Glucose supply should be adjusted to obtain blood glucose levels < 150 mg/dL, and even in narrower lim- its postoperatively following heart surgery. Glycemia should be accurately monitored incritically-illcardiac patients. Acute hyperglycemia is evidenced in 50% of ACS in non-diabetic patients andin 25% of diabetics. It has been proven that sustained hyperglycemia inthe first 24 hours in patients admitted for ACS, whether diabetic or not, is a factor of poor prognosis in terms of mortality at 30 days 16,17 (IIb).
energy expenditure (REE) measured by indirect calorimetry with 8 predictive equations with different variations and 15 different combinations. Only the Penn-State equation was accurate both globally andinthe different subgroups, so it is therefore considered to be the advisable equation for use incritically-ill patients, whether obese or not. It was confirmed that neither the severity of the disease as measured by the SOFA, nor fever or traumatic, surgical or medical disease, changed the precision of the equations.
ter and of the recommendations included in it was based on discussion at several meetings of the GTMyN until a final consensus on the contents of each subject was reached. This system of preparation of recommen- dations (progressive feedback) was used for all chap- ters. Any discrepancies or points on which any member of the group expressed his/her disagreement were dis- cussed and agreed on by consensus, putting special emphasis on reviewing the levels of evidence and grades of recommendation established. The Editorial Committee then proceeded to make the final adjust- ment of each chapter, including the literature review, for its submission and final approval at the meeting of the GTMyN held in March 2011.
23. Mesejo A , Vaquerizo Alonso C , Acosta Escribano J , Ortiz Leyba C, Montejo González JC; et al; forthe Spanish Society of Intensive Care Medicine and Coronary Units andthe Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE). Guidelinesforspecializednutritionalandmetabolicsupportinthecritically-illpatient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units andthe Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): Introduction and methodology. Medicina Intensiva [España] 2011;35(Suppl 1):1-6.
The increased NO synthesis in sepsis is based on the evidence of the high plasma concentration of its degra- dation products, nitrates, nitrites (NOx). However, there are disagreements about the real changes in vivo inthe genesis of NO and NOx. Forthe moment, there is only one study that has measured production in vivo of NO in septic patients via its conversion rate in NOx, and reporting slower NOx fractionated synthesis rates in septic patients (n = 6), while the absolute rate was identical to healthy controls (n = 10) 19 (IIb).
mation, not only for personality characteristics, but also for situations that require more advanced attention (expressed concerns) andfor indicators of possible comorbid clinical syndromes. Despite being a small convenience sampling, adolescents with ADHD are significantly differentiated for some personality traits measured through the MACI ques- tionnaire, when compared with the general population pa- rameters. The personality profile forthe group of women with ADHD resembles the non-patient reference group; on the other hand, the personality profile forthe men’s group resembles that of thepatient reference group. Based on these results, it can be stated that the group of female ad- olescent patients with ADHD included in this study had a more adaptive personality profile than the group of male subjects, which could lead to a lower risk of presenting per- sonality disorder inthe adulthood. On the other hand, spe- cial attention should be paid to the male patient population with ADHD to evaluate the need for preventive interven- tions in order to avoid the development of some type of personality disorder.
Some nurses gave suggestions for making patient safety implementation more effective in their workplace. Comments like “I would suggest more frequent training sessions about patient safety, hiring more professionals, and improving the infrastructure of the emergency ward” and “Increasing the number of nurs- ing professionals would definitively reduce the workload andthe likelihood of errors” indicate that there is a need for investments in train- ing, motivating and providing a system forpatient safety in this hospital. One participant suggested: “It would be nice to have in-service education or a permanent system to prevent safety issues inthe hospital, and especially inthe emergency ward. This could be helpful in raising awareness of safety measures and get- ting providers engaged. People have to be re- minded that they are dealing with people’s lives, so they have to be more than careful.”
Comparing these results with previous studies is not easy, due to differences inthe method of screening or assessment used, baseline characteristics of the study population and primary diagnosis, definition of malnu- trition followed, economic terms used and DRG sys- tems applied in different countries. The fact that our re- sults refer to all discharges, with no exclusion criteria, obtained through the standardized work system, with no ad hoc coding, means we believe they have an added value as they can be considered structural re- sults. Awareness of the prevalence and economic im- pact of malnutrition, 9,25,33 requires tools to improve its
In synthesis, fairly direct care includes organizing personnel and their distribution, which combines skills and functions to beneit thepatientandthe quality of care. In this type of care, the computer is the technological element of greatest use. Indirect care: institutional management forpatient care. Institutional management is conducted through the application of administration and management theories and has support technology. Those surveyed classiied inthe category of indirect care everything referring to administrative tasks, which constitute indirect care, management of processes, solution of problems, and care support. …you have to be there… to expedite exams, diagnostic aids and remissions, organize remissions and counter-remissions (E. Prado: E6P13PAR29-31). …report adverse events, be aware of any novelty during service: if suddenly oxygen runs out [,] request it immediately, order laboratory exams and patients’ studies, for example [:] ultrasound, CT, being aware of… an ininity of activities (Caliche: E7P3PAR24-29). … the paperwork is illed out in letterhead, monthly requests… those are administrative functions (Talu: E16P1PAR9-17).
Due to the diversity of underlying causes of agitation andthe different degrees of severity, choice of best treatment option is not always easy. In general, it was acknowledged by the expert group that there are two main trends to treat agitated patients. (I) “Imposing treatment,” which tends to occur when the psychiatrist is not familiar with thepatient (seen forthe first time) or in episodes of severe agitation. It includes more coercive interventions and invasive treatments such as intra- muscular medications and (II) “Proposing treatment,” which occurs more commonly when the psychiatrist is familiar with thepatient or in cases of mild agitation. It includes less intrusive management, such as verbal de-escalation, usually leading to patient cooperation and, if pharmacological treat- ment is needed, less invasive options can be proposed to thepatient, such as oral or inhaled medications. During one of the exercises, the participants were asked to state the approximate frequency of use of the different pharmacological options. Despite the fact that there was a large variety of choices depending on the different countries, or even depending on the various clinical settings, in general, antipsychotics (APs) were the most frequently used (more than 50%); followed by benzodiazepines (BZD), and just a few participants used other choices such as anti-depressants, anti-histamine medications, so on. Within the APs, oral and intramuscular formulations were currently the preferred ones, leaving the other formu- lations as second choices. Inhaled APs were still not com- monly used, although there was a trend toward increasing their use.
subarachnoid block is not without risks. Of all the side effects that are presented, the most common is hypo- tension, which appears with the use of opioids mainly due to the release of histamine and a manifest vaso- dilation, especially when they are used intravenously. This may affect the minimum values of heart and brain autoregulation, and cause damage to the perfusion of these organs. However, with adequate oxygenation, if vascular space is optimally filled with crystalloids and colloids, and vasopressors (ephedrine, phenylephrine or norepinephrine, dopamine) are used in an early and effective way, it is possible to counteract this disad- vantage and minimize the risks 26,27 . With the use of
informed consent, complete the self-administered questionnaire (SAQ), attend the clinic visit, and complete at least the anthropometric, DEXA, and vertebral X-ray procedures. The MrOS cohort recruited only men. Study of Osteoporotic Fractures (SOF): The Study of Osteoporotic Fractures (SOF) is a prospective multicenter study of risk factors for vertebral and non vertebral fractures. The cohort is comprised of 9704 community – dwelling women 65 years old or older recruited from populations-based listings in four U.S. areas: Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; andthe Monongahela Valley, Pennsylvania. Women enrolled inthe study were 99% Caucasian with African American women initially excluded from the study due to their low incidence of hip fractures. A cohort of AA women was recruited at the 6 th Visit. The SOF participants were followed up every four months by postcard or telephone to ascertain the occurrence of falls, fractures and changes in address. To date, follow-up rates have exceeded 95% for vital status and fractures. All fractures are validated by x-ray reports or, inthe case of most hip fractures, a review of pre-operative radiographs. The inclusion criteria were: 1) 65 years or older, (2) ability to walk without the assistance of another, (3) absence of bilateral hip replacements, (4) ability to provide self-reported data, (5) residence near a clinical site forthe duration of the study, (6) absence of a medical condition that (inthe judgment of the investigator) would result in imminent death, and (7) ability to understand and sign an informed consent. To qualify as an enrollee, the participant had to provide written informed consent, complete the self-administered questionnaire (SAQ), attend the clinic visit, and complete at least the anthropometric measures. The SOF study recruited only women
The idea of using systemic radionuclide therapy targeting bone metastases results in an effective strategy able to deliver high doses of radiation to metastatic bone lesions, limiting the toxicity on healthy tissues [9–11]. During the last years, bone-targeting radiopharmaceuticals were represented by radioactive isotopes emitting b-particles, and lately by conversion electron emitters [12,13]. At present, only three compounds, 89 Sr (approved in Europe for prostate cancer), 153 Sm-lexidronam (153Sm- EDTMP; approved in Europe for osteoblastic metastases) and 186Re-etidronate (186Re- HEDP; approved in some European countries) have been available for pain relief secondary to skeletal metastases [14,15]. Unfortunately, the exposure of surrounding tissues to β and γ-emissions is associated with toxicities due to the relatively long range of the radiation. On the other hand, preliminary studies reported that radionuclides emitting α- particles could represent a new approach in this setting . α-Emitters are characterized by shorter range (<0.1 mm) and higher energy radiation than β-particles and γ-rays, according to low linear energy transfer (LET) radiation. In addition, tissue penetration with α-emitters accounts for a diameter of 2–10 cells, minimizing the damage to healthy hematopoietic tissue. Besides, due to the high LET radiation, α- particles are evaluated as more lethal, inducing nonrepairable double-strand DNA breaks in adjacent tumor cells .
The liver is a key element of the coagulation sys- tem. Patients with cirrhotic liver disease fail to syn- thesize both prothrombotic and antithrombotic factors. In addition, endothelial damage, endothelial dysfunction, portal hypertension, infections and re- nal failure may disrupt the coagulation system he- mostasis in cirrhotic patients. The clinical presentation, whenever bleeding or thrombosis, de- pends upon the stage of cirrhosis, added triggering factors and individual factors such as pre existing prothrombotic or antithrombotic conditions. Regu- lar coagulation test, such as INR, PT or aPTT are poor predictors of bleeding or thrombotic complica- tions, since they not evaluate the entire coagulation system. TEG may be a useful tool for evaluating coagulation abnormalities in cirrhotic patients, since it takes into account primary hemostasis, coa- gulation, and fibrinolysis. Therapeutic approach should include both thrombotic and bleeding events, and should not be directed in achieving normal labo- ratory coagulation test results.
15. Kabbash P, MacKenzie IS, Buxton W. Human performance using computer input devices inthe preferred and non-preferred hands. Proceedings of the INTERACT’93 and CHI’93 Conference on Human Factors in Computing Systems: ACM 1993: 474–81. 16. Thaden JJ, Nkomo VT, Lee KJ, Oh JK. Doppler imaging in aortic stenosis: the importance of the nonapical imaging windows to determine severity in a contemporary cohort. J Am Soc Echocardiogr 2015;28:780–5.
On the other side, correlations show that dentists perceive that: 1) if thepatientand his/her family attend the clinic, he/she will recommend the service. This indicates that, for dentists, care of patients is important not only individually but also inthe role of family doctor. 2) For dentists, patient’s willingness to treatment drives hire of new services. This last issue is of great interest, given that it would allow for to detection of cross-selling patients (Liu- Thompkins & Tam, 2013). 3) For dentists, recommendation is a key aspect of dental clinic management. Dentists perceive that if a patient is satisfied, he/he will then recommend the clinic or viceversa. Moreover, forthe non loyal patient, they notice that recommendation is irrelevant.
We will include studies of adults (where the majority of partici- pants are aged 18 or over). Adult participants could include indi- viduals who are the subject of the AD, and/or their family mem- bers (or friend or guardian) who are their proxy or surrogate deci- sion maker. There will be no restrictions related to health status. Therefore, studies could include well people inthe community, or patients with a diagnosed health problem, or people who are the final stages of their life. Studies could also include only those peo- ple who are the proxy or surrogate decision maker (for example, in situations where thepatient is terminally ill, or has dementia, and no longer able to make decisions on their own behalf). We will include studies where the intervention is directed to health professionals only, as long as data on one of the outcomes for this review is collected.
Finally, current options for smoking cessation - both pharmacological and psychological - have proven to be quite effective inthe short term. However, inthe following year, abstinence rates are disappointing. New options have been explored; for example, free- ing up the market for cytisine could spur smoking cessation, especially in developing countries. With respect to psychosocial and behavioral interven- tions, a wave of new therapies - known as “third generation” - has emerged and has shown signifi- cant results on abstinence in clinical trials. Never- theless, evidence of their effectiveness on maintain- ing abstinence is needed. Another significant area of research is working with novel technologies that use the internet and mobile devices as important tools that complement psychological treatment since they can be used to deliver information on cessation to broad audiences, to focus and intensify counsel- ing for those who are attempting to quit, and to foster social support, which is invaluable inthe ces- sation process.