PubMed Health⌕ Search

Biomedical subjects

J Cowen

Publications and source records attributed to J Cowen.

At least 19 recordsLinked to original sources

Recognition, assessment, and treatment of anxiety in the critical care patient.

A multidisciplinary group of experts involved in the treatment of critically ill patients participated in a workshop conference designed to develop practice recommendations for the recognition, assessment, and treatment of anxiety in the critical care environment. Anxiety was identified as a ubiquitous problem in critical care that may interfere with healing and recovery. The faculty agreed that clinicians should be familiar with the signs and symptoms of anxiety and should be able to determine when interventions are necessary. Whenever possible, nonpharmacologic methods for anxiolysis should be incorporated into intensive care protocols. Intensive care personnel should be trained in those interventions that require specialized expertise, and they should become familiar with the drugs available for the treatment of anxiety. Protocols for determining the best agents to be used in a given setting and their most appropriate method of administration should be established. Pharmacologic and nonpharmacologic treatments are not mutually exclusive but should be complementary. Finally, procedures for obtaining psychiatric consultation, when necessary, should be in place.

Adaptation, Psychological↗

Pulmonary embolism in the critically ill: strategies for prevention and treatment.

Most ICU patients are at high risk for developing deep venous thrombosis; thus, they should be considered candidates for prophylaxis against pulmonary emboli (PE). If early ambulation is not an option, give low-dose heparin or apply lower extremity pneumatic compression. When PE cannot be prevented, rapid treatment is mandatory. Inotropic agents can be used to improve right ventricular contractility; however, the role of volume loading for augmenting preload is controversial. Heparin is the first-line therapy for halting ongoing thrombosis; administer a 5,000- to 10,000-U bolus, followed by a continuous infusion of about 35,000 U/d. Thrombolysis, embolectomy, and occlusive devices are other therapeutic options.

Bandages↗

Late presentation of vitamin D-dependent rickets.

An 8 1/2-year-old girl presented with rickets. This had developed despite a normal diet and in the absence of symptoms, signs, or laboratory evidence of malabsorption, hepatic or renal disease. The rickets healed with physiological doses of 1-alpha-hydroxy-cholecalciferol. It is suggested that this case provides evidence for genetic and metabolic heterogeneity in vitamin D-dependent rickets.

Age Factors↗

Absorption of chlorhexidine from the intact skin of newborn infants.

34 newborn infants who had been bathed in a standard manner with Hibiscrub were studied to find out whether it was absorbed percutaneously. Low levels of chlorhexidine were found in the blood of all 10 babies sampled by heel prick, and 5 of 24 from whom venous blood was taken. The detection of chlorhexidine varied greatly with the method and timing of sampling, and no correlation was found between gestational or postnatal age and chlorhexidine levels.

Age Factors↗

Spontaneous abortion and fetal abnormality in subsequent pregnancy.

In a prospective survey neural tube defects and other congenital abnormalities were studied in the babies born to 510 mothers ascertained during pregnancy. The women were divided into two groups according to the outcome of their immediately preceding pregnancy. Those whose preceding pregnancy had resulted in a spontaneous abortion (256 women) formed the index cases; those in whom the outcome had been a normal baby (254 women) served as controls. There was a highly significant increased number of congenital abnormalities in the index cases. This may possibly be explained by the trophoblastic "rest" hypothesis and suggests that spontaneous abortions are more relevent to congenital abnormalities than has been thought.

Abortion, Spontaneous↗

Group B streptococcal infection in a maternity unit.

Neonatal infection due to Group B streptococci is described in a maternity unit. Six babies were affected and two died. Three of the babies were born at term, and weighed more than 2.5 kg. Tachypnoea was the earliest clinical sign in each case, and we suggest that newborn infants with persistent tachypnoea and evidence of maternal or infant colonization with Group B streptococci should receive antibiotics. Alternative approaches to the diagnosis and management of infection with Group B streptococci are discussed and rejected.

Cross Infection↗