bluuebunny/crossref_metadata_2025 huggingface dataset:
Making the Studio Experience Work for Part-Time Students
Authors: Greene Sherwin
Published: November 2015

Most planning students now bring few, if any, graphic or design skills to graduate school. To maximize educational value from the experiential studio experience, students first need to develop a basic level of competence in physical planning. This is also essential preparation for coordinating the efforts of other design professionals and managing the comprehensive planning process. This paper suggests objectives and requirements for an initial studio course to help meet these needs for both full-time and part-time students.
Suburban Employment Centers: Probing the Influence of Site Features on the Journey-to-Work
Authors: Cervero Robert
Published: November 2015

This paper argues that the low-density, single-use character of most suburban workplaces in the U.S. has contributed to worsening traffic congestion by making most workers highly dependent on their own automobiles for accessing jobs. To test this proposition, land use and transportation data are examined for fifty of the largest suburban employment centers in the nation. Differences in the share of trips made by various modes, commuting speeds, and levels of service on major thoroughfares connecting suburban centers are compared among clusters of centers. The densities, sizes, and land use mixtures of suburban workplaces are generally found to be important determinants of worker travel behavior and local traffic conditions.
Thrombocytopenia and Critical Care Medicine
Authors: Gelinas Jean-Pierre , Stoddart Lanu V. , Snyder Edward L.
Published: November 2015

Platelet transfusions play an important role in the treatment of critically ill patients. Like any blood component, however, there are various aspects of platelet transfusion therapy that need be considered by the intensivist. These include the proper dose and type of platelet component to infuse, as well as the route and method of administration. Methods to reduce the volume of the transfused platelets, for example, must ensure that the infused platelets will be functional and viable, posttransfusion. Treatment and diagnosis of the HLA alloimmunized recipient can pose a serious challenge to the clinician and an obstacle to adequate platelet therapy. An ICU patient for whom an adequate posttransfusion platelet increment cannot be achieved is at great risk of suffering a fatal hemorrhage. The ICU physician should be aware of the techniques used in modern transfusion practice to avoid having to deal with this complication. Adverse reactions to platelet transfusion include not only serologic ones, but those related to febrile and allergic complications, as well as infectious complications. The latter group includes diseases caused by infection with cytomegalovirus, bacteria, and a cadre of viruses including HIV and hepatitis. The clinical approach to thrombocytopenia in the ICU will be covered in some detail in an effort to review many of the conditions associated with recipient thrombocytopenia, including ITP, TTP, dilutional thrombocytopenia, DIC, surgery, HELLP syndrome, and drug-induced thrombocytopenia. Unfortunately the treatment approaches traditionally used are not always derived from evidence-based studies. This review covers many of these topics in an attempt to help physicians become better able to manage thrombocytopenia in the ICU and thus provide the best transfusion therapy for their patients.
Syndromes of Acute Left Ventricular Failure
Authors: McDonald Kenneth M. , Francis Gary S.
Published: November 2015

The syndrome of acute left ventricular failure, manifesting as pulmonary edema and/or cardiogenic shock, occurs in many different clinical settings, has many different causes, and variable treatment strategies. Most commonly it is seen as a complication of acute myocardial infarction where loss of myocardial tissue results in ineffective systolic performance of the left ventricle. Urgent percutaneous transluminal coronary angioplasty may have a significant impact on outcome in this setting. Other complicating events following myocardial infarction may also precipitate left ventricular failure including papillary muscle dysfunction and ventricular septal defect. The syndrome of acute left ventricular failure is also commonly seen in patients with chronic congestive cardiac failure whereby myocardial infarction, arrhythmia and even minor increases in salt intake can precipitate acute decompensation. Other conditions such as fulminant myocarditis, bacterial endocarditis and disease processes characterized by diastolic dysfunction can all cause acute left ventricular failure. Moreover, cardiac function may be depressed in septic shock by the presence of cardiodepressant factors. In summary, acute left ventricular failure is a syndrome with a diverse etiology. Specific diagnosis of the particular cause is crucial to appropriate management.
Psychosocial Effects of Cardiac Transplantation
Authors: Dressler Diane K.
Published: November 2015

As more cardiac transplant procedures are performed, the psychosocial implications of the procedure can be identified and investigated. The process of cardiac transplant can be viewed as a series of stages and adaptive tasks which begin with the proposal of transplant and progress to successful postoperative adaptation.

The suggestion of transplant may evoke feelings of anxiety and ambivalence as patients realize that transplant may be their only option for long-term survival. The evaluation process determines the need for transplant and whether there are circumstances that might limit post-transplant survival. Psychosocial evaluation is important as survival depends in part on the recipient's ability to cope with stressors and comply with a complex medical regimen. This evaluation is not standardized, and research continues to identify reliable predictors of postoperative behavioral and psychiatric complications.

The wait for a donor may be the most stressful of all stages as candidates deal with increasing symptoms, increasingly intensive medical management and the fear of a donor will not be found in time. Following successful surgery, heart recipients and their families express feelings of joy and relief. During convalescence, adjustment difficulties may arise in the form of transient depression or body image concerns. After recipients are discharged from the hospital, they must comply with intensive medical follow-up to monitor their health. They continue to be vulnerable to physical, emotional and financial problems. They need to develop a realistic acceptance of life as a transplant recipient and to suppress feelings of vulnerability in order to view their future positively. Emotional support through counseling and support groups can be helpful. Increased functional capacity following cardiac transplantation is well documented, but studies pertaining to quality of life have varying results. Health professionals continue to work collaboratively to improve quality of life after cardiac transplantation.
Multiple Organ Failure Syndrome—Part I: Epidemiology, Prognosis, and Pathophysiology
Authors: Heard Stephen O. , Fink Mitchell P.
Published: November 2015

The multiple organ failure syndrome (MOFS) is the leading cause of death in intensive care units. Although sepsis is an important cause of MOFS, it is clear that MOFS can occur in the absence of infection. The pathophysiology of MOFS is complex and multifactorial and includes derangements in oxygen delivery and consumption, the release of inflammatory and vasoactive mediators capable of inflicting tissue damage, and alterations in the barrier function of the intestinal mucosa. Although advances have been made in our understanding of MOFS, treatment remains nonspecific and largely supportive. Early and aggressive restoration of tissue perfusion, adequate treatment of infection, timely nutritional support, and support of individual failed organs remain the mainstay of therapy. Therapeutic agents directed against the various mediators associated with the pathophysiology of MOFS may prove useful in the future.
Reduced Mortality of Pneumococcal Bacteremia after Early Intensive Care
Authors: Franklin Cory , Henrickson Kerry , Weil Max Harry
Published: November 2015

The mortality of pneumococcal bacteremia has been constant at 25 to 45% over the past 25 years, approximately the same mortality that was reported at our hospital in 1974 prior to the opening of the intensive care unit (ICU). In an effort to identify the effect of care in the ICU, we analyzed outcomes in 150 consecutive cases of adult patients with pneumococcal bacteremia over a 27-month period, devoting special attention to severity of illness and timing of transfer to the ICU. Ninety-six (64%) patients were cared for outside the ICU (mean APACHE II score, 11; range, 0-29) and 54 (36) were cared for in the ICU (mean APACHE II score, 20; range, 5-38). Of the patients cared for in the ICU, 48 (89%) were admitted there within two days of hospital admission. In the entire series, there were 28 deaths (overall mortality, 19%); 6 deaths occurred outside the ICU (ward mortality, 6%), and 22 deaths occurred in the ICU (ICU mortality, 41%). Only 3 deaths (11%) occurred during the first 24 hours of hospitalization, the interval that has been associated with the greatest risk of death in prior reports. These data support our recent experience that care in the ICU has improved outcome for selected cases of pneumococcal bacteremia, especially if patients are admitted to the ICU without delay.
Transport of Critically Ill Patients
Authors: Fromm Robert E. , Dellinger R. Philip
Published: November 2015

Critically ill patients are transported within and between hospitals on a regular basis; thus, transport of the critically ill is a component of most intensivists-practice. The motivation for these transports lies in obtaining diagnostic or therapeutic services not available at the bedside (intrahospital transport) or not available in the sending institution (interhospital transport). Deterioration in respiratory, cardiovascular, and other physiological systems is a potential complication of any patient transport. Using appropriate equipment and personnel and planning for each transport can minimize these complications and ensure optimal benefit to the patient.
Sedation in Neonatal and Pediatric Intensive Care
Authors: Arnold John H. , Truog Robert D.
Published: November 2015

Despite the widespread use of potent sedative and analgesic agents in adult patients, it is remarkable that systemic analgesia and sedation have not been administered routinely to neonates and children until very recently. Adequate sedation and analgesia have historically been withheld from these patients because of the mistaken beliefs that pain perception was not fully developed and that these patients were much more prone to adverse effects of the most commonly used agents. There is now overwhelming evidence that pain perception and physiologic responses to stress are present in neonates of all gestational ages and a variety of effective sedative/analgesic agents have recently been added to the therapeutic armamentarium. We will outline the classes of agents currently available, briefly describe mechanisms of action and the relevant pharmacokinetic—pharmacodynamic parameters, summarize the short-term and long-term side effects following prolonged administration of these agents, and highlight practical considerations for the most commonly used sedative-analgesic medications.
Thrombolytic Therapy: A Comprehensive Review of Its Use in Clinical Medicine. Part II
Authors: Bell William R. , Streiff Michael B.
Published: November 2015

The second part of this comprehensive review of thrombolytic therapy in clnical medicien focuses on its use in a wide renge of thrombotic disorders, including pulmonary embolism, deep venous thrombosis, arterial thrombocmbolism, catheter-related thrombosis, arterial thrombocmbolism, catheter-relted thrombosis, and prosthetic valve occlusion. New experimental applications in the management of unstable angina and cerebrovascular disease are also discussed.
Complications of Laparoscopy and Thoracoscopy
Authors: Paw Patrick , Sackier Jonathan M.
Published: November 2015

Laparoscopy was first performed at the turn of the century, but it was not until the introduction of laparoscopic cholecystectomy that the procedure became widely adopted by general surgeons. Since then, traditional open procedures, including cholecystectomy, exploratory laparotomy, colectomy, hernia repair, and appendectomy, are being widely performed laparoscopically. The advantages of laparoscopic surgery, including less postoperative pain due to smaller surgical incisions, shorter hospital stay, quicker return to preoperative activity, and superior cosmesis, resulted in widespread popularity with both surgeons and patients. In certain situations, the traditional method may be superior to the laparoscopic approach, as may be the case with laparoscopic hernia repair. It is difficult to justify converting a local, extraperitoneal, 45-minute, outpatient inguinal hernia repair in a virgin groin into a general anesthetic, transperitoneal, 2-hour plus, possibly inpatient laparoscopic procedure with the implantation of mesh. However, data may indicate that this operation does indeed have benefits. We must, therefore, carefully study such new operations. With the advent of a new surgical procedure, both surgeons and anesthesiologists must be familiar with the various complications unique to this technique. If recognized early, potentially life-threatening complications, including gas embolization and tension pneumothorax, can be corrected.
Spinal Aspergillus Abscess in a Patient with Bronchocentric Granulomatosis
Authors: Collier Jack , Wolfe Robert , Lerner Roger , Nathan Steven , Mohsenifar Zab
Published: November 2015

Aspergillus fumigatus hyphae is often found in the lung tissue of patients with bronchocentric granulomatosis (BCG). This organism is believed to be one agent responsible for inciting the hypersensitivity response and subsequent development of the characteristic pathology that defines BCG. The definitive etiology of this disease, however, remains conjectural. Corticosteroids represent the mainstay of therapy. The fungi recovered from patients with BCG are considered noninvasive; thus, the risk of fungal invasion secondary to steroid-induced immunosuppression is believed to be negligible. However, we report a case of spinal aspergillus abscess that developed in a patient with BCG subsequent to steroid therapy. This case also highlights the necessity for aggressive medical and neurosurgical intervention to avert the development of neurological sequelae.
A Prospective Study of Continuous Venovenous Hemodiafiltration in Critically Ill Patients with Acute Renal Failure
Authors: Bellomo Rinaldo , Farmer Michael , Boyce Neil
Published: November 2015

We studied the biochemical and the clinical consequences of the application of continuous venovenous hemodiafiltration to the management of acute renal failure in critically ill patients. One hundred consecutive surgical and medical ICU patients with acute renal failure were entered into a prospective clinical study at an intensive care unit of tertiary institution. Intervention included assessment of illness severity by APACHE II score on admission and by organ failure score prior to initiation of renal replacement therapy; treatment of patients with continuous venovenous hemodiafiltration; and measurement of biochemical variables prior to and after therapy. Outcome assessment included incidence of complications, duration of oliguria, duration of intensive care and hospital stays, and survival to hospital discharge. Measurements and main results included the following: mean patient age was 60.9 years (range 21–81 yr); mean APACHE II score, 28.6 (95% confidence interval; 27.4-29.8); and number of failing organs, mean, 4.1 (95% confidence interval; 3.8-4.4). At commencement of continuous venovenous hemofiltration with dialysis, 79% of patients were receiving inotropic drugs and 72% were septic, and, in 35%, bacteremia or fungemia was demonstrated. Renal replacement therapy was applied for a mean duration of 186.2 hours (95% confidence interval; 149.2-223.7), with a mean hourly net ultrafiltrate production of 621 mL (95% confidence interval; 594–648) and a mean urea clearance of 28.1 mL/min (95% confidence interval; 26.7-29.5). Azotemia was controlled in all patients (plasma urea < 30 mmol/L). During the more than 18,000 hours of treatment, there was no therapy-associated hemodynamic instability. Complications were rare. They included two cases of hemofilter rupture with minor blood loss and a single case of bleeding at the site of the vascular-access catheter. Forty-three patients survived to ICU discharge, and 40 survived to hospital discharge. Continuous venovenous hemodiafiltration is a safe and an effective form of renal replacement therapy in critically ill patients. In such patients, who have a high predicted mortality rate, it was associated with a 40% survival rate. These findings suggests that continuous venovenous hemodiafiltration may be ideally suited to patients with multisystem organ failure with acute renal failure.
Morbidity and Mortality After Traumatic Pneumonectomy: The Effect of Compromised Oxygenation and Cardiac Function
Authors: Goins Wendell A.
Published: November 2015

I describe the pathophysiological and hemodynamic events that occur after an emergency pneumonectomy for trauma and how they impact on subsequent mortality. Four patients were identified as requiring an emergency right pneumonectomy for trauma at a level 1 Urban Trauma Center within a 39-month period. A retrospective review of their hospital course served as the basis for our analysis. Three patients sustained gunshot wounds and one patient was a victim of blunt trauma. Hemodynamic data were available for three patients who survived more than 24 hours. All patients presented in shock and required massive transfusion. One patient died in the operating room due to air embolism and shock. After pneumonectomy, there was an increase in pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) more than 2 times normal, which coincided with a decrease in stroke volume, cardiac output, and right and left ventricular stroke work (RVSW/LVSW). The RVSW gradually increased to above normal levels by postoperative day 5, whereas the LVSWI remained below normal. Adult respiratory distress syndrome (ARDS) developed in all patients early in the postoperative period. There was evidence of oxygen delivery (DO2) dependent of oxygen consumption (VO2) and the DO2 remained below normal despite inotrope administration. The remaining three patients died 7 to 13 days after surgery due to various combinations of ARDS, cardiac failure, and sepsis. Until we have better methods to decrease PAP selectively, traumatic pneumonectomy should be avoided if possible, especially when it involves the right side or is associated with a contralateral lung injury. Early operative intervention and control of the pulmonary hilum may lessen the severity of shock. The hemodynamic changes that occur after pneumonectomy for trauma becomes additive in the presence of ARDS. This combination results in inadequate cardiac function, oxygen transport, and, ultimately, death.
A Critique of the ACCP Consensus Conference on Mechanical Ventilation
Authors: Albert Richard K.
Published: November 2015

The American College of Chest Physicians recently published a statement summarizing the results of the Consensus Conference on Mechanical Ventilation ( Chest 1993; 104:1833-1859). In this statement, the physiology of mechanical ventilation was extensively reviewed, and 5 principles and 38 guidelines or recommendations on which consensus was reached were presented. The following critique (1) summarizes the findings of the conference; (2) comments on selected principles, recommendations, and physiological concepts presented in the statement; and (3) discusses the strengths and the limitations of the consensus conference format, as well as the errors and biases inherent in the policy-making process. The Consensus Conference statement is one of the clearest, most complete reviews of physiology and techniques of mechanical ventilation I have yet encountered. The suggested guidelines and recommendations clearly follow from the physiological principles discussed. Unfortunately, numerous problems with the consensus conference format and the almost total lack of controlled randomized studies limit the confidence with which these suggestions can be accepted. Our experts in respiratory care are remiss for not providing outcome-based or preference-based data, and the pulmonary and critical care community is remiss for not demanding that they do so before changing our approaches on the basis of their suggestions.
Follow-up of NICU Graduates: Why, What, and by Whom
Authors: Mccormick Marie C. , Stewart Jane E. , Cohen Robyn , Joselaw Marsha , Osborne Priscilla S. , Ware Janice
Published: November 2015

Follow-up of the graduates of neonatal intensive care is an important component of the provision of such care. However, the objectives of these programs and their data-collection strategies vary widely. This report describes the potential objectives and different data-collection strategies. It then reviews briefly what is known about the outcomes of very low birth weight infants to guide the development of assessment packets: Finally, we describe the operation of our program and activities of our team to illustrate the follow-up experience in a large multi-institution program.
Adult Cardiac Transplantation
Authors: Martich G. Daniel , Boujoukos Arthur J.
Published: November 2015

Patients with severe drug-refractory heart failure experience one of two modes of death. Either they collapse from an arrhythmia and are deemed to have had sudden death, or they die of progressive congestive heart failure. In either instance, their poor functional status during life limits their ability to perform usual daily activities. Currently, the only proven long-term benefit to these patients is heart transplantation. The technique that led to the first human-to-human heart transplantation nearly 30 years ago has changed very little; however, refinements in post operative care have kept research in this field at the fore for many years. Immediate postoperative hemodynamic stabilization by experienced clinicians may improve a patient's chances of survival after heart transplantation. Improved immunosuppressive agents have decreased life-threatening rejection episodes. Better knowledge of the infectious diseases that attack these immunosuppressed patients has also contributed to the nearly 85% one-year survival of heart transplantation recipients. The longest surviving heart transplantation recipient remains alive and well after more than 22 years. The development of transplant-related coronary artery disease may be the only transplantation-associated factor that keeps recipients from living for many decades. Transplantation coronary artery disease leads the list of late causes of mortality. Unlike native coronary artery disease, there exists ongoing difficulty in both diagnosis and treatment of this dreaded complication. We cover current standards and future possibilities in adult heart transplantation. We look at history, demographics, indications, management, and outcome in these patients, as well as future goals.
Tuberculosis: An Update for Clinicians
Authors: Maslow Elizabeth R. , Lubman Richard L. , Barnes Peter F.
Published: November 2015

Tuberculosis is the most common cause of death due to a single pathogen world wide, and the number of tuberculosis cases in the United States has increased significantly since 1985. Drug-resistant tuberculosis is also increasing, and multidrug-resistant tuberculosis (resistant to isoniazid and rifampin) has fueled deadly epidemics in New York and Florida. The clinical manifestations of tuberculosis in patients with human immunodeficiency virus (HIV) infection are distinctive; chest radiographic findings include primary tuberculosis and an extremely high frequency of extrapulmonary tuberculosis. Promising new diagnostic tests for tuberculosis are based on amplification of mycobacterial DNA by polymerase chain reaction, but they have not yet been adapted to the clinical laboratory. Most tuberculosis patients in the United States should receive initial treatment with isoniazid, rifampin, pyrazinamide, and ethambutol. For drug-susceptible tuberculosis, these drugs are continued for 2 months, followed by isoniazid and rifampin for 4 months, which yields a cure rate of greater than 95%. For isoniazid-resistant organisms, rifampin, pyrazinamide, and ethambutol, with or without isoniazid, can be given for 6 months. For HIV-infected patients with drug-susceptible or isoniazid-resistant tuberculosis, we recommend continuation of therapy for a minimum of 9 months. Most forms of extrapulmonary tuberculosis due to drug-susceptible organisms are treated for 6 months, except for meningeal, miliary, and skeletal tuberculosis, for which a minimum of 12 months of therapy is recommended. To reduce nosocomial transmission of tuberculosis, health cafe facilities should institute administrative controls to reduce exposure to infectious patients, engineering controls to reduce the concentration of infectious droplet nuclei, and personal respiratory protection of health care workers with appropriate masks. Administrative controls are probably the most important part of a tuberculosis infection control program. Health care workers who were recently infected with Mycobacterium tuberculosis can be identified by serial skin testing, and those who convert their skin tests from negative to positive should receive chemoprophylaxis with isoniazid to prevent development of tuberculosis.
The Impact of Legislation Requiring DNR Orders: New York State Compared with Neighboring States
Authors: Teres Daniel , Boyd Keith , Rapoport John , Strosberg Martin , Baker Robert , Lemeshow Stanley
Published: November 2015

Decisions to place limitations on the care of patients are complex, and they often involve physicians, other medical professionals, patients, or a surrogate decision-maker, family members, and others. In 1988, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) and the New York State government adopted two different approaches to this complex issue of do-not-resuscitate (DNR) orders: one involved professional self-regulation, whereas the other mandated a standardized procedure requiring completion of legal documents. This study examines the impact of these two different approaches to writing of DNR orders for adult intensive care unit (ICU) patients on utilization and resulting length of stay. The study used three data bases. One is from a larger study designed to update the Mortality Probability Model (MPM), a measure of severity of illness for ICU patients. This data base includes consecutive admissions to the adult ICUs of four hospitals in the northeastern United States. The second is a similar data base from the European-North American Study of Severity Systems (ENAS), and it includes 20 hospitals. The third data base, a 1991 national survey of ICUs by the Society of Critical Care Medicine (SCCM), lists characteristics of patients in ICUs in the United States on a specific day. Logistic regression was used to analyze the first two data bases; the percentage of patients in New York with DNR orders was calculated for each of the three data bases and compared with patients in neighboring states. Length of ICU and hospital stay was measured in the first two data sets. In the MPM data, 14.4% of medical patients in New York had a DNR order written at the time of ICU discharge, compared with 198% of medical patients in Massachusetts; and 4.3% of New York surgical patients had a DNR order written at the time of ICU discharge, compared with 8.3% of surgical patients in Massachusetts. In the ENAS data, 7.4% of New York nonoperative patients has a DNR order in place within 24 hours, compared with 8.4% of such patients in the other states; and 1.0% of New York operative patients had DNR orders, compared with 3–5% of operative patients from other states. Logistic regression revealed that a New York patient was less likely to have a DNR order written than a patient located in one of the other states studied. Data from the SCCM survey demonstrated that the New York percentage of patients with “no CPR” orders was 5.50%, compared with a percentage of 6.87% in other states. With few exceptions, these differences between New York and surrounding states did not have an impact on hospital length of stay. During the period studied following implementation of New York's DNR Law, utilization of DNR orders in New York State was significantly lower than neighboring states. This decreased utilization, however, did not effect hospital utilization as measured through length of stay and ICU admissions.
Advances in Management of Carotid Atherosclerosis
Authors: Malkoff Marc D. , Williams Linda S. , Biller Jose
Published: November 2015

Carotid artery stenosis is a common and potentially treatable cause of stroke. Stroke risk is increased as the degree of carotid stenosis increases, as well as in patients with neurological symptoms referable to the stenosed carotid artery. Carotid stenosis can be quantified by ultrasound imaging, magnetic resonance angiography, or conventional angiography. Medical treatment with platelet antiaggregants reduces stroke risk in some patients; other patients are best treated with carotid endarterectomy. Experimental treatments for carotid stenosis, including carotid angioplasty with or without stenting, are under investigation. We summarize the current literature and provide treatment recommendations for patients with atherosclerotic carotid artery disease.
Salicylate Intoxication
Authors: Yip Luke , Jastremski Michael S. , Dart Richard C.
Published: November 2015

Aspirin (acetylsalicylic acid) is one of the most widely used over-the-counter medications. Because of its availability and widespread use, aspirin has a long history of human toxicity from accidental or intentional overdosing. According to the American Association of Poison Control Centers aspirin was implicated in 19083 exposures in 1995, with 11800 cases treated in a health care facility, and 52 associated deaths. Aspirin toxicity may be a life-threatening condition that produces multiple system organ failure requiring treatment in an intensive care unit. Managing a patient with salicylism will challenge the skills of the critical care team, especially in the areas of life support, fluid and electrolyte balance, and acid-base management. This article reviews the physiology, pathophysiology, acute and chronic salicylism in children and adults, and management of salicylate intoxication.
Fentanyl Therapy Controls Autonomic Hyperactivity in Tetanus
Authors: Moughabghab Ayad Victor , Prevost Gaetan , Socolovsky Catherine
Published: November 2015

Sympathetic overactivity is a well-recognized complication of generalized tetanus in humans. In this clinical situation, a variety of drugs with primary or secondary actions on the cardiovascular system has been used with varying success. We show successful management of severe generalized tetanus in adults associated with autonomic hyperactivity with large doses of intravenous fentanyl.
Infections After Organ Transplantation
Authors: Boden M. Derrick , Dummer J. Stephen
Published: November 2015

Over the last ten to fifteen years medical and surgical advances have led to lower rates of infection and infection-related mortality in transplant recipients. Despite these advances, the process whereby one diagnoses and manages infectious problems in transplant patients has become increasingly complex. Evaluation of transplant patients with infections requires a good understanding of the intricacies of modern immunosuppressive therapy and both the typical and atypical clinical manifestations of many conventional and opportunistic pathogens. In particular, it is incumbent upon the clinicians caring for transplant patients to be familiar with the biology of cytomegalovirus and other herpes viruses, and of the prophylactic strategies that have evolved to lessen the burden of disease from these agents. Thorough knowledge is also required of common fungal pathogens and the viruses that cause chronic hepatitis. Transplant patients also should always be evaluated in the temporal context of their transplant operation, because different diseases are prevalent at different times after transplantation. Since immunosuppressive drugs modify the clinical presentation of infections is important to maintain clinical vigilance and attend to even minor new symptoms. This chapter is designed to provide a relatively concise overview of transplant infections for intensivists or other clinicians who encounter transplant patients in their practice. The references encompass much of the classic transplant infectious disease literature; they are included, not only for citation, but as a bibliography for further study.
Aspiration-Induced Pulmonary Injury
Authors: Nelson Judith E. , Lesser Marvin
Published: November 2015

Pulmonary aspiration of gastric contents can cause a spectrum of sequelae that spans from relatively minor to rapidly lethal disease. To emphasize the extent of this spectrum and to encompass both noninfectious complications and infection, we use the term “aspiration-induced pulmonary injury” rather than “aspiration pneumonia.” In this article we review the relevant literature, focusing on more recent insights into the pathogenesis of lung injury, the natural history of aspiration, risk factors, the relationship between aspiration and infection, and recommendations for management. The relevance to human disease of studies using intra-airway acid instillation in animals is questioned. We discuss the difficulties in predicting the clinical course after aspiration. We identify risk factors for aspiration-induced pulmonary injury that are commonly encountered in the intensive care unit, and discuss in detail factors of special interest to the intensivist, including the impact of tracheal intubation; the effects of enteric intubation, particularly the comparison between pre- and postpyloric routes of enteric feeding administration; and the relative risks associated with particular feeding protocols. We conclude with recommendations regarding treatment and prevention strategies.
An Airway Management Device: The Laryngeal Mask Airway—A Review
Authors: Schmiesing Clifford A. , Brock-Utne John G.
Published: November 2015

The laryngeal mask airway (LMA) is an airway management device that has become an accepted part of anesthetic practice in both pediatric and adults surgical patients. It is inserted without the use of a laryngoscope or muscle relaxants into the hypopharynx forming a low pressure seal around the glottis. The LMA provides a better airway than a face mask with or without an oral airway. Insertion techniques are quickly learned and are described in this review. Since the LMA forms a less secure seal than an endotracheal tube (ETT), several important limitations and contraindications exist. This includes patients at high risk for regurgitation of gastric contents into the lungs causing pulmonary aspiration and patients requiring high ventilatory pressures or prolonged ventilation. These contraindications have limited its introduction and utilization in the intensive care unit (ICU). The LMA is a helpful tool in the management of both the expected and unexpected difficult airway, where it may serve both as an emergency airway and as a conduit to intubation of the trachea with an ETT over a fiberoptic bronchoscope (FOB) or gum elastic bougie. A lifesaving airway has been provided by the LMA where no other means of achieving ventilation were possible in patients, including neonates, trauma victims, woman undergoing cesarean section, and in the setting of cardiac arrest. There are very few reported uses of the LMA in the ICU. We believe that familiarity with the LMA's design, use, and limitations by critical care practitioners will increase its use in emergency airway management and in the ICU. The LMA may prove to be the first of a new generation of airway devices placed into the hypopharynx to provide an alternative to the endotracheal tube and mask airway.
Effects of Cytokines and Other Inflammatory Mediators on Human Acute Pancreatitis
Authors: Gloor Beat , Reber Howard A.
Published: November 2015

Most episodes of acute pancreatitis are mild, but severe disease complicated by multiple system organ failure develops in up to 20% of cases. In all patients with pancreatitis, the accumulation of leukocytes in pancreatic and extrapancreatic tissue, and the release of various mediators from them and other sites are important determinants of disease severity. Proinflammatory mediators, whose initial job is to limit the local damage, are released early in the disease. However, these mediators can exacerbate the severity of the pancreatitis when they continue to be elaborated in greater amounts or for longer periods than normal. When their actions are blocked or their release is inhibited, the severity of experimental pancreatitis and its associated mortality rate are less. This suggests the possibility that agents that inhibit the release and/or action of these mediators could be beneficial clinically.
Therapeutic Advances in the Treatment of Cigarette Addiction
Authors: Cooke Catherine E.
Published: November 2015

Smoking-related diseases are preventable. Along with behavioral counseling, nicotine replacement therapies improve the chance for a successful attempt at quitting. Many of these nicotine replacement products are available without a prescription. Pharmacists are in a unique position to help decrease the number of smokers by encouraging smokers to quit. Once a patient has made the decision to quit, the pharmacist should discuss the physical and psychological effects of nicotine addiction and withdrawal and provide counseling on behavioral modifications and nicotine replacement products. Pharmacists can offer smoking cessation programs in their practice and will be rewarded for cost-effective management of smoking cessation.
The Pharmacist's Role in Developing Diabetes Clinical Care Pathways and Diabetes Patient-Focused Care Plans
Authors: Cardenas Jodie J.
Published: November 2015

Diabetes is a serious, chronic disease affecting an estimated 16 million Americans with total costs in excess of $92 billion a year. A changing healthcare market is creating demand for coordinated, standardized methods of optimizing both outcomes and resource utilization. Diabetes clinical care pathways (DCCPs) and diabetes patient-focused care plans (DPFCPs) are valuable management tools used to coordinate the delivery of clinically appropriate, cost-effective, interdisciplinary diabetes healthcare services. This article identifies the characteristics of DCCPs and DPFCPs, and describes the pharmacist's role in their development and use in clinical practice.
Diets and Obesity Drug Treatment*
Authors: O'Donnell James T.
Published: November 2015

Weight control and dieting is a subject of great interest to the American public. The use of pharmacologically active agents to help take weight off and keep it off has ranged from following the golden rules of moderation, not eating to excess, and following a regular plan of exercise. Many people are unable or unwilling to maintain these well-known practices and have sought out chemical means of assisting them is losing weight and keeping it off. The sympathomimetics have a powerfully effective appetite suppression, but also have a long list of serious and habituating adverse effects. Many diets have employed specific schedules and types of food to eat or avoid, but there is no diet employing drugs that is completely safe and effective. One new diet, Fen-Phen represents a new approach. Instead of using a single agent, a combination of two agents is used which affects the brain'S neurotransmitters. The results have been impressive so far, but the adverse effects of these two agents and their use and possible interaction with other drugs remains a risk.
Pharmacologic Treatment of Migraine
Authors: Rothrock John F.
Published: November 2015

The vascular theory of migraine proposed by Wolff, attributing migrainous symptoms to paroxysmal constriction and dilation of the cranial vasculature, held sway for over four decades and even now remains embraced by many clinicians and the lay public. Recent investigations, however, suggest that this proposed mechanism is untenable; although changes in blood vessel caliber and blood flow do occur in some patients during some attacks, they are not required for the production of migrainous symptoms and appear to be largely epiphenomena, occurring subsequent (and consequent) to another primary process. Evidence is mounting that migraine may result from a pathologic alteration of neurotransmission within the brain stem and trigeminovascular system, and one of the neurotransmitters primarily involved is serotonin. This has led to an explosion of interest in therapeutic agents which influence serotoninergic receptors, and the astounding success enjoyed by the first of these agents to be utilized clinically (sumatriptan and dihydroergotamine) and their offspring suggests that our understanding of this common and vexing problem will increase and be paralleled by the identification of yet more specific and effective treatment intervention.
Pain Management in the Cancer Patient
Authors: Lenz Kristi L. , Marley Eileen M.
Published: November 2015

Of the over one million patients diagnosed with cancer each year, 30 percent will have pain at diagnosis and up to 85 percent will have pain as their disease progresses. Adequate pain management continues to be hindered by multiple patient-and clinician-related barriers; however, with increased awareness and knowledge, the pharmacy practitioner can play a key role in facilitating pain management. This review will focus on the mechanisms of cancer pain, the role of non-opioids, opioids, and adjuvant agents in the treatment of cancer pain, and the basic principles of cancer pain management that allow 70 to 90 percent of patients to achieve excellent pain control.
St. John's Wort: A Review of an Herbal Antidepressant
Authors: Snead Tarolyn J. , Jackson Cherry W.
Published: November 2015

Hypericum perforatum, more commonly known as St. John's wort, is an herbal product that has been utilized as an antidepressant in Europe for many years. This product has become popular in the United States as an alternative to traditional antidepressants. Due to the fact that St. John's wort is not regulated by the Food and Drug Administration (FDA), many questions exist about the safety and efficacy of this product. This article will provide a review of the history, pharmacology, and safety profile of St. John' wort, as well as its efficacy in the treatment of major depressive disorder.
Complementary and Alternative Medicine in Oncology
Authors: Torma Jennifer A.
Published: November 2015

Complementary and alternative medicine (CAM) has reentered mainstream medicine and is gaining interest with cancer patients for the treatment of their disease. The use of CAM by cancer patients varies depending on survey, but has been reported as high as 54 percent. As pharmacists we are expected to educate and counsel patients on herbal, pharmacologic and immunologic therapies. Several therapies that claim to treat cancer include laetrile, iscador, essiac, antineoplastins, immunoaugmentative therapy, IP6, PC-SPES, and cartilage products; these therapies and their limitations are discussed. Cancer patients are a unique population with special considerations when patients are utilizing CAM because disease and treatment related problems, such as bleeding, nutrition, and quality-of-life, could be worsened. Resources for pharmacists and cancer patients on CAM are outlined.
A Reappraisal of Automotive Management and Organizational Deployment
Authors: Bertodo R G
Published: November 2015

Previous published work traced the evolution of one company's organization from the traditional hierarchical structure to the deployment of multi-functional teams. The present paper reviews the five-year experiment in the light of persistent senior and middle management ambivalence, despite demonstrable and quantifiable performance gains. It is concluded that the relentless move towards a polyarchical organization is irreversible and will receive further reinforcement from the wider appreciation of information technology. This must lead to a new generation of managers better equipped to handle the complex interaction of ‘networking’, and more in tune with the culture and values of multi-functionalism. Transparency of data and performance will aid this shift. The transition is unlikely to be quick or easy and will demand stamina and consistency of purpose from the highest levels of the organization.
Transforming Corporate Governance
Authors: Athreya Mrityunjay
Published: November 2015

With the increasing liberalization and globalization of all economies, there is a worldwide recognition of higher freedom and role for corporations and managers, on the one hand, and consequently, the need for better governance, on the other. In this paper, we shall look at a three-step process for transforming corporate governance:

1. Laws for minimum good governance.

2. Competent entrepreneurs, professional managers and their dedicated leadership for better governance.

3. Business values and ethics for superior governance.
Imagination: Springboard of Management
Authors: Kumar Sharat
Published: November 2015

Imagination distinguishes man from all other living things. It is not at all a matter of inheritance. Complex imaginative manipulations are dealt with by use of symbols. Human imagination has a style. Yet, it is the same ability which has led to an inner conflict between individual and modern society. The author advocates that the close inter-relationship of imagination, art and management is unassailable
Loss making PSUs: Issue of Corporate Governance
Authors: Atmanand
Published: November 2015

The managements of PSUs, have little autonomy and in many cases are encouraged to maintain the status quo in business strategy rather than to risk change. Major decisions are delayed or not taken at all which includes among other things, the appointment of chief executive officers. In other words, most of the basic ingredients for good governance are missing Clarity of responsibility, transparency, checks and liala11ces and accountability. Corporate governance does not seem to exist at all.
Prospects of Agro-Exports to European Union in the Emerging Environment
Authors: Sharma Atul , Kumar Mehta Pradeep
Published: November 2015

India's export performance in the KV in the agro-based items will eventually depend on how the producers and exporters would respond to the new inventive structure, on the one hand, and the emerging challenges in the EU market, on the other. Indian agro-exports can be promoted by introduction of newer items, continuous up gradation of technology, removal of infrastructural bottlenecks, suitable institutional support etc.
Business School and Moral Education
Authors: Uberoi N.K.
Published: November 2015

This paper discusses issues relating to introduction of moral education in business schools. The difficulties encountered in this regard are described. Pedagogical skills are very important for initiating and sustaining a discussion on moral issues, whether in business or otherwise. To agree to certain moral issues does not assume that one has disposition for being moral. To develop disposition, class room discussion is an important step.
A Case Study on Emerging Influence of Internet on Indian Retail Business: Will myshop.com E-tailing Firm be a Success?
Authors: Shajahan S
Published: November 2015

This case describes the importance of electronic commerce in the retailing business in India. It narrates various strategies of cyber marketing, digital marketing and other tech - marketing mix in the overall strategies. This case hopes to give better clarity to the students of management when they look for self-employment opportunities through cyber media.