Articles: function.
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Mayo Clinic proceedings · Nov 2022
Randomized Controlled TrialClinician Adoption of an Artificial Intelligence Algorithm to Detect Left Ventricular Systolic Dysfunction in Primary Care.
To compare the clinicians' characteristics of "high adopters" and "low adopters" of an artificial intelligence (AI)-enabled electrocardiogram (ECG) algorithm that alerted for possible low left ventricular ejection fraction (EF) and the subsequent effectiveness of detecting patients with low EF. ⋯ Clinicians who most frequently followed the recommendations of an AI tool were twice as likely to diagnose low EF. Those clinicians with less complex patients were more likely to be high adopters.
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Minerva anestesiologica · Nov 2022
Understanding left ventricular diastolic dysfunction in anesthesia and intensive care patients: "a glass with progressive shape change".
Left ventricular (LV) diastolic dysfunction is a commonly encountered condition and its impact on the anesthesia and the intensive care population is often underestimated. The study of the diastole is known as "diastology" and comprises four phases: isovolumetric relaxation, early filling phase, diastasis, and late filling phase. Diastolic function needs at least the same attention as systolic function, since its alteration has been associated with worse prognosis. ⋯ First, we use a metaphor to consider the LV as a glass that progressively changes its shape and height along the disease course, resembling variable end-diastolic pressures and volumes at different stages while progressing with diastolic dysfunction. We guide readers in the process of diagnosis and grading of LV diastolic dysfunction, with description of pathophysiological changes in LV relaxation and consequently in the pressure gradient between the left-sided heart chambers. In the second part, starting from physiology we move towards suggestions for the clinical management of anesthesia and intensive care patients with diastolic dysfunction under different scenarios (hypo- and hypervolemia, weaning, sepsis, tachycardia and arrhythmias, right ventricular dysfunction).
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Pain and related consequences could contribute to comorbid illness and premature mortality in homeless and precariously housed persons. We analyzed longitudinal data from an ongoing naturalistic prospective study of a community-based sample (n = 370) to characterize risk factors and consequences of bodily pain. The aims were to describe bodily pain and associations with symptoms and psychosocial function, investigate factors that may increase or ameliorate pain, and examine the consequences of pain for symptoms, functioning, and all-cause mortality. ⋯ The frequency of prescribed and nonprescribed opioid use had nonlinear relationships with pain: intermittent use was associated with severe pain, without reverse association or change with the overdose epidemic. Greater longitudinal mean pain severity was associated with premature mortality, poorer functioning, and suicidal ideation. Considering the relationships between pain, intermittent opioid use, and depressive symptoms could improve health care for precariously housed patients.
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Gallbladder dyskinesia is a functional disorder of the gastrointestinal tract, which can result in debilitating episodes of abdominal pain and associated symptoms. Key diagnostic criteria include a diminished gallbladder ejection fraction on scintigraphy and absence of other causes for the symptoms. ⋯ Patients meeting the clinical and diagnostic criteria for gallbladder dyskinesia should be referred for cholecystectomy, and most of these patients will have relief of their symptoms. A comprehensive preoperative discussion on expected outcomes needs to take place.
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Fischer U, Kaesmacher J, Strbian D, et al. Thrombectomy alone versus intravenous alteplase plus thrombectomy in patients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial. Lancet. 2022;400:104-15. 35810756.