European journal of internal medicine
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Oxygen is one of the most common drugs used in secondary care. It is often used incorrectly on hospital wards, and it has been suggested that prescribing oxygen would facilitate correct administration. However, the knowledge of hospital doctors who would prescribe oxygen, and that of nurses who administer it, has not been tested. ⋯ Junior doctors and nurses do not have sufficient knowledge and understanding of oxygen therapy to be able to prescribe the drug appropriately and safely.
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Eur. J. Intern. Med. · Aug 2006
Quantitative acid-base physiology using the Stewart model. Does it improve our understanding of what is really wrong?
Traditional theories of acid-base balance are based on the Henderson-Hasselbalch equation to calculate proton concentration. The recent revival of quantitative acid-base physiology using the Stewart model has increased our understanding of complicated acid-base disorders, but has also led to several new controversies. With the help of three patient histories, we show that the Henderson-Hasselbalch equation should be regarded as a simplified version of the more general Stewart model and not as something completely different. Therefore, both models may be useful at the bedside.
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Eur. J. Intern. Med. · Jul 2006
Impact of the use of aminoglycosides in combination antibiotic therapy on septic shock and mortality due to Staphylococcus aureus bacteremia.
The purpose of this study was to evaluate the possible impact of antimicrobial combination regimens containing an aminoglycoside (AG) on morbidity and mortality associated with S. aureus bacteremia. ⋯ Although there was no decrease in mortality due to S. aureus infection in patients treated with AG therapy, we found a significant benefit of AG in preventing septic shock. This data argues for the early use of AG in patients with S. aureus bacteremia.
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Takayasu's arteritis (TA) is a chronic large vessel vasculitis. The physiopathology of TA has not been completely elucidated, but it appears to be multifactorial and to mainly involve cellular immunity. The pathologic sequence could implicate stimulation from an antigen that triggers heat shock protein (HSP)-65 expression in aortic tissue which, in turn, induces MHC class I-related chain A (MICA). ⋯ The use of corticosteroids and of other immunosuppressive agents can bring TA into remission in most patients. A better understanding of the immunological mechanisms responsible for the vascular injury has led to trials of anti-TNF-alpha agents with encouraging results. In the near future, new drugs specifically designed to target some of the mechanisms described above may be able to expand the physician's therapeutic arsenal in TA.
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Eur. J. Intern. Med. · May 2006
Burnout in internal medicine physicians: Differences between residents and specialists.
Burnout poses a substantial problem for physicians' well-being and for the quality of health care. The role of workload in comparison to subjective work characteristics has been rarely studied. The purpose of this study was to explore the associations of burnout with workload and subjective work characteristics in internal medicine specialists and residents. ⋯ Perceived working conditions were more important than workload in explaining the variance in burnout. In addition, burnout in medical specialists and residents was linked to different characteristics of their working environment.