Effectiveness and safety of CPNB and continuous local wound infusion
Basal infusion with PCA option
Types of pumps – elastomeric vs. electronic
Outpatient and home infusion pumps
PCA is neither “ one size fits all “ or a “ set and forget “ therapy
An Anesthesiologist style ……….
no fixed dose of drug fits all patient
make patient analgesia and take care
Option of interventional pain therapy in multimodal treatment of chronic cancer and non-cancer pain
Established role when pharmacotherapy or surgery not suitable
Indications well accepted
Evidence for efficacy moderate to strong
SpAn harus memberi waktu untuk pengelolaan nyeri
SpAn harus mampu mengelola nyeri dengan memilih cara yang paling aman, paling efektif dan paling ekonomis
Berperan aktif pada acute pain
Berperan, minimal partisipatif, dalam chronic pain
Berperan utama pada interventional pain management
Pain Physicians should consider nerve blocks when systemic analgesics are failing. (Adjuvant therapy)
Careful selection of patients
Benefits should outweigh the risks
Thorough knowledge of the limitations and side effects
Need for randomized controlled clinical trials.
Preventive analgesia:
Broader definition of preemptive analgesia
Perioperative analgesic regimen that able to control pain-induced sensitization
Not the timing of the analgesic treatment but the duration and efficacy of an analgesic intervention are more important for an effective postoperative pain relief
Adequate preventive analgesia should include multimodal techniques and with a sufficient duration of tretment
PCA is neither “ one size fits all “ or a “ set and forget “ therapy
An Anesthesiologist style ……….
no fixed dose of drug fits all patient
make patient analgesia and take care
Option of interventional pain therapy in multimodal treatment of chronic cancer and non-cancer pain
Established role when pharmacotherapy or surgery not suitable
Indications well accepted
Evidence for efficacy moderate to strong
SpAn harus memberi waktu untuk pengelolaan nyeri
SpAn harus mampu mengelola nyeri dengan memilih cara yang paling aman, paling efektif dan paling ekonomis
Berperan aktif pada acute pain
Berperan, minimal partisipatif, dalam chronic pain
Berperan utama pada interventional pain management
Pain Physicians should consider nerve blocks when systemic analgesics are failing. (Adjuvant therapy)
Careful selection of patients
Benefits should outweigh the risks
Thorough knowledge of the limitations and side effects
Need for randomized controlled clinical trials.
Preventive analgesia:
Broader definition of preemptive analgesia
Perioperative analgesic regimen that able to control pain-induced sensitization
Not the timing of the analgesic treatment but the duration and efficacy of an analgesic intervention are more important for an effective postoperative pain relief
Adequate preventive analgesia should include multimodal techniques and with a sufficient duration of tretment
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
Kesimpulan:
ANTI INFLAMMATORY DRUGS
a valuable adjuvant as part of a multimodal analgesic regimen for the management of pain in the perioperative period
effective adjunct in multimodal regimens to reduce postoperative pain
Preemptive Analgesia for Attenuation of Postoperative Pain in Patients Underg...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Aggressive preemtive multimodal including epidural or nerve block not only produce optimal analgesia but also may prevent the occurrence of chronic pain after surgical
Paracetamol as a single analgesic is only for mild and moderate pain.
However it can be combined with many analgesics to provide strong effect.
So, it can be the basic regiment for Multimodal Analgesia.
CHRONIC PAIN AND DEPRESSION: Cause or Effect or Linked?Sudhir Kumar
Chronic pain and depression are both common conditions, and in many patients, they co-exist. This presentation looks at the link between chronic pain and depression. Various drugs that can be used to treat chronic pain/depression have been discussed, with a special emphasis on tricyclic antidepressants.
Wireless Infusion Pumps: Securing Hospitals’ Most Ubiquitous Medical DevicePriyanka Aash
Imagine being dependent on a wireless infusion pump to receive the correct dosage of life-supporting medication. Now imagine the implications, were that pump to be maliciously hacked. In this session learn more about how to successfully secure these medical devices, based on work being conducted at the National Cybersecurity Center of Excellence (NCCoE) with premier health care organizations.
(Source: RSA USA 2016-San Francisco)
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
Kesimpulan:
ANTI INFLAMMATORY DRUGS
a valuable adjuvant as part of a multimodal analgesic regimen for the management of pain in the perioperative period
effective adjunct in multimodal regimens to reduce postoperative pain
Preemptive Analgesia for Attenuation of Postoperative Pain in Patients Underg...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Aggressive preemtive multimodal including epidural or nerve block not only produce optimal analgesia but also may prevent the occurrence of chronic pain after surgical
Paracetamol as a single analgesic is only for mild and moderate pain.
However it can be combined with many analgesics to provide strong effect.
So, it can be the basic regiment for Multimodal Analgesia.
CHRONIC PAIN AND DEPRESSION: Cause or Effect or Linked?Sudhir Kumar
Chronic pain and depression are both common conditions, and in many patients, they co-exist. This presentation looks at the link between chronic pain and depression. Various drugs that can be used to treat chronic pain/depression have been discussed, with a special emphasis on tricyclic antidepressants.
Wireless Infusion Pumps: Securing Hospitals’ Most Ubiquitous Medical DevicePriyanka Aash
Imagine being dependent on a wireless infusion pump to receive the correct dosage of life-supporting medication. Now imagine the implications, were that pump to be maliciously hacked. In this session learn more about how to successfully secure these medical devices, based on work being conducted at the National Cybersecurity Center of Excellence (NCCoE) with premier health care organizations.
(Source: RSA USA 2016-San Francisco)
Implantable Infusion Pumps: Insights For Your Next Animal Dosing StudyInsideScientific
A webinar for scientists interested in the use of implantable pumps as an alternative to repetitive injections when administering compounds to laboratory animals.
The administration of compounds and dosing methodologies are important considerations when planning experiments using laboratory animals. Injections are often used for animal dosing, but repeated injections over prolonged periods may be inadequate for some compounds (i.e. those with short half-lives) and can lead to great variations in serum concentrations. They are also stressful to the animal and inconvenient for the researcher. Implantable infusion pumps are useful drug delivery tools for preclinical research and drug development. They offer a reliable and convenient alternative to injections and other repetitive dosing methods. They allow greater control and accuracy in drug delivery, thus reducing dosing errors, ensuring stable dose levels and minimizing adverse effects. ALZET® Osmotic Pumps have been used in preclinical research for nearly four decades to successfully deliver a wide range of experimental agents. iPRECIO® programmable pumps have been developed more recently to facilitate highly demanding dosing requirements.
In this exclusive webinar sponsored by DURECT Corporation, Mr. José Gadea describes the features, benefits and applications of implantable pumps. Discussion focuses on clarifying the most common misconceptions circulating within the research community about implantable infusion pumps. This information is intended to help researchers make more informed decisions when choosing the most appropriate dosing method for their study.
Dear Friends here is a Presentation on , variety of Pumps , for many Industrial applications.
pumps allow us to transport Viscous Fluids, Adhesives, even Hot melts with great ease.
Watch this PPT
There are currently few options to extend the duration of regional analgesia at home beyond the one day expected from most single-injection nerve blocks. Continuous peripheral nerve block (CPNB) with a plain local anesthetic perineural infusion is the most established way to provide days of postoperative pain control and allows titration, but training in insertion techniques and a system to manage ambulatory CPNB patients are necessary. Adjuvants or depot formulations of local anesthetics may offer potential options for limited extension of block duration, but further studies regarding efficacy and safety for regional anesthesia as well as comparative-effectiveness versus CPNB are necessary.
At the conclusion of this activity, learners will be able to: discuss the indications for continuous peripheral nerve blocks; identify obstacles to implementing a continuous peripheral nerve block system; examine various techniques and equipment for continuous peripheral nerve block performance; and discuss the application of ultrasound guidance for perineural catheter insertion.
At the conclusion of this activity, learners will be able to: discuss the benefits of regional anesthesia on pain and rehabilitative outcomes; identify applications of “big data” in outcomes assessment; and critically evaluate the evidence related to regional anesthesia and analgesia and long-term outcomes.
After completion of this session, students should be able to discuss, identify, and describe:
The anatomical factors predisposing to nerve injuries.
The anatomy of deformity, weakness and sensory loss following the nerve injury.
The applied anatomy of clinical examination for specific nerves.
Surgical anatomy of treating nerve injuries.
this presentation reviews basic information on adjuncts to local anesthetics and peripheral nerve blockade. it was last undated and used for anesthesiology resident education in 2011. hope you find this information helpful. John Gerancher JC Gerancher MD
Long-acting local anesthetics - present and futurescanFOAM
A presentation by Joseph Cravero at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Summary:
Epidural Analgesia is effective in the management of perioperative pain --> neural transmission process can be inhibited by epidural analgesia
Epidural Analgesia decreases risk of Venous thromboembolisms, Pulmonary, complications, Arrhythmias, Postoperative ileus, Transfusion requirements, Pain, Stress/immune response
Epidural analgesia can not inhibit the surgical stress response perfectly, because this technique we can not block the circulation pathway / humoral pathway.
Surgical stress response affect the cardiovascular system, respiratory system, gastroinstestinal system, immune system, and metabolic function.
Long Island Periodontist presents "The Art and Science of the Painless Dental...Edward Brant DDS, MS
Periodontist who does his best when he provides Long Island with treatment for tooth and gum disease. Dentist, dental implants, laser gum treatment for periodontal disease, bone graft, gum surgery.
Explanation of how to give dental injections without causing the patient pain.
HISTORY OF 3-STEP LADDER WHO
1980 – WHO establishes Cancer Control Programme
Cancer prevention
Early diagnosis with curative treatment
Pain relief and palliative care
1986 – ” Cancer Pain Relief “ published by WHO
Step Ladder WHO
Updated on 1996
Worldwide acceptance protocol
Today, worldwide consensus favouring its used for management of all pain associated with serious illness
INADEQUATE PAIN TREATMENT STILL A FACT IN INDONESIA HEALTH SERVICES
PAIN AS A COMPLEX PROBLEM NEED MULTIDISCIPLINARY APPROACH FOR BETTER RESULT BASED INDIVIDUALLY PATIENT NEEDED
THERE IS A BIG ROLE OF PHYSICIAN AND HOSPITAL FOR BETTER PAIN MANAGEMENT
CHANGE PARADIGM TO MULTIDISCIPLINARY PAIN TREATMENT IS AN OBLIGATE FOR ALL PHYSICIAN
Pain is a common yet complex biopsychosocial phenomenon that affects every aspect of a patient’s life
Optimal management often requires good assessment, formulation of the problem in the patient, and combining pharmacological and non-pharmacological (psychological and social) interventions
Through palliative care, we change the role of a patient into a whole human being.
Through palliative care, we transform the stages leading to death into times filled with life
Pain is the production (out put ) of the brain.
Pain is invisible disease, we can’t see it like other disease, such as struma, fracture or blind.
What you have to do is to believe what ever the patient says.
Pain is what ever the patient says it is
Pain is invisible diseases, but is real for patient.
NUTRITIONAL THERAPY IN CRITICAL ILL PATIENTS
However, significant barriers can impede the enteral administration of nutrients, including gastroduodenal dysfunction reflected by high gastric residual volumes, and diarrhoea and constipation.
Possible solutions are suggested. In case of contraindication or failure of enteral nutrition, parenteral nutrition is indicated -----as a replacement or a supplement to failing enteral feeding.
The perfect timing of supplemental parenteral nutrition (early or late) remains uncertain, and parenteral nutrition should be carefully monitored
Solution of inadequate postoperative pain relief lies in developing Acute Pain Service.
APS has been shown to reduced morbidity and
mortality, increased out put and out come of
postoperative pain patients
Increased stisfaction of the patients
Shorten LOS in ICU and Hopital low cost
Nyeri adalah penggabungan perasaan sensorik dan emosional yang dipengaruhi oleh berbagai faktor.
Nyeri memiliki dua dimensi yg jelas, dimensi inderawi dan emosional
Peran dimensi emosional lebih dominan dibanding inderawi utamanya pada nyeri kronik.
History taking
Adequate time
Listen carefully
Empathetic
Trust building
Do not intervere
Pschosocioeconomic & spiritual codition
- quantity: VAS
- quality: nociceptive
- mode of onset and location
- duration & chronicity
- provocating & relieving factors
- special character
- timing of pain
- relation with posture
- associated complaints
Take home message
Acute pain is a symptom, tell us that there is something wrong in our body.
Chronic pain is a disease entity and that must be treated differently to acute pain.
Since chronic pain is biopsychosocial phenomenon it must be treated by multidisciplinary team with multidisiplinary approach.
Clossing
By 3 step ladder WHO cancer pain management, 90 % of cancer pain can be relief.
Since cancer patients cannot be cured, our main task is to let them die free of pain with Iman
Ideal pain clinic
Promoting multidisciplinary team approach
Coordinating all specialist effort
Measuring the outcome of treatment offered
Promoting palliative model rather than curative models of pain treatments
Identifying complications of IPM and promoting safe and base-evidence intervention
PiCCO tidak hanya memberikan informasi tentang curah jantung (CO) tapi bisa memberi pengukuran untuk menilai preload, kontraktilitas, afterload, dan air paru ekstravaskular (ELWI)
Role of the thalamus in propofol-induced unconsciousness relates primarily to the functional connections of nonspecific nuclei to the cortex (i.e., mediating multimodal integration of information)
The Anesthetized Brain is less Vulnerable to ischemic injury than the awake brain.
EEG changes suggestive of severe ischemia are present.
Basic Methode Brain Protection are “ Corner Stone “
CPP, CBF, CBV maintained in “Normal Range”, MAP may increased up to 10 – 20 %.
Anesthetics Drugs may have Brain Protectection effect.
Volatile anesthetics do provide some Transient Protection (< 1,5 MAC)
Barbiturates, although long considered to be the gold standard.
Hypothermic methode are controversial, Hyperthermia should be avoided.
Insulin is Administered if glucose values exceed 180 mg/dl.
Close monitoring of BSL to ensure that Hypoglycemia does not develop
Anesthesiologists should concern about the risk of POCD by making prevention and attentive to the potential risk factors.
It should be remembered that research in animal models which represent the specific characteristics of POCD in human remains unclear.
With many factors still unknown, there is still a chance for sinchronized preclinical and clinical research on POCD.
a better understanding of sleep and coma may lead to new approaches to general anesthesia based on new ways to alter consciousness,29,97,98 provide analgesia,99,100 induce amnesia, and provide muscle relaxation.66
More from Department of Anesthesiology, Faculty of Medicine Hasanuddin University (20)
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
7. Ultrasound Guidance Improves
Efficacy of PNB
• Higher rate of successful blocks
• Less time to perform, less discomfort
• Faster onset (29% shorter onset time)
• Longer duration (25% longer)
• Reduced risk of vascular puncture
Abrahams MS, et al. Br J Anaesth 2009;102:408-17
8. Advantages of Continuous
Peripheral Nerve Block
• Improved pain control during mobilisation
• Decrease opioid use
• Less nausea, vomiting, pruritus and sedation
• Greater patient satisfaction
• Improved functional outcomes
• Outpatient use
Capdevila X, et al. Anesthesiology 1999;91:8-15
Richman JM, et al. Anesth Analg 2006;102:248-57
Bingham AE, et al. Reg Anesth Pain Med 2012
9. 1. 19 RCT’s (11 double-blind)
2. Better analgesia for all time periods at 24, 48 and 72 h and all
catheters
3. Reduction in opioid use
4. Lower incidence of PONV (21 % vs. 49 %), sedation (27% vs.
52%), and pruritus (10 vs. 27 %) with PNB´s
5. Improved patient satisfaction (4 RCT’s only)
6. CPNB, regardless of catheter location, provided superior
postoperative analgesia and fewer opioid-related side effects
when compared with opioid analgesia
Anesth Analg 2006;102:248-57
Richman JM, et al. Anesth Analg 2006;102:248-57
10. Drugs
Local Anaesthetics
• Bupivacaine, levo-bupivacaine and ropivacaine
– Cardiotoxicity ratio 3: 1.7: 1
– Ropivacaine: less motor block
• Common concentrations:
– Bupivacaine or L-bupivacaine 0.1-0.25%
– Ropivacaine 0.2%
12. Clonidine
• Meta-analysis of 20 RCTs
• Prolongs analgesia and sensory by about 2 hrs
• Increases risk of hypotension, fainting,
bradycardia and sedation
• Prolongs motor block
Popping DM, et al. Anesthesiology 2009;111:406-15
14. Infusion Strategies
• Continuous infusion
– Greater use of LA
– May produce dense block
• Infusion with patient-controlled (PCA) boluses
– Comparable analgesia
– 30% less LA
• Patient-controlled (PCA) boluses only
– Higher pain scores
– Greater opioid consumption
16. Figure 1. Box plots of verbal rating pain scores (VRS) obtained from the two groups at 6, 8,
12, and 24 h postoperatively.
Taboada M et al. Anesth Analg 2008;107:1433-1437
17. Taboada M, et al. Anaesthesiology 2009;110:150-4
• 50 patients randomized to 0.125% levobupivacaine
infusion administered through a popliteal catheter as
an automated regular bolus or as CI, both combined
with PCA
• Both dosing regimens - similar postop analgesia
• Consumption of LA and dose request from the PCA
lower in the automated bolus group
18. 60 patients received ISB:
Gp 1: CI of 0.125% bupivacaine with sufentanil 0.1 microg/mL and
clonidine 1 microg/mL at 10 mL /h
Gp 2: 5 mL/h plus PCA boluses
Gp 3: only PCA boluses
Sensory block more frequent and pain control was significantly higher in
Groups 1 and 2 than in Group 3 (P < 0.01).
A basal infusion of 5 mL/h combined with PCA boluses most appropriate
Singelyn FJ, et al. Anesth Analg 1999;89:1216-20
19.
20. 0.2% ropivacaine delivered as
a CI combined with PCA bolus
doses via an infraclavicular
perineural catheter optimizes
analgesia while minimizing
oral analgesic use compared
with basal- or bolus only
dosing regimens.
21. Intermittent Bolus Superior?
• Intermittent bolus
– higher pressure and more volume per time
– may increase spread of LA in the popliteal fossa,
thus reaching the two trunks of the sciatic nerve
more easily
• Intermittent bolus doses may reach the
targeted nerve before they are taken up by
perineural tissue or removed by blood vessels
22. Advantage of PCA bolus
• Decreasing basal infusion rate and
theoretically decreasing motor block
• Decreasing incidence of insensate extremity
• Increasing duration of infusion/analgesia for
ambulatory patients discharged with a finite
volume of LA
Borgeat A, et al. Anesth Analg 2001;92:218-23
Ilfeld BM et al. Anesthesiology 2002;97:959-65
Ilfeld BM, et al. Anesthesiology 2004;101;970-7
23. Optimal Infusion Regimen
• Basal rate 4-10 ml/h
– Lower rates for catheters of the lower extremity
– Higher rates for catheters of the upper extremity
• Bolus volume 2-10 ml
• Bolus lockout period 20-60 minutes
24.
25. Elastomeric Pumps
• Lightweight, portable
• Simple to set up
• Disposable
• Overinfusion
– Initial 3-6 hrs
– Near reservoir exhaustion
• Infusion rate increases with
increasing ambient temp
and pump height
Ilfeld BM, et al. RAPM 2003;28:424-32
28. Electronic Infusion Pumps
• Accurate and consistent
infusion rates
• Adjustable infusion rate
• Has PCA function
• Variable bolus lockout
period
• Limited to inpatient use
Ilfeld BM, et al. RAPM 2003;28:424-32
29. Incisional Catheters
• Simple, safe, inexpensive
• Catheter placed at correct position under direct vision
• Eliminates risk of inadvertent penetration of vascular or neural structures
(vs. perineural)
• Only area of surgery affected allowing normal use of extremity and early
rehabilitation (vs. perineural)
• Useful for ambulatory and inpatient surgery
Liu, Kehlet
33. Continuous Wound Infusion
• 58 patients undergoing LSCS
• Randomized to:
– Wound infusion with ropivacaine 0.2% at 5ml/h
– Epidural morphine 2mg 12H
• Better analgesia at 24 and 48 hrs, less nausea,
vomiting, pruritus and urinary retention
O’Neill P, et al. Anesth Analg 2012;114:179-85
34. Summary
• Effectiveness and safety of CPNB and
continuous local wound infusion
• Basal infusion with PCA option
• Types of pumps – elastomeric vs. electronic
• Outpatient and home infusion pumps