American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of backrest position on intracranial and cerebral perfusion pressures in traumatically brain-injured adults.
Backrest positioning for brain-injured adults is variable. Some data support using a flat backrest to optimize cerebral perfusion pressure; other data support elevating the head of the bed at least 30 degrees to reduce intracranial pressure. ⋯ The results strengthen the research foundation for raising the backrest position for adults, 18 to 45 years old, who have nonvascular, nonpenetrating, severe brain injuries.
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Although popular, clinical practice guidelines are not universally accepted by healthcare professionals. ⋯ Physicians may think they are following sedation guidelines when they are not, and they may prescribe incorrect medications if the cause of agitation is misdiagnosed. Differences between physicians and nurses in values and perceptions may hamper implementation of clinical practice guidelines.
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Historical Article
Rejection after organ transplantation: a historical review.
Progress toward understanding the biochemical basis of human individuality spans centuries, but tissue rejection remains the primary clinical challenge of organ transplantation. This article highlights the chronology of scientific discoveries made in the quest to overcome the rejection associated with transplantation. The purposes of this review are to raise clinicians' awareness of the advances in surgery, genetics, immunology, and immunosuppression that have contributed to the current knowledge of tissue rejection and to indicate potential new directions in this challenging field.