Articles: outcome.
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To review the recent pharmacokinetic and pharmacodynamic reports of some of the commonly used antibiotics in critically ill patients and recommend alterations in their administration to improve their efficacy. ⋯ Applying pharmacokinetic and pharmacodynamic principles to critically ill patients will lead to better antibiotic use and hopefully a better outcome.
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Internal disc disruption is a common cause of disabling low back pain in a substantial number of young, healthy adults. A clinical diagnosis of internal disruption, in absence of objective clinical findings, is convincingly established only by means of provocation discography. Intradiscal electrothermal therapy has been shown to be effective in managing chronic disabling discogenic pain. ⋯ Further, the assessment of functional status showed significant improvement with standing and walking, whereas sitting also demonstrated significant improvement in 62% of the patients, though it was not statistically significant. No complications were noted in the perioperative period or during the follow-up period. In conclusion, intradiscal electrothermal therapy is a safe and effective procedure in patients suffering with chronic functionally limiting discogenic pain who fail to respond to aggressive conservative modalities of treatments as well as interventional therapy with injections.
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Pediatr Crit Care Me · Oct 2000
Relevance of diagnostic diversity and patient volumes for quality and length of stay in pediatric intensive care units.
Investigation of associations of the diagnostic diversity and volumes with efficiency and quality of care. ⋯ Patient volumes encountered in a PICU are important for maintaining quality and efficiency of care. In low-volume units, fewer diagnoses and higher volumes were both associated with higher efficiencies. In high volume units, diagnosis-specific volumes were generally large enough for achieving diagnosis-independent efficiency. Diagnostic mix was not associated with PICU mortality ratios, but higher PICU volumes were associated with lower mortality rates.
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Low back pain is an important medical, social, and economic problem involving approximately 15% to 39% of the population. Of the numerous therapeutic interventions available for treatment of chronic low back pain, including surgery, epidural administration of corticosteroids is one such intervention commonly used. Several approaches available to access the lumbar epidural space are the caudal, interlaminar, and transforaminal, also known as nerve root or selective epidural injection. ⋯ Reports of the effectiveness of epidural corticosteroids have varied from 18% to 90%. However, reports of the effectiveness of transforaminal epidural steroids have shown it to be superior, with outcome data indicating cost effectiveness as well as safety. This review describes various aspects of transforaminal epidural steroid injections in managing chronic low back pain.
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Objective. Post-herniorrhaphy pain syndrome can be difficult to treat. The exact mechanism of pain is not always apparent. ⋯ Conclusion. Post-herniorrhaphy pain can have the same features of both nociceptive and neuropathic pain syndromes. In cases which have failed conservative therapy we believe that a trial of spinal cord stimulation is warranted as in other cases of neuropathic pain syndromes.