Saint Louis University

About: Saint Louis University is a education organization based out in St Louis, Missouri, United States. It is known for research contribution in the topics: Population & Poison control. The organization has 18927 authors who have published 34895 publications receiving 1267475 citations. The organization is also known as: SLU & St. Louis University.

Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effect

Abstract: Of 136 million babies born annually, around 10 million require assistance to breathe. Each year 814,000 neonatal deaths result from intrapartum-related events in term babies (previously “birth asphyxia”) and 1.03 million from complications of prematurity. No systematic assessment of mortality reduction from tactile stimulation or resuscitation has been published. To estimate the mortality effect of immediate newborn assessment and stimulation, and basic resuscitation on neonatal deaths due to term intrapartum-related events or preterm birth, for facility and home births. We conducted systematic reviews for studies reporting relevant mortality or morbidity outcomes. Evidence was assessed using GRADE criteria adapted to provide a systematic approach to mortality effect estimates for the Lives Saved Tool (LiST). Meta-analysis was performed if appropriate. For interventions with low quality evidence but strong recommendation for implementation, a Delphi panel was convened to estimate effect size. We identified 24 studies of neonatal resuscitation reporting mortality outcomes (20 observational, 2 quasi-experimental, 2 cluster randomized controlled trials), but none of immediate newborn assessment and stimulation alone. A meta-analysis of three facility-based studies examined the effect of resuscitation training on intrapartum-related neonatal deaths (RR= 0.70, 95%CI 0.59-0.84); this estimate was used for the effect of facility-based basic neonatal resuscitation (additional to stimulation). The evidence for preterm mortality effect was low quality and thus expert opinion was sought. In community-based studies, resuscitation training was part of packages with multiple concurrent interventions, and/or studies did not distinguish term intrapartum-related from preterm deaths, hence no meta-analysis was conducted. Our Delphi panel of 18 experts estimated that immediate newborn assessment and stimulation would reduce both intrapartum-related and preterm deaths by 10%, facility-based resuscitation would prevent a further 10% of preterm deaths, and community-based resuscitation would prevent further 20% of intrapartum-related and 5% of preterm deaths. Neonatal resuscitation training in facilities reduces term intrapartum-related deaths by 30%. Yet, coverage of this intervention remains low in countries where most neonatal deaths occur and is a missed opportunity to save lives. Expert opinion supports smaller effects of neonatal resuscitation on preterm mortality in facilities and of basic resuscitation and newborn assessment and stimulation at community level. Further evaluation is required for impact, cost and implementation strategies in various contexts. This work was supported by the Bill & Melinda Gates Foundation through a grant to the US Fund for UNICEF, and to the Saving Newborn Lives program of Save the Children, through Save the Children US.

American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography.

Abstract: Continuing Medical Education Course for "American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography" Accreditation Statement The American Society of Echocardiography (ASE) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASE designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit .™ Physicians should only claim credit commensurate with the extent of their participation in the activity. The American Registry of Diagnostic Medical Sonographers and Cardiovascular Credentialing International recognize the ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers. The ASE is committed to resolving all conflict-of-interest issues, and its mandate is to retain only those speakers with financial interests that can be reconciled with the goals and educational integrity of the educational program. Disclosure of faculty and commercial support sponsor relationships, if any, have been indicated. Target Audience This activity is designed for all cardiovascular physicians, cardiac sonographers, and nurses with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, sonographers, and other medical professionals having a specific interest in contrast echocardiography may be included. Objectives Upon completing this activity, participants will be able to: 1. Demonstrate an increased knowledge of the applications for contrast echocardiography and their impact on cardiac diagnosis. 2. Differentiate the available ultrasound contrast agents and ultrasound equipment imaging features to optimize their use. 3. Recognize the indications, benefits, and safety of ultrasound contrast agents, acknowledging the recent labeling changes by the US Food and Drug Administration (FDA) regarding contrast agent use and safety information. 4. Identify specific patient populations that represent potential candidates for the use of contrast agents, to enable cost-effective clinical diagnosis. 5. Incorporate effective teamwork strategies for the implementation of contrast agents in the echocardiography laboratory and establish guidelines for contrast use. 6. Use contrast enhancement for endocardial border delineation and left ventricular opacification in rest and stress echocardiography and unique patient care environments in which echocardiographic image acquisition is frequently challenging, including intensive care units (ICUs) and emergency departments. 7. Effectively use contrast echocardiography for the diagnosis of intracardiac and extracardiac abnormalities, including the identification of complications of acute myocardial infarction. 8. Assess the common pitfalls in contrast imaging and use stepwise, guideline-based contrast equipment setup and contrast agent administration techniques to optimize image acquisition. Author Disclosures Sharon L. Mulvagh: research grant, Lantheus Medical Imaging, GE Healthcare, and Astellas Pharma; consultant/advisory, Acusphere, Point Biomedical. Mani A. Vannan: research grant, other research support, speaker bureau/honoraria, and consultant/advisory board, Lantheus Medical Imaging. Harald Becher: research grant, Philips, Sonosite, and Toshiba; speaker bureau/honoraria, Lantheus Medical Imaging; consultant/advisory board, Point Biomedical, Bracco, Acusphere, ICON, Lantheus Medical Imaging. S. Michelle Bierig: research grant, Lantheus Medical Imaging, Amersham. Peter N. Burns: consultant/advisory board, Philips Ultrasound, Lantheus Medical Imaging. Dalane W. Kitzman: research grant, Lantheus Medical Imaging, IMCOR, Sonus; speakers bureau, Lantheus Medical Imaging; consultant/advisory board, Lantheus Medical Imaging, Acusphere. Itzhak Kronzon: research grant, GE Healthcare. Arthur J. Labovitz: consultant/advisory board, ICON Medical. Roberto M. Lang: research grant, Acusphere, Point Biomedical; speaker bureau, Lantheus Medical Imaging; consultant/advisory board, Lantheus Medical Imaging. Julio E. Perez: consultant/advisory board, Biomedical Systems. Thomas R. Porter: research grant, Lantheus Medical Imaging; consultant/advisory board, Acusphere, ImaRx. Judy Rosenbloom: paid consultant with ultrasound equipment manufacturers. Kevin Wei: research grant, Lantheus Medical Imaging, Philips Ultrasound; consultant/advisory board, Acusphere. The following stated no disclosures: Harry Rakowski, Sahar S. Abdelmoneim, Ramon Castello, Patrick D. Coon, Mary E. Hagen, James G. Jollis, Thomas R. Kimball, Joseph Mathew, Stuart Moir, Sherif F. Nagueh, Alan S. Pearlman, G. Monet Strachan, Srihari Thanigaraj, Anna Woo, Eric H. C. Yu, and William A. Zoghbi. Conflicts of Interest: The authors have no conflicts of interest to disclose except as noted above. Estimated Time to Complete This Activity: 1 hour

Parasympathetic Nervous System and Heart Failure Pathophysiology and Potential Implications for Therapy

Abstract: Abundant evidence links sympathetic nervous system activation to outcomes of patients with heart failure (HF).1 In contrast, parasympathetic activation has complex cardiovascular effects that are only beginning to be recognized. In particular, the pathophysiological roles of normal and disordered parasympathetic innervation in patients with HF are not understood as comprehensively.2–5 In the present article, we review cardiovascular responses to parasympathetic activation, address the modulating factors that can affect parasympathetic function, discuss the role of the vagus nerve in ventricular dysfunction, and consider how activation of the parasympathetic nervous system may have important therapeutic implications for patients with congestive HF. The parasympathetic nervous system originates from medial medullary sites (nucleus ambiguous, nucleus tractus solitarius, and dorsal motor nucleus) and is modulated by the hypothalamus. Vagal efferents extend from the medulla to postganglionic nerves that innervate the atria via ganglia located in cardiac fat pads with neurotransmission that is modulated via nicotinic receptors. Postganglionic parasympathetic and sympathetic cholinergic nerves then affect cardiac muscarinic receptors (the Figure).6–8 Figure. Parasympathetic and sympathetic innervation of the heart: anatomy. Efferent fiber (vagus) comprises A-beta, A-delta, and unmyelinated C fibers. Reproduced from Martini FH. Fundamentals of Anatomy and Physiology . 8th ed. 2006. Chapter 20, by permission of Pearson Education, Inc Prentice Hall, copyright © 2006. Vagus nerve afferent activation, originating peripherally, can modulate efferent sympathetic and parasympathetic function centrally and at the level of the baroreceptor. Efferent vagus nerve activation can have tonic and basal effects that inhibit sympathetic activation and release of norepinephrine at the presynaptic level. Acetylcholine release from parasympathetic nerve terminals will activate ganglionic nicotinic receptors that in turn activate muscarinic receptors at the cellular level. Cardiovascular effects include heart rate reduction by inhibition of the sympathetic nervous system and by direct hyperpolarization of sinus nodal cells. Parasympathetic activation …

A rating system for use with patient pain drawings.

Abstract: Patients entering treatment for chronic benign pain often are asked to complete drawings indicating the intensity and location of their pain as part of the diagnostic process. While inferences have been made from pain drawings about the relative contributions of physiological and psychological factors to the patient's experience of pain, previous research has provided only equivocal support for this practice. A reliable method for assessing pain drawings is needed both for clinical use and to assess the validity of such interpretations. While a number of systems for using such drawings have been proposed, it is not always clear exactly what aspect of the drawing is being quantified. In this study, 101 patients who presented with chronic pain were asked to complete pain drawings which were than scored for the presence or absence of pain in each of 45 body areas. Scorers achieved a high rate of inter-rater agreement with relatively little training. The body surface scores obtained were shown to correlate highly with the penalty point system developed by Ransford et al., suggesting that extent of pain may account for much of the variance in this system. The results are discussed in relation to the clinical and experimental uses for such a system.