Articles: patients.
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Curr Opin Anaesthesiol · Apr 2000
Severity scoring systems and the prediction of outcome from intensive care.
Severity scoring systems are tools that provide a predicted mortality for a group of intensive care unit patients on the basis of derangement of their physiology and some past medical history. This predicted mortality can then be compared with the actual mortality to give some indicator of the effectiveness of the package of care delivered by the intensive care unit, corrected for differences in case-mix. ⋯ This may be partly due to limitations in their ability to predict mortality outside the population on which they were developed, and to the change in calibration of the system with time and advances in medical science. This review briefly addresses the limitations of severity scoring systems in light of recent publications.
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Appropriate documentation, billing and coding in interventional pain practice is a crucial issue with a wide arena of regulatory reforms. There have been reports of billions of dollars in losses in health care fraud. Office of Inspector General reports a massive war on health fraud. ⋯ This review describes the regulatory issues, steps in documentation of medical necessity, appropriate billing and coding, and examples of codes describing CPT 1999 and 2000 for a multitude of procedures. These illustrations and the information provide practical considerations for the use of interventional techniques in the management of chronic pain based on the current state of the art and science of interventional pain management, rules and regulations. However, this article and its descriptions do not constitute legal advice.
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Intravenous (IV) opioid titration is an accepted method of relieving acute renal colic. Studies have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) are also effective in this setting. Our objective was to compare single-dose ketorolac and titrated meperidine, both administered intravenously, with respect to speed and degree of analgesia, adverse effects and functional status. Our primary hypothesis was that these agents provide equivalent analgesia within 60 minutes. Our secondary hypotheses were that ketorolac-treated patients would experience fewer adverse effects and would be better able to resume usual activity. ⋯ In the doses studied, single-dose IV ketorolac is as effective as titrated IV meperidine for the relief of acute renal colic and causes less functional impairment.
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This study will report our experience on positioning of totally implanted venous catheter system (port-a-cath) as compared to ultrasound guidance versus blind technique. ⋯ US guided puncture of subclavian vein for the implantation of venous catheter system is faster by reducing procedure time, it is easier for the operator and safer for the patient than blind technique by exposing anatomical structures. Morevover US guidance reduces early complications and limits costs.
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Neuropathic pain is often resistant to opioids, so other medication classes, such as tricyclic antidepressants, anticonvulsants, and local anesthetics, are often used. Central sensitization, or pain 'wind-up', may perpetuate chronic neuropathic pain even when ongoing peripheral sensory input is absent. Wind-up is thought to cause allodynia, hyperalgesia, and hyperpathia. ⋯ No significant side effects were reported. Ketamine Gel may provide clinicians with a new option in the battle against chronic neuropathic pain. Until further information is available and larger trials can be conducted, we can only recommend this type of therapy for refractory cases in which all primary and secondary options have been exhausted.