The document discusses urinary catheters and catheter-associated urinary tract infections (CAUTIs). It provides information on:
- The history and development of urinary catheters from the 1920s to present.
- Risk factors for bacteriuria associated with urinary catheters. Studies show rates of bacteriuria increase significantly within the first week of catheter placement.
- Core strategies and supplemental strategies recommended by healthcare organizations to prevent CAUTIs, such as only using catheters when necessary, maintaining a closed drainage system, and hand hygiene.
Central-Line-Associated Bloodstream Infections (CLABSI) pause a major health problem in hospitalized patients. This disease is associated with people with a central line/tube inserted through the skin into the large vein, which can be used to give medicines, fluids, nutrients, or blood products to patients in critical conditions. The disease occurs when microbes enter through the central line invading the bloodstream.
Catheter-associated Urinary Tract Infections (CAUTI)
A urinary tract infection (UTI) is the most common type of healthcare-associated infection reported to the National Healthcare Safety Network (NHSN). Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay. The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed.
Infection Control Guidelines for Prevention of Catheter Associated Urinary Tract Infection
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Catheter Associated Urinary Tract Infections (CAUTI)Ujjwal Shah
This was prepared by Ujjwal Kumar Shah, a medical student at BPKIHS, for a seminar presentation on the topic "Health-care associated Infections" and the subtopic "CAUTI".
Prevention of Central Line Associated Blood Stream Infection (CLABSI )[compa...drnahla
Infection Control Guidelines for Prevention of Central Line Associated Blood Stream Infection (CLABSI )
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Central-Line-Associated Bloodstream Infections (CLABSI) pause a major health problem in hospitalized patients. This disease is associated with people with a central line/tube inserted through the skin into the large vein, which can be used to give medicines, fluids, nutrients, or blood products to patients in critical conditions. The disease occurs when microbes enter through the central line invading the bloodstream.
Catheter-associated Urinary Tract Infections (CAUTI)
A urinary tract infection (UTI) is the most common type of healthcare-associated infection reported to the National Healthcare Safety Network (NHSN). Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay. The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed.
Infection Control Guidelines for Prevention of Catheter Associated Urinary Tract Infection
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Catheter Associated Urinary Tract Infections (CAUTI)Ujjwal Shah
This was prepared by Ujjwal Kumar Shah, a medical student at BPKIHS, for a seminar presentation on the topic "Health-care associated Infections" and the subtopic "CAUTI".
Prevention of Central Line Associated Blood Stream Infection (CLABSI )[compa...drnahla
Infection Control Guidelines for Prevention of Central Line Associated Blood Stream Infection (CLABSI )
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Using the Central Line Bundle
Hand Hygiene
Remove Unnecessary Lines
Use of Maximal Barrier Precautions
Chlorhexidine for Skin Antisepsis
Avoid femoral lines
Report CLABSI rates to the units
Celebrate success!!
Ventilator associated pneumonia (VAP) was defined as per the Center of Disease Control (CDC) as a pneumonia that occurs in a patient who was intubated and ventilated at the time of or within 48 h before the onset of the event. Pneumonia was identified using a combination of radiological, clinical, and laboratory criteria
Safe iv cannulation (prevention of iv thrombophlebitis)Chaithanya Malalur
A basic introduction to applying an intravenous canula. A note on commonly accessible veins, purpose of IV cannulation, materials & procedure, after care, complications & management
Infection control guidelines for Prevention of Peripheral Venous Catheter (PV...drnahla
Infection Control Guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Evidence Based Practice: Assassination of Myths CAUTI (Catheter Associated Ur...man0032
Evidence Based Practice: Assassination of Myths CAUTI (Catheter Associated Urinary Tract Infections) reviews some of the myths healthcare teams use to perpetuate the need for indwelling urinary catheters (aka foleys) and replaces these myths with Evidence Based Practices. Citations and hyperlinks are included for all recommendations and are current as of Spring 2013. This presentation was presented to the Emory Healthcare system-wide CAUTI prevention retreat both in 2013 and 2014 and has been the basis for both entity and unit-based education to healthcare professionals.
Using the Central Line Bundle
Hand Hygiene
Remove Unnecessary Lines
Use of Maximal Barrier Precautions
Chlorhexidine for Skin Antisepsis
Avoid femoral lines
Report CLABSI rates to the units
Celebrate success!!
Ventilator associated pneumonia (VAP) was defined as per the Center of Disease Control (CDC) as a pneumonia that occurs in a patient who was intubated and ventilated at the time of or within 48 h before the onset of the event. Pneumonia was identified using a combination of radiological, clinical, and laboratory criteria
Safe iv cannulation (prevention of iv thrombophlebitis)Chaithanya Malalur
A basic introduction to applying an intravenous canula. A note on commonly accessible veins, purpose of IV cannulation, materials & procedure, after care, complications & management
Infection control guidelines for Prevention of Peripheral Venous Catheter (PV...drnahla
Infection Control Guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Evidence Based Practice: Assassination of Myths CAUTI (Catheter Associated Ur...man0032
Evidence Based Practice: Assassination of Myths CAUTI (Catheter Associated Urinary Tract Infections) reviews some of the myths healthcare teams use to perpetuate the need for indwelling urinary catheters (aka foleys) and replaces these myths with Evidence Based Practices. Citations and hyperlinks are included for all recommendations and are current as of Spring 2013. This presentation was presented to the Emory Healthcare system-wide CAUTI prevention retreat both in 2013 and 2014 and has been the basis for both entity and unit-based education to healthcare professionals.
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
Patient Safety Collaboratives - Dr Chris Streather, Managing Director, South London AHSN
Presentation from the Patient Safety Collaborative launch event held in London on 14 October 2014
More information at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/patient-safety-collaboratives.aspx
Critical care nursing lectures for undergraduate and post graduate students. The infection control in ICU includes all procedures needed to control infection among patients in ICU followed by nursing students
Running head PICOT AND LITERATURE SEARCH 1.docxtodd581
Running head: PICOT AND LITERATURE SEARCH 1
PICOT and Statement Literature Search
Student’s Name: Yeni Hernandez
Date: 7/22/2018
Course: NRS-433V
PICOT and Statement Literature Search
Nursing Practice Problem
Doctors use urinary catheters to empty urine from patients who have impaired urinary system. Such patients might suffer from kidney failure due to pressure exerted on their kidneys, this is dangerous and can permanently damage their kidneys. The Urinary catheters, however, may cause potential complications on the patients. Research carried on BMC Urology shows that most patients end up suffering from urinary tract infections (UTI) after the use of indwelling urinary catheters. Other complications such as kidney damage, injury to the urethra, bladder stones, and blood in the urine, septicemia and allergic reactions may arise from the usage of the urinary catheter (Feneley, Hopley, & Wells., 2015).
Picot Statement
Prognosis/Prediction: For pediatric patients 65 years and older (P), how does the use of catheters for much longer time (I) compared to the use of indwelling catheters for shorter time(C) influence the risk of Catheter-associated urinary infections(O) during the first ten weeks of indwelling catheter usage(T)?
Most patients who are placed in indwelling catheters for more than the expected time have had the risk of developing urinary tract infections, allergic reactions and others experience challenges in their kidneys.
What are some of the practical methods used to ensure that catheter-related diseases are reduced?
This study aims to make sure that indwelling urethral catheters (IDC) are carried out in a manner that minimizes risks to infection and trauma (Conway & Larson, 2011).
1st study
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engineering & Technology, 39(8), 459-470. doi:10.3109/03091902.2015.1085600
I chose this study because the there is a qualitative analysis of the article and the scale of the burden of urinary incontinence. Statistical data collected from the year 2006 to 2007 recorded millions of people in England with consistent problems, and in the year 2011, the number of patients had increased than the previous year. Studies show urinary infections have wider effects on the older generation, and those over 85 years of age suffered most, followed by those with over 65 years of age. Challenges emerge while an attempt is made to care for the old people and patients affected.
One study reveals that US nursing homes that received 420 admissions had 39% of patients experiencing a daytime urinary inconsistency most of them aged 65 years and above (Feneley, Hopley, & Wells., 2015).Clinicians often choose Catheterization as the last option due to high chances of urinary tract infections. In 2002, US had incidences of advance events of catheter induced_ infections occurring and causing deat.
Running head PICOT AND LITERATURE SEARCH 1.docxglendar3
Running head: PICOT AND LITERATURE SEARCH 1
PICOT and Statement Literature Search
Student’s Name: Yeni Hernandez
Date: 7/22/2018
Course: NRS-433V
PICOT and Statement Literature Search
Nursing Practice Problem
Doctors use urinary catheters to empty urine from patients who have impaired urinary system. Such patients might suffer from kidney failure due to pressure exerted on their kidneys, this is dangerous and can permanently damage their kidneys. The Urinary catheters, however, may cause potential complications on the patients. Research carried on BMC Urology shows that most patients end up suffering from urinary tract infections (UTI) after the use of indwelling urinary catheters. Other complications such as kidney damage, injury to the urethra, bladder stones, and blood in the urine, septicemia and allergic reactions may arise from the usage of the urinary catheter (Feneley, Hopley, & Wells., 2015).
Picot Statement
Prognosis/Prediction: For pediatric patients 65 years and older (P), how does the use of catheters for much longer time (I) compared to the use of indwelling catheters for shorter time(C) influence the risk of Catheter-associated urinary infections(O) during the first ten weeks of indwelling catheter usage(T)?
Most patients who are placed in indwelling catheters for more than the expected time have had the risk of developing urinary tract infections, allergic reactions and others experience challenges in their kidneys.
What are some of the practical methods used to ensure that catheter-related diseases are reduced?
This study aims to make sure that indwelling urethral catheters (IDC) are carried out in a manner that minimizes risks to infection and trauma (Conway & Larson, 2011).
1st study
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engineering & Technology, 39(8), 459-470. doi:10.3109/03091902.2015.1085600
I chose this study because the there is a qualitative analysis of the article and the scale of the burden of urinary incontinence. Statistical data collected from the year 2006 to 2007 recorded millions of people in England with consistent problems, and in the year 2011, the number of patients had increased than the previous year. Studies show urinary infections have wider effects on the older generation, and those over 85 years of age suffered most, followed by those with over 65 years of age. Challenges emerge while an attempt is made to care for the old people and patients affected.
One study reveals that US nursing homes that received 420 admissions had 39% of patients experiencing a daytime urinary inconsistency most of them aged 65 years and above (Feneley, Hopley, & Wells., 2015).Clinicians often choose Catheterization as the last option due to high chances of urinary tract infections. In 2002, US had incidences of advance events of catheter induced_ infections occurring and causing deat.
Hospital Acquired Infections/Health care associated infections/Nosocomial infection .
More useful for MBBS ,PG (MD/MS) Students to get a brief idea about HAI.
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
To interrupt blood supply to the acardiac twin in a case of TRAP sequence of monochorionic diamniotic multiple pregnancy to allow for continuation of the normal twin.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
Severe skin adverse drug reactions can result in death. Toxic epidermal necrolysis (TEN) has the highest mortality (30–35%); Stevens-Johnson syndrome and transitional forms correspond to the same syndrome, but with less extensive skin detachment and a lower mortality (5–15%). Hypersensitivity syndrome, sometimes called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), has a mortality rate evaluated at about 10%. It is characterised by fever, rash and internal organ involvement. Prompt diagnosis is vital, along with identification and early withdrawal of suspect medicines and avoidance of re-exposure to the responsible agent is essential. Cross-reactivity to structurally-related syndrome caused by Carbamazepine medicines is common, thus first-degree relatives may be predisposed to developing this syndrome. We report a case of DRESS secondary to use of Carbamazepine.
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
The spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also on the rise, although they may be under reported because of lack of awareness. We report two such cases of dengue hemorrhagic fever with hepatitis, intraocular hemorrhage, ARDS and myocarditis.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
Pediatric Liver Transplant (LT) is now an established procedure for End Stage Liver Disease (ESLD) with biliary atresia being the commonest indication. Intensive pre-transplant evaluation, nutritional buildup and immunization are the fundamental pre-requisites of a successful LT. With improvement in surgical micro-anastomotic techniques and superior immunosuppressive regimens the success rate of pediatric LT is in excess of 90%. Most of the transplants in our country however are Living related, due to which a fairly large number of children expire awaiting a donor liver. There should be a concerted effort to evolve the cadaveric donation program, so that majority of the children are benefitted.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
3. • Developed in the 1920s by
Dr. Frederick Foley
• Originally an open system
with the urethral tube
draining into an open
container
• Closed system (1950’s)
developed in which the
urine flowed through a
catheter into a closed bag
3
6. Most common type of healthcare-associated
infection
◦ > 30% of HAIs reported to NHSN
◦ Estimated > 560,000 nosocomial UTIs annually
Increased morbidity & mortality
◦ Estimated 13,000 attributable deaths annually
◦ Leading cause of secondary BSI with ~10% mortality
Excess length of stay : 2-4 days
Increased cost : $0.4-0.5 billion per year nationally
Unnecessary antimicrobial use
Hidron AI et al. ICHE 2008;29:996-1011 Givens CD, Wenzel RP. J Urol 1980;124:646-8
Klevens RM et al. Pub Health Rep 2007;122:160-6 Green MS et al. J Infect Dis 1982;145:667-72
Weinstein MP et al. Clin Infect Dis 1997;24:584-602 Foxman B. Am J Med 2002;113:5S-13S
Cope M et al. Clin Infect Dis 2009;48:1182-8 Saint S. Am J Infect Control 2000;28:68-75
7. In patients with indwelling urethral,
indwelling suprapubic, or intermittent
catheterization
Presence of symptoms or signs compatible with UTI
with
No other identified source of infection
103 colony forming units (cfu)/mL of 1 bacterial
species in a single catheter urine specimen
or
in a midstream voided urine specimen from a
patient whose catheter has been removed in previous
48 hrs.
8. Gold standard is urine culture
Dipstick and other non-culture tests are
not reliable
Number of organisms is controversial
9.
10.
11. Source of
microorganisms:
Endogenous - meatal,
rectal, or vaginal
colonization
Exogenous -
contaminated hands
of healthcare worker
Maki DG. Emerg Infect Dis 2001;7:1-6
13. Formation of
biofilms by urinary
pathogens common
on the surfaces of
catheters and
collecting systems
Bacteria within
biofilms resistant
to antimicrobials Scanning electron micrograph of S. aureus
bacteria on the luminal surface of an
and host defenses indwelling catheter with interwoven complex
matrix of extracellular polymeric substances
known as a biofilm
Photograph from CDC Public Health Image Library: http://phil.cdc.gov/phil/details.asp
15. Supplemental
Core Strategies Strategies
◦ High levels of ◦ Some scientific
scientific evidence evidence
◦ Variable levels of
◦ Demonstrated feasibility
feasibility
www.cdc.gov/hicpac
16. Insert catheters only for appropriate indications
Leave catheters in place only as long as needed
Ensure that only properly trained persons insert and
maintain catheters
Insert catheters using aseptic technique and sterile
equipment (acute care setting)
Maintain a closed drainage system
Maintain unobstructed urine flow
Hand hygiene and Standard precautions
http://www.cdc.gov/hicpac/cauti/001_cau
17. Acute urinary retention or obstruction
Accurate measurements in critically ill patients
Selected surgical procedures e.g. urologic
Healing of open sacral or perineal wounds
End of life comfort
Prolonged immobilisation
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/CAUTI_Guideline2009final.pdf
18. Urinary incontinence
Immobility
Use of diuretics
Ignorance of published guidelines
Clinical uncertainty of the patient’s medical
course
Convenience of staff
Jain et al (1995) Arch Intern Med 155:1425-9
19. Good hand hygiene Don sterile gloves before
before and after procedure
procedure
20. •Sterile technique
must be used
when inserting the
catheter
•Do not use
aggressive
cleaning once
urinary catheter is
in place
21.
22.
23. 12 month control period followed by
12 month intervention with nurse
generated daily reminders after D5
◦ Catheterization rate reduced from 7.0 +
1.1 days to 4.6 +/- 0.7 days; P < .001
◦ CAUTI rate reduced from 11.5 +/- 3.1
to 8.3 +/- 2.5 per 1,000 catheter-days;
P = .009
◦ Antibiotic cost reduced reduced by 69%
(from 4021 dollars +/- 1800 dollars to
1220 dollars +/- 941 dollars; P = .004)
Huang et al Infect Control Hosp Epidemiol. 2004
Nov;25:974-8
24. Maintain a closed drainage system (I B)
◦ If breaks in aseptic technique, disconnection, or
leakage occur, replace catheter and collecting
system
◦ Consider systems with preconnected, sealed
catheter-tubing junctions (II B)
◦ Obtain urine samples aseptically
http://www.cdc.gov/hicpac/cauti/001_cau
27. Maintain unobstructed urine flow (I B)
◦ Keep catheter and collecting tube free from
kinking
◦ Keep collecting bag below level of bladder at all
times (do not rest bag on floor)
◦ Empty collecting bag regularly using a separate,
clean container for each patient. Ensure
drainage spigot does not contact nonsterile
container.
http://www.cdc.gov/hicpac/cauti/001_cau
28. Use smallest catheter
size effective for
patient (14 or 16F)
Catheters should be
properly secured to
prevent movement and
urethral traction
29. Implement quality improvement
programs to enhance appropriate use of
indwelling catheters and reduce risk of
CA-UTI
Eg:
• Alerts or reminders
• Stop orders
• Protocols for nurse-directed removal of
unnecessary catheters
• Guidelines/algorithms for appropriate
perioperative catheter management
http://www.cdc.gov/hicpac/cauti/001_cau
30. Alternatives to indwelling urinary catheterization
(II)
Portable ultrasound devices for assessing urine
volume to reduce unnecessary catheterizations (II)
Antimicrobial/antiseptic-impregnated catheters (I
B)
After first implementing core recommendations
for use, insertion, and maintenance
31. Intermittent catheterization – consider for:
◦ Patients requiring chronic urinary drainage for
neurogenic bladder
Spinal cord injury
Children with myelomeningocele
◦ Postoperative patients with urinary retention
◦ May be used in combination with bladder ultrasound
scanners
External (i.e., condom) catheters – consider for:
◦ Cooperative male patients without obstruction or
urinary retention
32. Rationale: fewer catheterizations = lower risk
of UTI
2 studies of adults with neurogenic bladder
undergoing intermittent catheterization
Fewer catheterizations per day but no reported
differences in UTI
◦ Significant study limitations: likely underpowered;
UTIs undefined
Polliak T et al. Spinal Cord 2005;43:615-19
Anton HA et al. Arch Phys Med Rehab 1998;79:172-5
33. Decreased risk of bacteriuria compared to
standard latex catheters in a meta-analysis of
RCTs
Significant differences for silver alloy but not silver
oxide-coated catheters
Effect greater for patients catheterized < 1 week
Mixed results in observational studies in
hospitalized patients
◦ Most used laboratory-based outcomes (bacteriuria)
◦ 1 positive, 2 negative, 5 inconclusive
http://www.cdc.gov/hicpac/cauti/001_cau
34. Polymyxin
◦ Butler HK, Kunin CM. J Urol 1971;106:928
Cephalothin
◦ Lazarus SM, LaGuerre JN, Kay H, Weinberg S,
Levowitz BS. J Biomed Mater Res 1971;5:129
Both unsuccessful
35. 344 newly catheterised patients studied daily
◦ RR 0.672, P=0.30 overall
◦ OR 0.22, P=0.02 for GNRs
◦ Not effective for yeasts
◦ Little effect beyond 7 days
◦ Maki, Knasinski SHEA 1997
36. Core Measures Supplemental
Measures
Insert catheters only for Alternatives to
appropriate indications indwelling urinary
Leave catheters in place only catheterization
as long as needed Portable ultrasound
Only properly trained persons devices to reduce
insert and maintain catheters unnecessary
Insert catheters using aseptic catheterizations
technique and sterile Antimicrobial/antiseptic
equipment -impregnated catheters
Maintain a closed drainage
system
Maintain unobstructed urine
flow
Hand hygiene and standard (or
appropriate isolation)
precautions
38. Changing catheters or drainage bags at routine, fixed
intervals
Routine antimicrobial prophylaxis
Cleaning of periurethral area with antiseptics while
catheter is in place (use routine hygiene)
Irrigation of bladder with antimicrobials
Instillation of antiseptic or antimicrobial solutions into
drainage bags
Routine screening for asymptomatic bacteriuria (ASB)
http://www.cdc.gov/hicpac/cauti/001_cau
39. Documentation & review of indications for
catheter insertion
Asepsis during catheter insertion
Daily assesment for the need of catheter
Hand hygiene during daily catheter care
Positioning of the drainage bag below the
bladder
Regular emptying of the drainage bags