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October 2012 critical care case of the month  [cached]
Luedy H,Singarajah CU
Southwest Journal of Pulmonary and Critical Care , 2012,
Abstract: No abstract available. Article truncated at 150 words. History of Present Illness An 85 year old patient was admitted with hypotension and respiratory failure. He was intubated shortly after arrival and mechanical ventilation was begun. Fluids and vasopressors were begun for his hypotension. PMH, SH, FH His past medical history included peripheral vascular disease, abdominal aortic aneurysm repair, type 2 diabetes mellitus, hypertension, alcohol use, coronary artery disease, chronic obstructive pulmonary disease and hyperlipidemia. Physical Examination His vital signs were a temperature of 98.6 degrees F, heart rate 110 beats/min, respiratory rate 14 breaths per minute while intubated and receiving mechanical ventilation, and BP of 95/65 mmHg on vasopressors. He was sedated. Lungs were clear and the heart had a regular rhythm without murmur or gallop. Abdominal examination was unremarkable and neurologic exam was limited because of sedation but without localizing signs. Plantar reflexes were down-going. Admission Laboratory Significant initial laboratory findings included a white blood cell count …
February 2013 critical care case of the month: thoracentesis through the looking glass  [cached]
Singarajah CU,Blum JE,Thomas AR,Luedy H
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated at 150 words. A 62 year old male was recently diagnosed with Stage 4 squamous cell left lung cancer with metastases to the pleura, brain and mediastinum. He also had known chronic obstructive pulmonary disease (COPD) with a FEV1 = 1.96 L and a known left side pleural effusion (see Figure 1). Figure 1. Baseline chest radiograph showing left pleural effusion (red arrow). He was seen as an outpatient for symptomatic shortness of breath and underwent real time ultrasound guided left sided thoracentesis removing 500 ml of straw-colored fluid. The procedure was uneventful except that near the end, the patient started to cough. He denied any symptoms post procedure apart from some minor puncture site pain. A routine post procedure chest x-ray was performed (Figure 2). Figure 2. Post-thoracentesis x-ray (Panel A) and its negative image (Panel B). What new abnormality is identified on the post-procedure chest x-ray?1.Left pneumothorax2.Right pneumothorax …
Community pharmaceutical care: an 8-month critical review of two pharmacies in Kampala
Norbert Anyama, R O Adome
African Health Sciences , 2003,
Abstract: Background: The concept of pharmaceutical care is neither well developed nor adequately documented in Uganda. Objectives: This study is therefore an attempt to identify and quantify the various service components of community pharmacy practice in Kampala, Uganda's capital city. Setting: Two pharmacies operating retail outlets were chosen out of about 110 in Kampala. The city itself is fairly small with a rather congested population. It is Uganda's economic hub with the greatest number of private sector health facilities and pharmacy outlets. Methods: This study involved an 8-month observation period at the two pharmacies, combined with a data collection form to record demographic characteristics of respondents and parameters such as self-medication, pharmacy initiated therapy, prescription filling, patient/non-patient clients and treatment received. Results: 567 observations were made. Missing data for parameters studied were omitted during analysis, thus yielding different totals for the various sets of variables. Just less than half of 564 respondents (44.3%), were females compared to males (55.7%). The study found that clients over the age of 12 years seeking pharmaceutical services were 8-fold (93.1%) more likely to be the very patients compared to children (OR = 8.3; 95% CI, 3.7-18.7). Slightly ove r thirty percent of respondents (32.3%) were third party patients. About fifteen percent (14.7%) of respondents came to fill prescriptions, 28.8% to receive pharmacy-initiated therapy and 56.5% came for self-medication with all drugs including antibiotics at 22.4%. Most clients (75.2%) received treatment.The availability of a drug at the pharmacy was found to be a significant predictor of whether treatment was received, with the client age acting as a confounding variable (OR = 59.7; 95% CI 25.9-137.6). African Health Sciences 2003 3(2); 87-93
December 2012 critical care case of the month: sepsis-like syndrome in a returning traveler  [cached]
Chase E,Ong E,Bloom J
Southwest Journal of Pulmonary and Critical Care , 2012,
Abstract: not available. Article truncated at 150 words. History of Present Illness The patient is a 56 year old male with a past medical history that is significant only for well controlled hypertension presenting with acute onset of fever, hematuria, jaundice and fatigue. He had been hospitalized in Mexico for the last 5 days. When he failed to improve his friends chartered an airplane and brought him to the U.S. Prior to his hospitalization in Mexico he had traveled to Sierra Leone related to his work as a geologist. PMH, SH, FH Past Medical History: Hypertension, gastroesophageal reflux disease Past Surgical History: Vasectomy Medications: Omeprazole, Lisinopril Social History: Works as a geologist with recent travel to Sierra Leone, no history of alcohol abuse, intravenous drug abuse, or HIV. Physical Examination Vital signs: Temperature 97.5° F, Pulse 87 beats/min, Respiratory Rate 18 breaths/min, Blood Pressure 111/84 mm Hg, and SaO2 89% on room air. The patient was initially alert, …
Separating the articles of authors with the same name  [PDF]
Jose M. Soler
Computer Science , 2006,
Abstract: I describe a method to separate the articles of different authors with the same name. It is based on a distance between any two publications, defined in terms of the probability that they would have as many coincidences if they were drawn at random from all published documents. Articles with a given author name are then clustered according to their distance, so that all articles in a cluster belong very likely to the same author. The method has proven very useful in generating groups of papers that are then selected manually. This simplifies considerably citation analysis when the author publication lists are not available.
Critical care during epidemics
Lewis Rubinson, Tara O'Toole
Critical Care , 2005, DOI: 10.1186/cc3533
Abstract: We recommend several actions that could improve hospitals' and communities' abilities to deliver critical care during epidemics and bioterrorist attacks involving large numbers of victims with life-threatening illness. These recommendations are in part the result of deliberations by the multidisciplinary Working Group on Emergency Mass Medical Care, which comprises 33 professionals with expertise in critical care medicine, biosecurity, disaster preparedness, and infection control (Rubinson et al., unpublished data).In countries with widespread critical care capabilities few, if any, critically ill survivors of traumatic disasters have had to forgo acceptable critical care because of staff or resource shortages [1-7]. In contrast, a naturally occurring disease outbreak or a deliberate epidemic resulting from a covert bioterrorist attack could generate critically ill victims in numbers that greatly exceed a hospital's – or a region's – capacity to deliver traditional critical care [8,9] (Rubinson et al., unpublished data). In the absence of careful pre-event planning, demand for critical care services may quickly exceed available intensive care unit (ICU) staff, beds and equipment, leaving the bulk of the infected populace without the benefit of potentially life-saving critical care.It is likely that critically ill victims who present to hospitals early in the course of the epidemic – that is, some fraction of the total population who are infected and will become symptomatic – will receive 'traditional' critical care in hospital ICUs. Even with stockpiling of airway equipment, vaso-pressors, and mechanical ventilators (which are important components of the US Centers for Disease Control and Prevention's Strategic National Stockpile [10]), shortages of staff trained in critical care and limited quantities of the vast array of medications and medical equipment commonly used in ICUs make it unlikely that current standards of critical care could be provided for more than
September 2012 critical care case of the month  [cached]
Raschke RA
Southwest Journal of Pulmonary and Critical Care , 2012,
Abstract: No abstract available. Article truncated at 150 words. History of Present IllnessA 45 year old man was transferred from another medical center. He was found unresponsive, with muscle spasticity. After arrival at the outside medical center his vital signs were temperature 106.4 degrees F, heart rate 160 beats/min, respiratory rate 44 breaths per minute, and BP of 70/45 mm Hg. He was orally intubated for respiratory distress with induced by vecuronium. His white blood cell count was 21,000 cells/μL. Chest x-ray showed bilateral consolidations and he was given fluids and gatifloxacin. His blood pressure improved to 130/94 and he was transferred. PMH, SH, FHHe has a past medical history of quadriplegia at the C6 level with a history of severe back pain because syringomyelia. He has a history of autonomic dysreflexia. Despite his disability he is quite functional working as a personal injury lawyer. He had been managed with a variety of medications including benzodiazepams, narcotics …
Hospital based palliative care in sub-Saharan Africa; a six month review from Malawi
Julia B Tapsfield, M Jane Bates
BMC Palliative Care , 2011, DOI: 10.1186/1472-684x-10-12
Abstract: A retrospective review of case notes for all in-patients seen by Tiyanjane Clinic over a six month period (April-Sept 2009) was undertaken.A total of 177 patients were seen, for whom 137 case notes were available (77%). 58% of patients were male, 42% female. The average age of patients was 39.1 years (range 15-92 years). 54% of patients were HIV positive, with 34% on ARV drugs at the time of care. 42% of patients had HIV related diagnoses, including AIDS defining malignancies, 48% had (non AIDS related) cancers and 9% had other palliative diagnoses. The mean age of patients with HIV related diagnoses was 34 years, for cancer patients it was 48 years. Pain was the most commonly reported symptom (74%), with 56% of patients requiring oral morphine. The mean daily dose of morphine was 30 mg/day (range 9-100 mg). 65% of patients were discharged home, 26% of patients died during admission.The palliative care population in this setting is relatively young, especially among patients with HIV related diagnoses. HIV and cancer are the main diagnostic groups. Pain is the most commonly reported symptom, with oral morphine frequently required. Health workers require access to and knowledge of oral morphine in order to provide appropriate assistance to patients under their care.Palliative care improves the quality of life for patients and families who face life-threatening illnesses, from diagnosis through to end of life and bereavement [1]. In the developing world the majority of cancer patients present at an advanced stage of disease making palliative care an essential part of management [2]. Palliative care has also been shown to play a critical role in the management of other chronic conditions, including HIV and AIDS, even in places where anti-retroviral drugs (ARVs) are available [3,4]. Despite recognition from the World Health Organisation (WHO) of the importance of providing palliative care, studies show that the service provision in Africa remains patchy and inconsistent
Epidemiology studies in critical care
Greg Martin
Critical Care , 2006, DOI: 10.1186/cc4897
Abstract: Epidemiology studies are often overlooked in the current world of evidence-based medicine. The studies do not rank in the hierarchy of clinical trial data, they are not often considered to influence clinical care and they may be considered merely 'descriptive' of a medical problem. Despite the limitations of epidemiology studies, they remain a critical component of biomedical research without which the remaining 'higher order' studies, such as cohort studies and controlled trials, could not be effectively conducted.Critical care epidemiology studies, of which the current study from the Intensive Care National Audit and Research Center database is a good example [1], serve a variety of purposes that advance the mission of both practicing intensive care unit (ICU) physicians and scientific researchers. At the most basic level, epidemiology studies convey important information about disease characteristics, the type of patients affected, and the frequency and outcomes of the disease. Importantly, these studies keep medical events in perspective. Epidemiology studies report and reinforce the frequency of deaths related to atherosclerotic disease, cancer and sepsis in developed countries, and of deaths from a variety of infectious diseases and sepsis in developing countries. These reminders are essential in an era of increasing media attention on diseases such as severe acute respiratory syndrome and avian influenza that are less immediate public health concerns.Descriptive epidemiology studies also inform intensivists about the type of conditions they should expect to encounter in their ICU (i.e. the frequency of disease) and they guide clinicians in treating patients by reporting information on relative causality (such as Streptococcus pneumoniae being the most common cause of community-acquired pneumonia). Local and regional epidemiology data have long been disseminated to tailor therapy for infectious diseases based on local organism resistance patterns. In contrast,
Handheld computers in critical care
Stephen E Lapinsky, Jason Weshler, Sangeeta Mehta, Mark Varkul, Dave Hallett, Thomas E Stewart
Critical Care , 2001, DOI: 10.1186/cc1028
Abstract: Palm III series handheld devices were given to the ICU team, each installed with medical reference information, schedules, and contact numbers. Users underwent a 1-hour training session introducing the hardware and software. Various patient data management applications were assessed during the study period. Qualitative assessment of the benefits, drawbacks, and suggestions was performed by an independent company, using focus groups. An objective comparison between a paper and electronic handheld textbook was achieved using clinical scenario tests.During the 6-month study period, the 20 physicians and 6 paramedical staff who used the handheld devices found them convenient and functional but suggested more comprehensive training and improved search facilities. Comparison of the handheld computer with the conventional paper text revealed equivalence. Access to computerized patient information improved communication, particularly with regard to long-stay patients, but changes to the software and the process were suggested.The introduction of this technology was well received despite differences in users' familiarity with the devices. Handheld computers have potential in the ICU, but systems need to be developed specifically for the critical-care environment.The rapid development of computing technology has had a major impact on health care, particularly in technology-oriented areas such as critical care. Electronic patient records require a major commitment by the institution, in hardware, software, training, and support. In many places, bedside care of patients still relies on paper records or nonintegrated computer systems that do not take full advantage of their data-management capabilities [1]. Even where there are advanced computerized systems, the bedside clinician may still rely on written notes for patient management and billing, and refer to pocket textbooks or printed management algorithms.For busy clinicians, the use of computers for hospital-based clinical c
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