- Project SITUP: An Interdisciplinary Quality Improvement Initiative to Reduce Aspiration Pneumonia. [Journal Article]
- JNJ Nurs Care Qual 2018 Apr/Jun; 33(2):116-122
- The purpose of this quality improvement initiative was to improve oropharyngeal dysphagia screening and reduce aspiration pneumonia rates on 3 inpatient hospital medical units. Guided by a Plan-Do-St...
The purpose of this quality improvement initiative was to improve oropharyngeal dysphagia screening and reduce aspiration pneumonia rates on 3 inpatient hospital medical units. Guided by a Plan-Do-Study-Act methodology, an interdisciplinary health team developed and implemented a systematic process for oropharyngeal dysphagia screening and management. As a result, use of the screening protocol increased, timely initiation of speech language pathology consultations increased, and aspiration pneumonia rates decreased.
- Evaluation of the role ofstat3in antibody and TH17-mediated responses to pneumococcal immunization and infection using a mouse model of Autosomal Dominant Hyper IgE Syndrome. [Journal Article]
- IIInfect Immun 2018 Feb 20
- Loss-of-function mutations in Signal Transducer and Activator of Transcription 3 gene (stat3) result in Autosomal Dominant Hyper IgE Syndrome (AD-HIES), a condition in which patients have recurrent d...
Loss-of-function mutations in Signal Transducer and Activator of Transcription 3 gene (stat3) result in Autosomal Dominant Hyper IgE Syndrome (AD-HIES), a condition in which patients have recurrent debilitating infections, including frequent pneumococcal and staphylococcal pneumonias.Stat3mutations cause defective adaptive TH17-cellular responses, an immune mechanism believed to be critical for clearance of pneumococcal colonization, and diminished antibody responses. Here we wished to evaluate the role ofstat3in clearance of pneumococcal carriage and immunity using mice with astat3mutation recapitulating AD-HIES. We show here that naïve AD-HIES mice have prolonged nasal carriage of pneumococcus compared to WT mice. Mutant and wild-type mice were then immunized with a pneumococcal whole cell vaccine (WCV) that provides TH-17-mediated protection against pneumococcal colonization and antibody-mediated protection against pneumonia and sepsis. WCV-immunized AD-HIES mice made significantly less pneumococcal-specific IL-17A and antibody compared to WT mice. WCV-elicited protection against colonization was abrogated in AD-HIES mice, but immunization with WCV still protected AD-HIES mice against aspiration pneumonia/sepsis. Taken together, our results suggest that impaired clearance of nasopharyngeal carriage due to poor adaptive IL-17A responses may contribute to the increased rates of pneumococcal respiratory infection in AD-HIES patients.
- Effects of a novel method for enteral nutrition infusion involving a viscosity-regulating pectin solution: A multicenter randomized controlled trial. [Journal Article]
- CNClin Nutr ESPEN 2018; 23:34-40
- CONCLUSIONS: The novel method involving a viscosity-regulating pectin solution with EN administration can be clinically performed safely and efficiently, similar to the conventional method. Moreover, there were benefits, such as improvement in stool form, a short time for EN infusion, and a reduction in vomiting episodes, with the use of the novel method. This indicates some potential advantages in the quality of life among patients receiving this novel method.
- Dementia and Risk of 30-Day Readmission in Older Adults After Discharge from Acute Care Hospitals. [Journal Article]
- JAJ Am Geriatr Soc 2018 Feb 20
- CONCLUSIONS: Risk of hospital readmission associated with dementia varied according to primary diagnosis. Healthcare providers could enforce interventions to minimize readmission by focusing on comorbid conditions in individuals with dementia and specific primary diagnoses that increase their risk of readmission.
- A case of spinal anesthesia in a patient with progressive supranuclear palsy. [Journal Article]
- JCJA Clin Rep 2018; 4(1):12
- Progressive supranuclear palsy (PSP) is one of the rare diseases. PSP is characterized by oculomotor dysfunction, postural instability, akinesia, dysarthria, and dysphagia. The major cause of death i...
Progressive supranuclear palsy (PSP) is one of the rare diseases. PSP is characterized by oculomotor dysfunction, postural instability, akinesia, dysarthria, and dysphagia. The major cause of death in patients with PSP is aspiration pneumonia. Considering these complications, spinal anesthesia is useful in patients with PSP. However, the potential harmful effects of spinal anesthesia including neurotoxicity of local anesthetics and neurologic complications for patients with PSP are unclear, because there has been no report. Here, we present spinal anesthesia for a patient with PSP. An 80-year-old man with progressive oculomotor dysfunction, dysphagia, and history of repeated aspiration pneumonia was scheduled for inguinal hernia surgery. Acutely concerning about perioperative pulmonary complications, we performed spinal anesthesia. Fortunately, there was no complication associated with respiration or neural system during perioperative period. We hope our experience and case report will be helpful in specific perioperative anesthetic care for patients with PSP.
- Anesthetic management for laryngeal closure: retrospective evaluation of 50 cases. [Journal Article]
- JCJA Clin Rep 2017; 3(1):67
- Lung parenchymal involvement of primary bone marrow follicular lymphoma: a rare case study. [Journal Article]
- RCRespirol Case Rep 2018; 6(3):e00302
- A 76-year-old man presented with shortness of breath. Computed tomography revealed ground-glass opacity and interlobular thickening in the right lower lobe. Blood examination showed elevated levels o...
A 76-year-old man presented with shortness of breath. Computed tomography revealed ground-glass opacity and interlobular thickening in the right lower lobe. Blood examination showed elevated levels of white blood cell count and lymphocytes. Bone marrow aspiration revealed low-grade follicular lymphoma. Histopathological examination of the surgical lung biopsy from the right lower lobe demonstrated usual interstitial pneumonia and scattered aggregation of lymphocytes with poorly formed non-necrotizing granuloma. An 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) did not show intense uptake in areas other than the right lower lobe. We concluded that the granuloma in the lung was presumed to be a sarcoid reaction associated with bone marrow follicular lymphoma, and the intense 18F-FDG uptake in the right lower lobe might have been due to a sarcoid reaction. Immunohistochemistry or other genetic examinations are important even if 18F-FDG uptake on PET-CT seems to be a false-positive because of the possibility of a sarcoid reaction.
- Diagnostic validity of methods for assessment of swallowing sounds: a systematic review. [Journal Article]
- BJBraz J Otorhinolaryngol 2018 Feb 03
- CONCLUSIONS: Based on limited evidence and low methodological quality because few studies were included, with a small sample size, from all index testes found for this systematic review, Doppler showed excellent diagnostic accuracy for the discrimination of swallowing sounds, whereas microphone-reported good accuracy discrimination of swallowing sounds of dysphagic patients and stethoscope showed best screening test.
- Dysphagia and laryngeal pathology in post-surgical cardiothoracic patients. [Journal Article]
- JCJ Crit Care 2018 Feb 09; 45:121-127
- CONCLUSIONS: Early endoscopic assessment for identification of dysphagia and laryngeal injury in patients following cardiothoracic surgery may allow early management and prevention of secondary complications.
New Search Next
- Preoperative fasting in children: review of existing guidelines and recent developments. [Review]
- BJBr J Anaesth 2018; 120(3):469-474
- The current guidelines for preoperative fasting recommend intervals of 6, 4, and 2 h (6-4-2) of fasting for solids, breast milk, and clear fluids, respectively. The objective is to minimize the risk ...
The current guidelines for preoperative fasting recommend intervals of 6, 4, and 2 h (6-4-2) of fasting for solids, breast milk, and clear fluids, respectively. The objective is to minimize the risk of pulmonary aspiration of gastric contents, but also to prevent unnecessarily long fasting intervals. Pulmonary aspiration is rare and associated with nearly no mortality in paediatric anaesthesia. The incidence may have decreased during the last decades, judging from several audits published recently. However, several reports of very long fasting intervals have also been published, in spite of the implementation of the 6-4-2 fasting regimens. In this review, we examine the physiological basis for various fasting recommendations, the temporal relationship between fluid intake and residual gastric content, and the pathophysiological effects of preoperative fasting, and review recent publications of various attempts to reduce the incidence of prolonged fasting in children. The pros and cons of the current guidelines will be addressed, and possible strategies for a future revision will be suggested.