Palliative sedation is increasingly being utilised when patients are close to death. Despite clear guidelines, its implementation is often problematic. In this clinical lesson we describe two patients in whom sedation did not go according to plan.
View Article and Find Full Text PDFBackground: Emergency department (ED) crowding leads to prolonged emergency department length of stay (ED-LOS) and adverse patient outcomes. No uniform definition of ED crowding exists. Several scores have been developed to quantify ED crowding; the best known is the Emergency Department Work Index (EDWIN).
View Article and Find Full Text PDFBackground: Continuity of end-of-life care for patients receiving palliative care is an important challenge for out-of-hours services in general practice.
Aim: To investigate how frequent information is transferred on patients receiving palliative care from GPs to the out-of-hours services, to explore the perceptions of GP's on this information transfer and to study the relation between information transfer and the used GP information systems.
Methods: This is a mixed-method design study.
Background: The objective of this study is to evaluate whether a single palliative cancer care workshop, which included information about drug prescribing, had an effect on the opioid-prescription patterns of general practitioners in daily practice.
Method: The opioid-prescription figures of 68 general practitioners who had participated in the workshop were aggregated from the computer system of the Regional Sick Fund. The prescription figures of a year before and a year after the workshop were compared and a control group of non-participants was included.
Background: Cancer patients may unnecessarily suffer from pain and other symptoms due to insufficient knowledge on the part of their doctors. In The Netherlands, the general practitioner is considered to be the key provider of palliative care for the cancer patient. Therefore, the authors developed and conducted workshops to teach symptom control to general practitioners.
View Article and Find Full Text PDFJ Pain Symptom Manage
November 1998
Considerable research has focused on pain and other symptoms in terminal cancer patients referred to hospices and palliative care services. These patients differ from Dutch cancer patients in the palliative stage of their disease because the latter are cared for by general practitioners at home and medical specialists in outpatient departments. To clarify the experience of these Dutch patients, a study was started to investigate the prevalence and severity of pain and other symptoms as well as the functional status of consecutive patients visiting oncology outpatient departments for follow-up.
View Article and Find Full Text PDFFacial cellulitis in the pediatric hospital population can be classified as odontogenic and nonodontogenic. Emergency departments welcome timely diagnosis from consultants as cellulitis is associated with significant morbidity in children. The purpose of this retrospective study is to assist pediatric dentists in recognizing differences between odontogenic and nonodontogenic facial cellulitis and to determine whether odontogenic infections make up a major portion of facial swellings seen upon admission to the hospital.
View Article and Find Full Text PDFThe prevalence of respiratory syncytial virus (RSV) infection among severely malnourished children was studied at the University of Benin Teaching Hospital, Benin City, Nigeria at a time when the infection was known to be prevalent in the community. Nasopharyngeal washings were obtained from subjects on admission and thereafter every 4 days until discharge. RSV was detected by ELISA technique.
View Article and Find Full Text PDFCrit Care Med
September 1993
Objective: To study the effect of long-term extracorporeal membrane oxygenation (ECMO) support on neutrophil function.
Design: A prospective, clinical investigation.
Setting: A pediatric intensive care unit.
Ann Trop Paediatr
October 1992
The nosocomial spread of respiratory syncytial virus (RSV) was studied in a newborn nursery in Benin City, Nigeria at a time the virus was known to be highly prevalent in the community. Nasopharyngeal washings were obtained from babies on admission and, thereafter, every 4 days until discharged. Questionnaires were administered to medical personnel with upper respiratory tract infection (URTI).
View Article and Find Full Text PDFThe seasonal variation in respiratory syncytial virus (RSV) infections in children was examined in Benin City. Nasopharyngeal washes were obtained from children under 3 years hospitalised for acute lower respiratory infections during two seasons - rainy season (June-August) and dry season (December-February). RSV surface antigen was identified by ELISA.
View Article and Find Full Text PDFA patient is described with osteomyelitis of the cranium and epidural abscess due to Aspergillus fumigatus as the presenting manifestations of chronic granulomatous disease. The diagnosis was suggested by the unusual nature of the organism isolated and confirmed by appropriate laboratory studies. The details of diagnostic assessment and therapeutic management are discussed, and the central nervous system manifestations of chronic granulomatous disease are reviewed.
View Article and Find Full Text PDFAn animal model of neonatal protein deprivation was developed to examine the effects of maternal malnutrition on growth and development and on the host defense system of the suckling offspring. Adult rats were fed either a protein-deficient (3% casein) or normal (25% casein) diet beginning one day after parturition. Offspring of the protein-deprived animals showed biochemical signs of nutritional imbalance such as changes in serum acid hydrolase levels as early as the second day of life; growth retardation and hypoproteinemia developed by day 4.
View Article and Find Full Text PDFWhile neutrophils from neonates respond less efficiently in vitro to a chemotactic stimulus than do adult cells, the in vivo recruitment of phagocytic cells to focal sites of inflammation in some situations appears to be similar in adults and neonates. To resolve this apparent discrepancy between the in vitro and in vivo observations, neonatal and adult rats were inoculated intraperitoneally with a variety of chemotactic agents. The neutrophil response was far more intense in adults than in neonates, strengthening the hypothesis that chemotaxis is less efficient in neonates than in adults.
View Article and Find Full Text PDFTo test the hypothesis that intrauterine malnutrition may alter ontogeny of the host defense system, an animal model of fetal protein deprivation was developed. Young adult female rats were fed either a deficient (8% protein) diet or a normal (25% protein) diet for 10 days before insemination and throughout gestation. Offspring of the malnourished animals showed significant growth retardation and were hypoproteinemic.
View Article and Find Full Text PDFJ Reticuloendothel Soc
June 1982
The blood neutrophil response to lithium chloride challenge was determined in one-day-old and young adult rats to test the hypothesis that granulocytopoiesis is less efficient in neonates than in adults. Adult animals responded rapidly to lithium chloride treatment, showing a 134% increase in blood neutrophils on the second day of exposure and ultimately increasing by 260% by the tenth day. Newborn rats on the other hand, showed a 25% decrease in blood neutrophils after one day of treatment with lithium, then remained at that or at pretreatment levels throughout the subsequent 10 days.
View Article and Find Full Text PDFAnn Otol Rhinol Laryngol Suppl
October 1981
Fifty children aged 1 to 13 years with chronic or recurrent otitis media with effusion received a single dose of cefaclor (15 mg/kg body weight) by the oral route 30 minutes to seven hours before the removal of middle ear effusion and insertion of tympanostomy tubes. Serum and middle ear aspirate concentrations of the antibiotic were determined employing a microbiological assay technique by a disk diffusion method. Middle ear specimens were also cultured for aerobic bacteria.
View Article and Find Full Text PDFThe blood neutrophil response to endotoxin challenge was determined in one-day-old and young adult rats to test the hypothesis that the neonate is unable to mobilize neutrophils from bone marrow to the peripheral circulation at a rate similar to adults. Adult animals responded to endotoxin with a brief neutropenia followed rapidly by marked neutrophilia. The maximum adult neutrophil count occurred at 11 hr after challenge and returned to baseline values by 28 hr.
View Article and Find Full Text PDFTo test the hypothesis that inadequate in vivo mobilization of leukocytes may contribute to the unique susceptibility of neonates to infection, we studied the kinetics of phagocyte response to neonatal and adult rats to intraperitoneal infection with group B streptococcus, type Ia. The 50% lethal dose was considerably greater for adults than for neonates (1.1 x 10(7) colony-forming units per g versus 2.
View Article and Find Full Text PDFThe kinetics of phagocytosis by monocytes isolated from cord blood and from the blood of adult volunteers was studied. Monocytes attached to glass coverslips were incubated with polystyrene spheres (1.1 mu diameter) for up to 120 minutes.
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