State Sepsis Mandates — A New Era for Regulation of Hospital Quality

Hershey, Tina Batra; Kahn, Jeremy M.

doi:10.1056/nejmp1611928

Cited by 61 publications

(50 citation statements)

References 4 publications

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“…The regulations may also lead to antibiotic overuse, if hospitals, in an attempt to increase their adherence to guidelines, give antibiotics to patients who are not infected [32]. In a study among 49,331 patients at 149 hospitals, 40,696 (82.5%) had the 3-hour bundle completed within 3 hours [31].…”

Section: Potential Dangersmentioning

confidence: 99%

The SEP-1 quality mandate may be harmful: How to drown a patient with 30 mL per kg fluid!

Marik

Malbrain

2017

Anaesthesiol Intensive Ther

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Section: Potential Dangersmentioning

confidence: 99%

The SEP-1 quality mandate may be harmful: How to drown a patient with 30 mL per kg fluid!

Marik

Malbrain

2017

Anaesthesiol Intensive Ther

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“…New antibiotics are more effective in controlling infections, but they do not control deleterious inflammation. Among the inflammatory cytokines, Tumor Necrosis Factor (TNF) is a critical factor regulating the innate immune responses to infection or trauma (Angus, 2007; Hershey and Kahn, 2017; Martin et al, 2003; Sands et al, 1997; Ulloa and Deitch, 2009). However, excessive TNF production becomes more dangerous than the original infection and causes systemic inflammation, cardiovascular shock, and lethal multiple organ failure in sepsis (Cai et al, 2009; Tang et al, 2012; Tracey et al, 1987).…”

Section: Introductionmentioning

confidence: 99%

Exercise activates vagal induction of dopamine and attenuates systemic inflammation

Shimojo

Joseph

Shah

et al. 2019

Brain, Behavior, and Immunity

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Physical exercise is one of the most important factors improving quality of life, but it is not feasible for patients with morbidity or limited mobility. Most previous studies focused on high-intensity or long-term exercise that causes metabolic stress or physiological adaption, respectively. Here, we studied how moderate-intensity swimming affects systemic inflammation in 6–8 week old C57BL/6J male mice during endotoxemia. One-hour swimming prevented hypokalemia, hypocalcemia, attenuated serum levels of inflammatory cytokines, increased anti-inflammatory cytokines but affected neither IL6 nor glycemia before or after the endotoxic challenge. Exercise attenuated serum TNF levels by inhibiting its production in the spleen through a mechanism mediated by the subdiaphragmatic vagus nerve but independent of the splenic nerve. Exercise increased serum levels of dopamine, and adrenalectomy prevented the potential of exercise to induce dopamine and to attenuate serum TNF levels. Dopaminergic agonist type-1, fenoldopam, inhibited TNF production in splenocytes. Conversely, dopaminergic antagonist type-1, butaclamol, attenuated exercise control of serum TNF levels. These results suggest that vagal induction of dopamine may contribute to the anti-inflammatory potential of physical exercise.

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“…Eddy’s point is obvious when we consider the institutions and organisations that have enthusiastically embraced EBM from the start: national health systems, private healthcare payers, regulators, drug companies, public health departments, and disease specific interest groups have all taken a keen interest in EBM precisely for its ability to formulate standards of care—that is, clinical guidelines—and to encourage, reward,3 or even oblige45 doctors to practise in accordance with those standards.…”

Section: Yes—michel Accadmentioning

confidence: 99%