What's best for croup?

A single dose of corticosteroids is the first-line treatment for croup, resulting in fewer return visits and hospital admissions, shorter lengths of stay in the emergency department (ED) or hospital, and less need for supplemental medication (strength of recommendation [SOR]: A, meta-analysis and randomized controlled trials [RCTs]). A 0.15 mg/kg dose of oral dexame thasone is as effective as larger doses (SOR: B, small RCTs). Nebulized racemic or L-epinephrine reduces severity of symptoms in moderate-to-severe croup (SOR: C, limited-quality disease-oriented evidence). The role of heliox in moderate to severe croup remains uncertain. Studies to date have been inadequate (SOR: C, limited-quality disease-oriented evidence). Humidified air provides no demonstrable benefit in the acute setting (SOR: A, meta-analysis)

Lineare Programmierung mit What's Best

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Focus on buy-in might be the reason your change efforts keep failing

It's as if only managers could identify what's best for the organisation and everyone else just had to agree - by Polly Pasco

Menstrual disturbances in perimenopausal women: What's best?

It's best to start with nonsteroidal anti- inflammatory drugs (NSAIDs), which effectively reduce heavy menstrual bleeding (strength of recommendation [SOR]: B, systematic review of randomized clinical trials [RCTs]). Perimenopausal women with heavy bleeding not controlled by NSAIDs, or other forms of dysfunctional uterine bleeding, can benefit from continuous, combined hormonal therapy with estrogen and progestin; hormonal therapy with estrogen and a cyclical progestin; or a cyclical progestin alone (SOR: B, RCTs and a systematic review of RCTs). Intrauterine devices (IUDs) containing levonorgestrel also effectively reduce bleeding and may avoid surgical intervention (SOR: B, systematic review of RCTs)

What's best when a patient doesn't respond to the maximum dose of an antidepressant?

Consider possible causes of the inadequate response, then weigh treatment options in light of the characteristics of the individual patient and therapy. When managing a patient with nonpsychotic depression and inadequate response to the maximum dose of a single antidepressant, the physician should first identify factors that may contribute to the poor response, such as suboptimal dosage resulting from nonadherence, inadequate duration of therapy, and comorbid medical and psychiatric conditions (strength of recommendation [SOR]: C, expert opinion)

Premedication before euthanasia : what's best for the cat?

Ordet eutanasi (avlivning) kommer från grekiskans eu som betyder god och thanatos som betyder död och att den sista stunden i ett älskat sällskapsdjurs liv ska vara just god är nog de flesta överens om. När det gäller avlivning av katt i Sverige skiljer sig tillvägagångsättet mellan veterinärer angående sedering innan avlivning samt hur man tillför avlivningsvätskan (intravenöst, intraperitonealt eller intrakardiellt). Sedering innan injektion av avlivningvätska bidrar i många fall till en lugnare avlivningssituation men kan även medföra negativa effekter såsom illamående och minskat blodtryck med svårighet att anlägga en intravenös kanyl som följd. Enligt riktlinjer för avlivning av djur bör veterinären sträva efter att avlivningen ska ske snabbt, smärtfritt och utan stress eller obehag för djuret. Då illamående får antas orsaka en viss grad av stress och obehag hos katten, är det därför intressant att undersöka om någon av de sederingskombinationer som används till katt i idag är bättre eller sämre ur denna aspekt. Innan detta examensarbete påbörjades ställdes i Facebook-forumet ”Veterinärmedicin smådjur” frågan om vad man helst ger som sedering till katt innan avlivning samt vilket sätt avlivningsvätskan administreras på. Tillsammans med en sökning på liknande frågor i samma forum samlades 33 svar in och de tre vanligaste preparatkombinationerna var medetomidin-butorfanol, medetomidin-butorfanol-acepromazin och en mix av tiletamin-zolazepam-xylazin-butorfanol. Dessa tre preparatkombinationer i de vanligaste angivna doserna, valdes att ingå i följande studie och jämfördes i huvudsak avseende illamående. 21 privatägda katter som skulle avlivas av olika skäl ingick i studien. Katterna delades in i 3 grupper med 7 katter i varje grupp där varje grupp fick en av de tre möjliga preparatkombinationerna som premedicinering innan avlivning. Sederingen injicerades subkutant och katten observerades efteråt avseende reaktion på subkutan injektion, salivering, smackning, vokalisering, kräkning, hässjning, reaktion på kanylläggning, reaktion på pentobarbitalinjektion, agonala suckar samt muskelaktivitet postmortem. Ingen statistisk signifikant skillnad kunde ses mellan de olika grupperna vad gällde tecken på illamående (salivering, smackning, vokalisering eller kräkning) men 86 % av katterna i studien oavsett grupp, uppvisade något av dessa beteenden. Slutsatsen för detta arbete är att flera alternativa premedicineringsprotokoll eller alternativ till sedering/anestesi till katt innan avlivning som ger mindre negativa effekter såsom illamående, behöver undersökas.The word euthanasia comes from the Greek eu, meaning good and thanatos meaning death and most people would probably agree to that the last moment of a beloved pet's life should be good. When it comes to euthanasia of cats in Sweden, the approach between veterinarians differs regarding sedation prior to euthanasia, and the route of administration of the euthanasia drug (intravenous, intraperitoneal or intracardiac). Sedation before injection of the euthanasia drug contributes in many cases to a more peaceful euthanasia situation, but can also have negative effects such as nausea and decreased blood pressure with difficulty to place an intravenous catheter as a result. According to the guidelines for the euthanasia of animals, the veterinarian should aim for a euthanasia procedure performed quickly, painlessly and without stress or discomfort to the animal. Because nausea may be assumed to cause some degree of stress and discomfort to the cat, it is interesting to investigate whether any of the sedation combinations used to the cat, is better or worse from this point. Before this project started, a question was posted in the Facebook community “Veterinary Medicine Small Animal” what kind of sedation they give cats prior euthanasia and how the euthanasia drug is usually administered. Together with a search on similar issues in the same forum, 33 responses were gathered. The three most commonly used premedication combinations were medetomidine-butorphanol, medetomidine-butorphanol-acepromazine and a mix of tiletamine-zolazepam-xylazine-butorphanol. These three premedication combinations at the most commonly reported dosages were chosen to be part of the following study and compared primarily with respect to nausea. 21 privately owned cats who were to be euthanised for various reasons, were included in the study. The cats were divided into 3 groups of 7 cats in each groups, each group received one of the three possible combinations of premedication before administration of the pentobarbitone euthanasia preparation. Sedation was injected subcutaneously and the cat was observed afterwards regarding response to subcutaneous injection, salivation, licking, vocalization, vomiting, panting, reaction to placement of intravenous catheter, reaction to pentobarbital injection, agonal sighs and muscle activity postmortem. No statistically significant differences were seen between the groups regarding signs of nausea (salivation, licking, vocalization, or vomiting), but 86 % of the cats in the study, regardless of group, exhibited one or more of these behaviors. The conclusion of this work is that more sedation protocols or alternatives to sedation / anesthesia in cats prior to euthanasia, which produces less adverse effects such as nausea, need to be examined

HR Information Systems: Exploiting the Full Potential

[Excerpt] Human resource management has always faced a fundamental paradox: Top managers in any company will readily agree that the people are the keys to success, but few believe they know whether their people are well managed or if they are prepared to fortify and enhance the transformations facing the organization. The information tools applied to the employees of an organization pale by comparison with the tools used to analyze markets, financial resources and production design

No, Education Isn\u27t the Civil Rights Issue of Our Time

George W. Bush said it as he warned us about the soft bigotry of low expectations. Barack Obama said it. So did Mitt Romney, Arne Duncan, and John McCain. And now Donald Trump is saying it, too. In his first joint-session address to Congress, President Trump promised that our children will grow up in a nation of miracles and added the familiar kicker: Education is the civil rights issue of our time. He said it right before he announced his plan to ask Congress to pass new legislation supporting school choice. His idea of a school reform miracle, apparently, is to convince America to accept choice, rather than equity, as the controlling idea in public education. (excerpt

The Rockefeller Foundation Infrastructure Survey

Summarizes survey findings with respect to voters' views on the need for bipartisanship to address the nation's decaying transportation infrastructure; top priorities for investments; ways to pay for them; and reforms in spending by political affiliation