Hisham Mahran’s Post

📚 Loved this read The history of US hospital-based care and many of the most significant medical achievements in the modern age can be traced back to 462 1st Ave., New York, NY, or the one and only Bellevue Hospital. Named after the Belle Vue farm it sat on, Bellevue has become the institution of some of the most notable medical advancements, a treatment center for every major disease and outbreak, and the epicenter for research and public health initiatives. Here are some of the amazing achievements from the the 288 years of history: 🚑 First Ambulance Service (1869): Bellevue established the first ambulance service in the US, transforming emergency medical care and setting a standard for modern EMS systems. 🤰 First Maternity Ward (1799): Bellevue also established the first maternity ward in the US, with dedicated care throughout the marterinal journey, which lead to increidble innovations in maternal and infant care. 👩🔬 Pathological Laboratory (1874): Bellevue opened the first pathological laboratory in the country revolutionizing the analysis of blood, urine and tissue samples. 🧠 Pioneering Psychiatry: In the early 1930s, Bellevue's psychiatric division became the leading center for psychiatric research. This is a very checkered piece of their history as many controversial techniques an clinical failures are noted. 🔬 AIDS Research (1980s): Bellevue was at the center of developing the "Triple Drug Cocktail" or HAART treatment, a breakthrough in the treatment of AIDS. 💉 Innovations in Surgery: Bellevue has been at the forefront of surgical and trauma care, including the development of advanced techniques, such as performing the first mitral valve replacement to performing the first a kidney transplant, and the establishment of one of the first comprehensive trauma center. 📋 Public Health Initiatives: From pioneering the first tuberculosis control and being the designated hospital to treat Ebola patients, discovering streptokinase (blood clot treatments), inventing the first active immunization for hepatitis B, and addressing the health needs of millions of underserved populations. Bellevue's ethos: we treat everybody, regardless of their disease, regardless of their social standing.

Studying for the NCLEX? Here's content that you should study up on! In my professional/educator opinion ➡ emergencies that you should know: Some Nursing emergencies categorized by body systems: 📌 Neurological Emergencies: Stroke (Ischemic or Hemorrhagic) Traumatic Brain Injury (TBI)/Head Injuries) Seizures/Epileptic Events Meningitis Increased Intracranial Pressure (ICP) 📌 Cardiovascular Emergencies: Acute Myocardial Infarction (Heart Attack) Cardiac Arrest Pulmonary Embolism Aortic Dissection Cardiogenic Shock Cardiac Tamponade (Beck’s Triad) 📌 Respiratory Emergencies: Acute Respiratory Distress Syndrome (ARDS) COPD exacerbation Status Asthmaticus Pulmonary Edema Pneumothorax Foreign Body Aspiration 📌 Gastrointestinal Emergencies: Gastrointestinal Bleeding (Upper or Lower) Acute Pancreatitis Bowel Obstruction Perforated Peptic Ulcer Appendicitis with Peritonitis 📌 Renal/Genitourinary Emergencies: Acute Kidney Injury (AKI) Renal Colic (Kidney Stones) Urinary Tract Infection (UTI) with Sepsis Acute Glomerulonephritis Testicular Torsion 📌 Endocrine Emergencies: Diabetic Ketoacidosis (DKA) Hyperglycemic Hyperosmolar State (HHS) Hypoglycemia (Severe) Thyroid Storm Adrenal Crisis (Acute Adrenal Insufficiency) 📌 Hematological Emergencies: Disseminated Intravascular Coagulation (DIC) Sickle Cell Crisis Thrombotic Thrombocytopenic Purpura (TTP) Hemolytic Crisis (e.g., G6PD deficiency) Massive Transfusion Reaction 📌 Musculoskeletal Emergencies: Compartment Syndrome Open Fractures Spinal Cord Injury Crush Injuries Fat Embolism Dislocated Joints (especially Hip and Shoulder) 📌 Psychiatric Emergencies: Acute Suicidal Ideation/Attempt Agitation/Aggressive Behavior Psychotic Episodes Serotonin Syndrome Substance Intoxication/Withdrawal (e.g., Alcohol, Benzodiazepines) Acute Anxiety/Panic Attacks 📌 Obstetric/Gynecological Emergencies: Eclampsia/Pre-eclampsia with Seizures Placental Abruption Uterine Rupture Postpartum Hemorrhage Ectopic Pregnancy with Rupture 📌 Pediatric Emergencies: Respiratory Distress in Neonates (e.g., Respiratory Distress Syndrome) Sudden Infant Death Syndrome (SIDS) Status Epilepticus in Pediatrics Pediatric Septic Shock Acute Asthma Exacerbation in Pediatrics Please reshare ♻ ⭐ Career Tip #1: you DO NOT have to wait to schedule, take, or pass your NCLEX before you APPLY FOR A JOB! ⭐ Career tip #2: you CAN START wherever your heart desires! it is POSSIBLE! If you are ready to land your dream role, let's chat!! Book a consultation call if you are serious: https://lnkd.in/d74gJdpZ

Reevaluating Antenatal Steroid Practices: A Call for Evidence-Based Care Antenatal steroids have revolutionized neonatal outcomes by significantly reducing respiratory morbidity, as demonstrated by landmark trials like ALPS (Antenatal Late Preterm Steroids) and ASTEC (Antenatal Steroids for Term Elective Cesarean Section). However, emerging data suggests that the risks associated with their use beyond 34+6 weeks may outweigh the benefits, raising concerns about overuse in clinical practice What the Evidence Tells Us ALPS Trial (Gyamfi-Bannerman C, et al., NEJM, 2016): • Demonstrated reduced respiratory morbidity in late preterm neonates (34+0–36+6 weeks) • However, it also highlighted a significant increase in neonatal hypoglycemia, contributing to morbidity ASTEC Trial (Stutchfield P, et al., BMJ, 2005): • Showed reduced respiratory complications in neonates born via elective cesarean at term (37+0–37+6 weeks) • However, long-term follow-up revealed adverse impacts on intellectual ability and mathematical skills, raising concerns about cognitive outcomes Why the Concern? Despite clear guidelines and evidence, the administration of antenatal steroids beyond 34+6 weeks continues, sometimes extending up to 39 weeks This practice: • Contradicts RCOG and ACOG recommendations, which limit steroid use to pregnancies under 34+6 weeks • Exposes neonates to short-term risks such as hypoglycemia and long-term risks affecting neurodevelopment, without proven benefit Time for Change To ensure the best outcomes for mothers and newborns, it is imperative to: 1. Adhere to evidence-based guidelines: RCOG and ACOG recommend antenatal steroids only up to 34+6 weeks. Beyond this, the associated risks outweigh the benefits 2. Eliminate unnecessary steroid use beyond 34+6 weeks to avoid preventable neonatal and long-term complications 3. Promote awareness among clinicians about the emerging evidence on adverse effects, particularly on neurodevelopmental outcomes Let’s Discuss How can we work together to encourage adherence to these guidelines and standardize practices for maternal-fetal care? Have you encountered similar challenges in your clinical practice? It’s time to prioritize science, minimize unnecessary interventions, and safeguard the short- and long-term well-being of our patients #AntenatalCare #EvidenceBasedMedicine #Obstetrics #Gynecology #MaternalHealth #NeonatalCare #ClinicalGuidelines #SteroidUse #PatientSafety #MedicalResearch #OBGYNCommunity #HealthcareStandards #MedicalEducation #PerinatalCare #HealthyMothersHealthyBabies

In California, rates for #pediatric patients developing complications in the hospital before discharge can vary substantially across hospitals. From 2021-2022, 8 hospitals (3.1 percent) were rated “Above Average,” and 11 hospitals (4.3 percent) were rated “Below Average” on at least one risk-adjusted Pediatric Quality Indicator (PDI) when compared to the state average rates. To learn more, check out our PDI data visualization: https://bit.ly/3wGi3nK Hospitals can use these findings to improve their quality of pediatric care and consumers can use them to make informed health care decisions.

We need to help babies breathe... when they are premature and unable to do so on their own... but this help disrupts lung development and causes lung injury and inflammation which causes BPD. BPD not only causes short and long term issues with pulmonary function, but is associated with worse neurodevelopment outcomes (CP). We have long sought to prevent BPD or decrease the associated co-morbidities. Steroids, mainly dexamethasone, have been used to prevent BPD or to limit the progression of BPD and its associated morbidities in babies while they are receiving assisted ventilation. Here is a new and important study by Lex Doyle, a pioneer in neonatal research, and others evaluating systemic corticosteroids and BPD (https://lnkd.in/gaChD6fg). This study, of 3700 preterm infants at risk of BPD from neonatal intensive care units in 10 countries, employed a comparative effectiveness research approach, utilizing weighted meta-regression analysis of 26 randomized clinical trials (RCTs) conducted between June 1989 and March 2022 (NICU care has changed dramatically in this time period and there has been significant concerns about the safety and efficacy of dexamethasone use in premature babies over these 3+ decades). They found; dexamethasone was associated with improved survival free of cerebral palsy when the risk of BPD was greater than 70%. Conversely, it was associated with harm when the risk of BPD was less than 30%. Here is what I wish we knew (but still do not): 1- what are all the modifiable and non-modifiable factors associated with BPD? 2-what are the different phenotypes that exist within our current definition of BPD (so that we could develop better, individualized prevention and treatment strategies for BPD)? 3-what developmental window (brain and lung) is a safe and/or effective time to provide an intervention to prevent or treat BPD? 4-we need to stop searching for a single intervention and more closely look at bundled approaches of care that are focused on brain and lung development that start before and continue after birth. What are those bundles and when should we provide them? 5-when will we start leveraging the enormous amount of data that we have in the neonatal ICU in real-time to provide more precise and timely care (like that which could be leveraged from continuous physiological monitoring, assisted ventilation devices....)? RCTs are the gold standard for generating evidence in medicine. However, using their results to guide the care of an individual patient requires careful consideration because RCTs are designed to provide population-level insights, not necessarily provide answers on how an individual patient should be managed as each have unique clinical circumstances.  I can list on a single hand, the single interventions that have made a difference in the care of NICU patients... I wish it were more, but it is not. #UsingWhatWeHaveBetter

I’m thrilled to share the publication of our new multi-country study on pediatric nephrology services across Europe! Our survey covered 48 nations and over 200 million children, shedding light on urgent needs and success stories in caring for kids with kidney diseases. Key Takeaways: 1) Access Gaps: Limited or no access to dialysis in some countries and inadequate kidney transplant programs for pediatric patients. 2) Workforce Shortages: Many nations anticipate critical shortages of pediatric nephrologists, clinical nurses, and dialysis nurses by 2025. 3) Multidisciplinary Care: Lack of consistent support from dietitians, psychologists, social workers, and vocational counselors remains a major challenge. 4) Prenatal & Palliative Care: Only one-third of countries offer a fully integrated prenatal team, and palliative care models vary widely. 5) Achievements: New specialised centers, improved training programs, and cost-free treatment policies have emerged in several regions. Our hope is that these findings will drive meaningful policy changes, enhance training opportunities, and expand multidisciplinary teams—ultimately ensuring every child with kidney disease receives the care they deserve. If you’d like to learn more about the study or discuss how we can improve pediatric nephrology care, feel free to reach out or drop a comment below! Here is the full text (open access): https://lnkd.in/eY_3v78B #PediatricNephrology #ChildHealth #KidneyHealth #HealthcareInnovation #Nephrology #ESPN #HealthcareResearch #TeamWork

I wish we were not still talking about this. I have been practicing neonatal critical care medicine for the last 25 years and continue to see the pendulum swing to and fro. ....the issue of the Patent Ductus Arteriosus (PDA) in premature babies remains an unresolved issue. As with many things in society and healthcare, it is all in the perspective. Is a PDA bad? some think so and that they can identify the "bad" ones from imaging the heart and other vascular beds (and are actively increasing our knowledge with their focus-- thanks) Or is a PDA an innocent bystander being blamed for a lot of morbidities in neonatal critical care? some think so (various countries and units have taken varied approaches to PDA management https://lnkd.in/dxzmb7Rm) Despite intensive study, there is yet to be a clear evidence that closing a PDA leads to a beneficial outcome in a premature baby (despite many studies using various medications, surgery, and catheterization approaches to close the PDA). Dr. Benitz and Backes quite nicely distill this quandary down into a simple sentence, "The reasons for continued, universal use of these reported nonbeneficial treatments (to close the PDA) may at least partially be due dogma –how can a left to right shunt that is supposed to close after birth not affect the immature neonate?" https://lnkd.in/d5PH4Sxf They add some insight based on their recent review of relevant studies: "evidence that early (at or before 14 days of age) treatment with indomethacin or ibuprofen in the context of current practices and patient populations may result in increased mortality and possibly other long-term adverse out-comes, provision of early treatment as a component of standard neonatal care can no longer be recommended." There are at least 3 ongoing studies attempting to answer unresolved PDA dilemmas in the Neonatal ICU: ACEDUCT (novel therapy: co-administration of acetaminophen with ibuprofen), Neonatal Research Network Management of PDA (novel population: enrollment up to 21 days of age), and PIVOTAL (novel therapy: percutaneous device occlusion of ductus). My perspective --- I am less certain about PDA management today than I was 25 years ago. I think we need to better define the population that would benefit from closing a PDA at an appropriate developmental/intervention window and demonstrate improved long term outcomes. Easier said than done I am not certain I will see this answered clearly in my career.--just my perspective. What do you think? Michael Narvey, Ryan McAdams, MD, Prem Fort, MD, FAAP, Patrick McNamara, Theresa Grover, Michael Posencheg, Benjamin Courchia, M.D., John Zupancic,Mark Hudak,Mihai Puia-Dumitrescu,Clara Song, Karna Murthy, #UsingWhatWeHaveBetter

Challenges in critically ill pregnant patients and indications of ICU admission: 1-Physiological changes during pregnancy 2-Pregnancy induced diseases 3-Caring and welfare of both 2 persons in one body. Cause of ICU admission: 1- Hypertensive disorders 2-Massive Hge 3-Sepsis But what is important to be noted is the limited experience in caring such group of cases in ICU and HDU ,so multidisciplinary team and highly specialised obstetric CCUs should be aware about the management needs of critically ill pregnant and postpartum complications Always management of critically ill pregnant patients depend on data derived from Non pregnant patients because of limited data available on obstetric critically ill patients. Level of Maternal care : 4 levels based upon interventions and support required: 1-level 0 :General word care for low risk patients 2-pt need Non invasive observations and monitoring 3-Single organ support : Respiratory CVS CNS Hepatic 4-Pt in need to mechanical ventilation or Support for 2 or more organs. Level 0 need general word Level 1and 2 need HDU Level 3 ICU General internist and other specialist from many departments may underestimate the obstetric critically ill because of lack of information about physiological changes. In ICU mandatory multidisciplinary team for integrated and accurate approach Multidisciplinary team should be aware of caring 2 persons in one body so the wise decision is to keep both safe The Non obstetric conditions that maybe worsening during pregnancy and may need ICU admission: 1-Immune disease :SLE ,Mysthenia Gravis ,autoimmune thyroiditis 2-CVS diseases:Valvular dis.,Hypertension, pulmonary hypertension, arrhythmia, cardiomyopathy and congenital heart disease 3-Neurological conditions 4-DM 5-VTE 6-infectious diseases:pyelonephritis up to H1N1 . 7-Trauma 8-surgical emergency as appendicitis HELLP syndrome: Considered among the most common causes of ICU admission and diagnosis is : Clinical: hypertension But 15 % of HELLP are normotensive Lab findings Eclampsia one of the hypertensive disorder that necessitate ICU admission: convulsions in absence of Epilepsy or other CNS disease Need to Mg sulphate to abort convulsions so need to monitor therapeutic level to avoid toxicity Mg sulphate toxicity need ICU admission and even dialysis. Fluid management in pre-eclampsia should be balanced between pulmonary edema if fluid overload or Renal failure if restricted So maintain fluid 80 ml /hour this regimn proposed by certain studies . Delivery is the definitive ttt but should take Fetal maturity in consideration or help lung maturity by Dexamethason

Pediatric clinicians (of which I’m definitely not one, but I listen well) will frequently tell you: Children are not just little adults. That goes for clinical criteria used to diagnose pediatric conditions, and associated CDI and coding work. And in particular, respiratory failure. I was glad to see ACDIS and the American College of Physician Advisors (ACPA) collaborate on an important new white paper, “Developing Pediatric Respiratory Failure Criteria.” The paper is part 1 of a two-part series addressing respiratory failure in both pediatric and neonatal populations. Part 1 focuses on the pediatric population (patients older than 28 days and younger than 18 years). Neonatal patients will be covered in part 2. Normally ACDIS white papers are for members, but non-members can access it through Nov. 8. See link below. While the paper offers clinical information and definitions, it does not offer a formula for wholesale adoption. Rather, its purpose is to help healthcare organizations develop, refine, and validate their own internal criteria. The paper does offer some helpful baseline criteria. From the paper: 💡 “Respiratory failure is the inability of the respiratory system to meet the body’s oxygenation, ventilation, and/or metabolic requirements. It is important to know the values and presentations that are considered to be within the defined limits of each patient population. Any underlying condition, process, or trauma that interferes with oxygenation or ventilation can result in respiratory failure.” It then adds context for the pediatric population, listing examples of cardiopulmonary diseases, infections, neurologic disorders, traumas, and complications secondary to medical interventions. These are worth reviewing for any CDI or coding professional as the basis for compliant query. It also covers acute, chronic, and acute on chronic respiratory failure, as well as its three types (hypoxic, hypercapnic, combined). Perhaps most useful is discussion on clinical signs, symptoms and diagnostics, which should prove helpful for clinical validation of a respiratory failure diagnosis—potentially staving off payer denials. Per the paper: 💡 “Documentation should include indicators such as: Tachypnea, bradypnea, retractions (e.g., intercostal, subcostal, suprasternal), head bobbing, nasal flaring, grunting, cyanosis, diaphragmatic breathing, diaphoresis, lethargy, confusion, difficulty feeding, tripoding/posturing/ extended airway, wheezing, stridor, crackles (fine/coarse), diminished paradoxical movement, flail chest, tachycardia, bradycardia, hypoglycemia, acidosis (respiratory/metabolic).” Whether “the dark half” (i.e., payers) adopt similar diagnostic criteria to level the playing field and play with a common set of rules remains to be seen. But I applaud the effort. Have you read the paper? Does your organization struggle with pediatric respiratory failure (if you even have a pediatric CDI program)? Leave a comment below.