1,721,364 research outputs found
Mckenzie, C A, VX70110
No full textThis record was harvested from a previous catalogue system and will be withdrawn in 2025. Information in this record may be superseded or incomplete. Visit this record in UMA's new catalogue at: https://archives.library.unimelb.edu.au/nodes/view/403765Surname: MCKENZIE. Given Name(s) or Initials: C A. Military Service Number or Last Known Location: VX70110. Missing, Wounded and Prisoner of War Enquiry Card Index Number: 57702.239363
Item: [2016.0049.36057] "Mckenzie, C A, VX70110
Corticosteroids in delirium: Yet another critical care conundrum?
No full textIn this issue of Critical Care Medicine, Wolters et al (1) report an important piece of work undertaken in a mixed medical and surgical ICU in The Netherlands. The authors conducted a prospective case control study in which they showed no association between the presence of corticosteroids and the transition to delirium. Daily mental status was classified as “coma”, “delirium,” or an “awake without delirium” state. Transitions between states were analyzed using a first-order Markov multinomial logistic regression model with 11 different covariables.This is an important piece of work for the critical care multidisciplinary team. We are familiar with increase in mortality, morbidity, and long-term cognitive concerns that can be caused by critical care delirium (2, 3). There is also the less measured human cost of observing a dear relative or friend “going mad” acting aggressively to staff or appearing terrified out of their wits (4)
COVID-19 pneumonia and COVID-19 associated acuterespiratory distress syndrome: diagnosis andmanagement
No full textThe COVID-19 pandemic has had a significant global impact. At the date of publication, around 203 million people across the world have tested positive for the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since it was first identified in December 2019[1].The most critically unwell patients require urgent admission to an intensive care unit (ICU), often because of severe type 1 respiratory failure with gross hypoxia, meaning that they require mechanical ventilation[2]. Severe respiratory complications, such as COVID-19 pneumonia and/or COVID-19 associated acute respiratory distress syndrome (CARDS), contribute to high ICU mortality rates and affect 15–30% of hospitalised COVID-19 patients[2]. At the peak of the pandemic, the ICU mortality rate for COVID-19 patients reached 58%[2].Fortunately, as knowledge has expanded and new evidence-based therapies have emerged, associated ICU mortality rates in the UK have fallen to around 37% at 28 days[3]. The number of COVID-19 ICU admissions has also decreased — mostly owing to the successful rollout of the UK COVID-19 vaccination programme[4]. However, the emergence of the more transmissible Delta variant, coupled with the recent easing of lockdown restrictions, has contributed to a third wave of COVID-19 infections in the UK[4,5]. This could potentially lead to an increase in the number of serious complications, such as severe COVID-19 pneumonia and CARDS.It is therefore important that pharmacists can recognise the signs and symptoms of these diseases, and know how to appropriately manage patients presenting to community pharmacy and primary care.This article provides an overview of COVID-19 pneumonia and CARDS, summarising the pathophysiology, diagnosis and evidenced-based management strategies
Sedation in the Intensive Care Unit
No full textPurpose of ReviewThis narrative review illustrates literature over the last 5 years relating to sedation delivery to mechanically ventilated adult patients in intensive care units.Recent FindingsThere has been an increase in dexmedetomidine-related publications but although systematic reviews suggest dexmedetomidine reduces delirium, agitation, and length of stay, clinical trials have not supported these findings. It is likely to be useful for the managing patients with persisting agitation. Guidelines continue to recommend lightly sedating patients but considerable variation remains in clinical practice and in research trials. Protocols with no sedative infusions and morphine boluses as needed are feasible and safe, while educational interventions can decrease sedation-related adverse events.SummaryResearch trials have mainly focused on individual drugs rather than practice. Given evidence is slow to translate into practice; work is needed to understand and respond to the concerns of clinicians regarding deep sedation and agitation
Antibiotic dosing in critical illness
No full textEarly and effective antibiotic therapy is essential in the management of infection in critical illness. The loading dose is probably the most important dose and is a function of the volume of distribution of the drug and the desired plasma concentration but independent of renal function. Antibiotics are classified in a number of ways that have implications for dosing. Doses of hydrophilic agents such as β-lactams should be increased in the early stages of sepsis as the extravascular space increases. For lipophilic agents such as macrolides, the inflammatory process is less important, although factors such as obesity will affect dosing. Classification can also be based on pharmacodynamic properties. Concentration-dependent antibiotics such as aminoglycosides should be administered by extended interval regimens, which maximize bactericidal effect, minimize nephrotoxicity and allow time between doses for the post-antibiotic effect. The critical factor for time-dependent agents, such as β-lactams, is time above the MIC. Ideally administration of these agents should be continuous, although vascular access availability can restrict infusion time to between 4 and 6 h, which is probably adequate. As well as antibiotic factors, patient factors such as hepatic and renal failure will affect dosing. Hepatic failure will affect antibiotic metabolism, although it is most important in end-stage failure. Renal failure and support will affect drug elimination. Knowledge of these factors is essential. Patient safety and prevention of unnecessary harm is a weighty consideration in critical illness. To ensure effective treatment and minimize adverse effects, therapy should be reviewed daily and adjusted in the light of changes in patient organ function and underlying pathology
Atlas of rock forming minerals, par W. S. McKenzie, C. Guilford, 1980
No full textAtlas of rock forming minerals, par W. S. McKenzie, C. Guilford, 1980. In: Bulletin de Minéralogie, volume 103, 6, 1980. pp. 663-664
Atlas of rock forming minerals, par W. S. McKenzie, C. Guilford, 1980
No full textAtlas of rock forming minerals, par W. S. McKenzie, C. Guilford, 1980. In: Bulletin de Minéralogie, volume 103, 6, 1980. pp. 663-664
Japanese financial markets and the role of the yen
No full textThis volume presents some of the papers written for a conference on 'The Impact of Developments in Japan's Financial Markets in Asia and the Pacific', held in Canberra and Sydney, Australia, from 2 to 4 November 1987 -- Pref.Over the past ten years major structural changes have occurred in Japan’s financial markets. Japan has become both the world’s largest creditor and its largest exporter of capital
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