Articles: chronic.
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Sleep and headache have both generated curiosity within the human mind for centuries. The relationship between headache and sleep disorders is very complex. While Lieving in 1873 first observed that headaches were linked to sleep, Dexter and Weitzman in 1970 described the relationship between headache and sleep stages. ⋯ Patient education and lifestyle modification play a significant role in overall success of the treatment. Chronic tension-type headache and chronic migraine have high prevalence of insomnia and comorbid psychiatric disorders, which require behavioral insomnia treatment and medication if needed along with psychiatric evaluation. Apart from the abortive treatment tailored to the headache types, - such as triptans and DHE 45 for migraine and nonsteroidal anti-inflammatory medication for chronic tension-type headache, preventive treatment with different class of medications including antiepileptics (Topamax and Depakote), calcium channel blockers (verapamil), beta blockers (propranolol), antidepressants (amitriptyline), and Botox may be used depending upon the comorbid conditions.
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We described our endovascular techniques for the recanalization of chronic occlusions of the brachiocephalic and subclavian arteries. Given their large caliber, origins from the aorta, and proximity to the carotid and vertebral arteries, various complex endovascular techniques are required to achieve revascularization. Navigation of distal embolic protection devices into the carotid and vertebral arteries mandates varied catheter approaches. ⋯ Endovascular recanalization of the great vessels with the use of distal embolic protection devices requires multiple catheters and complex endovascular techniques but is feasible and safe. A significant percentage of these occlusions can likely be reopened through endovascular techniques.
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Curr Opin Crit Care · Dec 2013
ReviewCauses and consequences of disproportionate care in intensive care medicine.
Increased use of advanced life-sustaining measures in patients with poor long-term expectations secondary to more chronic organ dysfunctions, comorbidities and/or a poor quality of life has become a worrying trend over the last decade. This can lead to futile, disproportionate or inappropriate care in the ICU. This review summarizes the causes and consequences of disproportionate care in the ICU. ⋯ Disproportionate care is common in western ICUs. It can lead to violation of basic bioethical principles, suffering of patients and relatives and compassion fatigue and moral distress in healthcare providers. Avoiding inappropriate use of ICU resources and disproportionate care in the ICU should have high priority for ICU managers but also for every healthcare provider taking care of patients at the bedside.
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Multicenter Study Observational Study
Oxygen therapy in non-intubated adult intensive care patients: a point prevalence study.
Oxygen is commonly administered to intensive care unit patients. Although there is knowledge of how oxygen is administered to mechanically ventilated patients, there are few data about its use in non-intubated ICU patients. ⋯ Oxygen therapy is commonly administered to non-intubated adult patients in New Zealand and Australian ICUs. Most patients received oxygen by simple nasal cannulae, and oxygen therapy prescriptions were often absent or incomplete. We advise continuing education to ensure that oxygen is prescribed, administered and documented correctly.