Hospital practice (1995)
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Disturbed regional oxygenation is believed to contribute to organ dysfunction, organ failure, and death. Recent techniques such as orthogonal polarization spectral/sidestream darkfield imaging and near infrared spectroscopy have provided insight into the microcirculatory alterations present in critically ill patients. ⋯ Data on the effects of therapeutic interventions on the microcirculation are also being gathered and may help in developing strategies that can influence regional oxygenation and cellular metabolism, and thereby prevent or reverse organ failure. Whether monitoring the microcirculation can be used to guide therapy remains unclear and requires further study, and this is an exciting field of ongoing research.
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Hospital practice (1995) · Dec 2009
Randomized Controlled TrialSystemic hypothermia induced within 10 hours after birth improved neurological outcome in newborns with hypoxic-ischemic encephalopathy.
To evaluate the efficacy of systemic hypothermia when applied within 10 hours after birth to neonates with hypoxic-ischemic encephalopathy (HIE). ⋯ Systemic hypothermia reduced the risk of disability in infants with moderate HIE, in accordance with earlier studies. Hypothermia was induced within 6 hours in most infants, but delaying the onset to 6 to 10 hours after birth did not negatively affect primary outcome. Further studies with a large number of patients are needed to confirm that delayed cooling is equally effective.
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Acute kidney injury (AKI) is a common clinical syndrome in hospitalized patients associated with high morbidity and mortality rates. Despite several years of improvement in the medical care of the severely ill, there has been little improvement in outcome. ⋯ Although dialysis has been the mainstay of treating AKI for > 40 years, several questions regarding its application remain unsettled, including method (continuous vs intermittent), timing, and dose. The purpose of this review is to summarize recent advances in the epidemiology and treatment of AKI in hospitalized patients.
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Hospital practice (1995) · Dec 2009
ReviewCommon procedures in internal medicine: improving knowledge and minimizing complications.
Internal medicine physicians have long been trained with the skills, knowledge, and attitudes to become proficient at certain medical procedures. Specifically, the lumbar puncture, paracentesis, thoracentesis, and central venous catheter placement are common medical procedures encountered during residency. ⋯ In private practice many internists care for patients requiring these procedures. This review will summarize basic steps followed in these 4 medical procedures and highlight methods to minimize associated complications.
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Hospital practice (1995) · Dec 2009
Comparative StudyDo faculty intensivists have better outcomes when caring for patients directly in a closed ICU versus consulting in an open ICU?
Intensivists have been associated with decreased mortality in several studies, but in one major study, centers with intensivist-staffed units reported increased mortality compared with controls. We hypothesized that a closed unit, in which a unit-based intensivist directly provides and coordinates care on all cases, has improved mortality and utilization compared with an open unit, in which individual attendings and consultants provide care, while intensivists serve as supervising consultants. ⋯ We observed significant reductions in mortality and hospital LOS for patients initially admitted to a closed ICU versus an open unit. We did not observe a significant difference in ICU LOS or total cost after adjustment for severity.