Articles: patients.
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Patients with cystic fibrosis (CF) have an abnormal propensity for recurrent and chronic infections of the lower respiratory tract (LRT), and the most common cause of a shortened lifespan is chronic infection with Pseudomonas aeruginosa. A few other gram-negative organisms, primarily Burkholderia cepacia complex have, however, emerged as serious pathogens capable of establishing chronic LRT infection. Details of these and other CF pathogens can be found in the article by Dr. ⋯ Other more rare pathogens such as Stenotrophomonas maltophilia, Achromobacter xylosoxidans, and nontuberculous mycobacteria (NTM) appear less capable of causing patient-to-patient transmission. Both the physical proximity and the duration of exposure of noninfected patients to patients chronically infected with P. aeruginosa and B. cepacia complex are important determinants of the risk of cross-infection. Cohorting of patients according to presence or absence of specific pathogens coupled with conventional hygienic precautions can, however, lead to a decrease in incidence and prevalence of chronic infections with these two species, wherefore patient cohorting is now an integral component of infection control in patients with CF.
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Curr Opin Anaesthesiol · Dec 2003
Peripheral nerve block for ambulatory surgery and postoperative analgesia.
With this article we intend to increase the awareness of the efficiency and efficacy of peripheral nerve block as a treatment option for outpatient surgical anesthesia and postoperative home-based analgesia. ⋯ The recent advances and techniques described indicate that peripheral nerve block is both a valid and frequently a preferred option for ambulatory surgery.
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Postoperative vomiting remains a common complication of general anesthesia and occurs more frequently in children than adults. Prophylactic antiemetics have limited efficacy and have a potential for side effects. The new 5 HT3 antagonists are effective but expensive, while the older less expensive drugs such as droperidol have come under disrepute because of the potential for serious, life-threatening, cardiac arrhythmias. This review examines the literature to aid practicing anesthesiologists in the choice of patient who will benefit from prophylactic antiemetics. ⋯ Anesthesiologists should practice evidence-based medicine in reducing the common anesthetic complication of postoperative vomiting by an individualized approach that balances the choice of drugs with the expected risk of postoperative vomiting for cost-effective management.
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The objective was to investigate intentional and unintentional nonadherence to anti-HIV treatment regimens from a decision-making perspective. The participants (n = 117) being treated with anti-HIV medication completed a questionnaire asking about nonadherence; reasons for and against taking the medication; and medical consultation style. ⋯ Unintentional nonadherence was associated with demographic and clinical variables. The research highlights the importance of (i) treating intentional and unintentional nonadherence as separate entities; (ii) assessing individuals' idiosyncratic beliefs and internal logic when considering intentional nonadherence; and (iii) ensuring that individuals feel prepared for the effects of their medications.
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To determine the rate of bacterial meningitis among febrile infants in the emergency department (ED) who have pyuria detected in an initial catheterized urine specimen. ⋯ In this study of febrile children under 90 days of age with fever and pyuria, the incidence of concurrent meningitis was 0%. This suggests that recommendations for mandatory lumbar puncture in such children should be reconsidered. However, until larger prospective studies define a patient subset that does not require CSF analysis, it is prudent to rule out meningitis, administer parenteral antibiotics for urinary tract infection, and admit for close observation.