardial ischemia. During the “rule-out” phase, continuous ECG ST-segment monitoring can identify transient myocardial ischemia, even when asymptomatic. However, current ST-segment monitoring software is vastly underutilized due to false positive alarms, with resultant alarm fatigue. Current ST algorithms may contribute to alarm fatigue because; (1) they are not designed with a delay (minutes), rather alarm to brief spikes (i.e., turning, heart rate changes), and (2) alarm to changes in a single ECG lead, rather than contiguous leads.Purpose
This study was designed to determine sensitivity, and specificity, of ST algorithms when accounting for; ST magnitude (100 μV vs 200 μV), duration, and changes in contiguous ECG leads (i.e., aVL, I, ? aVR, II, aVF, III; V1, V2, V3, V4, V5, V6, V6, I).Methods
This was a secondary analysis from the COMPARE Study, which assessed occurrence rates for transient myocardial ischemia in hospitalized patients with suspected ACS using 12-lead Holter. Transient myocardial ischemia was identified from Holter using > 100 μV ST-segment ↑ or ↓, in > 1 ECG lead, > 1 min. Algorithms tested against Holter transient myocardial ischemia were done using the University of California San Francisco (UCSF) ECG algorithm and included: (1)100 μV vs 200 μV any lead during a 5-min ST average; (2)100 μV vs 200 μV any lead > 5 min, (3) 100 μV vs 200 μV any lead during a 5-min ST average in contiguous leads, and (4) 100 μV vs 200 μV > 5 min in contiguous leads (Table below).Results
In 361 patients; mean age 63 + 12 years, 63% male, 56% prior CAD, 43 (11%) had transient myocardial ischemia. Of the 43 patients with transient myocardial ischemia, 17 (40%) had ST-segment elevation events, and 26 (60%) ST-segment depression events. A higher proportion of patients with ST segment depression has missed ischemic events.Table shows sensitivity and specificity for the four algorithms tested.Alarms tested | 100 mV ST deviation (↓ or ↑) | 200 mV ST deviation (↓ or ↑) | ||
---|---|---|---|---|
Sensitivity | Specificity | Sensitivity | Specificity | |
1. ST-segment change any ECG lead 5 min average | 76.7% | 47.8% | 46.5% | 74.2% |
2. ST-segment change any ECG lead > 5 min | 76.7% | 54.4% | 46.5% | 77.4% |
3. ST-segment change contiguous leads 5 min average | 69.8% | 67.9% | 27.9% | 83.6% |
4. ST-segment change contiguous leads > 5 min | 62.8% | 73.0% | 20.9% | 86.8% |