With degrees in chemical engineering and computer science from Texas A&M University and the University of Houston, Kevin J. Smith began his career at the NASA Johnson Space Center in Houston, supporting the Mission Operations Directorate, and the next twelve years with Manugistics Inc. during the rapid global growth of supply chain management. He has been with HEAT Software for the last twelve years, working with market-leading clients on strategy, business models, and the implementation of technology and software solutions in support of IT service desk, IT service management, and broader IT strategic initiatives.
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Despite their beneficial effects, long-term systemic (oral or parenteral) use of these agents is associated with well-known adverse events (AEs) including: osteoporosis and fractures; adrenal suppression (AS); hyperglycemia and diabetes; cardiovascular disease (CVD) and dyslipidemia, dermatological and GI events; psychiatric disturbances; and immunosuppression. The objectives of this article are to: briefly review the properties and mechanisms of action of systemic corticosteroids; discuss the AEs most commonly associated with long-term use of these agents; and provide practical recommendations for patient monitoring and the prevention and management of these AEs.
Currently, evidence-based recommendations are lacking for withdrawal of high-dose GC treatment and management of individuals with biochemical evidence of AS. If high-dose GC therapy is no longer required, then GC doses can be reduced relatively quickly from pharmacologic to physiologic doses. Examples of withdrawal regimens for both adults and children are provided in Tables 13 and 14, respectively. These tables present modest, but safe, approaches to GC withdrawal and assume that the clinician has access to testing. However, in the absence of evidence-based guidelines, some physicians may choose to withdraw GC therapy gradually without testing. Regardless of the withdrawal regimen chosen, clinicians need to be aware of the symptoms of AS and to slow the withdrawal regimen should these symptoms arise.
Based on the findings of two expert panels attended by international experts in angioedema and emergency medicine, this review aims to provide practical guidance on the diagnosis, differentiation, and management of histamine- and bradykinin-mediated angioedema in the ED.
Because bradykinin-mediated angioedema is uncommon, there generally are not protocols in place in the ED and there is a lack of immediate access to appropriate drugs for bradykinin-mediated angioedema. For example, a recent survey of British EDs demonstrated that medications required to treat bradykinin-mediated angioedema were available in the majority of hospitals with specialist immunology services, but were not readily accessible in the ED (e.g., located in the main pharmacy). Additionally, only half the hospitals surveyed had established guidelines for the use of these medications [18].
Angioedema is a relatively common presentation in the ED and is potentially fatal. Angioedema management in the ED starts with assessing and securing the airway while initiating specific treatment. To ensure appropriate treatment and management, determination of whether the angioedema is mediated by histamine or bradykinin is essential. With the current lack of a reliable point-of-care test to distinguish the two pathophysiologies, ED physicians should familiarize themselves with available indicators to help guide treatment decisions. Histamine-mediated angioedema should be treated with H1 and H2 antagonists and oral corticosteroids along with epinephrine, as appropriate. Patients with HAE should receive a medication indicated for treating HAE such as a C1-INH inhibitor, ecallantide, or icatibant. Other causes of bradykinin-mediated angioedema may be treated with FFP. Hospitals should ensure that adequate procedures and treatments are in place for the management of angioedema.
Since the first scRNA-seq study was published in 2009 [5], there has been increasing interest in conducting such studies. Perhaps one of the most compelling reasons for doing so is that scRNA-seq can describe RNA molecules in individual cells with high resolution and on a genomic scale. Although scRNA-seq studies have been conducted mostly by specialist research groups over the past few years [5,6,7,8,9,10,11,12,13,14,15,16], it has become clear that biomedical researchers and clinicians can make important new discoveries using this powerful approach as the technologies and tools needed for conducting scRNA-seq studies have become more accessible. Here, we provide a practical guide for biomedical researchers and clinicians who might wish to consider performing scRNA-seq studies.
Kangaroo mother care is a method of care of preterm infants. The method involves infants being carried, usually by the mother, with skin-to-skin contact. This guide is intended for health professionals responsible for the care of low-birth-weight and preterm infants. Designed to be adapted to local conditions, it provides guidance on how to organize services at the referral level and on what is needed to provide effective kangaroo mother care. The guide includes practical advice on when and how the kangaroo-mother-care method can best be applied.
Residents in training, medical students and other staff in surgical sector, emergency room (ER) and intensive care unit (ICU) or Burn Unit face a multitude of questions regarding burn care. Treatment of burns is not always straightforward. Furthermore, National and International guidelines differ from one region to another. On one hand, it is important to understand pathophysiology, classification of burns, surgical treatment, and the latest updates in burn science. On the other hand, the clinical situation for treating these cases needs clear guidelines to cover every single aspect during the treatment procedure. Thus, 10 questions have been organised and discussed in a step-by-step form in order to achieve the excellence of education and the optimal treatment of burn injuries in the first 24 hours. These 10 questions will clearly discuss referral criteria to the burn unit, primary and secondary survey, estimation of the total burned surface area (%TBSA) and the degree of burns as well as resuscitation process, routine interventions, laboratory tests, indications of Bronchoscopy and special considerations for Inhalation trauma, immediate consultations and referrals, emergency surgery and admission orders. Understanding and answering the 10 questions will not only cover the management process of Burns during the first 24 hours but also seems to be an interactive clear guide for education purpose.
This practical guide is drawn to make it easy for any trainee, medical students and staff to understand the basic principles of management that should be carried out in each burn case during the first 24 hours. Any trainee should understand indeed his/her responsibility for these unique patients and should identify the management process in comprehensive way. This does not only mean covering of all wounds but also to bring the patient to his or her normal status including the psychological, social and of course the physical aspect.
Several guidelines regarding burn management exist. This includes those guidelines setup by organisations and by clinicians or researchers in the field. Kis et al searched the literature between 1990 and 2008 and retrieved 546 citations, of which 24 were clinical practice guidelines on the general and intensive care of burn patients. All major burn topics were covered by at least one guideline, but no single guideline addressed all areas important in terms of outcomes [31]. For example, Alsbjoern B et al structured a guideline for treatment but that was mainly concentrating on wound treatment rather than the comprehensive way [32].
Understanding and answering the above stated 10 questions will not only cover the management process of Burns during the first 24 hours but also should be an interactive clear guide for education purpose. Burn cases can extremely differ and, thus trainee, medical students and personnel in surgical sector, emergency room (ER) and intensive care unit (ICU) or Burn Unit face a multitude of questions regarding these critically ill patients. We found that this method serves good purposes and increases not merely the quality of treatment but also enhances education. Therfore it was good reason and positive motivation for us to structure another 10 questions as a clear guide that cover the treatment of burns after the first 24 hours until discharge.
Advanced Burn Life Support (ABLS) Course by American Burn Association provides guidelines in the assessment and management of the burn patient during the first 24 hours post injury. To date, this course is of great importance like the Advanced Trauma Life Support (ATLS) course, which is provided by the American College of Surgeons and many centres around the world. We should declare that there is no financial or commercial relationship between authors and those organisations providing these types of courses. 2ff7e9595c
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