J Formos Med Assoc
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Febrile neutropenia remains a major cause of morbidity and mortality in patients receiving chemotherapy. Major prophylactic strategies include granulocyte colony-stimulating factor and antibiotics, the most widely used of which are fluoroquinolones. ⋯ Given the increase in antimicrobial resistance with the use of prophylaxis, the risks and benefits of this strategy need to be carefully considered. This review presents the evidence for and against fluoroquinolone prophylaxis in areas of high fluoroquinolone resistance.
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Randomized Controlled Trial
Benefits of sevelamer on markers of bone turnover in Taiwanese hemodialysis patients.
Sevelamer hydrochloride is a recently developed phosphate binder, which is a quaternary amine anion exchanger without calcium or aluminum. Sevelamer is effective in controlling hyperphosphatemia without increasing the calcium load in chronic hemodialysis (HD) patients. We investigated whether sevelamer restored bone metabolism in chronic HD patients. ⋯ Sevelamer effectively reduces serum phosphorus with a lower incidence of hypercalcemic effects in HD patients. Sevelamer is an effective means of treatment for chronic hyperphosphatemic HD patients, especially those with hypoparathyroidism.
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Comparative Study
Applicability of the Chinese version of the Prodromal Questionnaire.
Early detection and intervention of psychosis is clinically important. This study aimed to test the applicability of the Chinese version of the Prodromal Questionnaire (CPQ) for identifying prodromal states of psychosis. ⋯ Applicability of the CPQ was demonstrated by its high reliability and good ability to discriminate between clinical patients and a comparison group. The 35-item positive symptom subscale can be useful alone in general mental health settings for screening psychotic cases.
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There is a lack of data regarding the occurrence of hemothorax in medical intensive care units (ICUs). The purpose of this study was to investigate the incidence, comorbidity and prognostic factors of hemothorax in medical ICU patients. ⋯ Chronic kidney disease was the most common comorbidity associated with hemothorax. Patients with chronic kidney disease might require close observation for hemothorax after invasive procedures, such as thoracentesis and chest tube thoracostomy. Prolonged prothrombin time and decreased hemoglobin level might be of prognostic value for critically ill patients with hemothorax.
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Randomized Controlled Trial
Effect of epidural neuraxial blockade-dependent sedation on the Ramsay Sedation Scale and the composite auditory evoked potentials index in surgical intensive care patients.
Peripheral deafferentation induced by neuraxial anesthesia reduces the degree of cortical arousal. This study investigated whether epidural analgesia blockade decreased sedation, as measured by the rapidly extracted auditory evoked potentials index, A-line autoregressive index (AAI) and Ramsay Sedation Scale (RSS) in sedated surgical intensive care patients, and looked at whether this was a concentration-dependent effect of lidocaine. ⋯ Epidural lidocaine analgesia could potentiate sedation in patients evaluated by the AAI, but had no effect on the RSS. The present study suggests that the AAI could provide an objective and more precise index than the RSS in evaluation of sedation level in patients who are undergoing epidural pain management in the intensive care unit.