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Challenging management dogma where evidence is non-existent, weak, or outdated: part II.
Intensive Care Med
November 2024
Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK.
Many dogmas influence daily clinical practice, and critical care medicine is no exception. We previously highlighted the weak, questionable, and often contrary evidence base underpinning four established medical managements-loop diuretics for acute heart failure, routine use of heparin thromboprophylaxis, rate of sodium correction for hyponatremia, and 'every hour counts' for treating bacterial meningitis. We now provide four further examples in this "Dogma II" piece (a week's course of antibiotics, diabetic ketoacidosis algorithms, sodium bicarbonate to improve ventricular contractility during severe metabolic acidosis, and phosphate replacement for hypophosphatemia) where routine practice warrants re-appraisal.
View Article and Find Full Text PDFThe importance of capillary distribution in supporting muscle function, building on Krogh's seminal ideas.
Comp Biochem Physiol A Mol Integr Physiol
April 2021
School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, United Kingdom. Electronic address:
Krogh's Nobel prize for insightful studies into the physiology of capillaries heralded a revolution in understanding that continues today. The view of passive conduits has been replaced by capillaries recognised as a key element in haemodynamic control, offering both a site where changes in tissue demand are sensed and a driver of integrated vascular responses. In addition, the capillary bed is known to play an important role in metabolic, hormonal and immune homeostasis.
View Article and Find Full Text PDFDesigning stem-cell-based dopamine cell replacement trials for Parkinson's disease.
Nat Med
July 2019
John van Geest Centre for Brain Repair, Department of Clinical Neurosciences and WT-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK.
Clinical studies of Parkinson's disease (PD) using a dopamine cell replacment strategy have been tried for more than 30 years. The outcomes following transplantation of human fetal ventral mesencephalic tissue (hfVM) have been variable, with some patients coming off their anti-PD treatment for many years and others not responding and/or developing significant side effects, including graft-induced dyskinesia. This led to a re-appraisal of the best way to do such trials, which resulted in a new European-Union-funded allograft trial with fetal dopamine cells across several centers in Europe.
View Article and Find Full Text PDFA re-appraisal of the systematic status of selected genera in Palaemoninae (Crustacea: Decapoda: Palaemonidae).
Zootaxa
November 2013
APEM Ltd., Diamond Centre, Works Road, Letchworth Garden City, SG6 1LW, United Kingdom; Email:
Recent phylogenetic work (Ashelby et al., 2012) has demonstrated the need for a fresh appraisal of the systematic status of some Palaemoninae genera. In the present contribution the accumulated morphological as well as molecular evidence is reviewed.
View Article and Find Full Text PDFReplacement therapy with hydrocortisone in catecholamine-dependent septic shock.
J Endotoxin Res
January 2002
Service de Réanimation Médicale, Hôpital Raymond Poincaré, Faculté de Médecine Paris-Ouest, Université Paris V, Garches, France.
Septic shock is one of the leading causes of death in intensive care units world-wide. Scientists have made great improvements in understanding mechanisms of inflammation, and the sequence of activation of the various pro- and anti-inflammatory markers is now well known. In contrast, physicians have failed to improve survival from septic shock despite the development of specific targets at various points in the cytokine cascade considered to have a key role in host survival in sepsis.
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