Articles: patients.
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Despite the popularity of epidural steroid injections for low back pain, there still remains a lack of consensus on which type of steroid to inject. Most comparison studies regarding epidural steroids are based on an assumption that different types of steroids are equal as long as equipotent doses are utilized. In the spring of 2002, a national shortage of all depo steroids allowed the authors to compare epidural methylprednisolone (Depo-Medrol) to a non depo form of betamethasone in patients with low back pain. ⋯ This study shows that the aqueous steroid betamethasone is not an effective alternative to the commonly used depo-steroid methylprednisolone (Depo-Medrol) when injected epidurally in patients with lumbar pain. The study also shows that the anti-inflammatory effect of a depo-steroid can be greater than a non-depo steroid, even at equipotent doses. This should be an important factor to consider when reviewing epidural steroid outcome studies, where the type of steroid might affect results as much as other variables such as route of administration, volume of injectate, or use of fluoroscopy.
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Estimation of stroke volume variation (e.g. systolic blood pressure and systolic area variability) and central extracellular compartment volume (e.g. initial volume of distribution of glucose, IVDG) may be useful in guiding fluid therapy in mechanically ventilated patients. The reliability of systolic blood pressure (SBP) variability has been well validated, but little is known about systolic area (SA) variability or IVDG. Our aim was to investigate SBP and SA variability and IVDG as predictors of preload responsive hypovolaemia in post-cardiac surgery patients. ⋯ Our results indicate that neither IVDG, nor SBP and SA variability are predictive of preload responsive hypotension in post-cardiac surgery patients. Spectral analysis of SBP and SA may be more sensitive at assessing preload responsiveness in this patient group than traditional maximum-minimum measures.
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Curr Treat Option Ne · Sep 2003
Potential Role of Neuroprotective Agents in the Treatment of Patients with Acute Ischemic Stroke.
Currently, intravenous recombinant tissue plasminogen activator is the only US Food and Drug Administration-approved therapy for acute ischemic stroke. Although efficacious, its usefulness is limited, mainly because of the very limited time window for its administration. Neuroprotective treatments are therapies that block the cellular, biochemical, and metabolic elaboration of injury during or after exposure to ischemia, and have a potential role in ameliorating brain injury in patients with acute ischemic stroke. ⋯ Recent innovations in strategies of preclinical drug development and clinical trial design that rectify past defects hold great promise for neuroprotective investigation, including novel approaches to accelerating time to initiation of experimental treatment, use of outcome measures sensitive to treatment effects, and trial testing of combination therapies rather than single agents alone. Although no neuroprotective agent is of proven benefit for focal ischemic stroke, several currently available interventions have shown promising results in preliminary trials and may be considered for cautious, off-label use in acute stroke, including hypothermia, magnesium sulfate, citicoline, albumin, and erythropoietin. Overall, the prospects for safe and effective neuroprotective therapies to improve stroke outcome remain promising.
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Triage reliability studies typically use hypothetical scenarios and weighted kappa scores where agreement within one level is considered satisfactory. But if triage category is used to help define ED case-mix groups for comparative or benchmarking processes, agreement on exact triage level and major system involved is important. Our hypothesis was that a computerized menu that links presenting complaints to preferred triage levels (PC-linked triage) would provide high triage reliability. ⋯ PC-linked triage has high inter-rater reliability in a real-time clinical setting. PC-linked triage may be useful as one factor in defining case-mix groups for benchmarking and comparative purposes.
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To review the human nutrition in the critically ill patient in a three-part presentation. ⋯ Nutritional requirements for the critically ill patient should be delivered enterally in patients who have a normally functioning gastrointestinal system. A standard formulation is usually prescribed and instilled into the stomach using a fine bore tube. If gastric emptying is delayed prokinetic agents are tried before a transpyloric tube or enterostomy tube feeding is considered. Diarrhoea caused by enteral pathogens may require specific treatment. If pathogens are excluded then fibre and probiotics may be considered. Motility reducing agents (e.g. opiates) may cause abdominal bloating.