Lincoln Hospital

About: Lincoln Hospital is a healthcare organization based out in New York, New York, United States. It is known for research contribution in the topics: Population & Emergency department. The organization has 1033 authors who have published 929 publications receiving 14486 citations. The organization is also known as: Lincoln Medical and Mental Health Center & Lincoln Hospital.

Anticoagulant therapy during primary percutaneous coronary intervention for acute myocardial infarction: a meta-analysis of randomized trials in the era of stents and P2Y12 inhibitors

Abstract: Objectives To investigate the relative benefits of unfractionated heparin, low molecular weight heparin(LMWH), fondaparinux, and bivalirudin as treatment options for patients with ST segment elevation myocardial infarction undergoing percutaneous coronary intervention (PCI). Design Mixed treatment comparison and direct comparison meta-analysis of randomized trials in the era of stents and P2Y12 inhibitors. Data sources and study selection A search of Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) for randomized trials comparing unfractionated heparin plus glycoprotein IIb/IIIa inhibitor(GpIIb/IIIa inhibitor), unfractionated heparin, bivalirudin, fondaparinux, or LMWH plus GpIIb/IIIa inhibitor for patients undergoing primary PCI. Outcomes The primary efficacy outcome was short term (in hospital or within 30 days) major adverse cardiovascular event; the primary safety outcome was short term major bleeding. Results We identified 22 randomized trials that enrolled 22 434 patients. In the mixed treatment comparison models, when compared with unfractionated heparin plus GpIIb/IIIa inhibitor, unfractionated heparin was associated with a higher risk of major adverse cardiovascular events (relative risk 1.49 (95% confidence interval 1.21 to 1.84), as were bivalirudin (relative risk 1.34 (1.01 to 1.78)) and fondaparinux (1.78 (1.01 to 3.14)). LMWH plus GpIIb/IIIa inhibitor showed highest treatment efficacy, followed (in order) by unfractionated heparin plus GpIIb/IIIa inhibitor, bivalirudin, unfractionated heparin, and fondaparinux. Bivalirudin was associated with lower major bleeding risk compared with unfractionated heparin plus GpIIb/IIIa inhibitor (relative risk 0.47 (0.30 to 0.74)) or unfractionated heparin (0.58 (0.37 to 0.90)). Bivalirudin, followed by unfractionated heparin, LMWH plus GpIIb/IIIa inhibitor, unfractionated heparin plus GpIIb/IIIa inhibitor, and fondaparinux were the hierarchy for treatment safety. Results were similar in direct comparison meta-analyses: bivalirudin was associated with a 39%, 44%, and 65% higher risk of myocardial infarction, urgent revascularization, and stent thrombosis respectively when compared with unfractionated heparin with or without GpIIb/IIIa inhibitor. However, bivalirudin was associated with a 48% lower risk of major bleeding compared with unfractionated heparin plus GpIIb/IIIa inhibitor and 32% lower compared with unfractionated heparin alone. Conclusions In patients undergoing primary PCI, unfractionated heparin plus GpIIb/IIIa inhibitor and LMWH plus GpIIb/IIIa inhibitor were most efficacious, with the lowest rate of major adverse cardiovascular events, whereas bivalirudin was safest, with the lowest bleeding. These relationships should be considered in selecting anticoagulant therapies in patients undergoing primary PCI.

Predicting the difficult laryngoscopic intubation: are we on the right track?

Abstract: REDICTION and forecasting an outcome is a tough business. In the movie "Matrix", even the Oracle made the "wrong prediction" when she postulated that Neil was not the ONE who could save them from the Matrix, and she was supposed to know the future! Predicting a difficult laryngoscopic intubation employing a myriad of measurements and observations has not demonstrated itself to be predictable or even reliable. Over the years, many univariate and multivariate predictors of difficult laryngoscopic intubation have been explored. However, as difficult laryngoscopic intubation is so uncommon, none of these predictors when studied has been reliably able to yield a high positive predictive value for difficult laryngoscopic intubation. 1 In this issue, Merah et al. 2 studied the potential of five airway measurements to predict a difficult direct laryngoscopic intubation in a West African population. The investigators found that the combination of a modified Mallampati score, the thyromental distance and the inter-incisor gap appeared to be the best predictors of a difficult laryngoscopic intubation with an 84.9% sensitivity, 94.6% specificity, and 35.5% positive predictive value. In light of the current state of knowledge with respect to airway evaluation, the investigators concluded that this prediction tool would behave similarly in Caucasians and West Africans. From a practical point of view with all of the shortcomings attending the prediction of difficult laryngoscopy and intubation, this type of multivariate airway assessment is probably about as good as it gets in predicting a difficult laryngoscopic intubation. While a difficult direct laryngoscopy may be considered uncommon, a grade II or III laryngoscopic view requiring multiple attempts and/or blades still occurs between 1 and 18% of the time. 3 Failed laryngoscopic intubation is really quite uncommon (0.05‐0.35%) and the cannot intubate cannot ventilate situation is even more rare (1:2250 in nonparturients and as high as 1:280 in parturients), but carries the high probability of an unfavourable outcome. 3 Will it ever be possible to devise a system that will identify, with a reliability approaching 100%, patients who should be intubated awake and those who can safely be intubated post induction? It doesn’t appear so. The real issue, however, is a broader one: ventilation and oxygenation, rather than ‘intubatability’. The important question thus becomes, ‘what factors contribute to the inability to effect gas exchange in the induced, paralyzed patient to the extent that life may be threatened?’ We need to change how we think about airway management. Rather than focusing only on predicting “intubatability”, we must focus on the broader issue of ‘ventilatability’. We should devise a framework that permits us to reliably predict our ability to provide oxygenation and ventilation for a specific patient. With gas exchange being the focus of airway management, we believe that there are four ‘dimensions’ to this functional and anatomic evaluation: 1) Will I be able to oxygenate this patient using bag mask ventilation (BMV)? The inability to effect a mask seal, overcome upper airway obstruction, or ventilate in the presence of a reduced pulmonary compliance and increased airways resistance all come into play; 4 2) Is it possible to ventilate the patient using a supraglottic device (SGD)? The use of a SGD may be difficult in the presence of a restricted mouth opening, upper or lower airway obstruction, a distorted or disrupted airway or a reduction in the pulmonary compliance; 3) Will I be able to place a tube in the trachea of the patient using a laryngoscope or other alternative techniques? Research has delineated anatomic predictors of difficult direct laryngoscopy. Other anatomic and pathologic predictors

Correlation of urinalysis and dipstick results with catheter-associated urinary tract infections in surgical ICU patients

Abstract: Objective To determine the utility of urinalysis and dipstick results in predicting urinary tract infections in catheterized ICU patients.