A Clinical Pharmacist-Led Transitions of Care Program for Veterans with Two Planned Care Transitions (Hospital to Skilled Care and Skilled Care to Home) amid the COVID-19 Pandemic.

Transitional care teams have been shown to improve patient safety. We describe a novel transitional care team with a clinical pharmacist as team leader initiated amid the COVID-19 pandemic. The program focused on Veterans with 2 planned transitions of care: hospital to skilled nursing facility (SNF) and from SNF to home.

2,4,6-Trichlorophenol mediated increases in extracellular peroxidase activity in three species of Lemnaceae.

Chlorinated phenols, or chlorophenols, are persistent priority pollutants that are widespread in the environment. Class III peroxidases are well-characterised plant enzymes that can catalyse the oxidative dechlorination of chlorophenols. Expression of these enzymes by plants is commonly associated with plant stress, therefore limiting scope for phytoremediation.

In-house versus on-call attending trauma surgeons at comparable level I trauma centers: a prospective study.

Background: The purpose of this study was to prospectively compare patient outcomes based on the presence of in-house versus on-call attending trauma surgeons at comparable Level I trauma centers.

Methods: Two designated Level I trauma centers agreed to prospectively review trauma admissions over a 6-month period, one institution with 24-hour in-house trauma attending surgeons (IH), and the other with trauma-attending surgeons taking call from home (OC) available to the hospital within 15 minutes of notification. A 6-month prospective study was conducted reviewing all trauma patients admitted to both trauma centers with an Injury Severity Score > or =16.

Leukocyte responses to hypoxic/ischemic conditions.

Ischemia is an interruption of oxygen and nutrient supply to a determined area of tissue for a period of time. Because of the heterogeneity of various tissues with regard to their microvascular flow reserve and oxidative capacity, as well as their markedly different metabolic needs, a single critical Po2 level below which ischemia occurs is unlikely. This is why there are variations of tolerance to hypoxia within and among organs.

Should critical care medicine be a formal part of the undergraduate curriculum?

Medical students were surveyed shortly after completing the third year of medical school. TIle survey was designed to identify those areas of critical care medicine students had been exposed to and expressed interest in learning more about. In addition, the surveys sought to discern the level of confidence students felt with respect to different critical illnesses and intensive care unit (lCU) therapeutic modalities.

Decreasing unplanned extubations in the surgical intensive care unit.

Background: Unplanned extubations are common, but can be life-threatening.

Methods: We conducted a prospective evaluation of all intubated patients in our surgical intensive care unit to examine the effects of three parameters on the likelihood of accidental extubation. The parameters were the method of endotracheal tube fixation, the use of sedation/paralysis, and the use of hand restraints.

Ethanol added to resuscitation improves survival in an experimental model of hemorrhagic shock.

Ethyl alcohol induces systemic vasodilation, decreases platelet aggregation, and inhibits neutrophil activation in vivo. Alcohol may thus be of potential benefit in resuscitation from shock by improving microcirculation. The purpose of this study was to test the effects of ethanol (ETOH) in resuscitation from hemorrhagic shock.

Effects of trauma on leukocyte intercellular adhesion molecule-1, CD11b, and CD18 expressions.

Background: During traumatic injury, a multitude of events, including ischemia, may cause leukocyte adhesion and margination. In this study, alterations of surface receptors involved in leukocyte adhesion were studied in traumatized patients. In an attempt to discern the role of hypoxia, additional experiments were conducted in which normal human leukocytes were subjected to hypoxic stress in vitro.

Soluble cytokine receptors and receptor antagonists are sequentially released after trauma.

Cytokine receptors and receptor antagonists (RAs) have been identified in trauma patients. We hypothesized that after traumatic injury, a sequential release of soluble cytokine receptors and RAs may exist that mirrors the release of the primary cytokines themselves. Twenty-two patients were included in the study: 14 males and 8 females.

Hypoxia-induced alterations of neutrophil membrane receptors.

Extravasation of leukocytes at sites of ischemia may mediate tissue injury. To determine how leukocyte accumulation may be induced by ischemia, effects of hypoxia on basal neutrophil expression of adhesion and activation receptors were examined. Effects of hypoxia upon preactivated cells were also studied.

A technique for repair of traumatic parasternal lung herniation: case report.

A case of traumatic lung herniation through an area of costalsternal separation in a 36-year-old male is presented. Persistent pain and the threat of strangulated lung tissue prompted repair that was accomplished with an expanded polytetrafluoroethylene Gortex tissue patch.

Respiratory distress in traumatized and burned children.

Incidence and significance of respiratory failure after trauma in children was the subject of this study. One thousand nine hundred eighty-nine pediatric trauma patients (aged 18 years or less) were treated at the authors' level I trauma center between 1985 and 1993. Of these, 364 (18%) were intubated.

A method to determine the adequacy of resuscitation using tissue oxygen monitoring.

The change in tissue PO2 in response to an increased inspired O2 challenge may be related to the state of cellular oxygenation, and hence the adequacy of resuscitation. To test this hypothesis, we measured tissue PO2 during inspired O2 challenges in 29 injured patients during acute resuscitation or intensive care unit monitoring. The O2 challenge test had 100% sensitivity and specificity in detecting flow-dependent O2 consumption in invasively monitored patients in the intensive care unit.

Radiation exposure from cervical spine radiographs.

Radiation exposure to hospital personnel during 41 cervical spine radiographs of 30 multiply injured patients was prospectively evaluated. A digital dosimeter was attached to the exposed torso of personnel applying upper extremity traction or managing the airway. Radiation exposure was measured during each radiograph.

Continuous arteriovenous hemodiafiltration in postoperative and traumatic renal failure.

Management of acute renal failure (ARF) in surgical patients has relied on supportive measures including hemodialysis and peritoneal dialysis. An alternative technique currently available is continuous arteriovenous hemodiafiltration (CAVH-D). Records of 44 surgical patients with ARF who were treated with CAVH-D in our surgical intensive care unit from 1989 to 1992 were reviewed.

Emergency thoracotomy with lung resection following trauma.

Over a 7-year period, 9443 trauma patients were evaluated with 2934 (31%) sustaining chest trauma. Of these, 347 (12%) patients required thoracotomy, with 12 patients undergoing emergency lung resection. Mean age was 23.

Pentoxifylline alone versus pentoxifylline combined with superoxide dismutase prolongs survival in a rat hemorrhagic shock model.

Pentoxifylline (PTX) and superoxide dismutase (SOD) have each proven effective in improving survival when administered during resuscitation in animal models of hemorrhagic shock. This study was conducted to determine if PTX and SOD combined would have synergistic effectiveness in the treatment of hemorrhagic shock. Sprague-Dawley rats (n = 40) were phlebotomized at 25 ml/kg for 2 min, then subjected to a 45-min ischemic period, and resuscitated with lactated Ringer's solution (LR) (50 ml/kg) over 1 h.

Orotracheal intubation in trauma patients with cervical fractures.

Objective: To evaluate orotracheal intubation with in-line stabilization of the cervical spine for emergency airway treatment of trauma patients with cervical spine injuries.

Design: Of 7518 trauma patients examined, 81 patients with cervical spine injuries received emergency orotracheal intubation. All intubations were performed by experienced anesthesiologists, with a separate individual maintaining in-line stabilization.

Tumor necrosis factor and monocytes are released during hemorrhagic shock.

Tumor necrosis factor (TNF) is a key mediator involved in many physiologic processes including immunity, inflammation, and metabolism. A relationship between TNF and hemorrhagic shock has not been clearly demonstrated. To help understand the role of TNF in hemorrhagic shock we developed a hemorrhagic shock model to measure TNF and monocyte levels during hemorrhage and resuscitation.

Trauma causes early release of soluble receptors for tumor necrosis factor.

The importance of tumor necrosis factor (TNF) in the pathophysiology of trauma and hemorrhagic shock is not known. In addition, TNF bioactivity may be modulated by soluble forms of the 55-kd and 75-kd membrane receptors (TNFR). This study was undertaken to determine circulating levels of TNF and TNFR after trauma.

Hypoxia induces a human macrophage cell line to release tumor necrosis factor-alpha and its soluble receptors in vitro.

Tissue hypoxia following hemorrhage and trauma is a possible initiating factor of the generalized inflammatory response seen after shock. The role of hypoxia in the release from a human monocyte cell line (THP-1) of tumor necrosis factor-alpha (TNF alpha) and its soluble membrane receptors (TNF alpha R) in-vitro is investigated in this study. Flat-bottom plates with 500,000 THP-1 cells/ml were placed in air-tight sealed boxes and exposed to hypoxia (O2 = 1%) or controls (O2 = 9%) for up to 24 hr.

Regional flow during experimental hemorrhage and crystalloid resuscitation: persistence of low flow to the splanchnic organs.

Unlabelled: BACKGROUND AND METHODS. Rapid changes in cardiac output (CO) and organ perfusion occur with hemorrhagic shock and fluid resuscitation. To assess regional alterations of flow, 40 Sprague-Dawley male rats were subjected to hemorrhagic shock and crystalloid resuscitation under halothane anesthesia.