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1.
Semin Cardiothorac Vasc Anesth ; : 1089253219899255, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31906821

RESUMEN

The 3-factor prothrombin complex concentrate (3FPCC) may be used off-label to treat refractory bleeding during cardiac surgery in children. This retrospective study examined the rate of clinical complications following the use of 3FPCC. Patients treated with 3FPCC were matched to controls for age, gender, prematurity, weight, cardiopulmonary bypass times, and cross-clamp times. Fifty-nine cases were individually matched to 59 controls based on propensity scores. 3FPCC was not associated with an increased risk of thromboembolic events, mortality, or need for postoperative extracorporeal membrane oxygenator support. These results suggest the safety of 3FPCC when used for refractory bleeding after cardiopulmonary bypass in children undergoing congenital heart surgery.

3.
Br J Nurs ; 28(20): 1332-1334, 2019 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-31714831
6.
F1000Res ; 72018.
Artículo en Inglés | MEDLINE | ID: mdl-29770201

RESUMEN

This review discusses the management of ventricular septal defects (VSDs) and atrioventricular septal defects (AVSDs). There are several types of VSDs: perimembranous, supracristal, atrioventricular septal, and muscular. The indications for closure are moderate to large VSDs with enlarged left atrium and left ventricle or elevated pulmonary artery pressure (or both) and a pulmonary-to-systemic flow ratio greater than 2:1. Surgical closure is recommended for large perimembranous VSDs, supracristal VSDs, and VSDs with aortic valve prolapse. Large muscular VSDs may be closed by percutaneous techniques. A large number of devices have been used in the past for VSD occlusion, but currently Amplatzer Muscular VSD Occluder is the only device approved by the US Food and Drug Administration for clinical use. A hybrid approach may be used for large muscular VSDs in small babies. Timely intervention to prevent pulmonary vascular obstructive disease (PVOD) is germane in the management of these babies. There are several types of AVSDs: partial, transitional, intermediate, and complete. Complete AVSDs are also classified as balanced and unbalanced. All intermediate and complete balanced AVSDs require surgical correction, and early repair is needed to prevent the onset of PVOD. Surgical correction with closure of atrial septal defect and VSD, along with repair and reconstruction of atrioventricular valves, is recommended. Palliative pulmonary artery banding may be considered in babies weighing less than 5 kg and those with significant co-morbidities. The management of unbalanced AVSDs is more complex, and staged single-ventricle palliation is the common management strategy. However, recent data suggest that achieving two-ventricle repair may be a better option in patients with suitable anatomy, particularly in patients in whom outcomes of single-ventricle palliation are less than optimal. The majority of treatment modes in the management of VSDs and AVSDs are safe and effective and prevent the development of PVOD and cardiac dysfunction.

7.
F1000Res ; 6: 2042, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29250321

RESUMEN

The purpose of this review is to discuss the management of atrial septal defects (ASD), paying particular attention to the most recent developments. There are four types of ASDs: ostium secundum, ostium primum, sinus venosus, and coronary sinus defects. The fifth type, patent foramen ovale-which is present in 25 to 30% of normal individuals and considered a normal variant, although it may be the seat of paradoxical embolism, particularly in adults-is not addressed in this review. The indication for closure of the ASDs, by and large, is the presence of right ventricular volume overload. In asymptomatic patients, the closure is usually performed at four to five years of age. While there was some earlier controversy regarding ASD closure in adult patients, currently it is recommended that the ASD be closed at the time of presentation. Each of the four defects is briefly described followed by presentation of management, whether by surgical or percutaneous approach, as the case may be. Of the four types of ASDs, only the ostium secundum defect is amenable to percutaneous occlusion. For ostium secundum defects, transcatheter closure has been shown to be as effective as surgical closure but with the added benefits of decreased hospital stay, avoidance of a sternotomy, lower cost, and more rapid recovery. There are several FDA-approved devices in use today for percutaneous closure, including the Amplatzer® Septal Occluder (ASO), Amplatzer® Cribriform device, and Gore HELEX® device. The ASO is most commonly used for ostium secundum ASDs, the Gore HELEX® is useful for small to medium-sized defects, and the cribriform device is utilized for fenestrated ASDs. The remaining types of ASDs usually require surgical correction. All of the available treatment modes are safe and effective and prevent the development of further cardiac complications.

8.
Prev Chronic Dis ; 14: E78, 2017 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-28880837

RESUMEN

Public health is what we do together as a society to ensure the conditions in which everyone can be healthy. Although many sectors play key roles, governmental public health is an essential component. Recent stressors on public health are driving many local governments to pioneer a new Public Health 3.0 model in which leaders serve as Chief Health Strategists, partnering across multiple sectors and leveraging data and resources to address social, environmental, and economic conditions that affect health and health equity. In 2016, the US Department of Health and Human Services launched the Public Health 3.0 initiative and hosted listening sessions across the country. Local leaders and community members shared successes and provided insight on actions that would ensure a more supportive policy and resource environment to spread and scale this model. This article summarizes the key findings from those listening sessions and recommendations to achieve Public Health 3.0.


Asunto(s)
Administración en Salud Pública/normas , Política de Salud , Promoción de la Salud , Humanos , Salud Pública , Administración en Salud Pública/métodos , Estados Unidos
11.
Transfusion ; 56(9): 2173-83, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27301995

RESUMEN

BACKGROUND: AABB surveyed AABB institutional members about their 2013 blood collection, transfusion, and patient blood management (PBM) programs. Results were compared with previous US national surveys. STUDY DESIGN AND METHODS: The 2013 AABB Blood Collection, Utilization, and Patient Blood Management Survey was distributed to AABB blood centers (79) and hospitals (1068). Statistical procedures were used to estimate blood collection and transfusion. RESULTS: Estimated whole blood (WB) and red blood cell (RBC) collections in 2013 totaled 13.6 million units, a 12.1% decrease from 15.5 million units in 2011 (p < 0.0001). Transfusions of WB and RBC units by AABB hospitals totaled 6.1 million units, 7.3% fewer compared to 2011 (p = 0.036). There was no change in overall platelet (PLT) distributions by blood collectors but WB-derived (WBD) PLT distributions increased significantly (27.1%, p < 0.0001). Transfusion of PLTs increased 15.4% totaling 1.3 million units (p = 0.0423), including increases in apheresis PLT (12.2%) and WBD PLT transfusions (30.7%). Distribution of plasma for transfusion declined 22.4% (p < 0.0001), while transfused plasma decreased only 9.9% (p = 0.036). Hospitals reduced outdated WB, RBC, and PLT components by 14.9% to 26.1% and wasted plasma components by 19.0%. PBM programs were reported by 37.8% of AABB hospitals. CONCLUSIONS: Compared to 2011, WB and RBC collections declined significantly in 2013 and disproportionately to the significant reductions in WB and RBC transfusions. Distributions of PLTs and plasma for transfusion declined in 2013, as did transfusions of plasma, while transfusion of PLTs increased significantly. Decreases in outdated and wasted components by hospitals suggest improvements in product and inventory management. Ongoing national surveys allow for trend analysis and are important for future planning.


Asunto(s)
Transfusión Sanguínea/estadística & datos numéricos , Transfusión Sanguínea/tendencias , Bancos de Sangre , Transfusión de Componentes Sanguíneos/estadística & datos numéricos , Transfusión de Componentes Sanguíneos/tendencias , Transfusión de Eritrocitos , Eritrocitos , Humanos , Leucocitos , Transfusión de Plaquetas , Estados Unidos
13.
Chronobiol Int ; 32(1): 92-102, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25187987

RESUMEN

Social rhythms, also known as daily routines (e.g. exercise, of school or work, recreation, social activities), have been identified as potential time cues to help to regulate the biological clock. Past research has shown links between regularity and healthy sleep. This study examined the regularity and frequency of daytime activities in a clinical insomnia population and a good sleeper comparison group. Participants (N = 69) prospectively monitored their sleep and daily activities for a 2-week period. Although participants with insomnia and good sleepers had similar levels of activity, relative to good sleepers, those with insomnia were less regular in their activities. Findings from this study add to the growing number of studies that highlight the relative importance of the regularity of daytime activities on sleep. Accordingly, future research should test treatment components that focus on regulating daytime activities, which would likely improve treatment outcomes.


Asunto(s)
Ritmo Circadiano , Hábitos , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Sueño , Conducta Social , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Encuestas y Cuestionarios , Factores de Tiempo , Adulto Joven
14.
Vaccine ; 32(50): 6847-54, 2014 Nov 28.
Artículo en Inglés | MEDLINE | ID: mdl-24530403

RESUMEN

NuThrax™ (Anthrax Vaccine Adsorbed with CPG 7909 Adjuvant) (AV7909) is in development. Samples obtained in a phase Ib clinical trial were tested to confirm biomarkers of innate immunity and evaluate effects of CPG 7909 (PF-03512676) on adaptive immunity. Subjects received two intramuscular doses of commercial BioThrax(®) (Anthrax Vaccine Adsorbed, AVA), or two intramuscular doses of one of four formulations of AV7909. IP-10, IL-6, and C-reactive protein (CRP) levels were elevated 24-48 h after administration of AV7909 formulations, returning to baseline by Day 7. AVA (no CPG 7909) resulted in elevated IL-6 and CRP, but not IP-10. Another marker of CpG, transiently decreased absolute lymphocyte counts (ALCs), correlated with transiently increased IP-10. Cellular recall responses to anthrax protective antigen (PA) or PA peptides were assessed by IFN-γ ELISpot assay performed on cryopreserved PBMCs obtained from subjects prior to immunization and 7 days following the second immunization (study day 21). One-half of subjects that received AV7909 with low-dose (0.25mg/dose) CPG 7909 possessed positive Day 21 T cell responses to PA. In contrast, positive T cell responses occurred at an 11% average rate (1/9) for AVA-treated subjects. Differences in cellular responses due to dose level of CPG 7909 were not associated with differences in humoral anti-PA IgG responses, which were elevated for recipients of AV7909 compared to recipients of AVA. Serum markers at 24 or 48 h (i.e. % ALC decrease, or increase in IL-6, IP-10, or CRP) correlated with the humoral (antibody) responses 1 month later, but did not correlate with cellular ELISpot responses. In summary, biomarkers of early responses to CPG 7909 were confirmed, and adding a CpG adjuvant to a vaccine administered twice resulted in increased T cell effects relative to vaccine alone. Changes in early biomarkers correlated with subsequent adaptive humoral immunity but not cellular immunity.


Asunto(s)
Adyuvantes Inmunológicos/administración & dosificación , Vacunas contra el Carbunco/inmunología , Carbunco/prevención & control , Inmunidad Innata , Oligodesoxirribonucleótidos/administración & dosificación , Linfocitos T/inmunología , Carbunco/inmunología , Vacunas contra el Carbunco/administración & dosificación , Anticuerpos Antibacterianos/sangre , Proteína C-Reactiva/análisis , Citocinas/sangre , Método Doble Ciego , Ensayo de Immunospot Ligado a Enzimas , Humanos , Inmunoglobulina G/sangre , Inyecciones Intramusculares , Vacunación/métodos
15.
Nurs Times ; 110(40): 22-5, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-26012032

RESUMEN

The Patient Blood Management initiative is an evidence-based, multidisciplinary approach to improve the care of patients who might need a transfusion of blood or blood components. It is an international initiative in best practice for transfusion medicine. This final article in our five-part series on blood transfusion outlines the origin and implementation of the Patient Blood Management initiative in England, why it matters, how it works, how it can be put into practice and nurses' role in supporting it.


Asunto(s)
Transfusión Sanguínea , Procedimientos Innecesarios , Ahorro de Costo , Humanos , Rol de la Enfermera , Participación del Paciente , Medicina Estatal , Reino Unido
16.
J Clin Sleep Med ; 9(6): 567-75, 2013 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-23772190

RESUMEN

STUDY OBJECTIVES: Research suggests that rumination may play an important role in insomnia. Whereas some have suggested that rumination mainly relates to depression, the evidence suggests that there may be insomnia-specific rumination. This paper explores insomnia symptom rumination across two distinct samples of varying levels of depressed mood and insomnia symptom severity. METHODS: The first sample consisted of nonclinical participants (N = 327) with a range of insomnia and depressed mood symptoms, and the second sample consisted of those who met both Major Depressive Disorder and Insomnia diagnoses (N = 66). Rather than relying on a measure developed for those with depression, we developed and tested an insomnia-specific measurement scale based on items from previous rumination studies and the addition of items derived from common daytime insomnia symptoms. RESULTS: Internal consistency was highly acceptable across the two samples for the new insomnia-specific rumination measure (Cronbach α was 0.93 and 0.94). In the first study, poor sleepers reported significantly higher levels of daytime symptom rumination than did good sleepers. Across both studies, rumination about daytime insomnia symptoms and depression were significantly correlated; however, insomnia rumination scores predicted insomnia even after controlling for depression. Moreover, in Study 2, insomnia-specific rumination was related to insomnia, but general depressive rumination was not predictive of insomnia. CONCLUSIONS: The findings provide support for the use of this insomnia-specific rumination scale; moreover the findings support previous observances regarding rumination about daytime insomnia symptoms that are not exclusive to depression.


Asunto(s)
Afecto , Síntomas Conductuales/psicología , Cognición , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Adolescente , Adulto , Anciano , Síntomas Conductuales/epidemiología , Comorbilidad , Depresión/epidemiología , Trastorno Depresivo Mayor/epidemiología , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Análisis Multivariante , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Estados Unidos/epidemiología
17.
Can Oncol Nurs J ; 22(3): 162-74, 2012.
Artículo en Inglés, Francés | MEDLINE | ID: mdl-22970472

RESUMEN

As many as 90% of women who have undergone mastectomy or lumpectomy for breast cancer surgery will choose to wear a breast prosthesis. To date, there has been little systematic exploration of experiences and preferences related to wearing external breast prostheses, especially with new products. For this qualitative descriptive study, 24 women were interviewed regarding their perspectives about the conventional breast prosthesis and 19 about their perspectives regarding a newly available custom-designed breast prosthesis. Women spoke about difficulties obtaining information regarding available breast prostheses options; the awkwardness of being measured and fitted for a prosthesis, especially with seemingly untrained staff; challenges in wearing an external prosthesis; and how a prosthesis can foster increased confidence, enhanced body image and self-esteem, and a sense of normalcy. All recommended that women must make an individual decision about wearing a breast prosthesis and emphasized how important it is to have information about options early in the cancer journey. The study findings can guide oncology nurses in educating women about breast prostheses.


Asunto(s)
Mamoplastia/psicología , Femenino , Humanos
18.
Cogn Behav Ther ; 41(1): 40-50, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22214181

RESUMEN

Research has shown that those with insomnia focus primarily on their sleep as a cause of daytime fatigue rather than the multitude of other possible causes of fatigue. This can create sleep-related anxiety and further perpetuate the sleep disturbance. In order to lessen the increased focus on sleep, the present study investigated whether people could learn to consider other attributions for fatigue via an information-based manipulation. Undergraduate students (N = 88) were randomized to two information groups: They either received information about common factors that could explain daytime fatigue (the fatigue information condition) or received generic sleep-related information (the control condition). Each group was tested pre- and post-intervention. Fatigue information participants were significantly more likely to consider non-sleep-related attributions for fatigue at post-intervention, relative to control participants. These results demonstrate that attributions for fatigue may be amenable to change via an information-based intervention; thus, this research explores a preliminary step toward investigating refinements to insomnia treatments.


Asunto(s)
Cultura , Fatiga/psicología , Educación del Paciente como Asunto/métodos , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Adolescente , Adulto , Fatiga/complicaciones , Fatiga/terapia , Femenino , Humanos , Masculino , Educación del Paciente como Asunto/estadística & datos numéricos , Proyectos Piloto , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Distribución Aleatoria , Trastornos del Inicio y del Mantenimiento del Sueño/complicaciones , Trastornos del Inicio y del Mantenimiento del Sueño/terapia
19.
Behav Ther ; 42(4): 644-54, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22035993

RESUMEN

Harvey's cognitive model of insomnia (2002a) proposes that sleep-related safety behaviors play a central role in the maintenance of insomnia because such maladaptive coping strategies are thought to reinforce threat-based appraisals of the likelihood and consequences of poor sleep. Research to date has assessed the frequency of safety behavior use in those with insomnia only; however, in addition to the frequency of occurrence, the function of safety behaviors (i.e., a belief that they will prevent a feared outcome from occurring), may be an important consideration. The purpose of this study was to examine sleep-related safety behaviors based on an expanded theoretical understanding of such behaviors across psychological disorders; that is, by examining both their frequency and perceived utility. Undergraduate students (N=376) completed an online survey about their sleep, mood, and use of sleep-related safety behaviors. Insomnia severity was associated with a greater perceived need to use safety behaviors (i.e., utility) but not with frequency of safety behavior use. Higher perceived utility of safety behaviors was also associated with unhelpful beliefs about sleep, fear and avoidance of fatigue, and both general and sleep-specific helplessness. These results suggest that these behaviors and the associated underlying maladaptive beliefs may be important targets in cognitive behavioral therapy for insomnia. The current study extends the existing literature and refines the concept of safety behaviors in insomnia to include both the function and frequency of these behaviors.


Asunto(s)
Adaptación Psicológica , Fatiga/psicología , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Sueño , Adolescente , Adulto , Femenino , Humanos , Masculino , Motivación , Percepción , Seguridad , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios
20.
Sleep ; 34(4): 531-9, 2011 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-21461332

RESUMEN

STUDY OBJECTIVES: We explored differences between individuals with DSM-IV-TR diagnoses of primary insomnia (PI) and insomnia related to a mental disorder (IMD) by using serial measurements of self-reported sleep variables (sleep onset latency, SOL; wake after sleep onset, WASO; total sleep time, TST; sleep efficiency, SE), and visual analogue scale ratings of 2 forms of bedtime arousal (cognitive and emotional). Furthermore, we sought to examine the relationship between sleep and arousal within each diagnostic subgroup. DESIGN: Between-group and within-group comparisons. SETTING: Duke and Rush University Medical Centers, USA. PARTICIPANTS: One hundred eighty-seven insomnia sufferers (126 women, average age 47.15 years) diagnosed by sleep specialists at 2 sleep centers as PI patients (n=126) and IMD patients (n=61). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Multilevel models for sleep measures indicated that IMD displayed significantly more instability across nights in their TST (i.e., larger changes) than did PI patients. With respect to pre-sleep arousal, IMD patients exhibited higher mean levels of emotional arousal, as well as more instability on the nightly ratings of this measure. Within the PI group, correlational analyses revealed a moderate relationship between the 2 arousal variables and SOL (r values 0.29 and 0.26), whereas the corresponding correlations were negligible and statistically nonsignificant in the IMD group. CONCLUSIONS: We found a number of differences on nighttime variables between those diagnosed with primary insomnia and those diagnosed with insomnia related to a mental disorder. These differences imply different perpetuating mechanisms involved in their ongoing sleep difficulties. Additionally, they support the categorical distinctiveness and the concurrent validity of these insomnia subtypes.


Asunto(s)
Nivel de Alerta/fisiología , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Sueño/fisiología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/fisiopatología , Persona de Mediana Edad , Polisomnografía , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Trastornos del Inicio y del Mantenimiento del Sueño/clasificación , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Encuestas y Cuestionarios , Factores de Tiempo
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