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JM Magarey 《Canadian Metallurgical Quarterly》1997,10(3):90-93
Pain management presents exciting opportunities for nurse anesthetists. Today there are thousands of pain clinics and pain services dedicated to the diagnosis and treatment of chronic and acute pain. By becoming familiar with the principles involved in the management of chronic and acute pain, the different treatment modalities available, and the organization of pain clinics and pain services, nurse anesthetists will be able to take advantage of the opportunities they provide. 相似文献
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J Marrow 《Canadian Metallurgical Quarterly》1996,72(849):413-418
Persons dying suddenly are very likely to be taken to the nearest Accident and Emergency Department. The task of informing and counselling bereaved relatives therefore frequently falls to the staff of these Departments. Adequate preparation is important in allowing such situations to be dealt with in a sensitive and appropriate manner. Advice on coping with different aspects of sudden death is given and some common reactions discussed. Special problems are also considered (eg, the death of a child, criminal violence, communication difficulties). Aftercare must also not be forgotten and staff should receive training in the care of the bereaved. 相似文献
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This article presents material from the treatment of a woman who experienced her living son as dead. This fantasy is interpreted both as a response to and defense against the trauma of loss. Shattered expectations and insecure attachment immure her in a relationship in which hope leads repeatedly to affective dysregulation and crushing disappointment. (PsycINFO Database Record (c) 2010 APA, all rights reserved) 相似文献
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L Goldman EF Cook PA Johnson DA Brand GW Rouan TH Lee 《Canadian Metallurgical Quarterly》1996,334(23):1498-1504
BACKGROUND: Patients who come to the emergency department with chest pain are a heterogeneous group. Some have ischemic heart disease that may lead to serious complications, whereas others have minor disorders. We performed a study to identify clinical factors that predict which patients will have complications requiring intensive care. METHODS: We first studied 10,682 patients with acute chest pain at seven hospitals between 1984 and 1986 (derivation set) to identify potential clinical predictors of the development of major complications. We then validated these predictors in a separate set of 4676 patients at one hospital between 1990 and 1994 (validation set). RESULTS: In the derivation set of patients, we identified the following set of clinical features, which, if present in the emergency department, were associated with an increased risk of complications: ST-segment elevation or Q waves on the electrocardiogram thought to indicate acute myocardial infarction, other electrocardiographic changes indicating myocardial ischemia, low systolic blood pressure, pulmonary rales above the bases, or an exacerbation of known ischemic heart disease. On the basis of these criteria, the patients in the validation set were stratified into four groups, with the risk of major complications in the first 12 hours ranging from 0.15 to 8 percent. After 12 hours, the probability of a major complication could be updated on the basis of whether the patient had already had a complication of major severity, a complication of intermediate severity, or a myocardial infarction (independent relative risks, 18.9, 7.7 and 4.0, respectively, as compared with patients without prior complications or myocardial infarction). CONCLUSIONS: The risk of major complications in patients with acute chest pain can be estimated on the basis of the clinical presentation and new clinical observations made during the hospital course. These estimates of risk help in making rational decisions about the appropriate level of medical care for patients with acute chest pain. 相似文献
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A Legras D Malvy AI Quinioux D Villers G Bouachour R Robert R Thomas 《Canadian Metallurgical Quarterly》1998,24(10):1040-1046
OBJECTIVE: To assess the incidence and to evaluate the feasibility of inter-unit continuous surveillance of intensive care unit (ICU)-acquired infections. DESIGN: Prospective multicentre, longitudinal, incidence survey. SETTING: Five ICUs in university hospitals in western France. PATIENTS: All patients admitted to the ICU during two 3-month periods (1994-1995). MEASUREMENTS AND RESULTS: The main clinical characteristics of the patients, ICU-acquired infections, length of exposure to invasive devices and the micro-organisms isolated were analysed. The study included 1589 patients (16970 patient-days) and the infection rate was 21.6 % (13.1 % of patients). The ventilator-associated pneumonia rate was 9.6 %, sinusitis 1.5 %, central venous catheter-associated infection 3.5 %, central venous catheter-associated bacteraemia 4.8 %, catheter-associated urinary tract infection 7.8 % and bacteraemia 4.5 %. The incidence density rate of ICU-acquired infections was 20.3% patient-days. Ventilator-associated pneumonia and sinusitis rates were 9.4 and 1.5% ventilation-days, respectively. Central venous catheter-associated infection and central venous catheter-associated bacteraemia rates were 2.8 and 3.8% catheter-days, respectively. The catheter-associated urinary tract infection rate was 8.5% urinary catheter-days and the bacteraemia rate 4.2% patient-days. Six independent risk factors for ICU-acquired infection were found by stepwise logistic regression analysis: absence of infection on admission, age > 60 years, length of stay, mechanical ventilation, central venous catheter and admission to one particular unit. A total of 410 strains of micro-organisms were isolated, 16.8 % of which were Staphylococcus aureus (58.0% methicillin-resistant). CONCLUSION: This prospective study using standardised collection of data on the ICU-acquired infection rate in five ICUs identified six risk factors. It also emphasized the difficulty of achieving truly standardised definitions and methods of diagnosis of such infections. 相似文献
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F Procaccio 《Canadian Metallurgical Quarterly》1998,64(5):207-208
Severe medical complications account for 20-30% of all deaths in patients with subarachnoid hemorrhage. High quality of intensive care is needed to prevent and correct pulmonary complications and electrolyte disturbances. Guidelines of intensive medical treatment should be defined to control intracranial hypertension and ischemic secondary cerebral damage in comatose patients. Extensive monitoring is necessary to achieve adequate observation in the perioperative period and safe treatment of vasospasm. A multidisciplinary approach in a critical area with intensive and sub-intensive beds, based on the cooperative role of neurosurgeons and anesthetists/intensivists, could improve the medical care, reducing complications, ICU stay and costs. 相似文献
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S Nava 《Canadian Metallurgical Quarterly》1998,79(7):849-854
OBJECTIVE: Pulmonary rehabilitation has been shown to be of benefit to clinically stable patients with chronic obstructive pulmonary disease (COPD). This study examined the effect of pulmonary rehabilitation on some physiologic variables in COPD patients recovering from an episode of acute respiratory failure. DESIGN: A prospective, randomized study. SETTING: A respiratory intensive care unit (RICU). PATIENTS: Eighty COPD patients recovering from an episode of acute respiratory failure were randomized in a 3:1 fashion to receive stepwise pulmonary rehabilitation (group A, n=60 patients) or standard medical therapy (group B, n=20 patients). MAIN OUTCOME MEASURES: Improvements in exercise tolerance, sense of breathlessness, respiratory muscle function, and pulmonary function test values were measured, respectively, by exercise capacity (6-minute walking distance [6MWD]), dyspnea score (Visual Analog Scale [VAS]), maximal inspiratory pressure (MIP), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). INTERVENTIONS: Group A received pulmonary rehabilitation that consisted of passive mobilization (step I), early deambulation (step II), respiratory and lower skeletal muscle training (step III), and if the patients were able, complete lower extremity training on a treadmill (step IV). Group B received standard medical therapy plus a basic deambulation program. RESULTS: Sixty-one of 80 patients were mechanically ventilated at admission to the unit and most of them were bedridden. Twelve of the 60 group A patients and 4 of the 20 group B patients died during their RICU stay, and 9 patients required invasive mechanical ventilation at home after their discharge. The total length of RICU stay was 38+/-14 days for patients in group A versus 33.2+/-11 days for those in group B. Most patients from both groups regained the ability to walk, either unaided or aided. At discharge, 6 MWD results were significantly improved (p < .001) in Group A only. MIP improved in Group A only (p < .05), while VAS scores improved in both groups, but the improvement was more marked in group A (p < .001) than in group B (p < .05). CONCLUSIONS: COPD patients who were admitted to a RICU in critical condition after an episode of acute respiratory failure and who, in most cases, required mechanical ventilation benefited from comprehensive early pulmonary rehabilitation, compared with patients who received standard medical therapy and progressive ambulation. 相似文献
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JJ Rodríguez Mondéjar JF Díaz Chicano R Martín Lozano J Sánchez Ruiz RM Jorge Guillén FC Carrión Tortosa 《Canadian Metallurgical Quarterly》1998,9(2):42-50
Withdrawal from drugs currently is and interesting topic because of the repercussions it has on different aspects of life, particularly: health, work, family and social relationships, etc. In this article we report a new system for minimizing the adverse effects of withdrawal from opiates (which usually are prolonged), and for carrying out withdrawal as quickly and effectively as possible. A protocol is described in detail, as well as special nursing care. This protocol is called ultrashort withdrawal (24 hours) and it has been developed and used in the intensive care department of the General University Hospital of Murcia (Spain), in collaboration with the center's hospital detoxification unit. 相似文献
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The needs of relatives during the patient's stay in intensive care following routine cardiac surgery
E Blackmore 《Canadian Metallurgical Quarterly》1996,1(5):230-236
The review outlines and discusses the original study carried out by Molter (1979) which explored the needs of relatives in the intensive care setting. It explores studies which have replicated and developed the knowledge generated by Molter's study in both USA and UK. The needs of relative are endless and individual and must be set within the context of the family. There appears to be some dissonance between relatives' perceptions of their needs and nurses understanding and ability to meet their needs. Communication and creation of a therapeutic relationship between nurses and relatives is fundamental to the provision of holistic care. There are few studies which have focused on relatives within the cardiothoracic intensive care setting. 相似文献
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P Hanson A Dive JM Brucher M Bisteau M Dangoisse T Deltombe 《Canadian Metallurgical Quarterly》1997,20(11):1371-1380
Several recent studies have attributed the occurrence of acute myopathy in intensive care unit patients to the combination of corticosteroids and neuromuscular junction blocking agents (NMBAs) used for mechanical ventilation. We present 4 patients who developed acute myopathy after administration of high doses of glucocorticoids during sedation with propofol without any NMBAs. All patients had elevated creatine kinase levels. Electrophysiological studies indicated normal motor and sensory nerve conduction velocities but reduced motor nerve response amplitudes. Needle electromyography identified abnormal spontaneous activity; motor unit potentials were polyphasic of low amplitude and short duration, characteristic of a myopathic process. Muscle biopsy demonstrated a prominent acute necrotizing myopathy in all 4 patients with a loss of thick filaments. Our observations support glucocorticoids rather than NMBAs as the main offending drug in acute corticosteroid myopathy. The predisposing factor should be the hypersensitivity of paralyzed muscles to corticosteroids regardless of the drug inducing paralysis: NMBAs or propofol. 相似文献
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The purpose of this study was to analyse the contribution of the Extension Courses in the Intensive Care held at the Nursing School from USP, with the aim to: 1) Follow up nurses in their work at the ICU. 2) Evaluate the contribution offered by the course. The population was formed by 38 nurses, considering that 60.5% didn't work in the ICU anymore mainly because they assumed another function in the institution and had several private problems. Regarding the contribution offered by the course, the main evaluation was the acquirement of knowledge (91.7%). However, 74.2% of the nurses declared the course didn't contribute to the increase of their wage, what do not impair them from investing in their professional improvement. 相似文献
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This article describes in short sections the use and interpretation of indirect blood pressure measurements, central venous pressure, body temperature, pulse oximetry, end tidal CO2 measurements, pulse and heart rate, urine production and emergency laboratory values. Most of these parameters are directly or indirectly linked to the perfusion of the patient. Optimizing these values are one of the most important goals in emergency and critical care medicine. 相似文献
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BACKGROUND: Pathophysiologic events in biological tissue are characterized by a shift of the electrical impedance spectra of the tissue under study. OBJECTIVE: To discuss studies on experimental skin reactions with an improved impedance spectrometer. The instrumentation is related to noninvasive techniques based on other physical principles. METHODS: The results from studies on patients with allergic contact reactions (n = 8), prick tests (n = 10), and irritant contact reactions (benzalkonium chloride [n = 14], sodium lauryl sulfate [n = 12], and nonanoic acid [n = 14]), and an appropriate number of controls are reviewed. RESULTS: Results show statistically significant changes of the impedance parameters when compared with relevant controls, at different types of experimental cutaneous reactions, both allergic and irritant type. Each reaction type had a specific impedance index pattern. CONCLUSIONS: Current data indicate that the improved impedance technique offers a possible noninvasive alternative for characterization and perhaps differentiation, not only between the skin responses induced by either an allergen or an irritant, but also a capability to distinguish responses induced by chemically different irritants. The assumption that the impedance method is capable to distinguish allergic from irritant contact reactions has not been proven yet in direct comparative studies. 相似文献
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