American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Facial expression is often used to evaluate pain in noncommunicative critically ill patients. ⋯ Upper facial expressions are most frequently activated during pain response in noncommunicative critically ill patients and might be a valid alternative to self-report ratings.
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Observational Study
Patterns of Opiate, Benzodiazepine, and Antipsychotic Drug Dosing in Older Patients in a Medical Intensive Care Unit.
Anecdotal observation suggests that older patients in medical intensive care units receive higher doses of psychoactive medications during evening shifts than day and night shifts. ⋯ In this longitudinal, observational sample of older patients, data indicated a positive association between dose levels of lorazepam and haloperidol during the evening nursing shifts relative to other shifts. Further investigation is needed to determine potential causes and to evaluate the impact on outcomes of sleep deprivation and delirium.
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A 25-year-old woman with a history of systemic lupus erythematosus who was taking steroids came to the hospital because of vague signs and symptoms of weight loss, constipation, and oral ulcers. Multiorgan dysfunction developed, and catastrophic antiphospholipid syndrome was suspected. ⋯ An autopsy revealed disseminated invasive aspergillosis. This case illustrates that invasive aspergillosis is a frequently missed diagnosis and should be part of the differential diagnosis for any patient who is immunosuppressed, including patients with autoimmune diseases such as systemic lupus erythematosus.
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Observational Study
Optimal timing of transfer out of the intensive care unit.
Little other than subjective judgment is available to help clinicians determine when a patient should be transferred out of the intensive care unit. ⋯ These data indicate an optimal time window for patients to leave the intensive care unit, with increased mortality not only if they leave earlier but also if they leave later than this optimal timing.