European journal of internal medicine
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Eur. J. Intern. Med. · Dec 2005
Deliberate self-poisoning with acetaminophen: a comparison with other medications.
Acetaminophen is the most common drug employed in deliberate self-poisoning (DSP) in many countries and can lead to acute liver failure. The purpose of the present study was to compare DSP with acetaminophen with DSP with other medications. ⋯ Taking an overdose of acetaminophen is a common method of DSP, with patients tending to have a more benign presentation and shorter hospital stay than those who attempt DSP with other medications. Further research on the optimal care of these patients and multi-disciplinary approaches to DSP prevention are needed.
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Patients with critical illness, particularly those who depend on intensive care for a prolonged period of time, have a high morbidity and mortality. The acute and chronic phases of critical illness are associated with distinct endocrine alterations. Acute endocrine adaptations to the severe stress of critical illness, comprising an activated anterior pituitary function, have been selected by nature and can, as such, be considered as beneficial for surviving. ⋯ Insulin infusion titrated to maintain normoglycemia may be a notable exception, as this intervention has been proven to increase survival and reduce morbidity of surgical intensive care patients. Treatment of "relative adrenal failure" with hydrocortisone also appears to improve the outcome of patients with septic shock, but diagnostic and dosing issues still remain unresolved. Although extensive research has shown that infusion of hypothalamic-releasing peptides is able to restore physiological hormonal patterns within the somatotropic, thyrotropic, and gonadal axes and, thereby, to generate a controlled anabolic response, further research is needed to investigate whether such interventions actually improve the outcome of critical illness.
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Eur. J. Intern. Med. · Apr 2005
Evaluation of health-related quality-of-life and dyspnea scales in patients with idiopathic pulmonary fibrosis. Correlation with pulmonary function tests.
Idiopathic pulmonary fibrosis (IPF) has a profound impact on the functional status of patients. We sought to determine whether the health-related quality of life is affected in patients with IPF. ⋯ Our results suggest that dyspnea scales and the SGRQ are sensitive tools for assessing health-related quality of life in patients with IPF.
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Anemia is common in acute critically ill patients. Although blood loss, either by trauma, surgery, phlebotomies or gastrointestinal bleeding, may play a role, the anemia in these patients bears many similarities to the anemia characteristic of chronic disease. Serum iron is low with a high concentration of ferritin and low-to-normal transferrin and serum transferrin receptor levels. ⋯ In individual situations, such as in cardiovascular and cancer patients, higher thresholds may be appropriate. The administration of rh-EPO is an alternative to reduce the need for red blood cell transfusions and to avoid transfusion-related complications. Although its efficacy has been shown, questions regarding cost-benefit, dose regimen and clinical outcomes need to be answered before its large-scale use can be recommended.
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This paper sets out the policy of the Union Europeenne des Medecins Specialistes/European Union of Medical Specialists (UEMS) on quality assurance (QA), which is defined here as the regular review against defined standards of medical care. Its aim is to provide a framework for confirming the good quality of health care in Europe and, specifically, of the contribution of specialist doctors. The paper provides guidelines that can be adopted for use in QA systems in all European countries. ⋯ The following list of key points drawn from the text expands this summary. It also serves as an index to specific paragraphs of the paper. KEY POINTS: