This document discusses strategies for preventing pneumonia in the ICU. It begins by defining hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), noting they are common ICU infections associated with high mortality. Risk factors and pathways for pneumonia are described. Strategies with probable effectiveness discussed include hand hygiene, vaccinations, isolation of resistant organisms, nutritional support like early enteral feeding, stress ulcer prophylaxis, and semi-recumbent positioning. Unproven strategies under investigation are also outlined. The document stresses bundles of interventions work better than individual measures to reduce ICU-acquired pneumonia.
Levofloxacin 500 mg film coated tablets smpc- taj pharmaceuticalsTaj Pharma
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Levofloxacin Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, Levofloxacin Dosage & Rx Info | Levofloxacin Uses, Side Effects -: Indications, Side Effects, Warnings, Levofloxacin - Drug Information - Taj Pharma, Levofloxacin dose Taj pharmaceuticals Levofloxacin interactions, Taj Pharmaceutical Levofloxacin contraindications, Levofloxacin price, Levofloxacin Taj Pharma Levofloxacin 500 mg Film-coated Tablets SMPC- Taj Pharma . Stay connected to all updated on Levofloxacin Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Etiopathogenesis and pharmacotherapy of DIPDs
a. the pathophysiology of selected disease states and the rationale for drug therapy;
b. the therapeutic approach to management of these diseases;
c. the controversies in drug therapy;
d. the importance of preparation of individualised therapeutic plans based on diagnosis;
e. needs to identify the patient-specific parameters relevant in initiating drug therapy,
and monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects);
f. describe the pathophysiology of selected disease states and explain the rationale for
drug therapy;
g. summarise the therapeutic approach to management of these diseases including
reference to the latest available evidence;
h. discuss the controversies in drug therapy;
i. discuss the preparation of individualised therapeutic plans based on diagnosis; and
j. identify the patient-specific parameters relevant in initiating drug therapy, and
monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects).
Etiopathogenesis and pharmacotherapy of DIPDs
a. the pathophysiology of selected disease states and the rationale for drug therapy;
b. the therapeutic approach to management of these diseases;
c. the controversies in drug therapy;
d. the importance of preparation of individualised therapeutic plans based on diagnosis;
e. needs to identify the patient-specific parameters relevant in initiating drug therapy,
and monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects);
f. describe the pathophysiology of selected disease states and explain the rationale for
drug therapy;
g. summarise the therapeutic approach to management of these diseases including
reference to the latest available evidence;
h. discuss the controversies in drug therapy;
i. discuss the preparation of individualised therapeutic plans based on diagnosis; and
j. identify the patient-specific parameters relevant in initiating drug therapy, and
monitoring therapy (including alternatives, time-course of clinical and laboratory
indices of therapeutic response and adverse effects).
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Combating Drug Resistance in The Intensive Care Unit (ICU)Apollo Hospitals
Drug resistance of microbes has become a major stumbling block to treating patients successfully in the ICU. There is no doubt that microbes have the capacity to mutate or acquire drug destroying enzymes, but a multitude of errors by health care providers plays a major role in facilitating the development of resistance. The maintenance of drug use discipline in closed ICUs and having a responsive microbiology department are the first steps towards prevention of microbe resistance. Having an infection control committee that is able to collect and disseminate data is the next essential step. Education of health care providers to provide uniformity of health care according to set guidelines is the culmination of this towards the goal of minimizing the development of anti microbial resistance.
Abstract Lung Abscess is a liquefactive necrosis of the lung tissue and arrangement of cavitation (in excess of 2 cm) containing necrotic debris and liquid brought about by parenchymal infection. It very well may be brought about by yearning, which may happen during changed cognizance and it for the most part causes a discharge filled depression. In addition, liquor addiction is the most widely recognized condition inclining to lung abscesses. Lung abscess is viewed as essential (60%) when it comes about because of existing lung parenchymal process and is named auxiliary when it entangles another procedure, e.g., vascular emboli or follows rupture of extrapulmonary abscess into lung. There are a few imaging strategies which can distinguish the material inside the thorax, for example, electronic tomography (CT) output of the thorax and ultrasound of the thorax. Broad Spectrum anti-biotics to cover blended vegetation is the pillar of treatment. Pneumonic physiotherapy and postural drainage are additionally significant. Surgeries are required in specific patients for pneumonic resection Keywords: Lung abscess, anti-bodies, video-assissted thoracoscopic medical procedure (VATS), thoracoscopy
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
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
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
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.
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. HAP is defined as pneumonia that occurs
48 hours or more after admission, which
was not present nor incubating at the time
of admission .
HAP accounts for 10-25% of all ICU infections
and for more than 50% of the antibiotics
prescribed .
Mortality rate for HAP may be as high as 30 -
70%,
3. *VAP....... 25% of all nosocomial
infections in ICU.
*VAP ........ 20-50% morbidity and
mortality.
*VAP...... is a preventable disease.
6. Source of
infection
Person to Person
S. pumonia, TB,
Mycoplasma and viral
Environment
Leiogenalla (water)
Pstacossis(bird)
Anthrax (soil)
Healthcare devices (contaminated nebulizers, ventilation
circuits or humidifiers)
The environment (air, water, equipment, and fomites),
Commonly the transfer of microorganisms between the
patient and staff.
Stomach, sinuses, dental plaque and oropharynx
(colonization),
7. Organism entry
Into lung
Inhalation
OR
Aspiration
Blood spread
Direct spread
OR
Colonization
1. Aspiration of oropharyngeal pathogens.
2. Inhalation of pathogens from contaminated aerosols,
3. Hematogenous spread from infected intravascular
catheters ,
4. Bacterial translocation from the gastrointestinal tract
lumen are quite rare.
8.
9. Regimens Of
Probable Efficacy
For Specific
Indications
Regimens Of
Probable Efficacy
used widely in some
clinical settings
Regimens Of
Unproven Value
Used On Limited
Investigational Or
Clinical Basis
Unproven
Regimens Still
Being Evaluated
Prevention of pneumonia
10. Vaccinations against s pneumonia and
influenza virus.
Hand washing between patient contact.
Isolations patients with highly resistant
organisms such as MRSA.
Regimens Of Probable Efficacy
For Specific Indications
11. A) Nutritional support.
1-Entral feeding via feeding jejenostomy better than
TPN and lower incidence of infections as entral
stimulate intestinal mucosa preventing bacterial
translocation.
2-use of orogastric rather than nasogastric can
decrease the incidence of nosocomial sinusitis which
lead to HAP.
3- risk of aspiration increase with large bore feeding
tube and with bolus feedings than with the use
smalled tubes of continuous feeding methods.
Regimens With Probable Effectiveness
Used Widely In Some Clinical Settings
12. B) Regimens for intestinal bleeding prophylaxis
sucralfate (doesn't increase gastric PH) when
compared with antacid ( increase both gastric PH and
volume increase risk of aspiration) or with H -2
Antagonist(decrease gastric PH enhancing bacterial
translocation).
C) Putting The Patients In The Semi Recumbent
Position appear to reduce risk of aspiration.
D) Handling Of Respiratory Equipments:
1- Suction Catheter single use non sterile disposal
gloves should be worn for suction, And change suction
catheter between patients and after each use.
13. 2- Suction Bottles single use disposal or reusable
wash with detergent, dry and disinfect them with
autoclave or in washing machine.
3- Breathing Circuits ventilator circuit are rapidly
colonized with bacteria and condensate within
these circuit can have high bacterial counts and
aspiration of condensate may play a role in
development of nosocomial pneumonia, so
change every 48 hs, periodic drain breathing
condensate.
4- Nebulizers change or reprocess devices
between patients by using sterilization or high
level of disinfection or use single disposal item.
14.
15. 5- Humidifiers clean and sterilize devices between
patients and fill with sterile water which must be
changed every 24 hs or sooner, if necessary single
use disposal humidifiers are available.
F) Subglottic Secretion Drainage:
Secretions pooled above
the endo tracheal tube cuff
represent reservoir
of the colonizing bacteria
thus removing this pool
may decrease incidence
of VAP.
16. ETT cuff inflation via minimal leak
technique to 20-25cmH2O(minimal
occlusive pressure).
17. A) Selective Digestive Decontamination (SDD)
SDD involve use of topical oral and intestinal
antibiotics, often with systemic antibiotic added for
the first few days of the regimens with the goal being
the elimination of all potential pathogens from GIT.
Sterilization of endogenous bacterial sources may
avoid infection, of debate as emergence of antibiotic
resistant organisms.
B) Topical antibiotic on the lower respiratory
tract. decrease incidence of pneumonia.
Regimens Of Unproven Value Used On
Limited Investigational Or Clinical Basis
18. A) Manipulations of endogenous source of
bacteria.
Unproven Regimens Still Being
Evaluated
19. The endotrachael tube can harbor the growth of
large no of bacteria along its inner surface, and the
bacteria at this site will persist in the airway free from
the effect of antibiotic and host defenses.
The development of new biomaterial for tubes could
lead to elimination of a tracheal tube biofilm and
eradication of reservoir of bacteria in the airways.
20. B) Biological response modifiers
These substances are immunomodulator have
the ability to up regulate or down regulate host
defense mechanisms. e.g..
1) Antilipopolysaccride antibodies(E5 and
HA-IA)
2) antibodies toward TNF, IN 1, PAF.
21. * Bundles are group of intervention related to a
disease that when instutes together give better
outcomes than when done individually.
* Provide a mechanism to enhance teamwork and
enhance outcome.
* The guideline become as road map to enhance
outcome.
22. Elevation of the bed between 30-45 degree
at all time (unless contraindicated).
Deep venous thrombosis (DVT)
prophylaxis (unless contraindicated).
Peptic ulcer prophylaxis
sedation interruption
Weaning protocol
Oral care
23. * Please remember to elevate the HOB>30 degree , and
raise knees for all ventilated patients unless
contraindicated .
*Elevation of HOB has been correlated with reduction in the
rate of the ventilator associated pneumonia.
Drakulovi Lancet, 1999
24. *As elevation of head of bed may contribute to
venous stasis and DVT.
*The risk of venous thromboembolism is reduced
if prophylaxis is consistently applied.
*A clinical practice guideline recommends DVT
prophylaxis for patients admitted to the ICU.
(Geerts, Chest,2004)
25. *Stress ulceration are the most common cause of
gastrointestinal bleeding in intensive care unit
patients .
*This predisposed to aspiration and VAP .
*Thus applying PUD prophylaxis is a necessary
intervention.
26. Sedation in ICU has the benefit of reducing
psychological problems to the patients .However
heavy sedation is harmful and predispose to VAP
by :
1-Inhibiting coughing.
2-Inhibiting mobilization.
3-Decreasing immune function.
4-Promoting aspiration.
5-Prolongs time on ventilator.
27. 1-Awake and cooperative patient.
2-Cough , swallowing reflexes intact.
3-Add analgesia to the protocol .
4-Intermittent rather than continuous sedation.
5-Sedation vacation (sedation interruption).
28. Application:
Hold sedation until patient is alert or can follow commands at least
once a day.
*After sedation interruption restart sedation at a fraction of the prior
dose (1/2 or 3/4).
*Kress et al .,conducted a randomized controlled trial in 128 adults
mechanically ventilated patients receiving continuous infusion of
sedative agents in a medical ICU, daily interruption of sedation
resulted in a highly significant reduction in time spent on mechanical
ventilation, from 7.3 days to 4.9 day (p=0.004).
(Kress, N Engl J Med,2000)
29. * Non-physician driven weaning protocol (by nurses or
respiratory therapists).
* Daily assessment of readiness to wean from ventilator:
keep TV and pressure low.
preextubation assessment and worksheet .
(Dries JTrauma,2006)
30. Designed for patients who are intubated
or tracheostomiazed
*Mouth care protocol.
*Brush twice .
*Swab every two hours.
*Chlorhexidine rinse.
*Apply mouth moisturizer.
(Chlebicki, Crit Care Med,2007)