Management of severe acute pancreatitis.

The risks, measurements of severity, and management of severe acute pancreatitis and its complications have evolved rapidly over the past decade. Evidence suggests that initial goal directed therapy, nutritional support, and vigilance for pancreatic complications are best practice. Patients can develop pancreatic fluid collections including acute pancreatic fluid collections, pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. Several randomized controlled trials and cohort studies have recently highlighted the advantage of managing these conditions with a progressive approach, with initial draining for infection followed by less invasive techniques. Surgery is no longer an early intervention and may not be needed. Instead, interventional radiologic and endoscopic methods seem to be safer with at least as good survival outcomes. Newly developed evidence based quality indicators are available to assess and improve performance. Development and clinical testing of drugs to target the mechanisms of disease are necessary for further advancements.

Longitudinal cystic fibrosis care.

Cystic fibrosis is a complex disease entity that presents considerable lifelong challenges. Implementation of medical and surgical treatment options involves multisystem interventions to prevent and treat lung and gastrointestinal manifestations of cystic fibrosis and associated comorbidities. From birth through adulthood, cystic fibrosis care entails a longitudinal regimen aimed at achieving relief of disease symptoms and enhanced life expectancy. With increased knowledge of the molecular behavior of the cystic fibrosis transmembrane conductance regulator (CFTR) in health and disease, clinical practice has been enriched by the prospect of novel strategies, including mutation-specific drug and gene therapy targeting restoration of corrupted transepithelial ion transport. Emerging paradigms of comprehensive care increasingly enable personalized solutions to address the root cause of disease-transforming management options for individuals with cystic fibrosis.

Craniofacial war injuries.

In this paper, recent concepts in the management of war wounds of the maxillofacial region are described. A brief differentiation is also given between general practice medicine and military medicine.

Seguimiento de los pacientes celíacos / No disponible

No disponible

Relación de la Unidad de Oncología Pediátrica con Atención Primaria: el papel de la Unidad de Hospital d Domicilio / Relation of the Pediatric Oncology Unit with Primary Care: the role of the home care unit

Las unidades de Oncología Pediátrica cubren habitualmente una extensa área geográfica. Las modalidades de alternativas de hospitalización, como el hospital a domicilio (HaD), requieren resolver el problema de la dispersión geográfica para ofrecer cobertura asistencial a todos los pacientes, con independencia de su lugar de domicilio. Gracias al amplio desarrollo de la Atención Primaria Pediátrica en nuestra Comunidad y a la implantación de un sistema de comunicación fluida bidireccional (Atención Primaria Unidad de Oncología) a través de la unidad de HaD, hemos establecido un cauce de actuación clínica, delegado en los equipos de Atención Primaria, cuando la distancia impide al personal de la Unidad de Oncología realizar la asistencia de forma directa. Así, la asistencia del niño con cáncer se efectúa en algunos puntos del proceso terapéutico por el pediatra de cabecera, contando con el respaldo del servicio de Oncología en cualquier momento (equipo de guardia localizada). Este aspecto es importante en todas las etapas de la enfermedad, pero especialmente trascendental y significativo en la fase terminal

In our country, Pediatric Oncology Units are reference centers for a wide geographic area. Alternatives to traditional hospitalization, as home care, must sort out the problem of the geographical dispersion of the patients in order to give medical attention to all of them independently from the distance home - hospital Primary care in Pediatrics is very well developed in our community. The creation of a bidirectional channel of communication between primary care teams and the hospital, through the home care unit from the hospital, allows to establish a network able to bring medical attention to patients living far from the hospital. Primary care team members directly carry on the clinical control of the patient at home, supported by the on call members of the home care team. This aspect is very important in every phase of the disease and specially relevant in the field of palliative care

Nursing observations on ward patients at risk of critical illness.

Research findings and anecdotal evidence from outreach nurses across the country have suggested that key indicators of critical illness (respiratory rate and fluid balance) are being missed on the wards and that critically ill patients are not being fed adequately. A group of outreach nurses in Kent carried out a survey to confirm or refute these claims and to ascertain the variation in outreach provision in Kent. The survey found widespread deficiencies in nursing care and observations, which represent a serious threat to patients' safety.

Care of the obesity surgery patient requiring immediate-level care or intensive care.

Most bariatric surgery patients are triaged directly to the medical surgical floor postoperatively. However, patients at high risk due to comorbid factors, who have failed postoperative extubation or have suffered intraoperative complication, may require intensive care unit (ICU) or intermediate-level care (IMC). The special needs of the morbidly obese IMC/ICU patient include: triage, mobility, visiting, fluid resuscitation, management of sleep apnea, airway management, transporting for out of ICU procedures, and preventing pressure ulcers. Traditional approaches to nursing care require new thought when dealing with the massively obese. Our experiences with the special needs of these critically ill morbidly obese bariatric surgery patients are described.

[Help in explaining to Turkish-speaking patients about the central affects of pharmaceuticals. Fact or fiction?]. / Hilfen bei der Aufklärung türkischsprachiger Patienten über zentral wirksame Pharmaka. Fact or Fiction?

Handouts in their mother tongue might be helpful in informing patients who do not speak German about medications that are prescribed. A survey among 97 producers of CNS active drugs used in neurology and psychiatry showed that only two patient information leaflets on preparations and nine on specific disorders are available in Germany. The producers who answered were mostly open-minded and mentioned causes like the legal situation and logistic problems.

Provision of long-term mechanical ventilation.

When patients suffer prolonged mechanical ventilation, physicians are faced with a series of decisions beginning in the intensive care unit (ICU) and extending into a broadening spectrum of post-ICU levels of care. This article reviews current thinking and outcome data on when and how to perform the tracheostomy, as well as when and where the patient should be transferred from the ICU for continued weaning efforts or support. Decannulation after success in weaning and continuation of ventilation at home are also addressed.