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Development and pilot implementation of a patient-oriented discharge summary for critically Ill patients

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World Journal of Critical Care Medicine 2022年第4期11卷 255-268页

作者： Anmol Shahid Bonnie Sept Shelly Kupsch Rebecca Brundin-Mather Danijela Piskulic Andrea Soo Christopher Grant Jeanna Parsons Leigh Kirsten M Fiest henr. t stelfox Department of Critical Care Medicine University of CalgaryCalgary T2N 4Z6AlbertaCanada Department of Psychiatry Hotchkiss Brain InstituteCalgary T2N 4Z6AlbertaCanada School of Health Administration Dalhousie UniversityHalifax B3H 4R2Nova ScotiaCanada

BACKGROUND Patients leaving the intensive care unit(ICU)often experience gaps in care due to deficiencies in discharge communication,leaving them vulnerable to increased stress,adverse events,readmission to ICU,and *** facilitate discharge communication,written summaries have been implemented to provide patients and their families with information on medications,activity and diet restrictions,follow-up appointments,symptoms to expect,and who to call if there are *** written discharge summaries for patients and their families are utilized frequently in surgical,rehabilitation,and pediatric settings,few have been utilized in ICU *** to develop an ICU specific patient-oriented discharge summary tool(PODS-ICU),and pilot test the tool to determine acceptability and *** Patient-partners(i.e.,individuals with lived experience as an ICU patient or family member of an ICU patient),ICU clinicians(i.e.,physicians,nurses),and researchers met to discuss ICU patients’specific informational needs and design the PODS-ICU through several cycles of discussion and iterative *** team nurses piloted the PODS-ICU with patient and family participants in two ICUs in Calgary,***-up surveys on the PODS-ICU and its impact on discharge were administered to patients,family participants,and ICU *** Most participants felt that their discharge from the ICU was good or better(n=13;87.0%),and some(n=9;60.0%)participants reported a good understanding of why the patient was in *** participants(n=12;80.0%)reported that they understood ICU events and impacts on the patient’s *** many patients and family participants indicated the PODS-ICU was informative and useful,ICU nurses reported that the PODS-ICU was“not reasonable”in their daily clinical workflow due to“time constraint”.CONCLUSION the PODS-ICU tool provides patients and their families with essential information as they discharge from the *** tool has

关键词： Discharge tool Patient discharge summary Patient communication Family communication transitions in care Intensive care unit

Integration of molecular testing for the personalized management of patients with diffuse large B-cell lymphoma and follicular lymphoma

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World Journal of Clinical Oncology 2023年第4期14卷 160-170页

作者： Ruth Stuckey Hugo Luzardo henr.quez Haridian de la Nuez Melian JoséCarlos Rivero Vera Cristina Bilbao-Sieyro María teresa Gómez-Casares Department of Hematology Hospital Universitario de Gran Canaria Dr.NegrínLas Palmas 35019Spain Department of Anatomical Pathology Hospital Universitario de Gran Canaria Dr.NegrínLas Palmas 35019Spain Department of Hematology Hospital Universitario de Gran Canaria Dr.NegrinLas Palmas de Gran Canaria 35019Las Palmas de Gran CanariaSpain Department of Morphology Universitario de Las Palmas de Gran CanariaLas Palmas 35001Spain Medical Science Universitario de Las Palmas de Gran CanariaLas Palmas 35001Spain

Diffuse large B-cell lymphoma(DLBCL)and follicular lymphoma(FL)are the most common forms of aggressive and indolent lymphoma,*** majority of patients are cured by standard R-CHOP immunochemotherapy,but 30%–40%of DLBCL and 20%of FL patients relapse or are refractory(R/R).DLBCL and FL are phenotypically and genetically hereterogenous B-cell *** date,the diagnosis of DLBCL and FL has been based on morphology,immunophenotyping and ***,next-generation sequencing(NGS)is widening our understanding of the genetic basis of the B-cell *** this review we will discuss how integrating the NGS-based characterization of somatic gene mutations with diagnostic or prognostic value in DLBCL and FL could help refine B-cell lymphoma classification as part of a multidisciplinary pathology *** will also discuss how molecular testing can identify candidates for clinical trials with targeted therapies and help predict therapeutic outcome to currently available treatments,including chimeric antigen receptor t-cell,as well as explore the application of circulating cell-free DNA,a non-invasive method for patient *** conclude that molecular analyses can drive improvements in patient outcomes due to an increased understanding of the different pathogenic pathways affected by each DLBCL subtype and indolent FL vs R/R FL.

关键词： Next-generation sequencing Prognosis Molecular analysis targeted therapy Chimeric antigen receptor t-cell therapy Personalized medicine

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World Journal of Critical Care Medicine 2022年第4期11卷 236-245页

作者： Vincent Issac Lau Jeffrey A Johnson Sean M Bagshaw Oleksa G Rewa John Basmaji Kimberley A Lewis M Elizabeth Wilcox Kali Barrett Francois Lamontagne Francois Lauzier Niall D Ferguson Simon J W Oczkowski Kirsten M Fiest Daniel J Niven henr. t stelfox Waleed Alhazzani Margaret Herridge Robert Fowler Deborah J Cook Bram Rochwerg Feng Xie Department of Critical Care Medicine University of AlbertaEdmonton T6G 2B7ABCanada School of Public Health Inst Hlth EconUniversity of AlbertaEdmonton T6G 2B7ABCanada Department of Medicine Division of Critical CareWestern UniversityLondon N6A 5W9Canada Division of Critical Care McMaster UniversityHamilton L8N 4A6Canada Interdepartmental Division of Critical Care University of TorontoToronto M5T 2S8Canada Department of Medicine University SherbrookeSherbrooke J1H 5N4Canada Departments of Medicine and Anesthesiology University LavalLaval G1V 4G2Canada Department Critical Care Medicine University of TorontoToronto M5G 2C4Canada Department of Medicine McMaster ClinHamilton Gen HospMcMaster UniversityHamilton L8N 4A6Canada Department of Community Health Sciences&Institute for Public Health University of CalgaryCalgary T2N 2T9Canada Department of Critical Care Medicine University CalgaryCalgary T2N 2T9Canada Department of Community Health Sciences University of CalgaryCalgary T2N 2T9Canada Department of Medicine McMaster UniversityHamilton L8N 4A6Canada Indepartmental Division of Critical Care University Health NetworkToronto M5G 2C4Canada Departments of Medicine and Critical Care Medicine Sunnybrook Health Sciences CenterInstitute of Health Policy Management and EvaluationUniversity of TorontoToronto M4N 3M5Canada Health Research Methods Evidence and ImpactMcMaster UniversityHamilton L8N 3Z5Canada

Mortality is a well-established patient-important outcome in critical care *** contrast,morbidity is less uniformly reported(given the myriad of critical care illnesses and complications of each)but may have a common end-impact on a patient’s functional capacity and health-related quality-of-life(HRQoL).Survival with a poor quality-of-life may not be acceptable depending on individual patient values and ***,as mortality decreases within critical care,it becomes increasingly important to measure intensive care unit(ICU)survivor *** measurements with a preference-based scoring algorithm can be converted into health utilities on a scale anchored at 0(representing death)and 1(representing full health).they can be combined with survival to calculate quality-adjusted life-years(QALY),which are one of the most widely used methods of combining morbidity and mortality into a composite *** QALYs have been use for health-technology assessment decision-making,an emerging and novel role would be to inform clinical decision-making for patients,families and healthcare providers about what expected HRQoL may be during and after ICU *** care randomized control trials(RCts)have not routinely measured or reported HRQoL(until more recently),likely due to incapacity of some patients to participate in patient-reported outcome *** differences in HRQoL measurement tools can lead to non-comparable *** this end,we propose the validation of a gold-standard HRQoL tool in critical care,specifically the *** combined health-utility and mortality(disaggregated)and QALYs(aggregated)can be reported,with disaggregation allowing for determination of which components are the main drivers of the QALY *** use of HRQoL,health-utility,and QALYs in critical care RCts has the potential to:(1)Increase the likelihood of finding important effects if they exist;(2)improve research efficiency;and(3)help inform optimal m

关键词： Critical care health-related quality of life Quality-adjusted life-years Health-utility Mortality Morbidity Kaplan-Meier curves

Erosion problem in tool steel using cold box core-making process

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China Foundry 2019年第3期16卷 204-210页

作者： Eduardo Rodríguez Alberto Pérez Rafael David Mercado-Solis Velasco-téllez Abraham Omar Jimenez Martin Flores Marco Aurelio Gonzalez Jesus Ibarra Universidad de Guadalajara Departamento de Ingeniería de Proyectos/CUCEI CONACyT México Facultad de Ingeniería Mecánica y Eléctrica UANL México Nemak México S.A. García México Instituto tecnológico José Mario Molina Pasquel y henr.quez Unidad Zapopan México

this paper presents the erosion results of the AISI H13 steel impinged by resin-bonded silica sand, using a testing rig that closely simulates the real blowing conditions during industrial core-making. Steel specimens were heat treated to obtain hardness of 294, 445 and 595 HV200 (29, 45 and 55 HRC). Erosion tests were carried out at impingement angles from 20° to 90° and air drag pressures of 1.38, 2.07 and 2.76 bar (20, 30 and 40 psi). the main results are summarized as follows:(i) the harder material, the lower erosion;(ii) the maximum erosion rate is at 30°;(iii) Little difference in erosion rate at impact angle of 60° and 90° for a constant pressure tested regardless of the hardness level;(iv) As the pressure increases, so does the erosion rate, being more sensitive for low impact angles. Finally, a differential form of the general erosion equation is applied on a practical core-making case to evaluate the erosion rate of the H13 steel at 30° and 90° impingement angles.

关键词： erosion cold box core-making H13 tool steel resin coated silica sand