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Sample records for managing acutely disturbed

  1. A double blind comparison of zuclopenthixol acetate with haloperidol in the management of acutely disturbed schizophrenics.

    Science.gov (United States)

    Chin, C N; Hamid, A R; Philip, G; Ramlee, T; Mahmud, M; Zulkifli, G; Loh, C C; Zakariah, M S; Norhamidah, M S; Suraya, Y; Roslan, K A; Chandramohan, P; Cheah, Y C; Leonard, A O

    1998-12-01

    The aim of this study was to evaluate the efficacy and side effects of zuclopenthixol acetate compared with haloperidol in the management of the acutely disturbed schizophrenic patient. Suitable subjects diagnosed as having schizophreniform disorder or acute exacerbation of schizophrenia admitted to the psychiatric wards Hospital Kuala Lumpur were randomised to receive either zuclopenthixol acetate or haloperidol. They were rated blind for three consecutive days using the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) and UKU Side Effects Scale. Apart from repeat injections of the same medication, no other anti-psychotic was given for the duration of the study. 50 subjects entered the study of which 44 completed. 23 were given zuclopenthixol acetate and 21 haloperidol. Both groups significantly reduced BPRS and CGI scores on all 3 days compared to the initial rating (p p > 0.05). More subjects on haloperidol than zuclopenthixol required more than 1 injection during the study. Both groups had minimal side effects. Zuclopenthixol acetate was effective in the management of the acutely disturbed schizophrenic.

  2. Managing Acute Behavioural Disturbances in the Emergency Department Using the Environment, Policies and Practices: A Systematic Review.

    Science.gov (United States)

    Weiland, Tracey J; Ivory, Sean; Hutton, Jennie

    2017-06-01

    Effective strategies for managing acute behavioural disturbances (ABDs) within emergency departments (EDs) are needed given their rising occurrence and negative impact on safety, psychological wellbeing, and staff turnover. Non-pharmacological interventions for ABD management generally fall into four categories: environmental modifications; policies; practice changes; and education. Our objective was to systematically review the efficacy of strategies for ABD management within EDs that involved changes to environment, architecture, policy and practice. We performed systematic searches of CINAHL Plus with Full Text, PsycINFO, MEDLINE, and EMBASE, as well as reference lists of relevant review articles to identify relevant studies published between January 1985 - April 2016. We included studies written in English, which reported management of behavioural disturbances in adults associated with the ED through the use of environmental modifiers (including seclusion, restraint, specialised rooms, architectural changes), policy, and practice-based interventions excepting education-only interventions. Efficacy outcomes of interest included incidence, severity, and duration of ABD, incidence of injuries, staff absenteeism, restraint use, restraint duration, and staff and patient perceptions. Two reviewers independently screened titles and abstracts, and assessed the relevancy and eligibility of studies based on full-text articles. Two authors independently appraised included studies. A narrative synthesis of findings was undertaken. Studies reporting interventions for managing ABDs within the ED are limited in number and quality. The level of evidence for efficacy is low, requiring caution in conclusions. While there is preliminary evidence for environmental change in the form of specialised behavioural rooms, security upgrades and ED modifications, these are not supported by evidence from controlled studies. Many of these "common sense" environmental changes recommended in

  3. Managing Acute Behavioural Disturbances in the Emergency Department Using the Environment, Policies and Practices: A Systematic Review

    Science.gov (United States)

    Weiland, Tracey J.; Ivory, Sean; Hutton, Jennie

    2017-01-01

    Introduction Effective strategies for managing acute behavioural disturbances (ABDs) within emergency departments (EDs) are needed given their rising occurrence and negative impact on safety, psychological wellbeing, and staff turnover. Non-pharmacological interventions for ABD management generally fall into four categories: environmental modifications; policies; practice changes; and education. Our objective was to systematically review the efficacy of strategies for ABD management within EDs that involved changes to environment, architecture, policy and practice. Methods We performed systematic searches of CINAHL Plus with Full Text, PsycINFO, MEDLINE, and EMBASE, as well as reference lists of relevant review articles to identify relevant studies published between January 1985 – April 2016. We included studies written in English, which reported management of behavioural disturbances in adults associated with the ED through the use of environmental modifiers (including seclusion, restraint, specialised rooms, architectural changes), policy, and practice-based interventions excepting education-only interventions. Efficacy outcomes of interest included incidence, severity, and duration of ABD, incidence of injuries, staff absenteeism, restraint use, restraint duration, and staff and patient perceptions. Two reviewers independently screened titles and abstracts, and assessed the relevancy and eligibility of studies based on full-text articles. Two authors independently appraised included studies. A narrative synthesis of findings was undertaken. Results Studies reporting interventions for managing ABDs within the ED are limited in number and quality. The level of evidence for efficacy is low, requiring caution in conclusions. While there is preliminary evidence for environmental change in the form of specialised behavioural rooms, security upgrades and ED modifications, these are not supported by evidence from controlled studies. Many of these “common sense

  4. Managing Sleep Disturbances in Cirrhosis

    Directory of Open Access Journals (Sweden)

    Xun Zhao

    2016-01-01

    Full Text Available Sleep disturbances, particularly daytime sleepiness and insomnia, are common problems reported by patients suffering from liver cirrhosis. Poor sleep negatively impacts patients’ quality of life and cognitive functions and increases mortality. Although sleep disturbances can be an early sign of hepatic encephalopathy (HE, many patients without HE still complain of poor quality sleep. The pathophysiology of these disturbances is not fully understood but is believed to be linked to impaired hepatic melatonin metabolism. This paper provides an overview for the clinician of common comorbidities contributing to poor sleep in patients with liver disease, mainly restless leg syndrome and obstructive sleep apnea. It discusses nondrug and pharmacologic treatment options in these patients, such as the use of light therapy and histamine (H1 blockers.

  5. Managing military training-related environmental disturbance.

    Science.gov (United States)

    Zentelis, Rick; Banks, Sam; Roberts, J Dale; Dovers, Stephen; Lindenmayer, David

    2017-09-17

    Military Training Areas (MTAs) cover at least 2 percent of the Earth's terrestrial surface and occur in all major biomes. These areas are potentially important for biodiversity conservation. The greatest challenge in managing MTAs is balancing the disturbance associated with military training and environmental values. These challenges are unique as no other land use is managed for these types of anthropogenic disturbances in a natural setting. We investigated how military training-related disturbance is best managed on MTAs. Specifically, we explored management options to maximise the amount of military training that can be undertaken on a MTA while minimising the amount of environmental disturbance. MTAs comprise of a number of ranges designed to facilitate different types of military training. We simulated military training-related environmental disturbance at different range usage rates under a typical range rotation use strategy, and compared the results to estimated ecosystem recovery rates from training activities. We found that even at relatively low simulated usage rates, random allocation and random spatial use of training ranges within an MTA resulted in environmental degradation under realistic ecological recovery rates. To avoid large scale environmental degradation, we developed a decision-making tool that details the best method for managing training-related disturbance by determining how training activities can be allocated to training ranges. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Expectations of Care, Perceived Safety, and Anxiety following Acute Behavioural Disturbance in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Magdalen Lim

    2011-01-01

    Full Text Available Objective. We explored perspectives of emergency department users (patients and visitors regarding the management of acute behavioural disturbances in the emergency department and whether these disturbances influenced their levels of anxiety. Methods. Emergency department patients and visitors were surveyed using the State-Trait Anxiety Inventory, and a purpose-designed questionnaire and semistructured interview. The main outcome measures were themes that emerged from the questionnaires, the interviews, and scores from the state component of the State-Trait Anxiety Inventory. Results. 70 participants were recruited. Users of the emergency department preferred behaviourally disturbed people be managed in a separate area from the general emergency department population so that the disturbance was inaudible (=32 and out of view (=40. The state anxiety levels of those that witnessed an acute behavioural disturbance were within the normal range and did not differ to that of ED patients that were not present during such a disturbance (median, control = 37, Code Grey = 33. Conclusions. Behavioural disturbances in the emergency department do not provoke anxiety in other users. However, there is a preference that such disturbances be managed out of visual and audible range. Innovative design features may be required to achieve this.

  7. Acute management of stones

    DEFF Research Database (Denmark)

    Jung, Helene; Osther, Palle J S

    2015-01-01

    INTRODUCTION: Stone management is often conservative due to a high spontaneous stone passage rate or non-symptomatic calyceal stones that do not necessarily require active treatment. However, stone disease may cause symptoms and complications requiring urgent intervention. MATERIAL AND METHODS......: In this review, we update latest research and current recommendations regarding acute management of stones, with particular focus on imaging, pain management, active stone interventions, medical expulsive therapy, and urolithiasis in pregnancy and childhood. RESULTS: Acute stone management should be planned...

  8. Inlfammatory mediators and microcirculatory disturbance in acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Xi-Ping Zhang; Zhi-Jun Li; Jie Zhang

    2009-01-01

    BACKGROUND: Inlfammatory mediators are not only initiation factors of acute pancreatitis (AP) but also key factors causing pancreatic hemorrhage and necrosis, which damage important organs such as the heart, brain, liver, kidney and lung. Microcirculatory disturbance in AP has attracted widespread attention. In order to provide a theoretical basis for clinical therapy of AP, it is very important to explore the effect of inlfammatory mediators on microcirculatory disturbance in this disease. DATA SOURCES: In this review, the impact of inlfammatory mediators on microcirculatory disturbance in AP was reviewed according to the literature, especially the articles indexed in PubMed and books published in China and reports from websites. RESULTS: At present, inlfammatory mediation and micro-circulatory disturbance are the two major hypotheses to explain the development of AP. Although experimental studies have shown that inlfammatory mediators induce or aggravate microcirculatory disturbance, the clinical application of these ifndings is still dififcult because the inlfammatory mediators are diverse and their research is not comprehensive and thorough. CONCLUSION: It is very important to explore the inlfuence of inlfammatory mediators on microcirculatory disturbance in AP.

  9. Acute management of stones

    DEFF Research Database (Denmark)

    Jung, Helene; Osther, Palle J S

    2015-01-01

    INTRODUCTION: Stone management is often conservative due to a high spontaneous stone passage rate or non-symptomatic calyceal stones that do not necessarily require active treatment. However, stone disease may cause symptoms and complications requiring urgent intervention. MATERIAL AND METHODS......: In this review, we update latest research and current recommendations regarding acute management of stones, with particular focus on imaging, pain management, active stone interventions, medical expulsive therapy, and urolithiasis in pregnancy and childhood. RESULTS: Acute stone management should be planned...... with careful consideration of stone size and location, symptoms, patient comorbidity and radiation dose. CONCLUSION: In case of infective hydronephrosis, compromised renal function or persistent pain despite adequate analgesic treatment acute intervention is indicated....

  10. Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

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    Cheatle, Martin D; Foster, Simmie; Pinkett, Aaron; Lesneski, Matthew; Qu, David; Dhingra, Lara

    2016-06-01

    Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain.

  11. Difficulties encountered by general practitioners during acute behavioral disturbances of their dementia patients.

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    Campana, Marion; Bonin-Guillaume, Sylvie; Yagoubi, Ramzi; Berbis, Julie; Franqui, Caroline

    2016-06-01

    Alzheimer diseases and related disorders (ADRD) remain a major public health issue. The progression of the disease is dominated by behavioral and psychological symptoms of dementia (BPSD) which are frequent and burdensome for caregivers. The aim of our survey was to study how the general practionner managed these behavioral disturbances (particularly agitation and aggressiveness) in community living patients with ADRD and support of their main caregivers. We based our study on a medical survey sent to all general practitioners (GP) practicing in four districts in Marseille near from a secure unit. Ninety five out of 260 answered to the survey and 57 had already been exposed to patients' behavioral decompensation. For these BPSD management, atypical neuroleptics and benzodiazepines were mostly prescribed, and according to the literature and guidelines. Half of the GP's recognized the weak effectiveness of this strategy. Almost all of them are interested in having a document summarizing the main strategy to be set up or a possibility to call a specialized mobile team with doctors and professionals caregivers. A few dedicated consultations were devoted to informal caregivers whereas GP were aware of negative effects of these decompensations on them. This study point out difficulties for GP to provide appropriate management for their patients with ADRD living at home and for their informal caregivers, particularly during acute behavioral disturbance, despite their practical knowledges.

  12. Early management of acute pancreatitis.

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    Schepers, Nicolien J; Besselink, Marc G H; van Santvoort, Hjalmar C; Bakker, Olaf J; Bruno, Marco J

    2013-10-01

    Acute pancreatitis is the most common gastro-intestinal indication for acute hospitalization and its incidence continues to rise. In severe pancreatitis, morbidity and mortality remains high and is mainly driven by organ failure and infectious complications. Early management strategies should aim to prevent or treat organ failure and to reduce infectious complications. This review addresses the management of acute pancreatitis in the first hours to days after onset of symptoms, including fluid therapy, nutrition and endoscopic retrograde cholangiography. This review also discusses the recently revised Atlanta classification which provides new uniform terminology, thereby facilitating communication regarding severity and complications of pancreatitis.

  13. Management of Acute Skin Trauma

    Institute of Scientific and Technical Information of China (English)

    Joel W. Beam

    2010-01-01

    @@ Acute skin trauma (ie, abrasions, avulsions, blisters, incisions, lacerations, and punctures) is common among individuals involved in work, recreational, and athletic activities. Appropriate management of these wounds is important to promote healing and lessen the risk of cross-contamination and infection. Wound management techniques have undergone significant changes in the past 40 years but many clinicians continue to manage acute skin trauma with long-established, traditional techniques (ie, use of hydrogen peroxide, adhesive strips/patches, sterile gauze, or no dressing) that can delay healing and increase the risk of infection. The purpose of this review is to discuss evidence-based cleansing, debridement, and dressing techniques for the management of acute skin trauma.

  14. Sensory Disturbances, but Not Motor Disturbances, Induced by Sensorimotor Conflicts Are Increased in the Presence of Acute Pain

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    Clémentine Brun

    2017-07-01

    Full Text Available Incongruence between our motor intention and the sensory feedback of the action (sensorimotor conflict induces abnormalities in sensory perception in various chronic pain populations, and to a lesser extent in pain-free individuals. The aim of this study was to simultaneously investigate sensory and motor disturbances evoked by sensorimotor conflicts, as well as to assess how they are influenced by the presence of acute pain. It was hypothesized that both sensory and motor disturbances would be increased in presence of pain, which would suggest that pain makes body representations less robust. Thirty healthy participants realized cyclic asymmetric movements of flexion-extension with both upper limbs in a robotized system combined to a 2D virtual environment. The virtual environment provided a visual feedback (VF about movements that was either congruent or incongruent, while the robotized system precisely measured motor performance (characterized by bilateral amplitude asymmetry and medio-lateral drift. Changes in sensory perception were assessed with a questionnaire after each trial. The effect of pain (induced with capsaicin was compared to three control conditions (no somatosensory stimulation, tactile distraction and proprioceptive masking. Results showed that while both sensory and motor disturbances were induced by sensorimotor conflicts, only sensory disturbances were enhanced during pain condition comparatively to the three control conditions. This increase did not statistically differ across VF conditions (congruent or incongruent. Interestingly however, the types of sensations evoked by the conflict in the presence of pain (changes in intensity of pain or discomfort, changes in temperature or impression of a missing limb were different than those evoked by the conflict alone (loss of control, peculiarity and the perception of having an extra limb. Finally, results showed no relationship between the amount of motor and sensory

  15. Sleep disturbances in Parkinson's disease patients and management options

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    Claassen DO

    2011-12-01

    Full Text Available Daniel O Claassen, Scott J KutscherDepartment of Neurology, Vanderbilt University, Nashville, TN, USAAbstract: Sleep disturbances are among the most common nonmotor complaints of patients with Parkinson's disease (PD, and can have a great impact on quality of life. These disturbances manifest in a variety of ways; for instance, insomnia, sleep fragmentation, and excessive daytime sleepiness. Sleep-related movement disorders such as restless legs syndrome and periodic leg movements may share a common pathophysiology, and occurrence of rapid eye movement behavior disorder may predate the onset of PD or other synucleinopathies by several years. Medications for PD can have a significant impact on sleep, representing a great challenge to the treating physician. Awareness of the complex relationship between PD and sleep disorders, as well as the varied way in which sleep disturbances appear, is imperative for successful long-term management.Keywords: sleep disorders, insomnia, restless legs syndrome, Parkinson disease, fatigue, REM behavior disorder

  16. Report of moderate or severe sodium and chloride disturbance on 82 cases with acute cerebral stroke

    Institute of Scientific and Technical Information of China (English)

    Ma shun-tian

    2000-01-01

    Abtract Objective: To decrease the fatality rate and prevalence rotc of acute cerebral stroke complicated with morderate or servere serum sodium and chioride disturbance by explonng the relation between the pathogency and prognosis Methods: Medical records were surveyed and clinical presentation, laboratory test, complicated。 Actiology pathogency and prognosis were analyzed m 82 cases with moderate or severe serum sodium and chloride disturbance among 736 cases with acute cerebral stroke collected, Results: The prevalence rate and fatality rate of acutc cerebral stroke complicated with moderate or severe serum sodium and chlorede disturbance were 11.3% (82/ 736) and 60.8% (49/52) which were different significantly form that complicated with normal or minimal sedium sodium and chloride disturbame (p (0.001) 。 The 82 cases occured at 3-13 days after hospitalization (mean 6 days) 。 The actiology and pathogency were mainly ralated with some endogenic and iatrogenic factors such as hypothalamic-pituitary system were destroyed resultly from acute cerbral stroke which led to SIADH。 Conclusion: The fatality rate of acute cerebral stroke complicatee with moderate or seyere serum sodium and chloride disturbance is mcreased significantly, Put prophylaxis first to decrease the prevalence rate and fatalty rate。 Pay attlention to comprehensive therapy of acute cerebral stoke to prevent endogenic sodium and chloride disturbance and especially place importance on iatrogenic disturbance。

  17. The management of acute asthma.

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    Cross, S

    1997-04-01

    Health professionals likely to come into contact with people experiencing an acute episode of asthma, such as school nurses, ambulance personnel and A&E staff, need clear guidelines on management. The British Thoracic Society guidelines, revised this year, advise on the categorisation of asthma, assessment and treatment.

  18. Disturbance, life history, and optimal management for biodiversity

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    Guo, Q.

    2003-01-01

    Both frequency and intensity of disturbances in many ecosystems have been greatly enhanced by increasing human activities. As a consequence, the short-lived plant species including many exotics might have been dramatically increased in term of both richness and abundance on our planet while many long-lived species might have been lost. Such conclusions can be drawn from broadly observed successional cycles in both theoretical and empirical studies. This article discusses two major issues that have been largely overlooked in current ecosystem management policies and conservation efforts, i.e., life history constraints and future global warming trends. It also addresses the importance of these two factors in balancing disturbance frequency and intensity for optimal biodiversity maintenance and ecosystem management.

  19. Pediatric acute pain management.

    Science.gov (United States)

    Golianu, B; Krane, E J; Galloway, K S; Yaster, M

    2000-06-01

    The past decade has brought about an explosion of knowledge about the physiology of nociception and many new techniques for pain relief, new analgesic drugs, and new applications of old analgesic drugs. These techniques include methods of opioid administration by transdermal and transmucosal absorption and the use of neuraxial analgesia for the management of pain in children. Interest in the use of regional anesthesia in children has been rekindled, and analgesic properties and pre-emptive analgesic properties of many agents not typically considered analgesics, such as clonidine and ketamine, have been recognized. Perhaps the greatest advance has been the paradigm shift in the recognition that pain not only exists in infants and children but also is a significant cause of morbidity and even mortality. Given the unprecedented interest in pain management in adults and children, physicians can now look forward to the development of new methods of drug delivery and of receptor-specific drugs that divorce analgesia from the untoward side effects of existing analgesics. Improvement in the quality of life of hospitalized children also will occur.

  20. Rational management of acute keratoconus

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    Yu. B. Slonimskiy

    2015-01-01

    Full Text Available Acute keratoconus is a common and severe complication of advanced progressive keratoconus that occurs in more than 30 % of cases. Acute corneal edema in advanced progressive keratectasia is reffered to as acute corneal hydrops (hydrops corneae. It has been also reported in other ectatic disorders such as pellucid marginal degeneration. The most common misdiagnosis in hydrops is HSV disciform keratitis or acute bacterial keratitis. 126 corneal hydrops patients (79 men, 47 women aged 16‑63 (129 eyes were observed and treated over the last five years. 124 patients were diagnosed with acute keratoconus and 2 patients were diagnosed with pellucid marginal degeneration. Acute kereatoconus patientsrepresented a special and compromised cohort with systemic allergic diseases (neurodermatitis and various atopic disorders, n = 48, Down’s syndrome (n = 16 or mental disorders (n = 19. In many of these patients who vigorously rubbed their eyes, keratectasia progressed more rapidly. In 7 cases, acute keratoconus developed during pregnancy. 3 cases of recurrent keratoconus were reported — in a woman with Down’s syndrome (recurrence in 3 years, in a man with severe neurodermatitis (recurrence in 5 years, and in a man with anamnestic acute keratoconus (recurrence in 20 years. 3 patients experienced bilateral acute keratoconus. Acute keratoconus can be subdivided by the area of corneal edema into three categories, i.e., partial (6 mm or less, 52 eyes, subtotal (7‑10 mm, 56 eyes, and total (more than 10 mm, 21 eyes. Corneal edema ultimately disappeared, however, acute keratoconus resulted in a deep local scarring through the corneal layers. Slit lamp exam revealed Descemet’s membrane ruptures (so-called fish mouth. 73 eyes were referred to refractive penetrating keratoplasty (PKP. Corneal perforation was unusual even in severe corneal thinning (4 cases. In one case, descemetocele with a high risk of perforation was observed. 4 eyes

  1. Managing acute care.

    Science.gov (United States)

    Russell, J S

    1993-02-01

    In the last few years, much medical-facility construction has been driven by what insurers want. Hospitals have built facilities for well-reimbursed procedures and closed money-losing ones. Health-maintenance organizations increasingly expect to hold down costs by making prepayment arrangements with doctors and their hospitals. President Clinton has pledged early action on health-care reform, which will likely change planners' priorities. Whether the nation goes to Clintonian "managed competition" or a Canadian-style nationwide single-payer system (the two most likely options), the projects on these pages reflect two large-scale trends that are likely to continue: the movement of more procedures from inpatient to outpatient facilities and the separation of treatment functions from ordinary office and administrative tasks so that the latter are not performed in the same high-cost buildings as technology-intensive procedures. Various schemes that make care more "patient-centered" have been tried and been shown to speed healing, even for outpatients, but such hard-to-quantify issues get short shrift in an era of knee-jerk cost containment. The challenge in tomorrow's healthcare universe--whatever it becomes--will be to keep these issues on the table.

  2. Acute Pain Management/Regional Anesthesia.

    Science.gov (United States)

    Tedore, Tiffany; Weinberg, Roniel; Witkin, Lisa; Giambrone, Gregory P; Faggiani, Susan L; Fleischut, Peter M

    2015-12-01

    Effective and efficient acute pain management strategies have the potential to improve medical outcomes, enhance patient satisfaction, and reduce costs. Pain management records are having an increasing influence on patient choice of health care providers and will affect future financial reimbursement. Dedicated acute pain and regional anesthesia services are invaluable in improving acute pain management. In addition, nonpharmacologic and alternative therapies, as well as information technology, should be viewed as complimentary to traditional pharmacologic treatments commonly used in the management of acute pain. The use of innovative technologies to improve acute pain management may be worthwhile for health care institutions. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Heparin improves organ microcirculatory disturbances in caerulein-induced acute pancreatitis in rats

    Institute of Scientific and Technical Information of China (English)

    Marek Dobosz; Lucjanna Mionskowska; Stanislaw Ha(a); Sebastian Dobrowolski; Dariusz Dymecki; Zdzislaw Wajda

    2004-01-01

    AIM: Microcirculatory disturbances are important early pathophysiological events in various organs during acute pancreatitis. The aim of the study was to evaluate changes in microperfusion of the pancreas, liver, kidney, stomach,colon, skeletal muscle, and to investigate the influence of heparin on the organ microcirculation in caerulein-induced experimental acute pancreatitis.METHODS: Acute pancreatitis was induced by 4 intraperitoneal injections of caerulein (Cn) (15 μg/kg). The organ microcirculation was measured by laser Doppler flowmetry. Serum interleukin 6 and hematocrit levels were analysed.RESULTS: Acute pancreatitis resulted in a significant drop of microperfusion in all examined organs. Heparin administration (2×2.5 mg/kg) improved the microcirculation in pancreas (36.9±4% vs 75.9±10%), liver (56.6±6% vs 75.2±16%), kidney (45.1±6% vs 79.3±5%), stomach (65.2±8% vs78.1±19%), colon (69.8±6% vs102.5±19%),and skeletal muscle (59.2±6% vs 77.9±13%). Heparin treatment lowered IL-6 (359.0±66 U/mL vs288.5±58 U/mL)and hematocrit level (53±4% vs 46±3%).CONCLUSION: Heparin administration has a positive influence on organ microcirculatory disturbances accompanying experimental Ch-induced acute pancreatitis.

  4. Mechanisms, detection, and potential management of microcirculatory disturbances in sepsis.

    Science.gov (United States)

    Mohammed, Imran; Nonas, Stephanie A

    2010-04-01

    Despite improvements in resuscitation and treatment of sepsis, the morbidity and mortality remain unacceptably high. Microvascular dysfunction has been shown to play a significant role in the pathogenesis of sepsis and is a potential new target in the management of sepsis. Clinical studies, aided by new techniques that allow for real-time assessment of the microcirculation, have shown that disturbances in microcirculatory flow are common in sepsis and correlate with worse outcomes. Bedside measurement of microcirculatory perfusion has become simpler and more accessible, and may provide key insights into prognosis in sepsis and guide future therapeutics, much like mean arterial pressure (MAP), lactate, and mixed central oxygen saturation (SvO(2)) do now. The authors review here the role of microcirculatory dysfunction in sepsis and its potential role as a therapeutic target in sepsis. Copyright 2010. Published by Elsevier Inc.

  5. Management of acute hepatitis B.

    Science.gov (United States)

    Shiffman, Mitchell L

    2010-02-01

    Acute hepatitis B virus (HBV) is a common cause of acute icteric hepatitis in adults. The vast majority of these patients resolve this acute infection and develop long-lasting immunity. In contrast, the vast majority of patients who develop chronic HBV have minimal symptoms and do not develop jaundice after becoming infected with HBV. These patients will frequently remain undiagnosed for years or decades. Approximately 1% of persons with acute HBV develop acute liver failure. Preventing acute HBV with vaccination is the best treatment. Although universal vaccination is now administered to newborns in many countries, the majority of adults have not been vaccinated and remain at risk. Because the majority of patients with acute HBV resolve this infection spontaneously, treatment with an oral anti-HBV agent is not necessary. However, the use of an oral anti-HBV agent is not unreasonable to use in a patient who is developing acute liver failure from severe acute HBV.

  6. Acute bronchitis: Evaluation and management.

    Science.gov (United States)

    Blush, Raymond R

    2013-10-10

    Acute bronchitis affects millions of individuals, significantly impacting patient health and the healthcare industry. Understanding evaluation and treatment guidelines for acute bronchitis allows the nurse practitioner to practice comprehensive care for patients. This article reviews evidence-based practices when caring for the patient with acute bronchitis, promoting optimization of healthy outcomes.

  7. Advances in Management of Acute Pancreatitis.

    Science.gov (United States)

    Janisch, Nigeen H; Gardner, Timothy B

    2016-03-01

    This article reviews advances in the management of acute pancreatitis. Medical treatment has been primarily supportive for this diagnosis, and despite extensive research efforts, there are no pharmacologic therapies that improve prognosis. The current mainstay of management, notwithstanding the ongoing debate regarding the volume, fluid type, and rate of administration, is aggressive intravenous fluid resuscitation. Although antibiotics were used consistently for prophylaxis in severe acute pancreatitis to prevent infection, they are no longer used unless infection is documented. Enteral nutrition, especially in patients with severe acute pancreatitis, is considered a cornerstone in management of this disease.

  8. Acute surgical management in idiopathic intracranial hypertension.

    LENUS (Irish Health Repository)

    Zakaria, Zaitun

    2012-01-01

    Idiopathic intracranial hypertension is a headache syndrome with progressive symptoms of raised intracranial pressure. Most commonly, it is a slow process where surveillance and medical management are the main treatment modalities. We describe herein an acute presentation with bilateral sixth nerve palsies, papilloedema and visual deterioration, where acute surgical intervention was a vision-saving operation.

  9. The nutritional management of acute diarrhea

    Directory of Open Access Journals (Sweden)

    MacLean William

    1996-01-01

    Full Text Available Acute diarrhea may have a profound effect on nutritional status worldwide. After rehvdra-tion, proper nutritional management can mitigate these effects. This paper discusses the advantages and disadvantages of continued feeding, emphasizing that breastfeeding should not be stopped during episodes of acute diarrhea.

  10. The nutritional management of acute diarrhea

    OpenAIRE

    MacLean William

    1996-01-01

    Acute diarrhea may have a profound effect on nutritional status worldwide. After rehvdra-tion, proper nutritional management can mitigate these effects. This paper discusses the advantages and disadvantages of continued feeding, emphasizing that breastfeeding should not be stopped during episodes of acute diarrhea.

  11. Management of Acute Migraine in Children

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2007-05-01

    Full Text Available The management of acute pediatric migraine headaches in the pediatric emergency department (ED and in a mixed pediatric and adult ED was compared at the University of Alberta, Edmonton, Canada.

  12. MANAGEMENT OF ACUTE MUSCULOSKELETAL PAIN ...

    African Journals Online (AJOL)

    Objectives: Acute musculoskeletal insult (injury and surgery) is very common. It is also one of ... Data Source:The material source is from various published articles in books and journals. ..... after the onset of symptoms, locking the gate after the.

  13. Potential increases in natural disturbance rates could offset forest management impacts on ecosystem carbon stocks.

    Science.gov (United States)

    John B. Bradford; Nicholas R. Jensen; Grant M. Domke; Anthony W. D' Amato

    2013-01-01

    Forested ecosystems contain the majority of the world’s terrestrial carbon, and forest management has implications for regional and global carbon cycling. Carbon stored in forests changes with stand age and is affected by natural disturbance and timber harvesting. We examined how harvesting and disturbance interact to influence forest carbon stocks over the Superior...

  14. Clinical impact of MRI perfusion disturbances and normal diffusion in acute stroke patients

    Energy Technology Data Exchange (ETDEWEB)

    Blondin, D. [Institute of Diagnostic Radiology, University Hospital Duesseldorf (Germany)], E-mail: blondin@med.uni-duesseldorf.de; Seitz, R.J. [Department of Neurology, University Hospital Duesseldorf (Germany); Biomedical Research Centre, Heinrich-Heine-Universitaet Duesseldorf (Germany); Brain Imaging Centre, Research Centre Julich (Germany); Rusch, O.; Janssen, H.; Andersen, K.; Wittsack, H.-J.; Turowski, B. [Institute of Diagnostic Radiology, University Hospital Duesseldorf (Germany)

    2009-07-15

    Purpose: In acute ischemic stroke MR-imaging typically shows diffusion abnormalities surrounded by reduced perfusion signifying the so-called ischemic penumbra. Mismatch between diffusion and perfusion abnormalities gives indication for thrombolysis. But is there an indication for thrombolytic treatment, if there is no diffusion abnormality but pathologic perfusion combined with acute stroke symptoms?. Material and methods: MR-imaging of 1465 patients treated on our Stroke Unit between June 2004 and May 2007 retrospectively are analyzed. 6 patients met the inclusion criteria of severe neurological symptoms, large territorial perfusion disturbances, lack of diffusion abnormalities and complete neurological recovery after treatment. Results: In all six patients MTT measurements showed a significantly depressed perfusion in the symptomatic hemisphere (p < 0.02). Time-to-peak delay correlated with the mean transit time delay (0.949, p < 0.01). Indication for thrombolysis was based on perfusion abnormalities and clinical symptoms. Stroke symptoms could be reversed in all patients without any complication. Conclusion: Whereas diffusion imaging could not reveal any abnormality, perfusion analysis legitimated therapy with systemic thrombolysis in heavily affected patients. This work underlines the importance of multimodal MR imaging for guiding treatment decisions in acute stroke patients.

  15. Acute variceal bleeding: general management

    Institute of Scientific and Technical Information of China (English)

    David Patch; Lucy Dagher

    2001-01-01

    @@ TREATMENT STRATEGIES FOR ACUTE VARICEAL BLEEDING Backgound Acute variceal bleeding has a significant mortality which ranges form 5% to 50% in patients with cirrhosis[1].Overall survival is probably improving,because of new therapeutic approaches,and improved medical care.However,mortality is still closely related to failure to control hacmorrhage or carly rebleeding,which is a distinct characteristic of portal hypertensive bleeding and occures in as many as 50% of patients in the first days to 6 weeks after admission et al[2].

  16. The Effects of Acute Stress-Induced Sleep Disturbance on Acoustic Trauma-Induced Tinnitus in Rats

    Directory of Open Access Journals (Sweden)

    Yiwen Zheng

    2014-01-01

    Full Text Available Chronic tinnitus is a debilitating condition and often accompanied by anxiety, depression, and sleep disturbance. It has been suggested that sleep disturbance, such as insomnia, may be a risk factor/predictor for tinnitus-related distress and the two conditions may share common neurobiological mechanisms. This study investigated whether acute stress-induced sleep disturbance could increase the susceptibility to acoustic trauma-induced tinnitus in rats. The animals were exposed to unilateral acoustic trauma 24 h before sleep disturbance being induced using the cage exchange method. Tinnitus perception was assessed behaviourally using a conditioned lick suppression paradigm 3 weeks after the acoustic trauma. Changes in the orexin system in the hypothalamus, which plays an important role in maintaining long-lasting arousal, were also examined using immunohistochemistry. Cage exchange resulted in a significant reduction in the number of sleep episodes and acoustic trauma-induced tinnitus with acoustic features similar to a 32 kHz tone at 100 dB. However, sleep disturbance did not exacerbate the perception of tinnitus in rats. Neither tinnitus alone nor tinnitus plus sleep disturbance altered the number of orexin-expressing neurons. The results suggest that acute sleep disturbance does not cause long-term changes in the number of orexin neurons and does not change the perception of tinnitus induced by acoustic trauma in rats.

  17. Managing acute invasive fungal sinusitis.

    Science.gov (United States)

    Dwyhalo, Kristina M; Donald, Carrlene; Mendez, Anthony; Hoxworth, Joseph

    2016-01-01

    Acute invasive fungal sinusitis is the most aggressive form of fungal sinusitis and can be fatal, especially in patients who are immunosuppressed. Early diagnosis and intervention are crucial and potentially lifesaving, so primary care providers must maintain a high index of suspicion for this disease. Patients may need to be admitted to the hospital for IV antifungal therapy and surgical debridement.

  18. Microcirculation disturbance affects rats with acute severe pancreatitis following lung injury

    Institute of Scientific and Technical Information of China (English)

    Xue-Min Liu; Qing-Guang Liu; Jun Xu; Cheng-En Pan

    2005-01-01

    AIM: To study the effects of microcirculation disturbance(MD) on rats with acute severe pancreatitis (ASP).METHODS: We developed ASP rat models, and anatomized separately after 1, 3, 5, 7, and 9 h. We took out blood and did hemorrheologic examination and erythrocyte osmotic fragility test, checked up the water content, capillary permeability, and genetic expression of intercellular adhesion molecule-1 (ICAM-1) in lung tissues, examined the apoptosis degree of blood vessel endothelium while we tested related gene expression of Bax and Bcl-2in lung tissues. We did the same examination in control group.RESULTS: The viscosity of total blood and plasma, the hematocrit, and the erythrocyte osmotic fragility were all increased. Fibrinogen was decreased. The water content in lung tissues and capillary permeability were increased.Apoptosis degree of blood vessel endothelium was increased too. ICAM-1 genetic expression moved up after1 h and reached its peak value after 9 h.CONCLUSION: MD plays an important role in ASP following acute lung injury (ALI). The functional damage of blood vessel endothelium, the apoptosis of capillary vessel endothelium, WBC edging-concentration and the increasing of erythrocyte fragility are the main reasons of ALI.

  19. Acute handling disturbance modulates plasma insulin-like growth factor binding proteins in rainbow trout (Oncorhynchus mykiss)

    Science.gov (United States)

    The effects of acute stressor exposure on proximal (growth hormone; GH) and distal (insulin-like growth factor-I; IGF-I and IGF-binding proteins) components of the somatotropic axis are poorly understood in finfish. We exposed rainbow trout (Oncorhynchus mykiss) to a 5-minute handling disturbance to...

  20. Pregnancy related acute kidney injury: nondialytic management

    Directory of Open Access Journals (Sweden)

    Kaliki Hymavathi Reddy

    2015-04-01

    Full Text Available Acute Kidney Injury (AKI is associated with increased mortality and morbidity unless timely diagnosed and promptly managed. An understanding of the renal physiologic changes that occur during pregnancy is essential for Proper evaluation, diagnosis, and management of Pregnancy Related AKI (PRAKI. In the general population, AKI can occur from prerenal, intrinsic/renal, and post-renal causes. Major causes of pre-renal azotemia include hyperemesis gravidarum and uterine hemorrhage in the setting of placental abruption. Intrinsic etiologies include infections from acute pyelonephritis and septic abortion, bilateral cortical necrosis, and acute tubular necrosis. Particular attention should be paid to specific conditions that lead to AKI during the second and third trimesters, such as preeclampsia, HELLP syndrome, acute fatty liver of pregnancy, and TTP-HUS. An understanding of the various etiologies of AKI in the pregnant patient is key to the appropriate clinical management and prevention of adverse maternal/fetal outcomes. Sometimes PRAKI may require intensive management and even dialysis adding additional economical burden to the patient. We here, with report an interesting case of PRAKI diagnosed and managed in time by simple medical measures thus delivering an effective treatment at a much lesser cost. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 486-489

  1. Managing acute and chronic pancreatitis.

    Science.gov (United States)

    Skipworth, James R A; Shankar, Arjun; Pereira, Stephen P

    2010-10-01

    Pancreatitis may be acute or chronic. Although both can be caused by similar aetiologies, they tend to follow distinct natural histories. Around 80% of acute pancreatitis (AP) diagnoses occur secondary to gallstone disease and alcohol misuse. AP is commonly associated with sudden onset of upper abdominal pain radiating to the back that is usually severe enough to warrant the patient seeking urgent medical attention. Onset of pain may be related to a recent alcohol binge or rich, fatty meal. The patient may appear unwell, be tachycardic and have exquisite tenderness in the upper abdomen. Overall, 10-25% of AP episodes are classified as severe, leading to an associated mortality rate of 7.5%. Disease severity is best predicted from a number of clinical scoring systems which can be applied at diagnosis in association with repeated clinical assessment, measurement of acute inflammatory markers, and CT. All patients with suspected AP should be referred urgently. Chronic pancreatitis (CP) follows continued, repetitive or sustained injury to the pancreas and 70% of diagnoses occur secondary to alcohol abuse. The characteristic presenting feature of CP is insidious progression of chronic, severe, upper abdominal pain, radiating to the back, caused by a combination of progressive pancreatic destruction, inflammation and duct obstruction. Signs and symptoms include weight loss and steatorrhoea and later on diabetes. CP patients may also present with recurrent episodes mimicking AP, both symptomatically and metabolically. Diagnosis of CP should be based on symptom profile, imaging and assessment of exocrine and endocrine pancreatic function. CT should be the first-line imaging investigation.

  2. Management of acute myeloid leukemia during pregnancy.

    Science.gov (United States)

    Avivi, Irit; Brenner, Benjamin

    2014-06-01

    Diagnosis of acute leukemia during pregnancy presents significant medical challenges. Pancytopenia, caused by bone marrow substitution with leukemic cells, impairs maternal and fetal health. Chemotherapeutic agents required to be immediately used to save the mother's life are likely to adversely affect fetal development and outcome, especially if administered at an early gestational stage. Patients diagnosed with acute leukemia during the first trimester are, therefore, recommended to undergo pregnancy termination. At later gestational stages, antileukemic therapy can be administered, although in this case, fetal outcome is still associated with increased incidence of growth restriction and loss. Special attention to the issue of future reproduction, adopting a personalized fertility preservation approach, is required. This article addresses these subjects, presenting women diagnosed with acute myeloid and acute promyelocytic leukemia in pregnancy. The rarity of this event, resulting in insufficient data, emphasizes the need for collaborative efforts to optimize management of this complicated clinical condition.

  3. Acute and chronic pancreatitis: surgical management.

    Science.gov (United States)

    Dzakovic, Alexander; Superina, Riccardo

    2012-08-01

    Pancreatitis is becoming increasingly prevalent in children, posing new challenges to pediatric health care providers. Although some general adult treatment paradigms are applicable in the pediatric population, diagnostic workup and surgical management of acute and chronic pancreatitis have to be tailored to anatomic and pathophysiological entities peculiar to children. Nonbiliary causes of acute pancreatitis in children are generally managed nonoperatively with hydration, close biochemical and clinical observation, and early initiation of enteral feeds. Surgical intervention including cholecystectomy or endoscopic retrograde cholangiopancreatography is often required in acute biliary pancreatitis, whereas infected pancreatic necrosis remains a rare absolute indication for pancreatic debridement and drainage via open, laparoscopic, or interventional radiologic procedure. Chronic pancreatitis is characterized by painful irreversible changes of the parenchyma and ducts, which may result in or be caused by inadequate ductal drainage. A variety of surgical procedures providing drainage, denervation, resection, or a combination thereof are well established to relieve pain and preserve pancreatic function.

  4. Management of Acute Bleeding Per Rectum

    Directory of Open Access Journals (Sweden)

    Benita K.T. Tan

    2004-01-01

    Conclusion: Perianal conditions contributed to the majority of acute patient admissions. Colonic causes of bleeding were less common and were most stable. There were differences in the frequencies of aetiologies in our population compared to Western populations. Understanding the common pathologies and outcomes guides the management of our patients.

  5. Acute Stroke Management in Patients Taking Dabigatran

    NARCIS (Netherlands)

    Brouns, Raf; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; De Raedt, Sylvie; Uyttenboogaart, Maarten; Luijckx, Gert-Jan; Jochmans, Kristin; De Keyser, Jacques

    Dabigatran etexilate is emerging as an alternative for vitamin K antagonists, but evidence-based guidelines for management of intracerebral hemorrhage and acute ischemic stroke in patients taking this drug are nonexistent. This review summarizes current knowledge on key pharmacological features and

  6. Assessing the effects of fire disturbance on ecosystems: a scientific agenda for research and management.

    Science.gov (United States)

    Daniel L. Schmoldt; David L. Peterson; Robert E. Keane; James M. Lenihan; Donald McKenzie; David R. Weise; David V. Sandberg

    1999-01-01

    A team of fire scientists and resource managers convened 17-19 April 1996 in Seattle, Washington, to assess the effects of fire disturbance on ecosystems. Objectives of this workshop were to develop scientific recommendations for future fire research and management activities. These recommendations included a series of numerically ranked scientific and managerial...

  7. Acute complicated diverticulitis managed by laparoscopic lavage

    DEFF Research Database (Denmark)

    Alamili, Mahdi; Gögenur, Ismail; Rosenberg, Jacob

    2009-01-01

    PURPOSE: The classic surgical treatment of acute complicated sigmoid diverticulitis with peritonitis is often a two-stage operation with colon resection and a temporary stoma. This approach is associated with high mortality and morbidity and the reversal of the stoma is in many cases not performed...... searched. RESULTS: Eight studies met the inclusion criteria and reported 213 patients with acute complicated diverticulitis managed by laparoscopic lavage. None of these studies were randomized. The patients' mean age was 59 years and most patients had Hinchey Grade 3 disease. All patients were treated...

  8. Management of acute childhood fevers.

    Science.gov (United States)

    Teuten, Polly; Paul, Siba Prosad; Heaton, Paul Anthony

    2015-01-01

    Feverish illnesses commonly affect children and are the second most frequent reason for a child to be admitted to hospital. Most cases are viral in origin, usually with a good prognosis. Fever can be caused by severe and rapidly progressive illness which needs urgent referral to hospital for potentially life-saving treatment, and community practitioners must be able to identify such cases showing 'red flag'features. The fear of serious disease among parents and carers may result in 'fever phobia' leading to minor illnesses being managed inappropriately. Community practitioners are well placed to reassure and support families, and to provide education regarding the facts about fever, the appropriate use of antipyretic medication, how to avoid dehydration, and the beneficial role of immunisation in preventing infection.

  9. Potential increases in natural disturbance rates could offset forest management impacts on ecosystem carbon stocks

    Science.gov (United States)

    Bradford, John B.; Jensen, Nicholas R.; Domke, Grant M.; D’Amato, Anthony W.

    2013-01-01

    Forested ecosystems contain the majority of the world’s terrestrial carbon, and forest management has implications for regional and global carbon cycling. Carbon stored in forests changes with stand age and is affected by natural disturbance and timber harvesting. We examined how harvesting and disturbance interact to influence forest carbon stocks over the Superior National Forest, in northern Minnesota. Forest inventory data from the USDA Forest Service, Forest Inventory and Analysis program were used to characterize current forest age structure and quantify the relationship between age and carbon stocks for eight forest types. Using these findings, we simulated the impact of alternative management scenarios and natural disturbance rates on forest-wide terrestrial carbon stocks over a 100-year horizon. Under low natural mortality, forest-wide total ecosystem carbon stocks increased when 0% or 40% of planned harvests were implemented; however, the majority of forest-wide carbon stocks decreased with greater harvest levels and elevated disturbance rates. Our results suggest that natural disturbance has the potential to exert stronger influence on forest carbon stocks than timber harvesting activities and that maintaining carbon stocks over the long-term may prove difficult if disturbance frequency increases in response to climate change.

  10. Contemporary Management of Acute Type B Dissection.

    Science.gov (United States)

    Scott, A J; Bicknell, C D

    2016-03-01

    Growing confidence in thoracic endovascular aortic repair (TEVAR) for the management of acute type B aortic dissection has resulted in controversies regarding optimum patient selection and the timing of intervention. In this review a clinical vignette to present a practical perspective on the contemporary management of acute type B dissection (ABAD) in a specialist vascular centre with particular focus on areas of debate is used. This is a narrative clinical review. Aggressive anti-impulse therapy is the cornerstone of management of all patients with ABAD. However, 20-30% of patients develop complicated ABAD defined by the presence of malperfusion syndromes, acute aortic dilatation, dissection extension, or persistent pain and hypotension. These complicated patients typically require intervention, and non-randomised series suggest TEVAR to be an effective alternative to open repair with a lower morbidity. There is considerable interest and controversy surrounding the use of TEVAR in uncomplicated ABAD patients for whom the intervention-free survival at 6 years is less than 50% for patients managed with anti-impulse therapy. Data regarding this question are sparse, but two randomised trials (ADSORB and INSTEAD) both demonstrated a higher rate of favourable aortic remodelling in patients managed with TEVAR than medical therapy alone. However, it is unclear whether this positive remodelling translates into a reduction in long-term mortality sufficient to balance the early perioperative hazards of endografting. Despite increasing adeptness at endovascular stenting, the long-term outcomes of patients with ABAD leave significant room for improvement. In particular, the optimum management of patients with uncomplicated disease is unclear and guidance from trials powered for long-term mortality is awaited. Until then, the principals of management of ABAD remain aggressive medical therapy for all patients, with TEVAR primarily reserved for those who develop complications

  11. A Disturbance Scheduling Technique for Managing Renovation Work.

    Science.gov (United States)

    1987-05-08

    performance. ..... Thesis Supervisor: Dr. Henry G. Irwig Title: Senior Lecturer, Department of Civil Engineering Di~t j dor 2 D~ BIOGRAPHICAL NOTE Wayne E...gratitude to Dr. Henry G. Irwig for his interest, encouragement, and invaluable guidance throughout the preparation of this thesis. I have enjoyed...Building Team," Building Design and Construction, Vol. 27, No. 5, (May 1986), pg 67. 13. Fayol , H. "General and Industrial Management." Pitman Paperbacks

  12. Clinical Review: Emergency management of acute poisoning

    Directory of Open Access Journals (Sweden)

    D.J. van Hoving

    2011-06-01

    The aim of this commissioned review was to establish concise guidelines for the initial management of the acutely poisoned patient in the Emergency Centre. The American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists are the international leaders in the field of toxicology and the guidelines in their position papers were generally followed. Most of the dosage regimes are according to the South African Medicines Formulary.

  13. Endovascular Management of Acute Limb Ischemia.

    LENUS (Irish Health Repository)

    Hynes, Brian G

    2011-09-14

    Despite major advances in pharmacologic and endovascular therapies, acute limb ischemia (ALI) continues to result in significant morbidity and mortality. The incidence of ALI may be as high as 13-17 cases per 100,000 people per year, with mortality rates approaching 18% in some series. This review will address the contemporary endovascular management of ALI encompassing pharmacologic and percutaneous interventional treatment strategies.

  14. Assessment and management of patients with acute red eye.

    Science.gov (United States)

    Watkinson, Sue

    2013-06-01

    This article provides an overview of the role of the nurse in the assessment and management of five ocular conditions that give rise to an acute red eye in older people. The conditions discussed are acute closed angle glaucoma, acute iritis, acute conjunctivitis, herpes zoster ophthalmicus and bacterial corneal ulcer.

  15. Coral population trajectories, increased disturbance and management intervention: A sensitivity analysis

    KAUST Repository

    Riegl, Bernhard

    2013-03-07

    Coral reefs distant from human population were sampled in the Red Sea and one-third showed degradation by predator outbreaks (crown-of-thorns-starfish=COTS observed in all regions in all years) or bleaching (1998, 2010). Models were built to assess future trajectories. They assumed variable coral types (slow/fast growing), disturbance frequencies (5,10,20years), mortality (equal or not), and connectivity (un/connected to un/disturbed community). Known disturbances were used to parameterize models. Present and future disturbances were estimated from remote-sensing chlorophyll and temperature data. Simulations and sensitivity analysis suggest community resilience at >20-year disturbance frequency, but degradation at higher frequency. Trajectories move from fast-grower to slow-grower dominance at intermediate disturbance frequency, then again to fast-grower dominance. A similar succession was observed in the field: Acropora to Porites to Stylophora/Pocillopora dominance on shallow reefs, and a transition from large poritids to small faviids on deep reefs. Synthesis and application: Even distant reefs are impacted by global changes. COTS impacts and bleaching were key driver of coral degradation, coral population decline could be reduced if these outbreaks and bleaching susceptibility were managed by maintaining water quality and by other interventions. Just leaving reefs alone, seems no longer a satisfactory option. 2013 The Authors. Ecology and Evolution.

  16. Coral population trajectories, increased disturbance and management intervention: a sensitivity analysis.

    Science.gov (United States)

    Riegl, Bernhard; Berumen, Michael; Bruckner, Andrew

    2013-04-01

    Coral reefs distant from human population were sampled in the Red Sea and one-third showed degradation by predator outbreaks (crown-of-thorns-starfish = COTS observed in all regions in all years) or bleaching (1998, 2010). Models were built to assess future trajectories. They assumed variable coral types (slow/fast growing), disturbance frequencies (5,10,20 years), mortality (equal or not), and connectivity (un/connected to un/disturbed community). Known disturbances were used to parameterize models. Present and future disturbances were estimated from remote-sensing chlorophyll and temperature data. Simulations and sensitivity analysis suggest community resilience at >20-year disturbance frequency, but degradation at higher frequency. Trajectories move from fast-grower to slow-grower dominance at intermediate disturbance frequency, then again to fast-grower dominance. A similar succession was observed in the field: Acropora to Porites to Stylophora/Pocillopora dominance on shallow reefs, and a transition from large poritids to small faviids on deep reefs. Synthesis and application: Even distant reefs are impacted by global changes. COTS impacts and bleaching were key driver of coral degradation, coral population decline could be reduced if these outbreaks and bleaching susceptibility were managed by maintaining water quality and by other interventions. Just leaving reefs alone, seems no longer a satisfactory option.

  17. Polycystic ovary syndrome: reviewing diagnosis and management of metabolic disturbances.

    Science.gov (United States)

    Spritzer, Poli Mara

    2014-03-01

    Polycystic ovary syndrome (PCOS) is a common condition in women at reproductive age associated with reproductive and metabolic dysfunction. Proposed diagnosed criteria for PCOS include two out of three features: androgen excess, menstrual irregularity, and polycystic ovary appearance on ultrasound (PCO), after other causes of hyperandrogenism and dysovulation are excluded. Based on these diagnostic criteria, the most common phenotypes are the "classic PCOS"--hyperandrogenism and oligomenorrhea, with or without PCO; the "ovulatory phenotype"--hyperandrogenism and PCO in ovulatory women; and the "non-hyperandrogenic phenotype", in which there is oligomenorrhea and PCO, without overt hyperandrogenism. The presence of obesity may exacerbate the metabolic and reproductive disorders associated with the syndrome. In addition, PCOS women present higher risk for type 2 diabetes and higher prevalence of cardiovascular risk factors that seems to be associated with the classic phenotype. The main interventions to minimize cardiovascular and metabolic risks in PCOS are lifestyle changes, pharmacological therapy, and bariatric surgery. Treatment with metformin has been shown to improve insulin sensitivity, lowering blood glucose and androgen levels. These effects are more potent when combined with lifestyle interventions. In conclusion, besides reproductive abnormalities, PCOS has been associated to metabolic comorbidities, most of them linked to obesity. Confounders, such as the lack of standard diagnostic criteria, heterogeneity of the clinical presentation, and presence of obesity, make management of PCOS difficult. Therefore, the approach to metabolic abnormalities should be tailored to the risks and treatment goals of each individual woman.

  18. Acute pain management in burn patients

    DEFF Research Database (Denmark)

    Gamst-Jensen, Hejdi; Vedel, Pernille Nygaard; Lindberg-Larsen, Viktoria Oline

    2014-01-01

    management addresses and alleviates these complications. The aim of our study was to compare clinical guidelines for pain management in burn patients in selected European and non-European countries. We included pediatric guidelines due to the high rate of children in burn units. METHOD: The study had...... patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn......OBJECTIVE: Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain...

  19. Acute diarrhea: evidence-based management.

    Science.gov (United States)

    Brandt, Kátia Galeão; Castro Antunes, Margarida Maria de; Silva, Gisélia Alves Pontes da

    2015-01-01

    To describe the current recommendations on the best management of pediatric patients with acute diarrheal disease. PubMed, Scopus, Google Scholar. There has been little progress in the use of oral rehydration salts (ORS) in recent decades, despite being widely reported by international guidelines. Several studies have been performed to improve the effectiveness of ORS. Intravenous hydration with isotonic saline solution, quickly infused, should be given in cases of severe dehydration. Nutrition should be ensured after the dehydration resolution, and is essential for intestinal and immune health. Dietary restrictions are usually not beneficial and may be harmful. Symptomatic medications have limited indication and antibiotics are indicated in specific cases, such as cholera and moderate to severe shigellosis. Hydration and nutrition are the interventions with the greatest impact on the course of acute diarrhea. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  20. Uncertainty management for aerial vehicles: Coordination, deconfliction, and disturbance rejection

    Science.gov (United States)

    Panyakeow, Prachya

    The presented dissertation aims to develop control algorithms that deal with three types of uncertainties managements. First, we examine the situation when unmanned aerial vehicles (UAVs) fly through uncertain environments that contain both stationary and moving obstacles. Moreover, a guarantee of collision avoidance is necessary when UAVs operate in close proximity of each other. Second, we look at the communication uncertainty among the network of cooperative UAVs and the efforts to establish and maintain the connectivity throughout their entire missions. Third, we explore the scenario when the aircraft flies through wind gust. The introduction of an appropriate control scheme to actively alleviate the gust loads can result into weight reduction and consequently lower the fuel cost. In the first part of this dissertation, we develop a deconfliction algorithm that guarantees collision avoidance between a pair of constant speed unicycle-type UAVs as well as convergence to the desired destination for each UAV in presence of static obstacles. We use a combination of navigation and swirling functions to direct the unicycle vehicles along the planned trajectories while avoiding inter-vehicle collisions. The main feature of our contribution is proposing means of designing a deconfliction algorithm for unicycle vehicles that more closely capture the dynamics of constant speed UAVs as opposed to double integrator models. Specifically, we consider the issue of UAV turn-rate constraints and proceed to explore the selection of key algorithmic parameters in order to minimize undesirable trajectories and overshoots induced by the avoidance algorithm. The avoidance and convergence analysis of the proposed algorithm is then performed for two cooperative UAVs and simulation results are provided to support the viability of the proposed framework for more general mission scenarios. For the uncertainty of the UAV network, we provides two approaches to establish connectivity among a

  1. Effect of Zinc supplementation on the Management of Acute ...

    African Journals Online (AJOL)

    Effect of Zinc supplementation on the Management of Acute Diarrhoea in Young ... Incidence and prevalence of diarrhea were compared between the groups. ... Supplementing the treatment of acute watery diarrhea with Zinc in just 2 cases ...

  2. Evidence-based diagnosis and management of acute bronchitis.

    Science.gov (United States)

    Hart, Ann Marie

    2014-09-18

    Acute bronchitis is a common respiratory infection seen in primary care settings. This article examines the current evidence for diagnosis and management of acute bronchitis in adults and provides recommendations for primary care clinical practice.

  3. Management of acute unstable acromioclavicular joint injuries.

    Science.gov (United States)

    Cisneros, Luis Natera; Reiriz, Juan Sarasquete

    2016-12-01

    Surgical management of acute unstable acromioclavicular joint injuries should be focused on realigning the torn ends of the ligaments to allow for healing potential. The most widely utilized treatment methods incorporate the use of metal hardware, which can alter the biomechanics of the acromioclavicular joint. This leads to a second surgical procedure for hardware removal once the ligaments have healed. Patients with unstable acromioclavicular joint injuries managed with arthroscopy-assisted procedures have shown good and excellent clinical outcomes, without the need for a second operation. These procedures incorporate a coracoclavicular suspension device aimed to function as an internal brace, narrowing the coracoclavicular space thus allowing for healing of the torn coracoclavicular ligaments. The lesser morbidity of a minimally invasive approach and the possibility to diagnose and treat concomitant intraarticular injuries; no obligatory implant removal, and the possibility of having a straight visualization of the inferior aspect of the base of the coracoid (convenient when placing coracoclavicular fixation systems) are the main advantages of the arthroscopic approach over classic open procedures. This article consists on a narrative review of the literature in regard to the management of acute acromioclavicular joint instability.

  4. Carbon Cycling, Climate Regulation, and Disturbances in Canadian Forests: Scientific Principles for Management

    Directory of Open Access Journals (Sweden)

    Jean-Sébastien Landry

    2015-01-01

    Full Text Available Canadian forests are often perceived as pristine and among the last remaining wilderness, but the majority of them are officially managed and undergo direct land use, mostly for wood harvest. This land use has modified their functions and properties, often inadvertently (e.g., age structure but sometimes purposefully (e.g., fire suppression. Based on a review of the literature pertaining to carbon cycling, climate regulation, and disturbances from logging, fire, and insect outbreaks, we propose five scientific principles relevant for Canadian managed forests. Among these, a principle we wish to highlight is the need to properly account for the management-related fossil fuel emissions, because they will affect the global carbon cycle and climate for millennia unless massive atmospheric carbon dioxide removal becomes a reality. We also use these five principles to address questions of current interest to research scientists, forest managers, and policy makers. Our review focusses on total ecosystem carbon storage and various mechanisms through which forests affect climate, in particular albedo and aerosols forcings—including how disturbances influence all these elements—but also touches on other ecosystem goods and services. Our review underscores the importance of conducting >100-year time horizon studies of carbon cycling, climate regulation, and disturbances in Canadian managed forests.

  5. Evaluation and management of acute vascular trauma.

    Science.gov (United States)

    Salazar, Gloria M M; Walker, T Gregory

    2009-06-01

    With the technical advances and the increasing availability of sophisticated imaging equipment, techniques, and protocols, and with continually evolving transcatheter endovascular therapies, minimally invasive imaging and treatment options are being routinely used for the clinical management of trauma patients. Thus, the primary treatment algorithm for managing acute vascular trauma now increasingly involves the interventional radiologist or other endovascular specialist. Endovascular techniques represent an attractive option for both stabilizing and definitively treating patients who have sustained significant trauma, with resultant vascular injury. Endovascular treatment frequently offers the benefit of a focused definitive therapy, even in the presence of massive hemorrhage that allows for preservation of major vessels or injured solid organs and serves as an alternative to an open surgical intervention. This article presents an overview of various endovascular techniques that can be used for trauma patients presenting with vascular injuries.

  6. Differences in Soil Microbial Biomass and Activity for Six Agroecosystems with a Management Disturbance Gradient

    Institute of Scientific and Technical Information of China (English)

    ZHANG Wei-Jian; FENG Jin-Xia; J. WU; K. PARKER

    2004-01-01

    Different management practices in six agroecosystems located near Goldsboro, NC, USA were conducted including a successional field (SU), a plantation woodlot (WO), an integrated cropping system with animals (IN), an organic farming system (OR), and two cash-grain cropping systems employing either tillage (CT) or no-tillage (NT) to examine if and how microbial biomass and activity differ in response to alterations in disturbance intensity from six land management strategies. Results showed that soil microbial biomass and activity differed, with microbial activity in intermediately disturbed ecosystems (NT, OR, IN) being significantly higher (P < 0.01) than systems with either high or low disturbance intensities. There was also a significant and a highly significant ecosystem effect from the treatments on microbial biomass C (MBC) (P < 0.05) and on microbial activity (respiration) (P < 0.01), respectively. Multiple comparisons of mean respiration rates distinctly separated the six ecosystem types into three groups: CT < NT, SU and WO < OR and IN.Thus, for detecting microbial response to disturbance changes these results indicated that the active component of the soil microbial community was a better indicator than total biomass.

  7. Pattern and Management Outcomes of Neonatal Acute Surgical ...

    African Journals Online (AJOL)

    Hp 630 Dual Core

    Key words: Neonates, Acute surgical conditions, Management, Outcomes. Introduction ... undergoing surgery should live and therefore effective and close interdisciplinary collaboration ..... anaesthesia and surgical stress leading to death 13.

  8. [Effect of emoxypine on myocardial electrical instability and homeostasis parameters in patients with acute disturbance of cerebrovascular circulation].

    Science.gov (United States)

    Stoliarova, V V

    2002-01-01

    The frequency of myocardial ischemia onsets, QT interval dispersion, homeostasis characteristics, and lipid peroxidation parameters were studied in a group of 49 patients with acute disturbance of cerebral circulation (ADCC). The Holter ECG monitoring revealed myocardial ischemia episodes in 42% of patients, and myocardial instability manifested by the QT interval variance in 82% of patients. The control group (30 patients) received standard complex therapy, while the test group (19 patients) additionally received emoxypine. The administration of emoxypine reduced the incidence of myocardial ischemia and positively influenced the QT interval variance and the main parameters of homeostasis.

  9. Neuropsychiatric disturbances associated with traumatic brain injury: a practical approach to evaluation and management.

    Science.gov (United States)

    Rao, Vani; Koliatsos, Vassilis; Ahmed, Faizi; Lyketsos, Constantine; Kortte, Kathleen

    2015-02-01

    Traumatic brain injury (TBI) causes a wide variety of neuropsychiatric disturbances associated with great functional impairments and low quality of life. These disturbances include disorders of mood, behavior, and cognition, and changes in personality. The diagnosis of specific neuropsychiatric disturbances can be difficult because there is significant symptom overlap. Systematic clinical evaluations are necessary to make the diagnosis and formulate a treatment plan that often requires a multipronged approach. Management of TBI-associated neuropsychiatric disorders should always include nonpharmacological interventions, including education, family involvement, supportive and behavioral psychotherapies, and cognitive rehabilitation. Pharmacological treatments include antidepressants, anticonvulsants, antipsychotics, dopaminergic agents, and cholinesterase inhibitors. However, evidence-based treatments are extremely limited, and management relies on clinical empiricism and resemblance of TBI neuropsychiatric symptom profiles with those of idiopathic psychiatric disorders. Although the understanding of TBI-associated neuropsychiatric disorders has improved in the last decade, further research is needed including prospective, longitudinal studies to explore biomarkers that will assist with management and prognosis as well as randomized-controlled studies to validate pharmacological and nonpharmacological treatments. The current review summarizes the available literature in support of a structured, systematic evaluation approach and treatment options as well as recommendations for further research directions.

  10. Earthworms as indicators for different forest management types and human disturbance in Ilam oak forest, Iran

    Directory of Open Access Journals (Sweden)

    Heydari Mehdi

    2014-09-01

    Full Text Available There has been observed widespread destruction of natural ecosystems around the world due to population growth, land use change and clear cutting which have affected soil properties. Different management strategies have been so far implemented to reduce this crisis in various regions of the world, such as e.g. short-term and long-term conservation management in the Zagros region. However, any management approach should be evaluated with appropriate measures to determine how managed areas respond. The main objective of the present study was to evaluate the potential of earthworms as an indicator for different forest management strategies and human disturbances in Zagros oak (Quercus persica Jaub. and Spach forest. The sites selected included undisturbed one as the control (Un, the sites under five-year conservation management (FCM and twenty-year conservation management (TCM as well as the disturbed site (D. The results of principal component analysis (PCA showed that different regions separated into the components: PC1 and PC2. Un and TCM sites gathered together and represented higher values of the factors such as pH, Kavailable, OC, clay content, Pavailable, CEC, overstory tree canopy, Ntot, biomass and abundance of earthworms. The positive direction of the first axis reflected a gradient of EC, BD and Ptot. According to the logistic model, NH4-N and EC played the most important role in earthworm presence and absence in Zagros forest ecosystem. Earthworm abundance and biomass could be a good indicator to evaluate different forest management strategies in the study area.

  11. Novel algorithm for management of acute epididymitis.

    Science.gov (United States)

    Hongo, Hiroshi; Kikuchi, Eiji; Matsumoto, Kazuhiro; Yazawa, Satoshi; Kanao, Kent; Kosaka, Takeo; Mizuno, Ryuichi; Miyajima, Akira; Saito, Shiro; Oya, Mototsugu

    2017-01-01

    To identify predictive factors for the severity of epididymitis and to develop an algorithm guiding decisions on how to manage patients with this disease. A retrospective study was carried out on 160 epididymitis patients at Keio University Hospital. We classified cases into severe and non-severe groups, and compared clinical findings at the first visit. Based on statistical analyses, we developed an algorithm for predicting severe cases. We validated the algorithm by applying it to an external cohort of 96 patients at Tokyo Medical Center. The efficacy of the algorithm was investigated by a decision curve analysis. A total of 19 patients (11.9%) had severe epididymitis. Patient characteristics including older age, previous history of diabetes mellitus and fever, as well as laboratory data including a higher white blood cell count, C-reactive protein level and blood urea nitrogen level were independently associated with severity. A predictive algorithm was created with the ability to classify epididymitis cases into three risk groups. In the Keio University Hospital cohort, 100%, 23.5%, and 3.4% of cases in the high-, intermediate-, and low-risk groups, respectively, became severe. The specificity of the algorithm for predicting severe epididymitis proved to be 100% in the Keio University Hospital cohort and 98.8% in the Tokyo Medical Center cohort. The decision curve analysis also showed the high efficacy of the algorithm. This algorithm might aid in decision-making for the clinical management of acute epididymitis. © 2016 The Japanese Urological Association.

  12. Management of acute severe ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Saurabh; Kedia; Vineet; Ahuja; Rakesh; Tandon

    2014-01-01

    The management strategy of acute severe ulcerative colitis has evolved over the past decade from being entirely restricted to twin choices of intravenous steroids or colectomy to include colon rescue therapies like cyclosporin as well as infliximab. However it still remains a medical emergency requiring hospitalization and requires care from a multidisciplinary team comprising of a gastroenterologist and a colorectal surgeon. The frame shift in management has been the emphasis on time bound decision making with an attempt to curtail the mortality rate to below 1%. Intravenous corticosteroids are the mainstay of therapy. Response to steroids should be assessed at day 3 of admission and partial/non-responders should be considered for alternative medical therapy/surgery. Medical rescue therapies include intravenous cyclosporin and infliximab. Cyclosporin is administered in a dose of 2 mg/kg per day and infliximab is administered as a single dose intravenous infusion of 5 mg/kg. Approximately 75% patients have short term and 50% patients have long term response to cyclosporin. Long term response to cyclosporin is improved in patients who are thiopurine na?ve and are started on thiopurines on day 7. Infliximab also has a response rate of approximately 70% in short term and 50% in long term. Both cyclosporin and infliximab are equally efficacious medical rescue therapies as demonstrated in a recent randomized control trial. Patientsnot responding to infliximab or cyclosporin should be considered for colectomy.

  13. Diagnosis and management of acute diverticulitis.

    Science.gov (United States)

    Wilkins, Thad; Embry, Katherine; George, Ruth

    2013-05-01

    Uncomplicated diverticulitis is localized diverticular inflammation, whereas complicated diverticulitis is diverticular inflammation associated with an abscess, phlegmon, fistula, obstruction, bleeding, or perforation. Patients with acute diverticulitis may present with left lower quadrant pain, tenderness, abdominal distention, and fever. Other symptoms may include anorexia, constipation, nausea, diarrhea, and dysuria. Initial laboratory studies include a complete blood count, basic metabolic panel, urinalysis, and measurement of C-reactive protein. Computed tomography, the most commonly performed imaging test, is useful to establish the diagnosis and the extent and severity of disease, and to exclude complications in selected patients. Colonoscopy is recommended four to six weeks after resolution of symptoms for patients with complicated disease or for another indication, such as age-appropriate screening. In mild, uncomplicated diverticulitis, antibiotics do not accelerate recovery, or prevent complications or recurrences. Hospitalization should be considered if patients have signs of peritonitis or there is suspicion of complicated diverticulitis. Inpatient management includes intravenous fluid resuscitation and intravenous antibiotics. Patients with a localized abscess may be candidates for computed tomography-guided percutaneous drainage. Fifteen to 30 percent of patients admitted with acute diverticulitis require surgical intervention during that admission. Laparoscopic surgery results in a shorter length of stay, fewer complications, and lower in-hospital mortality compared with open colectomy. The decision to proceed to surgery in patients with recurrent diverticulitis should be individualized and based on patient preference, comorbidities, and lifestyle. Interventions to prevent recurrences of diverticulitis include increased intake of dietary fiber, exercise, cessation of smoking, and, in persons with a body mass index of 30 kg per m(2) or higher, weight

  14. Management of pemphigus vulgaris during acute phase

    Directory of Open Access Journals (Sweden)

    Kar P

    2003-03-01

    Full Text Available We present our experience with 21 patients of pemphigus vulgaris seen over a period of 10 years managed in service hospitals during acute phase of the disease. Age groups of patients ranged from 25-45 years. Eighteen (85.7% were young adults, 30-40 years of age. Fifteen (71.4% were men and 6(28.6% were women. All the cases were hospitalized in ICU, till the acute phase of the disease subsided. Complete hematological profile, urinalysis, serum biochemistry and repeated bacterial cultures from the skin were carried out in all patients at the time of admission and thereafter weekly. The treatment comprised of potassium permanganate lotion bath (1:10000 and 1 framycetin gauze dressing of the denuded areas, maintenance of fluid and electrolyte balance. All suspected infections and septicemia were treated with appropriate antibiotics. The corticosteroids were usually administered as a single dose of prednisolone 1 mg/kg/day. Cyclophosphamide was given at an initial dose of 50mg/day and the dose was escalated to 100mg/day. Once the bulk of the lesions were healed, the dose of corticosteroids was gradually lowered by approximately 50% every two weeks and cyclophosphamide was continued till patients were symptomfree. Out of 21 patients receiving corticosteroids, cyclophosphamide and other supportive therapy, 20(95% had undergone clinical resolution of the disease. During follow up study 15(71.4% patients remained symptom-free and undergone clinical remission. Five patients (23.8% had relapse, out of which 4(19% remained symptom free, after subsequent treatment. There was one death (4.7% in our study.

  15. Survey of the management of acute asthma in children.

    LENUS (Irish Health Repository)

    Widger, J

    2009-12-01

    Acute asthma is one of the most common reasons for children presenting to the emergency department. International guidelines for the management of acute paediatric asthma are widely available. In this study we examined how acute asthma in children is managed across hospitals in Ireland and compared Irish practice with standard international guidelines. We surveyed 54 paediatricians across 18 centres in Ireland. A total of 30 (55.5%) individual paediatricians across 17 (94%) centres replied. The majority of centres had a written protocol for the management of acute asthma. A large number of centres use MDI and spacer devices in acute management although doses used varied widely. Only 29% of centres had written asthma action plans available from the emergency department and 53% had plans available from the ward. Irish practice is largely inline with established guidelines. A national asthma strategy could further help to improve asthma care.

  16. Assessing and Managing Acute Pain: A Call to Action.

    Science.gov (United States)

    Jungquist, Carla R; Vallerand, April Hazard; Sicoutris, Corinna; Kwon, Kyung N; Polomano, Rosemary C

    2017-03-01

    : Acute pain, which is usually sudden in onset and time limited, serves a biological protective function, warning the body of impending danger. However, while acute pain often resolves over time with normal healing, unrelieved acute pain can disrupt activities of daily living and transition to chronic pain. This article describes the effects of unrelieved acute pain on patients and clinical outcomes. The authors call on nurses to assess and manage acute pain in accordance with evidence-based guidelines, expert consensus reports, and position statements from professional nursing organizations in order to minimize the likelihood of its becoming chronic.

  17. Management of functional disturbances of the stomatognathic system; Behandlungsstrategien bei funktionellen Kiefergelenkveraenderungen

    Energy Technology Data Exchange (ETDEWEB)

    Piehslinger, E. [Universitaetsklinik fuer Zahn-, Mund und Kieferheilkunde, Vienna (Austria)

    2001-09-01

    In the management of functional disturbances of the stomatognathic system symptomatic and causal therapeutic methods can be distinguished. Symptomatic therapy encompasses medication, physical methods (heat, cold, radiation, TENS) in combination with physiotherapy and emergency splint. After one or two weeks of symptomatic therapy the patient should be free of pain allowing precise diagnostic procedures followed by causal therapy managing muscular problems, joint pathology and occlusal disturbances. Splint therapy is used to establish a therapeutic joint position according to articulator mounting. After splint therapy prosthodontic and/or orthodontic treatment is needed to restore occlusion. Interdisciplinary management in the therapy of functional disturbances of the stomatognathic system is of utmost importance due to the relationship between chewing muscles, neck muscles and body posture. In addition to splint therapy, physiotherapy, logopedic therapy, myofunctional therapy, psychologic and psychiatric intervention is performed. (orig.) [German] Zur Behandlung der Funktionsstoerungen im stomatognathen System stehen die symptomatische und die kausale Therapie zur Verfuegung. Die symptomatische Therapie kann mit Hilfe von Medikamenten, physikalischen Massnahmen (Hitze, Kaelte, Bestrahlung, TENS), auch in Kombination mit Physiotherapie, sowie mit Notfallaufbissbehelfen durchgefuehrt werden. Die symptomatische Therapie sollte in 1-2 Wochen soweit zur Schmerzreduktion gefuehrt haben, dass auf der Basis von gezielten diagnostischen Massnahmen eine kausale Therapie durchgefuehrt werden kann. Die kausale Therapie zielt auf primaer muskulaere Problematiken, Gelenkerkrankungen und Okklusionsstoerungen. Hier kommen v.a. Aufbissbehelfe zur Anwendung, die durch ihre Anfertigung im Artikulator eine therapeutische Gelenkpositionierung realisieren koennen. Nach der Therapie mit Aufbissbehelfen muss die Okklusion in vielen Faellen mit Hilfe prothetischer und

  18. Disturbances of serine and glycine metabolism as a cause of episodic acute polymorphous psychoses

    NARCIS (Netherlands)

    L. Pepplinkhuizen (Lolke)

    1983-01-01

    textabstractPsychiatrists are frequently confronted with psychoses that are difficult to classify. Many forms of these atypical psychoses have been described in European literature. They often have an acute onset and a tendency towards complete remission, albeit with an episodic course. Rich, multif

  19. Mechanisms of gastric emptying disturbances in chronic and acute inflammation of the distal gastrointestinal tract

    DEFF Research Database (Denmark)

    Keller, Jutta; Beglinger, Christoph; Holst, Jens Juul;

    2009-01-01

    . Thirteen healthy subjects (CON), 13 patients with Crohn's disease (CD), 10 with ulcerative colitis (UC), and 7 with diverticulitis (DIV) underwent a standardized (13)C-octanoic acid gastric emptying breath test. Plasma glucose, CCK, peptide YY, and glucagon-like peptide-1 (GLP-1) were measured periodically......It is unclear why patients with inflammation of the distal bowel complain of symptoms referable to the upper gastrointestinal tract, specifically to gastric emptying (GE) disturbances. Thus we aimed to determine occurrence and putative pathomechanisms of gastric motor disorders in such patients...

  20. Mechanisms of Gastric Emptying Disturbances in Chronic and Acute Inflammation of the Distal Gastrointestinal Tract

    DEFF Research Database (Denmark)

    Keller, Jutta; Beglinger, Christoph; Holst, Jens Juul

    2009-01-01

    in such patients. Methods: 13 healthy subjects (CON), 13 patients with Crohn's disease (CD), 10 with ulcerative colitis (UC) and 7 with diverticulitis (DIV) underwent a standardized (13)C-octanoic acid gastric emptying breath test. Plasma glucose, cholecystokinin (CCK), peptide YY (PYY) and glucagon-like peptide-1......Objective: It is unclear why patients with inflammation of the distal bowel complain of symptoms referable to the upper gastrointestinal tract, specifically to gastric emptying (GE) disturbances. Thus, we aimed to determine occurrence and putative pathomechanisms of gastric motor disorders...

  1. Disturbing forest disturbances

    Energy Technology Data Exchange (ETDEWEB)

    Volney, W.J.A.; Hirsch, K.G. [Natural Resources Canada, Canadian Forest Service, Northern Forestry Centre, Edmonton, AB (Canada)

    2005-10-01

    This paper described the role that disturbances play in maintaining the ecological integrity of Canadian boreal forests. Potential adaptation options to address the challenges that these disturbances present were also examined. Many forest ecosystems need fire for regeneration, while other forests rely on a cool, wet disintegration process driven by insects and commensal fungi feeding on trees to effect renewal. While there are characteristic natural, temporal and spatial patterns to these disturbances, recent work has demonstrated that the disturbances are being perturbed by climatic change that has been compounded by anthropogenic disturbances in forests. Fire influences species composition and age structure, regulates forest insects and diseases, affects nutrient cycling and energy fluxes, and maintains the productivity of different habitats. Longer fire seasons as a result of climatic change will lead to higher intensity fires that may more easily evade initial attacks and become problematic. Fire regimes elevated beyond the range of natural variation will have a dramatic effect on the regional distribution and functioning of forest ecosystems and pose a threat to the safety and prosperity of people. While it was acknowledged that if insect outbreaks were to be controlled on the entire forest estate, the productivity represented by dead wood would be lost, it was suggested that insects such as the forest tent caterpillar and the spruce bud worm may also pose a greater threat as the climate gets warmer and drier. Together with fungal associates, saproxylic arthropods are active in nutrient cycling and ultimately determine the fertility of forest sites. It was suggested that the production of an age class structure and forest mosaic would render the forest landscape less vulnerable to the more negative aspects of climate change on vegetation response. It was concluded that novel management design paradigms are needed to successfully reduce the risk from threats

  2. Clinical management of acute HIV infection: best practice remains unknown.

    Science.gov (United States)

    Bell, Sigall K; Little, Susan J; Rosenberg, Eric S

    2010-10-15

    Best practice for the clinical management of acute human immunodeficiency virus (HIV) infection remains unknown. Although some data suggest possible immunologic, virologic, or clinical benefit of early treatment, other studies show no difference in these outcomes over time, after early treatment is discontinued. The literature on acute HIV infection is predominantly small nonrandomized studies, which further limits interpretation. As a result, the physician is left to grapple with these uncertainties while making clinical decisions for patients with acute HIV infection. Here we review the literature, focusing on the potential advantages and disadvantages of treating acute HIV infection outlined in treatment guidelines, and summarize the presentations on clinical management of acute HIV infection from the 2009 Acute HIV Infection Meeting in Boston, Massachusetts.

  3. Perfusion and diffusion MRI study detecting CBF disturbance and edema formation in the acute phase of cerebral contusion

    Energy Technology Data Exchange (ETDEWEB)

    Kawamata, Tatsuro; Aoyama, Naoki; Mori, Tatsuro; Maeda, Takeshi; Katayama, Yoichi [Nihon Univ., Tokyo (Japan). School of Medicine

    1998-12-01

    In order to clarify the mechanisms underlying cerebral contusion-induced CBF disturbance and edema formation, echoplanar diffusion and perfusion images were obtained in the patients with cerebral contusion. In the acute phase within 48 hours post-trauma, the apparent diffusion coefficient (ADC) showed various levels with a tendency to increase in the central area of contusion (ADC ratio=1.06{+-}0.21). In contrast, the ADC was significantly reduced in the peripheral area of contusion (ADC ratio=0.87{+-}0.16). The ADC at 2 weeks post-trauma increased both in the central (ADC ratio=1.16{+-}0.26) and the peripheral area of contusion (ADC ratio=1.10{+-}0.26, p<0.05), as compared to those within 48 hours post-trauma. The perfusion images showed a wide spread CBF depression extending beyond the area of contusion observed on the T1 and T2 weighted images. These results indicate that; in the early phase of contusion-induced edema formation, cytotoxic edema is predominant, especially in the peripheral area of contusion, and vasogenic edema appears thereafter. The CBF depression may contribute such cytotoxic edema formation in the surrounding area of cerebral contusion. It is concluded that echo-planar diffusion and perfusion images are excellent technique to investigate the evolution of CBF disturbance and edema formation following traumatic brain injury. (author)

  4. Acute abdominal pain : considerations on diagnosis and management

    NARCIS (Netherlands)

    Toorenvliet, Boudewijn Ronald

    2011-01-01

    In this thesis several aspects on the diagnosing and management of patients with acute abdominal pain are investigated. 1; The efficacy and safety of standard outpatient re-evaluation for patients not admitted to the hospital after emergency department evaluation for acute abdominal pain. 2; The use

  5. Management of Acute Hypertensive Response in Patients With Ischemic Stroke

    Science.gov (United States)

    Qureshi, Adnan I.

    2016-01-01

    High blood pressure (BP) >140/90 mm Hg is seen in 75% of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages and is independently associated with poor functional outcome. While BP reduction in patients with chronic hypertension remains one of the most important factors in primary and secondary stroke prevention, the proper management strategy for acute hypertensive response within the first 72 hours of acute ischemic stroke has been a matter of debate. Recent guidelines recommend clinical trials to ascertain whether antihypertensive therapy in the acute phase of stroke is beneficial. This review summarizes the current data on acute hypertensive response or elevated BP management during the first 72 hours after an acute ischemic stroke. Based on the potential deleterious effect of lowering BP observed in some clinical trials in patients with acute ischemic stroke and because of the lack of convincing evidence to support acute BP lowering in those situations, aggressive BP reduction in patients presenting with acute ischemic stroke is currently not recommended. While the early use of angiotensin receptor antagonists may help reduce cardiovascular events, this benefit is not necessarily related to BP reduction. PMID:27366297

  6. Management of Acute Hypertensive Response in Patients With Ischemic Stroke.

    Science.gov (United States)

    AlSibai, Ahmad; Qureshi, Adnan I

    2016-07-01

    High blood pressure (BP) >140/90 mm Hg is seen in 75% of patients with acute ischemic stroke and in 80% of patients with acute intracerebral hemorrhages and is independently associated with poor functional outcome. While BP reduction in patients with chronic hypertension remains one of the most important factors in primary and secondary stroke prevention, the proper management strategy for acute hypertensive response within the first 72 hours of acute ischemic stroke has been a matter of debate. Recent guidelines recommend clinical trials to ascertain whether antihypertensive therapy in the acute phase of stroke is beneficial. This review summarizes the current data on acute hypertensive response or elevated BP management during the first 72 hours after an acute ischemic stroke. Based on the potential deleterious effect of lowering BP observed in some clinical trials in patients with acute ischemic stroke and because of the lack of convincing evidence to support acute BP lowering in those situations, aggressive BP reduction in patients presenting with acute ischemic stroke is currently not recommended. While the early use of angiotensin receptor antagonists may help reduce cardiovascular events, this benefit is not necessarily related to BP reduction.

  7. Acute pain management in children with sickle cell anaemia during ...

    African Journals Online (AJOL)

    Acute pain management in children with sickle cell anaemia during ... used to obtain information about the demographics of the patients and their parents, ... Pain was assessed for each patient using the Wong-Baker Faces Pain Rating Scale.

  8. Management of acute fever in children: Guideline for community ...

    African Journals Online (AJOL)

    Management of acute fever in children: Guideline for community healthcare ... Therefore, it is essential to distinguish between a child with fever who is at high risk ... the appropriate use of antipyretic medication and how to advise parents and ...

  9. Identifying and managing patients with delirium in acute care settings.

    Science.gov (United States)

    Bond, Penny; Goudie, Karen

    2015-11-01

    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.

  10. Contemporary Management of Acute Biliary Pancreatitis

    Directory of Open Access Journals (Sweden)

    Orhan Ozkan

    2014-03-01

    Full Text Available Acute biliary pancreatitis is one of the major causes of acute pancreatitis.Gallstones, biliary sludge and microlithiasis, especially in pancreatitis without detectable reason, can be the cause of acute pancreatitis. Acute biliary pancreatitis has many controversions in the literature, and its classification and guidelines are being updated very frequently. Atlanta classifications which determine the definitions and guidelines about acute pancreatitis were renewed and published in 2013. It has various clinical aspects, ranging from a mild form which is easily treated, to a severe form that causes complications leading to mortality. The pathogenesis of this disease has not been fully elucidated and several theories have been suggested. New scoring systems and laboratory methods such as proteomics have been suggested for both diagnosis and to predict disease severity, and research on these topics is still in progress. Novel therapeutic approaches with technological developments such as ERCP, ES, MRCP, and EUS are also suggested.

  11. Case of acute disseminated encephalomyelitis with convulsion, gait disturbance, facial palsy and with multifocal CT lesions

    Energy Technology Data Exchange (ETDEWEB)

    Nagano, Tetsu; Kurihara, Eiji; Mizuno, Yoshihiko; Tamagawa, Kimiko; Komiya, Kazuhiko; Mizuguchi, Masashi.

    1988-07-01

    A case of acute disseminated encephalomyelitis (ADEM) was presented. The patient was a 4-year-old boy with convulsion, ataxic gait, facial palsy. It was postulated that the influenza vaccine might induce the disease in this case. Cranial CT showed a low density arease in the right temporal lobe, which disappeared afterwards when other low density areas appeared in the right cerebellar hemisphere and in inner portion of the body of the left lateral ventricle. All symptoms disappeared without therapy and the CT findings improved within three months after onset.

  12. Medical management of the acute radiation syndrome.

    Science.gov (United States)

    López, Mario; Martín, Margarita

    2011-07-13

    The acute radiation syndrome (ARS) occurs after whole-body or significant partial-body irradiation (typically at a dose of >1 Gy). ARS can involve the hematopoietic, cutaneous, gastrointestinal and the neurovascular organ systems either individually or in combination. There is a correlation between the severity of clinical signs and symptoms of ARS and radiation dose. Radiation induced multi-organ failure (MOF) describes the progressive dysfunction of two or more organ systems over time. Radiation combined injury (RCI) is defined as radiation injury combined with blunt or penetrating trauma, burns, blast, or infection. The classic syndromes are: hematopoietic (doses >2-3 Gy), gastrointestinal (doses 5-12 Gy) and cerebrovascular syndrome (doses 10-20 Gy). There is no possibility to survive after doses >10-12 Gy. The Phases of ARS are-prodromal: 0-2 days from exposure, latent: 2-20 days, and manifest illness: 21-60 days from exposure. Granulocyte-colony stimulating factor (G-CSF) at a dose of 5 μg/kg body weight per day subcutaneously has been recommended as treatment of neutropenia, and antibiotics, antiviral and antifungal agents for prevention or treatment of infections. If taken within the first hours of contamination, stable iodine in the form of nonradioactive potassium iodide (KI) saturates iodine binding sites within the thyroid and inhibits incorporation of radioiodines into the gland. Finally, if severe aplasia persists under cytokines for more than 14 days, the possibility of a hematopoietic stem cell (HSC) transplantation should be evaluated. This review will focus on the clinical aspects of the ARS, using the European triage system (METREPOL) to evaluate the severity of radiation injury, and scoring groups of patients for the general and specific management of the syndrome.

  13. Acute upper gastrointestinal bleeding (UGIB) - initial evaluation and management.

    Science.gov (United States)

    Khamaysi, Iyad; Gralnek, Ian M

    2013-10-01

    Acute upper gastrointestinal bleeding (UGIB) is the most common reason that the 'on-call' gastroenterologist is consulted. Despite the diagnostic and therapeutic capabilities of upper endoscopy, there is still significant associated morbidity and mortality in patients experiencing acute UGIB, thus this is a true GI emergency. Acute UGIB is divided into non-variceal and variceal causes. The most common type of acute UGIB is 'non-variceal' and includes diagnoses such as peptic ulcer (gastric and duodenal), gastroduodenal erosions, Mallory-Weiss tears, erosive oesophagitis, arterio-venous malformations, Dieulafoy's lesion, and upper GI tract tumours and malignancies. This article focuses exclusively on initial management strategies for acute upper GI bleeding. We discuss up to date and evidence-based strategies for patient risk stratification, initial patient management prior to endoscopy, potential causes of UGIB, role of proton pump inhibitors, prokinetic agents, prophylactic antibiotics, vasoactive pharmacotherapies, and timing of endoscopy. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Laparoscopic management of acute appendicitis in situs inversus

    Directory of Open Access Journals (Sweden)

    Golash Vishwanath

    2006-01-01

    Full Text Available Situs inversus is often detected incidentally in adults during imaging for a acute surgical emergency. We present a case of acute appendicitis in an adult who was previously unaware about his situs anomaly. A laparoscopic approach is helpful to deal with this condition. A 40 year old man was admitted with history of acute left lower abdominal pain, with uncontrolled diabetic keto-acidosis. Clinically, he was diagnosed as acute diverticulitis with localized peritonitis. Subsequent imaging studies and laparoscopy confirmed the diagnosis of situs inversus and acute left- sided appendicitis. He successfully underwent laparoscopic appendectomy. His postoperative recovery was uneventful. Although technically more challenging because of the reverse laparoscopic view of the anatomy, the laparoscopic diagnosis and management of acute appendicitis is indicated in situs inversus.

  15. Mining communities from a resilience perspective: managing disturbance and vulnerability in Itabira, Brazil.

    Science.gov (United States)

    Wasylycia-Leis, Joseph; Fitzpatrick, Patricia; Fonseca, Alberto

    2014-03-01

    This paper applies the resilience lens to a social-ecological system characterized by the presence of large-scale mineral extraction operations. The system in question is the Brazilian community of Itabira, Minas Gerais, host to an iron ore operation of Vale, the world's second largest mining corporation. Utilizing a resilience assessment framework, this study describes the various components of the Itabira social-ecological system revealing the challenges brought about by mining's dominance. Data collection included literature reviews and semi-structured interviews with 29 individuals representing different stakeholder groups. Findings revealed that, despite recent efforts by government to regulate the industry, the mine continues to generate press and pulse disturbances that impact the resilience of the community. Operating from the standpoint that resilience depends largely upon the management capacity of stakeholders, the research identifies three ways to improve mining governance in Itabira. First, there is a need for local government to have more power in dealings with the corporation. Concurrent with this power, however, the municipality must demonstrate ownership over its fate, ideally through the creation of a sustainability plan. Finally, all key parties must demonstrate commitment to cooperating to resolve outstanding disturbances, even when these fall outside the regulatory approval process. While Itabira will remain a mining town for the foreseeable future, actions taken now to address challenges will only strengthen community well-being and sustainability moving forward.

  16. Mining Communities from a Resilience Perspective: Managing Disturbance and Vulnerability in Itabira, Brazil

    Science.gov (United States)

    Wasylycia-Leis, Joseph; Fitzpatrick, Patricia; Fonseca, Alberto

    2014-03-01

    This paper applies the resilience lens to a social-ecological system characterized by the presence of large-scale mineral extraction operations. The system in question is the Brazilian community of Itabira, Minas Gerais, host to an iron ore operation of Vale, the world's second largest mining corporation. Utilizing a resilience assessment framework, this study describes the various components of the Itabira social-ecological system revealing the challenges brought about by mining's dominance. Data collection included literature reviews and semi-structured interviews with 29 individuals representing different stakeholder groups. Findings revealed that, despite recent efforts by government to regulate the industry, the mine continues to generate press and pulse disturbances that impact the resilience of the community. Operating from the standpoint that resilience depends largely upon the management capacity of stakeholders, the research identifies three ways to improve mining governance in Itabira. First, there is a need for local government to have more power in dealings with the corporation. Concurrent with this power, however, the municipality must demonstrate ownership over its fate, ideally through the creation of a sustainability plan. Finally, all key parties must demonstrate commitment to cooperating to resolve outstanding disturbances, even when these fall outside the regulatory approval process. While Itabira will remain a mining town for the foreseeable future, actions taken now to address challenges will only strengthen community well-being and sustainability moving forward.

  17. CT perfusion mapping of hemodynamic disturbances associated to acute spontaneous intracerebral hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Fainardi, Enrico; Borrelli, Massimo; Saletti, Andrea; Ceruti, Stefano; Tamarozzi, Riccardo [Azienda Ospedaliera Universitaria, Neuroradiology Unit, Department of Neuroscience, Ferrara (Italy); Schivalocchi, Roberta; Cavallo, Michele [Azienda Ospedaliera Universitaria, Neurosurgery Unit, Department of Neuroscience, Ferrara (Italy); Azzini, Cristiano [Azienda Ospedaliera Universitaria, Neurology Unit, Department of Neuroscience, Ferrara (Italy); Chieregato, Arturo [Ospedale M. Bufalini, Neurocritical Care Unit, Cesena (Italy)

    2008-08-15

    We sought to quantify perfusion changes associated to acute spontaneous intracerebral hemorrhage (SICH) by means of computed tomography perfusion (CTP) imaging. We studied 89 patients with supratentorial SICH at admission CT by using CTP scanning obtained within 24 h after symptom onset. Regional cerebral blood flow (rCBF), cerebral blood volume (rCBV) and mean transit time (rMTT) levels were measured in four different regions of interest manually outlined on CT scan: (1) hemorrhagic core; (2) perihematomal low-density area; (3) 1 cm rim of normal-appearing brain tissue surrounding the perilesional area; and (4) a mirrored area, including the clot and the perihematomal region, located in the non-lesioned contralateral hemisphere. rCBF, rCBV, and rMTT mean levels showed a centrifugal distribution with a gradual increase from the core to the periphery (p < 0.0001). Perfusion absolute values were indicative of ischemia in hemorrhagic core, oligemia in perihematomal area, and hyperemia in normal-appearing and contralateral areas. Perihematomal rCBF and rCBV mean levels were higher in small ({<=}20 ml) than in large (>20 ml) hematomas (p<0.01 and p <0.02, respectively). Multi-parametric CTP mapping of acute SICH indicates that perfusion values show a progressive improvement from the core to the periphery. In the first 24 h, perihemorrhagic region was hypoperfused with CTP values which were not suggestive of ischemic penumbra destined to survive but more likely indicative of edema formation. These findings also argue for a potential influence of early amounts of bleeding on perihematomal hemodynamic abnormalities. (orig.)

  18. Effect of human disturbance on the prey of tiger in the Chitwan National Park--implications for park management.

    Science.gov (United States)

    Bhattarai, Bishnu Prasad; Kindlmann, Pavel

    2013-12-15

    Chitwan National Park is surrounded by large settlements of people who exploit the areas where tigers and their prey occur. In this study, we measured the associations between the abundance of the prey of tiger with habitat, topographic, predator and human disturbance variables, using canonical correspondence analysis. We show that the abundance of hog deer is closely associated with areas of tall grassland and floodplains, while that of other ungulate species is associated with that of forests and short grasslands. Primates were mainly abundant in riverine and mixed forests. Abundances of most species, except hog deer and wild pig, were more closely associated with areas of forests than with open areas, because the latter were mainly occupied by humans and livestock. The presence of the species studied was closely associated with habitat and disturbance variables. Proximity of water holes was more closely associated with the presence of ungulates than primates. There were close associations between human disturbance and abundances of primates and muntjac, possibly because these species are more tolerant and adapted to human disturbance. However, the major prey species of tiger were negatively associated with human disturbance. As a consequence, human disturbance has resulted in a decline in the abundance of tigers and the lack of prey could result in their extinction in the Chitwan NP. Therefore, in terms of the conservation and management of the park, minimizing human disturbance of wildlife habitats and restoration of a buffer zone forest should be the prime objectives. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Acute type B aortic dissection:update on proper management

    Institute of Scientific and Technical Information of China (English)

    Georgios Geropapas; George Galyfos; Ioannis Stefanidis; Ioannis Stamatatos; Stavros Kerasidis; Sotirios Giannakakis; Georgios Kastrisios; Gerasimos Papacharalampous; Chrisostomos Maltezos

    2014-01-01

    This study aims to collect and present all current literature data on the diagnostic and therapeutic management of acute typeB aortic dissection.It includes a comprehensive literature search utilizing the following keywords:‘acute aortic dissection’,‘typeB aortic dissection’,‘conservative management’,‘endovascular repair’,‘open surgery’ and‘diagnosis’.Uncomplicated acute type B aortic dissection can be effectively managed using conservative management, although open repair is indicated only for complicated cases.Endovascular repair shows promising results in selected patients with increased perioperative risk and without contraindications.Recent evidence supports endovascular repair even in uncomplicated cases, although more data on long-term outcomes are needed.Early risk stratification and evaluation of the patient is crucial for selection of optimal management.

  20. Endovascular management of acute limb ischemia.

    Science.gov (United States)

    Peeters, P; Verbist, J; Keirse, K; Deloose, K; Bosiers, M

    2010-06-01

    Acute limb ischemia (ALI) refers to a rapid worsening of limb perfusion resulting in rest pain, ischemic ulcers or gangrene. With an estimated incidence of 140 million/year, ALI is serious limb-threatening and life-threatening medical emergency demanding prompt action. Three prospective, randomized clinical trials provide data on trombolytic therapy versus surgical intervention in patients with acute lower extremity ischemia. Although they did not give us the final answer, satisfactory results are reported for percutaneous thrombolysis compared with surgery. Moreover, they suggest an important advantage of thrombolysis in acute bypass graft occlusions. Therefore, we believe thrombolytic therapy should be a part of the vascular surgeon's armamentarium to safely and successfully treat ALI patients.

  1. Acute urinary retention and the difficult catheterization: current emergency management.

    Science.gov (United States)

    Sliwinski, Ania; D'Arcy, Frank T; Sultana, Ron; Lawrentschuk, Nathan

    2016-04-01

    Acute urinary retention (AUR) is a common presentation to emergency departments. This article updates the reader on the appropriate management, investigations and guidelines for AUR. It looks at the mechanism of normal micturition and describes the theories of AUR. It outlines urethral catheterization techniques for difficult cases, reviews suprapubic catheterization procedures and describes the management of AUR in polytrauma. Although emergency management is by bladder drainage, key points in the history and examination may expose significant, latent pathologies.

  2. An evidence-based approach to managing acute otitis media.

    Science.gov (United States)

    Nesbit, Chadd E; Powers, Margaret C

    2013-04-01

    Acute otitis media is one of the most common pediatric illnesses; however, there is considerable controversy in its management. While most cases are treated with antibiotics, there is a growing concern regarding antibiotic overuse and subsequent drug resistance. Researchers in the Netherlands have developed a "watchful waiting" (ie, an observation approach) that has been successful in treating acute otitis media, although it has not gained widespread popularity in the United States. This review will summarize the latest research on diagnosing acute otitis media as well as different treatment regimens, including the efficacy of the watchful-waiting approach.

  3. Recent advances in the management of acute bronchiolitis

    Science.gov (United States)

    Ravaglia, Claudia

    2014-01-01

    Acute bronchiolitis is characterized by acute wheezing in infants or children and is associated with signs or symptoms of respiratory infection; it is rarely symptomatic in adults and the most common etiologic agent is respiratory syncytial virus (RSV). Usually it does not require investigation, treatment is merely supportive and a conservative approach seems adequate in the majority of children, especially for the youngest ones (bronchiolitis. This review focuses on the clinical, radiographic, and pathologic characteristics, as well as the recent advances in management of acute bronchiolitis. PMID:25580257

  4. Managing Acute Complications Of Sickle Cell Disease In Pediatric Patients.

    Science.gov (United States)

    Subramaniam, Sathyaseelan; Chao, Jennifer H

    2016-11-01

    Sickle cell disease is a chronic hematologic disease with a variety of acute, and often recurring, complications. Vaso-occlusive crisis, a unique but common presentation in sickle cell disease, can be challenging to manage. Acute chest syndrome is the leading cause of death in patients with sickle cell disease, occurring in more than half of patients who are hospitalized with a vaso-occlusive crisis. Uncommon diagnoses in children, such as stroke, priapism, and transient red cell aplasia, occur more frequently in patients with sickle cell disease and necessitate a degree of familiarity with the disease process and its management. Patients with sickle cell trait generally have a benign course, but are also subject to serious complications. This issue provides a current review of evidence-based management of the most common acute complications of sickle cell disease seen in pediatric patients in the emergency department.

  5. Fentanyl-induced hyperalgesia in acute pain management.

    Science.gov (United States)

    Lyons, Pamela J; Rivosecchi, Ryan M; Nery, Jose P; Kane-Gill, Sandra L

    2015-06-01

    There are safety concerns with the use of fentanyl, including respiratory depression, nausea, constipation, and possibly opioid-induced hyperalgesia (OIH). The purpose of this review is to evaluate the occurrence and significance of opioid-induced hyperalgesia (OIH) after acute fentanyl exposure. A literature search was conducted from October 1995 through January 2015 using MEDLINE, Embase, and Scopus with the terms hyperalgesia, fentanyl, pronociceptive, acute tolerance, and acute. Published articles evaluating the adverse effects of fentanyl during acute pain management (≤96 hours) in humans were included. Opioid-induced hyperalgesia is a phenomenon defined by increasing pain after opioid exposure with the worsening of pain occurring when opioid doses are increased. Hyperalgesia has been described following remifentanil and morphine use, but the question remains about the associated risk with acute fentanyl exposure. Six randomized, controlled trials evaluating the effect of fentanyl on pain in the acute setting have been conducted. Two trials oppose whereas four trials support the occurrence of fentanyl-induced hyperalgesia. The data on OIH after acute fentanyl exposure are limited and conflicting. Hyperalgesia should be considered in patients with uncontrolled pain despite escalating fentanyl doses, since the possibility of fentanyl-induced OIH exists in the acute setting. Well-designed trials are needed to determine the clinical significance of this phenomenon.

  6. Fuels Management and Habitat Restoration Activities Benefit Eastern Hognose Snakes (Heterodon platirhinos) in a Disturbance-Dependent Ecosystem

    Science.gov (United States)

    Michael E. Akresh; David I. King; Brad C. Timm; Robert T. Brooks

    2017-01-01

    Eastern Hognose Snakes (Heterodon platirhinos) are considered a species of conservation concern in the northeast United States because of their association with rare and declining habitats such as pine barrens and shrublands. These are disturbance-dependent habitats that currently require management to persist. We studied Eastern Hognose Snakes on...

  7. Effect of acute acid-base disturbances on ErbB1/2 tyrosine phosphorylation in rabbit renal proximal tubules.

    Science.gov (United States)

    Skelton, Lara A; Boron, Walter F

    2013-12-15

    The renal proximal tubule (PT) is a major site for maintaining whole body pH homeostasis and is responsible for reabsorbing ∼80% of filtered HCO3(-), the major plasma buffer, into the blood. The PT adapts its rate of HCO3(-) reabsorption (JHCO3(-)) in response to acute acid-base disturbances. Our laboratory previously showed that single isolated perfused PTs adapt JHCO3(-) in response to isolated changes in basolateral (i.e., blood side) CO2 and HCO3(-) concentrations but, surprisingly, not to pH. The response to CO2 concentration can be blocked by the ErbB family tyrosine kinase inhibitor PD-168393. In the present study, we exposed enriched rabbit PT suspensions to five acute acid-base disturbances for 5 and 20 min using a panel of phosphotyrosine (pY)-specific antibodies to determine the influence of each disturbance on pan-pY, ErbB1-specific pY (four sites), and ErbB2-specific pY (two sites). We found that each acid-base treatment generated a distinct temporal pY pattern. For example, the summated responses of the individual ErbB1/2-pY sites to each disturbance showed that metabolic acidosis (normal CO2 concentration and reduced HCO3(-) concentration) produced a transient summated pY decrease (5 vs. 20 min), whereas metabolic alkalosis produced a transient increase. Respiratory acidosis (normal HCO3(-) concentration and elevated CO2 concentration) had little effect on summated pY at 5 min but produced an elevation at 20 min, whereas respiratory alkalosis produced a reduction at 20 min. Our data show that ErbB1 and ErbB2 in the PT respond to acute acid-base disturbances, consistent with the hypothesis that they are part of the signaling cascade.

  8. Severe acute pancreatitis: Clinical course and management

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically.Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the SepsisRelated Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions.Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.

  9. Medical management of acute severe anorexia nervosa.

    Science.gov (United States)

    Norrington, Amy; Stanley, Ruth; Tremlett, Michael; Birrell, Ginny

    2012-04-01

    Anorexia nervosa (AN) is a common condition affecting young people. The medical management of AN on a general paediatric ward is challenging. It is important to identify young people who are at risk of medical complications, so early intervention can be instigated. This article aims to review the clinical practice and evidence supporting the current medical management of young people with AN. It provides a system-based approach to potential complications of the disease, guidance on feeding and the management of re-feeding syndrome. Approaches to legal and ethical challenges are also considered. While the importance of psychiatric treatment is recognised, the same is not discussed within this article.

  10. Acute stroke: postprocedural care and management of complications.

    Science.gov (United States)

    de Carvalho, Flávio Augusto; de Figueiredo, Marcelo Marinho; Silva, Gisele Sampaio

    2012-03-01

    Endovascular treatment for acute ischemic stroke is an important alternative to thrombolysis with recombinant tissue plasminogen activator (rt-PA) for patients who present beyond the thrombolysis time window, those who are ineligible for rt-PA, or those who do not improve after intravenous rt-PA. These patients generally require special attention in the postprocedural period because, although not frequent, complications of endovascular procedures in acute ischemic stroke have the potential to be devastating. Neurocritical care is essential to reduce and appropriately treat complications after endovascular procedures. Neurointensivists and neurocritical care nurses are experts in both critical care and neurologic disorders and have special training to recognize early physiological derangements in patients presenting with acute stroke. Close attention to the serial neurological examination, blood pressure control, adequate management of glucose, temperature, and immediate identification of complications such as reocclusion and hemorrhagic transformation are key elements that exemplify the importance of postprocedural neurocritical care in acute ischemic stroke.

  11. Management of acute viral bronchiolitis in children: Evidence beyond guidelines.

    Science.gov (United States)

    Iqbal, Shaikh Mohammed

    2012-01-01

    Acute viral bronchiolitis is one of the leading causes of worldwide admission of children under 2 years of age during winter months. There is a lack of consensus regarding the clinical definition of acute viral bronchiolitis in children and hence the management varies across the globe. The purpose of this article is to review the epidemiology, etiology, risk factors, pathophysiology, clinical presentation, assessment and management of children with respiratory syncytial virus (RSV) bronchiolitis. The available evidence in the worldwide literature suggests that supportive and symptomatic management is still the mainstay of management in this condition. The key to reducing the morbidity and mortality in children with RSV bronchiolitis is through prevention of infection through immunoprophylaxis especially in high-risk children.

  12. Disturbance and coastal forests: a strategic approach to forest management in hurricane impact zones

    Science.gov (United States)

    John A. Stanturf; Scott L. Goodrick; Kenneth W. Outcalt

    2007-01-01

    The Indian Ocean Tsunami focused world attention on societal responses to environmental hazards and the potential of natural systems to moderate disturbance effects. Coastal areas are critical to the welfare of up to 50% of the world's population. Coastal systems in the southern United States are adapted to specific disturbance regimes of tropical cyclones (...

  13. Acute Aortic Syndromes: Update in Current Medical Management.

    Science.gov (United States)

    Morris, Jacqueline H; Mix, Doran; Cameron, Scott J

    2017-04-01

    Advances in medical therapy and non-surgical percutaneous options to manage the specter of acute aortic syndromes have improved both patient morbidity and mortality. There are key features in the patient history and initial exam which physicians should be attuned to in order to diagnose acute aortic syndromes such as aortic dissection, penetrating aortic ulcer, and intramural hematoma. Once recognized, early initiation of the appropriate pharmacologic therapy is important, and further appreciating the limitations of such therapy before considering a surgical approach is critical to improve patient outcomes. For the undifferentiated patient with acute aortic dissection presenting to facilities who do not routinely manage this condition, adding pharmacologic agents in the correct sequence assures the best chance for a satisfactory outcome.

  14. [Management of an acute exacerbation of asthma and COPD].

    Science.gov (United States)

    Leuppi, Jörg D; Ott, Sebastian R

    2014-05-01

    Asthma and chronic obstructive airways disease are chronic pulmonary diseases which have a high prevalence world-wide. Both conditions can deteriorate acutely and potentially put patients into life-threatening situations. Management of an acute exacerbation starts in the emergency consultation-setting and ends only once the longterm management has been thoroughly assessed and optimised in order to prevent future exacerbations. Exacerbation frequency is strongly associated with long-term morbidity and mortality in both diseases. Recent data have shown that short-course systemic steroids (5 days) for the treatment of an acute exacerbation of COPD are as successful as long-course treatments (14 days) in preventing exacerbations during the subsequent 6 months. Similarly the targeted use of antibiotics is discussed in this review.

  15. Acute concentrated phenol dermal burns: Complications and management

    Directory of Open Access Journals (Sweden)

    Tapan Jayantilal Parikh

    2015-01-01

    Full Text Available Phenol burns can result in multiple organ failure. This is a case report of acute severe phenol dermal burn after accidental splash of 94% phenol on 35-year-old patient′s body who was brought to hospital after 90 min of exposure. Decontamination was done with high-density water and glycerol. Early complications in form of metabolic acidosis and acute renal failure required hemodialysis. Extensive protein denaturation was managed with IV albumin and high protein diet. Patient also developed pleural effusion and acute respiratory distress syndrome, but these were successfully managed by intercostal drain tube insertion and noninvasive ventilation. The patient survived after multiple organ failures and widespread burns despite the fact that it has been observed that outcome of phenol burns with >60 2 inches of skin affected or two or more organs failure involving renal system is nearly fatal.

  16. Acute radiation syndrones and their management

    Energy Technology Data Exchange (ETDEWEB)

    Cronkite, E.P.

    1988-01-01

    Radiation syndromes produced by large doses of ionizing radiation are divided into three general groups depending on dose of radiation and time after exposure. The CNS syndrome requires many thousands of rad, appears in minutes to hours, and kills within hours to days. The GIS appears after doses of a few hundred to 2000 rad. It is characterized by nausea, vomiting, diarrhea, and disturbances of water and electrolyte metabolism. It has a high mortality in the first week after exposure. Survivors will then experience the HS as a result of marrow aplasia. Depending on dose, survival is possible with antibiotic and transfusion therapy. The relationship of granulocyte depression to mortality in dogs and human beings is illustrated. The role of depth dose pattern of mortality of radiation exposure is described and used as an indication of why air exposure doses may be misleading. The therapy of radiation injury is described based on antibiotics, transfusion therapy, and use of molecular regulators. The limited role of matched allogenic bone marrow transplants is discussed. 52 refs., 13 figs.

  17. Management of acute vertigo with betahistine.

    Science.gov (United States)

    Bradoo, R A; Nerurkar, N K; Mhapankar, J B; Patil, S F; Kute, D G

    2000-04-01

    This open, prospective study was carried out in 29 outpatients of vertigo with Betahistine treatment at a dose of 16 mg three times daily far a maximum treatment period of 6 weeks or earlier until remission of vertigo attacks. The evaluations were carried out based on three parameters such as frequency, duration, and severity of vertigo attacks. Betahistino showed a significant improvement in the three parameters of frequency, duration and severity of vertigo attacks. Associated symptoms such as tinnitus, nausea, vomiting, headache, faintness showed a significant improvement with the therapy. Subgroup analysis showed a significant improvement of patients with severe and incapacitating verlign attaeks at baseline. Thus, this study proves excellent efficacy and goad tolerability of Betahistine as an anti-vertigo drug at a dose of 16 mg three times daily and gives a new insight for controlling acute or severe vertigo attacks without causing sedation.

  18. Management of acute coronary syndromes with fondaparinux

    Directory of Open Access Journals (Sweden)

    Harm Wienbergen

    2007-07-01

    Full Text Available Harm Wienbergen, Uwe ZeymerHerzzentrum Ludwigshafen, Medizinische Klinik B, GermanyAbstract: Fondaparinux is the first selective inhibitor of the coagulation factor Xa which is commercially avaliable for clinical use. It has been approved for the prevention of venous thromboembolism in patients undergoing orthopedic surgery and for the initial therapy of venous thromboembolism. In randomized clinical trials the value of fondaparinux in the treatment of ST-elevation myocardial infarction (STEMI has been investigated. The PENTALYSE study showed that fondaparinux was at least as effective and safe as unfractionated heparin in 333 patients with STEMI undergoing fibrinolysis with t-PA. In the recent large OASIS-6 trial with 12,092 patients the treatment with 2.5 mg fondaparinux daily significantly reduced death and reinfarctions until day 30 compared with guideline recommended usual care and compared with unfractionated heparin (9.7% vs 11.2%, p = 0.008 without increasing major bleedings (1.0% vs 1.3%, p = 0.13. This advantage was predominantly seen in the subgroups of patients with fibrinolysis and without early reperfusion therapy. However, in the subgroup of primary percutaneous coronary interventions (PCIs no clinical benefit of fondaparinux was found, but there were more catheter thrombosis and acute thrombotic complications. In summary, fondaparinux is a new antithrombin that is an efficient, safe, and easy to use in treatment for STEMI patients, particularly those not undergoing primary PCI.Keywords: selective factor Xa inhibition, fondaparinux, acute ST-elevation myocardial infarction, antithrombin therapy

  19. The initial management of acute burns.

    Science.gov (United States)

    Treharne, L J; Kay, A R

    2001-06-01

    The initial management of burns, in common with all trauma, follows the ABCDE approach. The outline management plan detailed above assumes the availability of certain medical supplies but even simple measures are invaluable in burn care if they are all that are available. The most basic supplies required to resuscitate a casualty are oral salt and water in appropriate volumes. Similarly it should be possible in field conditions to monitor vital signs and urine output, dress the burns with clingfilm or plastic bags and wrap the casualty in absorbent materials.

  20. The management of equine acute laminitis

    Directory of Open Access Journals (Sweden)

    Mitchell CF

    2014-12-01

    Full Text Available Colin F Mitchell, Lee Ann Fugler, Susan C Eades Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA Abstract: Laminitis is an extremely painful condition resulting in damage to the soft tissues anchoring the third phalanx to the hoof, which can result in life-threatening debilitation. Specific therapy is not available. The most important principles of therapy include aggressive nutritional and medical management of primary disease processes, cryotherapy, anti-inflammatory therapy, pain management, and biomechanical support. This review focuses on the principles of evidenced-based therapies. Keywords: laminitis treatment, laminitis biomechanics, laminitis pain

  1. Response of the coral reef benthos and herbivory to fishery closure management and the 1998 ENSO disturbance.

    Science.gov (United States)

    McClanahan, T R

    2008-02-01

    The hypothesis that herbivory is higher in areas without fishing and will increase the rate at which hard coral communities return to pre-disturbance conditions was tested in and out of the marine protected areas (MPA) of Kenya after the 1998 El Niño Southern Oscillation (ENSO). Herbivory was estimated by assay and biomass methods, and both methods indicated higher herbivory in fishery closures. Despite higher herbivory, the effect of the ENSO disturbance was larger within these closures, with reefs undergoing a temporary transition from dominance by hard and soft coral to a temporary dominance of turf and erect algae that ended in the dominance of calcifying algae, massive Porites, Pocillopora and a few faviids six years after the disturbance. The fished reefs changed the least but had a greater cover of turf and erect algae and sponge shortly after the disturbance. Higher herbivory in the fishery closures reduced the abundance and persistence of herbivore-susceptible erect algae and created space and appropriate substratum for recruiting corals. Nonetheless, other post-settlement processes may have had strong influences such that annual rates of coral recovery were low ( approximately 2%) and not different between the management regimes. Recovery, as defined as and measured by the return to pre-disturbance coral cover and the dominant taxa, was slower in fishery closures than unmanaged reefs.

  2. Programmed management of acute cervical cord trauma.

    Science.gov (United States)

    White, R J; Bryk, J P; Yashon, D; Albin, M S; Demian, Y K

    Results in ten patients admitted with the diagnosis of complete traumatic quadriplegia and with fracture-dislocation of the cervical spine are reviewed. Emphasis is placed on aggressive emergency surgical treatment of these lesions such as tracheostomy, laminectomy and cord cooling, incorporated into a detailed protocol of overall management.

  3. Managing and caring for distressed and disturbed service users: the thoughts and feelings experienced by a sample of English mental health nurses.

    Science.gov (United States)

    Chambers, M; Kantaris, X; Guise, V; Välimäki, M

    2015-06-01

    This paper reports the thoughts and feelings experienced by registered mental health nurses caring for distressed and/or disturbed service users in acute inpatient psychiatric settings in England. The prevailing thoughts of nurses were of cognitive dissonance and the conflict between benevolence and malevolence if coercive measures were seen as negative rather than positive; prevailing feelings experienced by nurses were fear, anxiety and vulnerability. To enhance care quality, nurses expressed the need for better communication with service users, and preventing the use of coercive measures and promotion of alternative methods of care and management. The nurses considered that debriefing dialogues following untoward incidents, practice development initiatives, education and training together with clinical supervision could be the way forward. The paper builds on the existing literature in offering clear explanations of nurses' thoughts and feelings when caring for distressed and/or disturbed service users in an English acute, inpatient psychiatric setting. Despite the small sample size and the limitations that it generates, the study findings will be of interest to the wider mental health nursing community. The findings will link to other national and international studies and therefore be valuable for future research studies of this kind. Collectively, they are building up a general picture of the distress, cognitive and emotional dissonance experienced by mental health nurses when using coercive interventions. The findings will help to develop mental health nurse education and enhance practice. High levels of distress and disturbance among service users experiencing acute mental illness is a major problem for mental health nurses (MHNs). The thoughts and feelings experienced by these nurses when caring for service users are of paramount importance as they influence clinical practice and caregiving. Similarly to research by other countries, this paper reports

  4. [Multimodal neuromonitoring for the critical care management of acute coma].

    Science.gov (United States)

    Ltaief, Z; Ben-Hamouda, N; Suys, T; Daniel, R T; Rossetti, A O; Oddo, M

    2014-12-10

    Management of neurocritical care patients is focused on the prevention and treatment of secondary brain injury, i.e. the number of pathophysiological intracerebral (edema, ischemia, energy dysfunction, seizures) and systemic (hyperthermia, disorders of glucose homeostasis) events that occur following the initial insult (stroke, hemorrhage, head trauma, brain anoxia) that may aggravate patient outcome. The current therapeutic paradigm is based on multimodal neuromonitoring, including invasive (intracranial pressure, brain oxygen, cerebral microdialysis) and non-invasive (transcranial doppler, near-infrared spectroscopy, EEG) tools that allows targeted individualized management of acute coma in the early phase. The aim of this review is to describe the utility of multimodal neuromonitoring for the critical care management of acute coma.

  5. Analysing the medicine-management interface in acute trusts.

    Science.gov (United States)

    Ong, B N; Boaden, M; Cropper, S

    1997-01-01

    The impact of the NHS reforms, and the resulting purchaser-provider split, has refocused attention on the relationship between management and medicine in acute hospitals. It is timely to assess the explanatory power of various theoretical models regarding the management-medicine interface. Argues that this interface is currently rather fluid and that a dynamic and adaptive model is best suited to understanding the way in which doctors and managers develop their relationship within the changing policy context. Two examples illustrate these shifting boundaries.

  6. Contemporary therapy: aromatherapy in the management of acute pain?

    Science.gov (United States)

    Ching, M

    1999-12-01

    Recent surveys indicate that people are increasingly using complementary therapies as an adjunct or alternative to conventional treatment options as well as for general health and well being. Whilst complementary therapies such as aromatherapy have been utilised in clinical settings as diverse as long term care facilities and palliative care, its application to the acute care setting has not been explored in depth. The changes in contemporary health care practices such as post-operative pain management and length of hospital admissions have provided nurses with the challenge of examining the range of therapeutic interventions that can be applied to their practice. The purpose of this paper is to examine critically the potential uses of aromatherapy in the management of acute post-operative pain. The concept of aromatherapy will be explored in relation to its effects on the pain pathways, methods of administration and therapeutic effects. Specific reference will be made to Lavender (Lavandula angustifolia) and its use in aromatherapy. A review of the literature points to gaps in the knowledge related to the clinical application of aromatherapy in relation to issues of dosage, methods of administration and therapeutic effects. The relatively small number of studies that have looked at aromatherapy in the acute care setting supports the literature reviewed. Issues such as small sample sizes and the difficulty in replicating these studies make it difficult to generalize the findings. In order to achieve best practice, further research is necessary to explore the use of aromatherapy in the management of acute post-operative pain.

  7. Acute diarrhoeal diseases--an approach to management.

    Science.gov (United States)

    Sur, Dipika; Bhattacharya, S K

    2006-05-01

    Acute diarrhoeal diseases rank second amongst all infectious diseases as a killer in children below 5 years of age worldwide. Globally, 1.3 billion episodes occur annually, with an average of 2-3 episodes per child per year. The important aetiologic agents of diarrhoea and the guidelines for management are discussed. Management of acute diarrhoea is entirely based on clinical presentation of the cases. It includes assessment of the degree of dehydration clinically, rehydration therapy, feeding during diarrhoea, use of antibiotic(s) in selected cases, micronutrient supplementation and use of probiotics. Assessment of the degree of dehydration should be done following the WHO guidelines. Dehydration can be managed with oral rehydration salt (ORS) solution or intravenous fluids. Recently WHO has recommended a hypo-osmolar ORS solution for the treatment of all cases of acute diarrhoea including cholera. Feeding during and after diarrhoea (for at least 2-3 weeks) prevents malnutrition and growth retardation. Antibiotic therapy is not recommended for the treatmentof diarrhoea routinely. Only cases of severe cholera and bloody diarrhoea (presumably shigellosis) should be treated with a suitable antibiotic. Pilot studies in several countries have shown that zinc supplementation during diarrhoea reduces the severity and duration of the disease as well as antidiarrhoeal and antimicrobial use rate. Probiotics may offer a safe intervention in acute infectious diarrhoea to reduce the duration and severity of the illness.

  8. Clinical management of acute diabetic Charcot foot in Denmark

    DEFF Research Database (Denmark)

    Jansen, Rasmus Bo; Svendsen, Ole Lander; Kirketerp-Møller, Klaus

    2016-01-01

    INTRODUCTION: Charcot foot is a severe complication to diabetes mellitus and treatment involves several different clinical specialities. Our objective was to describe the current awareness, knowledge and treatment practices of Charcot foot among doctors who handle diabetic foot disorders. METHODS...... and treatment practices of acute diabetic Charcot foot at diabetes foot clinics in Denmark. The responders seem to follow the international recommendations and guidelines on management of the acute diabetic Charcot foot, despite a lack of Danish guidelines. FUNDING: none. TRIAL REGISTRATION: not relevant....

  9. Endovascular vs medical management of acute ischemic stroke.

    Science.gov (United States)

    Chen, Ching-Jen; Ding, Dale; Starke, Robert M; Mehndiratta, Prachi; Crowley, R Webster; Liu, Kenneth C; Southerland, Andrew M; Worrall, Bradford B

    2015-12-01

    To compare the outcomes between endovascular and medical management of acute ischemic stroke in recent randomized controlled trials (RCT). A systematic literature review was performed, and multicenter, prospective RCTs published from January 1, 2013, to May 1, 2015, directly comparing endovascular therapy to medical management for patients with acute ischemic stroke were included. Meta-analyses of modified Rankin Scale (mRS) and mortality at 90 days and symptomatic intracranial hemorrhage (sICH) for endovascular therapy and medical management were performed. Eight multicenter, prospective RCTs (Interventional Management of Stroke [IMS] III, Local Versus Systemic Thrombolysis for Acute Ischemic Stroke [SYNTHESIS] Expansion, Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy [MR RESCUE], Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands [MR CLEAN], Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness [ESCAPE], Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial [EXTEND-IA], Solitaire With the Intention For Thrombectomy as Primary Endovascular Treatment [SWIFT PRIME], and Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours [REVASCAT]) comprising 2,423 patients were included. Meta-analysis of pooled data demonstrated functional independence (mRS 0-2) at 90 days in favor of endovascular therapy (odds ratio [OR] = 1.71; p = 0.005). Subgroup analysis of the 6 trials with large vessel occlusion (LVO) criteria also demonstrated functional independence at 90 days in favor of endovascular therapy (OR = 2.23; p acute ischemic stroke in the setting of LVO. © 2015 American Academy of Neurology.

  10. Improving acute medical management: Junior Doctor Emergency Prescription Cards.

    Science.gov (United States)

    Hutton, Joe; Gingell, Megan; Hutchinson, Lisa

    2016-01-01

    Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways. We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines. Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC "usability". To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12). The EPCs were well received (80% quite/very useful) and found "easy to use" (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route / additional required information (pre-intervention 75%, post-intervention 97

  11. Influence of Anthropogenic Disturbances on Stand Structural Complexity in Andean Temperate Forests: Implications for Managing Key Habitat for Biodiversity

    Science.gov (United States)

    2017-01-01

    Forest attributes and their abundances define the stand structural complexity available as habitat for faunal biodiversity; however, intensive anthropogenic disturbances have the potential to degrade and simplify forest stands. In this paper we develop an index of stand structural complexity and show how anthropogenic disturbances, namely fire, logging, livestock, and their combined presence, affect stand structural complexity in a southern Global Biodiversity Hotspot. From 2011 to 2013, we measured forest structural attributes as well as the presence of anthropogenic disturbances in 505 plots in the Andean zone of the La Araucanía Region, Chile. In each plot, understory density, coarse woody debris, number of snags, tree diameter at breast height, and litter depth were measured, along with signs of the presence of anthropogenic disturbances. Ninety-five percent of the plots showed signs of anthropogenic disturbance (N = 475), with the combined presence of fire, logging, and livestock being the most common disturbance (N = 222; 44% of plots). The lowest values for the index were measured in plots combining fire, logging, and livestock. Undisturbed plots and plots with the presence of relatively old fires (> 70 years) showed the highest values for the index of stand structural complexity. Our results suggest that secondary forests < 70-year post-fire event, with the presence of habitat legacies (e.g. snags and CWD), can reach a structural complexity as high as undisturbed plots. Temperate forests should be managed to retain structural attributes, including understory density (7.2 ± 2.5 # contacts), volume of CWD (22.4 ± 25.8 m3/ha), snag density (94.4 ± 71.0 stems/ha), stand basal area (61.2 ± 31.4 m2/ha), and litter depth (7.5 ± 2.7 cm). Achieving these values will increase forest structural complexity, likely benefiting a range of faunal species in South American temperate forests. PMID:28068349

  12. Inpatient management of acute alcohol withdrawal syndrome.

    Science.gov (United States)

    Perry, Elizabeth C

    2014-05-01

    Alcohol withdrawal is a common condition encountered in the hospital setting after abrupt discontinuation of alcohol in an alcohol-dependent individual. Patients may present with mild symptoms of tremulousness and agitation or more severe symptoms including withdrawal seizures and delirium tremens. Management revolves around early identification of at-risk individuals and symptom assessment using a validated tool such as the revised Clinical Institute Withdrawal Assessment for Alcohol score. Benzodiazepines remain the mainstay of treatment and can be administered using a front-loading, fixed-dose, or symptom-triggered approach. Long-acting benzodiazepines such as chlordiazepoxide or diazepam are commonly used and may provide a smoother withdrawal than shorter-acting benzodiazepines, but there are no data to support superiority of one benzodiazepine over another. Elderly patients or those with significant liver disease may have increased accumulation and decreased clearance of the long-acting benzodiazepines, and lorazepam or oxazepam may be preferred in these patients. Patients with symptoms refractory to high doses of benzodiazepines may require addition of a rescue medication such as phenobarbital, propofol or dexmedetomidine. Anticonvulsants (carbamazepine, valproate, gabapentin) may have a role in the management of mild to moderate withdrawal. Other medications such as β-antagonists or neuroleptics may offer additional benefit in select patients but should not be used a monotherapy.

  13. The Acute Management of Nonvariceal Upper Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Hisham AL Dhahab

    2012-01-01

    Full Text Available Background. The mortality from nonvariceal upper gastrointestinal bleeding is still around 5%, despite the increased use of proton-pump inhibitors and the advancement of endoscopic therapeutic modalities. Aim. To review the state-of-the-art management of acute non variceal upper gastrointestinal bleeding from the presentation to the emergency department, risk stratification, endoscopic hemostasis, and postendoscopic consolidation management to reduce the risk of recurrent bleeding from peptic ulcers. Methods. A PubMed search was performed using the following key words acute management, non variceal upper gastrointestinal bleeding, and bleeding peptic ulcers. Results. Risk stratifying patients with acute non variceal upper gastrointestinal bleeding allows the categorization into low risk versus high risk of rebleeding, subsequently safely discharging low risk patients early from the emergency department, while achieving adequate hemostasis in high-risk lesions followed by continuous proton-pump inhibitors for 72 hours. Dual endoscopic therapy still remains the recommended choice in controlling bleeding from peptic ulcers despite the emergence of new endoscopic modalities such as the hemostatic powder. Conclusion. The management of nonvariceal upper gastrointestinal bleeding involves adequate resuscitation, preendoscopic risk assessment, endoscopic hemostasis, and post endoscopic pharmacological and nonpharmacological treatment.

  14. Current strategies for endoscopic management of acute cholangitis.

    Science.gov (United States)

    Isayama, Hiroyuki; Yasuda, Ichiro; Tan, Damien

    2017-04-01

    At the pancreatobiliary session of Endoscopic Forum Japan (EFJ) 2016, current strategies for the endoscopic management of acute cholangitis were discussed. The topics consisted of two major parts, namely endoscopic management of acute cholangitis caused by common bile duct stones (CBDS) and biliary stent occlusion. Endoscopists from nine Japanese high-volume centers along with two overseas centers participated in the questionnaires and discussion. Strategies for management of cholangitis due to CBDS were agreed upon, and the clinical guideline of acute cholangitis (Tokyo guidelines 2013) was accepted. The best timing for drainage in Grade 2 (moderate) cholangitis urgent or early (strategies differed according to the stricture location (distal or hilar) and stent type initially placed (Covered or uncovered metal stent). Strategies for management of cholangitis caused by CBD stones are well established according to the TG13. More evidence is required before further recommendations can be made with regards to cholangitis due to stent occlusion. We aim to clarify this in the near future with questionnaires and consensus from experts. © 2017 The Authors. Digestive Endoscopy © 2017 Japan Gastroenterological Endoscopy Society.

  15. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.

    2008-01-01

    . All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed...... over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula...

  16. An update of clinical management of acute intermittent porphyria

    Directory of Open Access Journals (Sweden)

    Pischik E

    2015-09-01

    Full Text Available Elena Pischik,1,2 Raili Kauppinen,11Porphyria Research Unit, Division of Endocrinology, Department of Medicine, University Central Hospital of Helsinki, Helsinki, Finland; 2Department of Neurology, Consultative and Diagnostic Centre with Polyclinics, St Petersburg, Russia Abstract: Acute intermittent porphyria (AIP is due to a deficiency of the third enzyme, the hydroxymethylbilane synthase, in heme biosynthesis. It manifests with occasional neuropsychiatric crises associated with overproduction of porphyrin precursors, aminolevulinic acid and porphobilinogen. The clinical criteria of an acute attack include the paroxysmal nature and various combinations of symptoms, such as abdominal pain, autonomic dysfunction, hyponatremia, muscle weakness, or mental symptoms, in the absence of other obvious causes. Intensive abdominal pain without peritoneal signs, acute peripheral neuropathy, and encephalopathy usually with seizures or psychosis are the key symptoms indicating possible acute porphyria. More than fivefold elevation of urinary porphobilinogen excretion together with typical symptoms of an acute attack is sufficient to start a treatment. Currently, the prognosis of the patients with AIP is good, but physicians should be aware of a potentially fatal outcome of the disease. Mutation screening and identification of type of acute porphyria can be done at the quiescent phase of the disease. The management of patients with AIP include following strategies: A, during an acute attack: 1 treatment with heme preparations, if an acute attack is severe or moderate; 2 symptomatic treatment of autonomic dysfunctions, polyneuropathy and encephalopathy; 3 exclusion of precipitating factors; and 4 adequate nutrition and fluid therapy. B, during remission: 1 exclusion of precipitating factors (education of patients and family doctors, 2 information about on-line drug lists, and 3 mutation screening for family members and education about precipitating factors in

  17. Clinical presentation, diagnosis and management of acute mitral regurgitation following acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Rengin etin Guven; Tolga Sinan G uven

    2016-01-01

    Acute mitral regurgitation (MR) is a frequent complication of acute myocardial infarction, with a variable presentation depending on the severity of MR and the integrity of the subvalvular apparatus. While most cases are asymptomatic or have mild dyspnea, rupture of chordae tendinea or papillary muscles are catastrophic complications that may rapidly lead to cardiogenic shock and death. Despite the presence of pulmonary edema and/or cardiogrenic shock, the murmur of acute MR is usually subtle due to rapid equalization of left atrial and left ventricular pressure gradient, and therefore misleading. Echocardiog-raphy is the definite diagnostic modality, allowing quantification of the severity of MR and the structural abnormalities within the subvalvular apparatus. Severe MR accompa-nied by rupture of chordae or papillary muscles should be managed with temporary stabilization with medical treatment or with mechanical circulatory support, with sub-sequent surgical intervention to repair or replace the valve.

  18. Clinical presentation, diagnosis and management of acute mitral regurgitation following acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Rengin Çetin Güvenç

    2016-03-01

    Full Text Available Acute mitral regurgitation (MR is a frequent complication of acute myocardial infarction, with a variable presentation depending on the severity of MR and the integrity of the subvalvular apparatus. While most cases are asymptomatic or have mild dyspnea, rupture of chordae tendinea or papillary muscles are catastrophic complications that may rapidly lead to cardiogenic shock and death. Despite the presence of pulmonary edema and/or cardiogrenic shock, the murmur of acute MR is usually subtle due to rapid equalization of left atrial and left ventricular pressure gradient, and therefore misleading. Echocardiography is the definite diagnostic modality, allowing quantification of the severity of MR and the structural abnormalities within the subvalvular apparatus. Severe MR accompanied by rupture of chordae or papillary muscles should be managed with temporary stabilization with medical treatment or with mechanical circulatory support, with subsequent surgical intervention to repair or replace the valve.

  19. Acute pancreatitis: The role of imaging in diagnosis and management

    Energy Technology Data Exchange (ETDEWEB)

    Bharwani, Nishat, E-mail: nishat.bharwani@nhs.ne [Imaging Department, Barts and The London NHS Trust, St Bartholomew' s Hospital, Ground Floor, King George V Wing, London EC1A 7BE (United Kingdom); Patel, Shilpa; Prabhudesai, Shirish; Fotheringham, Tim; Power, Niall [Imaging Department, Barts and The London NHS Trust, St Bartholomew' s Hospital, Ground Floor, King George V Wing, London EC1A 7BE (United Kingdom)

    2011-02-15

    Acute pancreatitis is one of the more commonly encountered aetiologies in the emergency setting and its incidence is rising. Presentations range from a mild-self limiting condition which usually responds to conservative management to one with significant morbidity and mortality in its most severe forms. While clinical criteria are necessary to make the initial diagnosis, contrast-enhanced CT is the mainstay of imaging and has a vital role in assessing the extent and evolution of the disease and its associated complications. The purpose of this article is to summarise the natural course of acute severe pancreatitis, clarify confusing nomenclature, demonstrate the morphological stages in conjunction with radiological scoring systems and illustrate the complications. We will review and illustrate the increasing and significant role interventional radiology has in the management of these patients, which are often life-saving and surgery-sparing.

  20. Pain management in the acute care setting: Update and debates.

    Science.gov (United States)

    Palmer, Greta M

    2016-02-01

    Pain management in the paediatric acute care setting is underutilised and can be improved. An awareness of the analgesic options available and their limitations is an important starting point. This article describes the evolving understanding of relevant pharmacogenomics and safety data of the various analgesic agents with a focus on agents available in Australia and New Zealand. It highlights the concerns with the use of codeine in children and discusses alternative oral opioids. Key features of oral, parenteral, inhaled and intranasal analgesic agents are discussed, as well as evidence supported use of sweet tasting solutions and non-pharmacological interventions. One of the biggest changes in acute care pain management has been the advent of intranasal fentanyl providing reliable potent analgesia without the need for intravenous access. The article will also address the issue of multimodal analgesia where a single agent is insufficient.

  1. Patient-controlled modalities for acute postoperative pain management.

    Science.gov (United States)

    Miaskowski, Christine

    2005-08-01

    Although numerous clinical practice guidelines for pain management have been published throughout the last 12 years, inadequate pain relief remains a significant health care issue. Several patient-controlled analgesia (PCA) modalities are currently available for the treatment of acute postoperative pain, including intravenous (IV) PCA, epidural (PCEA), and oral PCA. Although PCEA and IV PCA are both commonly used modalities, IV PCA is considered the standard of care for postoperative pain management. Limitations of this modality do exist, however. Consequently, noninvasive PCA systems are under development to circumvent many of these limitations, including the fentanyl hydrochloride patient-controlled transdermal system (PCTS); (IONSYS Ortho-McNeil Pharmaceutical, Raritan, NJ) and a number of patient-controlled intranasal analgesia (PCINA) delivery systems. The objective of this article is to review the PCA modalities currently in use and to discuss those in development for the treatment of acute postoperative pain.

  2. ForWarn Forest Disturbance Change Detection System Provides a Weekly Snapshot of US Forest Conditions to Aid Forest Managers

    Science.gov (United States)

    Hargrove, W. W.; Spruce, J.; Kumar, J.; Hoffman, F. M.

    2012-12-01

    The Eastern Forest Environmental Threat Assessment Center and Western Wildland Environmental Assessment Center of the USDA Forest Service have collaborated with NASA Stennis Space Center to develop ForWarn, a forest monitoring tool that uses MODIS satellite imagery to produce weekly snapshots of vegetation conditions across the lower 48 United States. Forest and natural resource managers can use ForWarn to rapidly detect, identify, and respond to unexpected changes in the nation's forests caused by insects, diseases, wildfires, severe weather, or other natural or human-caused events. ForWarn detects most types of forest disturbances, including insects, disease, wildfires, frost and ice damage, tornadoes, hurricanes, blowdowns, harvest, urbanization, and landslides. It also detects drought, flood, and temperature effects, and shows early and delayed seasonal vegetation development. Operating continuously since January 2010, results show ForWarn to be a robust and highly capable tool for detecting changes in forest conditions. To help forest and natural resource managers rapidly detect, identify, and respond to unexpected changes in the nation's forests, ForWarn produces sets of national maps showing potential forest disturbances at 231m resolution every 8 days, and posts the results to the web for examination. ForWarn compares current greenness with the "normal," historically seen greenness that would be expected for healthy vegetation for a specific location and time of the year, and then identifies areas appearing less green than expected to provide a strategic national overview of potential forest disturbances that can be used to direct ground and aircraft efforts. In addition to forests, ForWarn also tracks potential disturbances in rangeland vegetation and agriculural crops. ForWarn is the first national-scale system of its kind based on remote sensing developed specifically for forest disturbances. The ForWarn system had an official unveiling and rollout in

  3. Is management of acute traumatic brain injury effective?

    OpenAIRE

    Lei, Jin; Gao, Guo-Yi; Jiang, Ji-Yao

    2012-01-01

    【Abstract】 Objective: To evaluate all the possible therapeutic measures concerning the acute management of traumatic brain injury (TBI) mentioned in Cochrane System-atic Reviews published in the Cochrane Database of Sys-tematic Reviews (CDSR). Methods: An exhausted literature search for all pub-lished Cochrane Systematic Reviews discussing therapeu-tic rather than prevention or rehabilitative interventions of TBI was conducted. We retrieved such databases as CDSR and Coch...

  4. Current perspectives for management of acute respiratory insufficiency in premature infants with acute respiratory syndrome.

    Science.gov (United States)

    Chen, Peng; Zhang, Ying; Li, Long-Yun

    2014-09-01

    Current perspectives for management of acute respiratory insufficiency in premature infants with acute respiratory syndrome and the pathology of acute respiratory insufficiency in the preterm infant, including the current therapy modalities on disposition are presented. Since the therapeutical challenge and primary clinical goal are to normalize ventilation ratio and lung perfusion, when respiratory insufficiency occurs, it is very important to introduce the respiratory support as soon possible, in order to reduce development of pulmonary cyanosis and edema, and intrapulmonary or intracardial shunts. A characteristic respiratory instability that reflects through fluctuations in gas exchange and ventilation is often present in premature infants. Adapting the respiratory support on a continuous basis to the infant's needs is challenging and not always effective. Although a large number of ventilation strategies for the neonate are available, there is a need for additional consensus on management of acute respiratory distress syndrome in pediatric population lately redefined by Berlin definition criteria, in order to efficiently apply various modes of respiratory support in daily pediatrician clinical use.

  5. Acute and long-term management of food allergy

    DEFF Research Database (Denmark)

    de Silva, D; Geromi, M; Panesar, S S

    2014-01-01

    BACKGROUND: Allergic reactions to food can have serious consequences. This systematic review summarizes evidence about the immediate management of reactions and longer-term approaches to minimize adverse impacts. METHODS: Seven bibliographic databases were searched from their inception to September...... management for non-life-threatening reactions. H1-antihistamines may be of benefit, but this evidence was in part derived from studies on those with cross-reactive birch pollen allergy. Regarding long-term management, avoiding the allergenic food or substituting an alternative was commonly recommended...... helpful, but allergen-specific immunotherapy may be disease modifying and therefore warrants further exploration. CONCLUSIONS: Food allergy can be debilitating and affects a significant number of people. However, the evidence base about acute and longer-term management is weak and needs to be strengthened...

  6. Regeneration and management of lesser known timber species in the Peruvian Amazon following disturbance by logging

    DEFF Research Database (Denmark)

    Karsten, Rune Juelsborg; Meilby, Henrik; Larsen, Jørgen Bo

    2014-01-01

    landing construction, and how the forest regenerates after such disturbances, remain poorly understood. This paper investigates the regeneration success of a range of well/lesser-known timber species in a tierra-firme forest concession in Peru. Sample plots (100 m2) were established in areas with three...

  7. Gouty Arthritis: A Review of Acute Management and Prevention.

    Science.gov (United States)

    Wilson, Liza; Saseen, Joseph J

    2016-08-01

    Gouty arthritis is one of the most common rheumatic diseases. The clinical burden of gouty arthritis has historically been well recognized; however, gout is often misdiagnosed and mismanaged. The prevalence of gout is rising and is likely attributed to several factors including increased incidence of comorbidities, lifestyle factors, and increased use of causative medications. With the increasing prevalence, there have been several innovations and evidence-based updates related to the diagnosis and management of gout. Acute gouty arthritis should be treated with nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or corticosteroids, or a combination of two agents. Xanthine oxidase inhibitor therapy remains the consensus first-line treatment option for the prevention of recurrent gout. Add-on therapies that reduce serum urate concentration include traditional uricosuric agents and a novel uric acid reabsorption inhibitor. Prophylaxis of acute gout with NSAIDs, colchicine, or corticosteroids is universally recommended when initiating any urate-lowering therapy in order to prevent acute gouty arthritis for a period of at least 6 months. In this review, we discuss the epidemiology and risk factors for gouty arthritis and evaluate diagnostic strategies and therapeutic regimens for the management of gout, including a new drug approval.

  8. An update on the management of acute esophageal variceal bleeding.

    Science.gov (United States)

    Cabrera, Lourdes; Tandon, Puneeta; Abraldes, Juan G

    2017-01-01

    The mortality rate in acute variceal haemorrhage remains high (around 15%). Treatment is based on the combined use of vasoactive drugs, endoscopic band ligation, and prophylactic antibiotics. Effective resuscitation (haemostasis, volume management) is essential to prevent complications. Treatment failure is best managed by transjugular intrahepatic portosystemic shunt (TIPS). Balloon tamponade or specifically designed covered oesophageal stents can be used as a bridge to definitive therapy in unstable patients. Early, pre-emptive TIPS should be the first choice in patients at high risk of treatment failure (Child-Pugh B with active bleeding or Child-Pugh C<14). This article reviews the most recent advances in the management of variceal bleeding and discusses the recent recommendations of the Baveno VI consensus conference. Copyright © 2016 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

  9. Challenges in the management of acute peptic ulcer bleeding.

    Science.gov (United States)

    Lau, James Y W; Barkun, Alan; Fan, Dai-ming; Kuipers, Ernst J; Yang, Yun-sheng; Chan, Francis K L

    2013-06-08

    Acute upper gastrointestinal bleeding is a common medical emergency worldwide, a major cause of which are bleeding peptic ulcers. Endoscopic treatment and acid suppression with proton-pump inhibitors are cornerstones in the management of the disease, and both treatments have been shown to reduce mortality. The role of emergency surgery continues to diminish. In specialised centres, radiological intervention is increasingly used in patients with severe and recurrent bleeding who do not respond to endoscopic treatment. Despite these advances, mortality from the disorder has remained at around 10%. The disease often occurs in elderly patients with frequent comorbidities who use antiplatelet agents, non-steroidal anti-inflammatory drugs, and anticoagulants. The management of such patients, especially those at high cardiothrombotic risk who are on anticoagulants, is a challenge for clinicians. We summarise the published scientific literature about the management of patients with bleeding peptic ulcers, identify directions for future clinical research, and suggest how mortality can be reduced.

  10. Acute Compartment Syndrome of the Limbs: Current Concepts and Management

    Science.gov (United States)

    Mabvuure, Nigel Tapiwa; Malahias, Marco; Hindocha, Sandip; Khan, Wasim; Juma, Ali

    2012-01-01

    Acute compartment syndrome (ACS) of the limb refers to a constellation of symptoms, which occur following a rise in the pressure inside a limb muscle compartment. A failure or delay in recognising ACS almost invariably results in adverse outcomes for patients. Unrecognised ACS can leave patients with nonviable limbs requiring amputation and can also be life–threatening. Several clinical features indicate ACS. Where diagnosis is unclear there are several techniques for measuring intracompartmental pressure described in this review. As early diagnosis and fasciotomy are known to be the best determinants of good outcomes, it is important that surgeons are aware of the features that make this diagnosis likely. This clinical review discusses current knowledge on the relevant clinical anatomy, aetiology, pathophysiology, risk factors, clinical features, diagnostic procedures and management of an acute presentation of compartment syndrome. PMID:23248724

  11. Robust food supply supply chains : an integrated framework for vulnerability assessment and disturbance management

    OpenAIRE

    Vlajic, J.V.

    2012-01-01

    The operation of supply chains (SCs) has for many years been focused on efficiency, leanness and responsiveness. This has resulted in reduced slack in operations, compressed cycle times, increased productivity and minimised inventory levels along the SC. Combined with tight tolerance settings for the realisation of logistics and production processes, this has led to SC performances that are frequently not robust. SCs are becoming increasingly vulnerable to disturbances, which can decrease the...

  12. Implications of future disturbance regimes on the carbon balance of Canada's managed forest (2010-2100)

    Energy Technology Data Exchange (ETDEWEB)

    Metsaranta, J.M.; Kurz, W.A.; Neilson, E.T.; Stinson, G. (Natural Resources Canada, Canadian Forest Service, Pacific Forestry Centre, Victoria, BC (Canada))

    2010-11-15

    Recent increases in fire and insect disturbances have contributed to a transition of Canada's managed forest carbon balance from sink to source. Further increases in area burned could contribute positive feedback to climate change. We made probabilistic forecasts of the recovery of C sinks in Canada's managed forest between 2010 and 2100 under two assumptions about future area burned by wildfire: (1) no increase relative to levels observed in the last half of the 20th century and (2) linear increases by a factor of two or four (depending on region) from 2010 to 2100. Recovery of strong C sinks in Canada's managed forest will be delayed until at least the 2030s because of insect outbreaks, even if predicted increases in area annually burned do not occur. After 2050, our simulations project an annual probability of a sink near 70% with no increase in area burned and 35% with increasing area burned. All simulations project a cumulative C source from 2010-2100, even if annual area burned does not increase. If the sink strength of terrestrial ecosystems is reduced because of increasing natural disturbances, then it will become more difficult to achieve global atmospheric CO{sub 2} stabilization targets.

  13. Management of acute attacks of hereditary angioedema: role of ecallantide

    Directory of Open Access Journals (Sweden)

    Duffey H

    2015-04-01

    Full Text Available Hannah Duffey,1 Rafael Firszt1,2 1Department of Pediatrics, 2Division of Allergy, Immunology and Rheumatology, University of Utah, Salt Lake City, UT, USA Abstract: Hereditary angioedema (HAE is characterized as an episodic swelling disorder with autosomal dominant inheritance. Clinical features include nonpitting edema of external or mucosal body surfaces, and patients often present with swelling of the extremities, abdominal pain, and swelling of the mouth and throat, which can lead to asphyxiation. Patients with HAE classically have no associated urticaria, which is often referred to as nonhistaminergic angioedema. Treatment for HAE involves long-term prophylaxis, short-term prophylaxis, and management of acute attacks. Up until the past few years, acute HAE episodes were predominately treated with supportive measures. Three classes of medications have recently been approved by the US Food and Drug Administration (FDA for the management of acute HAE attacks. Ecallantide, a recombinant protein that acts as a reversible inhibitor of kallikrein, is currently indicated for acute attacks of HAE in those aged 12 years. In two randomized, double-blind, placebo-controlled, multicenter trials, EDEMA3 and EDEMA4, patients treated with 30 mg of ecallantide demonstrated statistically significant improvement in symptoms compared to those on placebo. In addition to its use as treatment for HAE, ecallantide has been used off label in the management of nonhistaminergic angioedema, not due to HAE. Ecallantide has shown promise in the treatment of these other forms; however, data are limited to mainly case reports at this time. Ecallantide is generally a safe and well-tolerated medication; however, based on reports of anaphylaxis, ecallantide does contain a black box warning. Due to the risk of anaphylaxis, ecallantide cannot be self-administered and must be given by a health care professional. Overall, ecallantide is a safe and effective medication for the

  14. Gunshot wounds to the face--acute management.

    Science.gov (United States)

    McLean, J Nicolas; Moore, Charles E; Yellin, Seth A

    2005-08-01

    The complex facial trauma victim poses a genuine therapeutic challenge as a whole, and may be particularly challenging to the medical team. The literature on acute management of gunshot wounds to the face is scarce. We performed an extensive review of the English-language literature in an effort to better delineate the diagnosis and acute management of these injuries. Most of these injuries do not present with initial threat to life and can safely be managed non-operatively. Definitive treatment is often deferred in patients with multiple, or more severe, injuries. Airway compromise is the most frequent and most life-threatening early problem reported in most series. CT scan remains the most useful method in the evaluation of these types of injuries and associated cervical spine lesions. Facial bleeding is best controlled by angiography and subsequent embolization. Anatomic repair of soft tissue and bony injuries is recommended to obtain an optimal functional and aesthetic outcome. Despite the creation of some algorithms, no clear correlation has been found between the site of entrance wound and the injuries and outcome of gunshot wounds to the face.

  15. Contemporary concepts in management of acute otitis media in children.

    Science.gov (United States)

    Rettig, Eleni; Tunkel, David E

    2014-10-01

    Acute otitis media (AOM) is a common disease of childhood. AOM is most appropriately diagnosed by careful otoscopy with an understanding of clinical signs and symptoms. The distinction between AOM and chronic otitis media with effusion should be emphasized. Treatment should include pain management, and initial antibiotic treatment should be given to those most likely to benefit, including young children, children with severe symptoms, and those with otorrhea and/or bilateral AOM. Tympanostomy tube placement may be helpful for those who experience frequent episodes of AOM or fail medical therapy. Recent practice guidelines may assist the clinician with such decisions.

  16. Severe Raynaud's phenomenon-A streamlined approach to acute management.

    Science.gov (United States)

    Lee, Regent; Lomas, Oliver; Handa, Ashok

    2011-01-01

    Raynaud's phenomenon is an exaggerated vasospastic response to cold or emotional stress which not only may cause the patient severe pain but also critical ischaemia and necrosis of the digits. We report the case of a 69-year-old woman who presented with rest pain, impending ulceration and necrosis of finger tips due to an episode of left-sided Raynaud's phenomenon. Intravenous prostacyclin was administered successfully as a bridge to endoscopic thoracic sympathectomy. Vascular surgery units are ideally positioned for the acute management of severe Raynaud's phenomenon to provide continuity of care to patients with profound digital ischaemia and impending tissue loss.

  17. The Acute Management of Sport Concussion in Pediatric Athletes.

    Science.gov (United States)

    Resch, Jacob E; Kutcher, Jeffrey S

    2015-10-01

    During the past two decades the focus on sport concussion has increased significantly. Young athletes represent the most vulnerable population to sustain a sport concussion yet receive the least amount of attention. Specifically, young athletes who sustain a sport concussion can go unrecognized and continue to participate in sport putting them at an increased risk for a more significant injury. The purpose of this review is to provide a clinical framework for the evaluation and management of sport concussion. In addition, this review provides considerations for health care professionals in regard to clinical measures and follow-up strategies during the acute phase following concussion in young concussed athletes following injury.

  18. Acute Compartment Syndrome in Orthopedics: Causes, Diagnosis, and Management

    Science.gov (United States)

    Raza, Hasnain; Mahapatra, Anant

    2015-01-01

    Almost all orthopaedic surgeons come across acute compartment syndrome (ACS) in their clinical practice. Diagnosis of ACS mostly relies on clinical findings. If the diagnosis is missed and left untreated, it can lead to serious consequences which can endanger limb and life of the patient and also risk the clinician to face lawsuits. This review article highlights the characteristic features of ACS which will help an orthopaedic surgeon to understand the pathophysiology, natural history, high risk patients, diagnosis, and surgical management of the condition. PMID:25688303

  19. Effects of management intervention on post-disturbance community composition: an experimental analysis using bayesian hierarchical models.

    Science.gov (United States)

    Giovanini, Jack; Kroll, Andrew J; Jones, Jay E; Altman, Bob; Arnett, Edward B

    2013-01-01

    As human demand for ecosystem products increases, management intervention may become more frequent after environmental disturbances. Evaluations of ecological responses to cumulative effects of management interventions and natural disturbances provide critical decision-support tools for managers who strive to balance environmental conservation and economic development. We conducted an experiment to evaluate the effects of salvage logging on avian community composition in lodgepole pine (Pinus contorta) forests affected by beetle outbreaks in Oregon, USA, 1996-1998. Treatments consisted of the removal of lodgepole pine snags only, and live trees were not harvested. We used a bayesian hierarchical model to quantify occupancy dynamics for 27 breeding species, while accounting for variation in the detection process. We examined how magnitude and precision of treatment effects varied when incorporating prior information from a separate intervention study that occurred in a similar ecological system. Regardless of which prior we evaluated, we found no evidence that the harvest treatment had a negative impact on species richness, with an estimated average of 0.2-2.2 more species in harvested stands than unharvested stands. Estimated average similarity between control and treatment stands ranged from 0.82-0.87 (1 indicating complete similarity between a pair of stands) and suggested that treatment stands did not contain novel assemblies of species responding to the harvesting prescription. Estimated treatment effects were positive for twenty-four (90%) of the species, although the credible intervals contained 0 in all cases. These results suggest that, unlike most post-fire salvage logging prescriptions, selective harvesting after beetle outbreaks may meet multiple management objectives, including the maintenance of avian community richness comparable to what is found in unharvested stands. Our results provide managers with prescription alternatives to respond to severe

  20. Effects of management intervention on post-disturbance community composition: an experimental analysis using bayesian hierarchical models.

    Directory of Open Access Journals (Sweden)

    Jack Giovanini

    Full Text Available As human demand for ecosystem products increases, management intervention may become more frequent after environmental disturbances. Evaluations of ecological responses to cumulative effects of management interventions and natural disturbances provide critical decision-support tools for managers who strive to balance environmental conservation and economic development. We conducted an experiment to evaluate the effects of salvage logging on avian community composition in lodgepole pine (Pinus contorta forests affected by beetle outbreaks in Oregon, USA, 1996-1998. Treatments consisted of the removal of lodgepole pine snags only, and live trees were not harvested. We used a bayesian hierarchical model to quantify occupancy dynamics for 27 breeding species, while accounting for variation in the detection process. We examined how magnitude and precision of treatment effects varied when incorporating prior information from a separate intervention study that occurred in a similar ecological system. Regardless of which prior we evaluated, we found no evidence that the harvest treatment had a negative impact on species richness, with an estimated average of 0.2-2.2 more species in harvested stands than unharvested stands. Estimated average similarity between control and treatment stands ranged from 0.82-0.87 (1 indicating complete similarity between a pair of stands and suggested that treatment stands did not contain novel assemblies of species responding to the harvesting prescription. Estimated treatment effects were positive for twenty-four (90% of the species, although the credible intervals contained 0 in all cases. These results suggest that, unlike most post-fire salvage logging prescriptions, selective harvesting after beetle outbreaks may meet multiple management objectives, including the maintenance of avian community richness comparable to what is found in unharvested stands. Our results provide managers with prescription alternatives to

  1. Disturbingly Weak: The Current State of Financial Management Education in Library and Information Science Curricula

    Science.gov (United States)

    Burger, Robert H.; Kaufman, Paula T.; Atkinson, Amy L.

    2015-01-01

    Financial management skills are necessary for responsible library management. In light of the profession's current emphasis on financial literacy, the authors posed four questions: (1) to what extent are library and information science schools providing courses in financial management for their graduates; (2) what is the quality and quantity of…

  2. Disturbingly Weak: The Current State of Financial Management Education in Library and Information Science Curricula

    Science.gov (United States)

    Burger, Robert H.; Kaufman, Paula T.; Atkinson, Amy L.

    2015-01-01

    Financial management skills are necessary for responsible library management. In light of the profession's current emphasis on financial literacy, the authors posed four questions: (1) to what extent are library and information science schools providing courses in financial management for their graduates; (2) what is the quality and quantity of…

  3. Advances in Management of Acute Hypertension: A Concise Review

    Science.gov (United States)

    Tulman, David B.; Stawicki, Stanislaw P.A.; Papadimos, Thomas J.; Murphy, Claire V.; Bergese, Sergio D.

    2013-01-01

    Chronic hypertension affects >1 billion people worldwide and >70 million people in the United States. Acute hypertensive episodes (AHE) are defined as severe spikes in blood pressure that may result in end-organ damage. Although AHE may arise independently as de novo events, they are more likely to occur in patients with pre-existing hypertension. One of the controversies regarding the clinical approach to AHE is the selection of antihypertensive medication. Depending on the clinical presentation of the patient and the threat of end-organ damage resulting from blood pressure elevation, appropriate and prompt treatment is warranted. There are multiple agents available for the management of hypertension. However, the greatest challenge lies in the acute care setting where the need exists for better initial and sustained control of blood pressure spikes. Many anti-hypertensive agents effectively lower blood pressure, yet only few have the capacity to achieve strict control of hypertension in the acute setting. Clevidipine butyrate is an ultra short-acting intravenous dihydropyridine calcium-channel blocker. Clevidipine has unique pharmacodynamic and pharmacokinetic properties that enable the fast, safe, and adequate reduction of blood pressure in hypertensive emergencies, with the ability to provide highly precise titration necessary to maintain a narrowly-defined target blood pressure range. Several recently published phase I, II, and III clinical studies have shown Clevidipine to be an effective blood pressure modulator in such capacity. PMID:22642919

  4. Management of Acute Pancreatitis in Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Güniz Meyancı Köksal

    2010-12-01

    Full Text Available Pancreatitis is characterized by an inflammation occuring due to digestion of pancreatic self tissues and other organs after activation of digestive enzymes which are stable under normal conditions . For all the pancreatitis cases, the mortality rate is <%15. In the acute pancreatitis cases, the monitorization of the inspiration system, cardiovascular system and the metabolic status are needed. There is no primary therapy for the pancreatitis. All the therapy protocols are support therapy. The basic support therapy methods are: Liquid replacement, respiration support, pain management, pancreas secretion inhibition, metabolic support, intra-abdominal monitoring and decompression, nutrition, antibiotherapy, immunomodulation, coagulation mechanism monitoring. In the acute pancreatitis, the causes of early deaths are pancreatic shock and acute pulmonary thrombohemorrhage, within the first 7 days the causes of the 75% deaths are pulmonary shock and congestion and after 7 days the causes of the 77% are pancreas abscess, MOF (multiple organ failure, purulent peritonitis and erosive hemorrhage. (Journal of the Turkish Society of Intensive Care 2010; 8: 85-9

  5. Management of acute cardiogenic pulmonary edema: a literature review.

    Science.gov (United States)

    Johnson, Jeremy M

    2009-01-01

    Acute cardiogenic pulmonary edema (CPE) is a pathology frequently seen in patients presenting to emergency departments (EDs) and can usually be attributed to preexisting cardiovascular disease. Heart failure alone accounts for more than 1 million hospital admissions annually and has one of the highest ED morbidity and mortality to date (). Historically, CPE has been managed by the treating clinician in a manner that is based largely on anecdotal evidence. Furosemide (Lasix), morphine, and nitroglycerin have historically been the baseline standard for drug therapy in CPE management. A lack of drastic improvement in the patient's condition over the course of the ED visit may reflect a management style that results in higher morbidity and mortality for CPE patients. Several recent articles provide evidence-based outcomes that suggest changing standard therapy along with the adjunctive use of other medications. These articles also describe treatment modalities that result in a marked improvement in the management of patients with CPE along with decreases in adverse outcomes and hospital length of stay. The goal of this article is to present a summary of the evidence regarding the management of CPE and discuss the implications for current practice.

  6. Early phase of acute pancreatitis: Assessment and management

    Institute of Scientific and Technical Information of China (English)

    Veit; Phillip; Jrg; M; Steiner; Hana; Algül

    2014-01-01

    Acute pancreatitis(AP) is a potentially life-threatening disease with a wide spectrum of severity. The overall mortality of AP is approximately 5%. According to the revised Atlanta classification system, AP can be classified as mild, moderate, or severe. Severe AP often takes a clinical course with two phases, an early and a late phase, which should both be considered separately. In this review article, we first discuss general aspects of AP, including incidence, pathophysiology, etiology, and grading of severity, then focus on the assessment of patients with suspected AP, including diagnosis and risk stratification, followed by the management of AP during the early phase, with special emphasis on fluid therapy, pain management, nutrition, and antibiotic prophylaxis.

  7. Principles for Management of Intraoperative Acute Type A Aortic Dissection.

    Science.gov (United States)

    Gukop, Philemon; Chandrasekaran, Vankatachalam

    2015-12-01

    Intraoperative Type A aortic dissection is a rare pathology with incidence of 0.06-0.32%. It is associated with a high mortality between 30-50%. Some associated risk factors, including hypertension, enlarged aorta, peripheral vascular disease, advanced age, atheroma, and high arterial pressure on cardiopulmonary bypass, have been identified. Modification of these risk factors could reduce the incidence of this event. Prompt diagnosis and management, with the aid of intraoperative trans-esophageal echocardiography and/or epi-aortic ultrasound has been shown to reduce the mortality to 17%. We illustrate the principles of management of this pathology with the case of a 62-year-old female who developed acute Type A aortic dissection while undergoing minimally invasive mitral valve repair.

  8. [Transfer managment of postoperative acute pain therapy to outpatient aftercare].

    Science.gov (United States)

    Tank, C; Lefering, R; Althaus, A; Simanski, C; Neugebauer, E

    2014-10-01

    The significance of postoperative pain management for patients in the hospital is well known and has been a focus of research for several years. The ambulatory care after hospital discharge, however, is not well investigated. A prospective observational study was therefore conducted to study the transfer management from in-hospital patients to ambulatory care. A patient questionnaire was developed and patients were asked to fill it out at different time points after the operation: during the time in the hospital, then at 2 weeks and 6 months after hospital discharge. In addition, the responsible family doctor was approached and interviewed. The main focus of the questionnaire was the measurement of post-surgical pain (numeric rating scale NRS), patient satisfaction (Cologne patient questionnaire), and quality of life (SF 12). Of a total of 128 patients 72.9% described moderate to severe pain after the orthopaedic operations in the hospital. 90.8% of the patients had pain directly after discharge from the hospital; in 67.4% of the cases pain was ≥3 and in 23.4% of the cases pain was ≥6. Six months after discharge pain was significant in 29.4% of the patients, 60.8% of the patients were satisfied with the transfer to the home setting. 16% were not satisfied at all and 23.2% were neutral. Important factors for dissatisfaction with the transfer management were, according to stepwise logistic regeression analysis, sex (female patients), young age, a poor bodily constitution at the hospital and thereafter, and the pain management in the hospital and after discharge. The study shows the significance of the acute pain therapy not only during the hospital stay but also after discharge. There are very few data on pain therapy after discharge from the hospital. Based on the significance of the chronification of acute pain it is of the utmost importance to close this gap. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Angiographic evaluation and management of acute gastrointestinal hemorrhage

    Institute of Scientific and Technical Information of China (English)

    T Gregory Walker; Gloria M Salazar; Arthur C Waltman

    2012-01-01

    Although most cases of acute nonvariceal gastrointestinal hemorrhage either spontaneously resolve or respond to medical management or endoscopic treatment,there are still a significant number of patients who require emergency angiography and transcatheter treatment.Evaluation with noninvasive imaging such as nuclear scintigraphy or computed tomography may localize the bleeding source and/or confirm active hemorrhage prior to angiography.Any angiographic evaluation should begin with selective catheterization of the artery supplying the most likely site of bleeding,as determined by the available clinical,endoscopic and imaging data.If a hemorrhage source is identified,superselective catheterization followed by transcatheter microcoil embolization is usually the most effective means of successfully controlling hemorrhage while minimizing potential complications.This is now wellrecognized as a viable and safe alternative to emergency surgery.In selected situations transcatheter intra-arterial infusion of vasopressin may also be useful in controlling acute gastrointestinal bleeding.One must be aware of the various side effects and potential complications associated with this treatment,however,and recognize the high re-bleeding rate.In this article we review the current role of angiography,transcatheter arterial embolization and infusion therapy in the evaluation and management of nonvariceal gastrointestinal hemorrhage.

  10. Advances in the diagnosis and management of acute pulmonary embolism.

    Science.gov (United States)

    den Exter, Paul L; van der Hulle, Tom; Klok, Frederikus A; Huisman, Menno V

    2014-05-01

    The diagnostic management of acute pulmonary embolism (PE) is complicated by its heterogeneous clinical presentation. Current diagnostic algorithms, combining clinical probability estimation with D-dimer testing and imaging tests, are very safe to exclude PE, although at costs of high numbers of CT-examinations. In view of cost- and time-saving as well as safety issues, several attempts have recently been undertaken to reduce the number of required imaging tests. Especially the age-adjusted D-dimer threshold has greatly improved the potential for non-invasive exclusion of PE. Once the diagnosis of PE is established, immediate initiation of anticoagulant therapy is of vital importance. A new generation of direct oral anticoagulants, which overcomes the main disadvantages of conventional vitamin-K antagonists, has recently emerged. Risk stratification of hemodynamically stable PE patients with use of clinical decision rules, cardiac biomarkers or imaging tests, aids physicians in determining the most appropriate treatment approach for the individual patient. This is essential to differentiate patients at low risk of adverse outcome, who may be safely treated at home, from intermediate-risk patients, who require closer monitoring and for whom recent studies have evaluated the efficacy and safety of systemic thrombolytic therapy. This article reviews recent advances and challenges that remain in the diagnostic work-up and initial management of acute, clinically stable PE. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Emergent management of malignancy-related acute airway obstruction.

    Science.gov (United States)

    Theodore, Pierre R

    2009-05-01

    Acute obstruction of the airway in the emergent situation results from a wide variety of malignant and benign disease processes. Acute management involves establishing a secure and patent route for adequate gas exchange. This requires rapid determination of the location of the obstruction and nature of the obstruction followed by a thoughtful management approach based on findings. Difficult anatomy, hemorrhage, dense secretions, inflammation, and bulky tumor mass can significantly complicate the task of clearing the airway. Obstruction of the central airways by malignant tumor is associated with poor prognosis, but quality of life is considerably improved by restoration of adequate central airways. For both the patient and the clinician, the presentation can be frightening, and advanced interventional pulmonary/endobronchial techniques are required to achieve prompt relief of symptoms. The alleviation of central airway obstruction by tumor is most often palliative, with improvement of quality of life the primary goal rather than cure. This review will cover covers an approach to the patient with airway obstruction that results from malignancy involving the trachea or proximal bronchial tree and affecting gas exchange.

  12. A consensus statement on lipid management after acute coronary syndrome.

    Science.gov (United States)

    Schiele, François; Farnier, Michel; Krempf, Michel; Bruckert, Eric; Ferrières, Jean

    2016-11-17

    In patients admitted for acute coronary syndrome (ACS), the guidelines of the European Society of Cardiology give a Class I, Level A recommendation for the prescription of high-intensity statins to be initiated as early as possible, regardless of the low-density lipoprotein cholesterol (LDL-C) level. Although statins are widely prescribed after ACS, the intensity of therapy and the proportion of patients achieving target LDL-C values are often not in line with recommendations due to a lack of compliance with guidelines by the physicians, a lack of compliance with treatment or poor tolerance by patients, and poor dose adaptation. In this context, a group of French physicians came together to define strategies to facilitate and improve the management of lipid-lowering therapy after ACS. This paper outlines the scientific rationale for the use of statins at the acute phase of ACS, the utility of ezetimibe, the measurement of LDL-C during the course of ACS, the opportunities for detecting familial hypercholesterolaemia and the results of the consensus for the management of lipid-lowering therapy, illustrated in two decision-making algorithms.

  13. Unrecognized glycometabolic disturbance as measured by hemoglobin A1c is associated with a poor outcome after acute myocardial infarction

    DEFF Research Database (Denmark)

    Gustafsson, Ida; Kistorp, Caroline N; James, Margaret K;

    2007-01-01

    BACKGROUND: Glycated hemoglobin A1c (HbA1c) is a measure of the average blood glucose levels over 2 months and is minimally affected by acute hyperglycemia often observed in myocardial infarction (MI). In a large population of high-risk patients with MI, we examined the prognostic impact of HbA1c...

  14. Assessment of quality of care in acute postoperative pain management

    Directory of Open Access Journals (Sweden)

    Milutinović Dragana

    2009-01-01

    Full Text Available Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA, discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (χ, multiple correlation coefficient (R were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5 and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57% evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001. The analysis of patients evaluation (MANOVA p

  15. The Ima Hogg Therapeutic School Individualized Education, Behavioral Management in the Classroom and Psychotherapy for the Emotionally Disturbed and Behaviorally Disordered Child.

    Science.gov (United States)

    Wood, Constance D.; And Others

    Three papers discuss aspects of The Ima Hogg Therapeutic School for emotionally disturbed children. The first paper addresses the school's behavior development and management system, which rewards self management with freedom in physical activity and uses individualized target behaviors designed to increase the child's acceptable social…

  16. Evaluation of benthic macroinvertebrate assemblage for disturbance zonation in urban rivers using multivariate analysis: Implications for river management

    Indian Academy of Sciences (India)

    Ram Devi Tachamo Shah; Deep Narayan Shah

    2013-08-01

    River pollution has tremendously increased in the major cities of South Asia, where the rivers have become a repository for domestic, agricultural, municipal and industrial wastes. This study presents the evaluation of benthic macroinvertebrate assemblage as a means of assessing ecological status, determining different disturbance zones and identifying environmental variables and stressors that deteriorate the river ecosystem. In total, 20 sites in 36-km stretch of the main stem of the Bagmati River and 7 sites on its tributaries were selected for sampling in the post-monsoon and pre-monsoon seasons during the time period 2008–2010. The Ganga River System Biotic Score (GRSbios) index was applied to determine the ecological status. The ecological status of the different Bagmati River stretches ranged from reference, class 1 to class 5 (extremely polluted). We identified three types of disturbance zones along the river, ranging from minimally polluted to extremely polluted. A river corridor survey was conducted to identify any river stressing factors, revealing a sharp deterioration of the river from upstream to downstream with increasing concentrations of chloride and ortho-phosphate phosphorus. Effluents and Activities and Facilities were found to be the major stressing factors to the river ecosystem. The information gained should help water managers find the most time-efficient and cost-effective measures to address river degradation.

  17. Management outcome of acute urinary retention: model of prediction.

    LENUS (Irish Health Repository)

    Daly, Padraig

    2012-01-31

    OBJECTIVES: To assess for predictors of outcome in patients presenting with acute urinary retention (AUR). METHODS: A study was performed in our unit to evaluate trial without catheter (TWOC) and successive management. We assessed for predictors of surgical or medical management, which included: age, volume drained at time of catheterisation, cause of retention, serum creatinine, success of trial of voiding, co-morbidities, prostate-specific antigen (PSA) and prostate size on digital rectal examination (DRE). RESULTS: 72 men were entered into the study over an 18-month period: 27 had a successful first TWOC, 20 patients had a second TWOC, and 6 were successful. In total, 31 of the 33 patients with a successful TWOC remained on alpha-blockers without a further episode of AUR within a minimum of 6 months\\' follow-up. Patients failing TWOC were managed by transurethral resection of the prostate (n = 22), long-term catheterisation (n = 15) or prostatic stents (n = 3), and 1 patient died prior to intervention. Three predictors were significant on multivariate analysis: PSA (>2.9 ng\\/ml), prostate size on DRE (large) and volume drained at time of catheterisation (>or=1,000 ml). CONCLUSION: Patients with elevated PSA (>2.9 ng\\/ml), a large prostate size on DRE and a volume drained at time of catheterisation >1,000 ml are best managed by surgical intervention, while those with volumes drained at time of catheterisation of <1,000 ml, a PSA managed medically.

  18. Management of acute rhinosinusitis in Danish general practice: a survey

    Directory of Open Access Journals (Sweden)

    Hansen JG

    2011-07-01

    Full Text Available Jens Georg HansenDepartment of Clinical Epidemiology, Aarhus University Hospital and Aalborg Hospital, Aalborg, DenmarkPurpose: To evaluate whether the ongoing debate over diagnostic problems and treatment choices for acute rhinosinusitis has had any influence on the management of the disease.Methods: We randomly selected 300 Danish general practitioners (GPs from the files of the Research Unit for General Practice at Aarhus University. Invitations to participate and a questionnaire were sent to the GPs by mail.Results: A total of 149 (49% GPs answered the questionnaire. When asked about symptoms, the highest priority was given to sinus pain and signs of tenderness. The most frequent examinations were objective examination of the ear-nose-throat (ENT, palpation of the maxillofacial area, and C-reactive protein point-of-care testing (or CRP rapid test. Nearly all GPs prescribed local vasoconstrictors, and in 70% of cases, antibiotics were prescribed. Phenoxymethylpenicillin was the preferred antibiotic. Use of the CRP rapid test, years in practice, or employment in an ENT department did not have a significant impact on the diagnostic certainty and antibiotic prescribing rate.Conclusion: The clinical diagnoses are based on a few symptoms, signs, and the CRP rapid test. Other examinations, including imaging techniques, are seldom used. Phenoxymethylpenicillin is the preferred antibiotic, and the GPs' diagnostic certainty was 70%.Keywords: general practice, acute rhinosinusitis, diagnosis, treatment, antibiotic

  19. Sleep Disturbances

    Science.gov (United States)

    ... PD / Coping with Symptoms & Side Effects / Sleep Disturbances Sleep Disturbances Many people with Parkinson’s disease (PD) have ... stay awake during the day. Tips for Better Sleep People with PD — and their care partners too — ...

  20. The Pathophysiology, Diagnosis and Current Management of Acute Compartment Syndrome

    Science.gov (United States)

    Donaldson, James; Haddad, Behrooz; Khan, Wasim S

    2014-01-01

    Acute compartment syndrome (ACS) is a surgical emergency warranting prompt evaluation and treatment. It can occur with any elevation in interstitial pressure in a closed osseo-fascial compartment. Resultant ischaemic damage may be irreversible within six hours and can result in long-term morbidity and even death. The diagnosis is largely clinical with the classical description of ‘pain out of proportion to the injury’. Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt. Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level. If symptoms persist, definitive treatment is necessary with timely surgical decompression of all the involved compartments. This article reviews the pathophysiology, diagnosis and current management of ACS. PMID:25067973

  1. Management of cardiogenic shock complicating acute myocardial infarction.

    Science.gov (United States)

    Van Herck, Jozef L; Claeys, Marc J; De Paep, Rudi; Van Herck, Paul L; Vrints, Christiaan J; Jorens, Philippe G

    2015-06-01

    Cardiogenic shock complicates approximately 5-10% of cases with acute myocardial infarction and carries a poor prognosis. Early revascularization remains the cornerstone treatment of cardiogenic shock complicating myocardial infarction. Inotropic and/or vasopressor agents can be used for haemodynamic stabilization, although this comes at the expense of increased myocardial oxygen consumption and extended myocardial ischaemia. In recent years, the use of mechanical circulatory support has significantly increased. However, there is only limited data available from randomized trials evaluating the different percutaneous support systems. This review summarizes the available literature concerning the management of cardiogenic shock and gives an overview of the recommendations of the European and German-Austrian guidelines on cardiogenic shock.

  2. Recommendations for management of acute pharyngitis in adults.

    Science.gov (United States)

    Cots, Josep M; Alós, Juan-Ignacio; Bárcena, Mario; Boleda, Xavier; Cañada, José L; Gómez, Niceto; Mendoza, Ana; Vilaseca, Isabel; Llor, Carles

    2015-01-01

    Acute pharyngitis in adults is one of the most common infectious diseases seen in general practitioners' consultations. Viral aetiology is the most common. Among bacterial causes, the main agent is Streptococcus pyogenes or group A β-haemolytic streptococcus (GABHS), which causes 5%-30% of the episodes. In the diagnostic process, clinical assessment scales can help clinicians to better predict suspected bacterial aetiology by selecting patients who should undergo a rapid antigen detection test. If these techniques are not performed, an overdiagnosis of streptococcal pharyngitis often occurs, resulting in unnecessary prescriptions of antibiotics, most of which are broad spectrum. Consequently, management algorithms that include the use of predictive clinical rules and rapid tests have been set up. The aim of the treatment is speeding up symptom resolution, reducing the contagious time span and preventing local suppurative and non-suppurative complications. Penicillin and amoxicillin are the antibiotics of choice for the treatment of pharyngitis. The association of amoxicillin and clavulanate is not indicated as the initial treatment of acute infection. Neither are macrolides indicated as first-line therapy; they should be reserved for patients allergic to penicillin. The appropriate diagnosis of bacterial pharyngitis and proper use of antibiotics based on the scientific evidence available are crucial. Using management algorithms can be helpful in identifying and screening the cases that do not require antibiotic therapy. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  3. [Recommendations for management of acute pharyngitis in adults].

    Science.gov (United States)

    Cots, Josep M; Alós, Juan-Ignacio; Bárcena, Mario; Boleda, Xavier; Cañada, José L; Gómez, Niceto; Mendoza, Ana; Vilaseca, Isabel; Llor, Carles

    2016-11-01

    Acute pharyngitis in adults is one of the most common infectious diseases seen in general practitioners' consultations. Viral aetiology is the most common. Among bacterial causes, the main agent is Streptococcus pyogenes or group A β-haemolytic streptococcus (GABHS), which causes 5%-30% of the episodes. In the diagnostic process, clinical assessment scales can help clinicians to better predict suspected bacterial aetiology by selecting patients who should undergo a rapid antigen detection test. If these techniques are not performed, an overdiagnosis of streptococcal pharyngitis often occurs, resulting in unnecessary prescriptions of antibiotics, most of which are broad spectrum. Consequently, management algorithms that include the use of predictive clinical rules and rapid tests have been set up. The aim of the treatment is speeding up symptom resolution, reducing the contagious time span and preventing local suppurative and non-suppurative complications. Penicillin and amoxicillin are the antibiotics of choice for the treatment of pharyngitis. The association of amoxicillin and clavulanate is not indicated as the initial treatment of acute infection. Neither are macrolides indicated as first-line therapy; they should be reserved for patients allergic to penicillin. The appropriate diagnosis of bacterial pharyngitis and proper use of antibiotics based on the scientific evidence available are crucial. Using management algorithms can be helpful in identifying and screening the cases that do not require antibiotic therapy. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  4. Biological soil quality from biomass to biodiversity - importance and resilience to management stress and disturbance

    NARCIS (Netherlands)

    Brussaard, L.; Kuyper, T.W.; Didden, W.A.M.; Goede, de R.G.M.; Bloem, J.

    2004-01-01

    Various aspects of the soil biota react sensitively to changes in the environment, including agricultural management. Changes in soil biodiversity cannot easily observed directly (measured in terms of community structure of microbes and nematodes, giving early warnings of long-term changes in organi

  5. Managing the acute painful episode in sickle cell disease

    Directory of Open Access Journals (Sweden)

    B. Kaya

    2011-12-01

    Full Text Available Sickle cell pain is a complex but frequently experienced symptom. Acute painful events in children can be managed effectively in the community with appropriate support and education. If hospital management is required, rapid access to a consistent, reliable and safe analgesic pathway is recommended to ensure a good standard of care. Use of oral opiates in addition to short acting easily administrable forms of analgesia and strict adherence to protocoled monitoring will enable the acute event to be well managed and the negative pain experience minimised. An important part of the outpatient evaluation is determining the impact pain events are having on the child’s quality of life. Addressing psycho-social aspects, defining and modifying precipitating factors, if any are identified, and having a holistic approach to pain management is helpful. Education and use of self-management techniques can also be productive. Use of sickle modifying interventions such as hydroxycarbamide therapy or transfusion therapy can have a significant impact on reducing the severity and frequency of the acute pain event. 镰状细胞疼痛是一种复杂的常发症。 通过适当的支助和教育,儿童急性疼痛症可以得到有效抑制。 如果需要在医院进行护理,患者应尽快寻求持续可靠且安全的止痛方式,确保良好的护理。 除采取作用短、管理方便的止痛治疗和遵守监测协议之外,患者还需口服鸦片剂,这样,急性症状可以得到良好的抑制,还可尽量减轻疼痛感。 诊断门诊病人一个重要的部分就是确定疼痛症对患儿生活质量产生的影响。 问询生理社会方面问题,确定和修改诱发因子(如有),并整体分析可行的疼痛护理方法。 教育和使用个人护理法也很有效果。 采用镰状细胞修改干预法,例如羟基尿素疗法或输液疗法,对减轻急性疼痛症和减少发作频率有着显著效果。

  6. The diagnosis and management of acute otitis media.

    Science.gov (United States)

    Lieberthal, Allan S; Carroll, Aaron E; Chonmaitree, Tasnee; Ganiats, Theodore G; Hoberman, Alejandro; Jackson, Mary Anne; Joffe, Mark D; Miller, Donald T; Rosenfeld, Richard M; Sevilla, Xavier D; Schwartz, Richard H; Thomas, Pauline A; Tunkel, David E

    2013-03-01

    This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM. In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations. The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships. The practice guideline underwent comprehensive peer review before formal approval by the AAP. This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this

  7. Current trends in the management of acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Srinivasan Paramasivam

    2015-01-01

    Full Text Available Stroke is the leading cause of disability and most of the cases are those of ischemic stroke. Management strategies especially for large vessel occlusive stroke have undergone a significant change in the recent years that include widespread use of thrombolytic medications followed by endovascular clot removal. For successful treatment by endovascular thrombectomy, the important factors are patient selection based on clinical criterion including age, time of onset, premorbid clinical condition, co-morbidities, National Institute of Health Stroke Scale, and imaging criterion including computed tomography (CT head, CT angiogram and CT perfusion. Patients presenting within 4.5 hours of onset are considered for intravenous (IV recombinant tissue plasminogen activator treatment. Mechanical clot retrieval devices have evolved over the past decade. The Mechanical Embolus Removal in Cerebral Ischemia device was approved first followed by the penumbra revascularization system. They have proven in various studies to improve recanalization with acceptable rates of symptomatic intra-cerebral hemorrhage. Introduction of stent retrievers has led to a new era in the interventional management of acute ischemic stroke (AIS. Recent trials namely MRCLEAN, ESCAPE, SWIFT PRIMEs, and EXTEND-IA have used the stent retriever predominantly and have shown unequivocal benefit in the outcome at 90 days for AIS patients with large vessel occlusion. More recently, a new catheter namely 5 MAX ACE was introduced along with improvement in the suction device. This has led to a direct aspiration first pass technique resulting in faster recanalization. Advancements in the endovascular management of AIS with large vessel occlusion have resulted in a paradigm shift in the way this disease is managed. Improvements in patient selection using clinical and imaging criterion along with technical and technological advancements in mechanical thrombectomy have made possible a significantly

  8. Current trends in the management of acute ischemic stroke.

    Science.gov (United States)

    Paramasivam, Srinivasan

    2015-01-01

    Stroke is the leading cause of disability and most of the cases are those of ischemic stroke. Management strategies especially for large vessel occlusive stroke have undergone a significant change in the recent years that include widespread use of thrombolytic medications followed by endovascular clot removal. For successful treatment by endovascular thrombectomy, the important factors are patient selection based on clinical criterion including age, time of onset, premorbid clinical condition, co-morbidities, National Institute of Health Stroke Scale, and imaging criterion including computed tomography (CT) head, CT angiogram and CT perfusion. Patients presenting within 4.5 hours of onset are considered for intravenous (IV) recombinant tissue plasminogen activator treatment. Mechanical clot retrieval devices have evolved over the past decade. The Mechanical Embolus Removal in Cerebral Ischemia device was approved first followed by the penumbra revascularization system. They have proven in various studies to improve recanalization with acceptable rates of symptomatic intra-cerebral hemorrhage. Introduction of stent retrievers has led to a new era in the interventional management of acute ischemic stroke (AIS). Recent trials namely MRCLEAN, ESCAPE, SWIFT PRIMEs, and EXTEND-IA have used the stent retriever predominantly and have shown unequivocal benefit in the outcome at 90 days for AIS patients with large vessel occlusion. More recently, a new catheter namely 5 MAX ACE was introduced along with improvement in the suction device. This has led to a direct aspiration first pass technique resulting in faster recanalization. Advancements in the endovascular management of AIS with large vessel occlusion have resulted in a paradigm shift in the way this disease is managed. Improvements in patient selection using clinical and imaging criterion along with technical and technological advancements in mechanical thrombectomy have made possible a significantly improved outcome

  9. Nitrous oxide fluxes from tropical peat with different disturbance history and management

    Directory of Open Access Journals (Sweden)

    J. Jauhiainen

    2012-04-01

    Full Text Available Tropical peatlands are one of the most important terrestrial ecosystems in terms of impact on the atmospheric greenhouse gas composition. Currently, greenhouse gas emissions from tropical peatlands following disturbances due to deforestation, drainage or wildfire are substantial. We quantified in situ nitrous oxide (N2O fluxes during both dry and wet seasons using a closed chamber method at sites that represented differing land uses and land use change intensities in Central Kalimantan, Indonesia. Cumulative N2O fluxes were compared with carbon dioxide (CO2 and methane (CH4 fluxes.

    The mean N2O flux rates (N2O-N ±: SD, mg m−2 h−1 varied as follows: drained forest (0.112 ± 0.293 > agricultural peat at the Kalampangan site (0.012 ± 0.026 > drained burned peat (0.011 ± 0.018 > agricultural peat at the Marang site (0.0072 ± 0.028 > undrained forest (0.0025 ± 0.053 > clear-felled, drained, recovering forest (0.0022 ± 0.021. The widest N2O flux range was detected in the drained forest (max. 2.312 and min. −0.043 mg N2O-N m−2 h−1. At the other flux monitoring sites the flux ranges remained at about one tenth that of the drained forest site. The highest N2O emission rates were observed at water tables close to the peat surface where also the flux range was widest. Annual cumulative peat surface N2O emissions (expressed in CO2 equivalents as a percentage of the total greenhouse gas (N2O, CO2 and CH4 emissions were 9.2 % at highest, but typically ~1 %. Average N2O fluxes and also the total of monitored GHG emissions were highest in drainage-affected forest which is characterized by continuous labile nitrogen availability from vegetation, and water tables typically below the surface.

  10. Case Report and Management of Suspected Acute Appendicitis in Pregnancy

    OpenAIRE

    Murariu, Daniel; Tatsuno, Brent; Hirai, Cori-Ann M; Takamori, Ryan

    2011-01-01

    Suspected cases of acute appendicitis in pregnancy are considered surgical emergencies due to the potentially devastating outcomes for both mother and unborn child if the appendix perforates. Acute appendicitis is also the number one cause of non-traumatic acute abdomen in pregnancy, as well as the number one cause of fetal death. We present a case report with a typical presentation of suspected acute appendicitis in a pregnant woman. The work up and diagnostic tools available are discussed a...

  11. Modelling forest carbon stock changes as affected by harvest and natural disturbances. I. Comparison with countries' estimates for forest management.

    Science.gov (United States)

    Pilli, Roberto; Grassi, Giacomo; Kurz, Werner A; Viñas, Raúl Abad; Guerrero, Nuria Hue

    2016-12-01

    According to the post-2012 rules under the Kyoto protocol, developed countries that are signatories to the protocol have to estimate and report the greenhouse gas (GHG) emissions and removals from forest management (FM), with the option to exclude the emissions associated to natural disturbances, following the Intergovernmental Panel on Climate Change (IPCC) guidelines. To increase confidence in GHG estimates, the IPCC recommends performing verification activities, i.e. comparing country data with independent estimates. However, countries currently conduct relatively few verification efforts. The aim of this study is to implement a consistent methodological approach using the Carbon Budget Model (CBM) to estimate the net CO2 emissions from FM in 26 European Union (EU) countries for the period 2000-2012, including the impacts of natural disturbances. We validated our results against a totally independent case study and then we compared the CBM results with the data reported by countries in their 2014 Greenhouse Gas Inventories (GHGIs) submitted to the United Nations Framework Convention on Climate Change (UNFCCC). The match between the CBM results and the GHGIs was good in nine countries (i.e. the average of our results is within ±25 % compared to the GHGI and the correlation between CBM and GHGI is significant at P stock-change approach; (2) different assumptions for non-biomass pools, and for CO2 emissions from fires and harvest residues. In few cases, further analysis will be needed to identify any possible inappropriate data used by the CBM or problems in the GHGI. Finally, the frequent updates to data and methods used by countries to prepare GHGI makes the implementation of a consistent modeling methodology challenging. This study indicates opportunities to use the CBM as tool to assist countries in estimating forest carbon dynamics, including the impact of natural disturbances, and to verify the country GHGIs at the EU level, consistent with the IPCC

  12. Hydrologic connectivity of floodplains, northern Missouri: implications for management and restoration of floodplain forest communities in disturbed landscapes

    Science.gov (United States)

    Jacobson, R.; Faust, T.

    2014-01-01

    Hydrologic connectivity between the channel and floodplain is thought to be a dominant factor determining floodplain processes and characteristics of floodplain forests. We explored the role of hydrologic connectivity in explaining floodplain forest community composition along streams in northern Missouri, USA. Hydrologic analyses at 20 streamgages (207–5827 km2 area) document that magnitudes of 2-year return floods increase systematically with increasing drainage area whereas the average annual number and durations of floodplain-connecting events decrease. Flow durations above the active-channel shelf vary little with increasing drainage area, indicating that the active-channel shelf is in quasi-equilibrium with prevailing conditions. The downstream decrease in connectivity is associated with downstream increase in channel incision. These relations at streamflow gaging stations are consistent with regional channel disturbance patterns: channel incision increases downstream, whereas upstream reaches have either not incised or adjusted to incision by forming new equilibrium floodplains. These results provide a framework to explain landscape-scale variations in composition of floodplain forest communities in northern Missouri. Faust () had tentatively explained increases of flood-dependent tree species, and decreases of species diversity, with a downstream increase in flood magnitude and duration. Because frequency and duration of floodplain-connecting events do not increase downstream, we hypothesize instead that increases in relative abundance of flood-dependent trees at larger drainage area result from increasing size of disturbance patches. Bank-overtopping floods at larger drainage area create large, open, depositional landforms that promoted the regeneration of shade-intolerant species. Higher tree species diversity in floodplains with small drainage areas is associated with non-incised floodplains that are frequently connected to their channels and

  13. Inventory-based model estimates of the net impact of natural disturbances on the C balance of Canada’s managed forest lands

    Science.gov (United States)

    Stinson, G.; Kurz, W.; Neilson, E.; Metsaranta, J.

    2009-12-01

    The net impact of natural disturbances on the C budget of Canada’s managed forest lands (230 million ha) has not previously been estimated. Natural disturbances affect forest ecosystem C budgets by directly releasing C to the atmosphere, by transferring large quantities of living biomass to dead organic matter pools which subsequently decompose, and by altering the carbon uptake capacity of the affected ecosystems. We define the net impact as the difference in the forest carbon balance with and without a specific natural disturbance type. We estimated the net impact of fire and insect disturbances on Canada’s managed forest C budget from 1990 through 2007 using the CBM-CFS3, an inventory-based simulation model that uses data from Canada’s National Forest Carbon Monitoring, Accounting and Reporting System (NFCMARS). Four scenarios were simulated: (i) a base scenario that includes all natural disturbances, (ii) base with fire removed, (iii) base with insects removed, and (iv) base with both fire and insects removed. Disturbance impacts were found to be highly variable between years and not normally distributed about their means. Direct fire emissions ranged from 3 to 75 Tg C yr-1 (11 to 291 Mt CO2e yr-1, accounting for CO2, CO, CH4 and N2O) during 1990-2007. Fires that occurred during 1990-2007 reduced NEP during this same period by 1 to 5 Tg C yr-1 and insects reduced NEP by 1 to 17 Tg C yr-1. Fires resulted in a 1 to 12 Tg C yr-1 reduction in NPP while insects reduced NPP by 1 to 13 Tg C yr-1. Insect impacts on heterotrophic respiration (Rh) during 1990-2007 were minor because most of the recorded insect-induced tree mortality occurred towards the end of the period. Interactive effects between natural disturbances and forest management activities (harvest and salvage) were also analyzed. Quantification of natural disturbance impacts on the forest ecosystem C budget is not staight forward on a land base where natural and anthropogenic factors are interacting

  14. Acute wound management: revisiting the approach to assessment, irrigation, and closure considerations

    OpenAIRE

    Nicks, Bret A.; Ayello, Elizabeth A.; Woo, Kevin; Nitzki-George, Diane; Sibbald, R. Gary

    2010-01-01

    Background As millions of emergency department (ED) visits each year include wound care, emergency care providers must remain experts in acute wound management. The variety of acute wounds presenting to the ED challenge the physician to select the most appropriate management to facilitate healing. A complete wound history along with anatomic and specific medical considerations for each patient provides the basis of decision making for wound management. It is essential to apply an evidence‐bas...

  15. Post-traumatic acute bilateral facial nerve palsy - a management dilemma

    Directory of Open Access Journals (Sweden)

    Kumar Rakesh

    2015-03-01

    Full Text Available Acute bilateral facial nerve paralysis is a rare clinical entity, and its management remains very controversial (operative or conservative. Here we are presenting a case of acute onset bilateral facial nerve palsy following head injury with bilateral temporal bone fracture with clinico-radiographic contrary. Patient was managed conservatively with complete recovery. By this article, authors want to stress on combining clinical examination and radiological findings for decision making of this rare entity and tried to evaluate the management.

  16. Endoscopic management of acute cholangitis in elderly patients

    Institute of Scientific and Technical Information of China (English)

    Naresh Agarwal; Barjesh Chander Sharma; Shiv K Sarin

    2006-01-01

    AIM: To evaluate clinical presentation, etiology, complications and response to treatment in elderly patients with acute cholangitis.METHODS: Demographics, etiology of biliary obstruction, clinical features, complications and associated systemic diseases of 175 patients with acute cholangitis were recorded. Endoscopic biliary drainage was performed using nasobiliary drain or stent. The complications related to ERCP, success of biliary drainage, morbidity, mortality and length of hospital stay were evaluated.RESULTS: Of 175 patients, 52 aged≥60 years (groupⅠ,age<60 years; groupⅡ,age≥60 years) and 105 were men. Fever was present in 38 of 52 patients of group Ⅱ compared to 120 of 123 in group Ⅰ. High fever (fever≥38.0℃) was more common in group Ⅰ (118/120 vs 18/38). Hypotension (5/123 vs 13/52),altered sensorium (3/123 vs 19/52), peritonism (22/123 vs 14/52), renal failure (5/123 vs 14/52) and associated comorbid diseases (4/123 vs 21/52) were more common in group Ⅱ. Biliopancreatic malignancy was a common cause of biliary obstruction in group Ⅱ (n = 34) and benign diseases in group Ⅰ (n = 120). Indications for biliary drainage were any one of the following either singly or in combination: a fever of≥38.0℃ (n=136),hypotension (n=18), peritonism (n=36), altered sensorium (n=22), and failure to improve within 72h of conservative management (n=22). High grade fever was more common indication of biliary drainage in group Ⅰ and hypotension, altered sensorium, peritonism and failure to improve within 72 h of conservative management were more common indications in group Ⅱ. Endoscopic biliary drainage was achieved in 172 patients (nasobiliary drain: 56 group Ⅰ, 24 group Ⅱ,stent: 64 group Ⅰ, 28 group Ⅱ) without any significant age related difference in the success rate. Abdominal pain, fever, jaundice, hypotension, altered sensorium,peritonism and renal failure improved after median time of 5 d in 120 patients in group Ⅰ (2-15 d

  17. In vitro infection of pupae with Israeli acute paralysis virus suggests disturbance of transcriptional homeostasis in honey bees (Apis mellifera.

    Directory of Open Access Journals (Sweden)

    Humberto F Boncristiani

    Full Text Available The ongoing decline of honey bee health worldwide is a serious economic and ecological concern. One major contributor to the decline are pathogens, including several honey bee viruses. However, information is limited on the biology of bee viruses and molecular interactions with their hosts. An experimental protocol to test these systems was developed, using injections of Israeli Acute Paralysis Virus (IAPV into honey bee pupae reared ex-situ under laboratory conditions. The infected pupae developed pronounced but variable patterns of disease. Symptoms varied from complete cessation of development with no visual evidence of disease to rapid darkening of a part or the entire body. Considerable differences in IAPV titer dynamics were observed, suggesting significant variation in resistance to IAPV among and possibly within honey bee colonies. Thus, selective breeding for virus resistance should be possible. Gene expression analyses of three separate experiments suggest IAPV disruption of transcriptional homeostasis of several fundamental cellular functions, including an up-regulation of the ribosomal biogenesis pathway. These results provide first insights into the mechanisms of IAPV pathogenicity. They mirror a transcriptional survey of honey bees afflicted with Colony Collapse Disorder and thus support the hypothesis that viruses play a critical role in declining honey bee health.

  18. 1H NMR spectroscopic analysis detects metabolic disturbances in rat urine on acute exposure to heavy metal tungsten alloy based metals salt.

    Science.gov (United States)

    Tyagi, Ritu; Rana, Poonam; Gupta, Mamta; Bhatnagar, Deepak; Srivastava, Shatakshi; Roy, Raja; Khushu, Subash

    2014-03-25

    Heavy metal tungsten alloys (HMTAs) have been found to be safer alternatives for making military munitions. Recently, some studies demonstrating the toxic potential of HMTAs have raised concern over the safety issues, and further propose that HMTAs exposure may lead to physiological disturbances as well. To look for the systemic effect of acute toxicity of HMTA based metals salt, (1)H nuclear magnetic resonance ((1)H NMR) spectroscopic profiling of rat urine was carried out. Male Sprague Dawley rats were administered (intraperitoneal) low and high dose of mixture of HMTA based metals salt and NMR spectroscopy was carried out in urine samples collected at 8, 24, 72 and 120 h post dosing (p.d.). Serum biochemical parameters and liver histopathology were also conducted. The (1)H NMR spectra were analysed using multivariate analysis techniques to show the time- and dose-dependent biochemical variations in post HMTA based metals salt exposure. Urine metabolomic analysis showed changes associated with energy metabolism, amino acids, N-methyl nicotinamide, membrane and gut flora metabolites. Multivariate analysis showed maximum variation with best classification of control and treated groups at 24h p.d. At the end of the study, for the low dose group most of the changes at metabolite level reverted to control except for the energy metabolites; whereas, in the high dose group some of the changes still persisted. The observations were well correlated with histopathological and serum biochemical parameters. Further, metabolic pathway analysis clarified that amongst all the metabolic pathways analysed, tricarboxylic acid cycle was most affected at all the time points indicating a switchover in energy metabolism from aerobic to anaerobic. These results suggest that exposure of rats to acute doses of HMTA based metals salt disrupts physiological metabolism with moderate injury to the liver, which might indirectly result from heavy metals induced oxidative stress.

  19. Management of acute bursitis: outcome study of a structured approach.

    Science.gov (United States)

    Stell, I M

    1999-01-01

    In patients with septic bursitis the indications for admission and surgical intervention remain unclear, and practice has varied widely. The effectiveness of a conservative outpatient based approach was assessed by an outcome study in a prospective case series. Consecutive patients attending an emergency department with acute swelling of the olecranon or prepatellar bursa were managed according to a structured approach, subjective and objective outcomes being assessed after two to three days, and subsequently as required until clinical discharge. Long-term outcomes were assessed by telephone follow-up for up to eighteen months. 47 patients were included in the study: 22 had septic bursitis, 15 of the olecranon bursa and 7 of the prepatellar bursa. The mean visual analogue pain scores of those with septic bursitis improved from 4.8 at presentation to 1.7 at first follow-up for olecranon bursitis, and from 3.8 to 2.7 for prepatellar bursitis. Symptoms improved more slowly for patients with non-septic bursitis. No patients were admitted initially, but 2 were admitted (two days each) after the first follow-up appointment. One patient had incision and drainage on the third attendance, and 3 patients developed discharging sinuses, which all healed spontaneously. All patients made a good long-term symptomatic recovery and all could lean on the elbow or kneel by the end of the follow-up period. The management protocol, with specific criteria for admission and surgical intervention, thus produced good results with little need for operation or admission. PMID:10692903

  20. [Management of coronary artery disease at the acute phase].

    Science.gov (United States)

    Chatot, Marion; Schiele, François

    2015-03-01

    In patients with acute coronary syndrome (ACS), early management is of prime importance. However, the median time taken by the patient to call the emergency services is often very long, up to 2 hours. The presence of a physician as first responder ensures good quality resuscitation in case of cardiac arrest, and allows recording of a first ECG, which can be very informative, especially in ACS without ST segment elevation. Treatment at this stage is limited to sublingual nitroglycerin and aspirin. If the first ECG shows ST segment elevation, the patient should be immediately oriented for reperfusion, usually by percutaneous coronary intervention. in the absence of ST segment elevation, the diagnosis of ACS remains unconfirmed. This does not imply that the risk is lesser, but rather that the risk cannot be evaluated accurately in the pre-hospital setting. The use of risk scores can guide the choice of management towards an invasive strategy, including coronary angiography (immediately, or within 24-72 hours). Low-risk patients are candidates for an invasive strategy, provided non-invasive tests demonstrate the presence of ischemia. During the hospital phase, antiplatelet treatment should be initiated and must be adapted to the patient bleeding and thrombotic risk. Clopidogrel is recommended only in patients who are not amenable to prasugrel or ticagrelor. Statin therapy should be initiated from day one, regardless of the initial cholesterol level, preferably with 80 mg atorvastatin. Angiotensin-converting enzyme inhibitors and beta-blockers should also be prescribed to complete the medical prescription both in-hospital and in the long term.

  1. Quantifying Carbon Consequences of Recent Land Management and Disturbances in the Greater Yellowstone Ecosystems (GYE) by linking inventory data, remote sensing and carbon modeling

    Science.gov (United States)

    Zhao, F.; Huang, C.; Healey, S. P.; McCarter, J. B.; Garrard, C.; Zhu, Z.

    2015-12-01

    Natural disturbances and land management directly change C stored in biomass and soil pools, and can have indirect impacts on long-term C balance. The Greater Yellowstone Ecosystem (GYE), located in Central Rocky Mountains of United States, is of different land ownerships within similar environmental settings, making it an ideal site to examine the impacts of management and disturbances on regional carbon dynamics. Recent advances in the remote sensing of vegetation condition and change, along with new techniques linking remote sensing with inventory records, have allowed investigations that are much more tightly constrained to actual landscape environment, instead of hypothetical or generalized conditions. These new capabilities are built into the Forest Carbon Management Framework (ForCaMF), which is being used by the National Forest System to not only model, but to monitor across very specific management units, the impact of different kinds of disturbance on carbon storage. In this study, we used the ForCaMF approach to evaluate carbon effects of natural disturbances (e.g. wildfire) and land management (e.g. harvests) in GYE National Parks, Wilderness Area and National Forests. As might be expected, wildfire has been the dominant disturbance factor in the carbon cycle of GYE's administratively protected areas since the mid-1980s, while harvests have dominated storage trends on the managed land in the region's National Forests. Moving beyond this monitoring result but maintaining the same fidelity to historical vegetation patterns, we are also able to simulate alternative disturbance scenarios to provide landscape-specific insights to forest managers. We can estimate likely carbon storage impacts in GYE protected areas, for example, if more active fire suppression had been pursued since the mid-1980s. Likewise, we can identify differences in current carbon storage on managed lands if high harvest rates during the same period had been moderated. We discuss

  2. Management of Philadelphia chromosome-positive acute lymphoblastic leukemia.

    Science.gov (United States)

    Ottmann, O G

    2012-08-01

    Tyrosine kinase inhibitors (TKIs) directed against the ABL kinase are now used routinely during frontline therapy for Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL) and result in hematologic remission rates exceeding 90%. Minimal residual disease levels are generally lower when TKIs are used in combination with chemotherapy rather than as monotherapy. Although outcome has improved substantially with TKI-based regimens compared with historic controls, allogeneic stem cell transplantation (SCT) in first remission provides the best chance of cure for the majority of patients eligible for SCT. Administration of imatinib after SCT further reduces molecular recurrence and is associated with greatly improved relapse-free and overall survival. The high relapse rate in non-transplanted patients is largely attributable to the emergence of leukemic clones with mutations in the tyrosine kinase domain of BCR-ABL. Ongoing studies with newer TKIs will determine whether these more potent agents are able to sustain remissions without SCT. Assessment of minimal residual disease has become an integral part of the management of Ph+ALL, as it has prognostic importance and is used to guide therapeutic intervention. Novel immunotherapeutic interventions and combinations of TKIs are currently being investigated in clinical trials and may further improve the prognosis of patients with Ph+ALL.

  3. [The acute stage of the cerebrovascular accident; characteristics and management].

    Science.gov (United States)

    Schuling, J; Greidanus, J

    1992-02-29

    Description of stroke patient characteristics, outcome in the acute phase (the first 3 weeks post-stroke) and management by the general practitioner (GP). Community based prospective study. During the research period GPs reported all stroke patients (first event as well as recurring); these patients were followed at fixed intervals post-stroke regardless of treatment. The 98 GPs reported 185 patients. Stroke patients are predominantly old to very old people with a lot of comorbidity and an impaired pre-stroke functional status. The GP treated one third of the patients himself; half of the patients were instantly referred to a hospital. Younger patients are referred for further examination, probably because of possible therapeutic consequences. The very old are referred if their impairment makes home care impossible. Mortality, especially in the hospital group is high; 10% died within 24 hours, while after 1 week this figure was 17% and after 3 weeks 23%. In 21% of the referred patients no CT scan was made; the motive for referral was to provide sufficient care for the patient. In nine referred patients (8%) the diagnosis was changed. In choosing a strategy the GP considers several factors, of which impairment and the possibilities of home care are the most important. Diagnostic uncertainty played a minor role.

  4. Update on the management of acute pharyngitis in children

    Directory of Open Access Journals (Sweden)

    Galli Luisa

    2011-01-01

    Full Text Available Abstract Streptococcal pharyngitis is a very common pathology in paediatric age all over the world. Nevertheless there isn't a joint agreement on the management of this condition. Some authors recommend to perform a microbiological investigation in suspected bacterial cases in order to treat the confirmed cases with antibiotics so to prevent suppurative complications and acute rheumatic fever. Differently, other authors consider pharyngitis, even streptococcal one, a benign, self-limiting disease. Consequently they wouldn't routinely perform microbiological tests and, pointing to a judicious use of antibiotics, they would reserve antimicrobial treatment to well-selected cases. It has been calculated that the number of patients needed to treat to prevent one complication after upper respiratory tract infections (including sore throat, was over 4000. Even the use of the Centor score, in order to evaluate the risk of streptococcal infection, is under debate and the interpretation of the test results may vary considerably. Penicillin is considered all over the world as first line treatment, but oral amoxicillin is also accepted and, due to its better palatability, can be a suitable option. Macrolides should be reserved to the rare cases of proved allergy to β-lactams. Cephalosporins can be used in patients allergic to penicillin (with the exception of type I hypersensibility and have been also proposed to treat the relapses.

  5. Management of acute stroke: impact of registration studies.

    Science.gov (United States)

    Adams, Harold P

    2010-09-01

    Stroke is a life-threatening or life-changing disease that is expensive in health care costs and lost productivity. Stroke also is a leading cause of human suffering. While the risk of stroke may be reduced with advances in prevention, recent advances in acute care can limit the consequences of stroke. In particular, the success of reperfusion therapies including intra-arterial interventions and intravenous administration of thrombolytic agents means that some patients with stroke may be cured. Still, the time window for effective treatment of stroke is relatively short. As a result, modern stroke management requires the close collaboration of the public, health care providers, administrators, insurance companies, and the government. Potential strategies to extend modern stroke care to as many patients as possible include 1) educational programs to train community emergency medical service personnel and physicians, 2) development of stroke care plans at community hospitals, 3) an integrated community-comprehensive stroke center program based on consultation, and telemedicine. The goal is to have a highly integrated approach to provide emergency treatment of the stroke that provides key emergency treatment, including intravenous administration of thrombolytic medications, at a community hospital (primary stroke center) with evacuation to a comprehensive stroke center that has resources and expertise that are not available in the primary stroke center. Taiwan is an ideal location for the development of such regional stroke programs.

  6. Introduction of an acute surgical unit: comparison of performance indicators and outcomes for operative management of acute appendicitis.

    Science.gov (United States)

    Lancashire, John F; Steele, M; Parker, D; Puhalla, H

    2014-08-01

    The Acute Surgical Unit (ASU) is a recent change in management of acute general surgical patients in hospitals worldwide. In contrast to traditional management of acute surgical presentations by a rotating on-call system, ASUs are shown to deliver improved efficiency and patient outcomes. This study investigated the impact of an ASU on operative management of appendicitis, the most common acute surgical presentation, by comparing performance indicators and patient outcomes prior to and after introduction of an ASU at the Gold Coast Hospital, Queensland, Australia. A retrospective study of patients admitted from the Emergency Department (ED) and who underwent emergency appendectomy from February 2010 to January 2011 (pre-ASU) and after introduction of the ASU from February 2011 to January 2012 (post-ASU). A total of 548 patients underwent appendectomy between February 2010 and January 2012, comprising 247 pre-ASU and 301 post-ASU patients. Significant improvements were demonstrated: reduced time to surgical review, fewer complications arising from operations commencing during ASU in-hours, and more appendectomies performed during the daytime attended by the consultant. There was no significant difference in total cost of admission or total admission length of stay. This study demonstrated that ASUs have potential to significantly improve the outcomes for operative management of acute appendicitis compared to the traditional on-call model. The impact of the ASU was limited by access to theaters and restricted ASU operation hours. Further investigation of site-specific determinants could be beneficial to optimize this new model of acute surgical care.

  7. Acute respiratory distress syndrome: epidemiology and management approaches

    Directory of Open Access Journals (Sweden)

    Walkey AJ

    2012-07-01

    Full Text Available Allan J Walkey,1 Ross Summer,1 Vu Ho,1 Philip Alkana21The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA; 2Asthma Research Center, Brigham and Women's Hospital, Boston, MA, USAAbstract: Acute lung injury and the more severe acute respiratory distress syndrome represent a spectrum of lung disease characterized by the sudden onset of inflammatory pulmonary edema secondary to myriad local or systemic insults. The present article provides a review of current evidence in the epidemiology and treatment of acute lung injury and acute respiratory distress syndrome, with a focus on significant knowledge gaps that may be addressed through epidemiologic methods.Keywords: acute lung injury, acute respiratory distress syndrome, review, epidemiology

  8. JPN Guidelines for the management of acute pancreatitis: cutting-edge information

    OpenAIRE

    Takada, Tadahiro; Kawarada, Yoshifumi; Hirata, Koichi; Mayumi, Toshihiko; Yoshida, Masahiro; Sekimoto, Miho; Hirota, Masahiko; Kimura, Yasutoshi; Takeda, Kazunori; Isaji, Shuji; Koizumi, Masaru; Otsuki, Makoto; Matsuno, Seiki

    2006-01-01

    The JPN Guidelines for the Management of Acute Pancreatitis are organized under the subject headings: epidemiology, diagnosis, management strategy, severity assessment and transfer criteria, management of gallstone pancreatitis, nonsurgical management, and surgical management. The Guidelines contain cutting-edge information on each of these subjects, as well as a section on the Japanese medical insurance system which provides information that should prove useful to physicians in other countri...

  9. Acute Diagnosis and Management of Stroke Presenting Dizziness or Vertigo.

    Science.gov (United States)

    Lee, Seung-Han; Kim, Ji-Soo

    2015-08-01

    Stroke involving the brainstem and cerebellum frequently presents acute vestibular syndrome. Although vascular vertigo is known to usually accompany other neurologic symptoms and signs, isolated vertigo from small infarcts involving the cerebellum or brainstem has been increasingly recognized. Bedside neuro-otologic examination can reliably differentiate acute vestibular syndrome due to stroke from more benign inner ear disease. Sometimes acute isolated audiovestibular loss may herald impending infarction in the territory of the anterior inferior cerebellar artery. Accurate identification of isolated vascular vertigo is very important because misdiagnosis of acute stroke may result in significant morbidity and mortality.

  10. Case report and management of suspected acute appendicitis in pregnancy.

    Science.gov (United States)

    Murariu, Daniel; Tatsuno, Brent; Hirai, Cori-Ann M; Takamori, Ryan

    2011-02-01

    Suspected cases of acute appendicitis in pregnancy are considered surgical emergencies due to the potentially devastating outcomes for both mother and unborn child if the appendix perforates. Acute appendicitis is also the number one cause of non-traumatic acute abdomen in pregnancy, as well as the number one cause of fetal death. We present a case report with a typical presentation of suspected acute appendicitis in a pregnant woman. The work up and diagnostic tools available are discussed at length, as well as the finer points in treatment of this population.

  11. Acute Management and Secondary Prophylaxis of Esophageal Variceal Bleeding: A Western Canadian Survey

    Directory of Open Access Journals (Sweden)

    Justin Cheung

    2006-01-01

    Full Text Available BACKGROUND: Acute esophageal variceal bleeding (EVB is a major cause of morbidity and mortality in patients with liver cirrhosis. Guidelines have been published in 1997; however, variability in the acute management and prevention of EVB rebleeding may occur.

  12. Management of acute mastoiditis in children. A retrospective study and literature review

    Directory of Open Access Journals (Sweden)

    Wafa Abid

    2014-11-01

    Conclusion: Initial management of acute mastoiditis starts with intravenous antibiotics and computerized tomographic scan of the petrous temporal bones. Surgical approach is required in case of complications or failure of medical treatment. Watchful clinical monitoring is essential in all cases.

  13. A Nurse's Guide to the Acute Management of Suicidal Patients in the Student Health Center

    Science.gov (United States)

    Baker, Howard S.

    1978-01-01

    The acute management of suicidal patients requires that the helper (1) be aware of feelings of anger and fear toward these patients and (2) try to understand the nature of the patients' depression and helpless feelings. (MM)

  14. Understanding gut-immune interactions in management of acute infectious diarrhoea.

    Science.gov (United States)

    Calder, P; Hall, V

    2012-11-01

    This article discusses the role that immunity plays in the risk of diarrhoea and the potential role for probiotics in the management of acute infectious diarrhoea in older people, including antibiotic-associated diarrhoea and Clostridium difficile-associated diarrhoea.

  15. Acute intoxications: differences in management between six Dutch hospitals.

    NARCIS (Netherlands)

    Duineveld, C.; Vroegop, M.; Schouren, L.; Hoedemaekers, A.; Schouten, J.A.; Moret-Hartman, M.; Kramers, C.

    2012-01-01

    CONTEXT: Acute intoxications are frequently seen in Dutch hospitals. Based on single-centre studies and the fact that there are no clear guidelines, we hypothesised that hospital admission of acute intoxications may vary. Furthermore, decontamination treatment of poisonings may differ between hospit

  16. Acute intoxications: differences in management between six Dutch hospitals.

    NARCIS (Netherlands)

    Duineveld, C.; Vroegop, M.; Schouren, L.; Hoedemaekers, A.; Schouten, J.A.; Moret-Hartman, M.; Kramers, C.

    2012-01-01

    CONTEXT: Acute intoxications are frequently seen in Dutch hospitals. Based on single-centre studies and the fact that there are no clear guidelines, we hypothesised that hospital admission of acute intoxications may vary. Furthermore, decontamination treatment of poisonings may differ between

  17. Acute intoxications: differences in management between six Dutch hospitals.

    NARCIS (Netherlands)

    Duineveld, C.; Vroegop, M.; Schouren, L.; Hoedemaekers, A.; Schouten, J.A.; Moret-Hartman, M.; Kramers, C.

    2012-01-01

    CONTEXT: Acute intoxications are frequently seen in Dutch hospitals. Based on single-centre studies and the fact that there are no clear guidelines, we hypothesised that hospital admission of acute intoxications may vary. Furthermore, decontamination treatment of poisonings may differ between hospit

  18. [Management of avoidable acute transfers from an intermediate care geriatric facility to acute hospitals: critical aspects of an intervention protocol].

    Science.gov (United States)

    Colprim, Daniel; Casco, Mónica; Malumbres, Jennifer; Rodríguez, Ginés; Inzitari, Marco

    The unplanned transfers (UT) from post-acute intermediate care facilities, are associated with adverse outcomes for patients, and a significant cost to the system. We present a practical protocol and the design of an intervention study aimed at reducing avoidable UT from a geriatric post-acute rehabilitation setting to acute care hospitals. A quasi-experimental non randomized study. The intervention consists in: 1) protocol for early detection of symptoms in order to conduct a pro-active management of decompensation; 2) an advanced care planning structured protocol for the acute decompensations. We will compare the intervention group with a parallel and a historical cohort for demographic, functional, cognitive, comorbidity and social variables. number of UT to acute care hospitals. This is a quasi-experimental study, focused on everyday care practice that intends to assess the impact of multi-disciplinary and multi-factorial intervention to reduce UT from a post-acute rehabilitation unit. We expect that the project results will be useful for future randomized and controlled studies. Copyright © 2016 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Acute Pain Management Services: What Does the Air Force Have to Offer?

    Science.gov (United States)

    2013-01-29

    Unrelieved pain due to this nociception , after surgery or trauma is often unhealthy, but it is preventable or controllable in a majority of cases...DC 20503. 1. AGENCY USE ONLY (Leaveblank) 2. REPORT DATE 26-Sep-97 3. REPORT TYPE AND DATES COVERED 4. TITLE AND SUBTITLE ACUTE PAIN MANAGEMENT...Prescribed by ANSI Std. 239.18 Designed using Perform Pro, WHS/DIOR. Oct 94 ACUTE PAIN MANAGEMENT SERVICES: WHAT DOES THE AIR FORCE HAVE TO OFFER

  20. Acute mastoiditis in children: susceptibility factors and management.

    Science.gov (United States)

    Spremo, Slobodan; Udovcić, Biljana

    2007-05-01

    The objective was to review our experience with clinical course, diagnostic and therapeutic profile of children treated for acute mastoiditis, and to investigate for possible susceptibility factors. Study was designed as retrospective review of pediatric patients presenting with acute mastoiditis secondary to acute otitis media over the last 6 years, from 2000 to 2006. The study involved children aged from 1 to 16 years treated for acute mastoiditis and subsequent intratemporal and intracranial complications in Clinic for otorhinolaryngology, Clinic Center Banja Luka. Selected clinical parameters, mastoid coalescence and risk factors for necessity of surgical intervention were analyzed. Medical history review of a total of 13 patients with acute mastoiditis was analyzed. Acute coalescent mastoiditis occurred 11 patients (84%) while noncoalescent form of acute mastoiditis occurred in 2 cases (16%). Intracranial complication occurred in 3 patients (2 meningitis and 1 peridural intracranial abscess), while 2 patients had intratemporal complication (subperiostal abscess) associated to coalescent mastoiditis. We observed clinical profile of acute mastoiditis in regard to pathology found on the tympanic membrane, middle ear mucosa and destructions on the bony wall of the middle ear and mastoid. The main signs of progressive infection were tympanic membrane perforation, pulsatile suppurative secretion from the mucosa, and intratemporal abscess. All patients with coalescent mastoiditis required mastoidectomy, while noncoalescent mastoiditis was treated conservatively with broad-spectrum intravenous antibiotics and myringotomy. In conclusion acute mastoiditis is uncommon but serious complication of acute otitis media in children associated with significant morbidity. Coalescent mastoiditis concomitant with subperiostal abscess, intracranial complications and mastoiditis not responsive after 48 hours to intravenous antibiotics should urge clinician to timely mastoid surgery.

  1. Perspectives on the value of biomarkers in acute cardiac care and implications for strategic management.

    Science.gov (United States)

    Kossaify, Antoine; Garcia, Annie; Succar, Sami; Ibrahim, Antoine; Moussallem, Nicolas; Kossaify, Mikhael; Grollier, Gilles

    2013-01-01

    Biomarkers in acute cardiac care are gaining increasing interest given their clinical benefits. This study is a review of the major conditions in acute cardiac care, with a focus on biomarkers for diagnostic and prognostic assessment. Through a PubMed search, 110 relevant articles were selected. The most commonly used cardiac biomarkers (cardiac troponin, natriuretic peptides, and C-reactive protein) are presented first, followed by a description of variable acute cardiac conditions with their relevant biomarkers. In addition to the conventional use of natriuretic peptides, cardiac troponin, and C-reactive protein, other biomarkers are outlined in variable critical conditions that may be related to acute cardiac illness. These include ST2 and chromogranin A in acute dyspnea and acute heart failure, matrix metalloproteinase in acute chest pain, heart-type fatty acid binding protein in acute coronary syndrome, CD40 ligand and interleukin-6 in acute myocardial infarction, blood ammonia and lactate in cardiac arrest, as well as tumor necrosis factor-alpha in atrial fibrillation. Endothelial dysfunction, oxidative stress and inflammation are involved in the physiopathology of most cardiac diseases, whether acute or chronic. In summary, natriuretic peptides, cardiac troponin, C-reactive protein are currently the most relevant biomarkers in acute cardiac care. Point-of-care testing and multi-markers use are essential for prompt diagnostic approach and tailored strategic management.

  2. Pain Management in the Emergency Chain: The Use and Effectiveness of Pain Management in Patients With Acute Musculoskeletal Pain

    NARCIS (Netherlands)

    Pierik, J.G.J.; IJzerman, M.J.; Gaakeer, Menno I.; Berben, Sivera A.; Eenennaam, Fred L.; Vugt, van Arie B.; Doggen, C.J.M.

    2015-01-01

    Objective While acute musculoskeletal pain is a frequent complaint in emergency care, its management is often neglected, placing patients at risk for insufficient pain relief. Our aim is to investigate how often pain management is provided in the prehospital phase and emergency department (ED) and h

  3. Pain management in the emergency chain: the use and effectiveness of pain management in patients with acute musculoskeletal pain

    NARCIS (Netherlands)

    Pierik, J.G.; IJzerman, M.J.; Gaakeer, M.I.; Berben, S.A.; Eenennaam, F.L. van; Vugt, A.B. van; Doggen, C.J.

    2015-01-01

    OBJECTIVE: While acute musculoskeletal pain is a frequent complaint in emergency care, its management is often neglected, placing patients at risk for insufficient pain relief. Our aim is to investigate how often pain management is provided in the prehospital phase and emergency department (ED) and

  4. Role of general practitioner in the management of acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Beeleonie Beeleonie

    2005-12-01

    Full Text Available Acute myocardial infarction (AMI has been the leading cause of death in Western countries, as well as in Indonesia. Delay in diagnosis and incorrect early management often result in failure of thrombolytic reperfusion. General practitioner (GP as the primary care, needs to be equipped with the ability to diagnose and moreover to manage AMI. A case of fail thrombolytic management in a 47 years old man after seven hours of angina typical chest pain, after previously managed by GP, is being reported. (Med J Indones 2005; 14:249-52Keywords: acute myocardial infarction, reperfusion, general practitioner

  5. Emotional Disturbance

    Science.gov (United States)

    ... skills, and increase self-awareness, self-control, and self-esteem. A large body of research exists regarding methods ... not. Back to top Other Considerations Children and adolescents with an emotional disturbance should receive services based ...

  6. Intranasal fentanyl for the management of acute pain in children.

    Science.gov (United States)

    Murphy, Adrian; O'Sullivan, Ronan; Wakai, Abel; Grant, Timothy S; Barrett, Michael J; Cronin, John; McCoy, Siobhan C; Hom, Jeffrey; Kandamany, Nandini

    2014-10-10

    Pain is the most common symptom in the emergency setting; however, timely management of acute pain in children continues to be suboptimal. Intranasal drug delivery has emerged as an alternative method of achieving quicker drug delivery without adding to the distress of a child by inserting an intravenous cannula. We identified and evaluated all randomized controlled trials (RCTs) and quasi-randomized trials to assess the effects of intranasal fentanyl (INF) versus alternative analgesic interventions in children with acute pain, with respect to reduction in pain score, occurrence of adverse events, patient tolerability, use of "rescue analgesia," patient/parental satisfaction and patient mortality. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 1); MEDLINE (Ovid SP, from 1995 to January 2014); EMBASE (Ovid SP, from 1995 to January 2014); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO Host, from 1995 to January 2014); the Latin American and Caribbean Health Science Information Database (LILACS) (BIREME, from 1995 to January 2014); Commonwealth Agricultural Bureaux (CAB) Abstracts (from 1995 to January 2014); the Institute for Scientific Information (ISI) Web of Science (from 1995 to January 2014); BIOSIS Previews (from 1995 to January 2014); the China National Knowledge Infrastructure (CNKI) (from 1995 to January 2014); International Standard Randomized Controlled Trial Number (ISRCTN) (from 1995 to January 2014); ClinicalTrials.gov (from 1995 to January 2014); and the International Clinical Trials Registry Platform (ICTRP) (to January 2014). We included RCTs comparing INF versus any other pharmacological/non-pharmacological intervention for the treatment of children in acute pain (aged < 18 years). Two independent review authors assessed each title and abstract for relevance. Full copies of all studies that met the inclusion criteria were retrieved for further assessment. Mean difference (MD), odds

  7. Improving Survival and Growth of Planted Austrocedrus chilensis Seedlings in Disturbed Patagonian Forests of Argentina by Managing Understory Vegetation

    Science.gov (United States)

    Pafundi, Leticia; Urretavizcaya, M. Florencia; Defossé, Guillermo E.

    2014-12-01

    This study was aimed at determining, under field conditions, early interactions between planted cypress seedlings and their associated shrubs in a mesic area of Andean Patagonia and, in a nursery, the effects of increasing light availability on cypress performance when soil water was not a limiting factor. The field experiment was performed in a former cypress-coihue mixed forest (42°02'S, 71°33'W), which was replaced in the 1970s by a plantation of radiata pine. In 2005, 800 cypress seedlings were planted under maqui shrubs in a clear-cut area of the pine stand. In 2007, two treatments were set: no-competition treatment ([NCT] i.e., the surrounding aboveground biomass was removed) and competition treatment ([CT] i.e., without disturbance). The nursery experiment (42°55'S, 71°21'W) consisted of two groups: "shade" (grown under shade cloth) and "sun" (grown at full sun) cypress seedlings. After one growing season, seedling survival and stem growth (in height and diameter) were determined at both sites. Furthermore, the growth rate of leaves, stems, and roots was determined in the nursery. In the field experiment, height growth and survival in NCT were significantly greater than in CT, and a competition process occurred between cypress and surrounding shrubs. In the nursery, sun plants grew more in diameter and increased root weight more than shade plants. Results also showed that in mesic areas of Patagonia, decreasing competition and increasing light levels produced stouter seedlings better adapted to support harsh environmental conditions. Therefore, the removal of protecting shrubs could be a good management practice to improve seedling establishment.

  8. Diagnostic approach and management of acute abdominal pain.

    Science.gov (United States)

    Abdullah, Murdani; Firmansyah, M Adi

    2012-10-01

    The incidence of acute abdominal pain ranges between 5-10% of all visits at emergency department. Abdominal emergencies of hospital visits may include surgical and non-surgical emergencies. The most common causes of acute abdomen are appendicitis, biliary colic, cholecystitis, diverticulitis, bowel obstruction, visceral perforation, pancreatitis, peritonitis, salpingitis, mesenteric adenitis and renal colic. Good skills in early diagnosis require a sound knowledge of basic anatomy and physiology of gastrointestinal tract, which are reflected during history taking and particularly, physical examination of the abdomen. Advanced diagnostic approaches such as radiography and endoscopy enhance the treatment for acute abdomen including pharmacological and surgical treatment. Therapeutic endoscopy, interventional radiology treatment and therapy using adult laparoscopy are the common modalities for treating patients with acute abdomen.

  9. Advances in management of patients with acute diverticulitis

    Institute of Scientific and Technical Information of China (English)

    Sibilla Focchi; Alberto Carrara; Ettore Contessini Avesani

    2015-01-01

    Objective: To analyse the development of the medical and surgical treatment of acute diverticulitis to develop an appropriate decision-making algorithm. Methods:We analysed the demographic characteristics, radiological images, disease severity, treatments and surgical outcomes of all of the patients with a diagnosis of acute diverticulitis admitted to the Department of General and Emergency Surgery between 1 January 2009 and 30 June 2014. Results:During the 66-month study period, 219 patients with acute diverticulitis attended our department; 69% had simple diverticulitis (93% were treated conservatively and 7% surgically) and 31% had complicated diverticulitis (76% were treated surgically and 24% conservatively). Of the patients who were treated surgically, 62.5% underwent primary resection with anastomosis, 31.94% Hartmann's procedure, and 5.56% laparoscopic lavage and drainage. Conclusions: Our cases and a careful review of the literature allowed us to develop a decision-making algorithm for patients with acute diverticulitis.

  10. Advances in Management of Acute Promyelocytic Leukemia with Arsenic Trioxide

    Institute of Scientific and Technical Information of China (English)

    MA Jun

    2007-01-01

    @@ Acute promyelocytic leukemia (APL), with specific features in cell morphology, is classified as M3 by French-American-British (FAB).Among M3, 95% of patients show specific chromosome translocation t(15;17)q(22;21) with PML-RAR α fusion gene, and 5% of patients show other subtypes. According to the statistical analysis of 2 540 adult acute myeloid leukemia (AML)cases in Harbin Institute of Hematology & Oncology, APL accounted for 23%.

  11. Acute severe mitral regurgitation. Pathophysiology, clinical recognition, and management.

    Science.gov (United States)

    DePace, N L; Nestico, P F; Morganroth, J

    1985-02-01

    Acute severe mitral regurgitation often goes unrecognized as an emergency requiring prompt, lifesaving treatment. Its causes, physical signs, natural history, echocardiographic features, and findings on chest roentgenography, electrocardiography, and nuclear scintigraphic scanning are reviewed. Acute severe mitral insufficiency can be differentiated from chronic severe mitral insufficiency by noninvasive two-dimensional echocardiography. M-mode echocardiography is a valuable tool in evaluating mitral prosthetic paravalvular regurgitation.

  12. Parents' beliefs and knowledge about the management of acute otitis media: a qualitative study.

    Science.gov (United States)

    Hansen, Malene Plejdrup; Howlett, Janine; Del Mar, Chris; Hoffmann, Tammy C

    2015-07-07

    Acute otitis media is a common reason for antibiotic prescribing, despite strong evidence that antibiotics provide minimal benefit. Studies have demonstrated that patients' (or parents') expectations of antibiotics often influence general practitioners' (GPs) decision to prescribe antibiotics, but few have explored parents' expectations of the management of infections in children, or which factors influence the development of these expectations. This study aimed to explore parents' knowledge and beliefs about the management of acute otitis media in children. Individual semi-structured interviews were conducted with 15 parents of children who had recently presented to their GP with acute otitis media. Parents were recruited at childcare centres or playgroups in Brisbane, Australia. Many parents did not have an accurate understanding of what causes acute otitis media. GPs were primarily consulted for the management of symptoms such as pain and fever. Others specifically wanted reassurance or were concerned about hearing loss. Most parents assumed that antibiotics were the best treatment option. Parents' perceptions about the best treatment were mainly based on their previous experience and the advice of the GP. Pain relief medications, such as paracetamol and non-steroidal anti-inflammatory drugs, were not considered by parents to be sufficient treatment on their own. There is discrepancy between parents' beliefs and expectations of management of acute otitis media and the evidence-based recommendations. This study provides insights into parents' expectations of management of acute otitis media, which may help inform clinicians about perceptions and misperceptions that may be valuable to elicit and discuss.

  13. Management of acute pancreatitis: current knowledge and future perspectives.

    Science.gov (United States)

    Fantini, Lorenzo; Tomassetti, Paola; Pezzilli, Raffaele

    2006-05-23

    In recent years, a number of articles have been published on the treatment of acute pancreatitis in experimental models and most of them concerned animals with mild disease. However, it is difficult to translate these results into clinical practice. For example, infliximab, a monoclonal TNF antibody, was experimentally tested in rats and it was found to significantly reduce the pathologic score and serum amylase activity and also to alleviate alveolar edema and acute respiratory distress syndrome; however, no studies are available in clinical human acute pancreatitis. Another substance, such as interleukin 10, was efficacious in decreasing the severity and mortality of lethal pancreatitis in rats, but seems to have no effect on human severe acute pancreatitis. Thus, the main problem in acute pancreatitis, especially in the severe form of the disease, is the difficulty of planning clinical studies capable of giving reliable statistically significant answers regarding the benefits of the various proposed therapeutic agents previously tested in experimental settings.According to the pathophysiology of acute pancreatitis, the efficacy of the drugs already available, such as gabexate mesilate, lexipafant and somatostatin should be re-evaluated and should be probably administered in a different manner. Of course, also in this case, we need adequate studies to test this hypothesis.

  14. Management of acute pancreatitis: current knowledge and future perspectives

    Directory of Open Access Journals (Sweden)

    Tomassetti Paola

    2006-05-01

    Full Text Available Abstract In recent years, a number of articles have been published on the treatment of acute pancreatitis in experimental models and most of them concerned animals with mild disease. However, it is difficult to translate these results into clinical practice. For example, infliximab, a monoclonal TNF antibody, was experimentally tested in rats and it was found to significantly reduce the pathologic score and serum amylase activity and also to alleviate alveolar edema and acute respiratory distress syndrome; however, no studies are available in clinical human acute pancreatitis. Another substance, such as interleukin 10, was efficacious in decreasing the severity and mortality of lethal pancreatitis in rats, but seems to have no effect on human severe acute pancreatitis. Thus, the main problem in acute pancreatitis, especially in the severe form of the disease, is the difficulty of planning clinical studies capable of giving reliable statistically significant answers regarding the benefits of the various proposed therapeutic agents previously tested in experimental settings. According to the pathophysiology of acute pancreatitis, the efficacy of the drugs already available, such as gabexate mesilate, lexipafant and somatostatin should be re-evaluated and should be probably administered in a different manner. Of course, also in this case, we need adequate studies to test this hypothesis.

  15. Impacts of Disturbances, Management and Climate Change on Carbon Dynamics and N2O and CH4 Emissions from 1992 to 2050 in the US Great Plains

    Science.gov (United States)

    Liu, S.; li, Z.; Liu, J.; Chen, M.; Gleason, R.; Grangaard, L.; Young, C. J.; Schmidt, G.; Oeding, J.; Davis, B.; Zhu, Z.; Dahal, D.; Abdul-Aziz, O. I.; Sohl, T. L.; Hawbaker, T. J.; Sleeter, B. M.

    2011-12-01

    Natural disturbance, land management, and climate change strongly affect greenhouse gas (GHG) (CO2, CH4 and N2O) emissions from terrestrial ecosystems. Our understanding of current and future GHG emissions at regional to global scales are limited by (1) the scarcity of geospatial data layers characterizing the spatial and temporal change patterns of disturbances and management practices, and (2) the lack of adequate modeling systems that can well represent multiple controlling processes especially those relevant to disturbance and management. As a part of the USGS effort (LandCarbon) to assess ecosystem potentials for carbon sequestration and GHG emission reduction across the United States, we created and synthesized many geospatial data layers on climate change, land cover change, disturbance and land management. Furthermore, we simulated the biogeochemical cycles of carbon and nitrogen of the Great Plains from 1992-2050 using the General Ensemble Biogeochemical Modeling System (GEMS). Land-cover change information was systematically generated using the FOREcasting SCEnarios of future land cover (FORE-SCE) model with reference to the Intergovernmental Panel on Climate Change (IPCC) scenarios (A1B, A2, and B1), the National Land Cover Database (NLCD), US Land Cover Trends product, and the Vegetation Change Tracker (VCT) products. Natural disturbances (e.g., fire, insects, and hurricanes), major management practices (i.e., crop rotation, tillage, etc.) and other relevant information (e.g., atmospheric nitrogen deposition) were constructed based on historical observations and models (e.g., The Integrated Model to Assess the Global Environment (IMAGE)). The GEMS outputs include the carbon pool changes in vegetation, soils, and wood products; the GHG emissions and their global warming potentials, and the lateral movements of carbon and nitrogen caused by soil erosion and deposition. Our results indicated that annual change of carbon stocks in terrestrial ecosystems

  16. Longer-term Stream Nitrogen Dynamics after Wildfire and Salvage Harvesting: Implications for Management Concepts based on Trajectories of Post-disturbance Watershed Recovery.

    Science.gov (United States)

    Silins, U.; Emelko, M. B.; Bladon, K. D.; Stone, M.; Williams, C.; Martens, A. M.; Wagner, M. J.

    2015-12-01

    Biogeochemical processes reflecting interaction of vegetation and hydrology govern long-term export of nutrients such as nitrogen, phosphorus, and carbon over successional time scales. While management concepts of watershed "recovery" from disturbance back towards pre-disturbance conditions are often considered over much shorter timescales, few studies have directly explored watershed biogeochemical responses to disturbance long enough to directly document the longer-term trajectory of responses to severe land disturbance on nitrogen export. The objectives of this study were to document both the initial magnitude and patterns of longer-term recovery of stream nitrogen after the 2003 Lost Creek wildfire over nine years in front ranges of the Rocky Mountains in south-west Alberta, Canada. The study was conducted in seven instrumented catchments (4-14 km2), including burned, burned and salvage logged, and unburned (reference) conditions since 2004. Total nitrogen (TN) and nitrate (NO3-) concentrations and area-normalized yields were greater and more variable in burned and post-fire salvage logged catchments when compared with unburned catchments. Large initial increases in stream TN and NO3- production 1-3 years after both wildfire and post-fire salvage logging declined strongly to levels similar to, or below that of unburned watersheds 4-6 years after the fire, and continued to decline (although more slowly) 7-9 years after the wildfire. Post-fire salvage logging produced lower impacts on TN and NO3- in streams and these effects declined even more rapidly compared to the effects of wildfire alone. These changes closely corresponded to the early trajectory of establishment and rapid juvenile growth of post-fire regenerating forest vegetation in both catchment groups. While the concept of hydrologic recovery from disturbance is both a practical and meaningful concept for integrated landscape management for protection of forest water resources, the benchmark for

  17. Contemporary Review of Risk-Stratified Management in Acute Uncomplicated and Complicated Diverticulitis.

    Science.gov (United States)

    Boermeester, Marja A; Humes, David J; Velmahos, George C; Søreide, Kjetil

    2016-10-01

    Acute colonic diverticulitis is a common clinical condition. Severity of the disease is based on clinical, laboratory, and radiological investigations and dictates the need for medical or surgical intervention. Recent clinical trials have improved the understanding of the natural history of the disease resulting in new approaches to and better evidence for the management of acute diverticulitis. We searched the Cochrane Library (years 2004-2015), MEDLINE (years 2004-2015), and EMBASE (years 2004-2015) databases. We used the search terms "diverticulitis, colonic" or "acute diverticulitis" or "divertic*" in combination with the terms "management," "antibiotics," "non-operative," or "surgery." Registers for clinical trials (such as the WHO registry and the https://clinicaltrials.gov/ ) were searched for ongoing, recruiting, or closed trials not yet published. Antibiotic treatment can be avoided in simple, non-complicated diverticulitis and outpatient management is safe. The management of complicated disease, ranging from a localized abscess to perforation with diffuse peritonitis, has changed towards either percutaneous or minimally invasive approaches in selected cases. The role of laparoscopic lavage without resection in perforated non-fecal diverticulitis is still debated; however, recent evidence from two randomised controlled trials has found a higher re-intervention in this group of patients. A shift in management has occurred towards conservative management in acute uncomplicated disease. Those with uncomplicated acute diverticulitis may be treated without antibiotics. For complicated diverticulitis with purulent peritonitis, the use of peritoneal lavage appears to be non-superior to resection.

  18. Management of Acute Pancreatitis: "PANCREAS" Contains Eight Easy Steps to Remember the Treatment

    Directory of Open Access Journals (Sweden)

    Abdul Khaliq

    2010-09-01

    Full Text Available The most recent evidence-based medical findings for the management of acute pancreatitis has prompted us to propose the acronym “PANCREAS”(Perfusion, Analgesia, Nutrition, Clinical assessment, Radiological assessment, ERCP, Antibiotics, and Surgery for easy remembrance and management in daily medical practice

  19. Surgical management of acute cholecystitis. Results of a nation-wide survey among Spanish surgeons.

    Science.gov (United States)

    Badia, Josep M; Nve, Esther; Jimeno, Jaime; Guirao, Xavier; Figueras, Joan; Arias-Díaz, Javier

    2014-10-01

    There is a wide variability in the management of acute cholecystitis. A survey among the members of the Spanish Association of Surgeons (AEC) analyzed the preferences of Spanish surgeons for its surgical management. The majority of the 771 responders didn't declare any subspecialty (41.6%), 21% were HPB surgeons, followed by colorectal and upper-GI specialities. Early cholecystectomy during the first admission is the preferred method of management of 92.3% of surgeons, but only 42.7% succeed in adopting this practice. The most frequent reasons for changing their preferred practice were: Patients not fit for surgery (43.6%) and lack of availability of emergency operating room (35.2%). A total of 88.9% perform surgery laparoscopically. The majority of AEC surgeons advise index admission cholecystectomy for acute cholecystitis, although only half of them succeed in its actual implementation. There is room for improvement in the management of acute cholecystitis in Spanish hospitals.

  20. ANESTHETIC MANAGEMENT FOR A PATIENT WITH ACUTE INTERMITTENT PORPHYRIA

    Directory of Open Access Journals (Sweden)

    Nenad Savić

    2010-09-01

    Full Text Available Acute intermittent porphyria is a rare metabolic disorder resulting from a partial deficiency of porphobilinogen deaminase, enzyme in the heme biosynthetic pathway. Its inheritance is autosomal dominant. A deficiency of porphobilinogen deaminase is not sufficient by its self to produce acute intermittent porphyria, and other activating factors must also be present. These include some drugs, hormones, infection, injury and alcohol. Besides others, anesthetics have been implicated in the triggering of a number of severe porphyric reactions. Although there is no clinical evidence, the fear of hypothesized porphyrinogenicity of repetitive anesthetics exposures still remains. Despite these doubts, we report here the case of uneventful repeated exposure to anesthetics in a patient suffering from acute intermittent porphyria, within a fifteen- month period. On both occasions, the patient was safely exposed to certain anesthetics included: propofol, sevoflurane, rocuronium, midazolam and fentanyl.

  1. A RETROSPECTIVE STUDY OF MANAGEMENT OF ACUTE PANCREATITIS IN A PERIPHERAL TERTIARY HOSPITAL

    Directory of Open Access Journals (Sweden)

    Thomas Karunahara

    2016-06-01

    Full Text Available BACKGROUND & OBJECTIVES Acute pancreatitis (AP is one of the most common diseases in gastroenterology. Two percent of all patients admitted to hospital are diagnosed with AP. During the last decade, an increasing incidence was observed, mostly because of a higher sensitivity of diagnostic tests. Treatment of Acute Pancreatitis is still symptomatic and no specific medication is available today. As a result of popular belief that the pancreas should be put to rest during acute pancreatitis, the parenteral route for nutrition is still predominantly used in Acute Pancreatitis. There has been increasing evidence; however, about gut being main source of microorganisms causing infectious pancreatic complications and multiorgan failure. In patients with severe pancreatitis, oral intake is inhibited by nausea and subileus. Although some reports show that enteral feeding is possible in acute pancreatitis and associated with fewer septic complications. Although the evidence is inconclusive to support enteral nutrition in all patients with severe acute pancreatitis, the enteral route may be used if tolerated. Supportive treatment is the most important line of management in acute pancreatitis. The aim is to study the management of acute pancreatitis in a peripheral tertiary hospital and to assess the outcome of the management. METHODS & MATERIALS Data Collection: Patients with acute abdominal pain are admitted in hospital and diagnosed as acute pancreatitis based on blood investigations and radiological findings. Patients categorised- Revised Atlanta Classification. Different medical management modes followed and outcomes recorded, tabulated and analysed. Research Design: Retrospective study. Research Settings: Mahatma Gandhi Memorial Government Hospital, Trichy, Tamilnadu. Duration: 5 yrs. (2010-2015 Sample Size: 186. Inclusion Criteria: Patients between 12 and 75 yrs. of age, patients admitted to the hospital as a case of acute pancreatitis, both sexes

  2. Within-population genetic structure in beech (Fagus sylvatica L. stands characterized by different disturbance histories: does forest management simplify population substructure?

    Directory of Open Access Journals (Sweden)

    Andrea Piotti

    Full Text Available The fine-scale assessment of both spatially and non-spatially distributed genetic variation is crucial to preserve forest genetic resources through appropriate forest management. Cryptic within-population genetic structure may be more common than previously thought in forest tree populations, which has strong implications for the potential of forests to adapt to environmental change. The present study was aimed at comparing within-population genetic structure in European beech (Fagus sylvatica L. plots experiencing different disturbance levels. Five plot pairs made up by disturbed and undisturbed plots having the same biogeographic history were sampled throughout Europe. Overall, 1298 individuals were analyzed using four highly polymorphic nuclear microsatellite markers (SSRs. Bayesian clustering within plots identified 3 to 11 genetic clusters (within-plot θ ST ranged from 0.025 to 0.124. The proportion of within-population genetic variation due to genetic substructuring (F CluPlot = 0.067 was higher than the differentiation among the 10 plots (F PlotTot = 0.045. Focusing on the comparison between managed and unmanaged plots, disturbance mostly explains differences in the complexity of within-population genetic structure, determining a reduction of the number of genetic clusters present in a standardized area. Our results show that: i genetic substructuring needs to be investigated when studying the within-population genetic structure in forest tree populations, and ii indices describing subtle characteristics of the within-population genetic structure are good candidates for providing early signals of the consequences of forest management, and of disturbance events in general.

  3. Within-population genetic structure in beech (Fagus sylvatica L.) stands characterized by different disturbance histories: does forest management simplify population substructure?

    Science.gov (United States)

    Piotti, Andrea; Leonardi, Stefano; Heuertz, Myriam; Buiteveld, Joukje; Geburek, Thomas; Gerber, Sophie; Kramer, Koen; Vettori, Cristina; Vendramin, Giovanni Giuseppe

    2013-01-01

    The fine-scale assessment of both spatially and non-spatially distributed genetic variation is crucial to preserve forest genetic resources through appropriate forest management. Cryptic within-population genetic structure may be more common than previously thought in forest tree populations, which has strong implications for the potential of forests to adapt to environmental change. The present study was aimed at comparing within-population genetic structure in European beech (Fagus sylvatica L.) plots experiencing different disturbance levels. Five plot pairs made up by disturbed and undisturbed plots having the same biogeographic history were sampled throughout Europe. Overall, 1298 individuals were analyzed using four highly polymorphic nuclear microsatellite markers (SSRs). Bayesian clustering within plots identified 3 to 11 genetic clusters (within-plot θ ST ranged from 0.025 to 0.124). The proportion of within-population genetic variation due to genetic substructuring (F CluPlot = 0.067) was higher than the differentiation among the 10 plots (F PlotTot = 0.045). Focusing on the comparison between managed and unmanaged plots, disturbance mostly explains differences in the complexity of within-population genetic structure, determining a reduction of the number of genetic clusters present in a standardized area. Our results show that: i) genetic substructuring needs to be investigated when studying the within-population genetic structure in forest tree populations, and ii) indices describing subtle characteristics of the within-population genetic structure are good candidates for providing early signals of the consequences of forest management, and of disturbance events in general.

  4. State-and-transition simulation modeling to compare outcomes of alternative management scenarios under two natural disturbance regimes in a forested landscape in northeastern Wisconsin, USA

    Directory of Open Access Journals (Sweden)

    Amanda Swearingen

    2015-07-01

    Full Text Available Comparisons of the potential outcomes of multiple land management strategies and an understanding of the influence of potential increases in climate-related disturbances on these outcomes are essential for long term land management and conservation planning. To provide these insights, we developed an approach that uses collaborative scenario development and state-and-transition simulation modeling to provide land managers and conservation practitioners with a comparison of potential landscapes resulting from alternative management scenarios and climate conditions, and we have applied this approach in the Wild Rivers Legacy Forest (WRLF area in northeastern Wisconsin. Three management scenarios were developed with input from local land managers, scientists, and conservation practitioners: 1 continuation of current management, 2 expanded working forest conservation easements, and 3 cooperative ecological forestry. Scenarios were modeled under current climate with contemporary probabilities of natural disturbance and under increased probability of windthrow and wildfire that may result from climate change in this region. All scenarios were modeled for 100 years using the VDDT/TELSA modeling suite. Results showed that landscape composition and configuration were relatively similar among scenarios, and that management had a stronger effect than increased probability of windthrow and wildfire. These findings suggest that the scale of the landscape analysis used here and the lack of differences in predominant management strategies between ownerships in this region play significant roles in scenario outcomes. The approach used here does not rely on complex mechanistic modeling of uncertain dynamics and can therefore be used as starting point for planning and further analysis.

  5. Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis

    Directory of Open Access Journals (Sweden)

    Luca Castellazzi

    2016-06-01

    Full Text Available Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.

  6. Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis.

    Science.gov (United States)

    Castellazzi, Luca; Mantero, Marco; Esposito, Susanna

    2016-01-01

    Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.

  7. Management of Acute Apendicitis in the New Millennium

    NARCIS (Netherlands)

    K-H. in 't Hof (Klaas)

    2009-01-01

    textabstractThe prevalence of acute appendicitis in The Netherlands is 16460 times a year, 8647 man and 7813 women in 2006 and is still increasing. The chance of undergoing an appendectomy is higher in women than in men, 23 versus 12 percent, this is in contradiction with the chance of developing

  8. Acute-on-chronic liver failure: terminology, mechanisms and management.

    Science.gov (United States)

    Sarin, Shiv K; Choudhury, Ashok

    2016-03-01

    Acute-on-chronic liver failure (ACLF) is a distinct clinical entity and differs from acute liver failure and decompensated cirrhosis in timing, presence of acute precipitant, course of disease and potential for unaided recovery. The definition involves outlining the acute and chronic insults to include a homogenous patient group with liver failure and an expected outcome in a specific timeframe. The pathophysiology of ACLF relates to persistent inflammation, immune dysregulation with initial wide-spread immune activation, a state of systematic inflammatory response syndrome and subsequent sepsis due to immune paresis. The disease severity and outcome can be predicted by both hepatic and extrahepatic organ failure(s). Clinical recovery is expected with the use of nucleoside analogues for hepatitis B, and steroids for severe alcoholic hepatitis and, possibly, severe autoimmune hepatitis. Artificial liver support systems help remove toxins and metabolites and serve as a bridge therapy before liver transplantation. Hepatic regeneration during ongoing liver failure, although challenging, is possible through the use of growth factors. Liver transplantation remains the definitive treatment with a good outcome. Pre-emptive antiviral agents for hepatitis B before chemotherapy to prevent viral reactivation and caution in using potentially hepatotoxic drugs can prevent the development of ACLF.

  9. Imaging-based management of acute ischemic stroke patients: Current neuroradiological perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Na, Dong Gyu [Dept. of Radiology, Neuroradiology, Head and Neck Radiology, Thyroid Radiology Human Medical Imaging and Intervention Center, Seoul (Korea, Republic of); Sohn, Chul Ho [Dept. of Radiology, Seoul National University Hospital, Seoul (Korea, Republic of); Kim, Eung Yeop [Dept. of Radiology, Gachon University Gil Medical Center, Incheon (Korea, Republic of)

    2015-04-15

    Advances in imaging-based management of acute ischemic stroke now provide crucial information such as infarct core, ischemic penumbra/degree of collaterals, vessel occlusion, and thrombus that helps in the selection of the best candidates for reperfusion therapy. It also predicts thrombolytic efficacy and benefit or potential hazards from therapy. Thus, radiologists should be familiar with various imaging studies for patients with acute ischemic stroke and the applicability to clinical trials. This helps radiologists to obtain optimal rapid imaging as well as its accurate interpretation. This review is focused on imaging studies for acute ischemic stroke, including their roles in recent clinical trials and some guidelines to optimal interpretation.

  10. Parents' beliefs and knowledge about the management of acute otitis media

    DEFF Research Database (Denmark)

    Hansen, Malene Plejdrup; Howlett, Janine; Del Mar, Chris

    2015-01-01

    BACKGROUND: Acute otitis media is a common reason for antibiotic prescribing, despite strong evidence that antibiotics provide minimal benefit. Studies have demonstrated that patients' (or parents') expectations of antibiotics often influence general practitioners' (GPs) decision to prescribe...... antibiotics, but few have explored parents' expectations of the management of infections in children, or which factors influence the development of these expectations. This study aimed to explore parents' knowledge and beliefs about the management of acute otitis media in children. METHODS: Individual semi...... experience and the advice of the GP. Pain relief medications, such as paracetamol and non-steroidal anti-inflammatory drugs, were not considered by parents to be sufficient treatment on their own. CONCLUSION: There is discrepancy between parents' beliefs and expectations of management of acute otitis media...

  11. Acute pain management in morbid obesity - an evidence based clinical update.

    Science.gov (United States)

    Budiansky, Adele Sandra; Margarson, Michael P; Eipe, Naveen

    2017-03-01

    Increasing numbers of patients with morbid obesity are presenting for surgery and their acute pain management requires an evidence-based clinical update. The objective of this study was to complete a literature review for acute pain management in morbid obesity and provide an evidence-based clinical update with recommendations. Using standardized search terms, in March 2015, we completed a literature search to determine evidence for different acute pain pharmacological modalities in morbid obesity. For each modality the highest level of evidence was ascertained and recommendations for each pharmacological modality are presented. Though overall evidence is limited to few well conducted clinical trials, mostly related to weight loss surgery, multimodal analgesia with step-wise, severity-based, opioid-sparing approach appears to improve acute pain management in morbid obesity. The perioperative use of non-opioid adjuvants appears to offer further improvements in patient safety and outcomes. Further research into standardization of pain assessments and implementation of acute pain management protocols is required.

  12. Tools and early management of language and swallowing disorders in acute stroke patients.

    Science.gov (United States)

    Flamand-Roze, Constance; Cauquil-Michon, Cécile; Denier, Christian

    2012-02-01

    The role of the stroke units in improving morbidity, mortality, and recovery from stroke is clearly demonstrated. However, acute management of language disorders in these specialized units remains controversial, and management of swallowing disorders is usually nonstandardized. The recent validation of a scale for rapid screening of language disorders (LAST [Language Screening Test]) in acute stroke patients should allow optimization of their detection and early management. Swallowing disorders should be screened and managed using a standardized protocol. Following early initial evaluation repeated on a daily basis, they justify tailored rehabilitation sessions, adaptation of food textures, team formation, and families' information. The use of these protocols implies the cooperation and coordination of the medical and paramedical teams and the daily presence of speech therapists. These aspects are crucial for patients in the stroke units to achieve full benefits from the management proposed in this paper, leading to diminution of complications and better long-term functional prognosis.

  13. Acupuncture in the management of acute dental pain.

    Science.gov (United States)

    Grillo, Cássia Maria; Wada, Ronaldo Seichi; da Luz Rosário de Sousa, Maria

    2014-04-01

    Acute dental pain is the main reason for seeking dental services to provide urgent dental care; there is consensus about the use of alternative therapies, such as acupuncture, to control dental pain in pre-dental care. This study aimed to evaluate the use of acupuncture in reducing the intensity of acute dental pain in pre-dental care in patients waiting for emergency dental care, and was conducted at the After-Hours Emergency Dental Clinic of Piracicaba Dental School, and at the Emergency Center Dental Specialties I in Piracicaba, São Paulo, Brazil. The sample consisted of 120 patients. The Visual Analog Scale (VAS) was used to measure pain intensity. All patients underwent one session of acupuncture; the points LI4, ST44 and CV23 were selected and were used alone or in combinations. Reduction in pain was observed in 120 patients (mean initial VAS=6.558±1.886, panalgesia could be a technical adjunct to pain control in patients with acute dental pain, contributing to the restoration of health with social benefit.

  14. Managing acute medical admissions: a survey of acute medical services and medical assessment and planning units in New Zealand.

    Science.gov (United States)

    Providence, C; Gommans, J; Burns, A

    2012-01-01

    To determine the current provision of acute medical services, including the development of medical assessment and planning units (MAPUs), by district health boards (DHBs) throughout New Zealand (NZ). A questionnaire-based survey about organisation of acute medical services and establishment of MAPUs was sent to all 21 DHBs in NZ. All 21 DHBs responded. Seven DHBs serving 42% of the population have established MAPUs since 2003 and a further six have plans to do so over the next 3 years, potentially expanding service to 73% of the NZ population. All seven current MAPUs are in close proximity to and accept patients directly from emergency departments. Each MAPU has a documented target length of stay, four units have referral protocols, five provide guidelines for management of common medical emergencies and five routinely audit unit performance. Five MAPUs have cardiac monitored beds and isolation rooms. Rapid access is available to computed tomography scanning (six units), ultrasound (five) and echocardiography (four). Two units have no nominated physician leadership and two lack dedicated therapy resources. General physicians are involved in provision of acute medical services in 20 of 21 DHBs. Medical assessment and planning units have become an important component of acute medical service provision in NZ. The established units largely comply with Australasian recommendations, although important deficiencies exist. Training of physicians must combine the needs of acute medical patients and clinical roles of physicians within MAPUs with local DHB requirements for services to be most effective. © 2010 The Authors. Internal Medicine Journal © 2010 Royal Australasian College of Physicians.

  15. Recent Advances in Managing Acute Pancreatitis [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Nigeen Janisch

    2015-12-01

    Full Text Available This article will review the recent advances in managing acute pancreatitis. Supportive care has long been the standard of treatment for this disease despite extensive, but ultimately unsuccessful, efforts to develop disease-specific pharmacologic therapies. The primary interventions center on aggressive fluid resuscitation, initiation of early enteral nutrition, targeted antibiotic therapy, and the management of complications. In this article, we will detail treatment of acute pancreatitis with a focus on intravenous fluid resuscitation, enteral feeding, and the current evidence behind the use of antibiotics and other pharmacologic therapies.

  16. ForWarn: A Cross-Cutting Forest Resource Management and Decision Support System Providing the Capacity to Identify and Track Forest Disturbances Nationally

    Science.gov (United States)

    Hargrove, W. W.; Spruce, J.; Norman, S.; Christie, W.; Hoffman, F. M.

    2012-12-01

    The Eastern Forest Environmental Threat Assessment Center and Western Wildland Environmental Assessment Center of the USDA Forest Service have collaborated with NASA Stennis Space Center to develop ForWarn, a forest monitoring tool that uses MODIS satellite imagery to produce weekly snapshots of vegetation conditions across the lower 48 United States. Forest and natural resource managers can use ForWarn to rapidly detect, identify, and respond to unexpected changes in the nation's forests caused by insects, diseases, wildfires, severe weather, or other natural or human-caused events. ForWarn detects most types of forest disturbances, including insects, disease, wildfires, frost and ice damage, tornadoes, hurricanes, blowdowns, harvest, urbanization, and landslides. It also detects drought, flood, and temperature effects, and shows early and delayed seasonal vegetation development. Operating continuously since January 2010, results show ForWarn to be a robust and highly capable tool for detecting changes in forest conditions. ForWarn is the first national-scale system of its kind based on remote sensing developed specifically for forest disturbances. It has operated as a prototype since January 2010 and has provided useful information about the location and extent of disturbances detected during the 2011 growing season, including tornadoes, wildfires, and extreme drought. The ForWarn system had an official unveiling and rollout in March 2012, initiated by a joint NASA and USDA press release. The ForWarn home page has had 2,632 unique visitors since rollout in March 2012, with 39% returning visits. ForWarn was used to map tornado scars from the historic April 27, 2011 tornado outbreak, and detected timber damage within more than a dozen tornado tracks across northern Mississippi, Alabama, and Georgia. ForWarn is the result of an ongoing, substantive cooperation among four different government agencies: USDA, NASA, USGS, and DOE. Disturbance maps are available on the

  17. Utilization and cost of a new model of care for managing acute knee injuries: the Calgary acute knee injury clinic

    Directory of Open Access Journals (Sweden)

    Lau Breda HF

    2012-12-01

    Full Text Available Abstract Background Musculoskeletal disorders (MSDs affect a large proportion of the Canadian population and present a huge problem that continues to strain primary healthcare resources. Currently, the Canadian healthcare system depicts a clinical care pathway for MSDs that is inefficient and ineffective. Therefore, a new inter-disciplinary team-based model of care for managing acute knee injuries was developed in Calgary, Alberta, Canada: the Calgary Acute Knee Injury Clinic (C-AKIC. The goal of this paper is to evaluate and report on the appropriateness, efficiency, and effectiveness of the C-AKIC through healthcare utilization and costs associated with acute knee injuries. Methods This quasi-experimental study measured and evaluated cost and utilization associated with specific healthcare services for patients presenting with acute knee injuries. The goal was to compare patients receiving care from two clinical care pathways: the existing pathway (i.e. comparison group and a new model, the C-AKIC (i.e. experimental group. This was accomplished through the use of a Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ. Results Data from 138 questionnaires were analyzed in the experimental group and 136 in the comparison group. A post-hoc analysis determined that both groups were statistically similar in socio-demographic characteristics. With respect to utilization, patients receiving care through the C-AKIC used significantly less resources. Overall, patients receiving care through the C-AKIC incurred 37% of the cost of patients with knee injuries in the comparison group and significantly incurred less costs when compared to the comparison group. The total aggregate average cost for the C-AKIC group was $2,549.59 compared to $6,954.33 for the comparison group (p Conclusions The Calgary Acute Knee Injury Clinic was able to manage and treat knee injured patients for less cost than the existing state of healthcare delivery. The

  18. Nutritional Management of Acute Diarrhea in Infants and Children.

    Science.gov (United States)

    National Academy of Sciences-National Research Council, Washington, DC. Food and Nutrition Board.

    Written primarily for health professionals advising on programs and policy related to nutrition and diarrhea therapy, this report is aimed at management of diarrhea in less-developed countries, but its information and technical insights are relevant to an understanding of diarrhea and its management throughout the world. Technical in orientation…

  19. Whiteboards and discharge traffic lights: visual management in acute care.

    Science.gov (United States)

    O'Brien, Lauri; Bassham, Jane; Lewis, Melissa

    2015-04-01

    Flinders Medical Centre was experiencing issues with timely discharge and knowing the potential discharges and in-patient bed capacity for the next day. This case study describes the application of 'visual management' theory to discharge processes. The solutions developed were 'patient journey boards' and 'discharge traffic lights'. The implementation of these visual management systems has enabled the hospital to improve its discharge processes.

  20. Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis.

    Science.gov (United States)

    Liang, Tsung-Jung; Liu, Shiuh-Inn; Tsai, Chung-Yu; Kang, Chi-Hsiang; Huang, Wei-Chun; Chang, Hong-Tai; Chen, I-Shu

    2016-03-01

    The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively.We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis.Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach.In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity.

  1. Starting early: integration of self-management support into an acute stroke service.

    Science.gov (United States)

    Mäkelä, Petra; Gawned, Sara; Jones, Fiona

    2014-01-01

    Self-management support following stroke is rare, despite emerging evidence for impact on patient outcomes. The promotion of a common approach to self-management support across a stroke pathway requires collaboration between professionals. To date, the feasibility of self-management support in acute stroke settings has not been evaluated. The Bridges stroke self-management package (SMP) is based on self-efficacy principles. It is delivered by professionals and supported by a patient-held workbook. The aim of this project was to introduce the Bridges stroke SMP to the multidisciplinary staff of a London hyperacute and acute stroke unit. The 'Plan Do Study Act' (PDSA) cycle guided iterative stages of project development, with normalisation process theory helping to embed the intervention into existing ways of working. Questionnaires explored attitudes, beliefs and experiences of the staff who were integrating self-management support into ways of working in the acute stroke setting. Self-management support training was delivered to a total of 46 multidisciplinary stroke staff. Of the staff who attended the follow-up training, 66% had implemented Bridges self-management support with patients since initial training, and 100% felt their practice had changed. Questionnaire findings demonstrated that staff attitudes and beliefs had changed following training, particularly regarding ownership and type of rehabilitation goals set, and prioritisation of self-management support within acute stroke care. Staff initiated an audit of washing and dressing practices pre- and post-training. This was designed to evaluate the number of occasions when techniques were used by staff to facilitate patients' independence and self-management. They found that the number of occasions featuring optimum practice went from 54% at baseline to 63% at three months post-training. This project demonstrated the feasibility of integrating self-management support into an acute stroke setting. Further

  2. Effects of introducing an allied health assessment pro forma on the management of acute stroke patients.

    Science.gov (United States)

    Scurrah, Alena; Sheppard, Lorraine; Buttner, Petra

    2009-01-01

    There is a small body of evidence that supports the use of care pathways and assessment pro formas for the management of acute stroke patients, however, such tools applied specifically to the allied health disciplines are not in widespread use. This study sought to evaluate the effects of introducing an assessment pro forma on the allied health management of acute stroke patients. The allied health management of 40 consecutive stroke patients admitted after the introduction of the assessment pro forma was compared with that of a historical control group of the same size. The quality of allied health management was assessed by a variety of measures including the quality of documentation, the inclusion of specific recommended assessment components, the use of standardised assessment tools or outcome measures and the use of specific recommended interventions. These outcomes were used to calculate a total score for each of the allied health disciplines and the combined area of upper limb management, which were then used for analysis. At baseline, there was no statistically significant difference between the control and intervention groups. After the intervention, total allied health scores increased for all disciplines and for the upper limb management section. These increases were statistically significant for all disciplines (p forma specifically for the allied health disciplines may improve the management of acute stroke patients in terms of quality of documentation, and the use of specific assessment and treatment processes of care.

  3. The physician's role in managing acute stress disorder.

    Science.gov (United States)

    Kavan, Michael G; Elsasser, Gary N; Barone, Eugene J

    2012-10-01

    Acute stress disorder is a psychiatric diagnosis that may occur in patients within four weeks of a traumatic event. Features include anxiety, intense fear or helplessness, dissociative symptoms, reexperiencing the event, and avoidance behaviors. Persons with this disorder are at increased risk of developing posttraumatic stress disorder. Other risk factors for posttraumatic stress disorder include current or family history of anxiety or mood disorders, a history of sexual or physical abuse, lower cognitive ability, engaging in excessive safety behaviors, and greater symptom severity one to two weeks after the trauma. Common reactions to trauma include physical, mental, and emotional symptoms. Persistent psychological distress that is severe enough to interfere with psychological or social functioning may warrant further evaluation and intervention. Patients experiencing acute stress disorder may benefit from psychological first aid, which includes ensuring the patient's safety; providing information about the event, stress reactions, and how to cope; offering practical assistance; and helping the patient to connect with social support and other services. Cognitive behavior therapy is effective in reducing symptoms and decreasing the future incidence of posttraumatic stress disorder. Critical Incident Stress Debriefing aims to mitigate emotional distress through sharing emotions about the traumatic event, providing education and tips on coping, and attempting to normalize reactions to trauma. However, this method may actually impede natural recovery by overwhelming victims. There is insufficient evidence to recommend the routine use of drugs in the treatment of acute stress disorder. Short-term pharmacologic intervention may be beneficial in relieving specific associated symptoms, such as pain, insomnia, and depression.

  4. [Management of ocular and orbital complications in acute sinusitis].

    Science.gov (United States)

    Chahed, H; Bachraoui, R; Kedous, S; Ghorbel, H; Houcine, A; Mediouni, A; Marrakchi, J; Zainine, R; Ben Amor, M; Beltaief, N; Besbes, G

    2014-11-01

    Describe the clinical presentations of orbital complications of acute sinusitis and discuss therapeutic approaches. Retrospective study of 29 cases of acute sinusitis with orbital extension hospitalized over a period of 12years (2000 to 2012). There were 23 men and 6 women. The mean age was 15.75years. The average time until consultation was 7.68 days. Sinusitis was ethmoido-maxillary in 20 cases, ethmoidal in 6 cases, and frontal in 3 cases. Orbital extension was grouped according to the Chandler classification: stage I (3 cases), stage II (3 cases), stage III (15 cases), stage IV (8 cases). Antibiotic therapy was prescribed in all cases. Surgery was performed in 22 cases. Bacterial cultures revealed streptococcus (2 cases), aspergillus fumigatus (1 case) and were negative in 8 cases. The outcome was favorable in 27 cases. In two cases, the outcome was unfavorable with associated intracranial complications. Oculoorbital extension of acute sinusitis is a diagnostic and therapeutic emergency. Paranasal sinus CT is essential to confirm orbital extension and identify the causative sinus. Intravenous antibiotic therapy is the main treatment. The roles of corticosteroid and heparin therapy remain controversial. Surgery is indicated in the case of abscess or high visual risk. Endoscopic endonasal surgery appears to have a double role, in diagnosis and treatment. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  5. Assessment, management and treatment of acute fingertip injuries.

    Science.gov (United States)

    Kearney, Anthony; Canty, Louise

    2016-06-01

    Fingertip injuries with nail bed trauma can require specialist hand surgery, depending on severity. However, most of these injuries can be managed in well-equipped emergency departments by emergency nurses with an in-depth knowledge and understanding of the anatomy and physiology of the fingernail and surrounding structures, assessment and examination, pain management and treatment. This article describes the surface and underlying anatomy and physiology of the nail, the most common mechanisms of injury, relevant diagnostic investigations, and initial assessment and management. It also discusses treatment options, referral pathways, and patient discharge advice.

  6. ACUTE MANAGEMENT CONCEPTS OF THE ACROMIOCLAVICULAR JOINT: A CASE REPORT

    Science.gov (United States)

    2012-01-01

    Acromioclavicular injuries are quite common and approaches to early management of those that are described as a Type III are controversial. The Rockwood Type III classification implies complete disruption of the acromioclavicular and coracoclavicular ligaments, resulting in inferior positioning of the scapula and, thus, the glenohumeral complex while the clavicle appears more superiorly prominent. Clinical management can include surgical or conservative techniques. This case report outlines the decision making process related to this type of injury, as applied in the diagnosis and management of 61 year‐old recreational athlete. Level of Evidence 5 (Single Case report) PMID:23091789

  7. Conservative management of eosinophilic enteritis presenting with acute abdominal syndrome

    Directory of Open Access Journals (Sweden)

    Marco Bassi

    2013-04-01

    Full Text Available Eosinophilic enteritis, an increasing recognized condition, is rare and often presents with non-specific symptoms. We report a case of a 46-year old female who presented with acute onset abdominal pain and nausea associated with ascites, small bowel thickening and peripheral eosinophilia. Diagnosis was confirmed by biopsies taken at esophagogastroduodenoscopy demonstrating diffuse infiltration by inflammatory cells, mainly eosinophils. Appropriate therapy was instituted. The patient recovered well and was symptom-free at 1-month follow up. In this report, we discuss the clinical presentation and the diagnostic criteria of the eosinophilic enteritis, and examine the pathophysiological theories and therapeutic strategies. The relevant literature on eosinophilic enteritis is summarized.

  8. Management of Acute Kidney Injury in Pregnancy for the Obstetrician.

    Science.gov (United States)

    Acharya, Anjali

    2016-12-01

    Acute kidney injury (AKI) is a complex disorder that occurs in several clinical settings. During pregnancy, there are additional unique conditions that contribute to AKI. The clinical manifestations of AKI during pregnancy range from a minimal elevation in serum creatinine to renal failure requiring renal replacement therapy, similar to AKI in the general population. Recent epidemiologic studies in the general population show an increase in mortality associated with AKI, particularly when dialysis is required. The incidence of AKI in pregnancy remains a cause of significant morbidity and mortality.

  9. Cholecystectomy vs. percutaneous cholecystostomy for the management of critically ill patients with acute cholecystitis: a protocol for a systematic review

    OpenAIRE

    Ambe, Peter C; Kaptanis, Sarantos; Papadakis, Marios; Weber, Sebastian A.; Zirngibl, Hubert

    2015-01-01

    Background Acute cholecystitis is a common diagnosis. However, the heterogeneity of presentation makes it difficult to standardize management. Although surgery is the mainstay of treatment, critically ill patients have been managed via percutaneous cholecystostomy. However, the role of percutaneous cholecystostomy in the management of such patients has not been clearly established. This systematic review will compare the outcomes of critically ill patients with acute cholecystitis managed wit...

  10. 10 Watershed Disturbance.cdr

    African Journals Online (AJOL)

    Administrator

    resistance to disturbance because they serve as receptacles for .... company to prospect for the mineral (Rapid. Assessment .... constitute land use change, according to Ellis and Pontius .... (2003). Biodiversity management plan for the Atewa.

  11. Experiences of Indonesian mother managing preschool children's acute abdominal pain in Taiwan.

    Science.gov (United States)

    Tseng, Chiu-Lien; Huang, Chu-Yu; Park, Jeong-Hwan; Lin, Hung-Ru; Liang, Shu-Yuan; Cheng, Su-Fen

    2015-01-01

    The aim of this study was to understand the Indonesian mothers' experiences of managing preschool children's acute abdominal pain. The descriptive qualitative research design comprises semi-structured interviews with 11 Indonesian mothers. The qualitative content analysis revealed three themes, including (1) insight of abdominal pain, (2) "inheritance of the strategies for assessment of management for abdominal pain from the family of origin", (3) "obstacles and insights related to cultural differences". The results presented that pain management was affected by family, environment, cultural background and religious beliefs. Healthcare providers should provide culturally competent pain management care for the patients of difference nationalities.

  12. Management of children with acute malnutrition in resource-poor settings.

    Science.gov (United States)

    Brown, Kenneth H; Nyirandutiye, Daniele H; Jungjohann, Svenja

    2009-11-01

    Approximately 11% of children worldwide suffer from moderate or severe acute malnutrition, which is defined as low weight for height or mid-upper arm circumference with respect to international standards, or the presence of bipedal edema. These children have a considerably increased risk of dying. Experience from the past two decades indicates that children with uncomplicated moderate or severe acute malnutrition can be managed successfully as outpatients, by use of appropriate treatment of infections and either lipid-based, ready-to-use therapeutic foods or appropriately formulated home diets, along with psychosocial care. Children's caregivers prefer community-based treatment, which is also less costly than inpatient care. Children with severe acute malnutrition and life-threatening complications require short-term inpatient care for treatment of infections, fluid and electrolyte imbalances, and metabolic abnormalities. Initial dietary management relies on low-lactose, milk-based, liquid formulas but semi-solid or solid foods can be started as soon as appetite permits, after which children can be referred for ambulatory treatment. National programs for the community-based management of acute malnutrition (CMAM) provide periodic anthropometric and clinical screening of young children, and referral of those who meet established criteria. This Review describes the main components of the treatment of young children with acute malnutrition in resource poor settings and some recent advances in CMAM programs.

  13. Management of violent behaviour in acutely relapsed schizophrenics

    Directory of Open Access Journals (Sweden)

    L. Koen

    2004-09-01

    Full Text Available The management of aggressive behaviour has always been a criticai issue in psychiatry. Finding measures that can be used to accurately predict the likelihood of assaultative behaviour and thus ensure timeous appropriate pharmacological management remains a dilemma. The study objective was to investigate the naturalistic, pharmacological management of inpatient aggressive behaviour in a group of 50 schizophrenic subjects with a view to determine: (1 whether a presenting history of recent violence lead to altered pharmacological management and (2 whether the NOSIE could be regarded as a useful assessment tool with regards to inpatient behaviour management. No significant difference could be demonstrated between the 2 subsets of subjects (history of violence vs none with respect to total doses of medication administered. No statistical correlation could be found between the total NOSIE score and the dose of psychotropic medication used. The relationship between a subset of NOSIE-items and the total dose of medication was more complex and a clear linear relationship could be demonstrated for a total score of 0 to 5. In this particular ward setting a presenting history of recent violent behaviour did not influence the administration of medication and neither could the clinical judgement employed by the nursing staff to manage inpatient behaviour be captured by the NOSIE. However, a five-item subset of the NOSIE with questions relating to aggression and irritability warrants further scrutiny in this regard.

  14. The management of neonatal acute and chronic renal failure: A review.

    Science.gov (United States)

    Coulthard, Malcolm G

    2016-11-01

    Most babies with chronic renal failure are identified antenatally, and over half that are treated with peritoneal dialysis receive kidney transplants before school age. Most infants that develop acute renal failure have hypotension following cardiac surgery, or multiple organ failure. Sometimes the falls in glomerular filtration and urine output are physiological and reversible, and sometimes due to kidney injury, but (illogically) it is now common to define them all as having 'acute kidney injury'. Contrary to widespread opinion, careful interpretation of the plasma creatinine concentrations can provide sensitive evidence of early acute renal failure. Conservative management frequently leads to under-nutrition or fluid overload. Acute peritoneal dialysis is often technically fraught in very small patients, and haemotherapies have been limited by vascular access and anticoagulation requirements, the need to blood-prime circuits, and serious limitations in regulating fluid removal. Newer devices, including the Nidus, have been specifically designed to reduce these difficulties.

  15. Acute toluene intoxication--clinical presentation, management and prognosis: a prospective observational study.

    Science.gov (United States)

    Camara-Lemarroy, Carlos Rodrigo; Rodríguez-Gutiérrez, René; Monreal-Robles, Roberto; González-González, José Gerardo

    2015-08-18

    Toluene is one of the most widely abused inhaled drugs due to its acute neurologic effects including euphoria and subsequent depression. However, dangerous metabolic abnormalities are associated to acute toluene intoxication. It has been previously reported that rhabdomyolysis and acute hepatorenal injury could be hallmarks of the condition, and could constitute risk factors for poor outcomes. The objective was to describe the clinical presentation, to characterize the renal and liver abnormalities, the management and prognosis associated to acute toluene intoxication. We prospectively assessed 20 patients that were admitted to a single center's emergency department from September 2012 to June 2014 with clinical and metabolic alterations due to acute toluene intoxication. The main clinical presentation consisted of weakness associated to severe hypokalemia and acidosis. Renal glomerular injury (proteinuria) is ubiquitous. Biliary tract injury (alkaline phosphatase and gamma-glutamyl transpeptidase elevations) disproportional to hepatocellular injury is common. Rhabdomyolysis occurred in 80% of patients, probably due to hypokalemia and hypophosphatemia. There were three deaths, all female, and all associated with altered mental status, severe acidosis, hypokalemia and acute oliguric renal failure. The cause of death was in all cases due to cardiac rhythm abnormalities. The hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Liver injury and rhabdomyolysis are common. On admission, altered mental status, renal failure, severe acidemia and female gender (not significant in our study, but present in all three deaths) could be associated with a poor outcome, and patients with these characteristics should be considered to be treated in an intensive care unit.

  16. Quality indicators for the acute and long-term management of anaphylaxis

    DEFF Research Database (Denmark)

    Dhami, Sangeeta; Sheikh, Aadam; Muraro, Antonella

    2017-01-01

    is challenging. Quality indicators have the potential to support guideline implementation efforts. OBJECTIVE: To identify quality indicators to support the acute and long-term management of anaphylaxis. METHODS: We conducted a systematic review of the literature that involved searching Medline, EMBASE and CINAHL......) and long-term (n = 27) management of anaphylaxis. The majority of indicators were developed through expert consensus with relatively few of these having been formally piloted or tested to demonstrate that they could discriminate between variations in practice and/or that they were sensitive to change....... CONCLUSIONS: There is a need for a comprehensive set of quality indicators for anaphylaxis management. We have however identified some indicators for the acute and long-term management of anaphylaxis that could with relatively little additional work support efforts to translate guideline recommendations...

  17. Management of acute calcific tendinitis around the hip joint.

    Science.gov (United States)

    Park, Sang-Min; Baek, Ji-Hoon; Ko, Young-Bong; Lee, Han-Jun; Park, Ki Jeong; Ha, Yong-Chan

    2014-11-01

    Although the natural history of calcific tendinitis within the rotator cuff of the shoulder is established, the natural history of calcific tendinitis around the hip joint remains unknown. To examine the duration of symptoms including pain, the location of calcific tendinitis around the hip joint, the radiologic course of calcium phosphate crystals, and the proportion of patients who required surgical treatment. Case series; Level of evidence, 4. Thirty hips (29 patients) with acute calcific tendinitis were treated between January 2010 and December 2012. Level of subjective hip pain using the visual analog scale pain score, radiologic type, and the location and size of calcium deposits were measured during a follow-up period of 12 to 32 months. The 29 patients included 7 men (24%) and 22 women (76%) with a mean age of 51.5 years (range, 28-78 years). All visual analog scale pain scores significantly improved from a mean of 7.1 to 0.8 at the latest follow-up (P 3 months) of severe pain, solid type, and large size (range, 96-416 mm(2)) were treated with arthroscopic excision. Nonoperative treatment in patients with acute calcific tendinitis of the hip joint might be successful in most patients. Surgical treatment is of value for patients experiencing prolonged severe pain, solid type, and large size. © 2014 The Author(s).

  18. IAP/APA evidence-based guidelines for the management of acute pancreatitis.

    Science.gov (United States)

    2013-01-01

    There have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise these guidelines using an evidence-based approach. Twelve multidisciplinary review groups performed systematic literature reviews to answer 38 predefined clinical questions. Recommendations were graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The review groups presented their recommendations during the 2012 joint IAP/APA meeting. At this one-day, interactive conference, relevant remarks were voiced and overall agreement on each recommendation was quantified using plenary voting. The 38 recommendations covered 12 topics related to the clinical management of acute pancreatitis: A) diagnosis of acute pancreatitis and etiology, B) prognostication/predicting severity, C) imaging, D) fluid therapy, E) intensive care management, F) preventing infectious complications, G) nutritional support, H) biliary tract management, I) indications for intervention in necrotizing pancreatitis, J) timing of intervention in necrotizing pancreatitis, K) intervention strategies in necrotizing pancreatitis, and L) timing of cholecystectomy. Using the GRADE system, 21 of the 38 (55%) recommendations, were rated as 'strong' and plenary voting revealed 'strong agreement' for 34 (89%) recommendations. The 2012 IAP/APA guidelines provide recommendations concerning key aspects of medical and surgical management of acute pancreatitis based on the currently available evidence. These recommendations should serve as a reference standard for current management and guide future clinical research on acute pancreatitis. Copyright © 2013 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  19. Role of interventional radiology in the management of acute gastrointestinal bleeding

    Science.gov (United States)

    Ramaswamy, Raja S; Choi, Hyung Won; Mouser, Hans C; Narsinh, Kazim H; McCammack, Kevin C; Treesit, Tharintorn; Kinney, Thomas B

    2014-01-01

    Acute gastrointestinal bleeding (GIB) can lead to significant morbidity and mortality without appropriate treatment. There are numerous causes of acute GIB including but not limited to infection, vascular anomalies, inflammatory diseases, trauma, and malignancy. The diagnostic and therapeutic approach of GIB depends on its location, severity, and etiology. The role of interventional radiology becomes vital in patients whose GIB remains resistant to medical and endoscopic treatment. Radiology offers diagnostic imaging studies and endovascular therapeutic interventions that can be performed promptly and effectively with successful outcomes. Computed tomography angiography and nuclear scintigraphy can localize the source of bleeding and provide essential information for the interventional radiologist to guide therapeutic management with endovascular angiography and transcatheter embolization. This review article provides insight into the essential role of Interventional Radiology in the management of acute GIB. PMID:24778770

  20. A vascular laboratory protocol for improving and managing after-hours suspected acute deep venous thrombosis.

    Science.gov (United States)

    Martin, Angela H; Eckert, George; Lemmon, Gary W; Sawchuk, Alan; Dalsing, Michael C

    2014-04-01

    This study reviews the clinical and workforce impact of a suggested protocol designed for the management of suspected acute deep venous thrombosis (DVT) in patients seen after standard vascular laboratory business hours. The protocol included the use of Wells score, D-dimer and a single dose of therapeutic anticoagulant to defer venous duplex ultrasound (VDU) testing until routine business hours unless contraindicated. Information was collected on medical history, physical exam and the timing of any diagnostic studies and treatment provided. Over 15% of studies done after-hours were deemed unnecessary by our protocol and in every individual the results were negative for an acute DVT. There were no adverse events from a one-time dose of anticoagulant. Limiting emergency VDU coverage to evaluate for acute DVT based on a management protocol can eliminate unnecessary after-hours VDU testing without having a negative impact on patient care.

  1. Acute cardiac arrhythmias following surgery for congenital heart disease: mechanisms, diagnostic tools, and management.

    Science.gov (United States)

    Payne, Linda; Zeigler, Vicki L; Gillette, Paul C

    2011-06-01

    This article focuses on the management of those cardiac arrhythmias most commonly seen in the immediate postoperative period. They include ventricular tachycardia, ventricular fibrillation, atrial flutter, junctional ectopic tachycardia, bradycardia, and atrioventricular block. The mechanisms of cardiac arrhythmias are reviewed followed by a brief overview of the predominant acute arrhythmias, tools used for the diagnostic evaluation of these arrhythmias, management strategies, and, finally, nursing considerations.

  2. Airway Management & Assessment of Dyspnea in Emergency Department Patients with Acute Heart Failure

    Science.gov (United States)

    Pang, Peter S.; Zaman, Masood

    2013-01-01

    Shortness of breath is the most common symptom in patients with acute heart failure (AHF). Ensuring adequate oxygenation and ventilation as well as symptomatic relief are key goals of early emergency department management. In this focused review, we describe how to assess dyspnea in clinical practice and how to treat AHF patients to relieve dyspnea, with initial discussion on Airway and Breathing management for patients who present in extremis. PMID:23795334

  3. [Optimization of the management of acute heart failure. New concept of fast-track].

    Science.gov (United States)

    Andrieu, S; Jouve, B; Pansieri, M

    2016-11-01

    The acute heart failure generates a very important number of hospitalizations for a high cost. A recent reflection on optimizing its management is ongoing, based on the fastest management in the emergency department, with a distinction between which patient should remain and who returns at home, and under what conditions, allowing to limit the number of hospitalizations. It will require a reorganization of emergency department and updating of decision algorithms and new guidelines of care.

  4. IAP/APA evidence-based guidelines for the management of acute pancreatitis

    NARCIS (Netherlands)

    Goor, H. van

    2013-01-01

    BACKGROUND: There have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise t

  5. Left atrial ball thrombus with acute mesenteric ischemia: Anesthetic management and role of transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    Neeti Makhija

    2014-01-01

    Full Text Available A 62 year old female with severe mitral stenosis, large left atrial ball thrombus and acute mesenteric ischemia emergently underwent mitral valve replacement, left atrial clot removal and emergency laparotomy for mesenteric ischemia. Peri-operative management issues, particularly, the anesthetic challenges and the role of transesophageal echocardiography are discussed.

  6. Improving the management of post-operative acute pain: Priorities for change

    NARCIS (Netherlands)

    Meissner, W. (Winfried); F. Coluzzi (Flaminia); Fletcher, D. (Dominique); F.J.P.M. Huygen (Frank); B. Morlion (Bart); Neugebauer, E. (Edmund); Pérez, A.M. (Antonio Montes); J. Pergolizzi (Joseph)

    2015-01-01

    textabstractPoor management of post-operative acute pain can contribute to medical complications including pneumonia, deep vein thrombosis, infection and delayed healing, as well as the development of chronic pain. It is therefore important that all patients undergoing surgery should receive

  7. IAP/APA evidence-based guidelines for the management of acute pancreatitis

    NARCIS (Netherlands)

    Goor, H. van

    2013-01-01

    BACKGROUND: There have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise

  8. Acute leukemia during pregnancy: obstetric management and perinatal outcome of two cases.

    Science.gov (United States)

    Requena, A; Velasco, J G; Pinilla, J; Gonzalez-Gonzalez, A

    1995-12-01

    The coexistence of leukemia and pregnancy is extremely rare. This paper describes two cases of acute promyelocytic leukemia diagnosed during the second trimester of pregnancy and the most suitable approach to the management of this situation is analyzed. Possible teratogenic effects of mono- or polychemotherapy during pregnancy, depending upon the gestational age at which chemotherapy is given, are discussed.

  9. Management of non ST segment elevation acute coronary syndromes: A shift in the paradigm

    Institute of Scientific and Technical Information of China (English)

    Jean-Pierre Bassand

    2008-01-01

    @@ The new European guidelines on the management of non-ST segment elevation acute coronary syndromes (NSTE-ACS) were published in June 2007, two months before the American College of Cardiology-American Heart Association (ACC-AHA) guideline update on the same topic.1'2

  10. Improving the management of post-operative acute pain: Priorities for change

    NARCIS (Netherlands)

    Meissner, W. (Winfried); F. Coluzzi (Flaminia); Fletcher, D. (Dominique); F.J.P.M. Huygen (Frank); B. Morlion (Bart); Neugebauer, E. (Edmund); Pérez, A.M. (Antonio Montes); Pergolizzi, J. (Joseph)

    2015-01-01

    textabstractPoor management of post-operative acute pain can contribute to medical complications including pneumonia, deep vein thrombosis, infection and delayed healing, as well as the development of chronic pain. It is therefore important that all patients undergoing surgery should receive adequat

  11. Management and treatment of osteonecrosis in children and adolescents with acute lymphoblastic leukemia

    NARCIS (Netherlands)

    M.L. te Winkel (Mariël Lizet); R. Pieters (Rob); E.-J.D. Wind (Ernst-Jan); J.H.J.M. Bessems (Gert); M.M. van den Heuvel-Eibrink (Marry)

    2014-01-01

    textabstractThere is no consensus regarding how to manage osteonecrosis in pediatric acute lymphoblastic leukemia patients. Therefore, we performed a quality assessment of the literature with the result of a search strategy using the MESH terms osteonecrosis, children, childhood cancer, surgery,

  12. Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis.

    LENUS (Irish Health Repository)

    McDermott, F D

    2014-01-01

    The severity of acute diverticulitis ranges from mild, simple inflammation to pericolic abscesses, or perforation with faeculent peritonitis. Treatment of diverticulitis has evolved towards more conservative and minimally invasive strategies. The aim of this review is to highlight recent concepts and advances in management.

  13. Management and treatment of osteonecrosis in children and adolescents with acute lymphoblastic leukemia

    NARCIS (Netherlands)

    M.L. te Winkel (Mariël Lizet); R. Pieters (Rob); E.-J.D. Wind (Ernst-Jan); J.H.J.M. Bessems (Gert); M.M. van den Heuvel-Eibrink (Marry)

    2014-01-01

    textabstractThere is no consensus regarding how to manage osteonecrosis in pediatric acute lymphoblastic leukemia patients. Therefore, we performed a quality assessment of the literature with the result of a search strategy using the MESH terms osteonecrosis, children, childhood cancer, surgery, bis

  14. Acute care management of older people with dementia: a qualitative perspective.

    Science.gov (United States)

    Moyle, Wendy; Borbasi, Sally; Wallis, Marianne; Olorenshaw, Rachel; Gracia, Natalie

    2011-02-01

    This Australian study explored management for older people with dementia in an acute hospital setting. As the population ages, increasing numbers of older people with dementia are placed into an acute care hospital to manage a condition other than dementia. These people require special care that takes into account the unique needs of confused older people. Current nursing and medical literature provides some direction in relation to best practice management; however, few studies have examined this management from the perspective of hospital staff. A descriptive qualitative approach was used. Data were collected using semi-structured audio-taped interviews with a cross section of thirteen staff that worked in acute medical or surgical wards in a large South East Queensland, Australia Hospital. Analysis of data revealed five subthemes with the overarching theme being paradoxical care, in that an inconsistent approach to care emphasised safety at the expense of well-being and dignity. A risk management approach was used rather than one that incorporated injury prevention as one facet of an overall strategy. Using untrained staff to sit and observe people with dementia as a risk management strategy does not encourage an evidence-based approach. Staff education and environmental resources may improve the current situation so that people with dementia receive care that takes into account their individual needs and human dignity. Nurses can assist older people with dementia by encouraging evidence-based care practices to become the part of hospital policy. © 2010 Blackwell Publishing Ltd.

  15. Clinical Management of Acute Interstitial Pneumonia: A Case Report

    Directory of Open Access Journals (Sweden)

    Yang Xia

    2012-01-01

    Full Text Available We describe a 51-year-old woman who was admitted to hospital because of cough and expectoration accompanied with general fatigue and progressive dyspnea. Chest HRCT scan showed areas of ground glass attenuation, consolidation, and traction bronchiectasis in bilateral bases of lungs. BAL fluid test and transbronchial lung biopsy failed to offer insightful evidence for diagnosis. She was clinically diagnosed with acute interstitial pneumonia (AIP. Treatment with mechanical ventilation and intravenous application of methylprednisolone (80 mg/day showed poor clinical response and thus was followed by steroid pulse therapy (500 mg/day, 3 days. However, she died of respiratory dysfunction eventually. Autopsy showed diffuse alveolar damage associated with hyaline membrane formation, pulmonary interstitial, immature collagen edema, and focal type II pneumocyte hyperplasia.

  16. Acute right ventricular dysfunction: real-time management with echocardiography.

    Science.gov (United States)

    Krishnan, Sundar; Schmidt, Gregory A

    2015-03-01

    In critically ill patients, the right ventricle is susceptible to dysfunction due to increased afterload, decreased contractility, or alterations in preload. With the increased use of point-of-care ultrasonography and a decline in the use of pulmonary artery catheters, echocardiography can be the ideal tool for evaluation and to guide hemodynamic and respiratory therapy. We review the epidemiology of right ventricular failure in critically ill patients; echocardiographic parameters for evaluating the right ventricle; and the impact of mechanical ventilation, fluid therapy, and vasoactive infusions on the right ventricle. Finally, we summarize the principles of management in the context of right ventricular dysfunction and provide recommendations for echocardiography-guided management.

  17. Use of intranasal corticosteroids in the management of congestion and sleep disturbance in pediatric patients with allergic rhinitis.

    Science.gov (United States)

    Lanier, Bob Q

    2008-06-01

    Allergic rhinitis affects a large number of children and exerts a considerable socioeconomic impact. It is underdiagnosed and inadequately treated, which predisposes children to potentially serious comorbidities. Allergic rhinitis symptoms may create nighttime breathing problems and sleep disturbances and have a negative effect on a child's ability to learn in the classroom. Although antihistamines have shown efficacy in relieving many symptoms, they have little effect on nasal congestion. This article summarizes the advantages of intranasal corticosteroids, including their effectiveness against congestion and excellent safety profile. Intranasal corticosteroids with minimal systemic bioavailability provide topical drug delivery that minimizes the potential for systemic side-effects.

  18. The trend of acute burns pre-hospital management

    Directory of Open Access Journals (Sweden)

    Abubakar Hamdiya

    2015-08-01

    Conclusions: Burn injuries are common in our settings, a more reason for all to know the immediate intervention to give to victims of such accidents. The kind of first aid administered to burns victims possibly affects the burns management outcome. Thus, the earlier the right intervention implemented, the lesser the complications.

  19. Role of endoscopy in the management of acute diverticular bleeding

    Institute of Scientific and Technical Information of China (English)

    Charalampos Pilichos; Emmanouil Bobotis

    2008-01-01

    Colonic diverticulosis is one of the most common causes of lower gastrointestinal bleeding. Endoscopy is not only a useful diagnostic tool for localizing the bleeding site, but also a therapeutic modality for its management. To date, haemostatic methods have included adrenaline injection, mechanical clipping, thermal and electrical coagulation or combinations of them. The results of all published data are herein reviewed.

  20. Antibiotics versus appendectomy in the management of acute appendicitis: a review of the current evidence

    Science.gov (United States)

    Fitzmaurice, Gerard J.; McWilliams, Billy; Hurreiz, Hisham; Epanomeritakis, Emanuel

    2011-01-01

    Background Acute appendicitis remains the most common cause of the acute abdomen in young adults, and the mainstay of treatment in most centres is an appendectomy. However, treatment for other intra-abdominal inflammatory processes, such as diverticulitis, consists initially of conservative management with antibiotics. The aim of this study was to determine the role of antibiotics in the management of acute appendicitis and to assess if appendectomy remains the gold standard of care. Methods A literature search using MEDLINE and the Cochrane Library identified studies published between 1999 and 2009, and we reviewed all relevant articles. The articles were critiqued using the Public Health Resource Unit (2006) appraisal tools. Results Our search yielded 41 papers, and we identified a total of 13 papers within the criteria specified. All of these papers, while posing pertinent questions and demonstrating the role of antibiotics as a bridge to surgery, failed to adequately justify their findings that antibiotics could be used as a definitive treatment of acute appendicitis. Conclusion Appendectomy remains the gold standard of treatment for acute appendicitis based on the current evidence. PMID:21651835

  1. Emergent management of postpartum hemorrhage for the general and acute care surgeon

    Directory of Open Access Journals (Sweden)

    Blankenship Charles L

    2009-11-01

    Full Text Available Abstract Background Postpartum hemorrhage is one of the rare occasions when a general or acute care surgeon may be emergently called to labor and delivery, a situation in which time is limited and the stakes high. Unfortunately, there is generally a paucity of exposure and information available to surgeons regarding this topic: obstetric training is rarely found in contemporary surgical residency curricula and is omitted nearly completely from general and acute care surgery literature and continuing medical education. Methods The purpose of this manuscript is to serve as a topic specific review for surgeons and to present a surgeon oriented management algorithm. Medline and Ovid databases were utilized in a comprehensive literature review regarding the management of postpartum hemorrhage and a management algorithm for surgeons developed based upon a collaborative panel of general, acute care, trauma and obstetrical surgeons' review of the literature and expert opinion. Results A stepwise approach for surgeons of the medical and surgical interventions utilized to manage and treat postpartum hemorrhage is presented and organized into a basic algorithm. Conclusion The manuscript should promote and facilitate a more educated, systematic and effective surgeon response and participation in the management of postpartum hemorrhage.

  2. Management of acute pain in the postoperative setting

    DEFF Research Database (Denmark)

    Meissner, Winfried; Huygen, Frank Jpm; Neugebauer, Edmund A M

    2017-01-01

    /unsuccessful. In the hospital sector the development and implementation of QIs is complex. The nature of POPM requires a highly-trained, multidisciplinary team and it is at this level where major improvements can be made. Greater involvement of patients regarding pain management is also seen as a priority area for improving......Despite the introduction of evidence-based recommendations for postoperative pain management (POPM), the consensus is that pain control remains suboptimal. Barriers to achieving patient-satisfactory analgesia include deficient knowledge regarding POPM among staff, lack of instructions, insufficient...... pain assessments and sub-optimal treatment. Effective monitoring of POPM is essential to enable policy makers and healthcare providers to improve the quality of care. Quality indicators (QIs) are quantitative measures of clinical practice that can monitor, evaluate and guide the quality of care...

  3. Capacity-building in the management of moderate acute malnutrition.

    Science.gov (United States)

    Jackson, Alan; Ashworth, Ann

    2015-03-01

    Evidence from low- and middle-income countries indicates that although there is a willingness to prevent and treat malnutrition at scale, there is very limited capacity to achieve this. Three broad areas of concern are human resources and the quality of services; management systems and supplies; and demand side factors. This paper focuses on building human resources in the context of preventing and managing malnutrition. Training should provide several options and approaches suitable for different settings and focus on core competencies. Preservice training should be the main focus of training, while in-service training should be used for continuing medical education and refresher training. Communities of Practice, in which national and international health professionals come together to deepen their knowledge and pool their skills to pursue a common ambition, are seen as one way forward to building the necessary human resources for scaling up training.

  4. Fundamentals of management of acute postoperative pulmonary hypertension.

    Science.gov (United States)

    Taylor, Mary B; Laussen, Peter C

    2010-03-01

    In the last several years, there have been numerous advancements in the field of pulmonary hypertension as a whole, but there have been few changes in the management of children with pulmonary hypertension after cardiac surgery. Patients at particular risk for postoperative pulmonary hypertension can be identified preoperatively based on their cardiac disease and can be grouped into four broad categories based on the mechanisms responsible for pulmonary hypertension: 1) increased pulmonary vascular resistance; 2) increased pulmonary blood flow with normal pulmonary vascular resistance; 3) a combination of increased pulmonary vascular resistance and increased blood flow; and 4) increased pulmonary venous pressure. In this review of the immediate postoperative management of pulmonary hypertension, various strategies are discussed including medical therapies, monitoring, ventilatory strategies, and weaning from these supports. With early recognition of patients at particular risk for severe pulmonary hypertension, management strategies can be directed at preventing or minimizing hemodynamic instability and thereby prevent the development of ventricular dysfunction and a low output state.

  5. Current status of acute stroke management in Korea: a report on a multicenter, comprehensive acute stroke registry.

    Science.gov (United States)

    Kim, Beom Joon; Han, Moon-Ku; Park, Tai Hwan; Park, Sang-Soon; Lee, Kyung Bok; Lee, Byung-Chul; Yu, Kyung-Ho; Cha, Jae Kwan; Kim, Dae-Hyun; Lee, Jun; Lee, Soo Joo; Ko, Youngchai; Park, Jong-Moo; Kang, Kyusik; Cho, Yong-Jin; Hong, Keun-Sik; Cho, Ki-Hyun; Kim, Joon-Tae; Kim, Dong-Eog; Lee, Juneyoung; Lee, Ji Sung; Jang, Myung Suk; Broderick, Joseph P; Yoon, Byung-Woo; Bae, Hee-Joon

    2014-06-01

    There are limited data on the utilization of diagnostics and the variation of treatments at the national level in acute stroke care. Clinical Research Center for Stroke--5th division stroke registry aimed to describe stroke statistics and quality of care in Korea and to implement quality indicators. Clinical Research Center for Stroke--5th division registry was established in April 2008 and covers pretreatment demographics, medical and stroke severity measures, diagnostic evaluation, hyperacute revascularization, in-hospital management, discharge disposition, quality indicators, and long-term functional outcomes. Consecutive stroke cases from 12 participating centers are registered to a web-based database. Meticulous data management and auditing policy were applied. A total of 14,792 ischemic stroke cases were enrolled from April 2008 to January 2012. The median National Institutes of Health Stroke Scale score was 4 at admission, with median delay of onset to arrival of 14 h. Rate of risk factor management before stroke exceeds more than 80% for hypertension and diabetes. Revascularization procedures were performed in 1736 subjects (12%), and 34% were endovascular (n = 598). Substantial variability was noted in the preferred modality of hyperacute revascularization (range of endovascular recanalization = 6-60%), use of computed tomography (30-93%), and perfusion imaging (2-96%). The Clinical Research Center for Stroke--5th division registry documented that the current practice of acute stroke care in South Korea largely met the standard of guidelines, but variability of practice still remains. The registry would provide an opportunity to evaluate the quality of stroke care across South Korea and compare it with that of other countries. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

  6. Fluid in the management of the acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Karki S

    2013-06-01

    Full Text Available Introduction Non-cardiogenic pulmonary edema is the hallmark of the acute respiratory distress syndrome (ARDS. The amount of fluid and which fluid should be used in these patients is controversial. Methods 43 patients with ARDS treated in the intensive care unit (ICU of the Second Hospital, Jilin University between November 1, 2011-November 1, 2012 were prospectively analyzed and was observational. Volume and the type of fluid administered were compared to 90 day mortality and the 24 and 72 hour sequential organ failure assessment (SOFA score, lactate level, oxygenation index (PaO2/FiO2, duration of ICU stay, total ventilator days, and need for continuous renal replacement therapy (CRRT. Results Mortality was increased when hydroxylethyl starch (HES was used in the first day or plasma substitutes were used during the first 3 days (P3000 ml during the first 24 hours or >8000 ml during the first 72 hours were associated with higher SOFA scores at 24 and 72 hours (P<0.05, both comparisons. Colloid, especially higher volume colloid use was also associated with increased SOFA scores at either 24 or 72 hours. Conclusions Limiting the use of colloids and the total amount of fluid administered to patients with ARDS is associated with improved mortality and SOFA scores.

  7. Risk-Adapted Management of Acute Pulmonary Embolism: Recent Evidence, New Guidelines

    Directory of Open Access Journals (Sweden)

    Anja Käberich

    2014-10-01

    Full Text Available Venous thromboembolism (VTE, the third most frequent acute cardiovascular syndrome, may cause life-threatening complications and imposes a substantial socio-economic burden. During the past years, several landmark trials paved the way towards novel strategies in acute and long-term management of patients with acute pulmonary embolism (PE. Risk stratification is increasingly recognized as a cornerstone for an adequate diagnostic and therapeutic management of the highly heterogeneous population of patients with acute PE. Recently published European Guidelines emphasize the importance of clinical prediction rules in combination with imaging procedures (assessment of right ventricular function and laboratory biomarkers (indicative of myocardial stress or injury for identification of normotensive PE patients at intermediate risk for an adverse short-term outcome. In this patient group, systemic full-dose thrombolysis was associated with a significantly increased risk of intracranial bleeding, a complication which discourages its clinical application unless hemodynamic decompensation occurs. A large-scale clinical trial program evaluating new oral anticoagulants in the initial and long-term treatment of venous thromboembolism showed at least comparable efficacy and presumably increased safety of these drugs compared to the current standard treatment. Research is continuing on catheter-directed, ultrasound-assisted, local, low-dose thrombolysis in the management of intermediate-risk PE.

  8. Management of acute dislocation of the temporomandibular joint in dental practice.

    LENUS (Irish Health Repository)

    McGoldrick, David M

    2010-12-01

    Acute dislocation of the temporomandibular joint is a situation that, although rare, may present to the dentist in practice at any time. A number of activities, such as removal of a tooth, may cause dislocation. The event is painful and distressing for the patient, their family and the dental team. Prompt management minimises discomfort, distress and long-term morbidity to the patient. We describe the aetiology of acute dislocation and outline a number of techniques that will aid the clinican in dealing with this event.

  9. Optimal management of acute nonrenal adverse reactions to iodine-based contrast media

    Directory of Open Access Journals (Sweden)

    Nielsen YW

    2013-06-01

    Full Text Available Yousef W Nielsen, Henrik S Thomsen Department of Radiology, Copenhagen University Hospital Herlev, Copenhagen, Denmark Abstract: Acute adverse reactions to iodine-based contrast media occur within 60 minutes of administration. The reactions range from mild (flushing, arm pain, nausea/vomiting, headache to moderate (bronchospasm, hypotension, and severe (cardiovascular collapse, laryngeal edema, convulsions, arrhythmias. Most acute adverse reactions occur in an unpredictable manner. Use of the older group of ionic iodine-based contrast agents increases the risk of acute adverse reactions. Other risk factors include previous reactions to contrast media, asthma, and allergic conditions. The exact pathophysiology of the acute adverse reactions is unknown, but some of the reactions are pseudoallergic mimicking type 1 allergic reactions. As antibodies against contrast media have not been consistently demonstrated, the reactions are, in most cases, not truly allergic in nature. Most of the severe and fatal adverse reactions occur within the first 20 minutes after injection. Thus, it is important that patients are observed in the radiology department during this period. The radiologist should be near the room where contrast media is administered, and be ready to treat any acute nonrenal adverse reaction. Appropriate drugs and resuscitation equipment should be in/near the room where the contrast media is administered. The important first-line management of acute adverse reactions includes the establishment of an adequate airway, oxygen supplementation by mask, intravenous fluid administration, and measurement of blood pressure and heart rate. When severe anaphylactoid reactions occur, adrenaline should be given intramuscularly. Only one concentration of adrenaline (1:1000–1 mg/mL should be available in the radiology department to avoid dosing errors in stressful acute settings. Resuscitation team specialists should be the only ones giving intravenous

  10. Total quality in acute care hospitals: guidelines for hospital managers.

    Science.gov (United States)

    Holthof, B

    1991-08-01

    Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements.

  11. MANAGEMENT OF ACUTE SEVERE ULCERATIVE COLITIS: A CLINICAL UPDATE.

    Science.gov (United States)

    Sobrado, Carlos Walter; Sobrado, Lucas Faraco

    2016-01-01

    Acute severe colitis is a potentially lethal medical emergency and, even today, its treatment remains a challenge for clinicians and surgeons. Intravenous corticoid therapy, which was introduced into the therapeutic arsenal in the 1950s, continues to be the first-line treatment and, for patients who are refractory to this, the rescue therapy may consist of clinical measures or emergency colectomy. To evaluate the indications for and results from drug rescue therapy (cyclosporine, infliximab and tacrolimus), and to suggest a practical guide for clinical approaches. The literature was reviewed using the Medline/PubMed, Cochrane library and SciELO databases, and additional information from institutional websites of interest, by cross-correlating the following keywords: acute severe colitis, fulminating colitis and treatment. Treatments for acute severe colitis have avoided colectomy in 60-70% of the cases, provided that they have been started early on, with multidisciplinary follow-up. Despite the adverse effects of intravenous cyclosporine, this drug has been indicated in cases of greater severity with an imminent risk of colectomy, because of its fast action, short half-life and absence of increased risk of surgical complications. Therapy using infliximab has been reserved for less severe cases and those in which immunosuppressants are being or have been used (AZA/6-MP). Indication of biological agents has recently been favored because of their ease of therapeutic use, their good short and medium-term results, the possibility of maintenance therapy and also their action as a "bridge" for immunosuppressant action (AZA/6-MP). Colectomy has been reserved for cases in which there is still no response five to seven days after rescue therapy and in cases of complications (toxic megacolon, profuse hemorrhage and perforation). Patients with a good response to rescue therapy who do not undergo emergency operations should be considered for maintenance therapy using

  12. Increased tolerance to humans among disturbed wildlife

    Science.gov (United States)

    Samia, Diogo S. M.; Nakagawa, Shinichi; Nomura, Fausto; Rangel, Thiago F.; Blumstein, Daniel T.

    2015-01-01

    Human disturbance drives the decline of many species, both directly and indirectly. Nonetheless, some species do particularly well around humans. One mechanism that may explain coexistence is the degree to which a species tolerates human disturbance. Here we provide a comprehensive meta-analysis of birds, mammals and lizards to investigate species tolerance of human disturbance and explore the drivers of this tolerance in birds. We find that, overall, disturbed populations of the three major taxa are more tolerant of human disturbance than less disturbed populations. The best predictors of the direction and magnitude of bird tolerance of human disturbance are the type of disturbed area (urbanized birds are more tolerant than rural or suburban populations) and body mass (large birds are more tolerant than small birds). By identifying specific features associated with tolerance, these results guide evidence-based conservation strategies to predict and manage the impacts of increasing human disturbance on birds. PMID:26568451

  13. Increased tolerance to humans among disturbed wildlife.

    Science.gov (United States)

    Samia, Diogo S M; Nakagawa, Shinichi; Nomura, Fausto; Rangel, Thiago F; Blumstein, Daniel T

    2015-11-16

    Human disturbance drives the decline of many species, both directly and indirectly. Nonetheless, some species do particularly well around humans. One mechanism that may explain coexistence is the degree to which a species tolerates human disturbance. Here we provide a comprehensive meta-analysis of birds, mammals and lizards to investigate species tolerance of human disturbance and explore the drivers of this tolerance in birds. We find that, overall, disturbed populations of the three major taxa are more tolerant of human disturbance than less disturbed populations. The best predictors of the direction and magnitude of bird tolerance of human disturbance are the type of disturbed area (urbanized birds are more tolerant than rural or suburban populations) and body mass (large birds are more tolerant than small birds). By identifying specific features associated with tolerance, these results guide evidence-based conservation strategies to predict and manage the impacts of increasing human disturbance on birds.

  14. Functional outcome of the surgical management of acute acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    Naseem Munshi; Asad Abbas; Mohamed Amirali Gulamhussein; Ghulam Mehboob; Rija Aitzaz Qureshi

    2015-01-01

    Objective:To assess the functional outcome of early surgical management of displaced acetabular fractures and the complications associated with the procedure. Methods: This is a case series study and data was collected using specialized performance. The study included 75 patients and the sampling technique was a non-probability purposive type. Patients presenting with close displaced acetabular fractures of more than 2 mm within 10 days of injury were included. However, elderly patients presenting after 10 days of injury, with evidence of local infection, severe osteoporotic bone and co-morbid such as chronic obstructive pulmonary disease were not included in the study. New acetabular scoring system was used for assessing outcome of patients. Results:A total of 75 patients were operated on. Union was achieved in anatomical position in 66 (88%) patients and in malposition in 9 (12%) patients. Excellent results were obtained in 18 (24%) patients, good results in 41 (54.6%), fair results in 12 (16%), and poor results in 4 (5.4%) patients. Postoperative complications included infection [5 (6.7%)], heterotropic ossification [3 (4%)], sciatic nerve injury [10 (13.3%)], avascular necrosis [3 (4%)] patients. Conclusions: Patients with displaced acetabular fractures should be referred to specialised centres. Early surgical intervention and experienced management is a prime factor in achieving good results.

  15. The acute medical management of detained Somali pirates and their captives.

    Science.gov (United States)

    Schranz, Craig

    2012-09-01

    Over the last several years, piracy off the coast of East Africa has resulted in significant risks to merchant vessels and their crews. There have been multiple instances of both pirates being detained and captives being liberated by military vessels. The unique health concerns of this population have been minimally studied and military health providers must be prepared to identify and manage potential medical conditions. In an attempt to provide further guidance for providers, this article reviews the limited available literature and identifies potential health concerns of pirates and recently released captives. In addition to traumatic injuries, specific medical concerns that must be considered include infectious disease, wound management, dehydration, hypothermia, malnutrition, electrolyte disturbance, and potential psychiatric conditions. Infectious disease is also a major threat. Malaria, tuberculosis, and intestinal parasites likely pose the greatest risk. A careful medical screening along with an extensive intake history and physical examination are essential for rapid identification and initial management of this unique population.

  16. Brief review: Adoption of electronic medical records to enhance acute pain management.

    Science.gov (United States)

    Goldstein, David H; Phelan, Rachel; Wilson, Rosemary; Ross-White, Amanda; VanDenKerkhof, Elizabeth G; Penning, John P; Jaeger, Melanie

    2014-02-01

    The purpose of this paper is to examine physician barriers to adopting electronic medical records (EMRs) as well as anesthesiologists' experiences with the EMRs used by the acute pain management service at two tertiary care centres in Canada. We first review the recent literature to determine if physician barriers to adoption are changing given the exponential growth of information technology and the evolving healthcare environment. We next report on institutional experience from two academic health sciences centres regarding the challenges they encountered over the past ten years in developing and implementing an electronic medical record system for acute pain management. The key identified barriers to adoption of EMRs are financial, technological, and time constraints. These barriers are identical to those reported in a systematic review performed prior to 2009 and remain significant factors challenging implementation. These challenges were encountered during our institution's process of adopting EMRs specific to acute pain management. In addition, our findings emphasize the importance of physician participation in the development and implementation stages of EMRs in order to incorporate their feedback and ensure the EMR system is in keeping with their workflow. Use of EMRs will inevitably become the standard of care; however, many barriers persist to impede their implementation and adoption. These challenges to implementation can be facilitated by a corporate strategy for change that acknowledges the barriers and provides the resources for implementation. Adoption will facilitate benefits in communication, patient management, research, and improved patient safety.

  17. Update on the management of non-obstetric acute abdomen in pregnant patients.

    Science.gov (United States)

    Barber-Millet, Sebastián; Bueno Lledó, José; Granero Castro, Pablo; Gómez Gavara, Immaculada; Ballester Pla, Neus; García Domínguez, Rafael

    2016-05-01

    Acute abdomen is a rare entity in the pregnant patient, with an incidence of one in 500-635 patients. Its appearance requires a quick response and an early diagnosis to treat the underlying disease and prevent maternal and fetal morbidity. Imaging tests are essential, due to clinical and laboratory masking in this subgroup. Appendicitis and complicated biliary pathology are the most frequent causes of non-obstetric acute abdomen in the pregnant patient. The decision to operate, the timing, and the surgical approach are essential for a correct management of this pathology. The aim of this paper is to perform a review and update on the diagnosis and treatment of non-obstetric acute abdomen in pregnancy. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Nutrition Support in Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Orestis Ioannidis

    2008-07-01

    Full Text Available The management of acute pancreatitis differs according to its severity. Approximately 75% of patients with acute pancreatitis have mild disease with a mortality rate below 1%. Mortality increases up to 20% if the disease progresses to its severe necrotizing form and, in the most severe cases, mortality can increase to 30-40%. Severe acute pancreatitis is usually accompanied by systemic inflammatory response syndrome (SIRS which results in hypermetabolism with prominent protein catabolism. Acute malnutrition, commonly observed in patients with acute pancreatitis, is associated with immunological disturbances, septic complications and delayed healing of surgical wounds, and may lead to multiorgan dysfunction or failure syndrome (MODS or MOFS and increased morbidity and mortality [1].

  19. Disturbance of response to acute thermal pain in naturally occurring cholecystokinin-a receptor gene knockout Otsuka Long-Evans Tokushima Fatty (OLETF) rats.

    Science.gov (United States)

    Miyasaka, Kyoko; Nomoto, Shigeki; Ohta, Minoru; Kanai, Setsuko; Kaneko, Takao; Tahara, Shoichi; Funakoshi, Akihiro

    2006-08-01

    Otsuka Long-Evans Tokushima Fatty (OLETF) rats lack cholecystokinin-A receptor (CCK-AR) because of a genetic abnormality. We observed that body temperature homeostasis in response to changes in ambient temperature was deteriorated in OLETF rats, while the functions of the signal outputs from the hypothalamus to effectors were not impaired. Deteriorated homeostasis was also seen in CCK-AR deficient (-/-) mice. In the present study, we examined whether the sensory pathway involved in transmitting signals about temperature from the skin to the brain was impaired in OLETF rats. To elucidate the involvement of CCK-AR function, we conducted the same experiment in CCK-AR(-/-) mice. Responses to thermal pain were assessed using the Hargreaves' plantar test apparatus. Shortening of withdrawal latency was observed in OLETF rats compared to control rats, indicating thermal hyperalgesia. Behavioral responses following paw withdrawal were disturbed in OLETF rats. The 5-hydroxytryptamine (5-HT) and 5-hydroxyindole acetic acid contents in the hippocampus and frontal cortex of OLETF rats were significantly higher than in those of the controls. CCK-AR(-/-) mice did not show any differences from wild-type mice. In conclusion, OLETF rats showed thermal hyperalgesia and disturbed responses to thermal pain, and an alteration of 5-HT function might have a role in this disturbance.

  20. An overview of acute burn management in the Emergency Centre

    Directory of Open Access Journals (Sweden)

    Adaira Landry

    2013-03-01

    Full Text Available Despite the frequency and severity of burns in Low Income Countries, including many in Africa, there is a paucity of research and funding for these populations to aid in prevention, treatment and recovery of burn patients. The objectives of this paper are four-fold. First, by addressing the pathophysiology of burns the reader may strengthen understanding of the clinical progression of burns. Second, through describing proper assessment of burn patients one will learn how to decide if patients can be discharged, admitted or transferred to burn centre. Third, the inclusion of treatments solidifies the steps necessary to manage a patient in a hospital setting. Lastly, the overall goal of the paper, is to raise awareness that more research, publication and funding is required to create a better understanding of burns in Africa and why they continue to be devastating social and economic burdens.

  1. CLINICAL ASPECTS OF ACUTE POST-OPERATIVE PAIN MANAGEMENT & ITS ASSESSMENT

    Directory of Open Access Journals (Sweden)

    R.S.R Murthy

    2010-06-01

    Full Text Available Management of postoperative pain relieve suffering and leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. An effective postoperative management is not a standardized regime rather is tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to therapeutic agents given. The major goal in the management of postoperative pain is to minimize the dose of medications to lessen side effects & provide adequate analgesia. Postoperative pain is still under managed due to obstacles in implementation of Acute Pain Services due to insufficient education, fear of complications associated with available analgesic drugs, poor pain assessment and inadequate staff. This review reflects the clinical aspects of postoperative pain & its assessment & management with an emphasis on research for new analgesic molecules & delivery system.

  2. Clinical aspects of acute post-operative pain management & its assessment

    Directory of Open Access Journals (Sweden)

    Anuj Gupta

    2010-01-01

    Full Text Available Management of postoperative pain relieve suffering and leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. An effective postoperative management is not a standardized regime rather is tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to therapeutic agents given. The major goal in the management of postoperative pain is to minimize the dose of medications to lessen side effects & provide adequate analgesia. Postoperative pain is still under managed due to obstacles in implementation of Acute Pain Services due to insufficient education, fear of complications associated with available analgesic drugs, poor pain assessment and inadequate staff. This review reflects the clinical aspects of postoperative pain & its assessment & management with an emphasis on research for new analgesic molecules & delivery system.

  3. Acute leukemia and pregnancy: a review of management and outcome, 1972-1982.

    Science.gov (United States)

    Catanzarite, V A; Ferguson, J E

    1984-11-01

    Acute leukemia is a rare complication of pregnancy. Previous reviews that covered cases reported before the introduction of effective combination chemotherapy found fewer than 300 reported pregnancies, with a 36-69 per cent perinatal mortality and median maternal survival, from diagnosis, of less than 6 months. Advances in the fields of hematology-oncology, maternal-fetal medicine, and neonatology have resulted in a marked improvement in both perinatal survival statistics, and median maternal survival. Since 1972, there have been 14 pregnancies reported in patients cured of acute lymphocytic leukemia, with 1 early spontaneous abortion and 13 term infants. All mothers survived. There have been 47 reports of pregnancy in association with acute leukemia. In 40 pregnancies in which acute leukemia was treated, there were 5 abortions, 3 perinatal demises, 1 infant "liveborn in grave condition," and 31 surviving infants. Median maternal survival was at least 6, and possibly more than 12 months from delivery. In seven cases in which leukemia was untreated, there were one abortion, two perinatal demises, and four living infants; only one of six mothers survived beyond 6 months. Here, a case of pregnancy complicated by acute promyelocytic leukemia is presented. The mother was aggressively treated with combination chemotherapy. The fetus was closely monitored and delivered following a course of betamethasone at 34 weeks' gestation, and had no neonatal problems. The mother expired 13 months status-post bone marrow transplantation, 16 months after delivery. Cases of pregnancy complicated by acute leukemia reported in the period 1972-1982 are reviewed, and management is discussed in detail. Aggressive hematologic and obstetric management is advocated, and should result in further improvements in fetal and maternal outcome.

  4. Progression of Tokyo Guidelines and Japanese Guidelines for management of acute cholangitis and cholecystitis.

    Science.gov (United States)

    Mayumi, Toshihiko; Someya, Kazuki; Ootubo, Hiroki; Takama, Tatsuo; Kido, Takashi; Kamezaki, Fumihiko; Yoshida, Masahiro; Takada, Tadahiro

    2013-12-01

    The Japanese Guidelines for management of acute cholangitis and cholecystitis were published in 2005 as the first practical guidelines presenting diagnostic and severity assessment criteria for these diseases. After the Japanese version, the Tokyo Guidelines (TG07) were reported in 2007 as the first international practical guidelines. There were some differences between the two guidelines, and some weak points in TG07 were pointed out, such as low sensitivity for diagnosis and the presence of divergence between severity assessment and clinical judgment for acute cholangitis. Therefore, revisions were started to not only make them up to date but also concurrent with the same diagnostic and severity assessment criteria. The Revision Committee for the revision of TG07 (TGRC) performed validation studies of TG07 and new diagnostic and severity assessment criteria of acute cholangitis and cholecystitis. These were retrospective multi-institutional studies that collected cases of acute cholangitis, cholecystitis, and non-inflammatory biliary disease. TGRC held 35 meetings as well as international email exchanges with co-authors abroad and held three International Meetings. Through these efforts, TG13 improved the diagnostic sensitivity for acute cholangitis and cholecystitis, and presented criteria with extremely low false positive rates. Furthermore, severity assessment criteria adapted for clinical use, flowcharts, and many new diagnostic and therapeutic modalities were presented. The world's first management bundles of acute cholangitis and cholecystitis were also presented. The revised Japanese version was published with the same content as TG13. An electronic application of TG13 that can help to diagnose and assess the severity of these diseases using the criteria of TG13 was made for free download.

  5. European Stroke Organisation (ESO) guidelines for the management of temperature in patients with acute ischemic stroke.

    Science.gov (United States)

    Ntaios, George; Dziedzic, Tomasz; Michel, Patrik; Papavasileiou, Vasileios; Petersson, Jesper; Staykov, Dimitre; Thomas, Brenda; Steiner, Thorsten

    2015-08-01

    Hyperthermia is a frequent complication in patients with acute ischemic stroke. On the other hand, therapeutically induced hypothermia has shown promising potential in animal models of focal cerebral ischemia. This Guideline Document presents the European Stroke Organisation guidelines for the management of temperature in patients with acute ischemic stroke. A multidisciplinary group identified related questions and developed its recommendations based on evidence from randomized controlled trials elaborating the Grading of Recommendations Assessment, Development, and Evaluation approach. This Guideline Document was reviewed within the European Stroke Organisation and externally and was approved by the European Stroke Organisation Guidelines Committee and the European Stroke Organisation Executive Committee. We found low-quality evidence, and therefore, we cannot make any recommendation for treating hyperthermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and hyperthermia; moderate evidence to suggest against routine prevention of hyperthermia with antipyretics as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and normothermia; very low-quality evidence to suggest against routine induction of hypothermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke. The currently available data about the management of temperature in patients with acute ischemic stroke are limited, and the strengths of the recommendations are therefore weak. We call for new randomized controlled trials as well as recruitment of eligible patients to ongoing randomized controlled trials to allow for better-informed recommendations in the future. © 2015 World Stroke Organization.

  6. Sodium and water disturbances in patients with Sheehan's syndrome.

    Science.gov (United States)

    Pham, P C; Pham, P A; Pham, P T

    2001-09-01

    Sheehan's syndrome has been attributed to ischemic damage of the pituitary gland or hypothalamic-pituitary stalk during the peripartum period. Well-described clinical features of Sheehan's syndrome include hypothyroidism, adrenal insufficiency, hypogonadism, growth hormone deficiency, hypoprolactinemia, and different sodium and water disturbances. The occurrence of sodium and water disturbances associated with Sheehan's syndrome depends on the degree of pituitary damage, time of onset since the initial pituitary insult, and concurrent medical conditions that also may play a role in sodium and water balance. We present a patient with Sheehan's syndrome with severe chronic hyponatremia; discuss a potential problem in the patient's management; and review the literature for various sodium and water disturbances, including acute and chronic hyponatremia as well as overt and subclinical central diabetes insipidus. Although Sheehan's syndrome is more prevalent in developing countries, the increasingly large immigrant population within the United States warrants better awareness of this syndrome and its potential complicating sodium and water disturbances. Prompt diagnosis and an understanding of the pathogenic mechanisms of sodium and water disturbances associated with Sheehan's syndrome may avoid potential treatment-related complications.

  7. MANAGEMENT OF DIABETES IN ACUTE MYOCARDIAL INFARCTION IN CELJE GENERAL HOSPITAL IN 1999

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    Gregor Veninšek

    2001-12-01

    Full Text Available Background. DIGAMI study showed that intrahospital mortality and mortality at one year after myocardial infarction can be significantly reduced in diabetics treated in acute phase of myocardial infarction by GI infusion and afterwards for at least three months with intensive insulin treatment. Mortality can be reduced for more than 50% in a subgroup of patients younger than 70 years, without congestive heart failure, with first myocardial infarction, not treated with insulin or digitalis. In this perspective we reviewed treatment of diabetics with acute myocardial infarction in 1999 in Celje General Hospital.Methods. We reviewed documentation of treatment of all diabetics with acute myocardial infarction treated in Celje General Hospital in 1999. We collected data on number of newly discovered diabetes, on previous treatment of diabetes, on treatment of diabetes during hospitalization and at discharge, on drugs used for treatment of diabetes and on mortality during hospitalization.Results. Diabetics presented 20% of all patients with acute myocardial infarction treated in Celje General Hospital in 1999. None of patients received GI infusion, none had intensively managed blood sugar. 24% of patients were treated with sulfonylureas in acute phase of myocardial infarction. 33% of patients were discharged from hospital with insulin therapy. Intrahospital mortality was 9%, comparable with patients without diabetes.Conclusions. In 1999 was intrahospital treatment of diabetics with acute myocardial infarction in Celje General Hospital successful as their intrahospital mortality equaled non-diabetics. Treatment of diabetes itself, during hospitalization and after discharge, on the other hand, in 1999 had not been up to date according to results of recent studies. In our opinion, it is mandatory for diabetologist to make part of the team that treats diabetic with acute myocardial infarction

  8. The trend of acute burns pre-hospital management

    Institute of Scientific and Technical Information of China (English)

    Abubakar Hamdiya; Agbenorku Pius; Aboah Ken; Paa Ekow Hoyte-Williams

    2015-01-01

    Objective: To study the trend and knowledge of first aid administration of any kind among the burns patients and also to create awareness to the general public who mostly act as first aid givers who seem ignorant about the appropriate immediate care to render to the burns victim. Methods: Pre-tested questionnaires were administered to the burns victims who had received or not some form of first aid at the scene of the burn injury. Results: The study showed varied first aid knowledge and administration outcomes as a result of different substances such as water or sand, muddy water, starch, corn dough, cow dung, egg white, calamine lotion, gentian violet, ointments, creams, lotions, tooth paste etc. applied as first aid. Conclusions: Burn injuries are common in our settings, a more reason for all to know the immediate intervention to give to victims of such accidents. The kind of first aid administered to burns victims possibly affects the burns management outcome. Thus, the earlier the right intervention implemented, the lesser the complications.

  9. Pharmacist's impact on acute pain management during trauma resuscitation.

    Science.gov (United States)

    Montgomery, Kayla; Hall, A Brad; Keriazes, Georgia

    2015-01-01

    The timely administration of analgesics is crucial to the comprehensive management of trauma patients. When an emergency department (ED) pharmacist participates in trauma resuscitation, the pharmacist acts as a medication resource for trauma team members and facilitates the timely administration of analgesics. This study measured the impact of a pharmacist on time to first analgesic dose administered during trauma resuscitation. All adult (>18 years) patients who presented to this level II trauma center via activation of the trauma response system between January 1, 2009, and May 31, 2013, were screened for eligibility. For inclusion, patients must have received intravenous fentanyl, morphine, or hydromorphone in the trauma bay. The time to medication administration was defined as the elapsed time from ED arrival to administration of first analgesic. There were 1328 trauma response system activations during the study period; of which 340 patients were included. The most common analgesic administered was fentanyl (62% in both groups). When a pharmacist was participating, the mean time to first analgesic administered was decreased (17 vs 21 minutes; P = .03). Among the 78% of patients with documented pain scores, the overall mean reduction in pain scores from ED arrival to ED discharge was similar between the 2 groups. There was a 2.4 point reduction with a pharmacist versus 2.7 without a pharmacist, using a 0 to 10 numeric pain rating scale. The participation of a clinical pharmacist during trauma resuscitation significantly decreased the time to first analgesic administration in trauma patients. The results of this study supplement the literature supporting the integration of clinical ED pharmacists on trauma teams.

  10. [The Torino Network Project. Global management of acute myocardial infarction from the field to the hospital].

    Science.gov (United States)

    Casaccia, Michele; Sicuro, Marco; Scacciatella, Paolo

    2002-02-01

    A unidirectional clinical pathway for acute myocardial infarction from out-of-hospital setting to the coronary care unit and catheterization laboratory could lead to mortality reduction. The ongoing "Progetto Torino Network. Gestione globale dell'infarto miocardico acuto prime ore dal territorio all'ospedale" is based on this statement and described in the three-structural, diagnostic-therapeutical, multimedial issues. This project represents the historical evolution of our involvement in out-of-hospital cardiac emergency management.

  11. Double-button Fixation System for Management of Acute Acromioclavicular Joint Dislocation

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    Ali Torkaman

    2016-01-01

    Full Text Available Background: Surgical treatments for acromioclavicular (AC joint dislocation present with some complications. The present study was designed to evaluate the double-button fixation system in the management of acute acromioclavicular joint dislocation. Methods: This cross sectional study, done between February 2011 to June 2014, consisted of 28 patients who underwent surgical management by the double-button fixation system for acute AC joint dislocation. Age, sex, injury mechanism, dominant hand, side with injury, length of follow up, time before surgery, shoulder and hand (DASH, constant and visual analogue scale (VAS scores, and all complications of the cases during the follow up were recorded. Results: The mean age of patients was 33.23±6.7 years. Twenty four patients (85.71% were male and four (14.28% were female. The significant differences were observed between pre-operation VAS, constant shoulder scores and post-operation measurements (P=0.001, P=0.0001, P=0.0001, respectively. There were not any significant differences between right and left coracoclavicular (P=0.238, but two cases of heterotrophic ossifications were recorded. The mean follow-up time was 16.17±4.38 months. Conclusion: According to the results, the double-button fixation system for management of acute acromioclavicular joint dislocation has suitable results and minimal damage to the soft tissues surrounding the coracoclavicular ligaments.

  12. Double-button Fixation System for Management of Acute Acromioclavicular Joint Dislocation.

    Science.gov (United States)

    Torkaman, Ali; Bagherifard, Abolfazl; Mokhatri, Tahmineh; Haghighi, Mohammad Hossein Shabanpour; Monshizadeh, Siamak; Taraz, Hamid; Hasanvand, Amin

    2016-01-01

    Surgical treatments for acromioclavicular (AC) joint dislocation present with some complications. The present study was designed to evaluate the double-button fixation system in the management of acute acromioclavicular joint dislocation. This cross sectional study, done between February 2011 to June 2014, consisted of 28 patients who underwent surgical management by the double-button fixation system for acute AC joint dislocation. Age, sex, injury mechanism, dominant hand, side with injury, length of follow up, time before surgery, shoulder and hand (DASH), constant and visual analogue scale (VAS) scores, and all complications of the cases during the follow up were recorded. The mean age of patients was 33.23±6.7 years. Twenty four patients (85.71%) were male and four (14.28%) were female. The significant differences were observed between pre-operation VAS, constant shoulder scores and post-operation measurements. There were not any significant differences between right and left coracoclavicular, but two cases of heterotrophic ossifications were recorded. The mean follow-up time was 16.17±4.38 months. According to the results, the double-button fixation system for management of acute acromioclavicular joint dislocation has suitable results and minimal damage to the soft tissues surrounding the coracoclavicular ligaments.

  13. The effectiveness of manual hyperinflation during the physiotherapy management of acute atelectasis: a case report

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    H. van Aswegen

    2004-02-01

    Full Text Available Atelectasis is common in intubated and ventilated patients. Thereasons for the atelectasis are multifactorial. Atelectasis, if prolonged, may lead to hypoxaemia, pulmonary infection and fibrosis. The effectiveness of manual hyperinflation as an adjunct to standard respiratory physiotherapy management of patients in the ICU to re-inflate collapsed lung regions, to improve gas exchange and respiratory compliance and to assist with the removal of secretions, have been proclaimed by numerous authors. This case report demonstrates the effectiveness of the addition of manual hyperinflation to the physiotherapy management of an intubated patient with acute atelectasis.

  14. Coronary artery aneurysms in acute coronary syndrome: case series, review, and proposed management strategy.

    Science.gov (United States)

    Boyer, Nathan; Gupta, Rajesh; Schevchuck, Alex; Hindnavis, Vindhya; Maliske, Seth; Sheldon, Mark; Drachman, Douglas; Yeghiazarians, Yerem

    2014-06-01

    Coronary artery aneurysm (CAA) is an uncommon clinical finding, with an incidence varying from 1.5%-4.9% in adults, and is usually considered a variant of coronary artery disease (CAD). CAA identified in the context of acute coronary syndrome (ACS) represents a unique management challenge, particularly if the morphology of the CAA is suspected to have provoked the acute clinical syndrome. CAA is associated with thrombus formation due to abnormal laminar flow, as well as abnormal platelet and endothelial-derived pathophysiologic factors within the CAA. Once formed, mural thrombus may potentiate the deposition of additional thrombus within aneurysmal segments. Percutaneous revascularization of CAA has been associated with complications including distal embolization of thrombus, no-reflow phenomenon, stent malapposition, dissection, and rupture. Presently, there are no formal guidelines to direct the management of CAA in patients presenting with ACS; controversies exist whether conservative, surgical, or catheter-based management should be pursued. In this manuscript, we present an extensive review of the existing literature and associated clinical guidelines, and propose a management algorithm for patients with this complex clinical scenario. Armed with this perspective, therapeutic decisions may be tailored to synthesize patient factors and preferences, individualized clinical assessment, and existing American Heart Association/American College of Cardiology guidelines for management of ACS.

  15. Carbon stocks and changes on Pacific Northwest national forests and the role of disturbance, management, and growth

    Science.gov (United States)

    Andrew N. Gray; Thomas R. Whittier

    2014-01-01

    The National Forest System (NFS) of the United States plays an important role in the carbon cycle because these lands make up a large proportion of the forested land in the country and commonly store more wood per unit area than other forest ownerships. In addition to sustaining natural resources, these lands are managed for multiple objectives that do not always align...

  16. Duration of Hospitalization in Association with Type of Inhalation Therapy Used in the Management of Children with Nonsevere, Acute Bronchiolitis

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    Jamie M. Pinto

    2016-04-01

    Conclusion: Prolonged hospitalization of children younger than 2 years with acute, nonsevere bronchiolitis is associated with administration of nebulized 3% saline, independent of age, clinical presentation of disease, or inclusion of other treatments in their management.

  17. Guidelines for acute management of hyperammonemia in the Middle East region

    Science.gov (United States)

    Alfadhel, Majid; Mutairi, Fuad Al; Makhseed, Nawal; Jasmi, Fatma Al; Al-Thihli, Khalid; Al-Jishi, Emtithal; AlSayed, Moeenaldeen; Al-Hassnan, Zuhair N; Al-Murshedi, Fathiya; Häberle, Johannes; Ben-Omran, Tawfeg

    2016-01-01

    Background Hyperammonemia is a life-threatening event that can occur at any age. If treated, the early symptoms in all age groups could be reversible. If untreated, hyperammonemia could be toxic and cause irreversible brain damage to the developing brain. Objective There are major challenges that worsen the outcome of hyperammonemic individuals in the Middle East. These include: lack of awareness among emergency department physicians about proper management of hyperammonemia, strained communication between physicians at primary, secondary, and tertiary hospitals, and shortage of the medications used in the acute management of hyperammonemia. Therefore, the urge to develop regional guidelines is extremely obvious. Method We searched PubMed and Embase databases to include published materials from 2011 to 2014 that were not covered by the European guidelines, which was published in 2012. We followed the process of a Delphi conference and involved one preliminary meeting and two follow-up meetings with email exchanges between the Middle East Hyperammonemia and Urea Cycle Disorders Scientific Group regarding each draft of the manuscript. Results and discussion We have developed consensus guidelines based on the highest available level of evidence. The aim of these guidelines is to homogenize and harmonize the treatment protocols used for patients with acute hyperammonemia, and to provide a resource to not only metabolic physicians, but also physicians who may come in contact with individuals with acute hyperammonemia. Conclusion These suggested guidelines aim to ease the challenges faced by physicians dealing with acute hyperammonemia in the region. In addition, guidelines have demonstrated useful collaboration between experts in the region, and provides information that will hopefully improve the outcomes of patients with acute hyperammonemia. PMID:27099506

  18. Managing risk and conflict behaviours in acute psychiatry: the dual role of constant special observation.

    Science.gov (United States)

    Stewart, Duncan; Bowers, Len; Ross, Jamie

    2012-06-01

      This is a report of a study of events before and after the use of constant special observation on acute psychiatric wards, and the characteristics of patients who received it.   Constant special observation is a method of preventing acutely disturbed inpatients from harming themselves or others. It has been characterized as impersonal, intrusive and non-therapeutic. The circumstances of its use and place in broader intervention strategies are not well understood.   A sample of 522 patients were recruited from 84 acute psychiatric wards in 31 hospital locations in London and surrounding areas during 2009-2010. Data were collected for the first 2 weeks of admission from patients' case notes.   Sixteen per cent of patients received constant special observation during the first 2 weeks in hospital (7% at the point of admission and 11% after admission), but with variation between hospitals. Absconding, violence and self-harm were the most common events to precede constant special observation during a shift. Other methods of containment, especially intermittent special observation, were frequently tried first. Episodes of constant special observation often involved de-escalation and extra medication. Aggression was more prominent during than before constant special observation. Attempted suicides were limited to postadmission episodes.   Constant special observation is usually used in combination with other forms of containment, irrespective of when it is initiated. Placing patients considered at risk of suicide under constant special observation on admission may have a protective effect. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  19. Tapentadol immediate release: a new treatment option for acute pain management

    Directory of Open Access Journals (Sweden)

    Marc Afilalo

    2010-02-01

    Full Text Available Marc Afilalo1, Jens-Ulrich Stegmann2, David Upmalis31Sir Mortimer B. Davis Jewish General Hospital, Montréal, Canada; 2Global Drug Safety, Grünenthal GmbH, Aachen, Germany; 3Johnson & Johnson Pharmaceutical Research and Development, L.L.C., Raritan, New Jersey, USAAbstract: The undertreatment of acute pain is common in many health care settings. Insufficient management of acute pain may lead to poor patient outcomes and potentially life-threatening complications. Opioids provide relief of moderate to severe acute pain; however, therapy with pure µ-opioid agonists is often limited by the prevalence of side effects, particularly opioid-induced nausea and vomiting. Tapentadol is a novel, centrally acting analgesic with 2 mechanisms of action, µ-opioid receptor agonism and norepinephrine reuptake inhibition. The analgesic effects of tapentadol are independent of metabolic activation and tapentadol has no active metabolites; therefore, in theory, tapentadol may be associated with a low potential for interindividual efficacy variations and drug–drug interactions. Previous phase 3 trials in patients with various types of moderate to severe acute pain have shown that tapentadol immediate release (IR; 50 to 100 mg every 4 to 6 hours provides analgesia comparable to that provided by the pure µ-opioid agonist comparator, oxycodone HCl IR (10 or 15 mg every 4 to 6 hours, with a lower incidence of nausea, vomiting, and constipation. Findings suggest tapentadol may represent an improved treatment option for acute pain.Keywords: tapentadol IR, acute pain, opioid, gastrointestinal tolerability

  20. Anticoagulants in ischemia-guided management of non-ST-elevation acute coronary syndromes.

    Science.gov (United States)

    Mayer, Martin

    2017-03-01

    The most recent joint guidelines from the American Heart Association (AHA) and American College of Cardiology (ACC) on the management of non-ST-elevation acute coronary syndromes (NSTE-ACS) are a result of a substantial and considered undertaking, and those involved deserve much recognition for their efforts. However, the handling of anticoagulants seems somewhat inadequate, and this is a highly-relevant matter when managing NSTE-ACS. Among areas of potential uncertainty, emergency medicine professionals might still be left wondering about the particulars of anticoagulant therapy when pursuing ischemia-guided management of NSTE-ACS (that is, managing NSTE-ACS without an intent for early invasive measures, such as coronary angiography and revascularization). This review seeks to provide insight into this question. Relevant clinical trials are appraised and translated into clinical context for emergency medicine professionals, including the implications of noteworthy advancements in the management of NSTE-ACS. Although current guidelines from the AHA and ACC suggest enoxaparin has better evidence than other anticoagulants in the setting of NSTE-ACS management, careful review of the evidence shows this is not actually clearly supported by the available evidence in the era of contemporary management. Unless and until better contemporary data emerge, emergency medicine professionals must carefully weigh the available evidence, its limitations, and the possible clinical implications of the various anticoagulant options when managing NSTE-ACS. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis

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    Doucet Jean

    2008-01-01

    Full Text Available Abstract Background There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP. Methods The symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments – Urology (U, Infectious Diseases (ID, Internal Medicine (IM, Geriatrics (G – of two French university hospitals. Results The cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen. Overall, a 3:1 ratio of community-acquired AP (CA-AP to nosocomial AP (N-AP was observed. Urine culture isolated mainly E. coli (58% of AP, 68% of CA-AP, with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP (58% bi-therapy; 63% fluoroquinolone-based regimen. For N-AP, these treatments were more likely to be inadequate (42% vs. 8%, p vs. 19%, p Clinical failure at follow-up was more common than bacteriological failure (75% versus 24%, p Conclusion This study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.

  2. Diagnosis of presumed acute ischemic stroke and associated seizure management in a Congo African grey parrot.

    Science.gov (United States)

    Beaufrère, Hugues; Nevarez, Javier; Gaschen, Lorrie; Ryan, Kirk; Schnellbacher, Rodney; Tully, Thomas

    2011-07-01

    A 14-year-old Congo African grey parrot (Psittacus erithacus erithacus) was evaluated for an acute onset of falling off of its perch and tonic-clonic movements. Clinical signs were consistent with partial seizures. Findings on whole-body radiography, CBC, and plasma biochemical analysis were unremarkable. Plasma magnesium, ionized calcium, and bile acids concentrations were within reference limits. A magnetic resonance imaging (MRI) examination of the head revealed the presence of a focal hyperintensity at the central to left side of the optic chiasm and a hyperintense focus in the right side of the midbrain area in T2-weighted and FLAIR pulse sequence images. These findings were most consistent with an acute ischemic stroke with 2 brain infarcts. Seizures were initially managed with potassium bromide and phenobarbital administration. On the basis of poor results and difficulties to reach therapeutic blood concentrations, the treatment plan was changed to levetiracetam and zonisamide administration. Blood concentrations were monitored for both drugs, and the frequency of seizures substantially decreased thereafter. A follow-up MRI examination 2 months later revealed resolution of the hyperintense signals. During the 20-month follow-up period, subsequent clusters of seizures were managed by adjusting levetiracetam and zonisamide dosages and adding clonazepam and gabapentin administration to the treatment plan. Regression of intraparenchymal hyperintense lesions and improvement of clinical signs made a diagnosis of acute ischemic stroke most likely. Findings for this Congo African grey parrot indicated that an antemortem diagnosis of an acute ischemic stroke followed by long-term seizure management may be possible in affected psittacines.

  3. Disturbing Femininity

    DEFF Research Database (Denmark)

    Hvenegård-Lassen, Kirsten

    2013-01-01

    as a performative speech act, i.e. an act that creates the trouble it names. Ruling out gender equality as relevant was, however, continually interrupted by comments on how Thorning-Schmidt and other female politicians perform gender in ways that fit or do not fit with “doing politician”. These com-ments tended...... it comes to femininity – in need of management. Based on an analysis of the newspaper coverage of the elec-tion, I argue that highlighting gender (in)equality as either an important political issue or as something that conditions the possibilities of taking up a position as politician was evaluated...

  4. Management of people with acute low-back pain: a survey of Australian chiropractors

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    Walker Bruce F

    2011-12-01

    Full Text Available Abstract Introduction Chiropractors commonly provide care to people with acute low-back pain (LBP. The aim of this survey was to determine how chiropractors intend to support and manage people with acute LBP and if this management is in accordance with two recommendations from an Australian evidence-based acute LBP guideline. The two recommendations were directed at minimising the use of plain x-ray and encouraging the patient to stay active. Methods This is a cross sectional survey of chiropractors in Australia. This paper is part of the ALIGN study in which a targeted implementation strategy was developed to improve the management of acute LBP in a chiropractic setting. This implementation strategy was subsequently tested in a cluster randomised controlled trial. In this survey phase of the ALIGN study we approached a random sample of 880 chiropractors in three States of Australia. The mailed questionnaire consisted of five patient vignettes designed to represent people who would typically present to chiropractors with acute LBP. Four vignettes represented people who, according to the guideline, would not require a plain lumbar x-ray, and one vignette represented a person with a suspected vertebral fracture. Respondents were asked, for each vignette, to indicate which investigation(s they would order, and which intervention(s they would recommend or undertake. Results Of the 880 chiropractors approached, 137 were deemed ineligible to participate, mostly because they were not currently practising, or mail was returned to sender. We received completed questionnaires from 274 chiropractors (response rate of 37%. Male chiropractors made up 66% of respondents, 75% practised in an urban location and their mean number of years in practice was 15. Across the four vignettes where an x-ray was not indicated 68% (95% Confidence Intervals (CI: 64%, 71% of chiropractors responded that they would order or take an x-ray. In addition 51% (95%CI: 47%, 56

  5. Improving performance management for delivering appropriate care for patients no longer needing acute hospital care.

    Science.gov (United States)

    Penney, Christine; Henry, Effie

    2008-01-01

    The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management. A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs). A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also

  6. Prevention and management of aggression training and violent incidents on U.K. Acute psychiatric wards.

    Science.gov (United States)

    Bowers, Len; Nijman, Henk; Allan, Teresa; Simpson, Alan; Warren, Jonathan; Turner, Lynny

    2006-07-01

    Reports of violence and injuries to staff and patients in acute psychiatric inpatient settings have led to the development and implementation of training courses in the Prevention and Management of Violence and Aggression (PMVA). The purpose of this study was to explore the relationship between PMVA training of acute psychiatric ward nursing staff and officially reported violent incident rates. A retrospective analysis was conducted of training records (312 course attendances) and violent incident rates (684 incidents) over two-and-a-half years on 14 acute admission psychiatric wards (5,384 admissions) at three inner-city hospitals in the United Kingdom as part of the Tompkins Acute Ward Study. A positive association was found between training and rates of violent incidents. There was weak evidence that increased rates of aggressive incidents prompted course attendance, no evidence that course attendance reduced violence, and some evidence that attendance of briefer update courses triggered small short-term rises in rates of physical aggression. Course attendance was associated with a rise in physical and verbal aggression while staff were away from the ward. The failure to find a drop in incident rates after training, coupled with the small increases in incidents detected, raises concerns about the training course's efficacy as a preventive strategy. Alternatively, the results are consistent with a threshold effect, indicating that once adequate numbers of staff have been trained, further training keeps incidents at a low rate.

  7. Management and treatment of osteonecrosis in children and adolescents with acute lymphoblastic leukemia.

    Science.gov (United States)

    Te Winkel, Mariël L; Pieters, Rob; Wind, Ernst-Jan D; Bessems, J H J M Gert; van den Heuvel-Eibrink, Marry M

    2014-03-01

    There is no consensus regarding how to manage osteonecrosis in pediatric acute lymphoblastic leukemia patients. Therefore, we performed a quality assessment of the literature with the result of a search strategy using the MESH terms osteonecrosis, children, childhood cancer, surgery, bisphosphonates, 6 hydroxymethyl-glutaryl CoA reductase inhibitors, anticoagulants and hyperbaric oxygen, and terms related to these MESH terms. A randomized controlled trial showed that osteonecrosis can be prevented by intermittent, instead of continuous, corticosteroid administration. The studies on interventions after onset of osteonecrosis were of low-quality evidence. Seven pediatric acute lymphoblastic leukemia studies described non-surgical interventions; bisphosphonates (n=5), hyperbaric oxygen therapy (n=1), or prostacyclin analogs (n=1). Safety and efficacy studies are lacking. Five studies focused on surgical interventions; none was of sufficient quality to draw definite conclusions. In conclusion, preventing osteonecrosis is feasible in a proportion of the pediatric acute lymphoblastic leukemia patients by discontinuous, instead of continuous, steroid scheduling. The questions as to how to treat childhood acute lymphoblastic leukemia patients with osteonecrosis cannot be answered as good-quality studies are lacking.

  8. MANAGEMENT OF BLOOD PRESSURE AND HEART RATE IN PATIENTS WITH ACUTE STROKE.

    Science.gov (United States)

    Maida, Carlo; Tuttolomondo, Antonino; Raimondo, Domenico Di; Pinto, Antonio

    2017-07-14

    Stroke represent one of the most devastating of all neurological diseases, affecting about 15 million people per year and is an important cause of morbidity and mortality worldwide and currently the leading cause of adult disability in developed countries. Blood pressure and heart rate may undergo several modifications in patients with both ischemic and hemorrhagic stroke in fact raised blood pressure levels may lead to cerebral edema, hematoma expansion or hemorrhagic transformation and in contrast low blood pressure can lead to increased cerebral infarction or perihematomal ischemia. In addition, ECG abnormalities and cardiac arrhythmias, especially atrial fibrillation, are relatively frequent after stroke, and other well known complications such as heart failure, miocardial infarction and sudden death have been reported. The acute phase of brain infarction requires a careful management of both blood pressure levels and heart rate but despite the large amount of information, blood pressure and heart rate management are still under debate. Provide clear indications about the optimal blood pressure and heart rate management of both ischemic and hemorrhagic stroke, in view of the main available evidence. In this review, we discuss the evidence for blood pressure and heart rate management in acute stroke, the challenges and issues raised, and look to on-going and future trials that may provide some clarity in this controversial area. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  9. Successful Management of Gastrointestinal Haemorrhage Associated with Ischaemic Colonic Ulceration in Acute Pancreatitis with Video Assisted Retroperitoneal Debridement

    Directory of Open Access Journals (Sweden)

    Yogesh Puri

    2011-05-01

    Full Text Available Context Colonic involvement is an uncommon but potentially lethal complication of severe acute pancreatitis and has received little attention in the surgical literature. Such complications can range from localized colonic pathology to widespread ischaemic pancolitis. Treatment options have historically been limited to resection of the affected segment. Case report We describe the successful role of video assisted retroperitoneal pancreatic debridement in the management of two cases presenting with major gastrointestinal haemorrhage due to localised colonic ulceration on the background of acute necrotising pancreatitis. Conclusion Video assisted retroperitoneal debridement should be considered early in the management of local colonic complications associated with severe acute necrotising pancreatitis.

  10. Management of acute diarrhoeal disease at Edendale Hospital: Are standard treatment guidelines followed?

    Directory of Open Access Journals (Sweden)

    Kershinee Reddy

    2016-12-01

    Full Text Available Background. Diarrhoeal disease (DD is a major cause of childhood mortality in developing countries. In South Africa (SA, it ranks as one of the top five causes of under-5 mortality. Local and global guidelines on the management of acute DD are readily available. The Standard Treatment Guidelines (STGs and Essential Drugs List for Hospital Level Paediatrics are a recognised standard of care for children in SA hospitals. However, children still die from this preventable disease. Objective. To determine whether doctors adhered to standard treatment guidelines when treating children under 5 years of age presenting to Edendale Hospital in Pietermaritzburg, KwaZulu-Natal Province, with acute DD. Methods. The study was a retrospective clinical audit of individual patient records. Results. One hundred and thirty-five patient records were reviewed. Forty-seven percent had a correct nutritional assessment, 41% were correctly assessed for shock and 27% for dehydration. Appropriate investigations were undertaken in 12%. Ninety-seven percent of patients had appropriate fluid plans prescribed. Zinc was prescribed in only 39% of patients, whereas 84% were appropriately not prescribed antibiotics and no patients received anti-diarrhoeal medication. In 90% of patients, the correct post-care patient referral was made, and 47% of caregivers were adequately advised about ongoing care of their children. Conclusion. This study identifies substantial non-adherence to the SA STGs for the management of young children with acute DD.

  11. Management of Critically Ill Patients with Severe Acute Respiratory Syndrome (SARS

    Directory of Open Access Journals (Sweden)

    2004-03-01

    Full Text Available Severe acute respiratory syndrome (SARS is frequently complicated with acute respiratory failure. In this article, we aim to focus on the management of the subgroup of SARS patients who are critically ill. Most SARS patients would require high flow oxygen supplementation, 20–30% required intensive care unit (ICU or high dependency care, and 13–26% developed acute respiratory distress syndrome (ARDS. In some of these patients, the clinical course can progress relentlessly to septic shock and/or multiple organ dysfunction syndrome (MODS. The management of critically ill SARS patients requires timely institution of pharmacotherapy where applicable and supportive treatment (oxygen therapy, noninvasive and invasive ventilation. Superimposed bacterial and other opportunistic infections are common, especially in those treated with mechanical ventilation. Subcutaneous emphysema, pneumothoraces and pneumomediastinum may arise spontaneously or as a result of positive ventilatory assistance. Older age is a consistently a poor prognostic factor. Appropriate use of personal protection equipment and adherence to infection control measures is mandatory for effective infection control. Much of the knowledge about the clinical aspects of SARS is based on retrospective observational data and randomized-controlled trials are required for confirmation. Physicians and scientists all over the world should collaborate to study this condition which may potentially threaten human existence.

  12. Diagnosis and Management of Severe Acute Pancreatitis Complicated with Abdominal Compartment Syndrome

    Institute of Scientific and Technical Information of China (English)

    陶京; 王春友; 陈立波; 杨智勇; 许逸卿; 熊炯炘; 周峰

    2003-01-01

    Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective fluid resuscitation, if patients developed renal, pulmonary and cardiac insufficiency after abdominal expansion and abdominal wall tension, ACS should be considered.Cystometry could be performed to confirm the diagnosis. Emergency decompressive celiotomy and temporary abdominal closure with a 3 liter sterile plastic bag must be performed. It is also critical to prevent reperfusion syndrome. In 23 cases of ACS, 18 cases received emergency decompressive celiotomy and 5 cases did not. In the former, 3 patients died (16.7 %) while in the later, 4 (80%)died. Total mortality rate was 33.3% (7/21). In 7 death cases, 4 patients developed acute obstructive suppurative cholangitis (AOSC). All the patients who received emergency decompressive celiotomy 5 h after confirmation of ACS survived. The definitive abdominal closure took place mostly 3 to 5 days after emergency decompressive celiotomy, with longest time being 8 days. 6 cases of ACS at infection stage were all attributed to infected necrosis in abdominal cavity and retroperitoneum. ACS could occur in SIRS stage and infection stage during SAP, and has different pathophysiological basis. Early diagnosis, emergency decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to the management of the condition.

  13. Improving the management of post-operative acute pain: priorities for change.

    Science.gov (United States)

    Meissner, Winfried; Coluzzi, Flaminia; Fletcher, Dominique; Huygen, Frank; Morlion, Bart; Neugebauer, Edmund; Pérez, Antonio Montes; Pergolizzi, Joseph

    2015-11-01

    Poor management of post-operative acute pain can contribute to medical complications including pneumonia, deep vein thrombosis, infection and delayed healing, as well as the development of chronic pain. It is therefore important that all patients undergoing surgery should receive adequate pain management. However, evidence suggests this is not currently the case; between 10% and 50% of patients develop chronic pain after various common operations, and one recent US study recorded >80% of patients experiencing post-operative pain. At the first meeting of the acute chapter of the Change Pain Advisory Board, key priorities for improving post-operative pain management were identified in four different areas. Firstly, patients should be more involved in decisions regarding their own treatment, particularly when fateful alternatives are being considered. For this to be meaningful, relevant information should be provided so they are well informed about the various options available. Good physician/patient communication is also essential. Secondly, better professional education and training of the various members of the multidisciplinary pain management team would enhance their skills and knowledge, and thereby improve patient care. Thirdly, there is scope for optimizing treatment. Examples include the use of synergistic analgesia to target pain at different points along pain pathways, more widespread adoption of patient-controlled analgesia, and the use of minimally invasive rather than open surgery. Fourthly, organizational change could provide similar benefits; introducing acute pain services and increasing their availability towards the 24 hours/day ideal, greater adherence to protocols, increased use of patient-reported outcomes, and greater receptivity to technological advances would all help to enhance performance and increase patient satisfaction. It must be acknowledged that implementing these recommendations would incur a considerable cost that purchasers of

  14. Implementation of Novel Biomarkers in the Diagnosis, Prognosis, and Management of Acute Kidney Injury: Executive Summary from the Tenth Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

    Science.gov (United States)

    McCullough, Peter A.; Bouchard, Josee; Waikar, Sushrut S.; Siew, Edward D.; Endre, Zoltan H.; Goldstein, Stuart L.; Koyner, Jay L.; Macedo, Etienne; Doi, Kent; Di Somma, Salvatore; Lewington, Andrew; Thadhani, Ravi; Chakravarthi, Raj; Ice, Can; Okusa, Mark D.; Duranteau, Jacques; Doran, Peter; Yang, Li; Jaber, Bertrand L.; Meehan, Shane; Kellum, John A.; Haase, Michael; Murray, Patrick T.; Cruz, Dinna; Maisel, Alan; Bagshaw, Sean M.; Chawla, Lakhmir S.; Mehta, Ravindra L.; Shaw, Andrew D.; Ronco, Claudio

    2013-01-01

    Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allowing greater, earlier, and more accurate determination of diagnosis, prognosis, and with powerful implication for management. Biomarkers can be broadly considered as any measurable biologic entity or process that allows differentiation between normal function and injury or disease. The ADQI (Acute Dialysis Quality Initiative) had its Ninth Consensus Conference dedicated to synthesis and formulation of the existing literature on biomarkers for the detection of acute kidney injury in a variety of settings. In the papers that accompany this summary, ADQI workgroups fully develop key concepts from a summary of the literature in the domains of early diagnosis, differential diagnosis, prognosis and management, and concurrent physiologic and imaging measures. PMID:23689652

  15. Inner ear disturbances related to middle ear inflammation

    Science.gov (United States)

    Sone, Michihiko

    2017-01-01

    ABSTRACT The inner and middle ear are connected mainly through round and oval windows, and inflammation in the middle ear cavity can spread into the inner ear, which might induce a disturbance. In cases with intractable otitis media, attention should also be paid to symptoms related to the inner ear. In this paper, middle ear inflammation and related inner ear disturbances are reviewed with a focus on representative middle ear diseases (such as acute otitis media, chronic otitis media, otitis media with anti-neutrophil cytoplasmic antibody-associated vasculitis, eosinophilic otitis media, cholesteatoma with labyrinthine fistula, and reflux-related otitis media). Their clinical concerns are then discussed with reference to experimental studies. In these diseases, early diagnosis and adequate treatment are required to manage not only middle ear but also inner ear conditions.

  16. Historical perspective and contemporary management of acute coronary syndromes: from MONA to THROMBINS2.

    Science.gov (United States)

    Kline, Kristopher P; Conti, C Richard; Winchester, David E

    2015-01-01

    Acute coronary syndrome (ACS) remains a major burden on morbidity and mortality in the United States. Medical professionals and students often use the mnemonic 'MONA' (morphine, oxygen, nitroglycerin and aspirin) to recall treatments for ACS; however, this list of therapies is outdated. We provide a historical perspective on 'MONA,' attempt to uncover its origin in the medical literature, and demonstrate the myriad changes that have occurred over the last 50 years of ACS management. We have developed a novel mnemonic, 'THROMBINS2' (thienopyridines, heparin/enoxaparin, renin-angiotensin system blockers, oxygen, morphine, beta blocker, intervention, nitroglycerin, statin/salicylate) to help bedside clinicians recall all the elements of contemporary ACS management. We demonstrate the mortality benefit for each component of contemporary ACS management, correlating the continued improvement with historical data on mortality after myocardial infarction. We encourage providers to utilize this mnemonic to explore options and guide treatments in ACS patients.

  17. [Diagnosis and management of ENT conditions responsible for acute community acquired bacterial meningitis].

    Science.gov (United States)

    Klossek, J-M

    2009-01-01

    Only few epidemiological studies evaluate the role of ENT infections in meningitis. A retrospective review of data shows that the frequency of ENT infections is estimated at 25% in adults and children. Meningitis may occur during otological and nasosinusal infections. Acute otitis media and mastoiditis are the most common ear infections responsible for meningitis. Chronic otitis (cholesteatoma) are rarely involved. In case of acute rhinosinusitis, frequently responsible frontal and ethmoidal locations are investigated by nasal endoscopy and CT scan. A CSF leak originating mostly from anterior skull base or middle ear, either posttraumatic or spontaneous, may also be associated with meningitis. The management of ENT infections begins with antibiotics. Drainage may be discussed when identification of the bacteria is needed or if the medical treatment seems inefficient. In case of a CSF leak, closure of the defect is performed according to its location and size after evaluation by imaging (CT scan, MRI).

  18. The effect of sodium tetraborate and alum in the management of acute childhood diarrhoea.

    Science.gov (United States)

    Aung, M M; U, P P

    1986-03-01

    The effect of oral rehydration (OR) has been well established in the management of dehydration in acute childhood diarrhoea. Many authors have been trying to find additives of all types which would be effective in retaining oral fluids and promoting their active absorption into the circulation. Any agent which will effectively reduce oral rehydration requirements should be considered for prospective studies. Amongst the traditional medicines, it was noticed that sodium tetraborate (borax) and alum reduced appreciably the fluid requirement in many cases of acute childhood diarrhoea. This traditional usage of these chemicals without any noticeable side effects has been described for centuries. During preliminary observations on 26 of our children given these salts no side effects were detected.

  19. Acute genital ulcers in nonsexually active young girls: case series, review of the literature, and evaluation and management recommendations.

    Science.gov (United States)

    Rosman, Ilana S; Berk, David R; Bayliss, Susan J; White, Andrew J; Merritt, Diane F

    2012-01-01

    Acute genital ulcers rarely occur in nonsexually active young girls. When present, they can cause significant physical and emotional distress for the patient and her parents, and prompt an evaluation for sexual abuse and sexually transmitted diseases. With this review, we aim to further characterize acute genital ulcers in nonsexually active young girls by reviewing the medical records of patients with this disorder and to offer an approach to the diagnosis, evaluation, and treatment of acute genital ulcers based on our understanding and knowledge of this condition. We retrospectively review our understanding and knowledge of acute genital ulcers in nonsexually active girls at a pediatric hospital. A review of the recent literature on acute genital ulcers and a multidisciplinary approach to the diagnosis, evaluation, and treatment of acute genital ulcers are also presented. Twelve patients presented with acute genital ulcers, 11 of which were hospitalized for evaluation and pain management. Extensive work-up failed to reveal a specific infectious or autoimmune etiology in all but one patient, who was diagnosed with acute mycoplasma pneumonia. Acute genital ulcers in nonsexually active young girls likely represent a form of idiopathic vulvar aphthosis. Evaluation of a first episode of acute genital ulcers with mild prodromal symptoms should be limited. Treatment consists primarily of supportive care and symptom relief.

  20. The ICET-A Recommendations for the Diagnosis and Management of Disturbances of Glucose Homeostasis in Thalassemia Major Patients

    Science.gov (United States)

    De Sanctis, Vincenzo; Soliman, Ashraf T.; Elsedfy, Heba; Yaarubi, Saif AL; Skordis, Nicos; Khater, Doaa; El Kholy, Mohamed; Stoeva, Iva; Fiscina, Bernadette; Angastiniotis, Michael; Daar, Shahina; Kattamis, Christos

    2016-01-01

    Iron overload in patients with thalassemia major (TM) affects glucose regulation and is mediated by several mechanisms. The pathogenesis of glycaemic abnormalities in TM is complex and multifactorial. It has been predominantly attributed to a combination of reduced insulin secretory capacity and insulin resistance. The exact mechanisms responsible for progression from norm glycaemia to overt diabetes in these patients are still poorly understood but are attributed mainly to insulin deficiency resulting from the toxic effects of iron deposited in the pancreas and insulin resistance. A group of endocrinologists, haematologists and paediatricians, members of the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine (ICET-A) convened to formulate recommendations for the diagnosis and management of abnormalities of glucose homeostasis in thalassemia major patients on the basis of available evidence from clinical and laboratory data and consensus practice. The results of their work and discussions are described in this article. PMID:27872738

  1. Disturbing Femininity

    Directory of Open Access Journals (Sweden)

    Kirsten Hvenegård-Lassen

    2013-06-01

    Full Text Available When Helle Thorning-Schmidt in 2011 became the first female Prime Minister in Denmark, this “victory for the women” was praised in highly celebratory tones in Danish newspapers. The celebration involved a paradoxical representation of gen-der as simultaneously irrelevant to politics and – when it comes to femininity – in need of management. Based on an analysis of the newspaper coverage of the elec-tion, I argue that highlighting gender (inequality as either an important political issue or as something that conditions the possibilities of taking up a position as politician was evaluated as a performative speech act, i.e. an act that creates the trouble it names. Ruling out gender equality as relevant was, however, continually interrupted by comments on how Thorning-Schmidt and other female politicians perform gender in ways that fit or do not fit with “doing politician”. These com-ments tended to concern the styling of bodies and behaviour and followed well known – or sticky – gendered scripts.

  2. Can a chronic disease management pulmonary rehabilitation program for COPD reduce acute rural hospital utilization?

    Science.gov (United States)

    Rasekaba, T M; Williams, E; Hsu-Hage, B

    2009-01-01

    Chronic obstructive pulmonary disease (COPD) imposes a costly burden on healthcare. Pulmonary rehabilitation (PR) is the best practice to better manage COPD to improve patient outcomes and reduce acute hospital care utilization. To evaluate the impact of a once-weekly, eight-week multidisciplinary PR program as an integral part of the COPD chronic disease management (CDM) Program at Kyabram District Health Services. The study compared two cohorts of COPD patients: CDM-PR Cohort (4-8 weeks) and Opt-out Cohort (0-3 weeks) between February 2006 and March 2007. The CDM-PR Program involved multidisciplinary patient education and group exercise training. Nonparametric statistical tests were used to compare acute hospital care utilization 12 months before and after the introduction of CDM-PR. The number of patients involved in the CDM-PR Cohort was 29 (n = 29), and that in the Opt-out Cohort was 24 (n = 24). The CDM-PR Cohort showed significant reductions in cumulative acute hospital care utilization indicators (95% emergency department presentations, 95% inpatient admissions, 99% length of stay; effect sizes = 0.62-0.66, P indicators were statistically insignificant for the Opt-out Cohort (emergency department presentations decreased by 5%, inpatient admissions decreased by 12%, length of stay increased by 30%; effect size = 0.14-0.40, P > 0.05). Total costs associated with the hospital care utilization decreased from $130,000 to $7,500 for the CDM-PR Cohort and increased from $77,700 to $101,200 for the Opt-out Cohort. Participation in the CDM-PR for COPD patients can significantly reduce acute hospital care utilization and associated costs in a small rural health service.

  3. The medical and surgical management of typhlitis in children with acute nonlymphocytic (myelogenous) leukemia.

    Science.gov (United States)

    Shamberger, R C; Weinstein, H J; Delorey, M J; Levey, R H

    1986-02-01

    The treatment of acute leukemia in childhood has been increasingly successful. Infectious complications are the major cause of morbidity and mortality among these patients receiving aggressive chemotherapy. In particular, neutropenic enterocolitis or typhlitis has had a reported mortality of 50% to 100%. The authors reviewed a series of 77 previously untreated patients with acute myelogenous leukemia begun on treatment from March 1976 to June 1984 to better define the characteristics of typhlitis and its optimum management. Twenty-five patients had episodes of typhlitis, characterized by fever, abdominal pain, and tenderness, occurring during periods of neutropenia. Ten of these patients had watery diarrhea as a major additional symptom, and nine patients had a significant episode of gastrointestinal bleeding. In seven instances, blood culture results were positive, all for intestinal flora. The episodes of typhlitis occurred most frequently during the induction therapy (19 patients). Five patients experienced typhlitis during maintenance therapy, and one patient had acute appendicitis. Two patients had typhlitis during their reinduction therapy, and of note, one had had abdominal symptoms during her initial induction. All patients were treated initially with broad-spectrum antibiotics and bowel rest. Four criteria have been used for surgical intervention: (1) persistent gastrointestinal bleeding after resolution of neutropenia and thrombocytopenia and correction of clotting abnormalities; (2) evidence of free intraperitoneal perforation; (3) clinical deterioration requiring support with vasopressors, or large volumes of fluid, suggesting uncontrolled sepsis; and (4) development of symptoms of an intra-abdominal process, in the absence of neutropenia, which would normally require surgery. Using these criteria, five patients required surgical intervention for typhlitis or its sequelae and one for acute appendicitis. There was one perioperative death resulting from

  4. INTRA-ABDOMINAL INFECTION AND ACUTE ABDOMEN-EPIDEMIOLOGY, DIAGNOSIS AND GENERAL PRINCIPLES OF SURGICAL MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Jovanović Dušan

    2015-03-01

    Full Text Available Intra-abdominal infections are multifactorial and present an complex inflammatory response of the peritoneum to microorganisms followed by exudation in the abdominal cavity and systemic response Despite advances in management and critical care of patients with acute generalized peritonitis due to hollow viscus perforation, prognosis is still very poor, with high mortality rate. Early detection and adequate treatment is essential to minimize complications in the patient with acute abdomen. Prognostic evaluation of complicated IAI by modern scoring systems is important to assess the severity and the prognosis of the disease. Control of the septic source can be achieved either by nonoperative or operative means. Nonoperative interventional procedures include percutaneous drainages of abscesses. The management of primary peritonitis is non-surgical and antibiotic- treatment. The management of secondary peritonitis include surgery to control the source of infection, removal of toxins, bacteria, and necrotic tissue, antibiotic therapy, supportive therapy and nutrition. "Source control" is sine qua non of success and adequate surgical procedure involves closure or resection of any openings into the gastrointestinal tract, resection of inflamed tissue and drainage of all abdominal and pelivic collections.

  5. Rehabilitative management of oropharyngeal dysphagia in acute care settings: data from a large Italian teaching hospital.

    Science.gov (United States)

    Schindler, Antonio; Vincon, Elena; Grosso, Elena; Miletto, Anna Maria; Di Rosa, Rosalba; Schindler, Oskar

    2008-09-01

    A high incidence of oropharyngeal dysphagia (OD) in acute-care settings has been reported; however, no data on its management are found in the literature. Here we report the experience with rehabilitative management of OD in a large Italian hospital. The characteristics of inpatients with OD during 2004 have been studied prospectively. For each patient, demographic data, the department referring the patient, the disease causing OD, and the presence of a communication disorder were registered. The swallowing level at the beginning and at the end of rehabilitation were recorded. Of the 35,590 inpatients admitted to San Giovanni Battista Hospital of Turin during 2004, 222 of them were referred for the assessment and rehabilitation of OD. The inpatients with OD came from different departments and mainly had a neurologic disease. In 110 patients a communication disorder was present. The swallowing impairment was moderate to severe at the moment of referral, while on average patients were able to eat by mouth after swallowing therapy. Dysphagia rehabilitation in an acute care setting is requested from different departments because of its prevalence and severity; skilled specialists are needed for early assessment and the best management.

  6. Study on Vehicle Scheduling Disruption Management Problem with Capacity Disturbance%运力受扰下车辆调度干扰管理问题研究

    Institute of Scientific and Technical Information of China (English)

    王旭坪; 吴绪; 王征

    2011-01-01

    For solving the vehicle routing problem with disruption that may be vehicle breakdowns or traffic accidents in the logistics distribution system, this paper builds a mixed integer programming disruption management model. For the attributes of the vehicle routing problem with disruption, a series of solving-simplify strategies are given to simplify the solution space. On the basis of the characteristic of the model, the improved saving algorithm based on disturbed value is designed based on the disruption value. Numerical experiments from multiple wheel-driven vehicle scheduling problem and vehicle scheduling interference management problem are given to prove the efficiently of the disruption management model and algorithm.%为解决物流配送系统中因运输车辆毁坏而产生的干扰问题,建立混合整数规划干扰管理模型.针对多车场车辆调度干扰管理问题的特有属性,设计一系列求解简化策略,简化问题的求解空间.结合干扰管理模型的特点,使用基于扰动值的改进节约算法进行求解.数值实验从多车场车辆调度问题和车辆调度干扰管理问题2个角度验证干扰管理模型及改进算法的有效性.

  7. Respiratory care year in review 2011: long-term oxygen therapy, pulmonary rehabilitation, airway management, acute lung injury, education, and management.

    Science.gov (United States)

    Dunne, Patrick J; Macintyre, Neil R; Schmidt, Ulrich H; Haas, Carl F; Jones-Boggs Rye, Kathy; Kauffman, Garry W; Hess, Dean R

    2012-04-01

    For the busy clinician, educator, or manager, it is becoming an increasing challenge to filter the literature to what is relevant to one's practice and then update one's practice based on the current evidence. The purpose of this paper is to review the recent literature related to long-term oxygen therapy, pulmonary rehabilitation, airway management, acute lung injury and acute respiratory distress syndrome, respiratory care education, and respiratory care management. These topics were chosen and reviewed in a manner that is most likely to have interest to the readers of Respiratory Care.

  8. Audit of acute admissions of COPD: standards of care and management in the hospital setting.

    Science.gov (United States)

    Roberts, C M; Ryland, I; Lowe, D; Kelly, Y; Bucknall, C E; Pearson, M G

    2001-03-01

    Despite publication of several management guidelines for COPD, relatively little is known about standards of care in clinical practice. Data were collected on the management of 1400 cases of acute admission with Chronic Obstructive Pulmonary Disease in 38 UK hospitals to compare clinical practice against the recommended British Thoracic Society standards. Variation in the process of care between the different centres was analysed and a comparison of the management by respiratory specialists and nonrespiratory specialists made. There were large variations between centres for many of the variables studied. A forced expiratory volume in one second measurement was found in only 53% of cases. Of the investigations recommended in the acute management arterial blood gases were performed in 79% (interhospital range 40-100%) of admissions and oxygen was formally prescribed in only 64% (range 9-94%). Of those cases with acidosis and hypercapnia 35% had no further blood gas analysis and only 13% received ventilatory support. Long-term management was also deficient with 246 cases known to be severely hypoxic on admission yet two-thirds had no confirmation that oxygen levels had returned to levels above the requirements for long-term oxygen therapy. Only 30% of current smokers had cessation advice documented. To conclude, the median standards of care observed fell below those recommended by the guidelines. The lowest levels of performance were for patients not under the respiratory specialists, but specialists also have room for improvement. The substantial variation in the process of care between hospitals is strong evidence that it is possible for other centres with poorer performance to improve their levels of care.

  9. BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment.

    Science.gov (United States)

    Cooper, Stephen J; Reynolds, Gavin P; Barnes, Tre; England, E; Haddad, P M; Heald, A; Holt, Rig; Lingford-Hughes, A; Osborn, D; McGowan, O; Patel, M X; Paton, C; Reid, P; Shiers, D; Smith, J

    2016-08-01

    Excess deaths from cardiovascular disease are a major contributor to the significant reduction in life expectancy experienced by people with schizophrenia. Important risk factors in this are smoking, alcohol misuse, excessive weight gain and diabetes. Weight gain also reinforces service users' negative views of themselves and is a factor in poor adherence with treatment. Monitoring of relevant physical health risk factors is frequently inadequate, as is provision of interventions to modify these. These guidelines review issues surrounding monitoring of physical health risk factors and make recommendations about an appropriate approach. Overweight and obesity, partly driven by antipsychotic drug treatment, are important factors contributing to the development of diabetes and cardiovascular disease in people with schizophrenia. There have been clinical trials of many interventions for people experiencing weight gain when taking antipsychotic medications but there is a lack of clear consensus regarding which may be appropriate in usual clinical practice. These guidelines review these trials and make recommendations regarding appropriate interventions. Interventions for smoking and alcohol misuse are reviewed, but more briefly as these are similar to those recommended for the general population. The management of impaired fasting glycaemia and impaired glucose tolerance ('pre-diabetes'), diabetes and other cardiovascular risks, such as dyslipidaemia, are also reviewed with respect to other currently available guidelines.These guidelines were compiled following a consensus meeting of experts involved in various aspects of these problems. They reviewed key areas of evidence and their clinical implications. Wider issues relating to primary care/secondary care interfaces are discussed but cannot be resolved within guidelines such as these.

  10. Controversies in the management of acute idiopathic thrombocytopenic purpura: a survey of specialists.

    Science.gov (United States)

    Dubansky, A S; Oski, F A

    1986-01-01

    A total of 322 physicians, Board-certified in pediatric hematology, responded to a survey designed to determine several aspects of their management of children with acute idiopathic thrombocytopenic purpura. The survey demonstrates that, in practice among specialists, a controversy exists as to whether or not bone marrow examination needs to be performed, and how often corticosteroids should be prescribed. Seventy-four percent of practitioners would perform the bone marrow examination, whereas 26% would not do so. Forty-six percent of responders prescribe steroids more than half the time, whereas 54% prescribe steroids less than half the time. The questionnaire ascertained the reasons why physicians performed marrow aspirations and prescribed steroids.

  11. Community-based management of acute malnutrition in Bangladesh: feasibility and constraints.

    Science.gov (United States)

    Choudhury, Nuzhat; Ahmed, Tahmeed; Hossain, Md Iqbal; Mandal, Barendra Nath; Mothabbir, Golam; Rahman, Mustafizur; Islam, M Munirul; Husain, Mohammad Mushtuq; Nargis, Makhduma; Rahman, Ekhlasur

    2014-06-01

    To achieve the United Nations Millennium Development Goals, particularly reduction in child mortality (Millennium Development Goal 4), effective interventions to address severe and moderate acute malnutrition (SAM and MAM) among children under 5 years of age must be implemented and brought to scale alongside preventive measures. Bangladesh has an estimated 600,000 children with SAM, for a prevalence of 4%, while 1.8 million children suffer from MAM. To assess the feasibility and constraints of community-based management of acute malnutrition (CMAM), a relatively new approach, in managing SAM and MAM among children in Bangladesh. The methodology involved desk reviews of documents by searching through PubMed and other databases for published literature on CMAM in Bangladesh. We also did a hand search of policy and program documents, including the draft National Nutrition Policy 2013; the Health, Nutrition, Population Sector Development Program document of the Ministry of Health and Family Welfare, Government of Bangladesh; the Sixth Five Year Plan; and the Operational Plans of the National Nutrition Services of Bangladesh. . The conventional approach in Bangladesh has been to treat children suffering from SAM and associated complications in hospital settings. There is no program to take care of children with MAM. There is a dearth of local evidence to operationalize and implement CMAM in the context of Bangladesh. This paper summarizes the scientific literature and rationale for the implementation of CMAM in Bangladesh. It also provides recommendations to improve health strategies related to CMAM, discusses diets being developed that may result in better implementation of CMAM, and offers recommendations for areas of additional necessary research. A recommended approach for Bangladesh on the management of acute malnutrition would be to integrate CMAM into the rollout of the National Nutrition Services so that screening, identification, referral, and treatment of

  12. Management of acute open tendo-achilles injuries in Indian lavatory pans

    Directory of Open Access Journals (Sweden)

    Chatterjee Sasanka

    2006-01-01

    Full Text Available Injuries to the Tendo-achilles are common but rarely do they present directly to plastic surgeons. Eighteen patients with acute tendo-achilles injury due to fall in the lndian type of lavatory pan came directly to the emergency department of Institute of Post Graduate Medical Education and Research, Kolkata and subsequently were treated in the Department of Plastic Surgery. Direct repair with prolene or stainless steel (SS wires with or without flap cover were performed for management. Exercises were started 1 month later with gradual increase in activity. Complications were minor and temporary in nature. Long term results in the form of performing previous activities were excellent.

  13. β-Dystroglycan cleavage by matrix metalloproteinase-2/-9 disturbs aquaporin-4 polarization and influences brain edema in acute cerebral ischemia.

    Science.gov (United States)

    Yan, W; Zhao, X; Chen, H; Zhong, D; Jin, J; Qin, Q; Zhang, H; Ma, S; Li, G

    2016-06-21

    Dystroglycan (DG) is widely expressed in various tissues, and throughout the cerebral microvasculature. It consists of two subunits, α-DG and β-DG, and the cleavage of the latter by matrix metalloproteinase (MMP)-2 and -9 underlies a number of physiological and pathological processes. However, the involvement of MMP-2/-9-mediated β-DG cleavage in cerebral ischemia remains uncertain. In astrocytes, DG is crucial for maintaining the polarization of aquaporin-4 (AQP4), which plays a role in the regulation of cytotoxic and vasogenic edema. The present study aimed to explore the effects of MMP-2/-9-mediated β-DG cleavage on AQP4 polarization and brain edema in acute cerebral ischemia. A model of cerebral ischemia was established via permanent middle cerebral artery occlusion (pMCAO) in male C57BL/6 mice. Western blotting, real-time polymerase chain reaction (PCR), immunohistochemical staining, immunofluorescent staining, electron microscopy, and light microscopy were used. Captopril was applied as a selective MMP-2/-9 inhibitor. Recombinant mouse MMP (rmMMP)-2 and -9 were used in an in vitro cleavage experiment. The present study demonstrated evidence of β-DG cleavage by MMP-2/-9 in pMCAO mouse brains; this cleavage was implicated in AQP4 redistribution and brain edema in cerebral ischemia. In addition, captopril exacerbated cytotoxic edema and ameliorated vasogenic edema at 24h after pMCAO, and alleviated brain edema and neurological deficit at 48h and 72h. In conclusion, this study provides novel insight into the effects of MMP-2/-9-mediated β-DG cleavage in acute cerebral ischemia. Such findings might facilitate the development of a therapeutic strategy for the optimization of MMP-2/-9 targeted treatment in cerebral ischemia.

  14. Paroxysmal Sympathetic Hyperactivity in Pediatric Rehabilitation: Clinical Factors and Acute Pharmacological Management.

    Science.gov (United States)

    Pozzi, Marco; Conti, Valentino; Locatelli, Federica; Galbiati, Sara; Radice, Sonia; Citerio, Giuseppe; Clementi, Emilio; Strazzer, Sandra

    2015-01-01

    Paroxysmal sympathetic hyperactivity (PSH) is widely described as occurring during intensive care, but in a number of patients it may last longer into the rehabilitation phase. Furthermore, drug therapy has been based on isolated observations. In this study, our aims are to describe a group of 26 pediatric rehabilitation patients with PSH and to quantify the effect of several drugs used to suppress PSH episodes. Neurorehabilitation unit of IRCCS Eugenio Medea, Bosisio Parini (LC), Italy. A total of 407 pediatric patients with postacute acquired brain injury, 26 of which had PSH. Retrospective cohort study. Descriptive demographic and clinical data. Odds ratios quantification of the efficacy of drug therapies administered acutely to suppress PSH episodes. PSH was associated with a longer duration of coma and a greater incidence of death. When administered acutely to suppress PSH episodes, the best drugs were clonazepam, hydroxyzine, and delorazepam, while analgesic drugs showed little efficacy. PSH, whether causative or not, is associated with a worse long-term course in rehabilitation. Clinical management of PSH may be helped by a number of acutely administered drug therapies.

  15. The revised Atlanta criteria 2012 altered the classiifcation, severity assessment and management of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jie Huang; Hong-Ping Qu; Yun-Feng Zheng; Xu-Wei Song; Lei Li; Zhi-Wei Xu; En-Qiang Mao; Er-Zhen Chen

    2015-01-01

    BACKGROUND: The Atlanta criteria for acute pancreatitis (AP) has been revised recently. This study was to evaluate its practical value in classiifcation of AP, the severity assessment and management. METHODS: The clinical features, severity classiifcation, out-come and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria (RAC) and the original Atlanta criteria (OAC). RESULTS: Compared to the OAC group, the incidence of se-vere acute pancreatitis (SAP) was decreased by approximately one half (13.9% vs 28.2%) in the RAC group. The RAC present-ed a lower sensitivity but higher speciifcity, and its predictive value for severity and poor outcome was higher than those of the OAC. The proportion of SAP diagnosis and ICU admission in the early phase in the RAC group was signiifcantly lower than that in the OAC group (P CONCLUSIONS: The RAC showed a higher predictive value for severity and poorer outcome than the OAC. However, the RAC resulted in fewer ICU admissions in the early phase due to its lower sensitivity for diagnosis of SAP. Among SAP cases, older age, high CTSI, renal and cardiovascular failure, com-plications of acute necrotic collection and walled-off necrosis were independent risk factors for mortality.

  16. The revised Atlanta criteria 2012 altered the classiifcation, severity assessment and management of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jie Huang; Hong-Ping Qu; Yun-Feng Zheng; Xu-Wei Song; Lei Li; Zhi-Wei Xu; En-Qiang Mao; Er-Zhen Chen

    2016-01-01

    BACKGROUND: The Atlanta criteria for acute pancreatitis (AP) has been revised recently. This study was to evaluate its practical value in classiifcation of AP, the severity assessment and management. METHODS: The clinical features, severity classiifcation, out-come and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria (RAC) and the original Atlanta criteria (OAC). RESULTS: Compared to the OAC group, the incidence of se-vere acute pancreatitis (SAP) was decreased by approximately one half (13.9% vs 28.2%) in the RAC group. The RAC present-ed a lower sensitivity but higher speciifcity, and its predictive value for severity and poor outcome was higher than those of the OAC. The proportion of SAP diagnosis and ICU admission in the early phase in the RAC group was signiifcantly lower than that in the OAC group (P CONCLUSIONS: The RAC showed a higher predictive value for severity and poorer outcome than the OAC. However, the RAC resulted in fewer ICU admissions in the early phase due to its lower sensitivity for diagnosis of SAP. Among SAP cases, older age, high CTSI, renal and cardiovascular failure, com-plications of acute necrotic collection and walled-off necrosis were independent risk factors for mortality.

  17. Acute Respiratory Distress Syndrome (ARDS) from Endemic Influenza A/H1N1: Prehospital Management.

    Science.gov (United States)

    Salihefendic, Nizama; Zildzic, Muharem; Ahmetagic, Sead

    2015-02-01

    Acute respiratory distress syndrome (ARDS) is a form of acute life threatening respiratory failure. In daily practice there is difficulty in diagnostic and therapeutic management of Acute respiratory distress syndrome (ARDS). We observed delay in diagnostic and therapeutic procedures in patients with clinical signs for the presence of severe respiratory disorders. Finding timely evidence of the presence the clinical signs of threatening ARDS and underlying diseases like influenza A/H1N1 during prehospital period in early stage of disease it is possible introduce early adequate treatment: high flow oxygen, fluid replacement and pharmacological and antiviral therapy. This measure can reduce high mortality in patients who develop ARDS. It is important to improve diagnostic criteria for a precise definition of ARDS and transfer it in practice of emergency and family medicine, microbiology, intensive care units, hospital departments of infectious and respiratory diseases. In this article we underlined the key elements of the new definition of ARDS, diagnostic criteria and the importance of early diagnosis in prehospital period following clinical feature and course (a presence of severe dyspnea) by adding chest x-ray and laboratory investigations.

  18. Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage.

    Science.gov (United States)

    Loffroy, Romaric; Estivalet, Louis; Cherblanc, Violaine; Favelier, Sylvain; Pottecher, Pierre; Hamza, Samia; Minello, Anne; Hillon, Patrick; Thouant, Pierre; Lefevre, Pierre-Henri; Krausé, Denis; Cercueil, Jean-Pierre

    2013-10-07

    Acute variceal hemorrhage, a life-threatening condition that requires a multidisciplinary approach for effective therapy, is defined as visible bleeding from an esophageal or gastric varix at the time of endoscopy, the presence of large esophageal varices with recent stigmata of bleeding, or fresh blood visible in the stomach with no other source of bleeding identified. Transfusion of blood products, pharmacological treatments and early endoscopic therapy are often effective; however, if primary hemostasis cannot be obtained or if uncontrollable early rebleeding occurs, transjugular intrahepatic portosystemic shunt (TIPS) is recommended as rescue treatment. The TIPS represents a major advance in the treatment of complications of portal hypertension. Acute variceal hemorrhage that is poorly controlled with endoscopic therapy is generally well controlled with TIPS, which has a 90% to 100% success rate. However, TIPS is associated with a mortality of 30% to 50% in such a setting. Emergency TIPS should be considered early in patients with refractory variceal bleeding once medical treatment and endoscopic sclerotherapy failure, before the clinical condition worsens. Furthermore, admission to specialized centers is mandatory in such a setting and regional protocols are essential to be organized effectively. This review article discusses initial management and then focuses on the specific role of TIPS as a primary therapy to control acute variceal hemorrhage, particularly as a rescue therapy following failure of endoscopic approaches.

  19. Management of the acute scrotum in a district general hospital: 10-year experience.

    LENUS (Irish Health Repository)

    Tajchner, Lukas

    2012-01-31

    The acutely painful scrotum is a common urologic emergency. The primary objective of management is to avoid testicular loss. This requires a high index of clinical suspicion and prompt surgical intervention. In our series conducted between January 1996 and December 2005, 119 patients (age range: 4-62 years) underwent emergency operative exploration for acute scrotal pain. The most common finding was torted cyst of Morgagni (63\\/119, 52.9%), followed by testicular torsion (41\\/119, 34.4%). The majority of testicular torsions occurred in the pubertal group (22\\/41, 53.6%). Only one patient in this group had an unsalvageable testis necessitating orchidectomy, a testicular loss rate in torsion of 2.4%. There were no postoperative wound infections or scrotal haematomas. Testicular salvage depends critically on early surgical intervention, so the delay incurred in diagnostic imaging may extend the period of ischaemia. Furthermore, all radiological investigations have a certain false-negative rate. We advocate immediate surgical exploration of the acute scrotum. We report a low orchidectomy rate (2.4%) in testicular torsion.

  20. Leadership support for ward managers in acute mental health inpatient settings.

    Science.gov (United States)

    Bonner, Gwen; McLaughlin, Sue

    2014-05-01

    This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused.

  1. Anaesthetic Management of Parturient with Acute Atrial Fibrillation for Emergency Caesarean Section

    Directory of Open Access Journals (Sweden)

    Madhu Gupta

    2013-01-01

    Full Text Available A 31-year-antenatal lady with critical mitral stenosis presented for emergency caesarean section with fetal distress. She had acute onset atrial fibrillation. She was given a combined spinal epidural (CSE anaesthesia and her arrhythmia was successfully managed after delivery of the baby with intravenous calcium channel blocker. Mitral stenosis is the most common valvular heart disease complicating pregnancy in developing countries. The physiological changes during pregnancy may exacerbate their cardiac symptoms. They may present with complications like congestive cardiac failure, atrial fibrillation, or pulmonary thromboembolism during the antenatal, intrapartum, or postpartum period. Here we discuss the management of parturient woman with high maternal and fetal risk presenting for emergency caesarean. The merits of regional anaesthesia and the importance of invasive monitoring are also discussed.

  2. Successful management of acute respiratory failure with noninvasive mechanical ventilation after drowning, in an epileptic-patient.

    Science.gov (United States)

    Ruggeri, Paolo; Calcaterra, Salvatore; Bottari, Antonio; Girbino, Giuseppe; Fodale, Vincenzo

    2016-01-01

    Sea drowning is a common cause of accidental death worldwide. Respiratory complications such as acute pulmonary oedema, which is often complicated by acute respiratory distress syndrome, is often seen. Noninvasive ventilation is already widely used as a first approach to treat acute respiratory failure resulting from multiple diseases. We report a case of a 45 year old man with a history of epilepsy, motor and mental handicap who developed acute respiratory failure secondary to sea water drowning after an epileptic crisis. We illustrate successful and rapid management of this case with noninvasive ventilation. We emphasize the advantages and limitations of using noninvasive ventilation to treat acute respiratory failure due to sea water drowning syndrome.

  3. Successful management of acute respiratory failure with noninvasive mechanical ventilation after drowning, in an epileptic-patient

    Directory of Open Access Journals (Sweden)

    Paolo Ruggeri

    2016-01-01

    Full Text Available Sea drowning is a common cause of accidental death worldwide. Respiratory complications such as acute pulmonary oedema, which is often complicated by acute respiratory distress syndrome, is often seen. Noninvasive ventilation is already widely used as a first approach to treat acute respiratory failure resulting from multiple diseases. We report a case of a 45 year old man with a history of epilepsy, motor and mental handicap who developed acute respiratory failure secondary to sea water drowning after an epileptic crisis. We illustrate successful and rapid management of this case with noninvasive ventilation. We emphasize the advantages and limitations of using noninvasive ventilation to treat acute respiratory failure due to sea water drowning syndrome.

  4. Acute toxicity, critical body residues, Michaelis-Menten analysis of bioaccumulation, and ionoregulatory disturbance in response to waterborne nickel in four invertebrates: Chironomus riparius, Lymnaea stagnalis, Lumbriculus variegatus and Daphnia pulex.

    Science.gov (United States)

    Leonard, Erin M; Wood, Chris M

    2013-06-01

    We investigated the bioaccumulation and acute toxicity (48 h or 96 h) of Ni in four freshwater invertebrate species in two waters with hardness of 40 (soft water) and 140 mg L(-1) as CaCO(3) (hard water). Sensitivity order (most to least) was Lymnaea stagnalis > Daphnia pulex > Lumbriculus variegatus > Chironomus riparius. In all cases water hardness was protective against acute Ni toxicity with LC(50) values 3-3.5× higher in the hard water vs. soft water. In addition, higher water hardness significantly reduced Ni bioaccumulation in these organisms suggesting that competition by Ca and Mg for uptake at the biotic ligand may contribute to higher metal resistance. CBR50 values (Critical Body Residues) were less dependent on water chemistry (i.e. more consistent) than LC(50) values within and across species by ~2 fold. These data support one of the main advantages of the Tissue Residue Approach (TRA) where tissue concentrations are generally less variable than exposure concentrations with respect to toxicity. Whole body Ni bioaccumulation followed Michaelis-Menten kinetics in all organisms, with greater hardness tending to decrease B(max) with no consistent effect on K(d). Across species, acute Ni LC(50) values tended to increase with both K(d) and B(max) values - i.e. more sensitive species exhibited higher binding affinity and lower binding capacity for Ni, but there was no correlation with body size. With respect to biotic ligand modeling, log K(NiBL) values derived from Ni bioaccumulation correlated well with log K(NiBL) values derived from toxicity testing. Both whole body Na and Mg levels were disturbed, suggesting that disruption of ionoregulatory homeostasis is a mechanism of acute Ni toxicity. In L. stagnalis, Na depletion was a more sensitive endpoint than mortality, however, the opposite was true for the other organisms. This is the first study to show the relationship between Na and Ni. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Detection of rare blood group, Bombay (Oh) phenotype patients and management by acute normovolemic hemodilution.

    Science.gov (United States)

    Shrivastava, Manisha; Navaid, Seema; Peethambarakshan, A; Agrawal, Kalpana; Khan, Athar

    2015-01-01

    Due to lack of correct blood grouping practices, the rare Bombay Oh phenotype may be missed, subjecting patients to the risk of severe hemolytic transfusion reaction. In the absence of blood donor registry, transfusion management of patients needing immediate surgery is a challenge. This study presents detection of rare Bombay Oh phenotype patients and their management by acute peri-operative acute normovolemic hemodilution (ANH) in a hospital from central India. Blood grouping of patients and blood donors with a standard tube method was carried out and samples identified as rare Bombay phenotype were confirmed by saliva inhibition test. Surgical management of cases needing transfusion was done by ANH, as per the British Committee for Standards in Hematology guidelines. The incidence of Bombay phenotype was 0.002% or 1 in 51,924 in the study. Amongst three cases (patients) identified as Bombay phenotype, one was Bombay Oh, Rh negative. Two cases were missed in the first instance and one case actually did not require transfusion. In the absence of a blood donor registry for Bombay phenotype, the cases needing transfusion were successfully managed with ANH in the operation theatre. A simple test like blood grouping should be done with serious intention with incorporation of both forward and reverse grouping, so that no patient receives wrong blood leading to fatal hemolysis due to transfusion. ANH is a cost-effective transfusion option for suitable patients. Appropriate clinical decision making, use of strategies to decrease peri-operative blood losses and cost-effective country based planning could be more widely applied to improve clinical transfusion practice.

  6. Detection of rare blood group, Bombay (Oh phenotype patients and management by acute normovolemic hemodilution

    Directory of Open Access Journals (Sweden)

    Manisha Shrivastava

    2015-01-01

    Full Text Available Background: Due to lack of correct blood grouping practices, the rare Bombay Oh phenotype may be missed, subjecting patients to the risk of severe hemolytic transfusion reaction. In the absence of blood donor registry, transfusion management of patients needing immediate surgery is a challenge. This study presents detection of rare Bombay Oh phenotype patients and their management by acute peri-operative acute normovolemic hemodilution (ANH in a hospital from central India. Materials and Methods: Blood grouping of patients and blood donors with a standard tube method was carried out and samples identified as rare Bombay phenotype were confirmed by saliva inhibition test. Surgical management of cases needing transfusion was done by ANH, as per the British Committee for Standards in Hematology guidelines. Results: The incidence of Bombay phenotype was 0.002% or 1 in 51,924 in the study. Amongst three cases (patients identified as Bombay phenotype, one was Bombay Oh, Rh negative. Two cases were missed in the first instance and one case actually did not require transfusion. In the absence of a blood donor registry for Bombay phenotype, the cases needing transfusion were successfully managed with ANH in the operation theatre. Conclusion: A simple test like blood grouping should be done with serious intention with incorporation of both forward and reverse grouping, so that no patient receives wrong blood leading to fatal hemolysis due to transfusion. ANH is a cost-effective transfusion option for suitable patients. Appropriate clinical decision making, use of strategies to decrease peri-operative blood losses and cost-effective country based planning could be more widely applied to improve clinical transfusion practice.

  7. Incident reporting in post-operative patients managed by acute pain service

    Directory of Open Access Journals (Sweden)

    Syeda Fauzia Hasan

    2015-01-01

    Full Text Available Background and Aims: Incident reporting is a reliable and inexpensive tool used in anaesthesia to identify errors in patient management. A hospital incident reporting system was already present in our hospital, but we were unable to find any incident related to acute pain management. Hence, acute pain service (APS was started for voluntary incident reporting in post-operative patients to identify critical incidents, review the root cause and suggest remedial measures. Methods: All post-operative patients managed by APS were included in this observational study. A proforma was developed by APS, which included information about the type of incident (equipment and patient-related, human errors, severity of incident, person responsible and suggestions to prevent the same incident in the future. Patients and medical staff were informed about the reporting system. Whenever an incident was identified, a proforma was filled out by APS resident and data entered in SPSS programme. Results: Total of 98 (1.80% incidents were reported in 5432 patients managed by APS during 3 years period. Average age of the patients was 46 ± 17 years. Majority of incidents were related to epidural care (71% and occurred in surgical wards (87%. Most of the incidents occurred due to human error and infusion delivery set-related defects. Conclusion: Incident reporting proved to be a feasible method of improving quality care in developing countries. It not only provides valuable information about areas which needed improvement, but also helped in developing strategies to improve care. Knowledge and attitudes of medical and paramedical staff are identified as the targeted area for improvement.

  8. Management of levofloxacin induced anaphylaxis and acute delirium in a palliative care setting

    Directory of Open Access Journals (Sweden)

    Arunangshu Ghoshal

    2015-01-01

    Full Text Available Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence of Levofloxacin-associated anaphylaxis is rare and delirium secondary to Levofloxacin is a seldom occurrence with only few published case reports. It is an extremely rare occurrence to see this phenomenon in combination. Early identification and prompt intervention reduces both mortality and morbidity. A 17-year-old male with synovial sarcoma of right thigh with chest wall and lung metastasis and with no prior psychiatric morbidity presented to palliative medicine outpatient department with community-acquired pneumonia. He was initiated on intravenous (IV Ceftriaxone and IV Levofloxacin. Post IV Levofloxacin patient developed anaphylaxis and acute delirium necessitating IV Hydrocortisone, IV Chlorpheneramine, Oxygen and IV Haloperidol. Early detection and prompt intervention helped in complete recovery. Patient was discharged to hospice for respite after 2 days of hospitalization and then discharged home. Acute palliative care approach facilitated management of two life-threatening medical complications in a palliative care setting improving both quality and length of life.

  9. Acute viral bronchiolitis in South Africa: Strategies for management and prevention.

    Science.gov (United States)

    Zar, H J; Madhi, S A; White, D A; Masekela, R; Risenga, S; Lewis, H; Feldman, C; Morrow, B; Jeena, P

    2016-04-01

    Management of acute viral bronchiolitis is largely supportive. There is currently no proven effective therapy other than oxygen for hypoxic children. The evidence indicates that there is no routine benefit from inhaled, rapid short-acting bronchodilators, adrenaline or ipratropium bromide for children with acute viral bronchiolitis. Likewise, there is no demonstrated benefit from routine use of inhaled or oral corticosteroids, inhaled hypertonic saline nebulisation, montelukast or antibiotics. The last should be reserved for children with severe disease, when bacterial co-infection is suspected. Prevention of respiratory syncytial virus (RSV) disease remains a challenge. A specific RSV monoclonal antibody, palivizumab, administered as an intramuscular injection, is available for children at risk of severe bronchiolitis, including premature infants, young children with chronic lung disease, immunodeficiency, or haemodynamically significant congenital heart disease. Prophylaxis should be commenced at the start of the RSV season and given monthly during the season. The development of an RSV vaccine may offer a more effective alternative to prevent disease, for which the results of clinical trials are awaited. Education of parents or caregivers and healthcare workers about diagnostic and management strategies should include the following: bronchiolitis is caused by a virus; it is seasonal; it may start as an upper respiratory tract infection with low-grade fever; symptoms are cough and wheeze, often with fast breathing; antibiotics are generally not needed; and the condition is usually self limiting, although symptoms may occur for up to four weeks in some children.

  10. Impact of outpatient management following appendectomy for acute appendicitis: An ACS NSQIP-P analysis.

    Science.gov (United States)

    Litz, Cristen N; Stone, Laurie; Alessi, Roberta; Walford, Nebbie E; Danielson, Paul D; Chandler, Nicole M

    2017-06-30

    In 2012, a same-day discharge protocol following appendectomy for acute appendicitis was initiated. Our objective was to determine the success of the protocol by reviewing the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) outcomes following protocol development. The 2015 NSQIP-P Participant Use Data File was queried to identify patients with acute appendicitis who underwent appendectomy. Outcomes were compared to institutional outcomes. There were 154 institutional patients and 4973 from NSQIP-P centers. Institutional rate of outpatient management was higher compared to NSQIP-P (84% vs 48%, ppp=0.2), deep (0.6% vs 0.1%, p=0.17) or organ/space surgical site infections (1.3% vs 0.7%, p=0.31). The incidences of other complications (1.3% vs 0.6%, p=0.26) and 30-day readmissions (3.2% vs 2.6%, p=0.61) were similar. Outpatient management following appendectomy in children is possible with low morbidity and readmission rates. Comparison with other NSQIP-Pediatric centers suggests an opportunity to generalize this practice with considerable savings to the health care system. Prognosis study, level II. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. The acute oncologist’s role in managing patients with cancer and other comorbidities

    Directory of Open Access Journals (Sweden)

    Kate Shankland

    2015-08-01

    Full Text Available Background: An Acute Oncology Service (AOS is paramount to providing timely and improved pathways of care for patients who are admitted to hospital with cancer-related problems or suspected cancer. Objective: To establish an AOS pilot study to decide how best to implement such a service locally. Methods: The AOS, which included collaboration between the oncology and palliative care teams at the Northern General Hospital in Sheffield, UK, ensured that the majority of oncology patients in the region received timely assessment by an oncologist if they became acutely unwell as a result of their cancer or its treatment. The AOS consisted of a thrice-weekly ward round, and daily telephone advice service. Results: We report on patient data during the first 12 months of the pilot study. Delivery of the AOS enhanced communication between the services and provided inter-professional education and support, resulting in earlier oncological team involvement in the management of patients with cancer admitted under other teams, as well as provision of advice to patients and their caregivers and families. Provision of the AOS shortened the mean length of hospital stay by 6 days. Two case studies are presented to illustrate the typical challenges faced when managing these patients. Conclusions: Establishment of the AOS enabled effective collaboration between the oncology and other clinical teams to provide a rapid and streamlined referral pathway of patients to the AOS. Locally, this process has been supported by the development of acute oncology protocols, which are now in use across the local cancer network.

  12. The Effects of Massage Therapy on Pain Management in the Acute Care Setting

    Science.gov (United States)

    Adams, Rose; White, Barb; Beckett, Cynthia

    2010-01-01

    Background Pain management remains a critical issue for hospitals and is receiving the attention of hospital accreditation organizations. The acute care setting of the hospital provides an excellent opportunity for the integration of massage therapy for pain management into the team-centered approach of patient care. Purpose and Setting This preliminary study evaluated the effect of the use of massage therapy on inpatient pain levels in the acute care setting. The study was conducted at Flagstaff Medical Center in Flagstaff, Arizona—a nonprofit community hospital serving a large rural area of northern Arizona. Method A convenience sample was used to identify research participants. Pain levels before and after massage therapy were recorded using a 0 – 10 visual analog scale. Quantitative and qualitative methods were used for analysis of this descriptive study. Participants Hospital inpatients (n = 53) from medical, surgical, and obstetrics units participated in the current research by each receiving one or more massage therapy sessions averaging 30 minutes each. The number of sessions received depended on the length of the hospital stay. Result Before massage, the mean pain level recorded by the patients was 5.18 [standard deviation (SD): 2.01]. After massage, the mean pain level was 2.33 (SD: 2.10). The observed reduction in pain was statistically significant: paired samples t52 = 12.43, r = .67, d = 1.38, p massage therapy into the acute care setting creates overall positive results in the patient’s ability to deal with the challenging physical and psychological aspects of their health condition. The study demonstrated not only significant reduction in pain levels, but also the interrelatedness of pain, relaxation, sleep, emotions, recovery, and finally, the healing process. PMID:21589696

  13. Interdisciplinary Peripartum Management of Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation – a Case Report and Literature Review

    Science.gov (United States)

    Weyrich, J.; Bogdanski, R.; Ortiz, J. U.; Kuschel, B.; Schneider, K. T. M.; Lobmaier, S. M.

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) is increasingly used for the management of acute severe cardiac and respiratory failure. One of the indications is acute respiratory distress syndrome (ARDS) for which, in some severe cases, ECMO represents the only possibility to save lives. We report on the successful long-term use of ECMO in a postpartum patient with recurrent pulmonary decompensation after peripartum uterine rupture with extensive blood loss. PMID:27065489

  14. Interdisciplinary Peripartum Management of Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation - a Case Report and Literature Review.

    Science.gov (United States)

    Weyrich, J; Bogdanski, R; Ortiz, J U; Kuschel, B; Schneider, K T M; Lobmaier, S M

    2016-03-01

    Extracorporeal membrane oxygenation (ECMO) is increasingly used for the management of acute severe cardiac and respiratory failure. One of the indications is acute respiratory distress syndrome (ARDS) for which, in some severe cases, ECMO represents the only possibility to save lives. We report on the successful long-term use of ECMO in a postpartum patient with recurrent pulmonary decompensation after peripartum uterine rupture with extensive blood loss.

  15. The Challenge of Managing Fusiform Basilar Artery Aneurysms: From Acute Ischemic Stroke to a Massive Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Sofia Bezerra

    2011-02-01

    Full Text Available We present the case of a patient with acute brain stem ischemic stroke who was found to have a fusiform basilar aneurysm with a thrombus within the dilated vessel. Three days after the ischemic stroke, the patient had a massive subarachnoid hemorrhage and died. This case illustrates the difficulties in the acute management of ischemic events in patients with basilar fusiform aneurysms, because the natural history of this disease encompasses both bleeding and thrombosis.

  16. Assessment of post-operative pain management among acutely and electively admitted patients - a Swedish ward perspective.

    Science.gov (United States)

    Magidy, Mahnaz; Warrén-Stomberg, Margareta; Bjerså, Kristofer

    2016-04-01

    Swedish health care is regulated to involve the patient in every intervention process. In the area of post-operative pain, it is therefore important to evaluate patient experience of the quality of pain management. Previous research has focused on mapping this area but not on comparing experiences between acutely and electively admitted patients. Hence, the aim of this study was to investigate the experiences of post-operative pain management quality among acutely and electively admitted patients at a Swedish surgical department performing soft-tissue surgery. A survey study design was used as a method based on a multidimensional instrument to assess post-operative pain management: Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP). Consecutive patients at all wards of a university hospital's surgical department were included. Data collection was performed at hospital discharge. In total, 160 patients participated, of whom 40 patients were acutely admitted. A significant difference between acutely and electively admitted patients was observed in the SCQIPP area of environment, whereas acute patients rated the post-operative pain management quality lower compared with those who were electively admitted. There may be a need for improvement in the areas of post-operative pain management in Sweden, both specifically and generally. There may also be a difference in the experience of post-operative pain quality between acutely and electively admitted patients in this study, specifically in the area of environment. In addition, low levels of the perceived quality of post-operative pain management among the patients were consistent, but satisfaction with analgesic treatment was rated as good. © 2015 John Wiley & Sons, Ltd.

  17. Neurologic complications of electrolyte disturbances and acid-base balance.

    Science.gov (United States)

    Espay, Alberto J

    2014-01-01

    Electrolyte and acid-base disturbances are common occurrences in daily clinical practice. Although these abnormalities can be readily ascertained from routine laboratory findings, only specific clinical correlates may attest as to their significance. Among a wide phenotypic spectrum, acute electrolyte and acid-base disturbances may affect the peripheral nervous system as arreflexic weakness (hypermagnesemia, hyperkalemia, and hypophosphatemia), the central nervous system as epileptic encephalopathies (hypomagnesemia, dysnatremias, and hypocalcemia), or both as a mixture of encephalopathy and weakness or paresthesias (hypocalcemia, alkalosis). Disabling complications may develop not only when these derangements are overlooked and left untreated (e.g., visual loss from intracranial hypertension in respiratory or metabolic acidosis; quadriplegia with respiratory insufficiency in hypermagnesemia) but also when they are inappropriately managed (e.g., central pontine myelinolisis when rapidly correcting hyponatremia; cardiac arrhythmias when aggressively correcting hypo- or hyperkalemia). Therefore prompt identification of the specific neurometabolic syndromes is critical to correct the causative electrolyte or acid-base disturbances and prevent permanent central or peripheral nervous system injury. This chapter reviews the pathophysiology, clinical investigations, clinical phenotypes, and current management strategies in disorders resulting from alterations in the plasma concentration of sodium, potassium, calcium, magnesium, and phosphorus as well as from acidemia and alkalemia.

  18. Disturbance of Bcl-2, Bax, Caspase-3, Ki-67 and C-myc expression in acute and subchronic exposure to benzo(a)pyrene in cervix.

    Science.gov (United States)

    Gao, Meili; Li, Yongfei; Ji, Xiaoying; Xue, Xiaochang; Chen, Lan; Feng, Guodong; Zhang, Huqin; Wang, Huichun; Shah, Walayat; Hou, Zhanwu; Kong, Yu

    2016-03-01

    Epidemiological studies have demonstrated that cigarette smoking is an important cofactor or an independent risk factor for the development of cervical cancer. Benzo(a)pyrene (BaP) is one of the most potent tobacco smoke carcinogens in tobacco smoke. BaP induced DNA damage and over expression in p53 cervical tissue of mice as demonstrated in our previous study. Here we present the findings of exposure to BaP on the expression of Bcl-2, C-myc, Ki-67, Caspase-3 and Bax genes in mouse cervix. Acute intraperitoneal administration of BaP (12.5, 25, 50, 100mg/kg body weight) to ICR female mice induced a significant increase in Bcl-2, C-myc, Ki-67 mRNA and protein level till 72h except in Bcl-2 at 24h with 12.5, 25, 50mg/kg as well as at 48h with 12.5mg/kg body weight post treatment. A significant increase was also seen in Caspase-3 and Bax mRNA and protein level with peak level at 24h and gradual decrease till 72h, however, the expression of caspase-3 increased while that of Bax decreased with increasing dose of Bap after 24h. In sub chronic intraperitoneal and oral gavage administration of BaP (2.5, 5, 10mg/kg body weight), similar significant increase was observed for all the examined genes as compared to the control and vehicle groups, however the expression of Bax decreased in a dose dependent manner. The findings of this study will help in further understanding the molecular mechanism of BaP induced carcinogenesis of cervical cancer.

  19. Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management

    Energy Technology Data Exchange (ETDEWEB)

    Millet, Ingrid; Pages-Bouic, Emma; Curros-Doyon, Fernanda; Taourel, Patrice [CHU Lapeyronie, Department of Medical Imaging, Montpellier Cedex 5 (France); Sebbane, Mustapha [Department of Emergency Medicine, CHU Lapeyronie, Montpellier (France); Molinari, Nicolas [Department of Medical Information and Statistics, CHU Montpellier (France); Riou, Bruno [GH Pitie-Salpetriere, APHP, Department of Emergency Medicine and Surgery, Paris (France)

    2017-02-15

    To assess the added-value of systematic unenhanced abdominal computed tomography (CT) on emergency department (ED) diagnosis and management accuracy compared to current practice, in elderly patients with non-traumatic acute abdominal symptoms. Institutional review board approval and informed consent were obtained. This prospective study included 401 consecutive patients 75 years of age or older, admitted to the ED with acute abdominal symptoms, and investigated by early systematic unenhanced abdominal CT scan. ED diagnosis and intended management before CT, after unenhanced CT, and after contrast CT if requested, were recorded. Diagnosis and management accuracies were evaluated and compared before CT (clinical strategy) and for two conditional strategies (current practice and systematic unenhanced CT). An expert clinical panel assigned a final diagnosis and management after a 3-month follow-up. Systematic unenhanced CT significantly improved the accurate diagnosis (76.8% to 85%, p=1.1 x 10{sup -6}) and management (88.5% to 95.8%, p=2.6 x 10{sup -6}) rates compared to current practice. It allowed diagnosing 30.3% of acute unsuspected pathologies, 3.4% of which were unexpected surgical procedure requirement. Systematic unenhanced abdominal CT improves ED diagnosis accuracy and appropriate management in elderly patients presenting with acute abdominal symptoms compared to current practice. (orig.)

  20. Clinical review and implications of the guideline for the early management of patients with acute ischemic stroke.

    Science.gov (United States)

    Livesay, Sarah L

    2014-01-01

    Stroke is the fourth leading cause of death and the leading cause of significant, long-term disability in the United States. Clinicians' knowledge and use of evidence to guide the care of patients with ischemic stroke are paramount to improving patient outcomes. The recently updated "Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association" provides clinicians with evidence-based, expert consensus to guide the recognition and early management of patients with acute ischemic stroke. The guideline provides 115 recommendations for the management of patients with acute ischemic stroke, including 24 new recommendations and 51 revised recommendations divided into 14 major topic areas. This article reviews the recommendations and related literature and provides suggestions for use and implementation of the guideline within a stroke program of care.

  1. Management of hemichorea hemiballismus syndrome in an acute palliative care setting.

    Science.gov (United States)

    Damani, Anuja; Ghoshal, Arunangshu; Salins, Naveen; Deodhar, Jayita; Muckaden, Mary Ann

    2015-01-01

    Hemichorea hemiballismus (HCHB) is a rare and debilitating presentation of hyperglycemia and subcortical stroke. Early identification, proper assessment and management of HCHB can lead to complete symptom relief. We describe a case of HCHB presenting to a palliative care setting. A 63-year-old diabetic and hypertensive lady, with history of ovarian cancer presented to Palliative Medicine outpatient clinic with two days history of right HCHB. Blood investigations and brain imaging showed high blood sugar levels and lacunar subcortical stroke. Blood sugar levels were controlled with human insulin and Aspirin. Clopidogrel and Atorvastatin were prescribed for the management of lacunar stroke. HCHB reduced markedly post-treatment, leading to significant reduction in morbidity and improvement in quality of life. The symptoms completely resolved within one week of starting the treatment and the patient was kept on regular home and outpatient follow up for further monitoring. Acute palliative care (APC) approach deals with the management of comorbidities and their complications along with supportive care. Prompt assessment and management of such complications lead to better patient outcomes.

  2. Management of hemichorea hemiballismus syndrome in an acute palliative care setting

    Directory of Open Access Journals (Sweden)

    Anuja Damani

    2015-01-01

    Full Text Available Hemichorea hemiballismus (HCHB is a rare and debilitating presentation of hyperglycemia and subcortical stroke. Early identification, proper assessment and management of HCHB can lead to complete symptom relief. We describe a case of HCHB presenting to a palliative care setting. A 63-year-old diabetic and hypertensive lady, with history of ovarian cancer presented to Palliative Medicine outpatient clinic with two days history of right HCHB. Blood investigations and brain imaging showed high blood sugar levels and lacunar subcortical stroke. Blood sugar levels were controlled with human insulin and Aspirin. Clopidogrel and Atorvastatin were prescribed for the management of lacunar stroke. HCHB reduced markedly post-treatment, leading to significant reduction in morbidity and improvement in quality of life. The symptoms completely resolved within one week of starting the treatment and the patient was kept on regular home and outpatient follow up for further monitoring. Acute palliative care (APC approach deals with the management of comorbidities and their complications along with supportive care. Prompt assessment and management of such complications lead to better patient outcomes.

  3. Guidelines for acute management of hyperammonemia in the Middle East region

    Directory of Open Access Journals (Sweden)

    Alfadhel M

    2016-03-01

    Full Text Available Majid Alfadhel,1,2 Fuad Al Mutairi,1,2 Nawal Makhseed,3 Fatma Al Jasmi,4 Khalid Al-Thihli,5 Emtithal Al-Jishi,6 Moeenaldeen AlSayed,7 Zuhair N Al-Hassnan,7,8 Fathiya Al-Murshedi,5 Johannes Häberle,9 Tawfeg Ben-Omran10 Middle East Hyperammonemia and Urea Cycle Disorders Scientific Group (MHUSG 1Department of Pediatrics, Division of Genetics, 2King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 3Department of Pediatrics, Jahra Hospital, Ministry of Health, Jahra City, Kuwait; 4Department of Pediatric, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates; 5Genetic and Developmental Medicine Clinic, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman; 6Salmaniya Medical Complex, Arabian Gulf University, Manama, Bahrain; 7Department of Medical Genetics, King Faisal Specialist Hospital & Research Center, 8The National Newborn Screening Program, Ministry of Health, Riyadh, Saudi Arabia; 9Department of Pediatrics, Division of Metabolism and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland; 10Division of Clinical and Metabolic Genetics, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar Background: Hyperammonemia is a life-threatening event that can occur at any age. If treated, the early symptoms in all age groups could be reversible. If untreated, hyperammonemia could be toxic and cause irreversible brain damage to the developing brain.Objective: There are major challenges that worsen the outcome of hyperammonemic individuals in the Middle East. These include: lack of awareness among emergency department physicians about proper management of hyperammonemia, strained communication between physicians at primary, secondary, and tertiary hospitals, and shortage of the medications used in the acute management of hyperammonemia. Therefore, the urge to develop regional guidelines is

  4. Chiropractic Treatment vs Self-Management in Patients With Acute Chest Pain: A Randomized Controlled Trial of Patients Without Acute Coronary Syndrome

    DEFF Research Database (Denmark)

    Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner;

    2012-01-01

    OBJECTIVE: The musculoskeletal system is a common but often overlooked cause of chest pain. The purpose of the present study is to evaluate the relative effectiveness of 2 treatment approaches for acute musculoskeletal chest pain: (1) chiropractic treatment that included spinal manipulation and (2......) self-management as an example of minimal intervention. METHODS: In a nonblinded, randomized, controlled trial set at an emergency cardiology department and 4 outpatient chiropractic clinics, 115 consecutive patients with acute chest pain and no clear medical diagnosis at initial presentation were...... included. After a baseline evaluation, patients with musculoskeletal chest pain were randomized to 4 weeks of chiropractic treatment or self-management, with posttreatment questionnaire follow-up 4 and 12 weeks later. Primary outcome measures were numeric change in pain intensity (11-point box numerical...

  5. Pros and cons of colonoscopy in management of acute lower gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Dekey Y Lhewa; Lisa L Strate

    2012-01-01

    Acute lower gastrointestinal bleeding (LGIB) is a frequent gastrointestinal cause of hospitalization,particularly in the elderly,and its incidence appears to be on the rise.Endoscopic and radiographic measures are available for the evaluation and treatment of LGIB including flexible sigmoidoscopy,colonoscopy,angiography,radionuclide scintigraphy and multi-detector row computed tomography.Although no modality has emerged as the gold standard in the management of LGIB,colonoscopy is the current preferred initial test for the majority of the patients presenting with hematochezia felt to be from a colon source.Colonoscopy has the ability to diagnose all sources of bleeding from the colon and,unlike the radiologic modalities,does not require active bleeding at the time of the examination.In addition,therapeutic interventions such as cautery and endoclips can be applied to achieve hemostasis and prevent recurrent bleeding.Studies suggest that colonoscopy,particularly when performed early in the hospitalization,can decrease hospital length of stay,rebleeding and the need for surgery.However,results from available small trials are conflicting and larger,multicenter studies are needed.Compared to other management options,colonoscopy is a safe procedure with complications reported in less than 2% of patients,including those undergoing urgent examinations.The requirement of bowel preparation (typically 4 or more liters of polyethylene glycol),the logistical complexity of coordinating after-hours colonoscopy,and the low prevalence of stigmata of hemorrhage complicate the use of colonoscopy for LGIB,particularly in urgent situations.This review discusses the above advantages and disadvantages of colonoscopy in the management of acute lower gastrointestinal bleeding in further detail.

  6. Acute asthma management by a pediatric after-hours call center.

    Science.gov (United States)

    Nelson, Kyle A; Freiner, Donna; Garbutt, Jane; Trinkaus, Kathryn; Bruns, Julie; Sterkel, Randal; Smith, Sharon R; Strunk, Robert C

    2009-01-01

    To describe an asthma management protocol used in a nurse-staffed pediatric After-Hours Call Center (AHCC) that incorporates severity-based home treatment recommendations and follow-up call assessments. Call records for asthma advice from January 1, 2004 to June 30, 2004 were identified retrospectively and reviewed. Descriptive statistics were used to report patient demographics, frequencies of symptom severity zones (Red, Yellow, or Green) at initial calls, frequencies of call dispositions designating care advice provided (including home treatment recommendations and seeking emergency department [ED] care), and changes in severity zones between initial calls and follow-up calls when nurses reassessed patients after recommended home treatment. During the study period, 3,632 asthma calls (2,439 initial; 1,193 follow-up) were managed by AHCC nurses. Initial calls were classified mostly as Red (28%) or Yellow (42%) severity zones; 27% were Green zone and 3% could not be categorized. Fifty-two percent of initial calls with Red or Yellow severity zones involved home treatment recommendations; 50% of those Red zone and 63% of those Yellow zone calls had improved severity zones at follow-up call assessments. Twenty-eight percent of patients with home treatment recommendations were referred to the ED at the time of follow-up call nurse reassessment. This telephone-based nurse-staffed pediatric acute asthma management protocol includes provision of severity-based home treatment recommendations and follow-up assessments, and improved symptoms for many children with acute exacerbations. This protocol may also be successful in other locations and may improve outcomes, such as reduction in ED visits.

  7. Mechanistic aspects of inflammation and clinical management of inflammation in acute gouty arthritis.

    Science.gov (United States)

    Cronstein, Bruce N; Sunkureddi, Prashanth

    2013-01-01

    It has been recently demonstrated that interleukin 1β (IL-1β) plays a central role in monosodium urate crystal-induced inflammation and that the NALP3 inflammasome plays a major role in IL-1β production. These discoveries have offered new insights into the pathogenesis of acute gouty arthritis. In this review, we discuss the molecular mechanisms by which monosodium urate crystals induce acute inflammation and examine the mechanisms of action (MOAs) of traditional anti-inflammatory drugs (e.g., nonsteroidal anti-inflammatory drugs, colchicine, and glucocorticoids) and biologic agents (e.g., the IL-1β antagonists anakinra, rilonacept, and canakinumab) to understand how their MOAs contribute to their safety profiles. Traditional anti-inflammatory agents may act on the IL-1β pathway at some level; however, their MOAs are broad-ranging, unspecific, and biologically complex. This lack of specificity may explain the range of systemic adverse effects associated with them. The therapeutic margins of nonsteroidal anti-inflammatory drugs, colchicine, and glucocorticoids are particularly low in elderly patients and in patients with cardiovascular, metabolic, or renal comorbidities that are frequently associated with gouty arthritis. In contrast, the IL-1β antagonists act on very specific targets of inflammation, which may decrease the potential for systemic adverse effects, although infrequent but serious adverse events (including infection and administration reactions) have been reported. Because these IL-1β antagonists target an early event immediately downstream from NALP3 inflammasome activation, they may provide effective alternatives to traditional agents with minimal systemic adverse effects. Results of ongoing trials of IL-1β antagonists will likely provide clarification of their potential role in the management of acute gouty arthritis.

  8. Multidisciplinary management strategies for acute non-variceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Lu, Y; Loffroy, R; Lau, J Y W; Barkun, A

    2014-01-01

    The modern management of acute non-variceal upper gastrointestinal bleeding is centred on endoscopy, with recourse to interventional radiology and surgery in refractory cases. The appropriate use of intervention to optimize outcomes is reviewed. A literature search was undertaken of PubMed and the Cochrane Central Register of Controlled Trials between January 1990 and April 2013 using validated search terms (with restrictions) relevant to upper gastrointestinal bleeding. Appropriate and adequate resuscitation, and risk stratification using validated scores should be initiated at diagnosis. Coagulopathy should be corrected along with blood transfusions, aiming for an international normalized ratio of less than 2·5 to proceed with possible endoscopic haemostasis and a haemoglobin level of 70 g/l (excluding patients with severe bleeding or ischaemia). Prokinetics and proton pump inhibitors (PPIs) can be administered while awaiting endoscopy, although they do not affect rebleeding, surgery or mortality rates. Endoscopic haemostasis using thermal or mechanical therapies alone or in combination with injection should be used in all patients with high-risk stigmata (Forrest I-IIb) within 24 h of presentation (possibly within 12 h if there is severe bleeding), followed by a 72-h intravenous infusion of PPI that has been shown to decrease further rebleeding, surgery and mortality. A second attempt at endoscopic haemostasis is generally made in patients with rebleeding. Uncontrolled bleeding should be treated with targeted or empirical transcatheter arterial embolization. Surgical intervention is required in the event of failure of endoscopic and radiological measures. Secondary PPI prophylaxis when indicated and Helicobacter pylori eradication are necessary to decrease recurrent bleeding, keeping in mind the increased false-negative testing rates in the setting of acute bleeding. An evidence-based approach with multidisciplinary collaboration is required to optimize

  9. Management of acute central retinal artery occlusion: Intravenous thrombolysis is feasible and safe.

    Science.gov (United States)

    Préterre, Cécile; Godeneche, Gaelle; Vandamme, Xavier; Ronzière, Thomas; Lamy, Matthias; Breuilly, Christophe; Urbanczyk, Cédric; Wolff, Valérie; Lebranchu, Pierre; Sevin-Allouet, Mathieu; Guillon, Benoit

    2017-01-01

    Background Although acute central retinal artery occlusion is as a stroke in the carotid territory (retinal artery), its management remains controversial. The aim of this study was to assess the feasibility and safety of intravenous thrombolysis delivered within 6 h of central retinal artery occlusion in French stroke units. Methods We performed a retrospective analysis of patients treated with intravenous alteplase (recombinant tissue-plasminogen activator), based on stroke units thrombolysis registers from June 2005 to June 2015, and we selected those who had acute central retinal artery occlusion. The feasibility was assessed by the ratio of patients that had received intravenous alteplase within 6 h after central retinal artery occlusion onset among those who had been admitted to the same hospital for acute central retinal artery occlusion. All adverse events were documented. Results Thirty patients were included. Visual acuity before treatment was limited to "hand motion", or worse, in 90% of the cases. The mean onset-to-needle time was 273 min. The individuals treated with intravenous alteplase for central retinal artery occlusion represented 10.2% of all of the patients hospitalized for central retinal artery occlusion in 2013 and 2014. We observed one occurrence of major bleeding, a symptomatic intracerebral hemorrhage. Conclusion When applied early on, intravenous thrombolysis appears to be feasible and safe, provided that contraindications are given due consideration. Whether intravenous thrombolysis is more effective than conservative therapy remains to be determined. In order to conduct a well-designed prospective randomized control trial, an organized network should be in place.

  10. Acute and chronic cardiovascular effects of hyperkalemia: new insights into prevention and clinical management.

    Science.gov (United States)

    McCullough, Peter A; Beaver, Thomas M; Bennett-Guerrero, Elliott; Emmett, Michael; Fonarow, Gregg C; Goyal, Abhinav; Herzog, Charles A; Kosiborod, Mikhail; Palmer, Biff F

    2014-01-01

    The plasma pool of potassium is a partial reflection of the overall body, transient cellular shifts, and potassium elimination regulated by the kidneys. Potassium concentrations elevating above the upper limit of normal (> 5.0 mEq/L) have become more common in cardiovascular practice due to the growing population of patients with chronic kidney disease and the broad applications of drugs that modulate potassium excretion by either reducing production of angiotensin II (angiotensin-converting enzyme inhibitors, direct renin inhibitors, beta-adrenergic receptor antagonists), blocking angiotensin II receptors (angiotensin receptor blockers), or antagonizing the action of aldosterone on mineralocorticoid receptors (mineralocorticoid receptor antagonists). In addition, acute kidney injury, critical illness, crush injuries, and massive red blood cell transfusions can result in hyperkalemia. Progressively more severe elevations in potassium are responsible for abnormalities in cardiac depolarization and repolarization and contractility. Untreated severe hyperkalemia results in sudden cardiac death. Traditional management steps have included reducing dietary potassium and discontinuing potassium supplements; withdrawal of exacerbating drugs; acute treatment with intravenous calcium gluconate, insulin, and glucose; nebulized albuterol; correction of acidosis with sodium bicarbonate for short-term shifts out of the plasma pool; and, finally, gastrointestinal ion exchange with oral sodium polystyrene sulfonate in sorbitol, which is mainly used in the hospital and is poorly tolerated due to gastrointestinal adverse effects. This review explores hyperkalemia as a complication in cardiovascular patients and highlights new acute, chronic, and preventative oral therapies (patiromer calcium, cross-linked polyelectrolyte, ZS-9) that could potentially create a greater margin of safety for vulnerable patients with combined heart and kidney disease.

  11. Acute stroke unit improves stroke management-four years on from INASC.

    LENUS (Irish Health Repository)

    Shanahan, E

    2015-02-01

    The Irish Heart Foundation carried out the Irish National Audit of Stroke Care (INASC) in 2008. Management practices were significantly poorer than those in the UK Sentinel audits. Since then an acute stroke unit has been established in University Hospital Limerick. A stroke database was established. 12 key indicators of stroke management audited by INASC were identified. Results were compared to those in INASC. 89 stroke patients were admitted. 8 of the 12 key indicators scored significantly better than in INASC. 92.5% had a brain scan within 24hrs (INASC-40%, p = < 0.001). 100% of ischaemic strokes received anti-thrombotics (INASC-85%, p = 0.001). 94% had rehab goals agreed by MDT (22% in INASC p = 0.0000). 55% were treated in stroke unit (2% in INASC, p = 0.0000). MDT input improved with regard to physiotherapy (87% vs 43% in INASC, p = < 0.02) and SALT (74% vs 26%, p = < 0.02). Stroke management has significantly improved from 2008, however some deficiencies remain.

  12. The Optimal Management of Acute Febrile Encephalopathy in the Aged Patient: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Fereshte Sheybani

    2016-01-01

    Full Text Available The elderly comprise less than 13 percent of world population. Nonetheless, they represent nearly half of all hospitalized adults. Acute change in mental status from baseline is commonly seen among the elderly even when the main process does not involve the central nervous system. The term “geriatric syndrome” is used to capture those clinical conditions in older people that do not fit into discrete disease categories, including delirium, falls, frailty, dizziness, syncope, and urinary incontinence. Despite the growing number of elderly population, especially those who require hospitalization and the high burden of common infections accompanied by encephalopathy among them, there are several unresolved questions regarding the optimal management they deserve. The questions posed in this systematic review concern the need to rule out CNS infection in all elderly patients presented with fever and altered mental status in the routine management of febrile encephalopathy. In doing so, we sought to identify all potentially relevant articles using searches of web-based databases with no language restriction. Finally, we reviewed 93 research articles that were relevant to each part of our study. No prospective study was found to address how should AFE in the aged be optimally managed.

  13. Symptom experience and management among people with acute myeloid leukaemia in Thailand.

    Science.gov (United States)

    Temtap, Suthisa; Nilmanat, Kittikorn

    2011-08-01

    In Thailand, haematological malignancy is one of the most common types of cancer. This cross-sectional study, conducted in Southern Thailand, aimed to describe the symptom experiences of and symptom management strategies among patients with acute myeloid leukaemia (AML). Sixty hospitalized patients with AML were recruited. The Symptom Experience Scale and two open-ended questions regarding symptom-management strategies were used to collect data via face-to-face interviews 2 weeks after the induction phase of the AML protocol. The data was analysed using descriptive statistics and content analysis. High fever, weakness, nausea, and anorexia were the four most prevalent symptoms reported. Other prevalent symptoms included weight loss, bleeding, nausea and vomiting, dysphagia, and a cluster of psycho-emotional symptoms: worrying, fear, feeling discouraged, and feeling bored. Patients used various approaches and strategies to alleviate their symptoms, which could be categorized into five groups: preventive, direct, distraction, complementary, and restorative approaches. This study has provided important information for the development of symptom-management nursing programmes for patients with AML, particularly in Thailand.

  14. Potential advantages of acute kidney injury management by mesenchymal stem cells

    Institute of Scientific and Technical Information of China (English)

    Francesca; Bianchi; Elisa; Sala; Chiara; Donadei; Irene; Capelli; Gaetano; La; Manna

    2014-01-01

    Mesenchymal stem cells are currently considered as a promising tool for therapeutic application in acute kidney injury(AKI) management. AKI is characterized by acute tubular injury with rapid loss of renal function. After AKI, inflammation, oxidative stress and excessive deposition of extracellular matrix are the molecular events that ultimately cause the end-stage renal disease. Despite numerous improvement of supportive therapy, the mortality and morbidity among patients remain high. Therefore, exploring novel therapeutic options to treat AKI is mandatory. Numerous evidence in animal models has demonstrated the capability of mesenchymal stem cells(MSCs) to restore kidney function after induced kidney injury. After infusion, MSCs engraft in the injured tissue and release soluble factors and microvesicles that promote cell survival and tissue repairing. Indeed, the main mechanism of action of MSCs in tissue regeneration is the paracrine/endocrine secretion of bioactive molecules. MSCs can be isolated from several tissues, including bone marrow, adipose tissue, and blood cord; pre-treatment procedures to improve MSCs homing and their paracrine function have been also described. This review will focus on the application of cell therapy in AKI and it will summarize preclinical studies in animal models and clinical trials currently ongoing about the use of mesenchymal stem cells after AKI.

  15. Management of minor acute cutaneous wounds: importance of wound healing in a moist environment.

    Science.gov (United States)

    Korting, H C; Schöllmann, C; White, R J

    2011-02-01

    Moist wound care has been established as standard therapy for chronic wounds with impaired healing. Healing in acute wounds, in particular in minor superficial acute wounds - which indeed are much more numerous than chronic wounds - is often taken for granted because it is assumed that in those wounds normal phases of wound healing should run per se without any problems. But minor wounds such as small cuts, scraps or abrasions also need proper care to prevent complications, in particular infections. Local wound care with minor wounds consists of thorough cleansing with potable tap water or normal saline followed by the application of an appropriate dressing corresponding to the principles of moist wound treatment. In the treatment of smaller superficial wounds, it appears advisable to limit the choice of dressing to just a few products that fulfil the principles of moist wound management and are easy to use. Hydroactive colloid gels combining the attributes of hydrocolloids and hydrogels thus being appropriate for dry and exuding wounds appear especially suitable for this purpose - although there is still a lack of data from systematic studies on the effectiveness of these preparations. © 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology.

  16. Management of ramsay hunt syndrome in an acute palliative care setting

    Directory of Open Access Journals (Sweden)

    Shrenik Ostwal

    2015-01-01

    Full Text Available Introduction: The Ramsay Hunt syndrome is characterized by combination of herpes infection and lower motor neuron type of facial nerve palsy. The disease is caused by a reactivation of Varicella Zoster virus and can be unrepresentative since the herpetic lesions may not be always be present (zoster sine herpete and might mimic other severe neurological illnesses. Case Report: A 63-year-old man known case of carcinoma of gall bladder with liver metastases, post surgery and chemotherapy with no scope for further disease modifying treatment, was referred to palliative care unit for best supportive care. He was on regular analgesics and other supportive treatment. He presented to Palliative Medicine outpatient with 3 days history of ipsilateral facial pain of neuropathic character, otalgia, diffuse vesciculo-papular rash over ophthalmic and maxillary divisions of left trigeminal nerve distribution of face and ear, and was associated with secondary bacterial infection and unilateral facial edema. He was clinically diagnosed to have Herpes Zoster with superadded bacterial infection. He was treated with tablet Valacyclovir 500 mg four times a day, Acyclovir cream for local application, Acyclovir eye ointment for prophylactic treatment of Herpetic Keratitis, low dose of Prednisolone, oral Amoxicillin and Clindamycin for 7 days, and Pregabalin 150 mg per day. After 7 days of treatment, the rash and vesicles had completely resolved and good improvement of pain and other symptoms were noted. Conclusion: Management of acute infections and its associated complications in an acute palliative care setting improves both quality and length of life.

  17. Paediatric arterial ischemic stroke: acute management, recent advances and remaining issues.

    Science.gov (United States)

    Rosa, Margherita; De Lucia, Silvana; Rinaldi, Victoria Elisa; Le Gal, Julie; Desmarest, Marie; Veropalumbo, Claudio; Romanello, Silvia; Titomanlio, Luigi

    2015-01-01

    Stroke is a rare disease in childhood with an estimated incidence of 1-6/100.000. It has an increasingly recognised impact on child mortality along with its outcomes and effects on quality of life of patients and their families. Clinical presentation and risk factors of paediatric stroke are different to those of adults therefore it can be considered as an independent nosological entity. The relative rarity, the age-related peculiarities and the variety of manifested symptoms makes the diagnosis of paediatric stroke extremely difficult and often delayed. History and clinical examination should investigate underlying diseases or predisposing factors and should take into account the potential territoriality of neurological deficits and the spectrum of differential diagnosis of acute neurological accidents in childhood. Neuroimaging (in particular diffusion weighted magnetic resonance) is the keystone for diagnosis of paediatric stroke and other investigations might be considered according to the clinical condition. Despite substantial advances in paediatric stroke research and clinical care, many unanswered questions remain concerning both its acute treatment and its secondary prevention and rehabilitation so that treatment recommendations are mainly extrapolated from studies on adult population. We have tried to summarize the pathophysiological and clinical characteristics of arterial ischemic stroke in children and the most recent international guidelines and practical directions on how to recognise and manage it in paediatric emergency.

  18. Effective change management in a regional Sub-acute Ambulatory Care Services setting.

    Science.gov (United States)

    Campbell, Bruce W

    2012-02-01

    Government policies and community expectations in Australia continually lead to calls for healthcare change. These changes are often met with resistance from clinicians and managers. Making change happen requires consideration of the way policies, culture, context, shared vision and leadership can drive or impede change. This reflective case study critically investigates one change process; the evolution of a Sub-acute Ambulatory Care Services (SACS) program in an Australian regional hospital over a 3-year period. The new Community Rehabilitation Services (CRS) program evolved from a merger of Centre and Home Based Rehabilitation (CBR and HBR). Hospital amalgamations, closures and privatisation, and the Department of Health policy relating to SACS, ambulatory care and rehabilitation were some of the key elements explored in this paper.

  19. Clinical guidelines for the management of acute viral infections in patients with systemic lupus erythematosus.

    Science.gov (United States)

    Ramos-Casals, M; Cuadrado, M J; Alba, P; Sanna, G; Brito-Zerón, P; Bertolaccini, L; Babini, A; Moreno, A; D'Cruz, D; Khamashta, M A

    2009-12-01

    In recent decades, many research groups have focused on the role of viral infections in the etiopathogenesis of systemic lupus erythematosus (SLE), the so-called "viral hypothesis". The main candidates are herpes viruses such as Epstein-Barr virus (EBV) and cytomegalovirus (CMV), which have a high seroprevalence in the general population. However, a viral causal agent of SLE has not yet been discovered, although many interesting clinical findings on the complex interactions between viruses and SLE have been made. This review analyzes 88 cases of acute viral infections in adult patients with SLE and identifies situations in which viral infections influenced the diagnosis, prognosis or treatment of SLE. We also propose clinical guidelines for the management of these infections in patients with SLE.

  20. Management of acute asthma in the pediatric patient: an evidence-based review.

    Science.gov (United States)

    Jones, Brittany Pardue; Paul, Audrey

    2013-05-01

    Asthma is the most common chronic disease of childhood, with asthma exacerbations and wheezing resulting in more than 2 million emergency department visits per year. Symptoms can vary from mild shortness of breath to fatal status asthmaticus. Given the high prevalence of asthma and its potential to progress from mild to moderate to life-threatening, it is vital for emergency clinicians to have a thorough understanding of acute asthma management. Current evidence clearly supports the use of inhaled bronchodilators and systemic steroids as first-line agents. However, in those who fail to respond to nitial therapies, a variety of adjunct therapies and interventions are available with varying degrees of evidence to support their use. This review focuses specifically on evaluation and treatment of pediatric asthma in the emergency department and reviews the current evidence for various modes of treatment.

  1. Clinical course, management and in-hospital outcomes of acute coronary syndrome in Central Asian women

    Directory of Open Access Journals (Sweden)

    Ravshanbek Kurbanov

    2011-03-01

    Full Text Available The paper describes features history, risk factors and hospital management of acute coronary syndrome (ACS in women of the Central Asia (829 ACS patients are included, and also comparison of hospital outcomes of ACS in groups of men and women.ACS in women in the Central Asia comprises features as more non Q-wave myocardial infarction frequency, smaller adherence to treatment of dyslipidemia, more obesity degrees. Women arrive to hospital average in 4 hours after men; have more percent of the atypical form. In-hospital outcomes in men and women significantly did not differ because of general tendency to late arriving to the hospital and small quantity of revascularization procedures. The reasons of differences between men and women in the region are mostly connected to social sphere (late arriving, non-treated dyslipidemia than to physiological peculiarities.

  2. Acute colonic diverticulitis: an update on clinical classification and management with MDCT correlation.

    Science.gov (United States)

    Barat, Maxime; Dohan, Anthony; Pautrat, Karine; Boudiaf, Mourad; Dautry, Raphael; Guerrache, Youcef; Pocard, Marc; Hoeffel, Christine; Eveno, Clarisse; Soyer, Philippe

    2016-09-01

    Currently, the most commonly used classification of acute colonic diverticulitis (ACD) is the modified Hinchey classification, which corresponds to a slightly more complex classification by comparison with the original description. This modified classification allows to categorize patients with ACD into four major categories (I, II, III, IV) and two additional subcategories (Ia and Ib), depending on the severity of the disease. Several studies have clearly demonstrated the impact of this classification for determining the best therapeutic approach and predicting perioperative complications for patients who need surgery. This review provides an update on the classification of ACD along with a special emphasis on the corresponding MDCT features of the different categories and subcategories. This modified Hinchey classification should be known by emergency physicians, radiologists, and surgeons in order to improve patient care and management because each category has a specific therapeutic approach.

  3. A literature-based guide to the conservative and surgical management of the acute Charcot foot and ankle.

    Science.gov (United States)

    Schade, Valerie L; Andersen, Charles A

    2015-01-01

    Acute Charcot neuroarthropathy of the foot and ankle presents with the insidious onset of a unilateral acutely edematous, erythematous, and warm lower extremity. The acute stages are typically defined as Eichenholtz Stage 1, or Stage 0, which was first described by Shibata et al. in 1990. The ultimate goal of treatment is maintenance of a stable, plantigrade foot which can be easily shod, minimizing the risk of callus, ulceration, infection, and amputation. The gold standard of treatment is non-weight-bearing immobilization in a total contact cast. Surgical intervention remains controversial. A review of the literature was performed to provide an evidenced-based approach to the conservative and surgical management of acute Charcot neuroarthropathy of the foot and ankle.

  4. A literature-based guide to the conservative and surgical management of the acute Charcot foot and ankle

    Directory of Open Access Journals (Sweden)

    Valerie L. Schade

    2015-03-01

    Full Text Available Acute Charcot neuroarthropathy of the foot and ankle presents with the insidious onset of a unilateral acutely edematous, erythematous, and warm lower extremity. The acute stages are typically defined as Eichenholtz Stage 1, or Stage 0, which was first described by Shibata et al. in 1990. The ultimate goal of treatment is maintenance of a stable, plantigrade foot which can be easily shod, minimizing the risk of callus, ulceration, infection, and amputation. The gold standard of treatment is non-weight-bearing immobilization in a total contact cast. Surgical intervention remains controversial. A review of the literature was performed to provide an evidenced-based approach to the conservative and surgical management of acute Charcot neuroarthropathy of the foot and ankle.

  5. A Prevalence and Management Study of Acute Pain in Children Attending Emergency Departments by Ambulance.

    Science.gov (United States)

    Murphy, Adrian; McCoy, Siobhan; O'Reilly, Kay; Fogarty, Eoin; Dietz, Jason; Crispino, Gloria; Wakai, Abel; O'Sullivan, Ronan

    2016-01-01

    Pain is the most common symptom in the emergency setting and remains one of the most challenging problems for emergency care providers, particularly in the pediatric population. The primary objective of this study was to determine the prevalence of acute pain in children attending emergency departments (EDs) in Ireland by ambulance. In addition, this study sought to describe the prehospital and initial ED management of pain in this population, with specific reference to etiology of pain, frequency of pain assessment, pain severity, and pharmacological analgesic interventions. A prospective cross-sectional study was undertaken over a 12-month period of all pediatric patients transported by emergency ambulance to four tertiary referral hospitals in Ireland. All children (ambulance, of which 2,635 (41.4%, 95% confidence interval 40.2-42.3%) had pain as a documented symptom on the ambulance patient care report (PCR) form. Overall 32% (n = 856) of children who complained of pain were subject to a formal pain assessment during the prehospital phase of care. Younger age, short transfer time to the ED, and emergency calls between midnight and 6 am were independently associated with decreased likelihood of having a documented assessment of pain intensity during the prehospital phase of care. Of the 2,635 children who had documented pain on the ambulance PCR, 26% (n = 689) received some form of analgesic agent prior to ED arrival. Upon ED arrival 54% (n = 1,422) of children had a documented pain assessment and some form of analgesic agent was administered to 50% (n = 1,324). Approximately 41% of children who attend EDs in Ireland by ambulance have pain documented as their primary symptom. This study suggests that the management of acute pain in children transferred by ambulance to the ED in Ireland is currently poor, with documentary evidence of only 26% receiving prehospital analgesic agents.

  6. Systematic review and content analysis of asthma knowledge questionnaires: A focus on the knowledge surrounding acute exacerbation management.

    Science.gov (United States)

    Luckie, Kate; Pang, Tsz Chun; Kritikos, Vicky; Saini, Bandana; Moles, Rebekah Jane

    2017-07-31

    Asthma education is a key component of asthma management. Asthma education around the management of a person who is having an acute exacerbation of asthma (often referred to as asthma first aid (AFA) training) is important, particularly in a school setting. There is no gold standard assessment of asthma knowledge and also there is no specific tool to measure the knowledge of AFA. Our aim was to identify asthma knowledge questionnaires and perform a content analysis. We were interested in evaluating the number, the type and the format of AFA questions. A literature search was performed to identify the instruments which were able to assess asthma knowledge of people with asthma and/or caregivers of people with asthma. An electronic database search was performed in EMBASE, IPA, MEDLINE and PUBMED. Articles which described the development or psychometric testing of an asthma knowledge questionnaire were included. The content of questions in each instrument was analysed and categorised using the NVivo software, and a secondary analysis was performed to identify knowledge questions relevant to the management of an acute asthma exacerbation. Forty-four papers with 37 different instruments met the inclusion criteria. The majority of the instruments contained a relatively low proportion of questions related to the management of acute asthma, i.e., only 162 of the 780 questions (21%). No questionnaire had sufficient specific emphasis on acute asthma management knowledge to test the impact of AFA training. There is a scope to develop an up-to-date validated acute asthma management knowledge questionnaire for use in research and clinical settings.

  7. Practice development plans to improve the primary care management of acute asthma: randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Price David

    2007-04-01

    Full Text Available Abstract Background Our professional development plan aimed to improve the primary care management of acute asthma, which is known to be suboptimal. Methods We invited 59 general practices in Grampian, Scotland to participate. Consenting practices were randomised to early and delayed intervention groups. Practices undertook audits of their management of all acute attacks (excluding children under 5 years occurring in the 3 months preceding baseline, 6-months and 12-months study time-points. The educational programme [including feedback of audit results, attendance at a multidisciplinary interactive workshop, and formulation of development plan by practice teams] was delivered to the early group at baseline and to the delayed group at 6 months. Primary outcome measure was recording of peak flow compared to best/predicted at 6 months. Analyses are presented both with, and without adjustment for clustering. Results 23 consenting practices were randomised: 11 to early intervention. Baseline practice demography was similar. Six early intervention practices withdraw before completing the baseline audit. There was no significant improvement in our primary outcome measure (the proportion with peak flow compared to best/predicted at either the 6 or 12 month time points after adjustment for baseline and practice effects. However, the between group difference in the adjusted combined assessment score, whilst non-significant at 6 months (Early: 2.48 (SE 0.43 vs. Delayed 2.26 (SE 0.33 p = 0.69 reached significance at 12 m (Early:3.60 (SE 0.35 vs. Delayed 2.30 (SE 0.28 p = 0.02. Conclusion We demonstrated no significant benefit at the a priori 6-month assessment point, though improvement in the objective assessment of attacks was shown after 12 months. Our practice development programme, incorporating audit, feedback and a workshop, successfully engaged the healthcare team of participating practices, though future randomised trials of educational

  8. A randomized clinical trial of chiropractic treatment and self-management in patients with acute musculoskeletal chest pain

    DEFF Research Database (Denmark)

    Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner;

    2012-01-01

    We have previously reported short-term follow-up from a pragmatic randomized clinical trial comparing 2 treatments for acute musculoskeletal chest pain: (1) chiropractic treatment and (2) self-management. Results indicated a positive effect in favor of the chiropractic treatment after 4 and 12...

  9. Reducing the Incidence of Acute Pesticide Poisoning by Educating Farmers on Integrated Pest Management in South India

    NARCIS (Netherlands)

    Mancini, F.; Jiggins, J.L.S.; O'Malley, M.

    2009-01-01

    Sixty-five farmers reported on pesticide use and the signs and symptoms of acute pesticide poisoning when using two different plant protection strategies: in 2003 using chemical controls and in 2004 using an approach to Integrated Pest Management (IPM) based on an ecological analysis of the field

  10. Reducing the Incidence of Acute Pesticide Poisoning by Educating Farmers on Integrated Pest Management in South India

    NARCIS (Netherlands)

    Mancini, F.; Jiggins, J.L.S.; O'Malley, M.

    2009-01-01

    Sixty-five farmers reported on pesticide use and the signs and symptoms of acute pesticide poisoning when using two different plant protection strategies: in 2003 using chemical controls and in 2004 using an approach to Integrated Pest Management (IPM) based on an ecological analysis of the field co

  11. Management of acute promyelocytic leukemia: Recommendations from an expert panel on behalf of the European LeukemiaNet

    NARCIS (Netherlands)

    M.A. Sanz (Miguel Angel); D. Grimwade (David); M.S. Tallman (Martin); B. Löwenberg (Bob); P. Fenaux (Pierre); E.H. Estey (Elihu); T. Naoe (Tomoki); E. Lengfelder (Eva); T. Büchner (Thomas); H. Döhner (Hartmut); A.K. Burnett (Alan); F. Lo-Coco (Francesco)

    2009-01-01

    textabstractThe introduction of all-trans retinoic acid (ATRA) and, more recently, arsenic trioxide (ATO) into the therapy of acute promyelocytic leukemia (APL) has revolutionized the management and outcome of this disease. Several treatment strategies using these agents, usually in combination with

  12. Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction.

    Science.gov (United States)

    Musiienko, Anton M; Shakerian, Rose; Gorelik, Alexandra; Thomson, Benjamin N J; Skandarajah, Anita R

    2016-10-01

    The acute surgical unit (ASU) is a recently established model of care in Australasia and worldwide. Limited data are available regarding its effect on the management of small bowel obstruction. We compared the management of small bowel obstruction before and after introduction of ASU at a major tertiary referral centre. We hypothesized that introduction of ASU would correlate with improved patient outcomes. A retrospective review of prospectively maintained databases was performed over two separate 2-year periods, before and after the introduction of ASU. Data collected included demographics, co-morbidity status, use of water-soluble contrast agent and computed tomography. Outcome measures included surgical intervention, time to surgery, hospital length of stay, complications, 30-day readmissions, use of total parenteral nutrition, intensive care unit admissions and overall mortality. Total emergency admissions to the ASU increased from 2640 to 4575 between the two time periods. A total of 481 cases were identified (225 prior and 256 after introduction of ASU). Mortality decreased from 5.8% to 2.0% (P = 0.03), which remained significant after controlling for confounders with multivariate analysis (odds ratio = 0.24, 95% confidence interval 0.08-0.73, P = 0.012). The proportion of surgically managed patients increased (20.9% versus 32.0%, P = 0.003) and more operations were performed within 5 days from presentation (76.6% versus 91.5%, P = 0.02). Fewer patients received water-soluble contrast agent (27.1% versus 18.4%, P = 0.02), but more patients were investigated with a computed tomography (70.7% versus 79.7%, P = 0.02). The ASU model of care resulted in decreased mortality, shorter time to intervention and increased surgical management. Overall complications rate and length of stay did not change. © 2015 Royal Australasian College of Surgeons.

  13. The effect of severe acute respiratory syndrome (SARS) on emergency airway management.

    Science.gov (United States)

    Wong, Evelyn; Ho, Khoy Kheng

    2006-07-01

    From early March 2003 to late May 2003, severe acute respiratory syndrome (SARS) was detected in Singapore. The increase in workload and new infection control procedures were thought to affect resuscitation and airway management. Our aim was to study the effects of wearing of personal protective equipment (PPE) and powered air-purifying respirator (PAPR) and the restriction in the number of resuscitation personnel on airway management during the SARS crisis. Data was collected prospectively through an ongoing emergency airway registry. The data was divided into three periods: (1) before PPE was instituted from 1 November 2002 to 31 March 2003; (2) during SARS (when PPE use was mandatory) from 1 April to 31 July 2003; (3) post-SARs (when PPE use was non-mandatory but encouraged) from 1 August to 31 March 2004. There was no change in patient demographics during the three periods. There were significant increases in the proportion of resuscitation cases and airway interventions during the SARS period compared to the pre-SARS period. The resident medical officer intubation rate decreased from 45.1% pre-SARS to 35.2% during SARS and 17.7% post-SARS. The complication rates were 10.5%, 9.9% and 9.4% in periods 1-3, respectively. Restriction in the number of healthcare staff attending to each patient may have influenced the department's decision to allow only the most confident or experienced personnel to manage the airway. The exposure of junior medical officers in emergency airway management during SARS and the immediate post-SARS period was decreased. This trend should be monitored further and intervention may be necessary should it continue to decline.

  14. Trends in management and outcome of hospitalized patients with acute stroke and transient ischemic attack: the National Acute Stroke Israeli (NASIS) registry.

    Science.gov (United States)

    Tanne, David; Koton, Silvia; Molshazki, Noa; Goldbourt, Uri; Shohat, Tamar; Tsabari, Rakefet; Grossman, Ehud; Bornstein, Natan M

    2012-08-01

    Improving stroke management, guideline adherence, and outcome is a global priority. Our aim was to examine trends in nationwide use of reperfusion therapy, stroke in-hospital management, and outcome. Data were based on the triennial 2-month period of the National Acute Stroke Israeli registry (February to March 2004, March to April 2007, April to May 2010). The registry includes unselected patients admitted to all hospitals nationwide. There were in total 6279 patients: ischemic stroke, 4452 (70.9%); intracerebral hemorrhage, 485 (7.7%); undetermined stroke, 97 (1.6%); and transient ischemic attacks, 1245 (19.8%). Overall use of reperfusion therapy for acute ischemic stroke increased from 0.4% in 2004% to 5.9% in 2010 (Pischemic events increased from 2.1% in 2004% to 16.6% in 2010 (Pstroke patient volumes. In-hospital mortality after acute ischemic stroke decreased from 7.2% in 2004 to 3.9% in 2010 (Pstroke registry, use of reperfusion therapy, vascular imaging, and statins is steadily increasing, whereas in-hospital mortality is decreasing.

  15. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years.

    Science.gov (United States)

    Wald, Ellen R; Applegate, Kimberly E; Bordley, Clay; Darrow, David H; Glode, Mary P; Marcy, S Michael; Nelson, Carrie E; Rosenfeld, Richard M; Shaikh, Nader; Smith, Michael J; Williams, Paul V; Weinberg, Stuart T

    2013-07-01

    To update the American Academy of Pediatrics clinical practice guideline regarding the diagnosis and management of acute bacterial sinusitis in children and adolescents. Analysis of the medical literature published since the last version of the guideline (2001). The diagnosis of acute bacterial sinusitis is made when a child with an acute upper respiratory tract infection (URI) presents with (1) persistent illness (nasal discharge [of any quality] or daytime cough or both lasting more than 10 days without improvement), (2) a worsening course (worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement), or (3) severe onset (concurrent fever[temperature ≥39°C/102.2°F] and purulent nasal discharge for at least 3 consecutive days). Clinicians should not obtain imaging studies of any kind to distinguish acute bacterial sinusitis from viral URI, because they do not contribute to the diagnosis; however, a contrast-enhanced computed tomography scan of the paranasal sinuses should be obtained whenever a child is suspected of having orbital or central nervous system complications. The clinician should prescribe antibiotic therapy for acute bacterial sinusitis in children with severe onset or worsening course. The clinician should either prescribe antibiotic therapy or offer additional observation for 3 days to children with persistent illness. Amoxicillin with or without clavulanate is the firstline treatment of acute bacterial sinusitis. Clinicians should reassess initial management if there is either a caregiver report of worsening(progression of initial signs/symptoms or appearance of new signs/symptoms) or failure to improve within 72 hours of initial management.If the diagnosis of acute bacterial sinusitis is confirmed in a child with worsening symptoms or failure to improve, then clinicians may change the antibiotic therapy for the child initially managed with antibiotic or initiate antibiotic treatment of the child initially

  16. Payment analysis of two diagnosis and management approaches of acute otitis media.

    Science.gov (United States)

    Casey, Janet R; Pichichero, Michael E

    2014-08-01

    We determined the cost of care for 2 diagnosis and management approaches for acute otitis media (AOM) among children 6 to 30 months old. A case-control design was used. Cases included 208 children diagnosed with AOM based on a bulging tympanic membrane (TM) and treated with amoxicillin/clavulanate. Controls (5:1 ratio) included 1020 children with AOM diagnosed not requiring bulging of the TM and treated with amoxicillin. Fewer cases (49%) than controls (69%) were diagnosed with AOM (P < .001), fewer were diagnosed with recurrent AOM or AOM treatment failure (0.34 vs 1.6/child; P < .0001), and fewer had insertion of tympanostomy tubes (6.3% vs 14.8%) due to recurrent AOM (P < .0001). The combined direct payments and indirect costs for management of AOM were $539/case versus $1,023/control. Using Rochester NY payments generalized to the US birth cohort, this case diagnosis and treatment strategy could save $1.008 billion per year.

  17. Clinical implications of antibiotic resistance for management of acute otitis media.

    Science.gov (United States)

    Klein, J O

    1998-11-01

    Antibiotic resistance to available antimicrobial agents has been constant since the introduction of the sulfonamides in the 1930s. Multidrug-resistant Streptococcus pneumoniae and beta-lactamase-producing Haemophilus influenzae are a concern now because of the importance of these pathogens in infections of the respiratory tract in infants and children. Amoxicillin remains the drug of choice for initial episodes of acute otitis media (AOM) although increase of the dosage schedule to 80 mg/kg/day has been recommended by some investigators. There are 15 additional antimicrobial agents approved by the Food and Drug Administration for the indication of AOM. All approved drugs are clinically effective but some have been suggested to have priority for patients who fail amoxicillin: amoxicillin-clavulanate; an oral cephalosporin such as cefuroxime axetil; and intramuscular ceftriaxone. Management of the child with severe and recurrent disease should include antibiotic prophylaxis but the increased incidence of resistance requires selective use. Prevention of infection may be achieved by innovative techniques for interference with attachment of bacteria to the nasal mucosa such as administration of oligosaccharides in a nasal spray. The currently available polysaccharide pneumococcal vaccines have limited immunogenicity in infants, but the vaccine is useful in children 2 years of age and older who still have recurrent AOM. Children with frequent AOM during the prior respiratory season are candidates also for influenza virus vaccine. If medical management fails to prevent new episodes of AOM in children with severe and recurrent disease, placement of tympanostomy tubes and possible adenoidectomy should be considered.

  18. Antioxidant therapy in the management of acute, chronic and post-ERCP pancreatitis: A systematic review

    Institute of Scientific and Technical Information of China (English)

    Seyed Sajad Mohseni Salehi Monfared; Hamed Vahidi; Amir Hossein Abdolghaffari; Shekoufeh Nikfar; Mohammad Abdollahi

    2009-01-01

    We systematically reviewed the clinical trials which recruited antioxidants in the therapy of pancreatitis and evaluated whether antioxidants improve the outcome of patients with pancreatitis. Electronic bibliographic databases were searched for any studies which investigated the use of antioxidants in the management of acute pancreatitis (AP) or chronic pancreatitis (CP) and in the prevention of post-endoscopic retrograde cholangio-pancreatography (post-ERCP) pancreatitis (PEP) up to February 2009. Twenty-two randomized, placebo-controlled, clinical trials met our criteria and were included in the review. Except for a cocktail of antioxidants which showed improvement in outcomes in three different clinical trials, the results of the administration of other antioxidants in both AP and CP clinical trials were incongruent and heterogeneous. Furthermore, antioxidant therapy including allopurinol and N-acetylcysteine failed to prevent the onset of PEP in almost all trials. In conclusion, the present data do not support a benefit of antioxidant therapy alone or in combination with conventional therapy in the management of AP, CP or PEP. Further double blind, randomized, placebo-controlled clinical trials with large sample size need to be conducted.

  19. Mobile task management tool that improves workflow of an acute general surgical service.

    Science.gov (United States)

    Foo, Elizabeth; McDonald, Rod; Savage, Earle; Floyd, Richard; Butler, Anthony; Rumball-Smith, Alistair; Connor, Saxon

    2015-10-01

    Understanding and being able to measure constraints within a health system is crucial if outcomes are to be improved. Current systems lack the ability to capture decision making with regard to tasks performed within a patient journey. The aim of this study was to assess the impact of a mobile task management tool on clinical workflow within an acute general surgical service by analysing data capture and usability of the application tool. The Cortex iOS application was developed to digitize patient flow and provide real-time visibility over clinical decision making and task performance. Study outcomes measured were workflow data capture for patient and staff events. Usability was assessed using an electronic survey. There were 449 unique patient journeys tracked with a total of 3072 patient events recorded. The results repository was accessed 7792 times. The participants reported that the application sped up decision making, reduced redundancy of work and improved team communication. The mode of the estimated time the application saved participants was 5-9 min/h of work. Of the 14 respondents, nine discarded their analogue methods of tracking tasks by the end of the study period. The introduction of a mobile task management system improved the working efficiency of junior clinical staff. The application allowed capture of data not previously available to hospital systems. In the future, such data will contribute to the accurate mapping of patient journeys through the health system. © 2015 Royal Australasian College of Surgeons.

  20. The acute symptoms of sport-related concussion: diagnosis and on-field management.

    Science.gov (United States)

    Putukian, Margot

    2011-01-01

    Sport-related concussion is a common injury that occurs in a variety of sports. In recent years, more attention has been focused on the importance of this injury as well as the long-term complications of unrecognized, repetitive, and/or severe injury. The acute presentation of concussion as well as the diagnosis of concussion is often straightforward and obvious, but it can also be subtle and difficult to discern. Most injuries are short lived with complete recovery within a couple of weeks, with a small minority taking several months to resolve. Unfortunately, it is difficult to predict which injuries will linger. This article discusses the on-field presentation, diagnosis, and management of sport-related concussion. It is important to have a concussion protocol for high-risk sports, including a preseason and postinjury assessment, and an individualized yet comprehensive approach that includes evaluating symptoms, and a neurologic examination that includes cognitive function and balance testing. A multifaceted approach to the evaluation and diagnosis of concussion is endorsed for the optimal management of this injury.

  1. Percutaneous Ventricular Assist Devices: A Novel Approach in the Management of Patients With Acute Cardiogenic Shock.

    Science.gov (United States)

    Ergle, Kevin; Parto, Parham; Krim, Selim R

    2016-01-01

    Despite recent advances in the management of heart failure, cardiogenic shock remains a challenging and devastating condition with significant morbidity and mortality. We review currently available percutaneous mechanical circulatory support (MCS) devices and address each device's characteristics, mechanism of action, specific clinical indications, and contraindications. Four types of percutaneous MCS devices are currently available: the intraaortic balloon pump (IABP), Impella devices, the TandemHeart, and extracorporal membrane oxygenation (ECMO). IABPs provide less hemodynamic support compared to the Impella, TandemHeart, and ECMO devices. However, because of its ease of placement and relatively small access catheter size, the IABP remains the most commonly used MCS device for the treatment of cardiogenic shock. When full cardiopulmonary support is needed, ECMO is the best option. Temporary MCS has emerged as a therapeutic option in the management of patients with acute cardiogenic shock. However, clinician familiarity with the indications, limitations, and benefits of individual MCS devices and enhanced patient comfort with the placement are paramount to improve patient outcomes.

  2. Review of VA/DOD Clinical Practice Guideline on management of acute stress and interventions to prevent posttraumatic stress disorder

    Directory of Open Access Journals (Sweden)

    William P. Nash, MD

    2012-06-01

    Full Text Available This article summarizes the recommendations of the Department of Veterans Affairs (VA/Department of Defense (DOD VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress that pertain to acute stress and the prevention of posttraumatic stress disorder, including screening and early interventions for acute stress states in various settings. Recommended interventions during the first 4 days after a potentially traumatic event include attending to safety and basic needs and providing access to physical, emotional, and social resources. Psychological first aid is recommended for management of acute stress, while psychological debriefing is discouraged. Further medical and psychiatric assessment and provision of brief, trauma-focused cognitive-behavioral therapy are warranted if clinically significant distress or functional impairment persists or worsens after 2 days or if the criteria for a diagnosis of acute stress disorder are met. Follow-up monitoring and rescreening are endorsed for at least 6 months for everyone who experiences significant acute posttraumatic stress. Four interventions that illustrate early intervention principles contained in the VA/DOD Clinical Practice Guideline are described.

  3. Evaluation of soil disturbance using fuzzy indicator approach

    Science.gov (United States)

    Soil disturbance is great problem and the evaluation of soil disturbance is very important for making decisions on agricultural and ecological management. In this manuscript, a new method for potentially evaluating soil disturbance is described. With this method the use of two indicators called “Dis...

  4. Diagnostic value of ultrasonography in evaluation and management of acute abdominal conditions in the paediatric age group

    Directory of Open Access Journals (Sweden)

    Mohd Khalid

    2012-01-01

    Full Text Available Background: The aims of this study have been elaborated below: (1 to enumerate the common causes of acute abdominal emergencies by ultrasonography in paediatric patients; (2 to establish the diagnostic efficacy of ultrasonography in evaluation of acute abdominal conditions in children and to illustrate the associated ultrasonographic findings; (3 and, to discuss the role of ultrasonography in guiding the mode of intervention in these cases. Patients and Methods: This prospective study of ultrasonographic examination in 146 paediatric patients presenting with acute onset abdominal pain at the emergency/paediatric outpatient department section of Jawaharlal Nehru Medical College & Hospital, Aligarh, between June 2006 and December 2007, using 3.75 MHz and 8 MHz transducers of the ADARA (Siemens machine. Results : Common causes of acute abdominal emergencies in pediatric patients as noted on ultrasonography included nonspecific pain (28%, abdominal abscess (21%, acute appendicitis (7% and intussusception (7%. Ultrasonography was diagnostic in 45.2% cases and supportive in 12.3% of the cases. As for as the final outcome, ultrasonography prevented surgery in almost 20% cases and laparotomy was avoided in 7% of the patients as ultrasound guided interventions in the form of abscess aspiration were carried out. Conclusion: Ultrasonography evaluation of children with acute abdominal pain, helps in making significant changes in the management plan of the patients, and also reveals various clinically unsuspected diseases.

  5. Early Diagnosis and Management of Acute Vertigo from Vestibular Migraine and Ménière's Disease.

    Science.gov (United States)

    Seemungal, Barry; Kaski, Diego; Lopez-Escamez, Jose Antonio

    2015-08-01

    Vestibular migraine is the most common cause of acute episodic vestibular symptoms after benign paroxysmal positional vertigo. In contrast, Ménière's disease is an uncommon disorder. For both conditions, early and accurate diagnosis (or its exclusion) enables the correct management of patients with acute episodic vestibular symptoms. Long-term management of migraine requires changes in lifestyle to avoid triggers of migraine and/or prophylactic drugs if attacks become too frequent. The long-term management of Ménière's disease also involves lifestyle changes (low salt diet), medications (betahistine, steroids), and ablative therapy applied to the diseased ear (eg, intratympanic gentamicin). Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Gender-specific issues in the management of patients with acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    SHEN Wei-feng

    2008-01-01

    @@ Acute coronary syndrome (ACS) represents a continuum of acute myocardial ischemia including non-ST-elevation myocardial infarction and unstable angina, synonymous with non-ST-elevation ACS (NSTE-ACS),and ST-elevation myocardial infarction (STEMI).

  7. Single-stage laparoscopic management of acute gallstone pancreatitis: outcomes at different timings.

    Science.gov (United States)

    Navarro-Sanchez, Antonio; Ashrafian, Hutan; Laliotis, Aggelos; Qurashi, Kamran; Martinez-Isla, Alberto

    2016-06-01

    Definitive therapy for gallstone pancreatitis requires eradication of gallstones with cholecystectomy and common bile duct (CBD) clearance. Current guidelines recommend this be done within the same admission and preferably by laparoscopic cholecystectomy and CBD exploration. We report our experience of laparoscopic single-stage management with cholecystectomy and intraoperative cholangiogram followed by laparoscopic bile duct exploration (LBDE) when necessary performed at three different stages. From January 1998 to December 2012, 134 patients (100 females and 34 males) underwent single-stage laparoscopic management of gallstone pancreatitis. Patients were classified according to the timing of surgery: "A", ≤7 days from symptom onset (n=27); "B", 8 to 30 days (n=58) and "C", >30 days (n=49). LBDE was performed in 30 patients with a success rate of 100%. CBD stones were found in 25 patients (A: 22.2%, B: 22.4%, C: 12.2%). CBD stones were more common in patients undergoing surgery within 30 days of presentation than after this time point (P=0.35). Multiple choledocholithiasis was more frequent in patients treated within 7 days (P=0.04). The 30-day mortality after surgery was 0, with no conversion to an open approach. Overall complication rate was 11.9%, which did not differ significantly between patients treated within 7 days or after this time point (P=0.83). This study demonstrated the feasibility and reproducibility of single-stage laparoscopic management of acute gallstone pancreatitis, which has a low complication rate at any stage. Patients undergoing early treatment have a higher incidence of choledocholithiasis and multiple stones than those treated after 30 days, supporting the passage of stones with time.

  8. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015.

    Science.gov (United States)

    Gorter, Ramon R; Eker, Hasan H; Gorter-Stam, Marguerite A W; Abis, Gabor S A; Acharya, Amish; Ankersmit, Marjolein; Antoniou, Stavros A; Arolfo, Simone; Babic, Benjamin; Boni, Luigi; Bruntink, Marlieke; van Dam, Dieuwertje A; Defoort, Barbara; Deijen, Charlotte L; DeLacy, F Borja; Go, Peter Mnyh; Harmsen, Annelieke M K; van den Helder, Rick S; Iordache, Florin; Ket, Johannes C F; Muysoms, Filip E; Ozmen, M Mahir; Papoulas, Michail; Rhodes, Michael; Straatman, Jennifer; Tenhagen, Mark; Turrado, Victor; Vereczkei, Andras; Vilallonga, Ramon; Deelder, Jort D; Bonjer, Jaap

    2016-11-01

    Unequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis.

  9. Surgical management of acute upper gastrointestinal bleeding:still a major challenge.

    Science.gov (United States)

    Czymek, Ralf; Großmann, Anja; Roblick, Uwe; Schmidt, Andreas; Fischer, Frank; Bruch, Hans-Peter; Hildebrand, Philipp

    2012-05-01

    Acute upper gastrointestinal bleeding (UGIB) that cannot be managed with conservative interventional techniques is a life-threatening condition. This study assesses patient outcome and the role of different risk factors. We retrospectively analyzed data from 91 patients (58 men, 33 women) admitted between 2000 and 2009 and who underwent surgery for UGIB requiring transfusion. Mean patient age was 67.4 years. Overall mortality was 34.1%. Causes of bleeding were duodenal ulcer in 57 patients (62.6%) and gastric ulcer in 25 (27.5%). A median number of 21 blood units (range 6-120) were transfused. Surgical treatment consisted of non-resective surgery (52.7%), Billroth II (31.9%), Billroth I (4.4%) or gastric wedge resection (4.4%). The use of anticoagulants (p=0.040), a need for postoperative ventilation (p=0.007) and an intensive care unit (ICU) length of stay >7 days (p=0.004) were identified as significant risk factors for mortality. Transfusions of more than 10 units of blood (p=0.013), the need for further surgery (p=0.021), a prolonged ICU length of stay (p=0.000) and recurrent bleeding (p=0.029) we identified as significant risk factors for postoperative complications (such as pneumonia, sepsis, re-bleeding and anastomotic leakage). Over the past decade, mortality has not decreased in patients requiring surgery for acute UGIB despite diagnostic and therapeutic advances, explained by the fact that these cases represent a negative selection of patients after unsuccessful conservative treatment as well as by the rising age of the population and associated increases in comorbidity. Resective surgery, a need for postoperative ventilation and a prolonged ICU length of stay should be added to the list of significant risk factors for mortality.

  10. Emotion induction moderates effects of anger management style on acute pain sensitivity.

    Science.gov (United States)

    Burns, John W; Kubilus, Amanda; Bruehl, Stephen

    2003-11-01

    Anger management style (AMS) is related to both acute and chronic pain intensity. Recent work suggests that an anger expressive AMS in particular may influence acute pain, and that this effect may be most pronounced during anger provocation. The present study examined whether AMS was related to subsequent pain sensitivity without regard to prior emotion induction, only when a strong negative emotion was evoked, or only when anger was provoked. Sixty-four healthy normals partook in semi-structured interviews in which they recalled and verbally described an event in which either anger, sadness, or joy was elicited. They then underwent a cold pressor pain task. Results of hierarchical multiple regressions showed that an anger expressive AMS was related positively to pain threshold only for participants in the anger-recall condition, and that this effect was largely accounted for by their low SBP reactivity during emotion induction. An anger suppressive AMS was related positively to increases in self-reported pain severity, irrespective of emotion-induction condition, and this effect was not accounted for by reactivity in any cardiovascular index. Results extend those of previous studies by illuminating the potential importance of behavioral anger expression for individuals prone to express anger in modulating their reactivity and pain sensitivity. Findings suggest that the detrimental effects of an anger expressive style on pain sensitivity may be ameliorated under conditions in which behavioral anger expression occurs. Results are discussed in terms of recent work suggesting that an expressive AMS is associated with endogenous opioid dysfunction in the absence of behavioral anger expression.

  11. Management of acute kidney injury in children: a guide for pediatricians.

    Science.gov (United States)

    Andreoli, Sharon P

    2008-01-01

    Acute kidney injury (AKI; previously called acute renal failure) is characterized by a usually reversible increase in the blood concentration of creatinine and nitrogenous waste products and by the inability of the kidney to appropriately regulate fluid and electrolyte homeostasis. The incidence of AKI in children appears to be increasing and the etiology of AKI over the past decades has shifted from primary renal disease to multifactorial causes, particularly in hospitalized children. Renal failure can be divided into prerenal failure, intrinsic renal disease including vascular insults, and obstructive uropathies. The history, physical examination, and laboratory studies including a urinalysis and radiographic studies can establish the likely cause(s) of AKI. Once intrinsic renal failure has become established, management of the metabolic complications of AKI requires meticulous attention to fluid balance, electrolyte status, acid-base balance, and nutrition. Many children with AKI will need renal replacement therapy to remove endogenous and exogenous toxins and to maintain fluid, electrolyte, and acid-base balance until renal function improves. Renal replacement therapy may be provided by peritoneal dialysis (PD), intermittent hemodialysis (HD), or hemofiltration with or without a dialysis circuit. Many factors--including the age and size of the child, the cause of renal failure, the degree of metabolic derangements, blood pressure, and nutritional needs--are considered in deciding when to initiate renal replacement therapy and which modality of therapy to use. The prognosis of AKI is highly dependent on the underlying etiology of the AKI. Children who have AKI as a component of multisystem failure have a much higher mortality rate than children with intrinsic renal disease. Recovery from intrinsic renal disease is also highly dependent on the underlying etiology of the AKI. Children who have experienced AKI from any cause are at risk for late development of

  12. Update on the role of melatonin in the prevention of cancer tumorigenesis and in the management of cancer correlates, such as sleep-wake and mood disturbances: review and remarks.

    Science.gov (United States)

    Rondanelli, Mariangela; Faliva, Milena Anna; Perna, Simone; Antoniello, Neldo

    2013-10-01

    The aim of this article was to perform a systematic review on the role of melatonin in the prevention of cancer tumorigenesis--in vivo and in vitro--as well as in the management of cancer correlates, such as sleep-wake and mood disturbances. The International Agency for Research on Cancer recently classified "shift-work that involves circadian disruption" as "probably carcinogenic to humans" (Group 2A) based on "limited evidence in humans for the carcinogenicity of shift-work that involves night-work", and "sufficient evidence in experimental animals for the carcinogenicity of light during the daily dark period (biological night)". The clinical implications and the potential uses of melatonin in terms of biologic clock influence (e.g. sleep and mood), immune function, cancer initiation and growth, as well as the correlation between melatonin levels and cancer risk, are hereinafter recorded and summarized. Additionally, this paper includes a description of the newly discovered effects that melatonin has on the management of sleep-wake and mood disturbances as well as with regard to cancer patients' life quality. In cancer patients depression and insomnia are frequent and serious comorbid conditions which definitely require a special attention. The data presented in this review encourage the performance of new clinical trials to investigate the possible use of melatonin in cancer patients suffering from sleep-wake and mood disturbances, also considering that melatonin registered a low toxicity in cancer patients.

  13. Online network of subspecialty aortic disease experts: Impact of "cloud" technology on management of acute aortic emergencies.

    Science.gov (United States)

    Schoenhagen, Paul; Roselli, Eric E; Harris, C Martin; Eagleton, Matthew; Menon, Venu

    2016-07-01

    For the management of acute aortic syndromes, regional treatment networks have been established to coordinate diagnosis and treatment between local emergency rooms and central specialized centers. Triage of acute aortic syndromes requires definitive imaging, resulting in complex data files. Modern information technology network structures, specifically "cloud" technology, coupled with mobile communication, increasingly support sharing of these data in a network of experts using mobile, online access and communication. Although this network is technically complex, the potential benefit of online sharing of data files between professionals at multiple locations within a treatment network appear obvious; however, clinical experience is limited, and further evaluation is needed.

  14. ACUTE PERFORATED PEPTIC ULCER: A CLINICAL, DIAGNOSTIC AND MANAGEMENT ANALYSIS IN A TERTIARY HOSPITAL OF TELANGANA

    Directory of Open Access Journals (Sweden)

    Boda

    2015-12-01

    Full Text Available Treatment of Peptic Ulcer Disease in major hospitals is now limited to managing their complications like perforations of stomach or duodenum. This is also a common cause of peritonitis and remains a challenge to the surgeon. Diagnosis is based on clinical parameters like pain in the abdomen, shock, abdominal guarding/rigidity and abdominal distension. The diagnosis is confirmed by ultrasound examination of the abdomen, x-ray abdomen in erect posture. The predisposing factors include the age, smoking, alcohol intake, steroids and NSAIDs usage. The risk factors of mortality are presence of shock and pre-existing medical conditions and time of arrival to the casualty. The mortality and morbidity may be predicted using different scoring systems like ASA scoring and Boey’s scoring. AIM To analyze the different risk factors, clinical features and surgical treatment options of Acute Peptic Ulcer perforation in patients attending a Tertiary Hospital. To evaluate the prognostic factors causing death and complications in this condition. MATERIALS AND METHODS One hundred and sixty five patients attending with signs and symptoms of Acute Perforation of Peptic Ulcer were included. Males were predominantly affected than females with a 1.94:1 ratio. The median duration of illness was 9.64 days. History of smoking in 93.5%, NSAIDs in 78%, alcohol intake in 93.8% and steroids in 84% of the patients was present. Previous history of peptic ulcer disease was reported in 90% of the patients. Gastric ulcers were more common than with duodenal ulcer with a ratio of 1.32:1. The mortality rate was 6.66%. Among the complications wound infection was highest with 26% followed by paralytic ileus 23%. ASA and Boey’s scoring showed statistical significance in predicting the mortality with a P value of 0.00003. RESULTS The incidence of APPU was 0.35% of the total 46080 emergency surgical patients in a 4-year period. The incidence was high among the manual laborers and in

  15. [Errors and difficulties in the diagnosis and management of acute and chronic abdomen in children].

    Science.gov (United States)

    Sabetay, C; Singer, I; Zavate, A; Ciobanu, O; Cârstoiu, E; Stoica, A; Maloş, Anca; Farcaş, I; Kamel, J; Hams, I; Kastrati, A

    2002-01-01

    The authors are reviewing on a lot of 2844 cases between 1996 and 2000 the difficult problems of differential diagnosis between acute surgical abdomen in children and intestinal tuberculosis, abdominal tumors and inflammatory diseases such as acute osteomielitis. They are presenting 13 particular cases in which the acute abdomen diagnosis was difficult or even omitted.

  16. Using continuous renal replacement therapy to manage patients of shock and acute renal failure

    Directory of Open Access Journals (Sweden)

    Soni Sachin

    2009-01-01

    Full Text Available Background: The incidence of acute renal failure (ARF in the hospital setting is increasing. It portends excessive morbidity and mortality and a considerable burden on hospital resources. Extracorporeal therapies show promise in the management of patients with shock and ARF. It is said that the potential of such therapy goes beyond just providing renal support. The aim of our study was to analyze the clinical setting and outcomes of critically ill ARF patients managed with continuous renal replacement therapy (CRRT. Patients and Methods: Ours was a retrospective study of 50 patients treated between January 2004 and November 2005. These 50 patients were in clinical shock and had concomitant ARF. All of these patients underwent CVVHDF (continuous veno-venous hemodiafiltration in the intensive care unit. For the purpose of this study, shock was defined as systolic BP < 100 mm Hg in spite of administration of one or more inotropic agents. SOFA (Sequential Organ Failure Assessment score before initiation of dialysis support was recorded in all cases. CVVHDF was performed using the Diapact ® (Braun CRRT machine. The vascular access used was as follows: femoral in 32, internal jugular in 8, arteriovenous fistula (AVF in 4, and subclavian in 6 patients. We used 0.9% or 0.45% (half-normal saline as a prefilter replacement, with addition of 10% calcium gluconate, magnesium sulphate, sodium bicarbonate, and potassium chloride in separate units, while maintaining careful monitoring of electrolytes. Anticoagulation of the extracorporeal circuit was achieved with systemic heparin in 26 patients; frequent saline flushes were used in the other 24 patients. Results: Of the 50 patients studied, 29 were males and 21 females (1.4:1. The average age was 52.88 years (range: 20-75 years. Causes of ARF included sepsis in 24 (48%, hemodynamically mediated renal failure (HMRF in 18 (36%, and acute over chronic kidney disease in 8 (16% patients. The overall mortality was

  17. Monitoring the hospital management of acute asthma: the Italian Pediatric Network experience.

    Science.gov (United States)

    Martelli, A G; Bianchi, R; Boldrighini, B; Bosoni, M; De Vuono, A; Flores D'Arcais, A; Gargantini, G; Longhi, R; Ortisi, M T; Racchi, E; Parola, L

    2016-11-01

    The Study Group on Accreditation and Quality Improvement of the Italian Society of Pediatrics has developed an observational study about the hospital management of pediatric patients affected by severe asthma, in order to evaluate how the Guidelines for severe asthma in childhood are applied in the daily practice. This study included patients between 2 and 17 years, hospitalized or under short intensive observation for acute asthma. The data collection was carried out through the compilation of on-line forms. The statistical technique used was the Chi Square test. 409 forms were filled in by 32 Italian Centers. 17% of the patients showed severe asthma, 59% moderate and 24% mild. On arrival at the Emergency Room the oximetry was measured in 95% of the patients, the respiratory rate in 64% while the heart rate in 88% of them. 48% of the children were exposed to chest X-ray. More than half of the children received oxygen therapy, 98.5% received short-acting beta-2 agonists and systemic steroid therapy was given to 82% of children, mainly orally. At discharge only half of the children were provided with written instructions for the management of any subsequent asthmatic episode. The analysis of the collected data highlights that not all the children had their oxygen saturation measured, although this parameter is one of the main indicators of disease severity, as well as the respiratory rate, which was detected in a minimal percentage of cases. The frequency of chest X-ray was extremely high, even though it does not have any indication in the majority of asthma cases. The evaluation of the therapeutic treatment denotes an adequate use of the oxygen therapy according to the oximetry values found on arrival, but an abuse of steroid therapy. Critical issues emerge at discharge: children are not always educated about the home management of the disease and the self-evaluation of the illness seriousness. The pediatric network has become an excellent system of monitoring of

  18. The Reten-World survey of the management of acute urinary retention: preliminary results.

    Science.gov (United States)

    Emberton, Mark; Fitzpatrick, John M

    2008-03-01

    Acute urinary retention (AUR) is a urological emergency characterized by a sudden and painful inability to pass urine. It represents a significant worldwide public health issue, as mortality within the year following an AUR episode appears much higher than in the general population, especially in younger patients. Management of AUR involves immediate bladder catheterization usually followed, until recently, by prostatic surgery. The greater morbidity and mortality associated with emergency surgery (within a few days after AUR), and the potential morbidity associated with prolonged catheterization (bacteriuria, fever, urosepsis) has led to an increasing use of a trial without catheter (TWOC). TWOC involves catheter removal after 1-3 days, allowing 23-40% of patients to void successfully, so that surgery can be performed at a later stage, if needed. Use of an alpha(1)-blocker before a TWOC may also be of help, as it has been demonstrated that it increases the chances of successful voiding after catheter removal. In the UK, this TWOC policy has resulted in a progressive decrease in the number of surgical procedures following a first episode of AUR, with the detriment of a slight increase in the AUR recurrence rate. Currently, there is no consensus on the optimal management of AUR in terms of type of catheterization, duration of catheterization and management following catheterization. The Reten-World survey is aimed at assessing current practice in the management of AUR in France, Asia, Latin America, North Africa and the Middle East. Interim results based on 3785 men with AUR associated with benign prostatic hyperplasia show that a urethral catheter is inserted in most cases (87%). Following this initial step, a TWOC after a median of 3 days' catheterization has become standard practice worldwide, with only a minority of men (6%) undergoing immediate surgery. Treatment with an alpha(1)-blocker before a TWOC improves the chances of success, regardless of the duration

  19. Management of children’s acute diarrhea by community pharmacies in five towns of Ethiopia: simulated client case study

    Science.gov (United States)

    Abegaz, Tadesse Melaku; Belachew, Sewunet Admasu; Abebe, Tamrat Befekadu; Gebresilassie, Begashaw Melaku; Teni, Fitsum Sebsibe; Woldie, Habtamu Gebremeskel

    2016-01-01

    Background Acute diarrhea is the major cause of child morbidity and mortality in low-income nations. It is the second most common cause of death among children community pharmacists is clearly observed in the prevention and treatment of diarrhea. However, there is a paucity of data on how community pharmacies manage acute childhood diarrhea cases in Ethiopia. This study aimed to evaluate the experience of community pharmacies in the management of acute diarrhea in northern Ethiopia. Methods A simulated case-based cross-sectional study was conducted in community pharmacies from five towns of northern Ethiopia between April 2015 and September 2015. Convenience sampling technique was used to select sample towns. A structured questionnaire was organized to collect the information. Descriptive statistics, chi-squared test, one-way analysis of variance, and binary logistic regression were performed to describe, infer, and test for association between the variables. SPSS for Windows Version 21 was used to enter and analyze the data. A 95% confidence interval and P-value of 0.05 were set to test the level of significance. Results Approximately 113 community pharmacies were visited to collect the required data from five towns. Majority (78, 69%) of them were located away from hospitals and health care areas. Nine components of history taking were presented for dispensers. Regarding the patient history, “age” was frequently taken, (90.3%), whereas “chief complaint” was the least to be taken (23%), for patients presenting with diarrhea. Approximately 96 (85.0%) cases were provided with one or more medications. The remaining 17 (15%) cases did not receive any medication. A total of six pharmacologic groups of medications were given to alleviate acute diarrheal symptoms. Majority (66, 29.6%) of the medications were oral rehydration salts with zinc. The mean number of medications was 1.99 per visit. Components of advice, such as dose, frequency, duration, drug action

  20. National survey on perioperative anaesthetic management in the endovascular treatment of acute ischaemic stroke.

    Science.gov (United States)

    Romero Kräuchi, O; Valencia, L; Iturri, F; Mariscal Ortega, A; López Gómez, A; Valero, R

    2017-09-15

    To assess the anaesthetic management of treatment for endovascular acute ischaemic stroke (AIS) in Spain. A survey was designed by the SEDAR Neuroscience Section and sent to the Spanish anaesthesiology departments with a primary stroke centre between July and November 2016. Of the 47 hospitals where endovascular treatment of AIS is performed, 37 anaesthesiology departments participated. Thirty responses were obtained; three of which were eliminated due to duplication (response rate of 72.9%). Health coverage for AIS endovascular treatment was available 24hours a day in 63% of the hospitals. The anaesthesiologist in charge of the procedure was physically present in the hospital in 55.3%. There was large inter-hospital variability in non-standard monitoring and type of anaesthesia. The most important criterion for selecting type of anaesthesia was multidisciplinary choice made by the anaesthesiologist, neurologist and neuroradiologist (59.3%). The duration of time from arrival to arterial puncture was 10-15minutes in 59.2%. In 44.4%, systolic blood pressure was maintained between 140-180mmHg, and diastolic blood pressure<105mmHg. Glycaemic levels were taken in 81.5% of hospitals. Intravenous heparinisation was performed during the procedure in 66.7% with different patterns of action. In cases of moderate neurological deterioration with no added complications, 85.2% of the included hospitals awakened and extubated the patients. The wide variability observed in the anaesthetic management and the organization of the endovascular treatment of AIS demonstrates the need to create common guidelines for anaesthesiologists in Spain. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. IPOD Study: Management of Acute Left Colonic Diverticulitis in Italian Surgical Departments.

    Science.gov (United States)

    Sartelli, Massimo; Binda, Gian Andrea; Brandara, Francesco; Borasi, Andrea; Feroci, Francesco; Vadalà, Salvatore; Labricciosa, Francesco M; Birindelli, Arianna; Luridiana, Gianluigi; Coccolini, Federico; Di Saverio, Salomone; Catena, Fausto; Ansaloni, Luca; Campanile, Fabio Cesare; Agresta, Ferdinando; Piazza, Diego

    2017-03-01

    In recent years, the emergency management of acute left colonic diverticulitis (ALCD) has evolved dramatically despite lack of strong evidence. As a consequence, management strategies are frequently guided by surgeon's personal preference, rather than by scientific evidence. The primary aim of IPOD study (Italian Prospective Observational Diverticulitis study) is to describe both the diagnostic and treatment profiles of patients with ALCD in the Italian surgical departments. IPOD study is a prospective observational study performed during a 6-month period (from April 1 2015 to September 1 2015) and including 89 Italian surgical departments. All consecutive patients with suspected clinical diagnosis of ALCD confirmed by imaging and seen by a surgeon were included in the study. The study was promoted by the Italian Society of Hospital Surgeons and the World Society of Emergency Surgery Italian chapter. Eleven hundred and twenty-five patients with a median age of 62 years [interquartile range (IQR), 51-74] were enrolled in the IPOD study. One thousand and fifty-four (93.7%) patients were hospitalized with a median duration of hospitalization of 7 days (IQR 5-10). Eight hundred and twenty-eight patients (73.6%) underwent medical treatment alone, 13 patients had percutaneous drainage (1.2%), and the other 284 (25.2%) patients underwent surgery as first treatment. Among 121 patients having diffuse peritonitis, 71 (58.7%) underwent Hartmann's resection. However, the Hartmann's resection was used even in patients with lower stages of ALCD (36/479; 7.5%) where other treatment options could be more adequate. The IPOD study demonstrates that in the Italian surgical departments treatment strategies for ALCD are often guided by the surgeon's personal preference.

  2. Determinants of timely management of acute bacterial meningitis in the ED.

    Science.gov (United States)

    Schuh, Sabine; Lindner, Gregor; Exadaktylos, Aristomenis K; Mühlemann, Kathrin; Täuber, Martin G

    2013-07-01

    The purpose was to study the emergency management of patients with suspected meningitis to identify potential areas for improvement. All patients who underwent cerebrospinal fluid puncture at the emergency department of the University Hospital of Bern from January 31, 2004, to October 30, 2008, were included. A total of 396 patients were included in the study. For each patient, we analyzed the sequence and timing for the following management steps: first contact with medical staff, administration of the first antibiotic dose, lumbar puncture (LP), head imaging, and blood cultures. The results were analyzed in relation to clinical characteristics and the referral diagnosis on admission. Of the 396 patient analyzed, 15 (3.7%) had a discharge diagnosis of bacterial meningitis, 119 (30%) had nonbacterial meningitis, and 262 (66.3%) had no evidence of meningitis. Suspicion of meningitis led to earlier antibiotic therapy than suspicion of an acute cerebral event or nonacute cerebral event (P bacterial meningitis, the average time to antibiotics was 136 minutes, with a range of 0 to 340 minutes. Most patients (60.1%) had brain imaging studies performed before LP. On the other hand, half of the patients with a referral diagnosis of meningitis (50%) received antibiotics before performance of an LP. Few patients with suspected meningitis received antimicrobial therapy within the first 30 minutes after arrival, but most patients with pneumococcal meningitis and typical symptoms were treated early; patients with bacterial meningitis who received treatment late had complex medical histories or atypical presentations. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Using decision trees to manage hospital readmission risk for acute myocardial infarction, heart failure, and pneumonia.

    Science.gov (United States)

    Hilbert, John P; Zasadil, Scott; Keyser, Donna J; Peele, Pamela B

    2014-12-01

    To improve healthcare quality and reduce costs, the Affordable Care Act places hospitals at financial risk for excessive readmissions associated with acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN). Although predictive analytics is increasingly looked to as a means for measuring, comparing, and managing this risk, many modeling tools require data inputs that are not readily available and/or additional resources to yield actionable information. This article demonstrates how hospitals and clinicians can use their own structured discharge data to create decision trees that produce highly transparent, clinically relevant decision rules for better managing readmission risk associated with AMI, HF, and PN. For illustrative purposes, basic decision trees are trained and tested using publically available data from the California State Inpatient Databases and an open-source statistical package. As expected, these simple models perform less well than other more sophisticated tools, with areas under the receiver operating characteristic (ROC) curve (or AUC) of 0.612, 0.583, and 0.650, respectively, but achieve a lift of at least 1.5 or greater for higher-risk patients with any of the three conditions. More importantly, they are shown to offer substantial advantages in terms of transparency and interpretability, comprehensiveness, and adaptability. By enabling hospitals and clinicians to identify important factors associated with readmissions, target subgroups of patients at both high and low risk, and design and implement interventions that are appropriate to the risk levels observed, decision trees serve as an ideal application for addressing the challenge of reducing hospital readmissions.

  4. Novel drugs in the management of acute mountain sickness and high altitude pulmonary edema

    Directory of Open Access Journals (Sweden)

    Sikri G

    2015-12-01

    Full Text Available Gaurav Sikri, Anirban Bhattacharya Department of Physiology, Armed Forces Medical College, Wanowarie, Pune, IndiaWe read with great interest the review article titled “Wilderness medicine at high altitude: recent developments in the field” by Shah et al.1 The authors have comprehensively summarized the recent advances in the field of high altitude medicine relevant to sports and travel medicine. However, Shah et al have described potential drugs for management of high-altitude illnesses, such as acute mountain sickness (AMS, high altitude cerebral edema, and high altitude pulmonary edema (HAPE as one group under the section “Novel drug treatment for AMS”. The pathophysiologies of these two sets of diseases (AMS/high altitude cerebral edema as one and HAPE as another set are different2 and hence it would have been nice to have had the novel drugs described separately to elucidate the therapeutic approach for the two different classes of diseases.View original paper by Shah et al.

  5. Beyond crisis resource management: new frontiers in human factors training for acute care medicine.

    Science.gov (United States)

    Petrosoniak, Andrew; Hicks, Christopher M

    2013-12-01

    Error is ubiquitous in medicine, particularly during critical events and resuscitation. A significant proportion of adverse events can be attributed to inadequate team-based skills such as communication, leadership, situation awareness and resource utilization. Aviation-based crisis resource management (CRM) training using high-fidelity simulation has been proposed as a strategy to improve team behaviours. This review will address key considerations in CRM training and outline recommendations for the future of human factors education in healthcare. A critical examination of the current literature yields several important considerations to guide the development and implementation of effective simulation-based CRM training. These include defining a priori domain-specific objectives, creating an immersive environment that encourages deliberate practice and transfer-appropriate processing, and the importance of effective team debriefing. Building on research from high-risk industry, we suggest that traditional CRM training may be augmented with new training techniques that promote the development of shared mental models for team and task processes, address the effect of acute stress on team performance, and integrate strategies to improve clinical reasoning and the detection of cognitive errors. The evolution of CRM training involves a 'Triple Threat' approach that integrates mental model theory for team and task processes, training for stressful situations and metacognition and error theory towards a more comprehensive training paradigm, with roots in high-risk industry and cognitive psychology. Further research is required to evaluate the impact of this approach on patient-oriented outcomes.

  6. Clinical effectiveness in the diagnosis and acute management of pediatric nephrolithiasis.

    Science.gov (United States)

    Van Batavia, Jason P; Tasian, Gregory E

    2016-12-01

    The incidence of pediatric nephrolithiasis has risen over the past few decades leading to a growing public health burden. Children and adolescents represent a unique patient population secondary to their higher risks from radiation exposure as compared to adults, high risk of recurrence, and longer follow up time given their longer life expectancies. Ultrasound imaging is the first-line modality for diagnosing suspected nephrolithiasis in children. Although data is limited, the best evidence based medicine supports the use of alpha-blockers as first-line MET in children, especially when stones are small and in a more distal ureteral location. Surgical management of pediatric nephrolithiasis is similar to that in adults with ESWL and URS first-line for smaller stones and PCNL reserved for larger renal stone burden. Clinical effectiveness in minimizing risks in children and adolescents with nephrolithiasis centers around ED pathways that limit CT imaging, strict guidance to ALARA principles or use of US during surgical procedures, and education of both patients and families on the risks of repeat ionizing radiation exposures during follow up and acute colic events.

  7. Diagnosis and management of acute otitis media in the urgent care setting.

    Science.gov (United States)

    McCracken, George H

    2002-04-01

    The prevalence of otitis media is increasing, which affects health care resource utilization across all segments, including the urgent care setting. One of the greatest challenges in the management of acute otitis media (AOM) is the effective treatment of cases caused by pathogens that are resistant to commonly used antibiotics. Whereas the production of beta-lactamases among strains of Haemophilus influenzae and Moraxella catarrhalis is an important consideration for antimicrobial therapy, the high prevalence of resistance to penicillin and other classes of antibiotics among strains of Streptococcus pneumoniae represents a greater clinical concern. The Centers for Disease Control and Prevention (CDC) recently convened the Drug Resistant S. pneumoniae Therapeutic Working Group to develop evidence-based recommendations for the treatment of AOM in an era of prevalent resistance. The recommendations from this group included amoxicillin as the preferred first-line drug because of the demonstrated activity against penicillin-intermediate and -resistant strains of S. pneumoniae, using higher dosages of up to 90 mg/kg per day in certain settings. For patients in whom initial treatment is unsuccessful after 3 days, the recommended agents included high-dose amoxicillin-clavulanate (for activity against beta-lactamase-producing pathogens), clindamycin, cefuroxime axetil, or 1 to 3 doses of intramuscular ceftriaxone. The principles set forth in these guidelines can assist the therapeutic decisionmaking process for practitioners in the urgent care setting.

  8. Poor responsiveness to antiplatelet drugs in acute coronary syndromes: clinical relevance and management.

    Science.gov (United States)

    Reny, Jean-Luc; Bonvini, Robert F; Bonvini, John M; Roffi, Marco; Fontana, Pierre

    2012-02-01

    Cardiovascular diseases are the most common cause of mortality and morbidity in Western countries, accounting for more than 40% of total mortality. An optimal pharmacological management in these patients is of major importance and antiplatelet agents remain the cornerstone of acute coronary syndrome (ACS) therapy at hospital admission and during percutaneous coronary interventions (PCI). The recently described poor biological responses to aspirin and clopidogrel have been source of major concern, especially in era of drug eluting stent implantation. Indeed, insufficient platelet inhibition at the time of PCI has been consistently associated with an increased risk of complications and recurrence of ischemic events. Despite the lack of uniformly accepted definitions of aspirin and clopidogrel poor response, we sought to describe the current evidence and gaps in knowledge. While trials on the potential benefit of an increased antiplatelet maintenance dose after PCI have shown only marginal benefits, the strengthening of the initial antiplatelet regimens by additional loading doses of clopidogrel, by the administration of glycoprotein IIb/IIIa receptor inhibitors or phosphodiesterase inhibitors might further improve outcomes during ACS and PCI in patients with poor responsiveness to conventional dual antiplatelet therapy. Overall, tailoring the antiplatelet treatment on the basis of the individual biological response improves the short-term outcome after PCI. New and more potent antiplatelet drugs may overcome the clinical consequences of the poor response to antiplatelet agents. © 2010 Blackwell Publishing Ltd.

  9. Surgical Management of Traumatic Acute Subdural Hematoma in Adults: A Review

    Science.gov (United States)

    KARIBE, Hiroshi; HAYASHI, Toshiaki; HIRANO, Takayuki; KAMEYAMA, Motonobu; NAKAGAWA, Atsuhiro; TOMINAGA, Teiji

    2014-01-01

    Traumatic acute subdural hematoma (ASDH) is a major clinical entity in traumatic brain injury (TBI). It acts as a space occupying lesion to increase intracranial pressure, and is often complicated by co-existing lesions, and is modified by cerebral blood flow (CBF) changes, coagulopathy, and delayed hematomas. Because of its complicated pathophysiology, the mortality of ASDH is still remaining high. In this review article, its epidemiology, pathophyiology, surgical treatment, and salvage ability are described. With regard to epidemiology, as the population ages, growing number of elderly patients with ASDH, especially patients with prehospital anticoagulant and antiplatelets, increase. Concerning pathophysiology, in addition to well-known initial intracranial hypertension and subsequent ischemia, delayed hyperemia/hyperperfusion, or delayed hematoma is being recognized frequently in recent years. However, optimal treatments for these delayed phenomenons have not been established yet. With regard to surgical procedures, all of craniotomy, decompressive craniectomy, and initial trephination strategies seem to be effective, but superiority of each procedure have not been established yet. Since Glasgow Coma Scale (GCS) scores, age, papillary reaction, and computed tomographic findings are strongly correlated to outcome, each factor has been investigated as an indicator of salvage ability. None of them, however, has been defined as such one. In future studies, epidemiological changes as population ages, management of delayed pathophysiology, superiority of each surgical procedures, and salvage ability should be addressed. PMID:25367584

  10. Management of intra-operative acute pulmonary embolism during general anesthesia: a case report.

    Science.gov (United States)

    Mao, Yuanyuan; Wen, Shuai; Chen, Gezi; Zhang, Wei; Ai, Yanqiu; Yuan, Jingjing

    2017-05-26

    Acute pulmonary embolism (APE) can be life-threatening. Early detection is even more difficult for patients under general anesthesia as common symptoms are not available and the pathophysiological course of intra-operative APE is influenced by procedures of surgery and anesthesia, which makes patients under general anesthesia a distinctive group. We report a case of APE during orthopedic surgery under general anesthesia. A 64-year-old female with atrial fibrillation and surgical history of varicosity underwent total right hip replacement surgery under general anesthesia. No arterial or deep vein thrombosis (DVT) was found prior to the surgery, but APE still occurred intraoperatively. The sudden decrease in PETCO2 and increase in PaCO2 combined other clues raised the suspect of APE, which is further evidenced by transesophageal echocardiogram (TEE). Multidisciplinary consultation was started immediately. After discussion with the consultation team and communication with patient's family members, anticoagulation therapy was started and IVC filter was placed to prevent PE recurrence. The patient went through the operation and discharged uneventfully 30 days later. Pulmonary embolism is a rare and potentially high-risk perioperative situation, with a difficult diagnosis when occurs under anesthesia. The separation phenomenon of decrease in PETCO2 and increase in PaCO2 might be a useful and suggestive sign, enabling prompt management and therefore improving the prognosis.

  11. Indium 111-labeled granulocyte scan in the diagnosis and management of acute inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, R.L.; Subramanian, K.; Gasparaitis, A.; Abcarian, H.; Pavel, D.G. (Univ. of Illinois College of Medicine, Chicago (USA))

    1990-06-01

    The indium 111 granulocyte scan was used to evaluate 39 individuals known to have or suspected of having inflammatory bowel disease. Twenty-three of these individuals had positive scans and 16 had negative scans. Eighty-seven confirmatory studies, which consisted of barium radiography, endoscopy, operative findings, and histopathology, were performed in 37 of these individuals. The remaining two negative scans corroborated only by clinical course, CBC, and erythrocyte sedimentation rate. In addition, 10 follow-up scans were performed in six of the 39 patients to monitor therapy or investigate a change in symptoms. As an anatomic indicator of acute granulocytic infiltration of the intestinal lamina propria and crypts, the authors found that this scan had a 97 percent rate of sensitivity and 100 percent specificity. Specific indications for the use of the indium 111-labeled granulocyte scan are described. For the authors, in general, this test has become a vital adjunct to endoscopy and radiography in the diagnosis and management of patients with symptoms of inflammatory bowel disease.

  12. Effective management of patients with acute ischemic stroke based on lean production on thrombolytic flow optimization.

    Science.gov (United States)

    Liang, Zhuoyuan; Ren, Lijie; Wang, Ting; Hu, Huoyou; Li, Weiping; Wang, Yaping; Liu, Dehong; Lie, Yi

    2016-12-01

    The efficacy of thrombolytic therapy for acute ischemic stroke (AIS) decreases when the administration of tissue plasminogen activator (tPA) is delayed. Derived from Toyota Production System, lean production aims to create top-quality products with high-efficiency procedures, a concept that easily applies to emergency medicine. In this study, we aimed to determine whether applying lean principles to flow optimization could hasten the initiation of thrombolysis. A multidisciplinary team (Stroke Team) was organized to implement an ongoing, continuous loop of lean production that contained the following steps: decomposition, recognition, intervention, reengineering and assessment. The door-to-needle time (DNT) and the percentage of patients with DNT ≤ 60 min before and after the adoption of lean principles were used to evaluate the efficiency of our flow optimization. Thirteen patients with AIS in the pre-lean period and 43 patients with AIS in the lean period (23 in lean period I and 20 patients in lean period II) were consecutively enrolled in our study. After flow optimization, we reduced DNT from 90 to 47 min (p management of AIS.

  13. Role of magnetic resonance imaging in the clinical management of the acutely locked knee

    Energy Technology Data Exchange (ETDEWEB)

    McNally, Eugene G.; Nasser, Khalid N.; Dawson, Stewart; Goh, Leslie A. [Department of Musculoskeletal Radiology, Nuffield Orthopaedic Centre and Oxford Radcliffe Hospital, Oxford, OX3 7LD (United Kingdom)

    2002-10-01

    To explore prospectively the hypothesis that MRI of the acutely locked knee can alter surgical decision-making.Design and patients. The study group comprised patients with a clinical diagnosis of knee locking requiring arthroscopy. The decision to carry out arthroscopy was made by an experienced consultant orthopaedic surgeon specialising in trauma and recorded in the patient's notes prior to MRI. Preoperative MRI was carried out using a 1.5 T system. The management was altered from surgical to conservative treatment in 20 (48%) patients on the basis of the MR findings. Arthroscopy was limited to patients with an MR diagnosis of a mechanical block, usually a displaced meniscal tear or loose body. Both patient groups were followed clinically until symptoms resolved.Results. Forty-two patients were entered into the study. MRI identified a mechanical cause for locking in 22 patients (21 avulsion meniscal tears and 1 loose body). All were confirmed at arthroscopy. Twenty patients were changed from operative to non-operative treatment on the basis of the MRI findings. One patient in this group required a delayed arthroscopy for an impinging anterior cruciate ligament stump. The sensitivity/specificity/accuracy of MRI in identifying patients who require arthroscopy was therefore 96%/100%/98% respectively.Conclusion. MRI can successfully segregate patients with a clinical diagnosis of mechanical locking into those who have a true mechanical block and those who can be treated conservatively. MRI should precede arthroscopy in this clinical setting. (orig.)

  14. Peritoneal dialysis vs. haemodialysis in the management of paediatric acute kidney injury in Kano, Nigeria: a cost analysis.

    Science.gov (United States)

    Obiagwu, Patience N; Abdu, Aliyu

    2015-01-01

    To determine the cost of the dialytic management of paediatric acute kidney injury in a low-income country. All children under the age of 15 years, who had either peritoneal dialysis or haemodialysis for acute kidney injury in Aminu Kano Teaching Hospital over a 1-year period, were studied. The average cost of each dialysis modality was estimated. Of 20 children, who had dialysis for acute kidney injury, 12 (60%) had haemodialysis and 8 (40%) had peritoneal dialysis. The mean cost for haemodialysis exceeded that of peritoneal dialysis ($363.33 vs. $311.66, t = 1.04, P = 0.313) with the mean cost of consumables significantly accounting for most of the cost variation ($248.49 vs. $164.73, t = 2.91, P = 0.009). Mean costs of nephrologist visit and nursing were not found to be significant. Peritoneal dialysis is the less costly alternative for managing acute kidney injury in children in our environment. © 2014 John Wiley & Sons Ltd.

  15. Disturbed hepatic carbohydrate management during high metabolic demand in medium-chain acyl-CoA dehydrogenase (MCAD)-deficient mice.

    Science.gov (United States)

    Herrema, Hilde; Derks, Terry G J; van Dijk, Theo H; Bloks, Vincent W; Gerding, Albert; Havinga, Rick; Tietge, Uwe J F; Müller, Michael; Smit, G Peter A; Kuipers, Folkert; Reijngoud, Dirk-Jan

    2008-06-01

    Medium-chain acyl-coenzyme A (CoA) dehydrogenase (MCAD) catalyzes crucial steps in mitochondrial fatty acid oxidation, a process that is of key relevance for maintenance of energy homeostasis, especially during high metabolic demand. To gain insight into the metabolic consequences of MCAD deficiency under these conditions, we compared hepatic carbohydrate metabolism in vivo in wild-type and MCAD(-/-) mice during fasting and during a lipopolysaccharide (LPS)-induced acute phase response (APR). MCAD(-/-) mice did not become more hypoglycemic on fasting or during the APR than wild-type mice did. Nevertheless, microarray analyses revealed increased hepatic peroxisome proliferator-activated receptor gamma coactivator-1alpha (Pgc-1alpha) and decreased peroxisome proliferator-activated receptor alpha (Ppar alpha) and pyruvate dehydrogenase kinase 4 (Pdk4) expression in MCAD(-/-) mice in both conditions, suggesting altered control of hepatic glucose metabolism. Quantitative flux measurements revealed that the de novo synthesis of glucose-6-phosphate (G6P) was not affected on fasting in MCAD(-/-) mice. During the APR, however, this flux was significantly decreased (-20%) in MCAD(-/-) mice compared with wild-type mice. Remarkably, newly formed G6P was preferentially directed toward glycogen in MCAD(-/-) mice under both conditions. Together with diminished de novo synthesis of G6P, this led to a decreased hepatic glucose output during the APR in MCAD(-/-) mice; de novo synthesis of G6P and hepatic glucose output were maintained in wild-type mice under both conditions. APR-associated hypoglycemia, which was observed in wild-type mice as well as MCAD(-/-) mice, was mainly due to enhanced peripheral glucose uptake. Our data demonstrate that MCAD deficiency in mice leads to specific changes in hepatic carbohydrate management on exposure to metabolic stress. This deficiency, however, does not lead to reduced de novo synthesis of G6P during fasting alone, which may be due to the

  16. NEUROENDOCRINE DISTURBANCES FOLLOWING HEAD INJURIES

    Directory of Open Access Journals (Sweden)

    Vinayak

    2015-05-01

    Full Text Available INTRODUCTION: Traumatic brain injury (TBI is one of the main causes of death and disability in young adults, with consequences ranging from physical disabilities to long - term cognitive, behavioural, psychological and social defects. Recently, c linical evidence has demonstrated that TBI may frequently cause hypothalamic – pituitary dysfunction, probably contributing to a delayed or hampered recovery from TBI. CASE REPORT: 32 year s old female presented with a history of fall from two wheeler on back hitting the head on occipital region with no history of vomiting, loss of consciousness, ENT bleed. Her GCS was 15/15. Patient was asymptomatic and was discharged from hospital on fifth day. Seven days after discharge patient again presented with heavine ss in her both breasts associated with pain and whitish discharge from both the nipples and mild fever since last two days. CONCLUSION: TBI is a public health problem that requires more effective strategies to improve the outcome and minimize disability of the affected patients. Changes in pituitary hormone secretion may be observed during the acute phase post - TBI, representing part of the acute adaptive response to the injury. Neuroendocrine disturbances, caused by damage to the pituitary and/or hypothalam us, is a frequent complication of TBI and may occur at any time after the acute event. Pituitary dysfunction presents more frequently as an isolated, and more rarely as a complete, deficiency.

  17. Statin-associated rhabdomyolysis with acute renal failure complicated by intradialytic NSTEMI: a review of lipid management considerations.

    Science.gov (United States)

    Kar, Subrata; Chockalingam, Anand

    2013-01-01

    Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are associated with myopathy, myalgias, myositis, and rhabdomyolysis. Rhabdoymyolysis is a rare complication and may cause acute renal failure, which may be fatal. In such cases, alternative therapies should be considered. In this review, we attempted to elucidate the lipid management options in patients with rhabdomyolysis and coronary artery disease. We also describe a case report of a patient who developed rhabdomyolysis from dual antilipid therapy followed by acute renal failure and non-ST elevation myocardial infarction. Such a complex case has not been reported in the literature, and lipid management options may include niacin, omega 3-fatty acids, or bile acid sequestrants. Once alternative therapies are initiated, monitoring a patient closely with evaluation for associated adverse events should be performed.

  18. Do accident and emergency senior house officers know the British guidelines on the management of acute asthma?

    Science.gov (United States)

    Ulahannan, T; Hardern, R D; Hamer, D W

    1996-03-01

    Avoidable deaths from asthma continue, even in hospital. Since the management of acute severe asthma is often initiated in the Accident and Emergency department, it is crucial that staff there have adequate knowledge. An anonymous questionnaire, containing items based on chart 6 of the UK guidelines, was completed by 66 Accident and Emergency Senior House Officers from the Yorkshire region. The study aim was to establish these doctors' levels of knowledge about the recommended management of acute asthma in Accident and Emergency. The median score was 10 (out of a possible 24) and the interquartile range 8-13. Further efforts are required to implement these guidelines so that the best patient outcomes can be achieved.

  19. Birds and fish as bioindicators of tourist disturbance in springs in semi-arid regions in Mexico: a basis for management

    OpenAIRE

    2007-01-01

    Tourist disturbance in semi–arid springs was analysed; birds and fish were selected as bioindicators. Media Luna spring is the biggest and most spatially complex system in the region, with the highest biodiversity levels and tourist use. Areas with the highest bird species richness and abundances showed highest structural heterogeneity and least direct human impact. No differences in species richness of fish were observed between sectors and the most abundant species were found in the sectors...

  20. Birds and fish as bioindicators of tourist disturbance in springs in semi-arid regions in Mexico: a basis for management

    Directory of Open Access Journals (Sweden)

    Palacio-Núñez, J.

    2007-06-01

    Full Text Available Tourist disturbance in semi–arid springs was analysed; birds and fish were selected as bioindicators. Media Luna spring is the biggest and most spatially complex system in the region, with the highest biodiversity levels and tourist use. Areas with the highest bird species richness and abundances showed highest structural heterogeneity and least direct human impact. No differences in species richness of fish were observed between sectors and the most abundant species were found in the sectors least perturbed by human activity. Factors that explained the bird distribution were the species´ tolerance to the effects of direct tourism (noise and direct presence of people and habitat quality, mainly riparian vegetation. Aquatic vegetation condition was very important for fish. Six bird species and two fish species were relevant as indicators of the habitat quality related to human impact. Anthropic disturbance such as tree plantation favoured some bird species, whereas aquatic vegetation removal was favourable for some fish species, such as the endemic Cichlasoma bartoni, however, both types of disturbance were unfavourable for other species; riparian vegetation removal was negative for both groups. Controlled tourism promotes good conditions for C. bartoni establishment. Efficient conservation measures such as limiting touristic distribution are necessary for all species, especially for the fish community, in order to conserve biodiversity in general.

  1. What is new on the term probiotics and the role of probiotics for the management of acute gastroenteritis.

    Science.gov (United States)

    Szajewska, H

    2015-01-01

    There is an increasing interest in probiotics, and evidence of the effectiveness of probiotics in preventing or treating diarrhoeal diseases is also advancing. The purpose of this short opinion paper is to summarise two aspects of current development in regard to probiotics. First, it discusses what is new with regard to some key questions related to the term 'probiotic'. Second, recent, evidence-based, clinical practice guidelines on the use of probiotics for the management of acute gastroenteritis in children are presented.

  2. Clinical presentation, management and outcome of acute coronary syndrome in Yemen: Data from GULF RACE - 2 registry

    Directory of Open Access Journals (Sweden)

    Al-Motarreb Ahmed

    2013-01-01

    Conclusions: ACS patients in Yemen present at a relatively young age with high prevalence of Smoking, khat chewing and hypertension. STEMI patients present late, and their acute management is poor. In-hospital evidence-based medication rates are high, but coronary revascularization procedures were very low. In-hospital mortality was high and long-term mortality rates increased two folds compared with the in-hospital mortality.

  3. Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report.

    Science.gov (United States)

    Gollapalli, Rajesh Babu; Naiman, Ana Nusa; Merry, David

    2015-07-01

    Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.

  4. A placebo-controlled study to investigate the effect of Dog Appeasing Pheromone and other environmental and management factors on the reports of disturbance and house soiling during the night in recently adopted puppies (Canis familiaris

    OpenAIRE

    Taylor, Katy; Mills, Daniel S

    2007-01-01

    Disturbance and house soiling during the night are common problems faced by the new puppy dog owner. They may result as consequence of a mismatch between the developmental status of the puppy and its new environment and/or separation distress in a typically social animal. The aim of this study was to examine the effect of Dog Appeasing Pheromone (DAP, Ceva Santé Animale) as well as a range of other management and environmental factors that might affect this process. It has been suggested tha...

  5. Socio-economic position and time trends in invasive management and case fatality after acute myocardial infarction in Denmark

    DEFF Research Database (Denmark)

    Mårtensson, Solvej; Gyrd-Hansen, Dorte; Prescott, Eva

    2016-01-01

    BACKGROUND: Lower case fatality and increased use of evidence-based invasive management incl. coronary angiography (CAG) have been reported for patients admitted with acute myocardial infarction (AMI) in the last 25 years. This article seeks to investigate whether these advances have benefitted...... patients in all socio-economic groups and how this has impacted on inequality in case fatality. METHODS: Forty three thousand eight hundred and forty three patients admitted with AMI in the period from 2001 to 2009 were included. Socio-economic position was measured using individual information...... fatality is not primarily driven by inequality in invasive management of AMI....

  6. Management of the acute painful crisis in sickle cell disease- a re-evaluation of the use of opioids in adult patients.

    Science.gov (United States)

    Telfer, Paul; Bahal, Nawal; Lo, Alice; Challands, Joanne

    2014-07-01

    Management of the acute painful crisis (APC) of sickle cell disease (SCD) remains unsatisfactory despite advances in the understanding and management of acute pain in other clinical settings. One reason for this is an unsophisticated approach to the use of opioid analgesics for pain management. This applies to haematologists who are responsible for developing acute sickle pain management protocols for their patients, and to health care staff in the acute care setting. The objective of this article is to evaluate the evidence for use of opioids in APC management. We have highlighted the possibilities for improving management by using alternatives to morphine, and intranasal (IN) or transmucosal routes of administration for rapid onset of analgesia in the emergency department (ED). We suggest how experience gained in managing acute sickle pain in children could be extrapolated to adolescents and young adults. We have also questioned whether patients given strong opioids in the acute setting are being safely monitored and what resources are required to ensure efficacy, safety and patient satisfaction. We also identify aspects of care where there are significant differences of opinion, which require further study by randomized controlled trial.

  7. Modeling the longitudinal latent effect of pregabalin on self-reported changes in sleep disturbances in outpatients with generalized anxiety disorder managed in routine clinical practice

    Directory of Open Access Journals (Sweden)

    Ruiz MA

    2015-08-01

    Full Text Available Miguel A Ruiz,1 Enrique Álvarez,2 Jose L Carrasco,3 José M Olivares,4 María Pérez,5 Javier Rejas6 1Department of Methodology, School of Psychology, Universidad Autónoma de Madrid, Madrid, 2Department of Psychiatry, Hospital de la Santa Creu i San Pau, Barcelona, 3Department of Psychiatry, Hospital Clínico San Carlos, Madrid, 4Department of Psychiatry, Hospital Meixoeiro, Complejo Hospitalario Universitario, Vigo, 5Medical Department, Pfizer, S.L.U., Alcobendas, Madrid, 6Health Economics and Outcomes Research Department, Pfizer, S.L.U., Alcobendas, Madrid, Spain Background: Anxiety disorders are among the most common psychiatric illnesses, with generalized anxiety disorder (GAD being one of the most common. Sleep disturbances are highly prevalent in GAD patients. While treatment with pregabalin has been found to be associated with significant improvement in GAD-related sleep disturbance across many controlled clinical trials, mediational analysis has suggested that a substantial portion of this effect could be the result of a direct effect of pregabalin. Thus, the objective of this study was to model the longitudinal latent effect of pregabalin or usual care (UC therapies on changes in sleep in outpatients with GAD under routine clinical practice. Methods: Male and female GAD outpatients, aged 18 years or above, from a 6-month prospective noninterventional trial were analyzed. Direct and indirect effects of either pregabalin or UC changes in anxiety symptoms (assessed with Hamilton Anxiety Scale and sleep disturbances (assessed with Medical Outcomes Study-Sleep Scale [MOS-S] were estimated by a conditional latent curve model applying structural equation modeling. Results: A total of 1,546 pregabalin-naïve patients were analyzed, 984 receiving pregabalin and 562 UC. Both symptoms of anxiety and sleep disturbances were significantly improved in both groups, with higher mean (95% confidence interval score reductions in subjects receiving

  8. Conundrums in the management of malignant ovarian germ cell tumors: Toward lessening acute morbidity and late effects of treatment.

    Science.gov (United States)

    Gershenson, David M; Frazier, A Lindsay

    2016-11-01

    One of the most extraordinary stories in the chronicles of gynecologic cancers has been that of malignant ovarian germ cell tumors. Prior to the mid-1960s, most patients died of disease. Fifty years later, most survive. Precisely because high cure rates are achievable, the concentration over the past decade has been on minimizing toxicity and late effects. The present review focuses on five areas of interest related to the management of malignant ovarian germ cell tumors that highlight the different therapeutic strategies practiced by pediatric and gynecologic oncologists: 1) primary surgery, 2) surgery alone (surveillance) for patients with FIGO stage IA disease, 3) postoperative management of FIGO stage IC-III disease, 4) postoperative management of pure immature teratoma, and 5) postoperative management of metastatic pure dysgerminoma. All of these topics share a common overarching theme: Lessening acute morbidity and late effects of treatment.

  9. Communication with Disturbance Constraints

    CERN Document Server

    Bandemer, Bernd

    2011-01-01

    The problem of communication with disturbance constraints is introduced. The rate-disturbance region is established for the single constraint case. The optimal encoding scheme turns out to be the same as the Han-Kobayashi scheme for the two user-pair interference channel. For communication with two disturbance constraints, a coding scheme and a corresponding inner bound for the deterministic case are presented. The results suggest a natural way to obtain a new inner bound on the capacity region of the interference channel with more than two user pairs.

  10. A rapid evidence assessment of immersive virtual reality as an adjunct therapy in acute pain management in clinical practice.

    Science.gov (United States)

    Garrett, Bernie; Taverner, Tarnia; Masinde, Wendy; Gromala, Diane; Shaw, Chris; Negraeff, Michael

    2014-12-01

    Immersive virtual reality (IVR) therapy has been explored as an adjunct therapy for the management of acute pain among children and adults for several conditions. Therapeutic approaches have traditionally involved medication and physiotherapy but such approaches are limited over time by their cost and side effects. This review seeks to critically evaluate the evidence for and against IVR as an adjunctive therapy for acute clinical pain applications. A rapid evidence assessment (REA) strategy was used. CINAHL, Medline, Web of Science, IEEE Xplore Digital Library, and the Cochrane Library databases were screened in from December 2012 to March 2013 to identify studies exploring IVR therapies as an intervention to assist in the management of pain. Main outcome measures were for acute pain and functional impairment. Seventeen research studies were included in total including 5 RCTs, 6 randomized crossover studies, 2 case series studies, and 4 single-patient case studies. This included a total of 337 patients. Of these studies only 4 had a low risk of bias. There was strong overall evidence for immediate and short-term pain reduction, whereas moderate evidence was found for short-term effects on physical function. Little evidence exists for longer-term benefits. IVR was not associated with any serious adverse events. This review found moderate evidence for the reduction of pain and functional impairment after IVR in patients with acute pain. Further high-quality studies are required for the conclusive judgment of its effectiveness in acute pain, to establish potential benefits for chronic pain, and for safety.

  11. Acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Bo-Guang Fan

    2010-01-01

    Full Text Available Background : Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims : The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods : We reviewed the English-language literature (Medline addressing pancreatitis. Results : Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions : Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  12. Acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Bo-Guang Fan

    2010-05-01

    Full Text Available Background: Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims: The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods: We reviewed the English-language literature (Medline addressing pancreatitis. Results: Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions: Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  13. Acute Rheumatic Fever: An Evidence-Based Approach To Diagnosis And Initial Management.

    Science.gov (United States)

    Khanna, Kajal; Liu, Deborah R

    2016-08-01

    Acute rheumatic fever is an inflammatory reaction involving the joints, heart, and nervous system that occurs after a group A streptococcal infection. It typically presents as a febrile illness with clinical manifestations that could include arthritis, carditis, skin lesions, or abnormal movements. Of these, the cardiac manifestations of acute rheumatic fever are most concerning, as children may present in acute heart failure and may go on to develop valvular insufficiency or stenosis. Because this is a rare presentation to emergency departments in developed countries, it is crucial for clinicians to keep a broad differential when presented with clinical presentations suspicious for acute rheumatic fever. This issue focuses on the clinical evaluation and treatment of patients with acute rheumatic fever by offering a thorough review of the literature on diagnosis and recommendations on appropriate treatment.

  14. Western Disturbances: A review

    Science.gov (United States)

    Dimri, A. P.; Niyogi, D.; Barros, A. P.; Ridley, J.; Mohanty, U. C.; Yasunari, T.; Sikka, D. R.

    2015-06-01

    Cyclonic storms associated with the midlatitude Subtropical Westerly Jet (SWJ), referred to as Western Disturbances (WDs), play a critical role in the meteorology of the Indian subcontinent. WDs embedded in the southward propagating SWJ produce extreme precipitation over northern India and are further enhanced over the Himalayas due to orographic land-atmosphere interactions. During December, January, and February, WD snowfall is the dominant precipitation input to establish and sustain regional snowpack, replenishing regional water resources. Spring melt is the major source of runoff to northern Indian rivers and can be linked to important hydrologic processes from aquifer recharge to flashfloods. Understanding the dynamical structure, evolution-decay, and interaction of WDs with the Himalayas is therefore necessary to improve knowledge which has wide ranging socioeconomic implications beyond short-term disaster response including cold season agricultural activities, management of water resources, and development of vulnerability-adaptive measures. In addition, WD wintertime precipitation provides critical mass input to existing glaciers and modulates the albedo characteristics of the Himalayas and Tibetan Plateau, affecting large-scale circulation and the onset of the succeeding Indian Summer Monsoon. Assessing the impacts of climate variability and change on the Indian subcontinent requires fundamental understanding of the dynamics of WDs. In particular, projected changes in the structure of the SWJ will influence evolution-decay processes of the WDs and impact Himalayan regional water availability. This review synthesizes past research on WDs with a perspective to provide a comprehensive assessment of the state of knowledge to assist both researchers and policymakers, and context for future research.

  15. Burden of acute gastroenteritis, norovirus and rotavirus in a managed care population.

    Science.gov (United States)

    Karve, Sudeep; Krishnarajah, Girishanthy; Korsnes, Jennifer S; Cassidy, Adrian; Candrilli, Sean D

    2014-01-01

    This study assessed and described the episode rate, duration of illness, and health care utilization and costs associated with acute gastroenteritis (AGE), norovirus gastroenteritis (NVGE), and rotavirus gastroenteritis (RVGE) in physician office, emergency department (ED), and inpatient care settings in the United States (US). The retrospective analysis was conducted using an administrative insurance claims database (2006-2011). AGE episode rates were assessed using medical (ICD-9-CM) codes for AGE; whereas a previously published "indirect" method was used in assessing estimated episode rates of NVGE and RVGE. We calculated per-patient, per-episode and total costs incurred in three care settings for the three diseases over five seasons. For each season, we extrapolated the total economic burden associated with the diseases to the US population. The overall AGE episode rate in the physician office care setting declined by 15% during the study period; whereas the AGE episode rate remained stable in the inpatient care setting. AGE-related total costs (inflation-adjusted) per 100 000 plan members increased by 28% during the 2010-2011 season, compared with the 2006-2007 season ($832,849 vs. $1 068 116) primarily due to increase in AGE-related inpatient costs. On average, the duration of illness for NVGE and RVGE was 1 day longer than the duration of illness for AGE (mean: 2 days). Nationally, the average AGE-related estimated total cost was $3.88 billion; NVGE and RVGE each accounted for 7% of this total. The episodes of RVGE among pediatric populations have declined; however, NVGE, RVGE and AGE continue to pose a substantial burden among managed care enrollees. In conclusion, the study further reaffirms that RVGE has continued to decline in pediatric population post-launch of the rotavirus vaccination program and provides RVGE- and NVGE-related costs and utilization estimates which can serve as a resource for researchers and policy makers to conduct cost

  16. Depression Disturbs Germany

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    The suicide of Robert Enke,the goalkeeper of the Germany national football team who had battled depression for years,stunned the country and cast depression into the national spotlight as a disturbing disease.

  17. Sudden Ionospheric Disturbances (SID)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Sudden ionospheric disturbances (SID) are caused by solar flare enhanced X-rays in the 1 to 10 angstrom range. Solar flares can produce large increases of ionization...

  18. Management of acute renal colic in the UK: a questionnaire survey

    Directory of Open Access Journals (Sweden)

    Skinner Chas

    2004-12-01

    Full Text Available Abstract Background There is great variation in the Accident and Emergency workload and location of Urology services in UK hospitals. This study investigated the relationship of the initial management of acute renal colic with the department workload plus local facilities including location of X-ray and urology services in UK Accident and Emergency (A&E departments. Methods A&E departments in each of the 11 UK Deanery regions were stratified based on departmental workload, namely small; 30,000 to 50,000 (medium; 50,000 to 80,000 (large and >80,000 (very large patients per year. One third of departments were selected in each group leading to a sample size of 106. A questionnaire was administered. Associations between categorical variables were investigated using the chi-squared test and when not valid, Fisher's Exact test was employed. Differences between groups in ordinal variables were investigated using the Mann-Whitney test. Results All questionnaires were returned. Twenty-nine units (27.4% did not perform any radiological investigation on renal colic patients. The number of radiological investigations that were available to departments was associated with workload (P = 0.003; with 57.1% of the small departments performing none and at least 82.8% of units in the other categories performing at least one. Of those departments with X-ray facilities in or adjacent to the department, 63% performed an intravenous urography (IVU compared to 25% of those departments without (P = 0.026. Of those departments with on-site urology services, 86% performed at least one radiological investigation compared to 52% of units without such services (P = 0.001. Department workload was associated with the first choice analgesia (NSAIDs or parenteral opiates (P = 0.011. Of the small departments, 64.3% used NSAIDs, 21.4% used parenteral opiates and 14.3% used neither. In comparison, NSAIDS were used by at least 87%, and opiates by at most 12.5% of units in each of

  19. Literature Review and Global Consensus on Management of Acute Radiation Syndrome Affecting Nonhematopoietic Organ Systems

    Science.gov (United States)

    Dainiak, Nicholas; Gent, Robert Nicolas; Carr, Zhanat; Schneider, Rita; Bader, Judith; Buglova, Elena; Chao, Nelson; Coleman, C. Norman; Ganser, Arnold; Gorin, Claude; Hauer-Jensen, Martin; Huff, L. Andrew; Lillis-Hearne, Patricia; Maekawa, Kazuhiko; Nemhauser, Jeffrey; Powles, Ray; Schünemann, Holger; Shapiro, Alla; Stenke, Leif; Valverde, Nelson; Weinstock, David; White, Douglas; Albanese, Joseph; Meineke, Viktor

    2013-01-01

    Objectives The World Health Organization convened a panel of experts to rank the evidence for medical countermeasures for management of acute radiation syndrome (ARS) in a hypothetical scenario involving the hospitalization of 100 to 200 victims. The goal of this panel was to achieve consensus on optimal management of ARS affecting nonhematopoietic organ systems based upon evidence in the published literature. Methods English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to conferees in advance of and updated during the meeting. Published case series and case reports of ARS, publications of randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation system. In cases in which data were limited or incomplete, a narrative review of the observations was made. Results No randomized controlled trials of medical countermeasures have been completed for individuals with ARS. Reports of countermeasures were often incompletely described, making it necessary to rely on data generated in nonirradiated humans and in experimental animals. A strong recommendation is made for the administration of a serotonin-receptor antagonist prophylactically when the suspected exposure is >2 Gy and topical steroids, antibiotics, and antihistamines for radiation burns, ulcers, or blisters; excision and grafting of radiation ulcers or necrosis with intractable pain; provision of supportive care to individuals with neurovascular syndrome; and administration of electrolyte replacement therapy and sedatives to individuals with significant burns, hypovolemia, and/ orshock. A strong recommendation is made against the use of systemic steroids in the absence of a specific indication. A weak

  20. [Postoperative pain management. Aims and organization of a strategy for postoperative acute pain therapy].

    Science.gov (United States)

    Nolli, M; Nicosia, F

    2000-09-01

    The Health Services, not only the Italian one, is under pressure because of request for improving treatment quality and the financial need for reorganization and cost-saving. It's required a rationalization of intervention, together with a careful choice of the best and cheapest techniques and the demonstration of their efficacy. The anaesthesia service activity, in a period of cost rationalization and funds restriction should be aimed to appropriate outcome measures corrected by both patient's risk factors and surgical-anaesthesiological case-mix. The development of a complete strategy for surgical pain management might run into two phases. The first phase, internal and mono-specialistic, should develop like the creation of an Acute Pain Team. The main processes are: focusing the problem (charge of the care), training, information, teaching methodology (timing, methods, drugs, techniques, etc.) and the audit (before and after changes). The main aims are the evaluation of the level of analgesia and pain relief or patient's satisfaction which are partial endpoints useful to demonstrate the improvement and the efficacy of the new pain management strategies. The second phase, multidisciplinary, is directed toward the creation of a Postoperative Evaluation Team. The main objective is to set up a collaborative clinical group able to identify the criteria for quality, efficacy and safety. The major purpose is the evaluation of major outcome measures: surgical outcome, morbidity, mortality and length of hospitalization. The improvement in the quality of postoperative pain treatment goes through a better organization and a progressive increase of the already available therapy. The achievement of the result and the quality projects depend on the interaction among staff members with different behaviours and settings. Internal teaching and training, continuous education for doctors and nurses, and external information, marketing and improvement of attractive capability of