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This web-based survey assessed 1976 critical care practitioners' perceptions of the risks for unplanned extubation. Members of the American Association for Respiratory Care, the American Association of Critical Care Nurses, and the Society of Critical Care Medicine reported a number of factors associated with unplanned extubation, including outward migration of the endotracheal tube (ETT; reported by 73% of respondents), the patient tugging on the ETT (87%), removing a nasogastric tube (71%), absence of physical restraints (72%), a nurse/patient ratio of 1:3 (60%), trips out of the ICU for tests (59%), and light sedation (42%).
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A third inhaled corticosteroid and long-acting beta-agonist combination has been approved by the FDA, joining currently marked combinations fluticasone/salmeterol (Advair Diskus®) and budesonide/formoterol (Symbicort®). Mometasone furoate and formoterol fumarate is marketed by Schering as Dulera®
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Dietary pattern analysis of elderly subjects followed over at least 4 years showed lower risk for developing Alzheimer's disease when there was higher intake of nuts, fish, tomatoes, poultry, salad dressing, cruciferous vegetables, fruits, and dark and green leafy vegetables, along with lower intake of high-fat diary products, red meat, organ meat, and butter.
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Although there are few studies that specifically look at the elderly, this review provides useful information on the diagnosis and treatment of acute exacerbation of COPD and chronic bronchitis.
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In women, insomnia was not associated with increased risk of death, regardless of sleep duration. In men, mortality risk was significantly increased only in insomniacs who slept less than 6 hours and who were diabetic or hypertensive at baseline.
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In this issue: FDA Advisory Committee recommends approval of dabigatran, safety of proton pump inhibitors, effectiveness of glucosamine and chondroitin, FDA Actions.
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Although corticosteroids are beneficial in treating severe exacerbations of chronic obstructive pulmonary disease (COPD), studies to date have not shown high-doses (such as methylprednisolone, 2 mg/kg or more per 24 h) administered intravenously (IV) to be superior to lower doses (e.g., prednisone, 40 mg/day) given orally, with respect to clinically important outcomes.
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Paralytic agents such as vecuronium and cis-atracurium have been used as "rescue therapies" in patients with ARDS for many years, but, as with other rescue strategies including prone mechanical ventilation or inhaled vasodilators, evidence of a mortality benefit from this intervention has been lacking.
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