Articles: patients.
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The mortality of severe sepsis is growing due to increased incidense of the syndrome. The speed and appropriateness of therapy administered in the initial hours is likely to influence outcome. Thus, eleven organizations of experts have developed guidelines, evidence based as far as possible, for the bedside management of patients, aimed at improving diagnosis and outcome in sepsis. The guidelines are a part of a campaign named ?surviving sepsis campaign?, see www.survivingsepsis.org The present article is aimed at introducing the guidelines to icelandic doctors.
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To test whether participation in clinical audit is associated with improved care of a long-term health condition. ⋯ Patients with asthma benefit from being managed by a practice involved in a programme of audit.
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Aesthetic surgery journal · Nov 2004
Pain management in augmentation mammaplasty: a randomized, comparative study of the use of a continuous infusion versus self-administration intermittent bolus of a local anesthetic.
Indwelling catheters for pain control after augmentation mammaplasty appear to be safe and effective. However, little is known regarding the comparison of continuous flow to intermittent bolus anesthetics. ⋯ After augmentation mammaplasty, both indwelling catheters using continuous flow and intermittent bolus anesthesia as needed are effective in controlling postoperative pain. Continuous flow maintains a steady state of pain control without patient intervention. Self-administration allows patients to have a more active role if they have pain and is an effective low-cost alternative to a commercial pain pump. These conclusions are supported by a review of the literature and by our own experience with more than 380 consecutive patients.
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Our objective was to document and compare the views obtained at laryngoscopy during emergency department (ED) rapid sequence intubation (RSI) by anesthetists and emergency physicians of varying seniority and experience. ⋯ Anesthetic trainees obtain better laryngoscopic views than emergency medicine trainees, but these differences disappear with increasing emergency physician seniority, suggesting a training and experience effect. Emergency medicine trainees may benefit from additional focus on laryngoscopic visualization techniques early in their training period.
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J Stroke Cerebrovasc Dis · Nov 2004
Effect of contrast material (Levovist) infusion on peak systolic velocity in middle cerebral artery using transcranial color-coded duplex sonography.
It is of crucial importance to predict the presence of stenosis in cerebral artery before occurrence of a stroke. To determine stenosis in the middle cerebral artery (MCA), we examined the effect of contrast agent (Levovist) infusion on transcranial color-coded duplex sonography (TCCD). TCCD was performed in 24 patients with MCA stenosis determined by angiography and/or magnetic resonance angiography, and 42 patients without MCA stenosis were also examined as the control group. ⋯ Difference between precontrast and postcontrast infusion was significantly greater in the stenosis group than in the control group (p < 0.05). We conclude that PSV tends to be underestimate in poor visualization of vessels. To improve accuracy of PSV measurement, contrast enhancement material should be used.