Articles: function.
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Critical care nurse · Jun 2015
EditorialProgressive mobility as a team effort in transitional care.
With changing health care, progressive care nurses are working in diverse practice settings to meet patient care needs. Progressive care is practiced along the continuum from the intensive care unit to home. ⋯ The program's goals are improved functional status, self-care management, and home discharge with reduced risk for hospital readmission. The core culture of the program is interdisciplinary collaboration and team partnership for care of patients and their families.
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For patients with ischaemic heart disease, remote ischaemic conditioning may offer an innovative, non-invasive and virtually cost-free therapy for protecting the myocardium against the detrimental effects of acute ischaemia-reperfusion injury, preserving cardiac function and improving clinical outcomes. The intriguing phenomenon of remote ischaemic conditioning was first discovered over 20 years ago, when it was shown that the heart could be rendered resistant to acute ischaemia-reperfusion injury by applying one or more cycles of brief ischaemia and reperfusion to an organ or tissue away from the heart - initially termed 'cardioprotection at a distance'. ⋯ Since its initial discovery in 1993, the first proof-of-concept clinical studies of remote ischaemic conditioning followed in 2006, and now multicentre clinical outcome studies are underway. In this review article, we explore the potential mechanisms underlying this academic curiosity, and assess the success of its application in the clinical setting.
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Intensive care medicine · Jun 2015
Review Meta AnalysisDiastolic dysfunction and mortality in septic patients: a systematic review and meta-analysis.
Myocardial dysfunction may contribute to the haemodynamic instability which accompanies sepsis, and may result in circulatory failure. There is no association between systolic dysfunction (SD) and mortality in septic patients and there is conflicting evidence regarding the effects of diastolic dysfunction (DD) on mortality in septic patients. ⋯ Diastolic dysfunction is common in septic patients and it is associated with mortality. Systolic dysfunction is less common and is not associated with mortality in this group of patients.
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Critical care medicine · Jun 2015
ReviewUnderstanding and Reducing Disability in Older Adults Following Critical Illness.
To review how disability can develop in older adults with critical illness and to explore ways to reduce long-term disability following critical illness. ⋯ Older adults who survive critical illness have physical and cognitive declines resulting in disability at greater rates than hospitalized, noncritically ill and community dwelling older adults. Interventions derived from widely available geriatric care models in use outside of the ICU, which address modifiable risk factors including immobility and delirium, are associated with improved functional and cognitive outcomes and can be used to complement ICU-focused models such as the ABCDEs.
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Because anesthetic machines have become more complex and more expensive, they have become less suitable for use in the many isolated hospitals in the poorest countries in the world. In these situations, they are frequently unable to function at all because of interruptions in the supply of oxygen or electricity and the absence of skilled technicians for maintenance and servicing. Despite these disadvantages, these machines are still delivered in large numbers, thereby expending precious resources without any benefit to patients. ⋯ Additional economies are achieved by completely eliminating spillage of oxygen from the breathing system and by recycling the driving gas into the breathing system to increase the Fraction of Inspired Oxygen (FIO2) at no extra cost. Savings also are accrued when using the drawover breathing system as the need for nitrous oxide, compressed air, and soda lime are eliminated. The Glostavent enables the administration of safe anesthesia to be continued when standard machines are unable to function and can do so with minimal harm to the environment.