Climate Change and Emerging Infectious Diseases: A Precarious Relationship.

Climate change is apparent. Temperatures are rising. Floods are more frequent and devastating.

Post-COVID-19 Syndrome: Theoretical Basis, Identification, and Management.

As COVID-19 continues to spread, with the United States surpassing 29 million cases, health care workers are beginning to see patients who have been infected with SARS-CoV-2 return seeking treatment for its longer-term physical and mental effects. The term long-haulers is used to identify patients who have not fully recovered from the illness after weeks or months. Although the acute symptoms of COVID-19 have been widely described, the longer-term effects are less well known because of the relatively short history of the pandemic.

Memory-Related Frontal Brainwaves Predict Transition to Mild Cognitive Impairment in Healthy Older Individuals Five Years Before Diagnosis.

Background: Early prognosis of high-risk older adults for amnestic mild cognitive impairment (aMCI), using noninvasive and sensitive neuromarkers, is key for early prevention of Alzheimer's disease. We have developed individualized measures in electrophysiological brain signals during working memory that distinguish patients with aMCI from age-matched cognitively intact older individuals.

Objective: Here we test longitudinally the prognosis of the baseline neuromarkers for aMCI risk.

COVID-19: An Immunopathologic Assault.

When caring for patients with coronavirus disease 2019 (COVID-19), clinicians have noticed some unusual clinical presentations not observed before, such as profound hypoxia and severe hypotension. Scientists are probing the evidence to explain these issues and many other unanswered questions. Severe acute respiratory syndrome associated with coronavirus 2 presents an unchartered acute and critical care dilemma.

Antibiotic Stewardship in the Intensive Care Unit. An Official American Thoracic Society Workshop Report in Collaboration with the AACN, CHEST, CDC, and SCCM.

Intensive care units (ICUs) are an appropriate focus of antibiotic stewardship program efforts because a large proportion of any hospital's use of parenteral antibiotics, especially broad-spectrum, occurs in the ICU. Given the importance of antibiotic stewardship for critically ill patients and the importance of critical care practitioners as the front line for antibiotic stewardship, a workshop was convened to specifically address barriers to antibiotic stewardship in the ICU and discuss tactics to overcome these. The working definition of antibiotic stewardship is "the right drug at the right time and the right dose for the right bug for the right duration.

Immunology and Immunotherapy in Critical Care: An Overview.

Until recently, immunology was not a major focus of attention in the acute and critical care setting. With the evolution of immunotherapy, however-including the development of monoclonal antibodies, checkpoint inhibitors, and adoptive cellular therapies-an in-depth understanding of the immune system has become necessary to properly care for acutely ill patients. Lymphocytes (ie, T cells and B cells) play a major role in the daily functioning of the immune response.

Spared behavioral repetition effects in Alzheimer's disease linked to an altered neural mechanism at posterior cortex.

Objective: Individuals with dementia of the Alzheimer type (AD) classically show disproportionate impairment in measures of working memory, but repetition learning effects are relatively preserved. As AD affects brain regions implicated in both working memory and repetition effects, the neural basis of this discrepancy is poorly understood. We hypothesized that the posterior repetition effect could account for this discrepancy due to the milder effects of AD at visual cortex.

A cognitive electrophysiological signature differentiates amnestic mild cognitive impairment from normal aging.

Background: Noninvasive and effective biomarkers for early detection of amnestic mild cognitive impairment (aMCI) before measurable changes in behavioral performance remain scarce. Cognitive event-related potentials (ERPs) measure synchronized synaptic neural activity associated with a cognitive event. Loss of synapses is a hallmark of the neuropathology of early Alzheimer's disease (AD).

Research in Review: Advancing Critical Care Practice.

Research published in 2016 identified strategies to enhance acute and critical care, initiated discussions on professional roles and responsibilities, clarified complex care issues, and led to robust debate. Some of this important work addressed strategies to prevent delirium and pressure ulcers, considerations for pain management within the context of the opioid abuse crisis, strategies to guide fluid resuscitation in patients with sepsis and heart failure, and ways to enhance care for family members of intensive care patients. The new sepsis definitions highlight the importance of detecting and providing care to patients with sepsis outside of critical care areas.

Research in Review: Driving Critical Care Practice Change.

During the past year, studies were published that will lead to practice change, address challenges at the bedside, and introduce new care strategies. This article summarizes some of this important work and considers it in the context of previous research and practice. Examples of research-based practice changes include the performance and assessment of septic shock resuscitation, and the integration of tourniquets and massive transfusions in civilian trauma.

Antimicrobial Resistance: Thinking Outside the Box.

The health care system is challenged by another serious issue: antimicrobial resistance. Clostridium difficile is the most common infection in health care institutions and is becoming resistant to standard treatment. Carbapenem-resistant enterobacteriaceae can be found in almost every state in the United States.

Discrimination of mild cognitive impairment and Alzheimer's disease using transfer entropy measures of scalp EEG.

Mild cognitive impairment (MCI) is a neurological condition related to early stages of dementia including Alzheimer's disease (AD). This study investigates the potential of measures of transfer entropy in scalp EEG for effectively discriminating between normal aging, MCI, and AD participants. Resting EEG records from 48 age-matched participants (mean age 75.

Sugihara causality analysis of scalp EEG for detection of early Alzheimer's disease.

Recently, Sugihara proposed an innovative causality concept, which, in contrast to statistical predictability in Granger sense, characterizes underlying deterministic causation of the system. This work exploits Sugihara causality analysis to develop novel EEG biomarkers for discriminating normal aging from mild cognitive impairment (MCI) and early Alzheimer's disease (AD). The hypothesis of this work is that scalp EEG based causality measurements have different distributions for different cognitive groups and hence the causality measurements can be used to distinguish between NC, MCI, and AD participants.

Fever in acute and critical care: a diagnostic approach.

Determining the underlying cause of a fever can be a daunting task. Multiple reasons have been found for a patient to have a fever, but the use of an organized approach will assist clinicians in reaching a correct diagnosis. The first step in this process is a complete assessment, including a thorough physical assessment and an evaluation of the history of present illness as well as a detailed review of all the patient's medications.

Ventilator-associated pneumonia bundle: reconstruction for best care.

The ventilator-associated pneumonia (VAP) bundle is a focus of many health care institutions. Many hospitals are conducting process-improvement projects in an attempt to improve VAP rates by implementing the bundle. However, this bundle is controversial in the literature, because the evidence supporting the VAP interventions is weak.

Spectral and complexity analysis of scalp EEG characteristics for mild cognitive impairment and early Alzheimer's disease.

Amnestic mild cognitive impairment (aMCI) often is an early stage of Alzheimer's disease (AD). MCI is characterized by cognitive decline departing from normal cognitive aging but that does not significantly interfere with daily activities. This study explores the potential of scalp EEG for early detection of alterations from cognitively normal status of older adults signifying MCI and AD.

What an acute care nurse practitioner should know about reimbursement.

How to apply for reimbursement for ACNP services should be a carefully considered decision.It can be a complicated process and should be well understood before embarking on the“billing experience.” The ACNP can expect that this course of action may be challenging,but if successful, the NP can further pursue the quantification of patient outcomes that can enhance the NP role in the acute and critical care environment.

Resting EEG discrimination of early stage Alzheimer's disease from normal aging using inter-channel coherence network graphs.

Amnestic mild cognitive impairment (MCI) is a degenerative neurological disorder at the early stage of Alzheimer's disease (AD). This work is a pilot study aimed at developing a simple scalp-EEG-based method for screening and monitoring MCI and AD. Specifically, the use of graphical analysis of inter-channel coherence of resting EEG for the detection of MCI and AD at early stages is explored.

Hematologic complications of critical illness: anemia, neutropenia, thrombocytopenia, and more.

All critically ill patients are at risk for hematological complications during their hospitalization. It is essential that critical care nurses understand the hematological system and common complications. The purpose of this article is to briefly review some basic hematologic concepts involving each of the 3 cell lines: the white blood cell, the red blood cell, and platelets.

The nurse practitioner role: the communication link for cardiac surgery patients.

The communication process involving the care of cardiac surgery patients from admission to discharge can be a key component to successful outcomes. The nurse practitioner plays a pivotal role in this communication process and helps coordinate many facets of patient care. This article focuses on reviewing the process in one institution and then explores research options to assist with the application of the role.

Weaning smokers from mechanical ventilation.

Because smoking causes oxidant stress, inflammation, and protease-antiprotease imbalance of the lung tissue, smokers may have a lower threshold for initiation of mechanical ventilation. Critical care team members should realize that not only the pulmonary system is compromised but also other protective response mechanisms of the body. Therefore, the role of every critical care team member is pivotal to ensure a successful weaning and extubation process for smokers.

Enhancements in epilepsy forewarning via phase-space dissimilarity.

The authors extend the recent application of phase-space dissimilarity measures for scalp EEG data in two directions. First, a forewarning window of up to 8 hours was used, thereby providing more forewarning time of the seizure event. This window was limited to a maximum of 1 hour in their previous work.

Assessment of the mechanically ventilated patient: an advanced practice approach.

Multiple perspectives must be considered when assessing the mechanically ventilated patient. Assessment begins before the advance practice nurse (APN) encounters the patient. Important information about the patient can be gleaned from the history, medications, and social history.