Articles: outcome.
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Objectives. To determine whether deep brain stimulation is an effective treatment for neuropathic pain of varied etiology. Material and Methods. Thirty-four patients with intractable neuropathic pain were prospectively studied using visual analog scores, McGill Pain Questionnaire, and Quality of Life Questionnaires (EUROQOL EQ-5D VAS, and SF-36 v-2). Patients had either deep brain stimulation of either the periventricular gray or ventroposterolateral nucleus of the thalamus, or both. ⋯ Health-related quality of life improved by 38%. Conclusions. Deep brain stimulation is an effective treatment for neuropathic pain. The factors that influence outcome, including etiology and site of stimulation, are discussed.
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Critical care medicine · Mar 2006
Intensive care unit physician staffing: financial modeling of the Leapfrog standard.
To evaluate from a hospital's perspective the costs and savings, over a 1-yr period, of implementing The Leapfrog Group's Intensive Care Unit Physician Staffing (IPS) standard compared with the existing standard of nonintensivist staffing in adult intensive care units. ⋯ Financial modeling of implementation of the IPS standard using conservative assumptions demonstrated cost savings to hospitals. Only under worst-case scenario assumptions did intensivist staffing result in additional cost to hospitals. These economic findings must be interpreted in the context of significant reductions in patient morbidity and mortality rates also associated with intensivist staffing. Given the magnitude of its clinical and financial impact, hospital leaders should be asking "how to" rather than "whether to" implement The Leapfrog Group's ICU Physician Staffing standard.
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This review focuses on recent advances in the treatment of traumatic brain injury (TBI) during 2004 and 2005. Injured brain is a very heterogeneous structure, significantly evolving over time. Implementation of multimodal neuromonitoring will certainly provide more insights into pathophysiology of TBI. ⋯ Hypertonic saline may become a preferred osmotherapeutic agent in severely head-injured patients, especially those with refractory intracranial hypertension. Benefit and indications for performing a decompressive craniectomy remain to be determined. Overall, individualized treatment respecting actual status of a patient's intra- and extracranial homeostasis should be the key principle of our current therapeutic approach toward severely head-injured patients.
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Outcome in intensive care can be categorized as mortality related or morbidity related. Mortality is an insufficient measure of ICU outcome when measured alone and length of stay may be seen as an indirect measure of morbidity related outcome. The aim of the present study was to estimate the incidence and predictive factors for intrahospitalar outcome measured by mortality and LOS in patients admitted to a surgical ICU. ⋯ In conclusion, prolonged ICU stay is more frequent in more severely ill patients at admission and it is associated with higher hospital mortality. Hospital mortality is also more frequent in patients submitted to emergent and major surgery.
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Interact Cardiovasc Thorac Surg · Feb 2006
Massive CO2 embolism in cardiopulmonary bypass circuit - a near miss.
We report a case of massive air embolism in the cardiopulmonary bypass (CPB) circuit to highlight the principle of its immediate management and its preventive measures. ⋯ Massive air embolism in cardiopulmonary bypass (CPB) circuit is a life-threatening emergency. Immediate cerebral protective manoeuvres and rectification of the cause of air embolism are vital for favourable outcome. However, high degree of vigilance and cooperation amongst all teams involved are paramount to prevent its occurrence in the first place.