278 research outputs found
Skylab missions SL-1/SL-2, SL-3, and SL-4 hydrogen, and helium
Cryogenic boiling heat transfer for oxygen, nitrogen, hydrogen, and helium fluids - free and forced convection boiling method
Effects of antithrombin III (ATIII) treatment (high dose) in severe pre-eclampsia and HELLP syndrome with alterations of coagulation inhibitors and inflammatory markers: a preliminary report
Opioid use and effectiveness of its prescription at discharge in an acute pain relief and palliative care unit
The aim of this study was to present how opioids
are used in an acute pain relief and palliative care unit
(APRPCU), where many patients with difficult pain conditions
are admitted from GPs, home palliative care programs,
oncology departments, other hospitals or emergency units,
and other regional places. From a consecutive sample of
cancer patients admitted to an APRPCU for a period of
6 months, patients who had been administered opioids were
included in this survey. Basic information was collected as
well as opioid therapy prescribed at admission and, subsequently,
during admission and at time of discharge. Patients
were discharged once stabilization of pain and symptoms
were obtained and the treatment was considered to be optimized.
One week after being discharged, patients or relatives
were contacted by phone to gather information about
the availability of opioids at dosages prescribed at time of
discharge. One hundred eighty six of 231 patients were
specifically admitted for uncontrolled pain, with a mean
pain intensity of 6.8 (SD 2.5). The mean dose of oral
morphine equivalents in patients receiving opioids before
admission was 45 mg/day (range 10–500 mg). One hundred
seventy five patients (75.7 %) were prescribed around the
clock opioids at admission. About one third of patients
changed treatment (opioid or route). Forty two of 175
(24 %), 27/58 (46.5 %), 10/22 (45.4 %), and 2/4 (50 %)
patients were receiving more than 200 mg of oral morphine
equivalents, as maximum dose of the first, second, third, and
fourth opioid prescriptions, respectively. The pattern of
opioids changed, with the highest doses administered with
subsequent line options. The mean final dose of opioids,
expressed as oral morphine equivalents, for all patients was
318 mg/day (SD 798), that is more than six times the doses
of pre-admission opioid doses. One hundred eighty six
patients (80.5 %) were prescribed a breakthrough cancer
pain (BTcP) medication at admission. Sixty five patients
changed their BTcP prescription, and further 27 patients
changed again. Finally, eight patients were prescribed a
fourth BTcP medication. Of 46 patients available for interview,
the majority of them (n=39, 84 %) did not have
problems with their GPs, who facilitated prescription and
availability of opioids at the dosages prescribed at discharge.
For patients with severe distress, APRPCUs may
guarantee a high-level support to optimize pain and symptom
intensities providing intensive approach and resolving
highly distressing situations in a short time by optimizing
the use of opioids
Should we continue to use prediction tools to identify patients at risk of Candida spp. infection? If yes, why?
We read with interest the article from Shanin et al. about the Fungal Infection Risk Evaluation (FIRE) study [1] aiming to 'describe the incidence of IFD in UK critical care units and to develop and validate a clinical risk prediction tool to identify non-neutropenic, critically ill adult patients at risk of IFD'. The investigators should be congratulated for the way they collected a huge amount of data from 96 adult intensive care units (ICUs), managed the FIRE database, and developed and validated the risk model. However, they stated that the prediction model would help to identify patients who may benefit from antifungal prophylaxis and that a number of randomized controlled trials (RCTs) demonstrated a beneficial effect of antifungal prophylaxis and/or empiric treatment in terms of incidence of invasive fungal disease (IFD) and mortality. This statement is not supported by available evidence from RCTs. A recent Cochrane Systematic Review including 22 RCTs evaluating prophylaxis, pre-emptive, and empiric antifungal treatment with any antifungal drugs in 2761 non-neutropenic critically ill patients showed no significant effect on mortality (risk ratio (RR) 0.93, 95 % confidence interval (CI) 0.79 to 1.09) and a significant reduction in the risk of invasive fungal infection (IFI) (RR 0.57, 95 % CI 0.39 to 0.83) [2, 3]. In the subgroup analysis for type of intervention, antifungal prophylaxis was not associated with a significant mortality reduction but with a significant reduction of IFI [4]. This systematic review was the update of the one cited in the manuscript and published in 2006 including 12 RCT and 1606 patients
Tapentadol in cancer pain management: a prospective open-label study.
OBJECTIVES:
The aim of this prospective, open-label study was to evaluate the efficacy and tolerability of tapentadol (TP) in the management of cancer pain.
METHODS:
A 4 weeks' prospective study was carried out in 50 opioid-naive cancer patients with moderate-severe pain. Each patient initially received twice-daily doses of slow-release TP 50 mg. Doses were then managed to maintain adequate relief or dose-limiting toxicity, on the basis of the clinical response. The following parameters were recorded at weekly intervals for 4 weeks: pain and opioid-related adverse effects, quality of life measured with the Spitzer score, TP escalation index percent (TPEI%) and TP escalation index in mg (TPEImg), calculated at the end of the study, pain mechanisms, and PainDETECT at baseline.
RESULTS:
Of 50 patients, 39 completed the entire study and 11 discontinued the treatment for different reasons. Pain intensity significantly decreased from baseline to all the week intervals (p < 0.0005), and adverse effects did not changed significantly, while quality of life improved. TP escalation indexes were low and no relationship was found with age, gender, and pain mechanisms.
CONCLUSION:
Tapentalol started in doses of 100 mg/day was well-tolerated and effective in opioid-naive patients with cancer pain, regardless of the pain mechanism. It can be considered as a flexible drug to be used in patients with moderate-severe pain.
LIMITATIONS:
This was an open-label study for exploratory purposes. Data should be confirmed in controlled studies with a larger number of patient
A perioperative uncontrollable bleeding in an elderly patient with acquired hemophilia A: a case report
Acquired hemophilia A should be taken into account in the differential diagnosis of perioperative bleeding in patients without any apparent reason for activated partial thromboplastin time prolongation
Use of Cepheid Xpert Carba-R\uae for Rapid Detection of Carbapenemase-Producing Bacteria in Abdominal Septic Patients Admitted to Intensive Care Unit.
Abstract
Early institution of effective antibiotic therapy and source control are pivotal to improve survival of abdominal septic patients. Xpert\uae Carba-R is a real time polymerase chain reaction assay for rapid detection and differentiation of five genes (blaKPC, blaVIM, blaOXA-48, blaIMP-1, blaNDM) responsible for carbapenem resistance. We performed an observational study investigating the clinical usefulness and applicability of Xpert\uae Carba-R to detect carbapenem resistance in abdominal septic patients admitted to intensive care unit. We compared the results of Xpert\uae Carba-R with standard microbiological culture. We collected a set of two rectal/stomia swabs and two swabs from abdominal drainage fluid for each patient. We included 20 patients for a total of 45 comparisons between the two methods. In our clinical setting, the overall performance of Xpert\uae Carba-R for detection of carbapenem resistance in the presence of genes detectable and non-detectable by the method was: sensitivity 50% (95% CI 24.6-75.3); specificity 93.1% (95% CI 77.2-99.1); positive predictive value (PPV) 80% (95% CI 44.4-97.5); negative predictive value (NPV) 77.1% (95% CI 56.9-89.6). The inter-rater agreement was 0.47 (SE 0.14; 95% CI 0.20-0.74). When considering the only 5 mechanisms of resistance detected by both methods, the overall diagnostic performance was: sensitivity 100% (95% CI 69.1-100), specificity 94.2 (95% CI 80.8-99.3), PPV 83.3 (95% CI 59.6-97.9) and NPV 100% (95% CI 89.4-100). The inter-rater agreement was 0.88 (SE 0.08; 95% CI 0.71-1). Xpert\uae Carba-R may be considered an additional diagnostic tool for early diagnosis of carbapenem resistance in abdominal septic patients. Clinicians should be aware of their epidemiology before its introduction in the diagnostic protocol of their intensive care units
Ventilator-associated pneumonia in patients with covid-19: A systematic review and meta-analysis
The aim of this systematic review and meta-analysis was to estimate the pooled occurrence of ventilator-associated pneumonia (VAP) among patients admitted to an intensive care unit with COVID-19 and mortality of those who developed VAP. We performed a systematic search on PubMed, EMBASE and Web of Science from inception to 2nd March 2021 for nonrandomized studies specifically addressing VAP in adult patients with COVID-19 and reporting data on at least one primary outcome of interest. Random effect single-arm meta-analysis was performed for the occurrence of VAP and mortality (at the longest follow up) and ICU length of stay. Twenty studies were included in the systematic review and meta-analysis, for a total of 2611 patients with at least one episode of VAP. The pooled estimated occurrence of VAP was of 45.4% (95% C.I. 37.8–53.2%; 2611/5593 patients; I2 = 96%). The pooled estimated occurrence of mortality was 42.7% (95% C.I. 34–51.7%; 371/946 patients; I2 = 82%). The estimated summary estimated metric mean ICU LOS was 28.58 days (95% C.I. 21.4–35.8; I2 = 98%). Sensitivity analysis showed that patients with COVID-19 may have a higher risk of developing VAP than patients without COVID-19 (OR 3.24; 95% C.I. 2.2–4.7; P = 0.015; I2 = 67.7%; five studies with a comparison group)
Procalcitonin levels in candidemia versus bacteremia: A systematic review
Background: Procalcitonin (PCT) is a biomarker used to assess systemic inflammation, infection, and sepsis and to optimize antimicrobial therapies. Its role in the in the differential diagnosis between candidemia and bacteremia is unclear. The aim of this systematic review was to summarize the current evidence about PCT values for differentiating candidemia from bacteremia. Methods: PubMed and EMBASE were searched for studies reporting data on the diagnostic performance of serum PCT levels in intensive care unit (ICU) or non-ICU adult patients with candidemia, in comparison to patients with bacteremia. Results: We included 16 studies for a total of 45.079 patients and 785 cases of candidemia. Most studies claimed to report data relating to the use of PCT values for differentiating between candidemia and bacteremia in septic patients in the intensive care unit. However, the studies identified were all retrospective, except for one secondary analysis of a prospective dataset, and clinically very heterogeneous and involved different assessment methods. Most studies did show lower PCT values in patients with candidemia compared to bacteremia. However, the evidence supporting this observation is of low quality and the difference seems insufficiently discriminative to guide therapeutic decisions. None of the studies retrieved actually studied guidance of antifungal treatment by PCT. PCT may improve diagnostic performance regarding candidemia when combined with other biomarkers of infection (e.g., beta-D-glucan) but more data is needed. Conclusions: PCT should not be used as a standalone tool for the differential diagnosis between candidemia and bacteremia due to limited supporting evidence
Opioid switching from and to tapentadol extended release in cancer patients: conversion ratio with other opioids
Objectives:
The aim of this exploratory study was to assess the conversion ratios between tapentadol and other opioids in patients requiring an opioid switching.
Methods:
A prospective study was carried out in a convenience sample of consecutive patients admitted to an acute palliative care unit and a home care unit for a period of 1 year. Patients who were switched from/to tapentadol were selected. The initial ratio between tapentadol and other opioids, expressed as oral morphine equivalents was 1:3.3. The subsequent doses were flexible and were changed to fit the patients’ needs. Pain intensity and distress score were recorded until opioid doses were stable. In all, 37 patients were examined; 24 and 13 patients were switched from and to tapentadol, respectively.
Results:
The most frequent sequences were tapentadol–morphine (18 patients) in one direction, and morphine–tapentadol (8 patients) in the other direction. In the sequence tapentadol–morphine and morphine–tapentadol, the mean final tapentadol–morphine ratios were 3.9:1 (SD 2.3), and 1:4.5 (SD 3.2), respectively, which did not differ significantly from the initial established conversion ratio. A minority of patients were switched from/to tapentadol to/from other opioids. Globally, the initial ratio did not change after switching took place.
Conclusion:
Data suggest that a conversion ratio between tapentadol and other opioids, expressed in oral morphine equivalents could be 1:3.3 in both direction, particularly in patients who are switched in conditions of equianalgesia. The limited number of patients prevents a definitive conclusion to be drawn, and data should be interpreted with caution, given the exploratory nature of the study and the question of the low number of patients should be addressed in future studie
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