The latest medical research on Retrieval Medicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about retrieval medicine gathered by our medical AI research bot.

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Offsite primary care providers using telehealth to support a sustainable workforce in rural and remote general practice: A rapid review of the literature.

Australian Journal of Rural Health

Rural and remote general practices face increasing demands for care without the workforce required to meet patient needs. The coronavirus pandemic has created an opportunity to explore sustainable, telehealth-driven solutions to this chronic and complex problem.

This review examined interventions using offsite primary care providers to deliver ongoing patient care via telehealth to support rural and remote general practices. We aimed to understand the impact of such interventions on the Quadruple Aim (patient experience, provider experience, health care costs, and health outcomes).

A rapid review of studies published from 2011 and grey literature published from 2016.

Six studies met the eligibility criteria. No eligible Australian studies were identified. Most studies investigated ongoing primary care services provided via telehealth by offsite pharmacists. Patients and rural primary care staff reported positive experiences with the interventions. One study demonstrated potential return on investment for rural practices. While one study reported clinically and statistically significant improvements in health outcomes over time, two studies did not observe statistically significant differences in health outcomes between intervention and control cohorts.

Sustainable solutions to workforce shortages in rural and remote general practice are needed urgently. Using offsite primary care providers to deliver telehealth and support practices in these regions is one possible solution that warrants further investigation, particularly in Australia.

Co-design with aboriginal and torres strait islander communities: A journey.

Australian Journal of Rural Health

This paper explores the principles of co-design with Aboriginal and Torres Strait Islander communities by reflecting on the literature, learning from experiences of allied health professionals, and considering how co-design can be applied in rural and remote allied health practice.

This paper has been authored by a working group from Services for Rural and Remote Allied Health (SARRAH). SARRAH is a member-based allied health organisation, working to improve health outcomes for rural and remote Australians. SARRAH has been representing and supporting allied health professionals in rural and remote Australia for over 20 years, with a member base that includes students, practitioners, programme managers, policy makers and academics. As a non-Indigenous organisation, SARRAH works in partnership and receives guidance from the peak organisation, Indigenous Allied Health Australia (IAHA).

Over a period of 3 months, a group of eleven SARRAH members and staff came together to review available literature, seek member perspectives and share their experiences and understandings of co-design. Working group discussions were grounded in the knowledge and experiences shared by two Aboriginal and Torres Strait Islander group members.

This paper proposes that successful co-design with Aboriginal and Torres Strait Islander communities places legitimate value on different knowledge systems, is built on strong and trusting relationships, promotes inclusive involvement and requires authentic partnerships. Using these principles, SARRAH will engage with members and stakeholders to influence meaningful change in allied health practice in rural and remote Australia.

Soluble guanylyl cyclase activation rescues hyperoxia-induced dysfunction of vascular relaxation.

Shock

Perioperative alterations in perfusion lead to ischemia and reperfusion injury, and supplemental oxygen is administered during surgery to limit hypoxic injury but can lead to hyperoxia. We hypothesized that hyperoxia impairs endothelium-dependent and -independent vasodilation but not the vasodilatory response to heme-independent soluble guanylyl cyclase activation.

We measured the effect of oxygen on vascular reactivity in mouse aortas. Mice were ventilated with 21% (normoxia), 60% (moderate hyperoxia), or 100% (severe hyperoxia) oxygen during 30 minutes of renal ischemia and 30 minutes of reperfusion. Following sacrifice, the thoracic aorta was isolated, and segments mounted on a wire myograph. We measured endothelium-dependent and -independent vasodilation with escalating concentrations of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively, and we measured the response to heme-independent soluble guanylyl cyclase activation with cinaciguat. Vasodilator responses to each agonist were quantified as the maximal theoretical response (Emax) and the effective concentration to elicit 50% relaxation (EC50) using a sigmoid model and nonlinear mixed effects regression. Aortic superoxide was measured with dihydroethidium probe and HPLC quantification of the specific superoxide product 2-hydroxyethidium.

Hyperoxia impaired endothelium-dependent (ACh) and -independent (SNP) vasodilation compared to normoxia and had no effect on cinaciguat-induced vasodilation. The median ACh Emax was 76.4% (95% CI: 69.6 to 83.3) in the normoxia group, 53.5% (46.7 to 60.3) in the moderate hyperoxia group, and 53.1% (46.3 to 60.0) in the severe hyperoxia group (p < 0.001, effect across groups), while the ACh EC50 was not different among groups. The SNP Emax was 133.1% (122.9-143.3) in normoxia, 128.3% (118.1-138.6) in moderate hyperoxia, and 114.8% (104.6-125.0) in severe hyperoxia (p < 0.001, effect across groups), and the SNP EC50 was 0.38 log M greater in moderate hyperoxia than in normoxia (95% CI: 0.18 to 0.58, p < 0.001). Cinaciguat Emax and EC50 were not different among oxygen treatment groups (median range Emax 78.0% to 79.4% and EC50 -18.0 to -18.2 log M across oxygen groups). Aorta 2-hydroxyethidium was 1419 pmol/mg protein (25th-75th percentile: 1178-1513) in normoxia, 1993 (1831-2473) in moderate hyperoxia, and 2078 (1936-2922) in severe hyperoxia (p = 0.008, effect across groups).

Hyperoxia, compared to normoxia, impaired endothelium-dependent and -independent vasodilation but not the response to heme-independent soluble guanylyl cyclase activation, and hyperoxia increased vascular superoxide production. Results from this study could have important implications for patients receiving high concentrations of oxygen and at risk for ischemia reperfusion-mediated organ injury.

Early initiation of vasopressin reduces organ failure and mortality in septic shock.

Shock

To determine if initiating vasopressin earlier in septic shock reduces organ dysfunction and in-hospital all-cause mortality.

This multicenter, retrospective, cohort study evaluated patients admitted to the medical intensive care unit (ICU) between October 2011 and August 2018 with septic shock who received vasopressin within 48 hours of shock onset. The primary composite outcome was the proportion of patients with a change in the sequential organ failure assessment (SOFA) score of >3 from baseline to 72 hours after initiation of vasopressin and/or in-hospital all-cause mortality. Secondary outcomes included time to hemodynamic stability, acute kidney injury, and ICU length of stay.

A total of 385 patients included in the final evaluation with a mean APACHE II score of 31 and a mean baseline SOFA score of 13. Median time to initiation of vasopressin after norepinephrine was 7.3 hours. The primary composite outcome was significantly reduced in patients who had vasopressin initiated earlier in septic shock (OR = 1.08; 95% CI 1.03-1.13; p < 0.001). After controlling for baseline data in a multivariable regression model the primary outcome remained statistically significant (OR = 1.04; 95% CI 1.02-1.07, p = 0.001).

Early initiation of vasopressin in septic shock may reduce the risk of in-hospital all-cause mortality and/or organ dysfunction.

Intrapulmonary Treatment with a Novel TLR4 Agonist Confers Protection against Klebsiella Pneumonia.

Shock

Nosocomial pneumonia is a common complication in critically ill patients. The goal of this study was to examine the efficacy of the toll-like receptor 4 (TLR4) agonist 3-deacyl phosphorylated hexacyl disaccharide (3D PHAD), in a clinically relevant murine model of pneumonia and assess the cellular mechanisms that mediate the protective response.

Intrapulmonary treatment with 20 μg 3D PHAD for 2 consecutive days.

Intrapulmonary treatment with 3D PHAD decreased lung K. pneumoniae CFU and pneumonia severity with an associated improvement in survival compared to mice treated with vehicle. The numbers of neutrophils, monocytes and macrophages in the lungs of 3D PHAD-treated mice were higher than in vehicle-treated mice prior to infection, but were not significantly different from vehicle-treated mice at 48 hours after K. pneumoniae challenge. Lung innate leukocytes from 3D PHAD-treated mice had increased phagocytic capacity. Treatment with 3D PHAD alone increased cytokines in the lungs, but decreased cytokines in plasma during K. pneumoniae pneumonia as compared to control.

Intrapulmonary treatment with 3D PHAD augments innate immunity in the lung and facilitates resistance to K. pneumoniae pneumonia.

Vasopressor-resistant hypotension, combination vasopressor therapy, and shock phenotypes in critically ill adults with vasodilatory shock.

Shock

To examine the risk factors, resource utilization and 1-year mortality associated with vasopressor-resistant hypotension (VRH) compared with vasopressor-sensitive hypotension (VSH) among critically ill adults with vasodilatory shock. We also examined whether combination vasopressor therapy and patient phenotype were associated with mortality.

None.

VRH was defined as those requiring >0.2 mcg/kg/minute of norepinephrine equivalent dose of vasopressor consecutively for more than 6 hours and VSH was defined as patients requiring ≤0.2 mcg/kg/min to maintain mean arterial pressure between 55-70 mmHg after adequate fluid resuscitation. Of 5,313 patients with vasodilatory shock, 1,291 (24.3%) patients developed VRH. Compared with VSH, VRH was associated with increased risk of acute kidney injury (72.7% vs. 65.0%; P < 0.001), use of kidney replacement therapy (26.0% vs. 11.0%; P < 0.001), longer median (IQR) ICU length of stay (10 [IQR, 4.0-20.0] vs. 6 [IQR, 3.0-13.0] days; P < 0.001), and increased 1 year mortality (64.7% vs. 34.8%; P < 0.001). VRH was associated with increased odds of risk-adjusted mortality (adjusted odds ratio, [aOR], 2.93, 95% CI, 2.52-3.40; P < 0.001). When compared with monotherapy, combination vasopressor therapy with two (aOR, 0.91, 95%CI, 0.78 -1.06) and three or more vasopressors were not associated with lower mortality (aOR, 0.93, 95%CI, 0.68-1.27). Using a finite mixture model, we identified four unique phenotypes of patient clusters that differed with respect to demographics, severity of illness, processes of care, vasopressor use and outcomes.

Among critically ill patients with vasodilatory shock, VRH compared with VSH, is associated with increased resource utilization and long-term risk of death. However, combination vasopressor therapy was not associated with lower risk of death. We identified four unique phenotypes of patient clusters that requires further validation.

Intestinal damage and immune response after experimental blunt abdominal trauma.

Shock

Abdominal trauma (AT) is of major global importance, particularly because the civil, terroristic and military traumatic potential of blast injuries...

Hospital characteristics are associated with clinical outcomes in patients with cardiogenic shock.

Shock

Cardiogenic shock is associated with a high risk of morbidity and mortality. The impact of receiving hospital characteristics in emergency medical services (EMS) treated cardiogenic shock is poorly defined. This study aims to determine if receiving hospital characteristics influence clinical outcomes.

This population-based cohort study included consecutive adult patients with cardiogenic shock who were transferred to hospital by emergency medical services (EMS) between 1 January 2015 and 30 June 2019 in Victoria, Australia. Data were obtained from individually linked ambulance, hospital, and state death index datasets. The primary outcome assessed was 30-day mortality stratified by the availability of 24-hour coronary angiography (cardiac center) at the receiving hospital.

A total of 3,217 patients were transferred to hospital with cardiogenic shock. The population had an average age of 67.9 +/- 16.1 years and 1,289 (40.1%) were female. EMS transfer to a cardiac center was associated with significantly reduced rates of 30-day mortality (adjusted odds ratio (aOR) 0.78; 95% CI 0.64-0.95), compared to non-cardiac centers. Compared with the lowest annual cardiogenic shock volume quartile(<18 cases per year), hospitals in the highest volume quartile (>55 cases per year) had reduced risk of 30-day mortality (aOR 0.71; 95% CI 0.56-0.91). A stepwise reduction in the adjusted probability of 30-day mortality was observed in patients transferred by EMS to trauma level 1 centers (34.6%), compared with cardiothoracic surgical centers (39.0%), non-cardiac surgical metropolitan (44.9%), and rural (51.3%) cardiac centers, all p < 0.05.

Receiving hospital characteristics are associated with survival outcomes in patients with cardiogenic shock. These finding have important implications for establishing regionalized systems of care for patients with cardiogenic shock who are transferred to hospital by EMS.

A2A Adenosine Receptors Regulate Multiple Organ Failure After Hemorrhagic Shock in Mice.

Shock

Trauma hemorrhagic shock (T/HS) is a clinical condition which causes multiple organ failure (MOF) that needs rapid intervention. Restricted oxygen ...

Participant perspectives of an online co-design process to develop a prevention-focused mental health and well-being platform for primary producers.

Australian Journal of Rural Health

To explore participant experiences of an online co-design process to develop a web-based preventative mental health and well-being intervention targeting primary producers in rural Australia.

A qualitative study using semi-structured phone-based interviews was undertaken. A reflexive inductive approach to data analysis was employed to develop themes.

Eleven participants were interviewed, with an average age of 51 years, of which 7 were female. Five main themes were developed. These included: (1) participant diversity, (2) impact of online delivery on co-design participation, (3) experiences of the co-design process, (4) maintaining a shared vision and goals and (5) acting on the co-design recommendations. Use of online methods was a clear enabler to engage participants who were geographically dispersed and offers an alternative to more conventional approaches to co-design using face-to-face methods. Some aspects of participant engagement may need a greater focus when conducted online compared with face-to-face.

Using an online co-design method to develop a preventative mental health and well-being web-based platform for primary producers was novel. Findings address a gap in the literature around the experience of participants engaging in a co-design process and identify opportunities to improve participant engagement and experience with the online format.

PLATELET FUNCTION IN TRAUMA: IS CURRENT TECHNOLOGY IN FUNCTION TESTING MISSING THE MARK IN INJURED PATIENTS?

Shock

Platelets are subcellular anucleate components of blood primarily responsible for initiating and maintaining hemostasis. After injury to a blood ve...

TRAUMA-DERIVED EXTRACELLULAR VESICLES ARE SUFFICIENT TO INDUCE ENDOTHELIAL DYSFUNCTION AND COAGULOPATHY.

Shock

Although a number of studies have demonstrated increased release of extracellular vesicles (EVs) and changes in their origin differentials after tr...