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Items 1 - 10 of 10 |
One page. |
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Wide QRS duration.
Pelter MM, Adams MG.
Washoe Health System, Reno, NV, USA.
PMID: 15293590 [PubMed - indexed for MEDLINE]
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Critical care research: weaving a body-mind-spirit tapestry.
Guzzetta CE.
Children's Medical Center of Dallas, Dallas, Tex, USA.
Master weavers historically characterize the weaving of a tapestry as a calling, a transformation, a healing or sacred work. Tapestries are created by the collective efforts of many and are configured by the weavers' consciousness and spirit. A holistic framework used to weave a body-mind-spirit tapestry for guiding holistic clinical practice and research is described. Various research studies that document the effects of holistic interventions on patients' outcomes are examined. Implications for clinical practice are explored.
Publication Types:
PMID: 15293585 [PubMed - indexed for MEDLINE]
Comment on:
Arginine immunonutrition in critically ill patients.
Van Buren CT.
Publication Types:
PMID: 15293580 [PubMed - indexed for MEDLINE]
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Procrastination is the thief of time: surviving guidelines.
Bryan-Brown CW, Dracup K.
Publication Types:
PMID: 15293579 [PubMed - indexed for MEDLINE]
[Therapeutic hypothermia after traumatic brain injury or subarachnoid hemorrhageCurrent practices of German anaesthesia departments in intensive care.]
[Article in German]
Himmelseher S, Werner C.
Klinik fur Anaesthesiologie, Klinikum rechts der Isar, Technische Universitat Munchen, Munchen.
BACKGROUND. We aimed to explore current practices in use of therapeutic hypothermia after traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH) in intensive care of adults. METHODS. Questionnaires were sent to anaesthesia department chairs in German hospitals with neurosurgical care in January 2004 with a survey focussing on cooling procedures, temperature measurement, depth and duration of hypothermia, and rewarming after therapy. RESULTS. 99 (67%) questionnaires on TBI and 95 (64%) on SAH could be analysed. Hypothermia was used in 39% after TBI and 18% after SAH. Its aims were neuroprotection in approximately 45% and control of refractory intracranial hypertension in approximately 50%. However, in most cases (69% TBI, 59% SAH) hypothermia was used in less than a quarter of patients treated. A criterion for hypothermia was severe disease in approximately 40% and refractory intracranial hypertension in approximately 50%. Temperatures were targeted to 36-34 degrees C in 77% after TBI and 88% after SAH. In more than 80%, bladder temperatures were measured. For induction of hypothermia, surface cooling was applied in approximately 90%. The duration of hypothermia was 24-48 h in 62% after TBI and 29% after SAH. Cooling was orientated at the intracranial pressure (ICP) in 31% after TBI and 47% after SAH, and was used for more than 48 h in approximately 25%. After hypothermia was stopped, a rewarming rate of 0.5 degrees C/h was applied in 38% after TBI and 53% after SAH. In approximately 35%, rewarming was orientated at the ICP, and in 33% after TBI and 24% after SAH, it was performed over 24 h. After SAH, spontaneous rewarming was used in 24%. CONCLUSION. Therapeutic hypothermia is used in 39% after TBI and 18% after SAH in the intensive care of German anaesthesia departments. There is no standard in management, and there is wide variation in practices of duration of cooling and rewarming. For patients' benefit, evidence-based recommendations on therapeutic hypothermia should be published by the appropriate medical societies in the German language.
PMID: 15549192 [PubMed - as supplied by publisher]
 
Collaborative quality improvement to promote evidence based surfactant for preterm infants: a cluster randomised trial.
Horbar JD, Carpenter JH, Buzas J, Soll RF, Suresh G, Bracken MB, Leviton LC, Plsek PE, Sinclair JC.
Vermont Oxford Network, 33 Kilburn Street, Burlington, VT 05401, USA. horbar@vtoxford.org
OBJECTIVE: To test a multifaceted collaborative quality improvement intervention designed to promote evidence based surfactant treatment for preterm infants of 23-29 weeks' gestation. DESIGN: Cluster randomised controlled trial. SETTING AND PARTICIPANTS: 114 neonatal intensive care units (which treated 6039 infants of 23-29 weeks gestation born in 2001). MAIN OUTCOME MEASURES: Process of care measures: proportion of infants receiving first surfactant in the delivery room, proportion receiving first surfactant more than two hours after birth, and median time from birth to first dose of surfactant. Clinical outcomes: death before discharge home, and pneumothorax. INTERVENTION: Multifaceted collaborative quality improvement advice including audit and feedback, evidence reviews, an interactive training workshop, and ongoing faculty support via conference calls and email. RESULTS: Compared with those in control hospitals, infants in intervention hospitals were more likely to receive surfactant in the delivery room (adjusted odds ratio 5.38 (95% confidence interval 2.84 to 10.20)), were less likely to receive the first dose more than two hours after birth (adjusted odds ratio 0.35 (0.24 to 0.53)), and received the first dose of surfactant sooner after birth (median of 21 minutes v 78 minutes, P < 0.001). The intervention effect on timing of surfactant was larger for infants born in the participating hospitals than for infants transferred to a participating hospital after birth. There were no significant differences in mortality or pneumothorax. CONCLUSION: A multifaceted intervention including audit and feedback, evidence reviews, quality improvement training, and follow up support changed the behaviour of health professionals and promoted evidence based practice.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15514344 [PubMed - indexed for MEDLINE]
Clinical Trials of Antifungal Prophylaxis among Patients in Surgical Intensive Care Units: Concepts and Considerations.
Lipsett PA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
Background. Fungal infections are important clinical infections in patients in surgical intensive care units. In some institutions, antifungal prophylaxis has become commonplace, and increasing resistance has been reported. However, trials of antifungal prophylaxis are hampered by difficulties in trial design, and the findings may not be generalizable.Methods. Issues in clinical trial design are reviewed from existing and theoretical perspectives.Results. Identification of a primary hypothesis with a sound epidemiological basis is essential. The study must include institutions where fungal infections have a high and well-studied incidence. A high-risk patient population should be identified and enrolled. The agent selected should have an appropriate spectrum, be easily delivered to the population selected, and be cost effective with few adverse events. At present, fluconazole appears to be the best agent for targeted prophylaxis. The primary end point of the study should be based on an easily measured outcome, for example, days free from fungal infection rather than death due to fungal infection.Conclusions. Trials of antifungal prophylaxis for patients in surgical intensive care units have had problems in design, and several issues in the conceptual basis of future clincial trials must be addressed.
PMID: 15546117 [PubMed - in process]
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Emergence of New Strains of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit.
Healy CM, Hulten KG, Palazzi DL, Campbell JR, Baker CJ.
Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA. chealy@bcm.tmc.edu.
Background. Genetically distinct strains of methicillin-resistant Staphylococcus aureus (MRSA) of community rather than hospital origin have emerged in many areas of the United States. We determined if MRSA strains causing bacteremia in infants treated from birth in a neonatal intensive care unit (NICU) demonstrated the genetic traits of community-associated MRSA.Methods. A retrospective cohort study was conducted among NICU infants with bacteremia due to MRSA during 2003 in a large tertiary care center NICU in Houston. MRSA isolates were characterized by antimicrobial susceptibility testing and staphylococcal cassette chromosome mec (SCCmec) typing by polymerase chain reaction. All MRSA cases were reviewed for clinical severity of infection and outcome.Results. During 2003, a total of 8 (47%) of 17 infants with bacteremia due to S. aureus had MRSA infection. Isolates from 6 (75%) of these 8 infants carried the SCCmec genes (class B mec and ccr2) that are characteristic of community MRSA; 4 isolates were type IVa. All 6 isolates were resistant to beta -lactam antibiotics and erythromycin; 1 was also resistant to clindamycin. One isolate was nontypeable, and another carried the SCCmec type II gene (typical of hospital-associated strains) and was susceptible only to vancomycin. Seven (88%) of 8 infants presented in septic shock. Despite initial treatment with vancomycin, 3 (38%) died, and 3 survivors had complications requiring prolonged antimicrobial therapy; these 6 infants had MRSA isolates with genetic characteristics of isolates of community origin.Conclusions. Community-associated MRSA strains have emerged as a significant cause of sepsis in neonates hospitalized in NICU since birth and have caused disseminated infection with substantial morbidity and mortality.
PMID: 15546082 [PubMed - in process]
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Peter Sjokvist.
Sprung CL, Lemaire F.
General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, PO Box 12000, 91120 Jerusalem, Israel. sprung@cc.huji.ac.il
Publication Types:
- Biography
- Historical Article
Personal Name as Subject:
PMID: 15141289 [PubMed - indexed for MEDLINE]
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Safe paediatric intensive care. Part 1: Does more medical care lead to improved outcome?
Frey B, Argent A.
Department of Intensive Care and Neonatology, University Children's Hospital, 8032 Zurich, Switzerland. Bernhard.Frey@kispi.unizh.ch
Neonatal and paediatric intensive care has improved the prognosis for seriously sick infants and children. This has happened because of a pragmatic approach focused on stabilisation of vital functions and immense technological advances in diagnostic and therapeutic procedures. However, the belief that more medical care must inevitably lead to improved health is increasingly being questioned. This issue is especially relevant in developing countries where the introduction of highly specialised paediatric intensive care may not lead to an overall fall in child mortality. Even in developed countries, the complexity and availability of therapeutics and invasive procedures may put seriously ill children at additional risk. In both developing and industrialised countries the use of safe and simple procedures for appropriate periods, particular attention to drug prescription patterns and selection of appropriate aims and modes of therapy, including non-invasive methods, may minimise the risks of paediatric intensive care.
Publication Types:
PMID: 15103459 [PubMed - indexed for MEDLINE]
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