early goal directed therapy to improve renal outcome

... department; EGDT, early goal- directed therapy; HDU, high dependency unit; ICU, intensive care profile unit; IV, intravenous; NFR, not for resuscitation; SIRS, systemic inflammatory response syndrome ... quality improvement measure Accordingly, we sought to obtain institution-specific baseline information relevant to EGDT and studied the incidence and outcome of septic patients admitted to hospital ... cohort medical records were retrieved to obtain data on history, vital signs, laboratory results, treatment and details of outcome using the central laboratory database, the ICU patient information...

Ngày tải lên: 12/08/2014, 23:23

... blockade of luminal proton secretion using histamine receptor antagonists or proton pump inhibitors The need to use pharmacologic therapy adds to the cost and complexity of the monitoring strategy Second, ... abdominal, or orthopedic surgery to placement of a PAC or a CVP catheter In the patients assigned to receive a PAC, physiologic goal- directed therapy was implemented by protocol There were no differences ... on this basis, improve outcome for patients The stomach, however, may not be an ideal location for monitoring tissue PCO2 First, carbon dioxide can be formed in the lumen of the stomach when hydrogen...

Ngày tải lên: 12/08/2014, 22:22

... PE, Sibbald WJ: Effect of stored-blood transfusion on oxygen delivery in patients with sepsis JAMA 1993, 269: 3024-3029 11 Rhodes A, Bennett ED: Early goal- directed therapy: an evidence-based ... G, Tweeddale M, Schweitzer I, Yetisir E, The Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group: A multicenter, randomized, controlled clinical...

Ngày tải lên: 12/08/2014, 22:22

... bleed • Goal Directed Therapy has been shown to improve outcome when commenced before surgery, but this approach has proved impractical • This study suggests that post-operative Goal Directed Therapy ... index for goal- directed therapy and control groups durOxygen8-hour study period ing the 8-hour study period Results are means ± SEM DO2I, oxygen delivery index; GDT, goal- directed therapy R690 ... value (%) ICU, intensive care unit GDT, goal- directed therapy not possible In addition, the use of lithium indicator dilution and pulse power analysis to measure cardiac output obviates the need...

Ngày tải lên: 12/08/2014, 23:20

... interval; DD ESRD = dialysis dependent end stage renal disease; ED = emergency department; EGDT - early goal directed therapy; RR = respiratory rate; SBP = systolic blood pressure; SOFA = sequential organ ... 0.35 to 0.87) Initial SOFA score was a predictor of one year mortality; however, other factors such as dialysis dependent end-stage renal disease and corticosteroid treatment were not predictors ... 36:296-327 Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early goal- directed therapy in the treatment of severe sepsis and septic shock New Engl J Med 2001,...

Ngày tải lên: 13/08/2014, 19:20

... principles to influence human behavior to improve health or benefit society You don’t have to be a marketing expert to integrate social marketing into your public health practice, but it helps to understand ... is to determine: ® How to cluster your target audience into useful segments ® Which target audience segments are most ready to change their behavior ® What they want or need most in order to ... nonsmokers believe and think about tobacco use and exposure to secondhand smoke The agency also should have the ability to be responsive to, and flexible within, the changing tobacco environment If they...

Ngày tải lên: 18/02/2014, 02:20

... language, to the increasing range of actors involved in health Health systems are clearly a means to an end, not an end in themselves There needs to be a focus on providing support to countries ... major obstacles to scaling-up, and are prepared to commit significant funds to overcome them By engaging early on, with several departments working together, WHO has been able to shape the new ... SO8 To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health SO9 To improve...

Ngày tải lên: 06/03/2014, 21:20

... and shuffled to produce a mutant library, the members of which were then monitored for their ability to confer increased TMP resistance when fused to DHFR The genes corresponding to resistant ... ligand to a residue that is unlikely to bind metal The G270V residue is located next to a metal-binding residue ) this mutation is likely to cause a conformational change that is likely to further ... overexpression in soluble form will lead to TMP resistance However, if the fusion construct is insoluble, E coli will be susceptible to the inhibitor In order to increase solubility, the target gene...

Ngày tải lên: 23/03/2014, 07:20

... infrastructure exists, a top priority goal for all governments should be to (re)-align the regulatory and pricing policy of the telecommunications sector with health policy goals Use of various information ... group, HbA1c improved from 0.106 to 0.092 (13.20%) The control group improved from 0.112 to 0.102 (8.9%) No significant change in weight, random blood glucose, or insulin [14] Compared to no counselling, ... working with the WAP protocol to transmit blood chemistry data to clinic N = 12 Duration = months Wireless Application Protocol (WAP)based telemedicine system for patientmonitoring Feasibility study:...

Ngày tải lên: 11/08/2014, 18:20

... Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, the Early Goal- Directed Therapy Collaborative Group: Early goal- directed therapy in the treatment of severe sepsis and septic ... [16] 10 11 12 13 14 15 16 Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds M, Bennett D: Early goal- directed therapy after major surgery reduces complications and duration of hospital stay A randomised, ... delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery Br Med J 2004, 329: 258-261 Lang M, Niskanen M, Miettinen P, Alhava E, Takala J: Outcome and resource...

Ngày tải lên: 12/08/2014, 23:21

... vasoconstrictors such as noradrenaline, angiotensin II and endothelin-1, to maintain basal vascular tone [8] The relative change in the balance between vasoconstrictors and vasodilators may also ... the prevention of circulatory dysfunction [6] A not too dissimilar result has been achieved using vasoconstrictors and albumin prior to transjugular intrahepatic portosystemic stent shunt insertion ... interfere with renal blood flow autoregulation, causing increasing dependence of the renal blood flow on the renal perfusion pressure [3] The suggested improvement in renal perfusion pressure observed...

Ngày tải lên: 13/08/2014, 10:20

... group Melatonin group Difference P value of the difference 0.26 (0.17 to 0.36) 0.39 (0.27 to 0.51) 0.12 (-0.02 to 0.27) 0.09 Actigraphy 0.75 (0.67 to 0.83) 0.73 (0.53 to 0.93) -0.02 (-0.24 to 0.20) ... Nurse assessment 0.51 (0.35 to 0.68) 0.45 (0.26 to 0.64) -0.06 (-0.29 to 0.17) 0.58 Patient assessment (RCSQ) 0.50 (0.43 to 0.58) 0.41 (0.24 to 0.59) -0.09 (-0.28 to 0.09) 0.32 Primary analysis ... short-term melatonin administration [35] Melatonin treatment appeared to be well tolerated in our patients, with only one patient reporting a single episode of headache Melatonin appeared to be rapidly...

Ngày tải lên: 13/08/2014, 10:20

... formally evaluated in a GDT manner How to perform goal directed therapy in highrisk surgical patients Monitoring The first and most common step in GDT is to ensure that the circulating volume ... volume or cardiac output These can be used either to predict a patient likely to respond to a volume challenge or to carefully monitor the response to a fluid bolus This therefore provides a sophisticated ... sufficient to achieve goals of CO and DO2, and GDT using just fluids has been shown to improve outcome in certain groups of surgical patients [31,48,49] Often fluids may not be sufficient to achieve...

Ngày tải lên: 13/08/2014, 19:20

... important to consider the DO2 -to- O2 consumption (VO2) relationship than to indicate a specific value of DO2 as a goal [10] To this end, Donati and colleagues [7] demonstrated improved outcome in ... contributor to patient monitoring In critical illness, however, the ability of tissue to increase ERO2 might be impaired, and ‘normalized ScvO2’ would lose its ability to guide fluid or inotrope therapy ... protocols, as has been done in critical illness such as severe sepsis [12,15], before being considered eligible tools for high-risk surgery In total, we believe it would be more rational to apply...

Ngày tải lên: 13/08/2014, 21:21

... improve outcome [1,2] Careful monitoring of fluid administration by individualized goal- directed therapy (GDT) has been shown to reduce organ failure and hospital stay [3-5] As a supplement to ... tissue hypoperfusion were shown to improve outcome during highrisk surgery • Central venous -to- arterial CO2 difference might serve as a complementary tool to ScvO2 to identify insufficient flow ... Hamilton M, Rhodes A: Clinical review: Goal- directed therapy in high risk surgical patients Crit Care 2009, 13:231 Giglio MT, Marucci M, Testini M, Brienza N: Goal- directed haemodynamic therapy...

Ngày tải lên: 13/08/2014, 21:21

... child care that can lead to improved child well-being and later outcomes.20 The building blocks of learning develop early, well before the elementary school years Access to early education has grown ... contributors to society Second, federal, state, and local budgets will improve significantly when governments can dedicate more of their resources to productive endeavors, rather than to remediation, ... education” (ECE) is used to describe classroom-based public and private early education programs for three- and four-year-olds Prekindergarten is used to refer to state-funded early education initiatives,...

Ngày tải lên: 20/02/2014, 20:20

... intent to prescribe to the disciplines what they need to teach but to supplement and enhance what currently exists • This package is not intended to be given to students, but used by educators to ... environmental factors prior to delivery • Babies and children: – Describe normal childhood development – Identify abnormal indicators early – Describe the factors that impact upon early childhood ... peritoneal dialysis and the work-up needs of patients planning to have renal transplants, sufficient to be able to advise or refer the patient appropriately – Record and report using local tools...

Ngày tải lên: 14/03/2014, 20:20

... opioid therapy from acute to chronic non-cancer pain; Assessing and monitoring opioid therapy for chronic non-cancer pain; and Tapering or discontinuing opioids if an opioid trial fails to yield improvements ... time intervals to monitor treatment Once a decision is made to institute chronic opioid therapy, the prescriber is responsible for routinely monitoring the safety and effectiveness (improved function ... easy -to- use tools are recommended for their clinical utility in screening opioid therapy patients (The following screening tools are available in Appendix B.) Opioid Risk Tool (ORT)22 Purpose: to...

Ngày tải lên: 22/03/2014, 16:21

... Improving Robot-Assisted Therapy New Ideas for Improving Robot-Assisted Therapy In improving robot-assisted therapy to improve carryover after stroke new methods have sought to modify the environment ... distortion technique that uses error magnification to improve motor performance of a pinching task (index finger and thumb movements) Their results provide a new method to deal with compensatory ... best to implement trajectory planning for an Activity of Daily Living (ADL)-oriented approach to robot-assisted therapy with the goal of improving the ability of the ADL Exercise Robot (ADLER) to...

Ngày tải lên: 19/06/2014, 10:20

... respiratory drive parameters have been found to improve markedly after weight loss [17] The locoregional therapy protocol we implemented was chosen on the basis of evidence that combination therapy ... the decision was made to proceed with extended right hepatectomy to remove segments IV, V, VI, VII, and VIII after right portal vein embolization (PVE) to allow compensatory hypertrophy of segments ... weight The patient was also instructed to enroll in an aerobic and resistance exercise program in an attempt to improve her metabolic syndrome The treatment protocol consisted of weekly injections...

Ngày tải lên: 09/08/2014, 07:21