Articles: treatment.
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Spinal Cord Stimulation (SCS) is a treatment option for chronic pain patients. The most common indication for SCS is the failed back syndrome with leg pain. In the last decade, advances in our understanding of appropriate stimulation programming, lead placement and the physiology of SCS, have led to changes in multi-site stimulation, and stimulation with differing programs. In the past, low back, axial neuropathic type pain was not responsive to SCS. With dual electrode arrays, and dual stimulation with alternating programs of stimulation, steering of stimulation paresthesia, and versatile programmable stimulation parameters, SCS has become a more versatile form of analgesia. ⋯ SCS is the most effective treatment for limb pain not amenable to surgical decompression. The success of SCS in this chronic pain group is 80% successful in treatment of leg pain, and much less effective in treatment of axial pain.
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Sedation and analgesia are important means of providing care for the critically ill patient. ⋯ Sedation and analgesia are now regarded as an integral part of treatment on the intensive care unit instead of being an unpleasant but necessary and minor issue. The importance of monitoring the level of sedation and analgesia has only recently been realized. It remains to be shown that new management strategies including an evaluation of the patient, planned interventions and the choice of drugs will further improve the care for the critically ill.
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To summarize new advances and research findings that relate to the treatment of burn victims. ⋯ The combination of innovative approaches and a dedicated burn team is expected to continue to improve survival in the next few years even in the most severe cases.
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Curr Opin Anaesthesiol · Apr 2003
Treatment of sepsis and septic shock: is there a light at the end of the tunnel?
For years, the field of sepsis research was extremely active; the net result, however, was rather disappointing. Sepsis is still a major problem in intensive care units worldwide. Frustratingly, sepsis is characterized by a high morbidity and mortality. Although multiple (animal) studies with promising results have been published, the clinical situation has changed only a little. However, the recent 2 or 3 years of sepsis research brought significant results that will have a significant impact on clinical routine. ⋯ A breakthrough in sepsis research was long awaited. Recent clinical studies demonstrated that an improvement in outcome can be achieved even with simple means. This review focuses on these new therapeutic concepts, hopefully helping to transfer scientific advantages into everyday clinical routine.
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End-of-life decisions play an important role in the intensive care unit. This review discusses the most important studies on end-of-life decisions published from October 2001 to October 2002. ⋯ The new studies put emphasis on the facts that all care providers should participate in the decision and that communication with surrogates is of extreme importance. Many valid points from other medical fields also apply to the intensive care unit situation.