Articles: hospitals.
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The coronavirus disease 2019 infection has significantly impacted the world and placed a heavy strain on the medical system and the public, especially those with cardiovascular diseases. Hoverer, the differences in door-to-balloon time and outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are not known too much. ⋯ SARS-CoV-2 positivity is significantly associated with longer door-to-balloon time and higher in-hospital mortality in STEMI patients undergoing primary percutaneous coronary intervention.
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Controversy surrounds the administration of blood products to severely traumatized patients before they arrive in the hospital in order to compensate for early blood loss and/or to correct coagulation disturbances that arise shortly after the traumatic event. A number of terrestrial and air rescue services have begun to provide this kind of treatment. ⋯ The studies that have been published to date yield no clear evidence either for or against the early pre-hospital administration of blood products. Any treatment of this kind should be accompanied by scientific evaluation.
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Pain after cardiac surgery via median sternotomy can be difficult to treat, and if inadequately managed can lead to respiratory complications, prolonged hospital stays and chronic pain. ⋯ The analgesic regimen for cardiac surgery via sternotomy should include paracetamol and NSAIDs, unless contraindicated, administered intra-operatively and continued postoperatively. Intra-operative magnesium and dexmedetomidine infusions may be considered as adjuncts particularly when basic analgesics are not administered. It is not clear if combining dexmedetomidine and magnesium would provide superior pain relief compared with either drug alone. Parasternal block/surgical site infiltration is also recommended. However, no basic analgesics were used in the studies assessing these interventions. Opioids should be reserved for rescue analgesia. Other interventions, including cyclo-oxygenase-2 specific inhibitors, are not recommended because there was insufficient, inconsistent or no evidence to support their use and/or due to safety concerns.
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Curr Opin Crit Care · Oct 2023
ReviewDigital solutions and the future of recovery after critical illness.
Digital technologies may address known physical and psychological barriers to recovery experienced by intensive care survivors following hospital discharge and provide solutions to care fragmentation and unmet needs. The review highlights recent examples of digital technologies designed to support recovery of survivors of critically illness. ⋯ Digital interventions supporting recovery comprise web or app-based recovery clinics or pathways and digital delivery of psychological interventions. Understanding of efficacy is relatively nascent, although several studies demonstrate feasibility and acceptability. Future research is needed but should be mindful of the risk of digital exclusion.
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Emerg Med Australas · Oct 2023
ReviewClosing the miscommunication gap: A user guide to developing picture-based communication tools for Aboriginal and Torres Strait Islander peoples in emergency departments.
To document an illustration-based methodology for culturally safe communication between Indigenous patients and clinicians in an urban ED. ⋯ Co-design methodologies can guide improvements in culturally safe clinical communication with First Nations patients in EDs.