Severe sepsis and septic shock are among the leading causes of mortality in the intensive care unit. Over a decade ago, early goal-directed therapy (EGDT) emerged as a novel approach for reducing sepsis mortality and was incorporated into guidelines published by the international Surviving Sepsis Campaign. In addition to requiring early detection of sepsis and prompt initiation of antibiotics, the EGDT protocol requires invasive patient monitoring to guide resuscitation with intravenous fluids, vasopressors, red cell transfusions, and inotropes. The effect of these measures on patient outcomes, however, remains controversial. Recently, three large randomized trials were undertaken to re-examine the effect of EGDT on morbidity and mortality: the ProCESS trial in the United States, the ARISE trial in Australia and New Zealand, and the ProMISe trial in England. These trials showed that EGDT did not significantly decrease mortality in patients with septic shock compared with usual care. In particular, whereas early administration of antibiotics appeared to increase survival, tailoring resuscitation to static measurements of central venous pressure and central venous oxygen saturation did not confer survival benefit to most patients. In the following review, we examine these findings as well as other evidence from recent randomized trials of goal-directed resuscitation. We also discuss future areas of research and emerging paradigms in sepsis trials.
almost 7 years ago
Measuring the height of the uterus from the symphysis pubis (SFH) in pregnancy for detecting problems with fetal growth | Cochrane
Monitoring the baby’s growth is important during pregnancy. If growth is poor then this should be identified as soon as possible, because delay might result in the baby’s death. The simplest way to determine growth is to examine the baby by palpating the mother's by abdomen and estimate the size of her womb compared with a landmark such as the navel (umbilicus). An alternative method is to use a tape measure to take a measurement, known as the symphysial fundal height (SFH) measurement, from the mother’s pubic bone (symphysis pubis) to the top of the womb. The measurement is then applied to the gestation by a simple rule of thumb and compared with normal growth.
over 6 years ago
Differences in Mechanosensory Discrimination Across the Body Surface - Neuroscience - NCBI Bookshelf
The accuracy with which tactile stimuli can be sensed varies from one region of the body to another, a phenomenon that illustrates some further principles of somatic sensation. Figure 9.4 shows the results of an experiment in which variation in tactile ability across the body surface was measured by two-point discrimination. This technique measures the minimal interstimulus distance required to perceive two simultaneously applied stimuli as distinct (the indentations of the points of a pair of calipers, for example). When applied to the skin, such stimuli of the fingertips are discretely perceived if they are only 2 mm apart. In contrast, the same stimuli applied to the forearm are not perceived as distinct until they are at least 40 mm apart! This marked regional difference in tactile ability is explained by the fact that the encapsulated mechanoreceptors that respond to the stimuli are three to four times more numerous in the fingertips than in other areas of the hand, and many times more dense than in the forearm. Equally important in this regional difference are the sizes of the neuronal receptive fields. The receptive field of a somatic sensory neuron is the region of the skin within which a tactile stimulus evokes a sensory response in the cell or its axon (Boxes A and B). Analysis of the human hand shows that the receptive fields of mechanosensory neurons are 1–2 mm in diameter on the fingertips but 5–10 mm on the palms. The receptive fields on the arm are larger still. The importance of receptive field size is easy to envision. If, for instance, the receptive fields of all cutaneous receptor neurons covered the entire digital pad, it would be impossible to discriminate two spatially separate stimuli applied to the fingertip (since all the receptive fields would be returning the same spatial information). Figure 9.4Variation in the sensitivity of tactile discrimination as a function of location on the body surface, measured here by two-point discrimination. (After Weinstein, 1969.)
over 6 years ago
A government policy designed to reduce the regulatory burden on business is making it increasingly difficult to introduce measures to improve public health in the United Kingdom, such as steering people away from unhealthy foods, a group of medical bodies and charities has warned.
over 6 years ago
In the first comparison of bariatric surgery and medical treatment over 5 years, 50% of surgical patients with type 2 diabetes demonstrated remission, while 80% reached the ADA treatment goal with one drug and/or dietary measures.
over 6 years ago