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But for the woman who frequently makes applications of this kind buy fenofibrate 160 mg without a prescription, it is necessary that she anoint her vagina inside with cold unguents lest she becomes excessively heated buy cheap fenofibrate 160mg online. Let her drink strong wine if she has no pain in the head nor any nervous disorder nor any fever purchase fenofibrate 160mg mastercard, because wine is harmful in any fever buy fenofibrate 160 mg mastercard. Vel contigit quandoque propter nimiam sanguinis calefactionem ex colera redundante a felle buy generic fenofibrate 160 mg online, que facit sangui- nem ebullire adeo ut non possitf in uenis contineri, uel quia fleuma salsumg admisceturh sanguini et ipsum attenuat et a uenis facit prorumperei extra. Hiis de causis mulier discoloraturf et [vb] macrescit, et si diu durauerit, in ydropisim de facili conuertit,g epatis enim substantia infri- gidatur propterh subtractionem cibi per quam membra debent in suo calore naturali conseruari. Post purgatio- nem uerob apponenda sunt aliquac quedam constrictiua exterius et interius que constringant. Potet ergo aquam in qua cocta sintd cortex mali granati, psidia, rose, galle, nux muscata, folia quercus, bedegar, rubus,e agrimonia, plantago. Post cibum uel [ra] inter cibaria detur eis puluis lapidisf emathicis cum aqua pluuialig distemperatus ad potandum, uel puluis coralli et gummi, balaustie, seminis mirte, et portu- ¶a. Book on the Conditions of Women  On Excessive Flux of the Menses [] Sometimes the menses abound beyond what is natural, which has hap- pened because the veins of the womb are wide and open, or because sometimes they break open and the blood flows in great quantity. And the flowing blood looks red and clear, because a lot of blood is generated from an abundance of food and drink; this blood, when it is not able to be contained within the ves- sels, erupts out. Or sometimes this has happened on account of the excessive heating of the blood caused by bile pouring out from the gall bladder, which makes the blood boil to such an extent that it is not able to be contained in the veins. Or [this has happened] because salty phlegm is mixed with the blood and thins it and makes it erupt out of the veins. Illnesses of this kind emerge on account of corrupt humors within, which corruption Nature refuses to sustain. Sometimes it has happened on account of ulcera- tion,12 from which death veryoften follows. From these conditions thewoman is discolored and she wastes away, and if it last for a long time, it easily changes into dropsy, for the substance of the liver is chilled on account of the subtrac- tion of food through which the organs ought to be preserved in their natural heat. Or sometimes it has happened on account of a defect of heat which is incapable of digesting the abundance of fluids and which is not strong enough to change it into humors in the customary fashion. If, therefore, the blood is the cause, let it be bled off from the hand or the arm where the blood is provoked upward. After the purgation, there ought to be applied some sort of constrictive both externally and internally. Let her drink, there- fore, water in which are cooked the bark of pomegranate, pomegranate skin, roses, oak apples, nutmeg, oak leaves, eglentine, bramble, agrimony, and great plantain. After eating or during meals, let there be given to them to drink powder of hematite stone mixed with rainwater, or a powder of coral and gum arabic, pomegranate, sweet gale ¶a. Bibat ptisanam de ordeo factam, primitus in quac coqua- tur radix plantaginis, et bulliat cum ptisana et melius erit. Postea fac emplastrum de stercoribusb auium uel cati cum an- xungia et superponatur uentri et renibus. Quandoquec paciuntur sincopin, et ita pulsus euanescit quod penitus non sen- ¶a. Book on the Conditions of Women  seed, and purslane, Armenian bole, and powder of buck’s-horn plantain, great plantain, knotgrass, dragon’s blood,16 burnt elephant bones, and quince seed. Let her drink a decoction made from barley, in which great plan- tain root is first cooked, and boil it with the decoction and it will be even better. And afterward boil [the root] in seawater until it cracks and becomes wrinkled, and let vinegar be added and let it be strained through a cloth and let it be given to drink. Then make a plaster of the dung of birds or of a cat [mixed] with animal grease and let it be placed upon the belly and loins. On Suffocation of the Womb [] Sometimes thewomb is suffocated, that is to say,when it is drawn upward, whence there occurs [stomach] upset and loss of appetite from an overwhelm- ing frigidityof the heart. Quandoque mulier contrahitur ita quod capud iungitur genibus, et [va] uisu caret, et uocis officium amittit, nasus distorquetur, labia contrahuntur,d et dentes stringit, et pectus sursum preter solitum eleuatur. Galyenus uero lanam bene carpinatam nar- ibus et ori eius apposuit, cuius motu eam uiuam cognouit. Contingit autem hece mulieribus quia sperma nimium corruptum habundat in eis, et in ueneno- samf naturam conuertitur. Virginibus etiamb solet euenire cum ad annosc nubiles peruenerunt et uiris uti non possunt, et cum in eis multum habundetd sperma, quod per masculum natura uellet educere, ex hoc semine superhabundante et corruptoe que[vb]dam fumositasf frigida dissoluitur et ascendit ad partes quasdam que a uulgo collaterales22 dicuntur, quia cordi et pulmoni sunt uicine et ceteris instrumentis uocis principaliter, unde solet fieri impedimentum uocis. Et si deficiant menstrua et superhabundetg semen, tanto moles- tior et prolixior erith morbus, et maxime quando partes occupat altiores. Sed tamen oleis et unguentis cali- dis que sunt odoris aromatici debent uulue earum inungi, ut yreleon, camo- mileon, musceleon, nardileon. Item in sero accipiat dyaciminum cum [ra] succo apii uel cum siropod de calamento uel nepita,e uel cum succo ius- quiami uel succof nepite. Book on the Conditions of Women  so that from the same cause it is barely perceptible.

Evaluation showed that women who came into contact with trained staff had significantly smaller declines in their sense of control and self-efficacy than women in the control group discount 160 mg fenofibrate mastercard, although an effect on diet was not observed [57] 160 mg fenofibrate amex. Self-efficacy and sense of control are psychological factors known to be associated with diet quality among disadvantaged women buy 160mg fenofibrate fast delivery. These findings suggest that the intervention could improve women’s health behaviors if it were delivered in a setting that allowed frequent contact between women and trained staff buy generic fenofibrate 160mg on line. Women access services during pregnancy order fenofibrate 160 mg without prescription, providing an opportunity for repeated exposure to the Healthy Conversation Skills intervention and a trial that is assessing the efficacy of the intervention during pregnancy in women who receive antenatal care in Southampton’s maternity hospital is currently underway. Changing the health behaviors of women preconceptionally is more challenging but, arguably more important than pregnancy as a period for prevention of later disease. One of the challenges is how to engage women in interventions preconceptionally and to find ways of sustaining their engagement in a way that is both acceptable and affordable. The behavior change skills (Healthy Conversation Skills) implemented in the Southampton Initiative for Health can be used by health and social care staff in a range of settings and have the potential to address the challenges of engaging women preconceptionally. The skills are easily-acquired and theory-based, and are designed for use in brief consultations, to support diet and lifestyle change. Engaging adolescents is likely to pose additional challenges since they are less likely than women of other ages to be in contact with routine health and social care. Teenagers aged 13–14 years, who attend Hampshire secondary schools, have three weeks of school lessons, supported by teacher professional development, and a visit to an educational facility in the local hospital. The aim of Lifelab is to improve young people’s health literacy and understanding of the long-term influences of their health behaviors on their subsequent health and that of their children [58]. In South Africa, for example, rates of obesity are high among adolescent girls leading to high rates of gestational diabetes and low birth weight. An intervention to reduce obesity among adolescent girls is being developed, that will use community health workers trained in behavior change techniques, to empower adolescent girls to improve their health behaviors [59]. Novel technologies also have potential for engaging adolescents in changing their health behaviors. Such interventions are becoming increasingly common, and there is some evidence of effectiveness [61] though surprisingly little of this evidence concerns adolescence. The challenge that remains is to overcome the problems of low usage, attrition and small effect sizes which have so far characterized such interventions [62]. Interventions across the lifecourse, particularly those focusing on early life factors, may also produce economic benefits. The main gains resulted from improved labor productivity as well as from reduced morbidity and mortality [63]. A lifecourse approach with a focus on early years also has the potential to reduce health inequalities which in turn will produce Healthcare 2017, 5, 14 9 of 12 further economic benefits [10]. Future interventional studies should collect economic data in order to incorporate appropriate analyses of cost-effectiveness. Observational and mechanistic evidence has demonstrated the importance of maternal nutrition, during preconception and pregnancy, as an influence on future offspring health and has also shed light on the mechanisms that link maternal nutrition to fetal and childhood growth and development. The evidence points to the importance of interventions that have the potential to improve maternal nutrition, using a range of nutritional and behavioral strategies targeted at women before and during pregnancy. Fall and Kalyanaraman Kumaran are supported by the Medical Research Council and Department for International Development. Inskip and Cyrus Cooper are supported by the Medical Research Council and the National Institute for Health Research. Early developmental conditioning of later health and disease: Physiology or pathophysiology? Birth weight, infant weight gain, and cause-specific mortality: The Hertfordshire Cohort Study. Reduced fetal growth rate and increased risk of death from ischaemic heart disease: Cohort study of 15,000 Swedish men and women born 1915–1929. The effect of prenatal diet and glucocorticoids on growth and systolic blood pressure in the rat. In utero undernourishment perturbs the adult sperm methylome and intergenerational metabolism. Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: The Pune Maternal Nutrition Study. Maternal and child undernutrition: Consequences for adult health and human capital. Maternal and child undernutrition: Global and regional exposures and health consequences. Obese women exhibit differences in ovarian metabolites, hormones, and gene expression compared with moderate-weight women. Neonatal bone mass: Influence of parental birthweight, maternal smoking, body composition, and activity during pregnancy. Maternal predictors of neonatal bone size and geometry: The Southampton Women’s Survey.

Womenwho Definition wish to become pregnant need special advice fenofibrate 160mg cheap, but there Rapid onset of global but fluctuating confusion with an is no reason why they should not have children 160 mg fenofibrate visa. There underlying toxic fenofibrate 160mg without prescription, vascular order fenofibrate 160 mg, ictal (seizure) or metabolic are support groups available discount 160 mg fenofibrate otc. Chapter 7: Disorders of conciousness and memory 311 Aetiology Adetailed history including pre-morbid cognitive state, r Predisposing factors: The very young and very old, alcohol and drugs is essential, fluctuation helps sep- hearing loss or visual difficulty, those with diffuse arate delirium from dementia, examination should brain disease such as dementia or taking drugs with look for focal neurological signs and any evidence anticholinergic properties such as tricyclic antidepres- of other illness. Consider saving r Disorientation and impaired conscious level – urine for toxicology screen. Management r Motoractivity may be increased but is often purpose- r Detection of the underlying cause of the confusional less. Severe cases may require benzodiazepines, Toxic Alcohol intoxication, withdrawal haloperidol or one of the newer anti-psychotics such Drugs Prescribed/illicit drugs, including as risperidone or olanzapine. The prognosis is dependent Hepatic failure on the underlying cause and co-morbid features. Hypoxia Hypoxia and/or hypotension Vitamin deficiency Vitamin B12 Thiamine (Wernicke–Korsakoff) Coma Intracrania Definition Trauma Head injury Coma is a state of unrousable unconsciousness. Vascular Transient ischaemic attack, stroke, any intracranial bleed or space- occupying lesion Aetiology Epilepsy May be post-ictal (after a seizure) or The causes are mainly those of acute confusional state nonconvulsive status (see Table above), although there are other causes as well. No response 1 Best verbal response Management Orientated 5 Following resuscitation treatment of the underlying Disorientated 4 Inappropriate words 3 cause is the main priority. In at-risk patients such as alco- Best motor response holics and in pregnancy, intravenous thiamine should Obeys verbal commands 6 be given prior to any intravenous glucose as there Localizes painful stimuli 5 Withdrawal to pain 4 is a small risk of precipitating irreversible Wernicke– Flexion to pain 3 Korsakoff’s syndrome. No response 1 r Empirical use of naloxone (reverses opiates), flumaze- nil (reverses benzodiazepines) should be considered. Head Injury Definition Head injury is one of the most common causes of death Clinical features and disability in young men, mainly due to road traffic It is important to establish the level of consciousness. Incidence 1 The first priority is resuscitation – stabilise airway, Common;basedonhospitalattendancesandadmissions breathing and circulation and check the glucose level the incidence is ∼250 per 100,000 population. Hypoxia, hypoglycaemia or hypotension are reversible causes of coma and will exacerbate any Age other cause. Chapter 7: Disorders of conciousness and memory 313 r Penetrating trauma: Penetration of the skull by an ex- swelling of the brain. Pathophysiology The pathology of head injury can be divided into two groups: Complications r Primary brain damage: Short term: Vascular, e. Subarachnoid and intracerebral ticularly on the side of the trauma (coup lesion) and haemorrhage may also occur. Long term: ii Diffuse axonal injury due to shearing forces caus- r Posttraumatic epilepsy. Patients r Chronic traumatic encephalopathy (the punch drunk who survive such injury may have severe brain syndrome seen in professional boxers). Ifneckinjuryissuspected,thepatientshould cal treatment, whereas primary brain damage occurs be immobilised until a spinal cord injury or unstable at the time of injury and therefore can only be in- cervical spine has been excluded. Followingtrauma,thebrainismuch Coma Scale, and full neurological and general exami- more susceptible to hypoxia and hypotension due to nation. The decision to admit for observation is based disruption of autoregulation and impaired vascular on the history and assessment at presentation. Osmotic diuretics such as mannitol Clinical features may also be used to reduce brain oedema. In more severe injuries, there is persistent post- mission to intensive care for intracerebral pressure traumatic amnesia. Patients All patients require close monitoring to check for devel- may have other injuries depending on the nature of the opment of complications that require urgent treatment. Over a period of several hours there is oozing of r the patient is difficult to assess, e. Apathy and/or depression are common, there may be Prognosis disturbances of sleep, confusion of day & night, with Recovery may take weeks to months. Other neurological signs with a persisting disability or impairment is 100 such as hemiparesis, seizures tend to occur very late in per 100,000. Generally, in the early stages, the patient is aware of a loss of their memory and may become very frus- Dementia trated and anxious. They lose the ability to function in daily life grad- Definition ually, and in later stages they become more apathetic, Asyndromeofacquiredcognitiveimpairment,withpro- with little spontaneous effort and therefore require full gressive global loss of cognitive function in the context personal care such as feeding, washing, dressing and of normal arousal. Acollateral history from a relative or close carer who Incidence has known the patient for a long time is essential. The 1% of those aged 65–74 years, 10% of those over 75 and carer is often the one most emotionally affected by the 25% of those over 85 years. Aetiology There are numerous causes of dementia, including Investigations r Alzheimer’s disease (most common >60%). These are to exclude any treatable causes of chronic con- r multi-infarct dementia caused by multiple small in- fusion. Management The specific management strategies are covered under Clinical features specific causes but general treatment includes the fol- See also under specific causes of dementia. Patients may lowing: have impairment of the following cognitive functions: r Multidisciplinary assessment.

It is reassuring to know that the health ized facilities or signifcant travel are diffcult to integrate into benefts of physical activity accrue with as little as thirty min- daily life buy 160 mg fenofibrate with amex. A lunchtime walk discount 160mg fenofibrate overnight delivery, an evening jog buy fenofibrate 160mg low price, or a regular swim utes of moderate-intensity exercise most days of the week purchase 160mg fenofibrate with mastercard. Biking to work and taking the stairs whenever pos- important buy fenofibrate 160 mg with mastercard, health-enhancing properties of an active lifestyle. Physical activity that frequently involves family and friends has a further motivation built in. Encouraging Case resolution the whole family to engage in regular physical activity can allow Deciding to make one’s personal health a priority is an you to pass on your exercise “values” to your children, opti- important step in making time for physical activity. Skiing, biking, sledding, will always be rounds to attend and journals to read, and hiking—he choices are limitless. Establishing time, recognizing the realities of an on-call schedule, favourite physical activities early in a career helps to ensure and discussing these issues with resident colleagues, this that enjoyable, anticipated and active periods will be integrated resident is able to incorporate regular physical activity into into weekly rhythms for the long term. The resident no longer takes elevators unless of exercise intensity will help prevent injury and increase the absolutely necessary (there’s a “Stairway to Health” pro- likelihood of enjoyable physical recreation over a lifetime. As benefts to physical health, physical activity allows private, chief resident, they also encourage younger colleagues to personal time for refection and recreation. Family vacations for physicians to integrate physical activity into their personal are now chosen with physical activities in mind: camping lifestyles in ways that are both practical and, most importantly, and canoeing in the summer. By demonstrating to friends and colleagues that physi- Key references cal activity is important to one’s well-being, the resident Frank E, Breyan J, Elon L. Physician disclosure of ensures understanding and support as they optimize time healthy personal behaviors improves credibility and ability to for personal health. Physical inactiv- portive advice on the importance of personal health and ity among physicians. The resident’s bicycle helmet serves as a reminder to colleagues, hospital and attending staff that personal health and physical activity are important, central components of a contemporary practitioner’s lifestyle. The resident’s example and leadership result in the hospital providing bike racks and shower facilities for staff. And it is a • introduce a model of considering the role of spirituality in practice that requires ongoing self-refection and attention. We tend to forget to care Case for ourselves when we are single-mindedly committed to the A frst-year resident is feeling disillusioned with medicine. Compassion that does not include The resident entered medicine because their father died oneself is incomplete. Now feeling frustrated by the inevitable deaths of too many of Burnout is distressingly common in medicine, as in other their patients the resident is thinking of taking a year off occupations where time is spent supporting others. The what might be regarded as a spiritual illness: if engagement wisdom and compassion that this engenders does not make us with one’s life is a sign of spiritual health, burnout is the oppo- more expert; it makes us more human. Physicians who were once wholeheartedly committed to to do; spirituality, how to be. As physicians, we can beneft from medicine begin to avoid work, become less interested in their practising both. Courses on spirituality have begun to appear in medical school Not surprisingly, burnout can lead to depression, addiction and curricula. Spirituality is primar- ideals, long hours, tensions between personal and work obliga- ily an inner, subjective matter, whereas Western medicine is tions, and historical insensitivity of the medical profession to based on objective, empirical science. Whether or not spiritual the health of its members all contribute to the psychological matters belong in our medical curricula, surveys suggest that and emotional vulnerability of physicians. This vulnerability most medical practitioners do consider spiritual questions is intensifed in residency by the lack of a sense of personal and values personally relevant. Given that burnout is an principle central to all spiritual traditions, is embedded in the occupational risk for physicians, how can they lessen it? Interestingly, there is now some important way is to develop spiritual resilience. Perhaps Immunizing ourselves against the inevitable stresses of our this is because the scientifc and pragmatic knowledge acquired profession requires us to regularly nourish the spirit. One during training, together with the stresses of medical training, essential means of doing this is to deepen self-awareness by result in an “objectifcation” of patients which may make us consciously paying attention to our own selves. Diet, exercise, to say, caring as empathetic concern is gradually replaced by relationships, study, play, work—these all need to be integrated caring as a means to an end: freedom from disease. But who decides on the relative weight two aspects of caring, the spiritual and the material, are not we place on each aspect of this whole, and how do we know mutually exclusive. From the spiritual perspective, one could say that caring is Balance doesn’t derive from a checklist, nor can it be con- not so much a means to an end as an end in itself.

A study of manufacturer-supported trials of nonsteroidal anti-inflammatory drugs in the treatment of arthritis cheap 160mg fenofibrate free shipping. Evaluation of conflict of interest in economic analyses of new drugs used in oncology cheap fenofibrate 160 mg overnight delivery. This is justified as an attempt to limit the influence of those con- flicts and protect the integrity of research outcomes and patient-care decisions order fenofibrate 160mg free shipping. Surprisingly cheap fenofibrate 160 mg without prescription, some academicians have argued against such management on the grounds that it impugns the integrity of honest physicians and scientists buy generic fenofibrate 160mg on line. Some institutions have decided that limiting the opportunity for outside interests pre- vents recruitment and retention of the best faculty. The degree to which these activities are conflicts of interests remains an ongoing debate in the academic community. Nearly all academic institutions engaging in research currently have policies to manage and/or limit conflicts of interest. Most of these focus exclusively on financial conflicts and are designed primarily to protect the institutions finan- cially. Increased awareness of the consequences of conflict of interest will hope- fully result in the development of policies that offer protection to research sub- jects and preserve the integrity of the research record. The most common is requiring disclosure of conflicts of interest with the ratio- nale that individuals are less likely to act on conflicts if they are known. Other methods include limitations on the value of outside interests such as limiting the equity a researcher could have in a company with whom they work or limit- ing the amount of consultation fees they can collect. Recently some professional organizations have suggested that the only effective management for potential conflicts of interest is their complete elimination. Some of the most difficult conflicts occur when physicians conduct clinical studies where they enroll their own patients as research subjects. This can place the performance of the research and patient care in direct conflict. Another com- mon area of conflict is in studies funded by pharmaceutical companies. Often they desire a veto in all decisions affecting the conduct and publication of the results. Research with human participants In order to obtain definitive information on the pathophysiologic sequelae of human disease, as well as to assess risk factors, diagnostic modalities, and ther- apeutic interventions, it is necessary to use people as research subjects. One outcome of this leg- islation was the publication of the Belmont Report that laid the foundation of ethical principles which govern the conduct of human studies and provide pro- tection for human participants. Informed consent requires that individuals be made fully aware of the risks and benefits of the experimental protocol and that they be fully able to evaluate this information. The principle of beneficence manifests itself in the assessment of risk and benefit. The aim of research involving human subjects is to produce benefits to either the research subject, society at large, or both. The nature of experimental pro- cedures generally dictates that everything about them is not known and so risks, including some that are unforeseen, may occur. Research on human sub- jects should only take place when the potential benefits outweigh the poten- tial risks. At the onset of a study, the research aims, treatment and control, are equally likely to result in the best outcome. At the very least, the comparison group must be receiving a treatment consistent with the current standard of care. The application of this principle could render some placebo-controlled studies unethical. The principle of justice manifests itself in the selection of research sub- jects. This principle dictates that the benefits and the risks of research be dis- tributed fairly within the population. For example, groups should be selected for inclu- sion into the research study based on characteristics of patients who would ben- efit from the therapy, and not because they are poor or uneducated. These must include members of varying background, both scientific and non-scientific, who are knowledgeable of the institution’s commitments and regulations, applicable law and ethics, and stan- dards of professional conduct and practice. One of the most difficult roles for the physician is the potential conflict between patient care responsibilities and the objectivity required of a researcher. But, it ensures that subjects, our patients, are not subjected to useless or incompetently done research. Peer review is the mechanism used to judge the quality of research and is applied in several contexts.

Intensive Care Med 2009 order fenofibrate 160mg without prescription; 35:1738–1748 tinuous insulin infusion protocols in the medical intensive care unit: 333 purchase fenofibrate 160 mg without prescription. Comparison of hemodialysis and continuous arte- 137:544–551 riovenous hemofltration] generic 160 mg fenofibrate with mastercard. Crit Care 2010 quality fenofibrate 160 mg; 14:324 hemofltration: Improved survival in surgical acute renal failure? Kansagara D generic fenofibrate 160 mg with mastercard, Fu R, Freeman M, et al: Intensive insulin therapy in hospitalized patients: A systematic review. Kierdorf H: Continuous versus intermittent treatment: Clinical results 154:268–282 in acute renal failure. Bellomo R, Mansfeld D, Rumble S, et al: Acute renal failure in critical arrest care: 2010 American Heart Association Guidelines for Car- illness. Conventional dialysis versus acute continuous hemodiafltra- diopulmonary Resuscitation and Emergency Cardiovascular Care. Nephron 1995; 71:59–64 lin therapy for the management of glycemic control in hospitalized 362. Ann Intern Med 2011; 154:260–267 acute renal failure patients in the intensive care unit. Jacobi J, Bircher N, Krinsley J, et al: Guidelines for the use of an renal replacement therapy for acute renal failure in intensive care insulin infusion for the management of hyperglycemia in critically ill units: Results from a multicenter prospective epidemiological survey. Tonelli M, Manns B, Feller-Kopman D: Acute renal failure in the inten- concentration and short-term mortality in critically ill patients. Anes- sive care unit: A systematic review of the impact of dialytic modality thesiology 2006; 105:244–252 on mortality and renal recovery. J Diabetes Sci Technol 2009; 3:1292–1301 trial comparing intermittent with continuous dialysis in patients with 348. Kanji S, Buffe J, Hutton B, et al: Reliability of point-of-care testing Nephrol Dial Transplant 2005; 20:1630–1637 for glucose measurement in critically ill adults. Vinsonneau C, Camus C, Combes A, et al; Hemodiafe Study Group: 33:2778–2785 Continuous venovenous haemodiafltration versus intermittent hae- 350. John S, Griesbach D, Baumgärtel M, et al: Effects of continuous Trials Group, Cook D, Meade M, Guyatt G, et al: Dalteparin ver- haemofltration vs intermittent haemodialysis on systemic haemody- sus unfractionated heparin in critically ill patients. New Engl J Med namics and splanchnic regional perfusion in septic shock patients: A 2011; 364:1305–1314 prospective, randomized clinical trial. Chest 2007; 131:507–516 parison of the hemodynamic response to intermittent hemodialysis 394. Intensive Care Med 1996; 22:742–746 patients with severe renal insuffciency with the low-molecular-weight 374. Am Surg 1998; 64:1050–1058 vival and recovery of renal function in intensive care patients with 396. A randomized trial comparing 2002; 30:2205–2211 graduated compression stockings alone or graduated compression 376. Mathieu D, Neviere R, Billard V, et al: Effects of bicarbonate therapy vein thrombosis with low molecular-weight heparin in patients under- on hemodynamics and tissue oxygenation in patients with lactic aci- going total hip replacement: A randomized trial. Scott Med J 1981; thrombotic therapy and prevention of thrombosis, 9th ed: Ameri- 26:115–117 can College of Chest Physicians Evidence-Based Clinical Practice 384. Chest 2012; 141(Suppl 2):7S–47S prevention of fatal pulmonary embolism in patients with infectious 403. Lancet 1996; phylaxis of acute upper gastrointestinal bleeding in high risk patients. Prophylaxis in Medical Patients with trointestinal hemorrhage in critically ill patients. Canadian Critical Care Trials Association of Non-University Affliated Intensive Care Specialist Group. Kupfer Y, Anwar J, Seneviratne C, et al: Prophylaxis with subcuta- cal intensive care unit. Am J Med 1984; 76:623–630 neous heparin signifcantly reduces the incidence of deep venous 409. Am J Crit Care Med 1999; mechanically ventilated patients: Integrating evidence and judgment 159(Suppl):A519 using a decision analysis. Crit Care Med and the Australian and New Zealand Intensive Care Society Clinical 2010; 38:2222–2228 Critical Care Medicine www. National Heart, Lung, and Blood Institute Acute Respiratory Distress enteric infection in patients taking acid suppression. N Engl J Med 1998; 338:791–797 intensive insulin therapy in critically ill patients: A randomized con- 415. Lin P, Chang C, Hsu P, et al: The effcacy and safety of proton pump trolled trial.