Annals of internal medicine
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Randomized Controlled Trial Clinical Trial
Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia.
To determine whether continuous subglottic aspiration prevents nosocomial pneumonia in mechanically ventilated patients. ⋯ The incidence of nosocomial pneumonia in mechanically ventilated patients can be significantly reduced by using a simple method that decreases the chronic microaspirations through the cuff of endotracheal tubes.
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Multicenter Study Clinical Trial
The SUPPORT prognostic model. Objective estimates of survival for seriously ill hospitalized adults. Study to understand prognoses and preferences for outcomes and risks of treatments.
To develop and validate a prognostic model that estimates survival over a 180-day period for seriously ill hospitalized adults (phase I of SUPPORT [Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments]) and to compare this model's predictions with those of an existing prognostic system and with physicians' independent estimates (SUPPORT phase II). ⋯ A limited amount of readily available clinical information can provide a foundation for long-term survival estimates that are as accurate as physicians' estimates. The best survival estimates combine an objective prognosis with a physician's clinical estimate.
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Recent nosocomial outbreaks of tuberculosis have increased concern about the occupational acquisition of tuberculosis by health care workers. The Centers for Disease Control and Prevention (CDC), Department of Health and Human Services, and the Occupational Safety and Health Administration, Department of Labor, have issued recommendations and regulations in an effort to decrease health care workers' risk for exposure to patients with infectious tuberculosis. ⋯ As stated in the Draft Guidelines, the major components of health care worker protection from Mycobacterium tuberculosis infection include administration or source controls, engineering controls, and respiratory protective devices. We review the evolution of the seemingly conflicting recommendations for respiratory protective devices made by these Centers of the CDC and explain how the recommendations in the current CDC Guidelines were reached.
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Clinical Trial Controlled Clinical Trial
Type III procollagen peptide in the adult respiratory distress syndrome. Association of increased peptide levels in bronchoalveolar lavage fluid with increased risk for death.
To determine whether bronchoalveolar lavage fluid levels of the N-terminal peptide of type III procollagen (procollagen III) are increased in patients with the adult respiratory distress syndrome and, if so, whether increased procollagen III levels in lavage fluid are associated with increased fatality rates. ⋯ Increased levels of type III procollagen in bronchoalveolar lavage fluid are frequently detected in patients with the adult respiratory distress syndrome and are strongly associated with increased risk for fatal outcome independent of other variables related to fatality in patients with the syndrome.