Nipple aspirate fluid and its use for the early detection of breast cancer.

Nipple aspirate fluid is the physiological biofluid lining ductal epithelial cells. Historically, cytology of nipple fluid has been the gold standard diagnostic method for assessment of ductal fluid in patients with symptomatic nipple discharge. The role of biomarker discovery in nipple aspirate fluid for assessment of asymptomatic and high-risk patients is highly attractive but evaluation to date is limited by poor diagnostic accuracy.

Traumatic brain injured patients: primum non nocere.

Purpose Of Review: Traumatic brain injury (TBI) remains an unfortunately common disease with potentially devastating consequences for patients and their families. However, it is important to remember that it is a spectrum of disease and thus, a one 'treatment fits all' approach is not appropriate to achieve optimal outcomes. This review aims to inform readers about recent updates in prehospital and neurocritical care management of patients with TBI.

BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization.

Background: Patients admitted to intensive care and on mechanical ventilation, are administered sedative and analgesic drugs to improve both their comfort and interaction with the ventilator. Optimizing sedation practice may reduce mortality, improve patient comfort and reduce cost. Current practice is to use scales or scores to assess depth of sedation based on clinical criteria such as consciousness, understanding and response to commands.

Anaesthesia for neuroradiology: thrombectomy: 'one small step for man, one giant leap for anaesthesia'.

Purpose Of Review: Endovascular management of acute thrombotic strokes is a new management technique. Anaesthesia will play a key role in the management of these patients. To date there is no established method of managing these patients from an anaesthetic perspective.

Clinical 'Pearls' of maternal critical care: part I.

Purpose Of Review: This review outlines the challenges in looking after pregnant women with thromboembolism and sepsis who either become or are at risk of becoming critically ill during pregnancy.

Recent Findings: The Pregnancy Mortality Surveillance systems in both the USA and UK record the most common causes of maternal death as thromboembolism and sepsis. Both of these conditions have improved outcomes with timely maternal critical care provided by a multidisciplinary team.

Traumatic brain injury: physiological targets for clinical practice in the prehospital setting and on the Neuro-ICU.

Purpose Of Review: Over many years, understanding of the pathophysiology in traumatic brain injury (TBI) has resulted in the development of core physiological targets and therapies to preserve cerebral oxygenation, and in doing so prevent secondary insult. The present review revisits the evidence for these targets and therapies.

Recent Findings: Achieving oxygen, carbon dioxide, blood pressure, temperature and glucose targets remain a key goal of therapy in TBI, as does the role of effective prehospital care.

Systemic complications of traumatic brain injury.

Purpose Of Review: Increased understanding of the pathophysiology in traumatic brain injury (TBI) has resulted in the development of core physiological targets and therapies to preserve cerebral oxygenation, and in doing so prevent secondary insult. This review addresses the many systemic complications of TBI that make achieving these targets challenging and can influence outcome.

Recent Findings: There are a wide range of systemic complications following TBI.

Maternal critical care: 'one small step for woman, one giant leap for womankind'.

Purpose Of Review: The purpose of this study is to outline the challenges of looking after women who either become or are at a risk of becoming critically ill during pregnancy.

Recent Findings: In recent years, there has been an increased demand in the need for maternal critical care. This is partly due to women with complex medical conditions surviving to child-bearing age, coupled with improvements in foetal medicine resulting in more high-risk pregnancies reaching term.

The Monitoring and Management of Severe Traumatic Brain Injury in the United Kingdom: Is there a Consensus?: A National Survey.

Background: To survey the current practice of monitoring and management of severe traumatic brain injury (TBI) patients in the critical care units across the United Kingdom.

Methods: A structured telephone interview was conducted with senior medical or nursing staff of all the adult neurocritical care units. Thirty-one neurocritical care units that managed adult patients with severe TBI were identified from the Risk Adjustment in Neurocritical Care (RAIN) study and the Society of British Neurological Surgeons.

What's new in the management of traumatic brain injury on neuro ICU?

Purpose Of Review: In recent years, we have begun to better understand how to monitor the injured brain, look for less common complications and importantly, reduce unnecessary and potentially harmful intervention. However, the lack of consensus regarding triggers for intervention, best neuromonitoring techniques and standardization of therapeutic approach is in need of more careful study. This review covers the most recent evidence within this exciting and dynamic field.

Does the use of a bougie reduce the force of laryngoscopy in a difficult airway with manual in-line stabilisation?: a randomised crossover simulation study.

Context: Manual in-line stabilisation is usually used during tracheal intubation of trauma patients to minimise movement of the cervical spine and prevent any further neurological injury. Use of a bougie in combination with laryngoscopy may reduce the forces exerted on the cervical spine.

Objective: To evaluate the difference in force applied to the head and neck during tracheal intubation with a Macintosh laryngoscope with or without simultaneous use of a bougie.

Updates in the management of intracranial pressure in traumatic brain injury.

Purpose Of Review: Traumatic brain injury remains a common and often debilitating event across the world, producing significant burdens upon health and social care. Effective neurocritical care coupled with timely and appropriate neurosurgical intervention can produce significant improvements in patient outcome. There remains controversy about how best to manage intracranial pressure on the ICU; we review the recent literature addressing a number of key variables.

Practice patterns related to block selection, nerve localization and risk disclosure: a survey of the American Society of Regional Anesthesia and Pain Medicine.

Background And Objectives: We aimed to identify current clinical practice patterns among members of the American Society of Regional Anesthesia and Pain Medicine (ASRA) members that relate to complications of regional anesthesia (RA).

Methods: Invitations were posted to the 3,732 ASRA members, to participate in our survey. Members were asked to report the types and numbers of blocks performed annually, preferred nerve localization techniques, and routine risk disclosure practices prior to common neuraxial (NAB) and peripheral nerve (PNB) block techniques.