Critical Care - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

CRITICAL CARE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Critical Care: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00312-0 1. Critical Care-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on critical care. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON CRITICAL CARE ......................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Critical Care.................................................................................. 4 E-Journals: PubMed Central ....................................................................................................... 56 The National Library of Medicine: PubMed ................................................................................ 61 CHAPTER 2. NUTRITION AND CRITICAL CARE ............................................................................. 103 Overview.................................................................................................................................... 103 Finding Nutrition Studies on Critical Care............................................................................... 103 Federal Resources on Nutrition ................................................................................................. 104 Additional Web Resources ......................................................................................................... 105 CHAPTER 3. ALTERNATIVE MEDICINE AND CRITICAL CARE....................................................... 107 Overview.................................................................................................................................... 107 National Center for Complementary and Alternative Medicine................................................ 107 Additional Web Resources ......................................................................................................... 117 General References ..................................................................................................................... 119 CHAPTER 4. DISSERTATIONS ON CRITICAL CARE......................................................................... 121 Overview.................................................................................................................................... 121 Dissertations on Critical Care ................................................................................................... 121 Keeping Current ........................................................................................................................ 123 CHAPTER 5. PATENTS ON CRITICAL CARE ................................................................................... 125 Overview.................................................................................................................................... 125 Patents on Critical Care............................................................................................................. 125 Patent Applications on Critical Care ......................................................................................... 151 Keeping Current ........................................................................................................................ 171 CHAPTER 6. BOOKS ON CRITICAL CARE ....................................................................................... 173 Overview.................................................................................................................................... 173 Book Summaries: Federal Agencies............................................................................................ 173 Book Summaries: Online Booksellers......................................................................................... 174 Chapters on Critical Care........................................................................................................... 177 CHAPTER 7. PERIODICALS AND NEWS ON CRITICAL CARE ......................................................... 179 Overview.................................................................................................................................... 179 News Services and Press Releases.............................................................................................. 179 Academic Periodicals covering Critical Care ............................................................................. 181 CHAPTER 8. RESEARCHING MEDICATIONS .................................................................................. 183 Overview.................................................................................................................................... 183 U.S. Pharmacopeia..................................................................................................................... 183 Commercial Databases ............................................................................................................... 184 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 189 Overview.................................................................................................................................... 189 NIH Guidelines.......................................................................................................................... 189 NIH Databases........................................................................................................................... 191 Other Commercial Databases..................................................................................................... 193 APPENDIX B. PATIENT RESOURCES ............................................................................................... 195 Overview.................................................................................................................................... 195 Patient Guideline Sources.......................................................................................................... 195 Finding Associations.................................................................................................................. 198 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 201 Overview.................................................................................................................................... 201 Preparation................................................................................................................................. 201

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Finding a Local Medical Library................................................................................................ 201 Medical Libraries in the U.S. and Canada ................................................................................. 201 ONLINE GLOSSARIES................................................................................................................ 207 Online Dictionary Directories ................................................................................................... 208 CRITICAL CARE DICTIONARY ............................................................................................... 209 INDEX .............................................................................................................................................. 269

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with critical care is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about critical care, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to critical care, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on critical care. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to critical care, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on critical care. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON CRITICAL CARE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on critical care.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and critical care, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “critical care” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Alzheimer's Disease and Critical Care: Interactions, Implications, Interventions Source: Journal of Gerontological Nursing. 9(2): 86-90. February 1983. Summary: Critical care unit nurses are presented with a special challenge in caring for patients with a chronic progressive neuropsychiatric disorder, such as Alzheimer's disease, who require treatment because of concurrent disease or trauma. It is important not to blame cognitive cloudiness and physical or emotional agitation on Alzheimer's disease alone before other causes are eliminated. Meticulous skin and mouth care and range of motion exercises are necessary nursing interventions. Immobility poses the most serious threat to patients with Alzheimer's in a critical care setting. A major goal of the nursing staff must be to return clients to their homes with minimal to no deterioration in function due to hospitalization. Careful planning, open communication,

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and awareness of one's own feelings regarding aging and chronic dementing disorders will minimize trauma to both the nursing staff routine and the patient. 12 references.

Federally Funded Research on Critical Care The U.S. Government supports a variety of research studies relating to critical care. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to critical care. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore critical care. The following is typical of the type of information found when searching the CRISP database for critical care: •

Project Title: ACADEMIC TRAINING PROGRAM IN PEDIATRIC PULMONARY DISEASE Principal Investigator & Institution: Abman, Steven H.; Professor; Pediatrics; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 15-JUL-1994; Project End 30-JUN-2004 Summary: Advances in our understanding and treatment of childhood respiratory disorders have been limited by a lack of insight into basic mechanisms of disease and the development of novel therapeutic strategies. The purpose of this program is to provide rigorous multi-disciplinary training for academically-oriented pediatricians interested in childhood lung diseases. This proposal is a renewal of the NIH Training Program in Pediatric Lung Disease at the University of Colorado School of Medicine, and represents the continuation of a well-established program that has existed since 1988. This current proposal has been expanded to represent the evolution of our training program and to reflect our highly interactive, multi-disciplinary faculty. Strengths of this program include benefits derived from the integration of extensive resources of two collaborating hospitals (The Children's Hospital (TCH) and National Jewish Medical and Research Center (NJMRC)) and five research units at the NJMRC and the UCHSC campus (Developmental Lung Biology Laboratory, Pediatric Heart Lung Center Laboratory, the Perinatal Research Facility, and the Cardiovascular Pulmonary Laboratories). These resources are combined into a versatile training environment for both basic and applied research. Faculty in this program include the PIs of 2 PPGs, 2 SCORs, a Therapeutic Development Center Award in Cystic Fibrosis, an NIH Clinical Research Center Grant, and several individual awards that address basic, applied and clinical research questions in the area of pulmonary biology. Collaborations between

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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laboratory and clinical investigators are a major strength of this proposal, enhancing interactions between scientists and clinicians from diverse backgrounds and encouraging "bench to bedside" approaches to pediatric lung disease. All participants in the training program are full-time academic faculty, and include pediatric pulmonary and critical care physician- investigators, along with several basic (PhD) and other scientists from throughout UCHSC. The most promising individuals with clearly defined academical goals are selected from candidates within our pediatric pulmonary, critical care and neonatology fellowship training programs. After a clinical year of training (funded from other sources), laboratory or clinical research experience is provided under the direct mentorship of a senior investigator. Structured course work in statistics, molecular biology, cell physiology, ethics, and other areas are provided to the trainees. Review of fellows' progress is closely monitored by the head of the training grant, fellowship directors, their laboratory mentor and special advisors to the program. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ALCOHOL, GLUTATHIONE, AND ALVEOLAR MACROPHAGE FUNCTION Principal Investigator & Institution: Burnham, Ellen L.; Medicine; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2008 Summary: (provided by applicant): Each year in the United States, there are an estimated 4 million cases of pneumonia, accounting for 600,000 hospitalizations with an annual cost of $23 billion. Alcohol is a common risk factor for the development of both community-acquired and nosocomial pneumonia. Presently, the mechanisms by which chronic alcohol abuse alters human pulmonary immunity and increases the likelihood of developing pneumonia are essentially unknown. We hypothesize that increased oxidative stress via glutathione (GSH) depletion leads to abnormal function and viability of human alveolar macrophages (AM), and subsequently impairs alveolar clearance of infectious particles leading to pulmonary infections. In this proposal, the impact of alcohol abuse on the development of pneumonia will be explored by examining the function and viability of AM obtained from two patient cohorts: individuals with a prior history of chronic alcohol abuse and critically ill patients with acute lung injury. Additionally, we will determine the efficacy of oral antioxidant replacement therapy on AM function in individuals with a prior history of chronic alcohol abuse. The goal of this research endeavor is effective medical therapy to decrease the risk of community-acquired and nosocomial pneumonia in the millions of individuals who chronically abuse alcohol. Dr. Ellen Burnham is presently a fellow in Pulmonary and Critical Care Medicine at Emory University. During the next five years, she will work with several investigators in the Emory Alcohol and Critical Care Clinical Research Program in order to develop necessary clinical and basic research skills. With the support of this proposal, Dr. Burnham will not only receive personal supervision from these established clinical and basic investigators, but will also enroll in the Clinical Research Curriculum Award (CRCA) program at Emory University and the Rollins School of Public Health, and obtain a Masters of Science in Clinical Research to further enhance her ability to perform high-quality research. The ultimate goal of this award is to develop an independent research career in "translational" investigation for Dr. Burnham, examining the systemic effects of alcohol abuse as it relates to pulmonary and critical care medicine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: AMINOCAPROIC ACID AND BLEEDING IN SPINAL SURGERY Principal Investigator & Institution: Berenholtz, Sean M.; Anesthesiology/Crit Care Med; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The candidate, Sean Berenholtz, is on the faculty at Johns Hopkins University, in the Division of Adult Critical Care Medicine (CCM), Department of Anesthesiology/CCM. His goal is to become an independent clinician scientist focused on applying rigorous research design to quality improvement in the intensive care unit, with an emphasis on evaluating alternatives to allogeneic blood transfusion in critically ill patients. To realize this goal, he will enroll in a formal advanced degree program in clinical investigation and he will receive structured mentoring by senior investigators for the conduct of supervised, innovative research. The specific aims and related hypothesis of the proposed research are: 1. To identify preoperative patient or hospital characteristics that predict allogeneic transfusion in adult patients undergoing spine surgery in Maryland from 1997 to 2000. We will analyze hospital discharge data for adult patients in non-federal acute care hospitals in Maryland who had a primary procedure code for spine surgery from 1997 to 2000 (n=3988). We hypothesize that preoperative patient characteristics, including advanced age and the presence of cardiac disease, are associated with an increased incidence of allogeneic transfusion. 2. To determine the association of allogeneic blood transfusion with clinical and economic outcomes following high-volume surgeries at Johns Hopkins Hospital. We will conduct a prospective review of data from the Johns Hopkins discharge database. We hypothesize that there is a dose-response association between anincreased number of allogeneic transfusions and an increased incidence of postoperative complications, including nosocomial infections, ICU length of stay, and hospital costs. 3. Assess the efficacy and safety of epsilon aminocaproic acid (EACA) in reducing allogeneic blood transfusion requirements in 170 patients undergoing spine surgery at Johns Hopkins Hospital. We will conduct a randomized controlled trial of EACA versus placebo in 170 patients undergoing spine surgery and we have completed a pilot study demonstrating the feasibility of this approach. We hypothesize that patients receiving EACA will require 30% fewer allogeneic blood transfusions than patients receiving placebo. 4. Evaluate the impact of EACA on economic outcomes, including hospital length of stay (LOS) and direct costs of hospital care in patients undergoing spine surgery at Johns Hopkins Hospital. We hypothesize that thedirect costs of EACA are less than those in the control group. Completion of the proposed research will significantly advance our knowledge of who is likely to require allogeneic transfusion, the complications associated with transfusion, and strategies to reduce transfusion exposure. These projects and the career development plan described will build a foundation for a successful career as an independent investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: AN ELECTRICAL IMPEDANCE MONITOR Principal Investigator & Institution: Clark, Justin S.; Medical Physics, Inc. 825 North 300 West, Ste 420 Salt Lake City, Ut 84103 Timing: Fiscal Year 2004; Project Start 21-MAY-2004; Project End 20-NOV-2004 Summary: (provided by applicant): Knowledge of Hematocrit (Hct) is important in several chronic and critical care situations. Presently, Hct measurement requires finger sticks, heel sticks, and blood withdrawals, causing patient trauma as a result of such blood sampling. The development of noninvasive Hct measurement instrument is

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proposed which will eliminate the trauma of present invasive measurement methods as well as provide immediate results. The method relies upon the sensitivity of the electrical impedance of blood to hematocrit, which differs at high and low frequencies. This principle has been used successfully to measure hematocrit in vitro and in pulse oximetry. The method should be ideal as a screening tool for prospective blood donors as well as for applications in doctors' offices. Since this is a monitoring instrument that provides a continuous measurement, patients in surgery or critical care would benefit from the immediacy of the results compared to the time taken in waiting for lab test results. The tasks of Phase I are directed toward the development and validation of the method. Assuming a successful Phase I, a commercial prototype instrument will be designed and tested in the Phase II. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANGIOGENESIS IN HYPEROXIC LUNG FIBROSIS Principal Investigator & Institution: Douglas, Ivor S.; Medicine; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): This 5-year training program proposes the development plan for a career as an independent biomedical researcher in the area of lung injury and angiogenesis. The principal investigator, has completed Pulmonary and Critical Care Fellowship training through the ABIM Research Pathway. With the sponsors and experienced collaborators he will expand on his scientific skills in preparation for career progression as an independent physician-scientist. The program will emphasize skills in molecular biology of angiogenesis and macrophage regulation of fibrosis using a murine hyperoxia model. To advance his knowledge in computational biology he will attend courses in applied statistics. Steven Greenberg M.D. a macrophage biologist, and Paul Rothman M.D., a renowned immunologist in the area of molecular regulation of cytokine signaling, will provide sponsorship. The program will benefit from collaborative expertise of Jan Kitajewski PhD, an expert in angiogenesis and Patty Lee, M.D. who will provide consultative support for the hyperoxia studies. Additionally, George Yancopoulos, a world renowned investigator, will collaborate and serve with the sponsors, Drs. Kitajewski and Lee on an advisory committee every 8 weeks. This committee will review progress and provide close scientific support and career advice. Prolonged hyperoxia results in lung fibrosis in humans and mice. The accompanying vascular remodeling contributes to pulmonary hypertension, right heart failure, and premature death. This program addresses the questions: Do macrophage-derived angiogenic regulatory factors, particularly angiopoietin-2 (Ang-2), contribute to vascular remodeling in response to prolonged sublethal hyperoxia. Do these vascular alterations contribute, independently, to the development of lung fibrosis? And does macrophage-derived Ang-2 directly inhibit endothelial cell survival in response to hyperoxia? The role of macrophage-derived mediators in hyperoxic lung injury remains unclear. We demonstrate in preliminary experiments, increased Ang-2 mRNA and protein in response to hyperoxic exposure in RAW 264.7 and in a mouse model of sublethal hyperoxic lung fibrosis. These mice develop macrophage-predominant cellular infiltration, collagen deposition and pulmonary vascular regression that recapitulates features of subacute lung fibrosis in humans. The following specific aims will be accomplished: 1) The characterization of fibrotic and vascular remodeling responses in hyperoxia-exposed mice by immunohistochemistry, Western and Northern blotting and ELISA to quantify changes in markers of lung fibrosis, angiogenesis and expression of angiogenic regulators and their

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receptors. The effects on pulmonary vasculature will be evaluated by confocal microscopy. 2) Functional changes in response to altered expression of macrophagederived angiogenic regulators by angiogenesis assays. Macrophage-depleted mice will be used to assess the contribution of lung macrophages. 3) Lung targeted overexpression of Ang-1 or 2 by adenovirus transfection or blocking antibodies prior to hyperoxia to determine the contribution of Ang-2 to pulmonary vascular remodeling and fibrosis during prolonged sublethal hyperoxia. 4) Determine if Ang-2 mediated endothelial survival inhibition is PI3K/Akt dependent. Columbia University has an established record of successful mentorship and training for K08 Career awardees in their preparation for careers as independent. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANYTIME, ANYPLACE LEARNING FOR CRITICAL CARE Principal Investigator & Institution: Jeffries, Pamela R.; Associate Professor; Academic Edge, Inc. 216 W Allen St, Ste 143 Bloomington, in 47403 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2003 Summary: (provided by applicant): The purpose of this proposal is to develop and test one module for a Web-based course to prepare nurse for employment in critical care. This course, designed as an Online Community of Professional Practice (OCPP), will use the collaborative work tools within the course to create an environment in which core content, clinical practice and interaction with expert nurse clinicians, researchers, and learning resources will provide nurses and nursing students an opportunity to acquire the knowledge, skills, and best practices, and become socialized to critical care nursing. Upon completion, the entire course will provide a professional certificate with continuing nursing education contact hours or can be transferred as academic credit in an undergraduate-nursing program. The model for the OCPP to be developed in this project has three components: didactic core content, clinical practicum, and a Virtual Center of Best Practices. The core content will include principles, nursing care management, and critical thinking skills. The clinical practicum component of the course involves the use of preceptors to facilitate learning, skills demonstration and validation, and evaluation of learning in the clinical setting. The centerpiece of the project, The Virtual Center of Best Practices, will offer state-of-the-art online skills demonstration, clinical databases, nursing practice protocols, access to learning resources, and dialogue with expert clinicians and researchers in critical care nursing. Test of feasibility for the one module includes comparing learning outcomes with traditional learning methods and assessing the impact of using technology and educational practices on the outcomes of the course. PROPOSED COMMERCIAL APPLICATION: The target market for this course is nurses who are seeking an educational program to prepare them for employment in critical care. The course will also have market potential for health care agencies that wish to recruit and prepare nurses for practice in critical care. The course will be appealing to nursing students who seek entry into critical care practice after graduation and schools of nursing who wish to offer a basic or elective course in critical care. When proven effective, the model maybe applied to different areas of healthcare education, thereby broadening the scope of impact considerably. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CARDIAC OXYGENATION MONITOR FOR RESUSCITATION Principal Investigator & Institution: Klomhaus, Jill T.; Rose Biomedical Development Corporation 4545 E 9Th Ave, Ste 110 Denver, Co 802203902

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Timing: Fiscal Year 2004; Project Start 15-MAR-2004; Project End 14-AUG-2004 Summary: (provided by applicant): Each year, approximately 350,000 people in the U.S. die from cardiac arrest. Resuscitation rates remain less than 1% in many communities. Critical care specialists at the Post Resuscitative and Initial Utility in Life Saving Efforts (PULSE) conference determined that the research and practice of resuscitation medicine would be aided by a diagnostic device that provides real-time data on the effect of therapeutic interventions on myocardial status. The Minimally Invasive Cardiac Oxygenation Monitor (MICOM) is designed to provide real-time data on myocardial oxygenation using minimally invasive technology that can deliver valuable clinical information in emergency situations, as well as in institutional critical care settings. MICOM incorporates the proven technologies - ultrasound and near-infrared spectroscopy - to support accurate readings of tissue oxygenation at the myocardium. MICOM is designed to improve outcomes by directing therapy and evaluating efficacy of resuscitative technologies. The equipment will be designed so that it can ultimately be used by EMTs in the field with minimal training. RBDC anticipates that MICOM will evolve into a diagnostic platform to improve outcomes by providing a wide range of quantitative information for diagnosis and treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CARDIOLOGY AND PULMONARY RESEARCH TRAINING GRANT Principal Investigator & Institution: Strom, Brian L.; Professor of Medicine and Pharmacology; Biostatistics and Epidemiology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2003; Project Start 01-JUL-1998; Project End 30-JUN-2008 Summary: (provided by applicant): The Center for Clinical Epidemiology, and Biostatistics (CCEB); the Division of Cardiovascular Medicine; and the Pulmonary, Allergy, and Critical Care Division of the University of Pennsylvania School of Medicine submit this request for the renewal of an innovative research training program for postdoctoral training for clinicians in cardiovascular and pulmonary clinical research, specifically designed to strengthen the links among traditional epidemiology and clinical cardiovascular and pulmonary medicine. The objective of the program is to train individuals who already are physicians to be rigorous and independent academic investigators able to use the range of approaches available in epidemiology to address research issues regarding the etiology, prognosis, prevention and early detection, treatment, clinical economics, technology assessment, medical decision making, and quality of patient care of cardiovascular or pulmonary disease. The two- to three-year training program consists of required courses in clinical epidemiology, research methodology, and biostatistics; elective courses, and extensive independent readings; attendance at and participation in research seminars at the CCEB, Division of Cardiovascular Medicine; and the Pulmonary, Allergy, and Critical Care Division; plus the completion of an independent research project. Specifically, the program is designed to: (1) provide in-depth knowledge of the research techniques appropriate to clinical research; (2) provide research experience with mentors in clinical epidemiology and cardiovascular and pulmonary research; and (3) bring together faculty and fellows in the CCEB, Division of Cardiovascular Medicine, and the Pulmonary, Allergy, and Critical Care Division. Trainees will matriculate in the Master of Science in Clinical Epidemiology degree program. Strengths of the proposed program are the long history of successful research training programs in the CCEB and in cardiovascular and pulmonary medicine; the collaborative links that have already been forged among the CCEB, Division of Cardiovascular Medicine, and the Pulmonary, Allergy, and Critical

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Care Division; and the comprehensive course offerings and research programs that are available to trainees. In addition, the availability of the broad range of rich expertise of the faculties in the CCEB and the cardiovascular and pulmonary medicine programs at Penn, numerous existing large databases available to these groups that can be used for research projects and training, a broad array of specialized analytic capabilities available for clinical studies (e.g., clinical trials, case-control, cohort research, etc.), and the faculties' commitment to collaborative research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OUTCOMES

CHRONIC

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ILLNESS:

SYMPTOMS/ASSOCIATED

Principal Investigator & Institution: Nelson, Judith E.; Medicine; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2007 Summary: (provided by investigator): A large and growing population of patients survive acute critical illness only to become "chronically critically ill," with profound debilitation, prolonged hospitalization, and often permanent dependence on lifesustaining technology. Chronic critical illness is a serious health problem for the nation and especially for older adults, as the majority of these patients are over age 65. Despite technologically advanced treatment, mortality rates remain high and extreme functional dependence is typical for survivors. No previous research has focused on the symptom experience during treatment for chronic critical illness in any care setting, yet potential sources of suffering for chronically critically ill patients are many, and preliminary data suggest significant symptom distress. Nor has there been an investigation of the relationship between symptom burden and other important clinical or utilization outcomes of chronic critical illness, although symptom distress is known to predict adverse outcomes in other clinical settings. The proposed research will fill these gaps in existing knowledge. Our First Aim is to determine the prevalence and characteristics of distressing symptoms during chronic critical illness. The investigators will assess symptoms and related distress through patient self-reports in a prospective cohort study using a validated symptom assessment instrument that is practical and feasible for use with chronically critically ill patients. The Second Aim of this project is to evaluate the association of symptom distress with other important outcomes of chronic critical illness, including success in liberation from mechanical ventilation, time to ventilator independence, functional status, and survival. Using symptom information and data collected with respect to selected patient-related variables and medications, the investigators will perform statistical modeling to evaluate associations between symptom burden and other outcomes of interest. Rigorous study of the prevalence, intensity, and impact of symptom distress is a necessary precondition and strong impetus for quality improvement efforts. Data and analyses from the research we propose here will provide the evidentiary foundation for development of interventions specifically aimed at symptoms associated with distress and clinically important outcomes for older patients with chronic critical illness. We plan to evaluate such interventions in a future phase of research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL CENTER IN COPD Principal Investigator & Institution: Bailey, William C.; Professor and Director; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294

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Timing: Fiscal Year 2003; Project Start 15-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Chronic Obstructive Pulmonary Disease (COPD) is a serious public health problem responsible for more than 500, 000 hospitalizations, 100,000 deaths, and $15 billion in direct costs of medical care in the United States each year. We propose to form a collaborative COPD CRN Clinical Center at the University of Alabama at Birmingham (UAB) and the Birmingham Veterans Affairs Medical Center (BVAMC). The UAB/BVAMC Clinical Center will be headed by, Drs. William C. Bailey and J. Allen D. Cooper. The proposed investigators and their research staff have extensive experience in recruitment and retention for clinical trials, as well as study design and implementation. The collaborative effort between UAB and the BVAMC will allow us to quickly and efficiently recruit large numbers of COPD patients for clinical research studies. In addition, the UAB/BVAMC COPD Clinical Center will have access to a large network of experts at the University of Alabama at Birmingham who can assist in the design and implementation of clinical trials. The UAB/BVAMC Clinical Center proposes two studies aimed at enhancing treatment for moderate-to severe COPD. The first study will examine measures of inflammation and responsiveness to bronchodilator challenge, responsiveness to systemic steroid treatment, and responsiveness to inhaled steroid treatment. This study may provide a new method for identifying subgroups of COPD patients who are most likely to respond to inhaled corticosteroids. The second project will examine the causes of poor responsiveness to the pneumococcal vaccine with the long term goal of using this information to reduce pneumococcal infections and related exacerbations in COPD patients. The UAB/BVAMC Clinical Center also proposes a Clinical Research Skills Training Core. Dr. J. Allen D. Cooper, the Director for fellowship training in Pulmonary and Critical Care Medicine at UAB, will head this core. Trainees will be funded for a total of two years and will be required to enroll in one of the UAB K30 Clinical Research Curriculum Development Award components (either the Clinical Research Training Program or the Master's of Science in Public Health in Clinical Research). Trainees will also receive funding for a pilot project, which will be developed and conducted under the supervision of the Training Core Investigators. These Investigators have expertise in COPD, Clinical Research and Study Design, Behavioral Science, Epidemiology, and Statistics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COGNITION AND ERROR MANAGEMENT FOR CRITICAL CARE Principal Investigator & Institution: Patel, Vimla L.; Professor; Biomedical Informatics; Columbia University Health Sciences Po Box 49 New York, Ny 10032 Timing: Fiscal Year 2004; Project Start 01-FEB-2004; Project End 31-JAN-2007 Summary: (provided by applicant): The medical error report from the Institute of Medicine (1999) has greatly increased people's awareness of the frequency, magnitude, complexity, and seriousness of medical errors. As the eighth leading cause of death in US, ahead of motor vehicle accidents, breast cancer, and AIDS, medical errors need immediate attention from academic, health care, and government organizations. While medical errors can be dealt with from several perspectives, such as organizational restructuring or automation, our concern is with cognitive factors of medical errors and their clinical implications. We propose a theoretical framework in which errors are viewed as inevitable but cognitively useful phenomena that cannot be totally eliminated. In our view human errors are products of cognitive activities in people's adaptation to their complex physical, social, and cultural environments. Our cognitive approach stresses actions in conceptual understanding and thought processes during

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clinical problem solving. The actions reflect the level of expertise and the demands of tasks in clinical performance. In order to manage errors during clinical decision-making, it is critical to understand how decisions are made and what underlying cognitive mechanisms are used to process information during interactions with patients, colleagues, and technology in the health care environment. The broad objective of the proposed research is to develop a cognitive framework of medical errors in critical care environments (medicine, surgery and psychiatry), where decisions are often made under high stress, time pressure, and with incomplete information. Our specific aims include (1) applying and refining our initial cognitive taxonomy of errors where each category of medical error is associated with a specific cognitive mechanism, and (2) providing a theoretical explanation of why these errors occur and predicting the circumstances in which such errors would occur. Unlike the popular goal of achieving flawless performance (through development of error-free systems), the results from this study will have implications for developing adaptive systems that anticipate errors, respond to them, or substitute less serious errors that allow subsequent intervention before they result in an adverse event. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COGNITIVE FOUNDATION OF MEDICAL ERRORS Principal Investigator & Institution: Zhang, Jiajie; Associate Professor and Associate Dean f; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2003 Summary: (PROVIDED BY APPLICANT) The fundamental causes of medical errors are cognitive, although the errors are not always the fault of the individual who makes them. From the perspective of cognitive science, medical errors occur in large part due to inadequate information processing in cognitive tasks. In order to prevent or greatly reduce medical errors, it is critical to understand the underlying cognitive mechanisms that cause medical errors and how a person?s work environment contributes to and even induces those errors. The objective of this three-year project is to develop a cognitive framework of medical errors that includes a cognitive taxonomy, a cognitive theory, and a set of intervention strategies. We will achieve the following specific aims: First, we will systematically collect medical error data from published reports, public databases, and from our own observations in critical care settings by ethnographical and other naturalistic methodologies. We will focus on errors in medical decisionmaking, reasoning, and problem-solving tasks. Second, based on the data collected, we will develop a cognitive taxonomy that associates each type of medical error to a specific underlying cognitive mechanism. Third, we will develop a cognitive theory that explains why and predicts when and where a specific error occurs. Fourth, based on the cognitive taxonomy and the cognitive theory, we will develop a cognitive intervention strategy for each type of error in the taxonomy. These cognitive intervention strategies will be able to prevent or greatly reduce medical errors in a systematic way and on a large scale. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COMPUTERIZED MANAGEMENT OF CHILDHOOD RESPIRATORY FAILURE Principal Investigator & Institution: Maloney, Christopher G.; Medical Informatics; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2002; Project Start 16-SEP-2002

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Summary: This proposal outlines a strategy for weaning children from mechanical ventilation, using a computerized protocol. This proposal has two major goals: 1) Integration of a computerized decision support tool that accesses existing database servers at Primary Children's Medical Center. 2) Evaluation of the feasibility and utility of a computerized protocol to assist with weaning children with acute respiratory failure from mechanical ventilation. In the first specific aim, a consensus panel of pediatric critical care practitioners will develop a weaning algorithm that is simple and reasonable. The protocols and incorporated logic will be examined, at the bedside, using paper-flow diagrams for applicability in weaning children from mechanical ventilation. These protocols will then be programmed using network technology to access existing database servers. Practitioners involved in weaning children, with acute respiratory failure, from mechanical ventilation will then evaluate the validity of the protocols. In the second specific aim, children will be entered into a prospective, randomized, controlled clinical trial to evaluate the utility of a computerized protocol to wean critically ill children from mechanical ventilation. Children with acute respiratory failure requiring mechanical ventilation will be entered into either a computerized protocol driven weaning strategy arm or the "standard" physician driven weaning arm. These studies will yield information regarding the feasibility of using computerized protocols in pediatric critical care and potentially allow for the development of advanced protocols to assist physicians in managing critically ill children in a more efficient manner. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONSEQUENCES OF CHILDHOOLD

SURVIVING CRITICAL

ILLNESS

IN

Principal Investigator & Institution: Watson, R Scott.; Critical Care Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2004; Project Start 08-JUN-2004; Project End 31-MAR-2009 Summary: (provided by applicant): The purpose of this proposal is to provide Dr. Scott Watson with the means and structure to transition to an independent investigator. The candidate is an Assistant Professor of Critical Care Medicine and Pediatrics at the University of Pittsburgh with training in epidemiology and health services research. His long-term career goal is to optimize the long-term, multi-dimensional patient- and family-centered outcomes of critical illness in childhood. This career award application contains a well defined curriculum in psychometric, quantitative, and clinical research methods, has the institutional support of a leading Department of Critical Care Medicine, and has the commitment of an experienced, successful mentor, Dr. Derek C. Angus. The candidate will study long-term outcomes of an inception cohort of critically ill children at the Children's Hospital of Pittsburgh. A quarter million children aged 1 to 19 years receive care in an intensive care unit (ICU) in the US each year. Although most survive, the survivors are at risk of impairment in multiple domains. The need for additional research evaluating long-term outcomes and functional status after critical illness in children was highlighted at a recent NIH-sponsored conference. The goals of the research portion of this proposal are to determine the incidence and extent of patient morbidity, the impact of illness on families, and risk factors for adverse sequelae following critical illness in children. The candidate will build a stratified prospective cohort of 300 previously healthy children who survive critical illness in the Children's Hospital of Pittsburgh Pediatric ICU. He will perform assessments of 3 primary domains: 1) Functional status and quality of life, 2) Neuropsychologic sequelae, and 3) Family effects. Patients and their families will be evaluated in the hospital and followed

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for a minimum of 12 months, with evaluations 1,6, and 12 month post-discharge and every 12 months thereafter. Teachers of school aged children will be also be contacted. This study will identify independent risk factors of adverse sequelae related to children's ICU course and will have implications for interventional trials and larger observational studies. It will allow the candidate to obtain skills in multi-dimensional, long-term outcome assessment of critically ill children integral to his development into an independent investigator in pediatric critical care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONTINUOUS GLUCOSE MONITORING IN CRITICALLY ILL PATIENTS Principal Investigator & Institution: Esenaliev, Rinat O.; Assistant Professor and Director of Labo; Physiology and Biophysics; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2004; Project Start 01-MAR-2004; Project End 28-FEB-2007 Summary: (provided by applicant): In both nondiabetic and diabetic patients, hyperglycemia and insulin resistance commonly complicate critical illness. Even moderate hyperglycemia, at levels that conventionally have not been treated acutely with insulin because of the risk of inducing hypoglycemia, contributes to morbidity and mortality. A recent randomized clinical trial in critically ill patients demonstrated that intensive insulin therapy to tightly control blood glucose concentration (80 - 110 mg/dL) substantially reduced morbidity and mortality by more than 40% (from 8.0% to 4.6%) but was associated with a 5.0% incidence of severe hypoglycemia (glucose concentration < 40 mg/dL). Therefore, in critically ill patients, continuous glucose monitoring, ideally noninvasive, would be invaluable to guide insulin infusion to both control hyperglycemia and avoid hypoglycemia. For this purpose, optical coherence tomography (OCT) based on low-coherence interferometry, a high-resolution optical technique that sensitively detects photons coherently scattered from tissue, is highly promising. We have developed a novel, OCT-based glucose sensor that precisely, continuously and noninvasively measures the decrease of tissue light scattering that linearly accompanies increases of blood glucose concentration. During the past two years, supported by an NIDDK R-21 grant under the PA-99-036 ("Pilot and Feasibility Program in Diabetes Endocrinology and Metabolism"), we performed preliminary animal and clinical studies of the novel glucose sensor. Our studies demonstrated: 1) a sharp and linear decrease of the OCT signal slope in skin and oral mucosa as blood glucose concentration increased; and 2) substantial improvement of accuracy of the OCT signal slope measurement by optimizing the dimensions of the probed tissue area. The goals of the proposed project are: (1) to further refine the glucose sensor in animal studies; and (2) to validate the resulting sensor in clinical studies in normal subjects and critically ill patients. Successful implementation of the project will produce a continuous, noninvasive, and accurate glucose sensor that will substantively contribute to reduced mortality and morbidity in critically ill patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORE--CLINICAL EPIDEMIOLOGY CORE Principal Investigator & Institution: Moss, I Marc.; Assistant Professor; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2003; Project Start 01-FEB-2003; Project End 31-DEC-2007

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Summary: (provided by applicant): The Clinical Epidemiology Core (Core C) will support the clinical studies in this Center Grant application that are included in three of the projects and several of the pilot studies. Dr. Marc Moss will be the project leader of this core. He made the sentinel observation that chronic alcohol abuse increased the incidence and severity of ARDS in critically ill patients. He is also considered a national expect in clinical research methods in the critically ill as evidenced by his appointment to chair a symposium at the 2002 International American Thoracic Society meeting entitled, "Building the Critical Care Clinical Research Laboratory", and by his participation in the NIH-NHLBI Working Group on "Research Opportunities in the Clinical Epidemiology of Lung Injury and Critical Illness" in 2000. This Core will be primarily located at Grady Memorial Hospital but will routinely access the enormous quantity of critically ill patients in the 145 intensive care unit beds at the four Emory affiliated hospitals (Grady Memorial, Crawford Long, Emory University, and the Atlanta Veterans Administration). Dr. Moss has organized a cohesive team of investigators. These individuals draw upon the outstanding personnel at both the Emory School of Medicine and the Rollins School of Public Health at Emory University. These individuals will perform all of the necessary steps required to effectively identify and enroll patients into properly designed and accurately analyzed clinical studies. The core will also be responsible for ensuring that all institutional and federal policies regarding research involving human subjects are properly followed. This Alcohol and Critical Care Clinical Research Program has already been established and presently serves as an active working team. More importantly, this clinical core is a flexible system that can and will incorporate new members and encourage the growth, development, and implementation of new research protocols concerning novel hypotheses concerning the association between alcohol abuse and critical illness. i Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CRITICAL ROLE OF ALVEOLAR FIBRIN IN ACUTE LUNG INJURY Principal Investigator & Institution: Allen, Gilman B.; Medicine; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2004; Project Start 15-JUL-2004; Project End 30-JUN-2009 Summary: (provided by applicant): This proposal describes a 5-year training program for the development of an academic career in medical research. The principal investigator, Gilman B. Allen, has completed a 3-year fellowship in pulmonary and critical care medicine and an additional year of protected research time at the University of Vermont. He will now develop and refine his skills as a clinician-scientist investigating the role of fibrin as a determinant of mechanical lung function in acute lung injury (ALI) and ventilator-induced lung injury (VILI). Jason H.T. Bates, PhD, will mentor the principal investigator's scientific development. Dr. Bates is a recognized authority on the bioengineering aspects of the respiratory system and has made seminal contributions to our understanding of pulmonary mechanics. Dr. Bates is a Research Professor in the Department of Medicine, and has mentored numerous research trainees (both PhD and MD). Dr. Bates is also a senior member of the Vermont Lung Center (VLC), a well-funded and diverse collection of scientists collaborating on research in pulmonary disease. Two other senior members of the VLC and a biomedical engineer from Boston University constitute an advisory committee that will provide ongoing advice in both scientific and career development matters. Preliminary data from mouse models of ALI lead us to hypothesize that alveolar fibrin accumulation is critical for producing the changes in lung mechanics associated with ALI. We also suspect that alveolar fibrin is a major risk factor for the subsequent development of VILI. These

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concepts will be tested in three specific aims. Specific Aim 1 will establish the relationship between fibrin and ALI by showing that accumulation of fibrin within the alveolar space of mice is both necessary and sufficient to produce the derangements of lung mechanics associated with ALI. Specific Aim 2 will then seek to establish the converse, that the pharmacologic removal of alveolar fibrin in the setting of ALI leads to an improvement in lung function. Finally, Specific Aim 3 will explore the association between alveolar fibrin levels and development of VILI through the application of injurious modes of mechanical ventilation in mouse models of ALI. By using advanced methods of physiological measurement, this research is expected to provide insight into an important and common clinical condition. This program of research, together with the collective expertise within the VLC and its focus on nurturing exceptional young scientists, constitute an ideal setting for a trainee clinician-scientist to attain the diverse and specialized skills necessary to develop a research career in lung biology and pathophysiology. (End of Abstract) Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CRITICALLY III DEVELOP.HOST FROM PATHOGENESIS TO OUTCOME Principal Investigator & Institution: Mariscalco, Mary Michele.; Pediatrics; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): This postdoctoral training program addresses a need in the field of Pediatric Critical Care to train scientific investigators focusing on issues that specifically affect critically ill children. These issues fall into areas of 1) the impact of the developing host on the pathogenesis of and recovery from critical illness and 2) the effects of critical illness on development. This proposal is based upon the assumption that the field is best served by training both M.D. and Ph.D. investigators, as early collaboration between these two groups will establish stronger links between basic research and the bedside. To facilitate these interactions trainees throughout the training period will participate in workshops, journal clubs and group discussions which will focus on the pathophysiologic processes of critical illness in the developing host. Mentors are senior academicians whose areas of service or research link to pediatric critical care. Synergy between mentors will be required to establish an environment for research projects that fit the special needs of pediatric critical care, since very few investigators work on basic pathophysiologic mechanisms of critical illness in the context of child development outside the neonatal period. The major training method is a research preceptorship and trainees are supported for two years but additional training with support from other sources is encouraged. This program addresses the unique educational needs of both the M.D. and Ph.D. fellows. For the M.D. fellows?, individual committees headed by his/her mentor, will supervise and guide the research experience. The committee will suggest necessary/desirable course work, approve final proposals, and ensure that potentially beneficial collaborations have been explored, and assess progress. Ph.D. fellows participate in a limited, highly focused educational series on the pathobiology of disease in the critically ill developing host to provide them with the framework from which they can explore relevant questions in their basic investigations. To assure cohesiveness and cross-fertilization of research and clinical expertise between M.D. and Ph.D. scholars, a series of workshops and series have been developed. Dr. Mariscalco and Dr. Smith as Co-Directors are responsible for the administration and direction of the program. Their collaboration will provide the necessary integration of basic and clinical issues for the proposed training, and foster a

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multidisciplinary approach for trainees. The Executive Committee meets to review scientific and operational aspects of the training program, select trainees, review the trainees? progress, and select potential new mentors. An external Advisory Committee meets yearly to ensure the program is meeting its stated objectives. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ERYTHROCYTE NITROSOTHIOL FLUX AND VASOREGULATION IN LUNG Principal Investigator & Institution: Doctor, Allan; Assistant Professor of Pediatrics; Pediatrics; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2004; Project Start 01-JAN-2004; Project End 31-DEC-2008 Summary: (provided by applicant): This proposal describes a five-year plan for the attainment of research skills necessary in the career development of an academic physician-scientist in Critical Care. The candidate is a junior faculty member in an established Division of Pediatric Critical Care and has preliminary research training in pulmonary physiology. The award will be utilized to broaden this background by acquiring a foundation in vascular cell biology and the biochemistry of nitrosative signaling to enable independent investigation of erythrocytic and endothelial communication in the pathobiology of disrupted vasomotor control. Ben Gaston, MD, a leader in pulmonary nitrosothiol signaling research, will serve as primary mentor for the award and Brian Duling, PhD, a pioneer in microcirculation research and vascular cell biology will serve as Co-Mentor. Specific expertise in nitrosative hemoglobin chemistry will be provided by collaboration with investigators from Duke and the University of Pennsylvania. Additionally, an advisory committee of senior scientists will provide scientific and career guidance. Research conducted with this award will investigate the role of the erythrocyte as a link between dysregulated pulmonary blood flow and remote inflammation via nitric oxide (NO) and hemoglobin (Hb) interactions. There is evidence for a nitrosative signaling network in which Hb and NO reactions are balanced to transduce regional redox gradients, coupling oxygen tension and the distribution of NO (and thus flow), in vascular beds. In this regard, we hypothesize oxidative stress in the systemic inflammatory response syndrome (SIRS) may disrupt normal erythrocytic nitrosative signaling and explain dysregulated pulmonary blood flow in this state. We aim, in this project, to determine (1) the degree of abnormal NO loading of RBCs in SIRS, correlating with onset and severity of respiratory failure and (2) to determine the change in Hb vasoactivity in the lung following addition of NO to a beta-chain cysteine (betacys93), the allosteric control of this change, and (3) the endothelial regulation of Hb-based nitrosative signaling. We will pursue these goals on three levels: (1) molecular investigation of intraerythrocytic Hb approximately NO chemistry (2) pharmacologic, immunohistochemical, and proteomic investigations of NO signaling between erythrocytes and endothelial cells in culture, and (3) physiologic correlation of our findings in the isolated murine lung, permitting further transgenic and pharmacologic query. At the conclusion of this project, we expect to define the mechanism of NO traffic between remote vascular beds and the lung via the erythrocyte, as effected by serial transnitrosation reactions. At the conclusion of the development period, the candidate will have acquired skills to pursue further independent investigation of (S)NO and erythrocyte vasoactivity with the hope of informing therapy directed at the dysregulation of regional blood flow in the lung. The candidate's long-term goal is to define the mechanism of NO traffic between regional vascular beds via the erythrocyte, and its role in the evolution of multiple organ failure in severe inflammatory states.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GCRC-CAP-EMILY L. DOBYNS, M.D. Principal Investigator & Institution: Dobyns, Emily L.; Pediatrics; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 25-SEP-2000; Project End 31-AUG-2005 Summary: (Adapted from the applicant's abstract): This grant proposal seeks funding for Dr. Emily Dobyns for the NIH CAP Award. Dr. Dobyns is a board- certified pediatrician and Assistant Professor in Pediatrics at the UCHSC. During her fellowship in pediatric critical care medicine, Dr. Dobyns was trained in laboratory research on the in vitro role of eicosanoids in the neonatal pulmonary circulation. This initial experience spawned her interest in the mechanisms of acute lung injury in the clinical setting. Since joining the faculty in 1991, Dr. Dobyns' primary responsibilities have been in the clinical setting, teaching, providing patient care, and administration. During this time, she has become increasingly interested and involved in clinical studies of acute hypoxemic respiratory failure (AHRF) in pediatrics, including a randomized controlled multicenter trial on the effects of inhaled nitric oxide (iNO) in the treatment of AHRF. She has also completed several related projects including measurements of cytokine levels in pediatric AHRF and infant lung function following treatment with iNO. These experiences have increased her interest in clinical research and led to a desire to expand her skills which would enable her to design and execute efficient clinical trials. Prior to this time, opportunities for this level of clinical training have not been available. The facilities available at UCHSC and Dr. Dobyns' experience place her in and ideal position for this training. Her immediate career goals are to: 1) become proficient in the skills needed to be a fully trained clinical-investigator; and 2) to use this training and interaction with experienced clinical researchers to better understand the pathophysiology and treatment of AHRF. Dr. Dobyns' long-term career goal is to become an independent clinical investigator. This award would allow her to attain these goals by providing: 1) time for supervised study within a rigorous didactic training program that has been designed to provide an optimal environment and mechanism for learning; 2) sufficient time to gain experience in advanced methods and experimental approaches in clinical research; 3) time for close association with an experienced mentor; 4) support from the Pediatric GCRC facilities and personnel for her research project; 5) to refine her clinical research as her training progresses; and 6) to achieve independence as a clinical investigator. This proposal details an organized plan for integrating the didactic training and critical interactions with experienced mentors, thereby allowing her to fulfill her long-term goals of achieving independence as a clinical investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENETIC MODIFIERS OF CYSTIC FIBROSIS Principal Investigator & Institution: Boyle, Michael P.; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2003; Project Start 04-JUL-2003; Project End 30-JUN-2008 Summary: (provided by applicant): Dr. Michael Patrick Boyle is an Assistant Professor in the Pulmonary and Critical Care Division of the Johns Hopkins School of Medicine. He is fully committed to an academic career investigating genotype and phenotype relationships in cystic fibrosis (CF). The mentor of this application, Dr. Garry Cutting, is a world-recognized expert in the genetics of CF, professor and director of graduate education at the McKusick-Nathans Institute of Genetic Medicine, and previous mentor

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of numerous successful K awards. The didactic and mentoring program outlined in this application is the result of close collaboration between Dr. Boyle and Dr. Cutting and will provide the foundation for Dr. Boyle's development as an independent investigator. CF is caused by mutations in the chloride channel CFTR. A wide range of severity of pulmonary disease is seen in CF individuals with identical CFTR genotypes, making it clear that CFTR genotype is not the main determinant of severity of CF lung disease. The overall goal of this proposal is to help identify the basis for variability of CF lung disease in individuals with identical CFTR genotype. We aim to answer: Do genes which modify the severity of CF lung disease exert their influence by altering the level of expression and function of CFTR, or through mechanisms unrelated to the underlying CFTR defect (e.g. inflammatory mediators, airway defense)? To do this we will determine if there is a difference in CFTR expression and function in the airway epithelium of homozygous delta F508 CF patients with mild and severe lung disease. First, we will use Nasal Potential Difference Measurement, the most sensitive in-vivo measurement of the ion-transport function of CFTR, to determine if there are differences in CFTR ion-transport. Second, because some cellular functions of CFTR are not reflected in these ion transport measurements, we will evaluate for differences in CFTR expression by comparing mRNA levels. These ion-transport and mRNA studies should allow us to determine if variability in CF lung disease is associated with alterations in level of expression and function of CFTR. Last, we will evaluate three of the strongest current CF candidate modifier genes to determine if the distribution of their functional alleles segregates with severity of lung disease in our CF clinic population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GRAPHICAL CV DISPLAY FOR HEMODYNAMIC MONITORING Principal Investigator & Institution: Doig, Alexa K.; None; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2004; Project Start 01-JAN-2005 Summary: (provided by applicant): Adverse physiological events occur frequently in critically ill patients and often lead to catastrophic outcomes. Technological improvements in monitoring displays have the potential to enhance nursing performance and patient outcomes by allowing nurses to better visualize the hemodynamic status of their patients. This study will explore the application of graphical display technology in the critical care environment. The goal is to determine whether a new graphical display for hemodynamic monitoring improves critical care nurses' ability to detect, identify, and manage adverse physiological events in critically ill patients. Bioengineering and human factors research suggests that presenting complex information graphically is more intuitive than waveform or numerical representation. Phase 1 of this research will involve adapting a graphical cardiovascular display that was originally designed for use in operating rooms. Display adaptation to critical care nursing will be an iterative process, guided by an established design refinement protocol. Phase 2 will evaluate the effects of this display on critical care nurses' ability to detect changes in hemodynamic status, correctly identify adverse physiologic events, and initiate appropriate nursing interventions. Using a full-scale patient simulator, performance and cognitive workload for nurses using the adapted graphical display will be compared to those using a traditional monitoring display. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GUIDELINES APPLIED IN PRACTICE-GAP: HEART FAILURE CARE Principal Investigator & Institution: Casey, Donald E.; Catholic Healthcare Partners 615 Elsinore Pl Cincinnati, Oh 452021459 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2003 Summary: The overall purpose of this project, for which funding to support the planning and feasibility study is requested by this application, is to develop a structured approach for the implementation of evidence-based guidelines for inpatient cardiac care. Literature indicates that the use of such guidelines can decrease length of stay in the acute setting and shift care to outpatient venues, with commensurate decrease in cost. However, literature also supports the difficulty of implementing new models of care. This project will have 4 major aims: (1) To develop through the partnership an evidence-based model for comprehensive Heart Failure (HF) care that can be readily adopted by each CHP region and incorporated into existing activities; (2) To adapt the interventions of the ACC's Guidelines Applied in Practice ("GAP") project for improving AMI care to HF care; (3) To implement information technology applications, including computerized physician order entry ("CPOE") systems that support the first and second aims, especially in the context of managing a chronic disease state such as HF, and (4) To demonstrate the ability to establish and sustain effective, broad-based partnerships among a variety of diverse health care organizations, provider groups, professional medical societies and health care information technology corporations and their stakeholders. Two aspects of implementing guidelines will be examined during the planning phase. First, the study team will examine knowledge sharing frameworks and propose a specific framework to serve as the model for the educational and implementation approach. Among the models to be examined are, for example, transtheoretical frameworks for the adoption of change and Dixon's "common knowledge" framework concerning the structure and process of knowledge transfer. The second aspect of guideline adoption to be examined includes the role of technology in facilitating change and supporting practice. The multidisciplinary project council, including representatives from an health information technology company (McKesson), will examine the feasibility and cost-effectiveness of programming the selected guidelines into existing and new computerized physician order entry and other IT tools. Objectives for phase I of the project include: adaptation of specific HF guidelines and associated measures for the Catholic Health Partners system, consisting of 31 hospitals located in 5 states (which discharged over 8,000 patients with HF during calendar year 2001); development of a knowledge transfer framework with which to structure implementation of the guidelines; and the development of a prototype for the CPOE. At least two hospital sites will serve as the pilot sites, participating in the development of the implementation approach, and testing the implementation protocols and the use of the CPOE. Based on the findings of the planning phase, additional sites will be added in phase II, during which we will make revisions to the software and protocols based on phase I results, and implement the revised information technology-assisted approach. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GUT ISCHEMIA/REPERFUSION INJURY: MODULATION BY NUTRIENTS Principal Investigator & Institution: Kozar, Rosemary A.; Surgery; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2002; Project Start 10-AUG-2002; Project End 31-JUL-2007

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Summary: (provided by applicant): Candidate: Dr. Kozar is a new faculty member at the University of Texas-Houston Medical School (UTHMS), where she is a member of the Department of Surgery. She first acquired basic research skills as a NRSA Fellow while obtaining her PhD at Baylor College of Medicine. Following completion of her general surgery training, the candidate accepted a faculty position in Trauma and Critical Care at MCP-Hahnemann University School of Medicine under the direction of Dr. Joel Rosyln. During this time she began to develop research experience in the field of Trauma and Critical Care by investigating the activity of antioxidant enzymes in an acute lung injury model, funded by a private grant for which she was the principal investigator. Since becoming a faculty member in the Department of Surgery at UTHMS she has become very active in the NIGMS-sponsored Trauma Research Center, focusing on the role of the gut in multiple organ failure. A Career Development Award, in conjunction with the support of two highly respected mentors, would enhance the acquisition of the necessary skills and talents crucial to becoming a future independent investigator. Research: The proposed research project is an extension of the Trauma Research Center?s interest in the link between gut dysfunction and multiple organ failure. As proposed in this application, the candidate wilt test the hypothesis that specific enterat nutrients during gut ischemia/reperfusion impair gut function and enhance gut injury. The goal of the proposed project is to understand how enterat nutrients during times of metabolic stress can be detrimental to gut function. The results obtained will facilitate a better understanding of postinjury gut dysfunction and aide in future strategies to achieve enteral tolerance in patients at high risk for multiple organ failure. Environment: The UTHMS in the center of the Texas Medical Center is comprised of 42 member institutions dedicated not only to outstanding patient care but also to the highest standards and quality of research. As part of the Department of Surgery's Trauma Research Center, the candidate has the guidance and support of numerous researchers in the Department of Surgery as well as in Integrative Biology, and Medicine. The sponsors are an integral part of this arrangement and are especially suited to ensure success of the proposed project. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEMANGIOBLASTIC PROGENITORS IN ACUTE LUNG INJURY Principal Investigator & Institution: Sanders, Ronald C.; Pediatrics; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2003; Project Start 05-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): This proposal establishes a five year plan for Dr. Ronald Sanders Jr. to develop the skills and experience needed to be a successful clinician/scientist in the field of Pediatric Critical Care. Currently, Dr. Sanders has completed 3 years of a clinical fellowship in pediatric critical care. Dr. Sanders has a strong interest in respiratory physiology and worked under the auspices of Dr. Mark Heulitt over 3 years investigating imposed work of breathing with mechanical ventilation. In addition, he earned a masters degree in the department of physiology and biophysics during the last two years of his fellowship. He studied an in vitro wound healing model that could quantify cell migration, spreading and proliferation using an immortalized respiratory epithelial cell line in the lab of Dr. Richard Kurten. After his fellowship, he spent a year in the lab of Dr. Billie Moat-Staats practicing techniques in RT-PCR, molecular cloning, plasmid splicing and in situ hybridization using rodent respiratory lung cells/tissue. Dr. Sanders immediate goal is to broaden his research skills through a combination of a carefully structured didactic teaching program and completion of a research project in the laboratory of his mentor. Dr. Sanders long-term

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goal is to become an independent investigator capable of combining the discipline of stem cell biology with issues of respiratory pathology in clinical critical care. Dr. Sanders' research project is based on the hypothesis that the adult hematopoietic stem cell serves as a progenitor for pulmonary angiogenesis after lung injury. This hypothesis is based on the observation in the Scott laboratory of hemangioblastic activity from adult hematopoietic stem cells after a retinal ischemic injury. In addition, Dr. Sanders has observed GFP+ signals in the lung tissue of mice from the retinal ischemic model that were transplanted with GFP+ bone marrow. The Scott lab has refined the methodology of stem cell transplantation in the murine model. Dr. Scott's laboratory provides an excellent environment for Dr. Sanders to carry out this proposal. A research advisory committee that meets the NIH requirements has been arranged that will assist Dr. Sanders in achieving his goals. In this rich and supportive environment, Dr. Sanders will gain the experience necessary to contribute to the understanding of the early cellular and in vivo events in angiogenesis related to acute lung injury. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HYPOTHERMIA FOR ACUTE BRAIN INJURY IN CHILDREN Principal Investigator & Institution: Cox, Charles S.; Surgery; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2003; Project Start 08-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): The Traumatic Brain Injury (TBI) Consortium at the University of Texas-Houston Medical School has a major commitment to multicenter clinical investigation. The PI, Charles Cox, M.D., is the Children's Fund for Pediatric Trauma Associate Professor of Surgery and Pediatrics and the Co-PI, Kevin Lally, M.D., the A.G. McNeese Professor and Chief of Pediatric Surgery. The TBI consortium has a track record for identifying and recruiting TBI patients for clinical studies across multiple points of care. The PI and Co-PI are board certified in both pediatric surgery and surgical critical care, which allows control of the acute care management of TBI patients. The group also includes a nationally recognized inpatient and outpatient rehabilitation center (The Institute for Rehabilitation and Research, TIRR). TIRR admits approximately 750 patients per year and has a 36-bed inpatient brain injury unit. TIRR also has a track record of NIH/NIDRR funded clinical research involving TBI patients. Post-rehabilitation outcomes follow-up is an established and mature component of the TBI component with outcome studies since 1982. Longitudinal studies of children with TBI are now in their 5th-9th year. UT-Houston provides: (A) A large patient population Approximately 4,500 patients are admitted to the UT-Houston/Memorial Hermann Trauma Service per year (958 with a GCS of < 12), of which 1,400 are pediatric patients (167 with a GCS <12 between the ages 12-21). This application offers the rare combination of expertise in the management of patients with severe TBI and a very large, eligible patient population. (B) Methodological and multidisciplinary expertise The Pls have extensive experience in basic and clinical research. The TBI team members have a unique combination of clinical expertise across the continuum of acute care, combined with extensive experience in TBI clinical intervention protocols, rehabilitation and the design of neuropsychiatric developmental outcome measures within the institution. (C) Supportive leadership and institutional commitment - The departments in the TBI consortium have all demonstrated a commitment to the support of collaborative clinical research. This is evidenced by the large number of past and ongoing multicenter trials and the establishment of the two NICHD-funded clinical research (Neonatal Intensive Care Units and Maternal Fetal Medicine Units) networks at UT-Houston. There is an active NIH sponsored Clinical Research Curriculum and

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Mentorship Program (K30 HL 04137) designed to train clinical investigators as well as a University Clinical Research Center (M01 RR02558) with a track record in clinical research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IATROGENIC OPIOID DEPENDENCE IN CRITICALLY ILL CHILDREN Principal Investigator & Institution: Lugo, Ralph A.; Pharmacy Practice; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-AUG-2004 Summary: (Applicant's Abstract) Critically ill children in the pediatric intensive care unit often require long-term sedation and analgesia. Fentanyl has a rapid onset, short duration of action, and stable hemodynamic profile. Thus, it is the most desirable opioid for continuous analgesia and sedation in the pediatric intensive care unit. However, continuous administration of fentanyl often leads to rapid development of tolerance, progressive dose escalations, and ultimately iatrogenic opioid dependence. Discontinuation of fentanyl in these children will precipitate acute abstinence syndrome which may compromise the care of the child. Currently, it is not fully understood which patients are at risk for opioid dependence and withdrawal, nor is there a validated method of objectively assessing the severity of withdrawal. Although the optimal treatment of iatrogenic opioid abstinence syndrome has not been established in critically ill children, oral methadone is often used to facilitate fentanyl discontinuation while preventing signs and symptoms of withdrawal. However, no data are available regarding the optimal dose or pharmacokinetics of methadone in this patient population. This proposal aims to generate data on wide ranging aspects of iatrogenic fentanyl dependence, including diagnosis and evaluation of its severity, determination of risk factors for its development, and the pharmacokinetics of fentanyl and methadone in critically ill children. The specific aims of these studies are: 1) to validate a clinical scoring tool to be used by the bedside nurse to objectively measure the severity of iatrogenic fentanyl abstinence syndrome. This scoring tool may be used to determine when treatment of fentanyl withdrawal is necessary; 2) to quantitate fentanyl exposure by measuring fentanyl's cumulative area under the concentration-time curve; 3) to evaluate the relationship between systemic fentanyl exposure and the risk of iatrogenic opioid abstinence syndrome; and 4) to define the pharmacokinetics and bioavailability of methadone which is used to treat fentanyl withdrawal in these critically ill children. These data will significantly augment our understanding of opioid withdrawal in critically ill children and increase our knowledge of fentanyl and methadone pharmacokinetics, both of which are critical in safely administering these agents to children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: VENTILATION

IMMUNOMODULATORY

EFFECTS

OF

MECHANICAL

Principal Investigator & Institution: Altemeier, William A.; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2003; Project Start 24-JUL-2003; Project End 30-JUN-2008 Summary: (provided by applicant): This proposal describes a five-year training program for the development of a physician-scientist in the field of Pulmonary and Critical Care Medicine. The principal investigator has completed clinical training and has research

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experience in the field of pulmonary physiology. The objective of the proposed training program is to provide the skills necessary to integrate the study of cellular mechanisms with whole organ physiologic response. This objective will be achieved through the combination of didactic education and a carefully designed research program mentored by Dr. Robb Glenny, an expert in the field of pulmonary physiology, and Dr. Karol Bomsztyk, and expert in cellular regulatory pathways of gene transcription. The research program will focus on the role of mechanical ventilation as a co-factor in the development of acute lung injury (ALl). Mechanical ventilation strategy determines survival in patients with ALl; however, neither its role in the pathogenesis of ALl nor the cellular pathways involved are known. The proposed experiments will use a rabbit model of sepsis to evaluate both the proximal mechanical stimulus and the end-effector pathway by which mechanical ventilation promotes lung injury. Because TNF-alpha is a principal mediator of inflammation, experiments will look specifically at the major cellular response pathways that result from TNF ligand-receptor binding: NF-kappaB nuclear translocation and initiation of the caspase cascade. Specific aims include: 1) Quantifying the effect of mechanical ventilation on the development of endotoxinmediated lung injury; 2) Quantifying the effect of different mechanical ventilation strategies on the regional development of endotoxin-mediated lung injury; 3) Evaluating the effect of mechanical ventilation on NF-kappaB activation during endotoxemia 4) Evaluating the effect of mechanical ventilation on caspase-mediated cell death during endotoxemia This application takes advantage of the diversity of resources available within the Department of Medicine at the University of Washington to provide the principal investigator with a unique training program designed to foster a successful research career focused on integrative pulmonary physiology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPROVING OUTCOMES IN MECHANICALLY VENTILATED PATIENTS Principal Investigator & Institution: Hoffman, Leslie A.; Professor and Chair; Acute/Tertiary Care; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-DEC-2003 Summary: The provision of critical care has changed markedly since its inception. Intensive care units (ICUs), developed to provide highly skilled care during a brief illness, now also provide care for substantial numbers of patients who require extended support due to inability to wean from mechanical ventilation (MV). ACUTE Care Nurse Practitioners (ACNP) are prepared to perform a wide range of nursing functions, as well as certain functions traditionally performed by physicians, including diagnosis, management, and interpreting diagnostic studies. These competencies make the ACNP an excellent candidate to test an intervention designed to facilitate recovery from critical illness. The primary aim of this study is to test ability of an ICU and in the post discharge period. The secondary aim is to identify factors which promote weaning progression and weaning success in this population. The study will use a 2 X 2 nonrandomized, repeated measures, equivalent time- samples design. During the intervention, an ACNP will management subjects admitted to a SD-ICU, and provide consultation to these patients and their families for one month after discharge. Usual care subjects will be managed by physicians-in-training and followed for the same time period, but will not receive post discharge consultation. Dependent variables will be: 1) weaning progress (hours off full MV support); 2) recovery trajectory (rapid, shallow breathing ratio [f/Vt], pulmonary capillary wedge pressure estimated non-invasively

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[ePCWP], acute physiology and chronic health evaluation [APACHE] III scores; 4) information needs (Patient/Family Information Needs Scale); 5) ICU resource consumption (ratio of cost to charges); 6) health-related quality of life (Health Assessment questionnaire, Medical Outcomes Study SF- 36); 7) medical record documentation, and 8) disposition. Measures will be obtained at SD-ICU admission, when weaning occurs or the subject is discharged from the SD-ICU and 1, 6, and 12 months after discharge. During weaning trials, f/Vt and ePCWP will be also measured at 3-day intervals. Data will be analyzed using logistic regression, analysis of covariance, proportional hazards regression, and linear mixed effect models. To accomplish our Secondary Aims, we will construct weaning patterns for each subject, identify the proportion of weaning patterns which can be reliably differentiated as consistent weaning progress, and use stepwise multiple logistic regression to identify variables which predict weaning consistent progress, irrespective of group. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPROVING RESPIRATORY OUTCOMES IN ALS Principal Investigator & Institution: Lechtzin, Noah; Environmental Health Sciences; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The Principal Investigator, Dr. Noah Lechtzin, is a promising young investigator who has made a substantial commitment to an academic career in clinical research. His commitment is evident in his pursuit of advanced clinical and research training, including completion of a residency in internal medicine, a fellowship in pulmonary and critical care medicine, and a Master's in Health Science degree in clinical epidemiology. This background provides a solid foundation for him to address challenging questions related to respiratory impairment in amyotrophic lateral sclerosis (ALS). ALS is a devastating fatal neurodegenerative illness in which most patients die from respiratory muscle weakness and associated complications. Despite major efforts, the cause of ALS remains elusive and there is no known cure. While it is recognized that evaluation and management of respiratory failure is critical to the care of ALS patients, there has been relatively little research directed at these problems. The proposed research in this application builds on Dr. Lechtzin's previous research and addresses questions of fundamental importance for the management of respiratory illness in ALS. Non-invasive positive pressure ventilation (NIPPV) is a method to augment alveolar ventilation without the use of an endotracheal airway. Because it has limited risks, NIPPV has rapidly become the standard of care for treating respiratory failure in ALS. However, there is relatively limited data on its use and effectiveness in ALS. The primary objective of this proposal is to understand how NIPPV works, how it is being used, and whether it alters pulmonary function, respiratory symptoms, and quality of life. To this end, we propose three related studies: a) an investigation of the immediate effect of NIPPV on lung compliance; b) a randomized trial of NIPPV in patients with mild respiratory muscle weakness; and c) a cohort study evaluating the effect of NIPPV on quality of life and survival. The principal investigator will be strengthening his knowledge base in the methodology of clinical investigation in a supervised environment guided by exceptionally talented mentors.By combining the resources of the Johns Hopkins Medical Institutions toward the completionof the outlined aims, the Mentored Patient-Oriented Research Career Development Award will provide Dr. Lechtzin the opportunity to expand the skills required for development into an independent clinical investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMPROVING THE QUALITY OF COMMUNICATION ABOUT ENDOF-LIFE Principal Investigator & Institution: Curtis, J Randall.; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 15-AUG-2002; Project End 30-JUN-2007 Summary: (provided by applicant): This application is for salary support for Dr. Curtis under the K24 mechanism. This support will relieve him from clinical and administrative duties and allow him to redirect his research program to patient-oriented studies and the mentoring of new clinical investigators. This K24 award will have the support of the Division of Pulmonary and Critical Care Medicine at the University of Washington and the fellowship-training program of this Division. The projects are designed to measure and improve the quality of communication with patients and families about end-of-life care for patients with COPD and critical illness with respiratory failure. The specific aims are: Project 1: Measuring and improving the quality of communication about end-of-life care in severe COPD. 1) Develop and validate a measure of the quality of patient-physician communication about end-of-life care for persons with severe COPD. 2) Determine whether increased quality of communication is associated with increased quality of end-of-life care. 3) Assess the role of culture and ethnicity in communication about end-of-life care. 4) Develop and evaluate culturally-sensitive interventions to improve the quality of patient-physician communication about end-of-life care for patients with severe COPD. Project 2: Measuring and improving the quality of communication in the ICU family conference. 1)Describe the content and process of clinician-family communication about end-of-life care occurring as part of ICU family conferences using qualitative analysis based on grounded theory. 2) Evaluate the quality of clinician-family communication about endof-life care occurring as part of ICU family conferences using a combination of qualitative and survey methods. 3) Examine the reliability and validity of a questionnaire assessing the quality of clinician-family communication about end-of-life care occurring as part of ICU family conferences. 4) Assess key components of cultural competence in cross-cultural ICU family conferences. 5) Develop and evaluate culturally-sensitive interventions to improve the quality of clinician-family communication. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INHALED STEROID ADHERENCE IN MODERATE & SEVERE ASTHMA Principal Investigator & Institution: Apter, Andrea J.; Associate Professor of Medicine; Medicine; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 10-SEP-2000; Project End 31-AUG-2005 Summary: Candidate's Plans/Training: I, Andrea J. Apter, MD, MSc, plan a change in career emphasis from clinician-educator to an independent investigator in asthma clinical research. I want to use my extensive clinical experience and recent prior training in clinical epidemiology to better understand how social setting with its barriers to treatment influences disease. The training is designed to fill my knowledge gaps and will be interdisciplinary. it will include advanced formal course work in epidemiology, biostatistics, behavioral science, and health services research along with structured mentoring as I conduct the proposed research project. Environment: The University of Pennsylvania is an environment uniquely suited for this training award. its Center for Clinical Epidemiology and Biostatistics will provide structured mentoring and formal

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coursework. The Leonard Davis institute is a renowned center for health services research and the Annenberg School is a center for behavioral science research. The Pulmonary, Allergy, Critical Care Division serves a large, diverse patient population and has a record of outstanding clinical research. Research: Given the substantial morbidity and mortality associated with asthma and the proven efficacy of inhaled steroids in reducing this morbidity and mortality, identifying solutions for the problem of poor adherence to inhaled steroid regimens takes on great urgency. Recent research indicates low socioeconomic status and inadequacy of physician-patient communication are predictors of poor adherence. The low-income inner city asthma population is at high risk for poor clinical outcome. This project identifies potentially modifiable sociobehavioral factors that impede adherence to inhaled steroid regimens with a focus on the inner city poor population. The central hypothesis is that mutable social and behavioral factors influence adherence and that adherence can be improved by modifying these factors. This project has two phases, an observational cohort study and a randomized intervention. Phase I has 2 aims. We will identify potentially modifiable sociobehavioral barriers associated with poor adherence using electronic monitoring and controlling for disease activity and socioeconomic status (Aim 1). A behavioral model of adherence will be employed to formulate and test hypotheses. Aim 2 will examine how fluctuations in adherence influence asthma severity measured by electronic monitoring of nighttime use of a short-acting beta-agonist. In Phase II we will implement a randomized controlled pilot trial to improve adherence (Aim 3). Possible interventions that will be studied include the effect of enhanced patient-physician communication using electronic monitoring data and/or an educational program on improving adherence. This intervention will be designed taking into account the results of the cohort study performed in Phase I of this training program. Upon the foundation of my prior clinical experience and education, this training program is designed to equip me with the additional skills and research experience necessary to become a fully independent investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTEGRATED TOXICOLOGY PROGRAM Principal Investigator & Institution: Di Giulio, Richard T.; Professor; None; Duke University Durham, Nc 27710 Timing: Fiscal Year 2002; Project Start 01-JUL-1978; Project End 30-JUN-2006 Summary: (Provided by Applicant) The Duke University Integrated Toxicology Training Program (ITP) has been an important component of science education and research at Duke University since 1978. Its mission is to provide outstanding predoctoral and postdoctoral training in toxicology and thus to contribute both to the advancement of the field as well as to the careers of the individual trainees. The ITP is an interdepartmental and multi-disciplinary program in which Ph.D. degrees are awarded jointly by the Department and the Program. Post-doctoral trainees perform toxicological research under the mentorship of ITP faculty, and are tightly integrated into the program through seminars, symposia, poster programs, governance committees, and participation as students and lecturers in ITP core courses. There are four, well-established research strengths in toxicology at Duke University, and trainees with interests in and aptitudes for these areas are targeted for recruitment: Mutagenesis and Carcinogenesis, Oxidative Stress and Pulmonary Toxicology, Endocrine Disruptors and Developmental Toxicology, and Neurotoxicology. At the core of the Program is the excellent academic and research environment provided by participating units from the Duke University Medical Center, the Nicholas School of the Environment, and Trinity

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College of Arts and Sciences. This year (2000), two premier scientists have been recruited to the Duke ITP, David Hinton (first Nicholas Chair of Environmental Toxicology) and David Schwartz (Director of the Division of Pulmonary and Critical Care Medicine). Currently there are 26 core Duke faculty in the ITP that can serve as primary advisors for Ph.D. students or as preceptors for postdoctoral fellows. The program is enriched by the participation of additional adjunct faculty associated with the Research Triangle Park-based institutions such as the NIEHS, the U.S. EPA, and the Chemical Industries Institute of Toxicology. These faculty provide seminars, guest lectures in courses, serve on student committees, and/or provide technical expertise and research facilities. Through the ITP, students and research associates receive classroom and laboratory training that prepares them for competitive research at the highest level. This success depends in good part on the investigators ability to attract excellent students into the program, and our recruiting and admissions efforts have consistently provided us with outstanding young people eager to embark upon a career in toxicology. This competitive renewal includes a number of changes in the faculty and organizational structure of the ITP that will enhance the ability of the ITP to attract the brightest toxicology students in the U.S. and provide them with the educational opportunities they deserve. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTEGRATING DATA, MODELS, AND REASONING IN CRITICAL CARE Principal Investigator & Institution: Mark, Roger G.; Health Sciences Technology; Massachusetts Institute of Technology Room E19-750 Cambridge, Ma 02139 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): The objective of this Bioengineering Research Partnership is to focus the resources of a powerful interdisciplinary team from academia (MIT), industry (Philips Medical Systems), and clinical medicine (Beth Israel Deaconess Medical Center, BIDMC) to develop and evaluate advanced ICU patient monitoring systems that will substantially improve the efficiency, accuracy, and timeliness of clinical decision making in intensive care. Modern intensive care units employ an impressive array of technologically sophisticated instrumentation to provide detailed measurements of the pathophysiological state of each patient. In the long term, we plan to build monitoring systems that not only report these measurements to human users but also form pathophysiological hypotheses that best explain the rich and complex volume of relevant data from clinical observations, bedside monitors, mechanical ventilators and a wide variety of laboratory tests and imaging studies. Such systems should reduce the ever-growing problem of information overload, and provide much more accurate and timely alarms than today's unintegrated limit alarms. By helping to focus the practitioner's attention on the most significant events and changes in the patient's state and by suggesting likely physiological interpretations of that state, such systems will eventually permit early detection of even complex problems and provide useful guidance on therapeutic interventions; thus their use should lead to improved patient outcomes. To achieve these long-term goals, we propose a step-wise approach. First, we will create a research database of 500 data-rich ICU cases that we will deidentify and thoroughly annotate so that we can make it available as a resource for ourselves and other researchers. Second, we will develop an array of sophisticated model-based and reasoning methods and corresponding software to analyze the data we collect and to create the technical means of abstracting from detailed data to pathophysiological hypotheses. Third, we will evaluate the utility of our newly

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developed tools in the laboratory utilizing the new database. Finally, we will deploy the most successful of our new techniques into clinical practice in the BIDMC ICUs to compare their safety and efficacy with existing monitoring systems. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTESTINAL APOPTOSIS IN SHOCK AND INJURY Principal Investigator & Institution: Coopersmith, Craig M.; Surgery; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2005 Summary: (Adapted from the applicant's abstract) Ischemia/reperfusion and sepsis are associated with increased intestinal epithelial and lymphocytic apoptosis. The principal investigator for this career development award is a critical care surgeon, whose longterm career objective is to develop mechanistic insights into the body's response to shock and sepsis, leading to improved survival in the surgical intensive care unit. As immediate goals, the applicant seeks to elucidate the role of intestinal apoptosis in shock and sepsis and to develop an expertise in immunology to assess crosstalk between the intestinal epithelium and the immune system. This research proposal will provide the framework for achieving these goals through a period of formal instruction and investigation supervised by mentors with established track records of developing independent investigators. Septic patients have markedly increased levels of intestinal and lymphocytic apoptosis. In addition, animal models of shock and sepsis show elevated levels of intestinal and immune apoptosis, with a survival advantage conferred on transgenic mice which overepress the antiapoptotic mediator, Bcl-2, in lymphocytes. The applicant hypothesizes that alterations in apoptosis in the intestinal epithelium contribute to the morbidity and mortality resulting from ischemia/ reperfusion and/or sepsis. To address this hypothesis, the applicant's two interlocking specific aims are (1) to determine the relationship between ischemia/ reperfusion and/or sepsis and apoptosis in the intestinal epithelium and assess the therapeutic potential of decreasing programmed cell death via alterations in Bcl-2, and (2) to demonstrate crosstalk between the intestine and the immune system in ischemia/reperfusion and/or sepsis-induced apoptosis. Transgenic animals overexpressing or deficient in Bcl-2 and lymphocyte deficient Rag-1-/- animals will be utilized to determine the mechanisms by which alterations in death levels in one organ system affect the other. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: KRUPPEL LIKE FACTOR IN P. AERUGINOSA AIRWAY VIRULENCE Principal Investigator & Institution: Saavedra, Milene T.; Medicine; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2003; Project Start 04-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Of the 2,500 children born every year with cystic fibrosis (CF) in the United States, 80% harbor P. aeruginosa by the time they reach 18 years of age. Recurrent Pseudomonas pulmonary infections are the major cause of morbidity and mortality in these patients. Airway structural damage is induced by excessive neutrophil populations in the airway, releasing large amounts of proteases which impair phagocytic killing of organisms. To date, the repertory of antiinflammatory therapies to limit excessive epithelial cell signaling to inflammatory mediators remains limited and imperfect, which may be partially due to a limited understanding of critical pathways to curb inflammation and their role in the pathogenesis of CF. Evidence suggests that the zinc finger protein, lung kruppel like

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factor (LKLF), described here for the first time as highly regulated by infection, plays a significant role in the regulation of the airway epithelial cell response to Pseudomonas infection. Based on preliminary data, Dr. Saavedra hypothesizes that a) the transcriptional activator LKLF is cytoprotective in normal airway cells, b) that it suppresses nuclear factor kappa B activation and c) that in cystic fibrosis, overexpression of LKLF is not protective due to alternate apoptotic/death pathway activation. These aims will be studied with an in vitro epithelial cell air liquid interface culture model system and the well characterized Pseudomonas strain PAO1. The approach will initially utilize functional genomics to define pathways activated by overexpression of this gene utilizing an LKLF plasmid construct. The true focus will be on elucidating gene function with apoptosis assays, luciferase reporter constructs, EMSA experiments and use of various constructs overexpressing genes involved in NFkappaB activation to ascertain target site of LKLF activity along that pathway. These experiments are designed to further understanding of how epithelial cells drive neutrophil recruitment, knowledge of which may contribute to development of new therapeutic interventions in inflammatory airways diseases such as CF. This project will allow Dr. Saavedra to become an independent investigator and expert in the realm of Pseudomonas and airway epithelial cell biology, via a multi-faceted approach of 75% dedicated laboratory time and didactic training with a special focus on mechanisms of microbial pathogenesis. Outside of the laboratory, 25% clinical time will be spent as an instructor in adult Pulmonary and Critical Care Medicine, taking care of both inpatients and outpatients with CF, with the ultimate goal of a closely knit research and clinical niche as a principal investigator and expert adult CF doctor. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MICROARRAY DETERMINANTS IN COMMUNITY-ACQUIRED PNEUMONIA Principal Investigator & Institution: Wood, Kelly; Critical Care Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2008 Summary: (provided by applicant): I am a junior faculty member in the Department of Critical Care Medicine at the University of Pittsburgh. I am trained in Pulmonary and Critical Care Medicine and have a Masters of Health Science degree in clinical research. My short-term goal is to become expertly trained in clinical research of the critically ill, specifically focusing on the integration of emerging knowledge of the biology of critical illness with advances in clinical research, biostatistics, and data management. My longterm goal is to bring a new level to critical care medicine where an individual's pathophysiologic response to illness is used to predict outcome and guide care. Under the tutelage and mentorship of Dr. Angus (sponsor) and key consultants, I have developed a set of formal coursework, directed reading and tutorials that will form the educational and training core necessary to achieve my goals. This training and education will take place in the Department of Critical Care Medicine, the Department of Biostatistics in the Graduate School of Public Health, the Center for Human Genetics and integrative Biology at the University of Pittsburgh Medical Center, and at the adjacent Carnegie Mellon University. My research project, "Microarray Determinants in Community-Acquired Pneumonia (CAP)" is designed to both provide important new information and provide an important educational opportunity complimenting the other components of my training and education. CAP is a major public health problem, frequently fatal in the elderly. The proposed study will perform a high throughput genetic analysis of elderly Caucasian males with pneumococcal CAP using microarray

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technology. Two substudies will occur. The first substudy is designed to develop a mortality risk prediction that distinguishes survivors and non-survivors, who are phenotypically similar, from a pre-existing database of stored whole blood samples (n=50). The second substudy involves the recruitment of a prospective inception cohort (n=50) of elderly white males with pneumococcal pneumonia. The value that provocation testing (with pneumococcal vaccine) has in providing additional information with regard to predicting clinical outcome will be explored. This second substudy will also serve as a validation cohort for the model developed in the first substudy. This proposed study will generate a new predictive tool of clinical outcome based on gene expression analysis in the narrowly defined, homogeneous cohort of elderly Caucasian males with CAP and potentially identify genes not previously known to be involved in the immune response to infection. Information will also be generated regarding the pathophysiology of infection and possible points of early intervention with medical therapy that may alter the course of the disease process. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MODULATION OF NEUROENDOCRINE FUNCTION IN SEPSIS Principal Investigator & Institution: Carlson, Drew E.; Associate Professor; Surgery; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2006 Summary: REVISED ABSTRACT: In trauma patients sepsis is a life-threatening complication. Our broad objective is to identify possible mechanisms that underlie the abnormalities in neuroendocrine and adrenocortical function that occur in septic patients at risk for death. We hypothesize that inoculations of E. coli into the peritoneal compartment of chronically prepared rats elicit local actions on the endings of vagal afferent nerves to initiate the neuroendocrine response. In contrast, inoculations of E. coli into the vascular compartment cause an increase in circulating mediators that act on the central nervous system. When simultaneous inoculations are made into both the vascular and peritoneal compartments, the ascending signals synergize to augment the early hormonal response. We will test TNFalpha, cyclooxygenase pathways, and neurokinins as mediators of the responses to peritoneal and intravenous inoculations of E. coli and to simultaneous inoculations of E. coli into both compartments. Selective surgical elimination of the afferent nerves from the subdiaphragmatic vagi to the brain and selective surgical elimination of the efferent nerves from the brain to the subdiaphragmatic vagi will be used to test the role of each of these pathways in the responses to the inoculations of E. coli. Since clinical infections can spread from a local site into the circulation, we will determine the ffect of intravenous inoculations that are done 4 or 24 h after peritoneal inoculations. Immunocytochemistry and in situ hybridization for the immediate-early gene product, Fos, will identify areas in the brain that respond to inoculations of E. coli into either compartment alone and central areas where the ascending signals from both compartments converge after inoculations into both compartments. Mediators implicated by the experiments involving the inoculations of E. coli will be examined with immunocytochemistry or in situ hybridization for possible action in the brain. Such mediators will be blocked pharmacologically or surgically to determine their role in the central neural expression of Fos. The mechanisms revealed are likely to play a significant role in the suppression of host defense and the onset of septic shock. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MOLECULAR AND CELL BIOLOGY IN ENVIRONMENTAL MEDICINE Principal Investigator & Institution: Reibman, Joan; Associate Professor; Medicine; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2003; Project Start 01-JUL-1992; Project End 30-JUN-2007 Summary: (provided by applicant) New York University Medical Center is a leader in producing academicians through interdisciplinary training programs in biomolecular medicine. Three academic programs (Division of Pulmonary and Critical Care Medicine, Department of Environmental Medicine, and Sackler Institute of Graduate Biomedical Sciences) interact on the Environmental/Occupational Pulmonary Medicine training program in the basic sciences of cell and molecular biology research. The Division of Pulmonary and Critical Care Medicine has 50 full-time faculty, eight laboratories, and 15 NIH and CDCP grants. The Department/ Nelson Institute of Environmental Medicine has 60 full-time faculty and is in the 38th year of a NIEHS Center grant. The Sackler Institute has 112 faculty in the basic science departments and is expanding into the new Skirball Institute of Biomolecular Medicine. We propose a two year research fellowship emphasizing environmental lung disease with patientoriented research of asthma, fibrosis, lung cancer, and the pulmonary response to environmental toxicants. Studies are basic science oriented with emphases on cytokine and growth factor gene regulation, receptor expression and signal transduction, oncogenes, and tumor suppressor genes. The investigators recruited 29 preceptors with expertise in research fellowship training in mechanisms of disease pertinent to their mission in the environmental health sciences. They will continue to train physicians who have completed internal medicine residency and pulmonary clinical rotations in patientoriented research of environmental lung disease. Nineteen of 22 research follows continue to pursue academic careers and 13 individuals are members of underrepresented minorities. The principal investigator and co-principal investigator utilize a Research Training Committee to assist selecting, advising, and monitoring the progress of the trainees. Research fellows develop their own projects and practically all have presented their research at national meetings with publications appearing in peerreviewed journals covering asthma, ozone, asbestosis, tuberculosis, lung cancer, silicosis, and gene therapy. The goal of the investigators? program is to train academicians to provide Environmental Occupational Pulmonary Medicine leadership for the 21st century. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MOLECULAR BIOLOGY & GENE THERAPY IN BURNS AND TRAUMA Principal Investigator & Institution: Moldawer, Lyle L.; Professor and Vice Chairman for Research; Surgery; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2002; Project Start 01-JUL-1999; Project End 30-JUN-2004 Summary: The overall goal of this training program is to provide a focused two year research experience for two surgical residents-in-training expressing a commitment to a career in trauma, injury, burn or inflammation research. The research program will focus on mastery of molecular biology and gene therapy as it applies to inflammation research and translational biology. This program will take advantage of the unique strengths of the College of Medicine in the expanding field of gene therapy and molecular biology, as well as the developing collaborations between nationally recognized basic scientists and clinicians dedicated to the training of future clinical

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academicians. The interface between the basic science of gene therapy/molecular biology and inflammation research will be targeted to the problems of adult respiratory distress syndrome (ARDS), SIRS or sepsis syndromes, ischemia/reperfusion injury, delayed wound healing and the burn wound, and CNS injury. The faculty will be drawn from basic scientists in the Departments of Surgery, Obstetrics and Gynecology, Neuroscience and Molecular Genetics and Microbiology at the University of Florida College of Medicine, who will serve as research mentors to the trainees. Clinical mentors from the Departments of Surgery and Anesthesiology (Critical Care Medicine) will interact with the trainees and the research faculty to assure that the trainees are being exposed to clinically-important issues in inflammation research. Overall direction of the program will rest with the Principal Investigator and the Executive Committee. Candidates for the fellowship will be recruited nationally and from the University of Florida College of Medicine Department of Surgery General Surgery Residency Program. Successful applicants will with the assistance of the Executive Committee identify a research and clinical mentor who will assist in the formulation of a formal training program and period review of the trainee's progress. The bulk of the training program will be in the laboratory of an experienced research mentor, but trainees will also be required to fulfill basic course work in research ethics and statistical methods, and will be encouraged to obtain supplemental didactic training in molecular biology and gene therapy. Furthermore, trainees are expected to participate in seminars in the Gene Therapy Center, and in their basic science departments, as well as weekly laboratory research meetings. They will also be expected to attend clinical seminars, including Surgery and Critical Care Medicine Grant Rounds. It is anticipated that successful graduates of the program will possess sufficient research skills to compete for transitional funding in inflammation research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR PHYSIOLOGY OF NKG2D LIGAND EXPRESSION Principal Investigator & Institution: Carayannopoulos, Leondias N.; Internal Medicine; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2004; Project Start 01-FEB-2004; Project End 31-JAN-2008 Summary: (provided by applicant): To withstand assaults by viral pathogens, animals mount two types of immune responses following infection. An initial innate response acts both to limit pathogen growth and to prime the later adaptive response that generates cells and antibodies highly specific for a given pathogen. Innate effector cells such as natural killer (NK) cells recognize infection using germline-encoded receptors that detect molecular patterns common to subgroups of pathogens. These cells can also recognize infection or injury indirectly through receptors that detect "distress signals" displayed by damaged tissue. Understanding these receptors and their ligands would aid the production of agents that mimic or block those signals in the clinical setting. NKG2D is such a receptor expressed by all NK cells. It can trigger NK cell function in response to cells injured by viruses and other insults. In preliminary work, the applicant with his mentor and others have shown that NKG2D recognizes multiple ligands possessing very different gene expression patterns and binding kinetics. Herein, the applicant proposes to investigate the biological function of NKG2D ligands in relation to these differences in binding. This work is part of a career development plan. The specific aims of the investigation are: 1) to characterize the relationship between the binding kinetics of these ligands and their abilities to signal through NKG2D; 2) to determine whether viral infection preferentially induces cellsurface expression of the high-affinity and/or slowly-dissociating ligands; and 3) to demonstrate the role of NKG2D and its

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binding partners in viral infection in vivo. This career development program will provide the applicant with a transition to research independence. The applicant is a physician with a Ph.D. in immunology and biophysics. He is completing his fellowship training in pulmonary and critical care medicine at Washington University School of Medicine under the supervision of Dr. Wayne Yokoyama. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR PHYSIOLOGY OF THE LUNG Principal Investigator & Institution: Choi, Augustine M.; Professor; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 01-JUL-1984; Project End 30-JUN-2007 Summary: (provided by applicant): The Division of Pulmonary, Allergy, and Critical Care Medicine (PACCM) at the University of Pittsburgh School of Medicine has a tradition of commitment to the training of academic pulmonary investigators. In parallel with emerging lung research, prior T-32 support, had initially focused on studying the human pathophysiology of lung diseases. Subsequent training directions have focused on the cellular and molecular physiology of lung disorders. The current proposal represents the synthesis of these efforts under new leadership and direction. The goal of the PACCM Multidisciplinary Training Program (PACCM MTP) is to prepare physicians and PhDs for biomedical research careers by providing a concentrated, indepth research experience. This proposal will outline the comprehensive resources available to support six postdoctoral fellows yearly. This program is designed to foster a rigorous approach to scientific inquiry in basic science or clinical investigation. Four thematic units of research are emphasized: (1) cell biology and molecular immunology of the lung; (2) lung and vascular injury; (3) human pathophysiology; and 4) epideniiology/bioinformatics. The outstanding collaborations established through prior training grant proposals (Drs Pitt and Frizzell), ongoing growth in Departmental research programs (Drs Kapoor and Roberts), and new collaborative efforts (Drs. Kleyman, A.Ray, P.Ray, Billiar, and Bahar) provide a trainer group of tremendous breadth and international quality. A comprehensive didactic curriculum will provide the tools necessary for training in a new era of genomics research. The training program has successfully experienced a transition in leadership. Dr. Augustine Choi has been recruited from Yale University after an exhaustive national search. This proposal will outline a deep commitment of resources from the University and Department of Medicine to maintain and expand the University of Pittsburgh as a premier program for lung investigation. A newly constructed $3 million dollar Respiratory Science Center will synergize the basic research efforts of PACCM faculty and collaborators (Pitt and Billiar). Strengthening of the program through selective faculty recruitment will also be outlined. The research profile of the Division has increased by greater than 2-fold in the short 9 months since Dr. Choi?s arrival in Pittsburgh. The outstanding training record of the program faculty will be outlined. Dr. Choi?s training and investigative record will confirm that he is uniquely qualified to provide an unparalleled training opportunity for academic leaders of tomorrow. The institutional and departmental commitment is clearly in focus to maintain and expand the University of Pittsburgh as a premier program for basic and clinical research training in lung diseases. The PACCM MTP will use the tradition of the past with new energy and resources, to achieve a comprehensive training opportunity for the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEGLECTFUL PARENTING AND CHILDREN'S AGGRESSION Principal Investigator & Institution: Knutson, John F.; Psychology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-AUG-2005 Summary: Although child neglect is the most prevalent form of child maltreatment, there has been a comparative lack of empirical research into the characteristics of neglecting families and the psychological consequences of neglect. In studying neglectful families, existing research has failed to distinguish between two forms of neglect -- denial of critical care and supervision -- and to use micro-social coding of direct observations of parent-child interactions to develop an understanding of the parent-child relations in neglecting families. The work will then be able to test the hypothesis that it is the relational aspects of neglect that determine the impact of neglect on the psychological outcome for the child. Because neglect is often associated with physical abuse and punitive discipline, the proposed research is also designed to understand the relative importance of neglect and punitive discipline in the development of children's aggression. By distinguishing between instrumental or proactive, and irritable or reactive aggression, the research will be able to determine whether neglect and punitive discipline differentially influence the development of two different kinds of aggression in young school-age children. To conduct the research and to assure a sample that is ethnically diverse and drawn from both rural and urban areas, 270 maltreating families and 270 economically disadvantaged, or high risk, families will be recruited in Iowa, Nebraska, and Wisconsin. Structural equation modeling will be used to determine the role of neglect, punitive discipline, and parent attributes, as well as the mediating influences of peer interaction and social competence, on young children's aggression. Because all of the constructs studied will be based on a multimethod/multisource approach, including direct observations of family interaction and social competence in children, and peer nomination indices of aggression, the research is designed to provide an understanding of family function and children's aggression that is not compromised by shared method and shared source variance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NON-INVASIVE PNEUMOTHORAX DETECTOR Principal Investigator & Institution: Kelsch, Daniel N.; Engineering Program Mgr; Biomec, Inc. 1771 E 30Th St Cleveland, Oh 441144407 Timing: Fiscal Year 2003; Project Start 30-SEP-2000; Project End 30-APR-2005 Summary: Pneumothorax, while easily treatable, can become life threatening if not detected at any early stage. Current methods for diagnosing pneumothorax (chest x-ray, chest CT scan) are not possible for emergency squads and not practical for long-term monitoring of critical care patients. A portable handheld pneumothorax detector that is inexpensive, accurate, and non-invasive therefore would be very attractive. In Phase I, we investigated the feasibility of such a device, based on micropower impulse radar (MIR) technology. In animal studies (swine model), we are determined that pneumothorax as small as 30 ml were clearly detectable by the MIR device. This level of detection is important for the feasibility, since it is below the threshold of clinical significance. In Phase II, we propose to further optimize the MIR characteristics of the device and the signal algorithms. We will then acquire scans on human subjects to confirm the correlation of the MIR measure to the chest x-ray, which is the present standard of care. After finalizing the device parameters, we will continue with device development, miniaturization, and packaging. This research will result in a design

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ready for commercialization that fulfills the need for a non- invasive pneumothorax detector. PROPOSED COMMERCIAL APPLICATIONS: A handheld inexpensive pneumothorax will be commercially attractive to emergency medical personnel and trauma clinicians. Also, it would be useful for patient monitoring in critical care units. The combined market for these applications if very large. With further development, the device may be tunable to detect other trauma conditions, such as hemotoma and hemorrhagic stroke. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NOVEL LUNG MAP KINASE Principal Investigator & Institution: Abe, Mark K.; Pediatrics; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2002; Project Start 01-AUG-1998; Project End 31-JUL-2003 Summary: (Adapted from applicant's abstract) The Principal Investigator, Dr. Abe, has the long-term goal of pursuing independent investigation in the field of lung cell signal transduction. Receipt of a Mentored Clinical Scientist Development Award will facilitate the growth of Dr. Abe's investigative skills and experience by expanding his knowledge of molecular techniques, as outlined in the proposed studies. The learning objectives set out in this proposal, combined with the support of his Mentors, Drs. Marc Hershenson and Marsha Rosner, and the critical environment within the Section of Pulmonary Biology and Critical Care, and Ben May Institute for Cancer Research at the University of Chicago, will foster Dr. Abe's progression to independent lines of investigation into the mechanisms of lung diseases. The Specific Aims in this proposal will extend earlier inquiries by Dr. Abe into extracellular signal-regulated kinase (ERK) "611", a novel mitogen-activated protein kinase present in the lung which includes a Src-homology 3(SH3) binding motif. Three immediate goals are defined: (1) Determine the tissue specificity and developmental regulation of ERK611 expression in the lung. Extracts and sections from mature and fetal rat tissues will be probed using labeled antisense riboprobes (Northern analysis, in situ hybridization) and antibodies raised against the aminoand carboxy-terminal peptide sequences (Western analysis, immunohistochemistry). (2) Determine the activators of ERK611 in a cell culture system, and the substrates phosphorylated by ERK611 in vitro. Cells will be treated with putative activators of ERK611 and ERK611 phosphorylation and also be determined by examining the function of chimeric ERK611 proteins including either the regulatory or substrate domains of ERK2. (3) Determine the binding partners of ERK611. Binding of ERK611 to various SH3-containing proteins will be assessed both in vivo and in vitro. ERK611 mutations will be used to define specific SH3 binding domains. Finally, the yeast two-hybrid system will be used to identify additional binding partners of ERK611. Elucidation of ERK611 function may provide insight into disease processes which involve lung cell proliferation or apotptosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ONCOTIC PRESSURE AND EXTRAVASCULAR LUNG WATER IN ARDS Principal Investigator & Institution: Martin, Gregory S.; Medicine; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-JUL-2005 Summary: Applicant's Abstract This proposal is part of a career development plan integrating didactics in the form of a Master's Degree in Clinical Investigation with

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direct, mentored experience in the design and conduct of randomized clinical trials. Expertise in these areas will provide the necessary components for a successful career in patient-oriented critical care research. The Center for Lung Research at Vanderbilt University has focused substantial efforts toward the understanding of fluid and solute exchange in the injured lung, both in the pre-clinical arena and in prospective, randomized clinical trials. The mentors and consulting faculty in this environment are well recognized, established senior investigators in critical care research with vast preclinical and clinical experience. ARDS is defined by acute impairment of oxygenation and radiographic infiltrates compatible with pulmonary edema without increased hydrostatic pressures. It affects approximately 15,0000 people per year in the United States, with mortality approaching 50% and a financial burden estimated to exceed $5 billion. Fluid overload, weight gain, and hyperproteinemia are associated with increased mortality in patients with ARDS. Reduced oncotic pressure gradients related to hypoproteinemia may contribute to generation and maintenance of pulmonary edema in this condition. Previous trials have demonstrated clinical benefits associated with albumin and diuretic therapy in patients with ARDS, through the mechanisms by which these improvements occur is unclear. It is hypothesized that these benefits occur through increases in the oncotic pressure gradient and reductions in extravascular lung water, through the exact mechanism is unknown. The purpose of this project is to elucidate the pulmonary and hemodynamic effects of colloid and diuretic therapy in patients with ARDS using recently developed technology, which permits simple and accurate measurement of systemic hemodynamics and extravascular lung water in critically ill patients. This investigational proposes a critical trial randomizing hypoproteinemic ARDS patients to albumin and furosemide or dual placebo with targeted goals of diuresis and weight loss. Therapeutic effects on respiratory function, extravascular lung water, oncotic pressure, alveolar fluid clearance, and systemic hemodynamics will be characterized. This trial could advance our understanding of factors affecting fluid balance in patients with ARDS and has the potential to change clinical practice standards. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHARMACOGENETICS IN SURGICAL CRITICAL CARE Principal Investigator & Institution: Freeman, Bradley D.; Assistant Professor; Surgery; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-AUG-2005 Summary: (Adapted from the applicant's abstract) The applicant proposes that using pharmacogenetics (i.e., drug prescription based on a patient's genetic background) may dramatically enhance the efficacy of many therapies commonly used in critically ill patients. The PI for this career development award is a trauma/critical care surgeon whose long term research career goal is the application of pharmacogenetic techniques to surgical critical care. As an immediate goal, the PI seeks to develop expertise in molecular genetic techniques essential to this type of translational research. The research proposal, which examines warfarin pharmacogenetics, will provide the framework for achieving the immediate goal through a period of instruction, supervision, and investigation based in a clinical molecular diagnostics laboratory. Like many drugs used in surgical critical care, warfarin has a narrow therapeutic index, an unpredictable doseresponse, and untoward interactions with many medications. Despite frequent monitoring, potentially lethal toxicities are common. Current empiric methods of warfarin dosing are inaccurate. Warfarin is metabolized by two distinct subfamilies of the cytochrome P450 complex: CYP2A6 and CYP2C9. Common polymorphisms of these

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enzymes result in impaired warfarin metabolism. Interindividual variability in warfarin dosing may be attributable to these polymorphisms. The hypothesis is that warfarin dosing based on CYP2C9 and CYP2A6 genotyping will be more accurate and effective than current methods. To address this hypothesis, the applicant will accomplish two Specific Aims. He will (1) determine the frequency of CYP2C9 and CYP2A6 polymorphisms in an ethnically defined population of patients receiving warfarin; and (2) establish the relationship between CYP2C9 and CYP2A6 genotypes and warfarin dose and develop a genetically-based approach to warfarin dosing. The environment for this project is Washington University School of Medicine, an institution with access to a large clinical volume and established expertise in genomic research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PULMONARY AND CRITICAL CARE MEDICINE TRAINING PROGRAM Principal Investigator & Institution: Strieter, Robert M.; Professor and Chief; Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2008 Summary: (provided by applicant): The application is for a multi-disciplinary training program in pulmonary and critical care medicine at the UCLA School of Medicine. The grant will provide training in basic science and clinical research relevant to the study of pulmonary and critical care medicine disorders. The program proposes to support a total of six (3 each year) postdoctoral trainees (M.D.s, MD./Ph.D.s, and/or Ph.D.s) for a two year experience in a "laboratory environment" under the close supervision of a faculty trainer. On an individual basis, the focus of research for each trainee will be in molecular and cellular biology; signal transduction regulation; cytokine/chemokine biology; defensin biology; innate and adaptive immunology of the lung; the pathobiology of fibrotic lung diseases; pathobiology and prevention of lung cancer; leukocyte biology; epithelial cell biology of the airway and alveolar capillary wall; fibroblast biology; proteinase biology; arachidonic acid biochemistry; pulmonary epidemiology; molecular genetics of candidate genes influencing susceptibility to lung disorders; outcomes in lung disease; quality improvement; foundation in the computational and statistical sciences; fundamental methods of clinical trials; biomedical ethics; and principles of clinical pharmacology relevant to pulmonary and critical care medicine disorders. The program will utilize faculty trainers from several Departments at the UCLA School of Medicine and the School of Public Health at UCLA. The faculty trainers have either extensive research experience in diverse yet overlapping areas of molecular and cellular biology, biostatistics, epidemiology, clinical study design or medical ethics. All faculty trainers have previously trained postdoctoral trainees, who have subsequently gone on to independent and productive careers in academic institutions. The environment at UCLA together with the faculty trainers will offer an outstanding training experience for trainees in multiple basic science or clinical research disciplines relevant to pulmonary and critical care medicine disorders. The program will provide a structured curriculum that contains appropriate course work, exposure to relevant lecture series, and an intensive basic science or clinical research "laboratory" experience. The program is designed for trainees to subsequently be competitive for K01, K08, or K23 awards, and ultimately, R01 funding that will allow them to pursue academic careers in pulmonary and critical care medicine research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PULMONARY, CRITICAL CARE, AND MOLECULAR TRAINING Principal Investigator & Institution: Boucher, Richard C.; Director; Medicine; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 01-JUL-1975; Project End 30-JUN-2005 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: QUICK PLACEMENT EEG ELECTRODE AND INSTALLATION TOOL Principal Investigator & Institution: Abbott, Michael S.; Key Technologies, Inc. 1414 Key Hwy, Ste 300 Baltimore, Md 21230 Timing: Fiscal Year 2003; Project Start 09-MAY-2003; Project End 30-APR-2004 Summary: (provided by applicant): The electroencephalogram (EEG) electrode is a critical component for diagnosing and understanding neurological phenomenon. Electrode placement on the scalp is currently problematic, time consuming, and labor intensive. In partnership with Baltimore Biomedical, Inc., a novel self-installed electrode technology was developed and patented as part of a prior NIH SBIR program and uses hair to anchor the electrode near the scalp. Based on this prior art, Key Technologies has conceived of an electrode placement system specifically to support studies in the EEG laboratory environment. The new system consists of a disposable electrode and an installation tool. The new electrode will fulfill the requirements of standard silver/silver chloride and other commercially available electrodes and provides signal quality equivalent to the gold standard colloidal placed electrodes. This design uniquely provides the ability for quick placement of multiple electrodes via a single, hand-held installation tool without the need for messy adhesives or excess electrolyte. The small size, high comfort level, and quick placement attributes make the system ideal for critical care, EEG, and extended monitoring in which multiple electrodes are required. Unlike the current industry standard, the electrodes will be disposable; a desirable attribute with the current concern to control the spread of communicable diseases. The goals, through Phase III, are to design, prototype, validate, market, manufacture, and commercialize this novel electrode system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REDOX MACROPHAGES

REGULATED

HIV

EXPRESSION

IN

ALVEOLAR

Principal Investigator & Institution: Ieong, Michael H.; Medicine; Boston University Medical Campus 715 Albany St, 560 Boston, Ma 02118 Timing: Fiscal Year 2003; Project Start 15-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): This proposal describes a 5 year training program for the development of an academic career in Pulmonary and Critical Care Medicine. The principal investigator has completed a three year residency in Internal Medicine at the University of Maryland and a four year subspecialty training program in Pulmonary and Critical Care Medicine at Boston University (BU). He now seeks to develop his scientific skills of investigation into redox biology and HIV pathogenesis in the lung. Hardy Kornfeld, MD will mentor the principal investigator's development. He is an established investigator and an expert in the area of innate immunity and HIV dynamics in the lung. He has successfully trained graduate students and numerous fellows who are active in academic medicine. Expertise in the area of redox biology will be provided by the co-sponsor Jane Freedman, MD. A committee composed of senior investigators in

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the areas of redox, HIV and pulmonary biology will meet quarterly with the principal investigator to advise him on scientific and career matters. Research will focus on redox regulation of HIV-1 replication in human alveolar macrophage (AM). Preliminary studies demonstrate inhibition of HIV-1 by reactive oxygen intermediate (ROI) inhibitors at the transcriptional level. The effect of HIV-1 infection and viral proteins on AM production of ROI and reactive nitrogen intermediates (RNI) will be studied. This examination will be extended to naturally infected AM from seropositive individuals to examine the impact of hyperoxia and microbial challenge on redox regulated HIV- 1 replication in AM. The specific aims include: 1 characterizing the effect of HIV on the redox state of AM and its impact on HIV replication dynamics, 2) Determining the mechanism of ROI/RNI induced transcription of HIV, and 3) Determining whether HIV can be induced from naturally infected AM from seropositive patients by altering the redox state. These studies will be the first to analyze the effect of oxidative stress on HIV-1 replication in the human AM, a reservoir of persistent HIV-1 infection in the asymptomatic patient. The Pulmonary Center at BU and The Center for AIDS Research at UMass will provide customized training and outstanding interdisciplinary environments that will support the development of the principal investigators niche in lung biology and facilitate his transition to an independent investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REGULATION OF EXTRACELLULAR SUPEROXIDE DISMUTASE BY PROT Principal Investigator & Institution: Bowler, Russell P.; National Jewish Medical & Res Ctr and Research Center Denver, Co 80206 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 30-JUN-2005 Summary: National Jewish Medical Center in Denver Colorado is a well established center of excellence in pulmonary medicine. The laboratory of Dr. James Crapo has a long history of productive research in fife radical biology and is well equiped for fiiture research. I will use this highly productive environment to build my career in independent research and, by simultaneously completing a Ph.D. in cell and structural biology, I will have taken an unusual, but rigorous path to complete this goal. The Ph.D., which I started during my fellowship in Pulmonary and Critical Care Medicine, will be an integral part in my development into an independent scientist and in my fiirther studies of free radical biology in the lung. Superoxide plays an important role in inflammation and may also play a role in modulation of blood pressure. Superoxide dismutases are a highly conserved, ubiquitous family of enzymes which convert superoxide into hydrogen peroxide. Extracellular superoxide dismutase (EC-SOD) is the primary extracellular antioxidant enzyme; it is uniquely abundant in lung tissue and in vessel walls. A region within the carboxyterminus of this protein is rich in positive charge and is responsible for the distribution of the enzyme within extracellular spaces. Recently we have shown that this region can be specifically cleaved by an endoprotease. Three observations have made us think that proteolytic cleavage of this enzyme is physiologically significant: (1) the distribution of cleaved versus uncleaved EC-SOD varies among tissues; uncleaved or native EC-SOD predominates in vascular organs such as heart and aorta while cleaved EC-SOD is more prevalent in lung and liver; (2) we have recently found that total EC-SOD and the ratio of cleaved to native EC-SOD are increased during inflammation; and, (3) proteolytic cleavage occurs intracellularly. We propose to test the hypothesis that cells specifically regulate whether they secrete cleaved or intact EC-SOD based on the intended function EC-SOD. We further propose that a primary function of uncleaved EC-SOD is to modulate the EDRF response in

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blood vessels and that a primary function of cleaved EC-SOD is to protect the extracellular milieu from free radical mediated injury during inflammation. We expect to find that uncleaved EC-SOD predominates in blood vessels in both wild type and transgenic animals and that this EC-SOD activity will protect EDRF mediated vasodilation in aortic ring bath preparations. We further expect to show in cell culture and animal models that inflammation upregulates both total EC-SOD and the ratio of cleaved to intact EC-SOD. W will show that this correlates with a more diffuse distribution of the enzyme and a reduction of free radial mediated lung injury. This will not only define new aspects of the pathogenesis and regulation of vascular tone and inflammation, but can open new approaches to pharmacologically control these events. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MEDICINE

RESEARCH

TRAINING

IN

ANESTHESIA/PERIOPERATIVE

Principal Investigator & Institution: Deutschman, Clifford S.; Professor; Anesthesia; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2003; Project Start 01-JUL-1978; Project End 30-JUN-2008 Summary: (provided by applicant): The purpose of the Anesthesia/Perioperative Medicine Research Training Grant is to provide academic anesthesiologists with two years of full-time research training. We aim to identify, select and educate highly motivated individuals desiring an investigative career to function as clinician/scientists. The special importance of this grant is that it will provide an opportunity and support for a budding clinician/ scientist to pursue research on a full time basis. Many individuals are not pursuing research training due to the demands of practice, even in academics, are so great. It further provides the opportunity to receive formal didactic training in basic, epidemiologic or biostatistical science, including obtaining and advanced degree. Research opportunities are organized around four Tracks; Neuroscience/Pain Management, Vascular Biology/Bioengineering, Inflammatory Biology/Critical care medicine and Outcomes/Health Care Services Research. In each of these areas there is a highly experienced Director to provide global oversight, and a series of Participating Faculty members who will directly supervise research training. Most of these potential mentors are senior faculty at the University of Pennsylvania, although many are not primarily appointed in the Department of Anesthesia. Trainees select an area of interest, identify a potential mentor and the two together develop an investigative project. The Executive Committee, consisting of the four Track Directors, selects from among these individuals and their projects based on the originality, viability and feasibility for long-term potential of the project, the promise of the trainee and the "fit" between trainee and mentor. The Track structure permits inclusion of relatively junior faculty as mentors, since the Track Director can "mentor the mentor". Trainees and mentors are evaluated by the Executive Committee several times each year to assure that appropriate progress is being made. We anticipate offering three positions each year, with each position of two years duration. Thus, at most times we should have six individuals in the program. These positions will likely be filled by graduates of our clinical training program, many of whom are attracted to the department because of its long-standing and serious commitment to research. We will advertise positions widely to seek out the best and the brightest to expand the horizons of research being performed by anesthesiologist/perioperative physicians. This program has been reorganized and now consists of four areas of emphasis or tracks, Neuroscience/Pain Medicine, Vascular Biology/Bioengineering, Inflammatory Biology/Critical Care and Outcomes/Health Care Delivery Systems. Each area is directed by a senior member of

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the Anesthesia Faculty with special expertise in the field. Each track director has direct responsibility for trainees, rather than the overall program director. The goal of the program continues to be to train and develop academic investigators in anesthesiology. The program has an excellent training faculty, and a strong history of success in recruiting excellent trainees who go on to pursue careers in academic anesthesia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RESEARCH TRAINING IN LUNG DISEASE Principal Investigator & Institution: Dickey, Burton F.; Professor and Chairman; Medicine; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2003; Project Start 01-JUL-1993; Project End 31-AUG-2008 Summary: (provided by applicant): The training program to be supported by this award will provide post-doctoral research training for fellows holding M.D. or Ph.D. degrees. The major emphasis will be basic research related to lung disease. Areas of expertise include molecular genetics, molecular and cellular biology, physiology and bioengineering. The major goal is to prepare scientists to work at the interface of physiology and cellular and molecular biology. The program is based in the Pulmonary and Critical Care Section of the Department of Medicine with a multi-disciplinary faculty including scientists with primary appointments in other administrative units. All of the faculty with primary appointments in the Pulmonary and Critical Care Section have joint appointments in one or more basic science departments. Most of the faculty are linked by collaborative research interests which have been strengthened during the previous periods of this training program. The faculty from other departments are senior scientists who, because of their scientific expertise have a strong interest in lung disease. Administrative units at Baylor College of Medicine include the Institute for Molecular Genetics, the Center for Leukocyte Biology, the DeBakey Heart Center, the Biology of Inflammation Center, the Center for Experimental Therapeutics, the Departments of Cell Biology, Molecular Physiology and Biophysics, Molecular Genetics and Pediatrics, and the sections of Cardiovascular Sciences; Allergy, Immunology and Rheumatology; Thrombosis; and Hypertension in the Department of Medicine. The Bioengineering laboratories at Rice University, the Director of which, is an adjunct Professor of Medicine at Baylor College of Medicine also participates. The program goal is to have approximately 60% of the trainees with Ph.D. degrees and 40% with M.D.s who have had at least one year of research training prior to being supported by the grant. The trainees are encouraged to apply for individual research fellowships for second and subsequent years, during the first year of grant support. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RESPIRATION AND CIRCULATION DURING HYPOXIA Principal Investigator & Institution: Mcmurtry, Ivan F.; Professor; Medicine; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 01-JUL-1976; Project End 30-JUN-2007 Summary: (provided by applicant): Purpose: This program trains individuals with doctoral degrees in either biological or medical sciences for successful academic careers in research and teaching. After 24 years of NHLBI funding, 43 of our 66 trainees (65 percent) maintain successful academic careers, and this ratio has risen to 75 percent (six of eight trainees) over the past 4 years of funding. Our program is unique in that it trains a mix of basic scientists and physicians in cardiovascular /pulmonary biomedicine with

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a focus on the pathophysiological effects of hypoxia. We use a multidisciplinary team approach to both mentoring and research training that emphasizes integration of studies at the molecular, cellular, tissue/organ, and physiological (in vivo) levels. Resources: The senior training faculty comprises a mix of PhD and MD preceptors that have distinguished academic records and are well funded by grants from NIH and other organizations. Training occurs primarily in the adjacent Cardiovascular Pulmonary Research Laboratory, Developmental Lung Biology Laboratory, Center for Genetic Lung Disease, and Women?s Health Research Center at UCHSC. Adjunctive facilities are also available in various basic science and clinical departments at UCHSC, the VA Medical Center, and the National Jewish Center for Immunology and Respiratory Medicine. These facilities provide trainees with access to a myriad of physiological, cellular, biochemical, molecular, and bioinformatics/biostatistical expertise, techniques, and equipment. Program: The PhD, MD, and occasional DVM trainees are selected from a pool of applicants comprising graduates of basic science departments from around the country and clinical fellows of the UCHSC's Divisions of Pulmonary Sciences/Critical Care Medicine, Pediatric Critical Care Medicine, and Cardiology. Selection is based on the candidate's academic credentials, prior research experience, and evidence of enthusiasm and aptitude for a career in biomedical research. In addition to training in laboratory analytical techniques, our trainees receive extensive instruction and experience in study rationale and design, statistical analysis of data, and both oral and written communication. The length of training is 3 years, and the trainees are strongly encouraged to apply for individual fellowships and start-up grants within the second year of their fellowship. The program director, with the advice and consent of the senior program faculty, is responsible for the administration and coordination of the program. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RESPIRATORY RESEARCH TRAINING GRANT Principal Investigator & Institution: Hudson, Leonard D.; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-JUL-1994; Project End 30-JUN-2004 Summary: The purpose of this program is to train physician-scientist or post- doctoral PhD biologic scientists in a multi-disciplinary collaborative approach to clinically relevant research in pulmonary and critical care medicine, and thus prepare them for academic careers characterized by independent research productivity and the expertise of its training faculty, its successful integration of multiple disciplines and diverse research methodologies and its success in the past in training academicians. Research training is available in three tracks: respiratory cell and molecular biology; respiratory physiology; and clinical investigation. Each track has several experienced mentors providing a range of research topics for the trainee. Each track has recommended didactic course work to enrich the research training experience by exposing the trainee to a broader range of methodology and research topics. The clinical investigator track includes enrollment in an MPH program in the Departments of either Epidemiology or Health Services. The program features a process of research mentor and project selection by the first year (clinical) trainees including counseling each trainee by senior training faculty followed by a week in the fall during which trainees are relieved of their clinical responsibilities to conduct interviews with selected potential mentors in order to enhance optimal choice of mentor and research topic. Mentoring committees track the fellows' progress toward their research training goals and provide feedback which includes career counseling and academic job placement. Fellows present their research in several forums including informally at laboratory meeting as well as in more

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structured research study groups, a University-wide pulmonary research conference (once to twice per year) and at regional and national meetings. The training includes instruction in manuscript and grants. The program stresses the conduct of research in an ethical and scientifically responsible manner. The program also includes an ongoing effort to attract individuals from under-represented minorities into the filed of pulmonary and critical care medicine as well as into this specific program. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SECONDARY BRAIN INJURY IN INTRACEREBRAL HEMORRHAGE Principal Investigator & Institution: Hemphill, Jesse C.; Neurology; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 15-JUL-2001; Project End 30-JUN-2006 Summary: (provided by applicant): Acute primary non-traumatic intracerebral hemorrhage (ICH) is a common disorder for which there is currently no therapy of proven benefit in improving mortality and functional outcome. In fact, there remains controversy regarding the mechanisms by which ICH creates primary and secondary brain injury. The overall objective of this proposal is to produce a program which combines didactic teaching, mentoring, and clinical research to build upon Dr. Hemphill's training in neurologic critical care, thereby allowing him to develop into an independent clinical investigator studying mechanisms of injury and treatment of ICH. While management decisions in ischemic stroke, head trauma, and subarachnoid hemorrhage may be made based on clinical and diagnostic monitoring for secondary brain injury, the usefulness of this in ICH is not known. The overall hypothesis for this project is that secondary brain injury adversely effects outcome after ICH and that approaches that decrease secondary brain injury after ICH will improve outcome. This will be investigated through a series of studies related to clinical, neuromonitoring, and neuroimaging evaluation of secondary brain injury in ICH, culminating in a pilot clinical trial of ICH treatment. Studies will address: 1) the impact of clinical secondary brain insults (systemic hypoxia, hypotension, fever, and seizures) on outcome, 2) the influence of brain tissue hypoxia (measured through direct monitoring of brain tissue oxygen tension in the neurologic intensive care unit) on outcome, 3) the correlation between brain tissue hypoxia and ischemia on dynamic CT perfusion and MR diffusionweighted imaging, and 4) the feasibility of targeting secondary brain injury in a pilot study of ICH treatment. This research should provide new and important information about the role of secondary brain injury in ICH. In conjunction with the didactic training and mentoring undertaken, this program will foster Dr. Hemphill's development into an independent researcher in neurologic critical care, specifically focusing on intracerebral hemorrhage. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SEDATION AND PSYCHOPHARMACOLOGY IN CRITICAL CARE Principal Investigator & Institution: De Wit, Marjolein; Internal Medicine; Virginia Commonwealth University Richmond, Va 232980568 Timing: Fiscal Year 2003; Project Start 15-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Marjolein de Wit, M.D., Assistant Professor of Medicine in the Pulmonary and Critical Care Division at Virginia Commonwealth University, seeks support for this research training in order to establish herself as an independent clinical investigator examining sedation of critically ill patient. Her goal is to evaluate the effectiveness of various sedation strategies, to evaluate the prevalence of

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psychiatric complications, and to compute the pharmacokinetics of commonly used sedatives. In order to enhance her research skills, Dr. de Wit will enroll in a master's degree program in clinical research and design offered by the institution as well as obtain formal training in pharmacokinetics and pharmacodynamics. Certain methods of sedation increase the duration of respiratory failure. Two strategies, a nursingimplemented sedation algorithm and daily interruption of sedatives, decrease length of mechanical ventilation compared to "conventional care" but have not been compared to each other. The reason certain methods of sedation lead to prolonged respiratory failure is unknown but may be related to altered pharmacokinetics and dynamics that are unique to critically ill patients. Critically ill patients receive substantial doses of sedatives over prolonged periods. The impact of these management strategies on shortand long-term psychiatric complications are unknown. The study proposed in this grant application seeks to test the central hypothesis that sedation practices impact strongly on outcome of respiratory failure and psychiatric complications. The three specific aims are (1) to compare two sedation strategies (protocol directed sedation and daily interruption of sedatives), (2) to examine the prevalence of psychiatric complications, and (3) to compute the pharmacokinetics of commonly used sedatives and narcotics. These aims will be achieved by enrolling critically ill patients in a prospective randomized trial comparing the above mentioned sedation strategies, and assessing sedation level as well as delirium throughout the duration of respiratory failure. Sedative plasma levels will be measured, and pharmacokinetics computed. Psychiatric morbidity will be assessed by administration of validated questionnaires. This study design creates a pathway for new understanding of the impact of sedation and the incidence of morbidity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SEDATION MANAGEMENT IN PEDIATRIC PATIENTS Principal Investigator & Institution: Curley, Martha A.; Children's Hospital (Boston) Boston, Ma 021155737 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): The purpose of this two-year project is to pilot test an intervention to change sedation management in pediatric patients supported on mechanical ventilation for acute respiratory failure in the pediatric intensive care unit (PICU). While ensuring patient comfort is an integral part of pediatric critical care, analgesic and sedative use in this patient population can be associated with iatrogenic injury; specifically, comfort medications may depress spontaneous ventilation and prolong the duration of weaning from mechanical ventilation. Additionally, drug tolerance develops over time and may precipitate iatrogenic abstinence syndrome when the patient no longer requires sedation. Alternatively, suboptimal comfort management contributes to ventilator dysynchrony and unplanned endotracheal extubation. Our group has developed and validated a nurse-implemented sedation algorithm to guide titration of comfort medications that may optimize patient comfort and reduce the risk of under-medication, but this algorithm needs to be evaluated further. We will pilot test the sedation algorithm in a randomized controlled clinical trial of two matched pediatric intensive care units in two different hospitals. One hospital will be randomized to their usual standard practices for managing sedation, while the other will receive (a) multidisciplinary team education and consensus building, (b) multidisciplinary team identification of the patient's trajectory of illness and daily prescription of a sedation goal, (c) a nurse-implemented sedation algorithm to guide titration of comfort medications, and (d) team feedback on clinical performance. We hypothesize that

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pediatric patients managed per sedation protocol will experience fewer days of mechanical ventilation than patients receiving usual care. Secondary outcomes include time to recovery from acute lung injury, duration of weaning from mechanical ventilation, occurrence of adverse events, total exposure to comfort medications, occurrence of iatrogenic opioid and benzodiazepine withdrawal symptoms, PICU length of stay, barriers to successful implementation of the intervention and PICU costs. The overall objective of this study is to develop an intervention that can be implemented in any PICU that will provide comfort to intubated and mechanically ventilated infants and children that will not cause them harm. Results of this pilot study will be used to design a future multi-center randomized controlled clinical trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SICU CARE AT THE END OF LIFE Principal Investigator & Institution: Buchman, Timothy G.; Edison Professor of Surgery; Surgery; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 30-NOV-2003 Summary: Advances in surgery and in critical care have extended therapeutic options as well as the range of patients offered these options. Physiologically brittle patients, including the elderly and chronically ill, are operated upon with increasing frequency using progressively more complex procedures. Nearly all initially survive their operations. When complications threaten patients, the surgical intensive care unit is mobilized to rescue the patient. Although many rescues are successful, some falter and ultimately fail. Problems acknowledging this failure complicate interactions among surgeons, other caregivers, the patient and their loved ones and appear to adversely affect care at the end of these patients' lives. Our long-term objectives are (1) to understand the dynamics and consequences of this interaction; (2) to educate the caregivers regarding these dynamics and their consequences; (3) to test whether this education changes behaviors in ways which improve the interaction and (4) to disseminate our findings to others engaged in related activities. Our premises are that (1) surgeons' management of a dying patient is affected by their perception of accountability for the death and (2) surgeons' exaggerated sense of responsibility for the imminent death adversely affects the experience of other caregivers, patients, their loved ones and the surgeons themselves. We propose to classify, illuminate and (ultimately) manipulate the surgeon's self-perception and others' perception of his accountability for the death. Convergent studies of surgeons, intensivists and critical care nurses in an academic surgical intensive care unit will achieve three specific aims: (1) to investigate, describe, examine and understand how the surgeons' role in care (i.e. as operating surgeon, as non- operating attending physician or as intensivist) affects the rescue imperative; (2) to investigate, describe, examine and understand how the critical care nurses' dual roles, as caregiver and as culture broker, influence one another in negotiating the change in focus from cure to comfort; (3) to investigate, describe, examine and understand how the progress of the negotiation among caregivers and family affects family and friends' perception of their roles and of the well-being of their loved ones. We propose to employ psychological (vignette analyses, microlinguistic analysis); sociological (focus group methodology); and anthropological (ethnography) approaches to achieve these aims. The main products of this initial grant cycle will include a monograph describing the ethnography of death in the surgical intensive care unit; articles in the critical care and surgical literature; and a major multidisciplinary conference to explore appropriate intervention strategies. In the next funding cycle, we will propose the development and dissemination of specific interventions aimed at

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expanding critical care-based caregivers' understanding of their roles in the dying process so that all can more effectively deliver care to the dying and the bereaved. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STAFF HAND HYGIENE AND NOSOCOMIAL INFECTION IN NEONATES Principal Investigator & Institution: Larson, Elaine; Professor; None; Columbia University Health Sciences Po Box 49 New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 01-FEB-2001; Project End 31-JAN-2004 Summary: Nosocomial infections are one of the most prevalent and devastating complications among hospitalized and high-risk neonates. Although hand hygiene of health care professionals is one of the primary mechanisms to reduce risk of transmission of infectious agents in high-risk health care settings, adherence to recommended hand-washing practices is universally suboptimal, indicating a critical need to enhance adherence with acceptable hand hygiene regimens. Further, the need for frequent washing and gloving among staff in critical care settings causes skin damage with concomitant changes in normal flora and shedding of more organisms into the environment, ironically increasing risk of nosocomial transmission from the hands of personnel. The challenge is to maximize the antimicrobial effectiveness of hand hygiene practice while minimizing changes to the skin's health of microflora. The aim of this 3-year clinical trial is to compare effects of two hand hygiene protocols used by staff in neonatal ICU on nosocomial infection rates among the neonates and on the skin health and microbiology of staff hands. In a sequential design, the staff of two NICUs in NYC (100 beds) will be assigned to one of two-hand care regimens (traditional antiseptic detergent and scrub of non-antiseptic detergent with alcohol-based rinse and emollient) in two alternative 12-month blocks of time. Outcome measures include infections (using standardized prospective surveillance protocols), skin condition (measured by validated, standardized tools), and microbiology of staff hands. Molecular epidemiologic techniques (pulsed field gel electrophoresis) will be used to identify genetic relatedness of clinical isolates from infected neonates and isolates from hands of personnel. This is the first clinical trial of the role of staff hand hygiene in nosocomial transmission to neonates using molecular epidemiologic methods, and the first to compare alcohol degerming and traditional soap and water while controlling for potential confounders such as gloving and lotion use. Results of this study can be generalized to many clinical settings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: STRATEGIES FOR IMPROVING SEDATION OUTCOMES IN THE ICU Principal Investigator & Institution: Kress, John P.; Medicine; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2006 Summary: (provided by applicant): John P. Kress, M.D., Instructor of Medicine in the Section of Pulmonary and Critical Care Medicine of the University of Chicago, seeks support for research training in order to establish a career as a clinical investigator examining issues related to the care of critically ill patients. In order to enhance his research skills, Dr. Kress will meet regularly with his mentor, Dr. Jesse Hall, a nationally regarded critical care clinical investigator and Chief of the Section of Pulmonary and Critical Care Medicine. He will also enroll in the certificate program sponsored by the

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University's NIH-funded Clinical Research Training Program. Dr. Kress's research proposal describes several studies assessing practical strategies for sedation of critically ill patients that optimize efficacy and minimize complications. The specific aims of this proposal include a further evaluation of the strategy of daily sedative interruption recently described by Dr. Kress and colleagues, which was found to significantly reduce duration of mechanical ventilation and intensive care unit length of stay. Dr. Kress will attempt to uncover problems with the strategy of daily sedative interruption, with a focus on long term psychological maladjustments in patients exposed to daily interruption of sedative infusions and acute myocardial ischemia during the time of daily sedative interruption. He will also study outcomes of critically ill patients sedated by a strategy of intermittent bolus administration of sedatives versus a strategy of continuous infusion of sedatives with a daily scheduled interruption. These studies focus on practical bedside strategies that can be undertaken in a wide variety of settings. The goal of this project will be to develop and test strategies that attempt to assure optimal patient comfort while reducing complications of sedative drug administration in critically ill patients who frequently manifest altered, unpredictable pharmacokinetics and pharmacodynamics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SURFACTANT AND TUBERCULOSIS PATHOGENESIS Principal Investigator & Institution: Ferguson, J Scott.; Internal Medicine; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 01-AUG-1998; Project End 31-JUL-2003 Summary: (Adapted from applicant's abstract) Tuberculosis is the leading cause of death due to an infectious disease in the world. As a pulmonary pathogen, the initial interaction between the causative bacterium Mycobacterium tuberculosis (M.tb) and the human host is in the lung where surfactant, epithelial cells, and alveolar macrophages are located. This initial interaction between these components of the alveolus and M.tb dictate the outcome of infection. The understanding of this process is limited, but critical in this disease. This five year award will provide insight into the pathogenesis of tuberculosis, specifically in the role that surfactant components play in the early host response to this host-adapted microorganism. The specific aims are to: characterize the binding of surfactant protein D (SP-D) to virulent and attenuated M.tb strains, and their major surface components, and to determine the impact of this binding on bacterial agglutination; determine if SP-D alone or in conjunction with surfactant protein A (SPA), and the major surfactant phospholipid, dipalmitoyl phosphatidylcholine (DPPC), influences the phagocytosis of M.tb by macrophages; determine if SP-D, SP-A, and DPPC influence the intracellular survival of M.tb in the macrophage, and to examine whether this is the result of altered cellular responses such as phagosome-lysosome fusion or the oxidative burst; and, determine if SP-D, SP-A, and DPPC influence the M.tb-pulmonary epithelial cell interaction. These specific aims will be accomplished using in vitro techniques available at the primary laboratory and through collaborative efforts. The candidate is a fellow in the Division of Pulmonary, Critical Care, and Occupational Medicine. Through an intense course of didactic and laboratory study, he will define the essential role that surfactant components play in the host defense response to M.tb using methods of microbiology, immunology, biochemistry, molecular biology, and cell physiology. He will determine the role that SP-A, SP-D, and DPPC, have in regulating the immune response of macrophages and epithelial cells to this intracellular pathogen. The proposed work will be performed at the University of Iowa, a well-known leader in biomedical research. The work to be performed encompasses the

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Division of Infectious Diseases and the Division of Pulmonary, Critical Care, and Occupational Medicine, as well as various departments from the College of Medicine. Laboratory facilities are at the Iowa City Veterans Administration Center, and the University of Iowa. The candidate, mentors, advisory committee, and collaborators will work closely to achieve the goals of this proposed award: to define critical interactions between the human pathogen M.tb and the host, and for the principal investigator to become an accomplished independent biomedical investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: T LYMPHOCYTE GROWTH REGULATION BY PROINTERLEUKIN16 Principal Investigator & Institution: Wilson, Kevin C.; Medicine; Boston University Medical Campus 715 Albany St, 560 Boston, Ma 02118 Timing: Fiscal Year 2003; Project Start 04-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): This proposal describes a 5-year training program for the development of an academic career in pulmonary medicine and immunology. The principle investigator has completed a residency program in Internal Medicine at Massachusetts General Hospital and is in the final year of a fellowship program in Pulmonary and Critical Care Medicine at Boston University School of Medicine. He now seeks to expand upon his scientific skills through an integration of intellectual, educational, and technical resources. This program will promote expertise in the area of T lymphocyte activation and proliferation as applied to pulmonary immune diseases. David Center will mentor the principle investigator's scientific development. Dr. Center is a recognized leader in the field of T cell biology. He is the Chief of Pulmonary and Critical Care Medicine and has trained numerous post-doctoral fellows and graduate students. In addition, an advisory committee of highly regarded medical scientists will provide scientific and career advice. Research will focus on regulation of T cell activation and proliferation by prointerleukin-16 (pro-lL-16). Pro- IL-16 is an abundant T cell nuclear and cytoplasmic protein. Our laboratory has demonstrated that pro-lL-16 is a potent suppressor of T cell growth, whose major affect is to arrest the cell cycle in G0/G1. This is associated with marked rises in the cell cycle inhibitor p27KIP1 following decreases in the ubiquitin ligase F box protein Skp2 which is associated with p27KIP1 degradation. Along these lines, following T cell receptor (TcR) activation, pro-lL-16 mRNA is markedly downregulated and pro-lL-16 protein disappears from the nucleus prior to cell cycle progression. Our hypothesis is that loss of nuclear pro-lL-16 is essential for cell cycle progression. We will test this hypothesis by: 1) Identifying pro-lL16-regulated genes by microarray analyses that affect TcR-dependent activation and growth and 2) Determining the functional significance of pro-lL-16 regulation of selected cell cycle related genes. The Pulmonary Center of Boston University School of Medicine provides an ideal setting for training physician-scientists by incorporating expertise from diverse resources into programs individualized to meet the investigator's interests and skills. Such an environment maximizes the potential for the principle investigator to establish a scientific niche from which an academic career can be constructed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TELEMEDICINE FOR CHILDREN IN RURAL EMERGENCY DEPARTMENTS Principal Investigator & Institution: Marcin, James P.; Pediatrics; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 956165200

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Timing: Fiscal Year 2002; Project Start 19-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): Rural hospitals are often under served with respect to pediatric specialty and emergency services. As a consequence, acutely ill and injured children presenting to rural hospitals may receive delayed or inappropriate care. The use of telemedicine to provide under served hospitals with pediatric emergency and critical care telemedicine consultations has not been described, and the effect that these consultations would have on the processes, frequency of errors, outcomes and costs of health care provided to children is unknown. The objective of this application is to determine the impact of telemedicine consultations on the quality and satisfaction of care that critically ill and injured children receive in rural emergency departments. Preliminary data suggests that telemedicine consultations to a rural hospital can aid in the management of critically ill children. The candidate hypothesizes that emergency pediatric telemedicine consultations to rural, under served emergency departments will reduce the frequency of medication errors; enhance the quality of care as measured by implicit review; and decrease unnecessary patient transports. Furthermore, it is hypothesized that these departments will be regarded as high in quality compared to control emergency departments without telemedicine consultations. Two rural, under served emergency departments will be studied that will utilize telemedicine consultations for acutely ill and injured children (Telemedicine ED). The acutely ill and injured children presenting to the two matched control emergency departments (Control ED) will act as control subjects. Historical control data will be collected from all four emergency departments so that a pretest-posttest design with concurrent matched controls can be used. UC Davis Children?s Hospital critical care physicians will provide consultations to the rural emergency departments. Review of the blinded medical records will be used to determine medication error rates, implicit quality assessments, and patient transfer rates in the telemedicine and control emergency departments. Satisfaction surveys completed by the parents/guardians will also be compared between patients cared for in telemedicine and control emergency departments to evaluate the effects of telemedicine on overall patient satisfaction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE GENETIC EPIDEMIOLOGY OF ASTHMA IN COSTA RICA Principal Investigator & Institution: Celedon, Juan C.; Assistant Professor; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 05-JUL-2001; Project End 30-APR-2006 Summary: (Applicant?s abstract) This proposal seeks to provide an opportunity for the Principal Investigator (PI) to gain knowledge and skills in genetic epidemiology, under the direct supervision of a highly qualified sponsor, to further enhance his potential to develop into an independent investigator. The PI, who is trained in clinical Pulmonary and Critical Care Medicine, has recently obtained a M.P.H. degree, in addition to completing a respiratory epidemiology fellowship and the initial requirements for a Dr. P.H. degree in Genetic Epidemiology. The first two years of this proposal will incorporate needed course work, seminars, and hands-on experience in genetic analysis and molecular biology techniques to enable the PI to undertake an intensive research experience in the latter three years of the proposal. The overall scientific goal of this proposal is to study the genetic influences on the development of asthma and asthmarelated phenotypes in a large and homogeneous subset of Hispanic subjects. We hypothesize that a subset of chromosomal regions previously linked to asthma-related phenotypes will contribute to the expression of asthma in a genetically isolated Costa Rican population. To test this hypothesis, we will conduct a directed screen on two

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chromosomal regions (5q31 - q33 and 12q15- q24.1) By identifying genetic determinants of asthma among subjects of Latin American ancestry, this proposal could greatly contribute to our understanding of the pathogenesis of asthma, particularly among Hispanics. In addition, it will create a bank of phenotypic and genotypic information that will facilitate further hypothesis testing in a unique patient cohort. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRAINING IN LUNG MODULAR AND CELL PATHOBIOLOGY Principal Investigator & Institution: Brody, Arnold R.; Professor and Vice Chairman; Medicine; Tulane University of Louisiana New Orleans, La New Orleans, La 70112 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): A solid base of biomedical and basic molecular research in lung diseases has evolved at Tulane University. In 1992, as part of a campus wide strategic plan by Tulane to improve and modernize the lung research activities into the areas of cell and molecular pathobiology Drs. Mitchell Friedman (Principal Investigator) and Arnold Brody (Co-Principal Investigator) were recruited to Tulane University Medical Center. Dr. Friedman is Professor of Medicine and Chief of the Section of Pulmonary Diseases, Critical Care and Environmental Medicine at Tulane University Medical Center. Dr. Brody is currently Professor of Pathology, Vice Chairman of the Department of Pathology at Tulane and Director of the Tulane Lung Biology Program. With the recruitment of Drs. Friedman and Brody a solid and highly competitive lung disease research program has evolved into the highly collaborative Lung Biology Program at Tulane University over the past seven years. The individual faculty members of the Lung Biology Program represent two departments in the Medical School (Medicine, Pathology and the total amount of all research awards to these investigators is approximately $3 million/year. Furthermore, critical interactive research programs have been developed between the Tulane Ltmg Biology Program and other research centers at Tulane including the Center for Gene Therapy, Department of Biomedical Engineering, Department of Pharmacology, and the Tulane Cancer Center. The total federal and non-federal monies awarded to the entire faculty on a yearly basis is now approximately $10,200,000 in direct costs. This research award level includes grants from the NIH, DoD, NIOSH, State of LA, associations, and foundations. As an example of productivity of the faculty, for 1998-2002, there have been approximately 113 publications in prestigious journals and numerous presentations at national and international meetings. The main research areas are in mechanisms of lung fibrosis, lung cancer, pulmonary circulation, asthma, COPD, gene therapy, and effects of inhaled toxicants on the lung and airway inflammation mechanisms. The rapid growth of research faculty and research projects in lung ceil and molecular pathobiology at Tulane since 1992 has also been associated with the development of pre-doctoral and postdoctoral training activities. There are presently 23 trainees being mentored by the training faculty. The funding for these trainees are presently derived from individual faculty research grants and contracts, funding from the Tulane Molecular and Cell Biology Program and the Tulane/Xavier Center for Bioenvironmental Research, and foundations and endowments. The Pulmonary, Critical Care and Environmental Medicine Section also provides training for 9 clinical fellows in Pulmonary and Critical Care Medicine. The diversity of the training program is exemplified by the fact that of these trainees, 9 were female, 3 Black, 1 Native American and 7 Asian. The Training program faculty, since 1992, have had 64 post-doctoral trainees obtain academic faculty positions. The wide range of research activities at the cell and molecular level in lung disease, the track record of achievement and training by the faculty, the development of

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excellent research experience for our trainees, the productivity of the faculty and trainees as evidenced by their publication record and grant funding and the fact that a number of trainees have obtained faculty positions serve as the basis for the submission of this new T-32 training grant to offer funded formalized research training in lung cell and molecular pathobiology. The main objective of this proposal is to train highlyqualified post-doctoral students in basic mechanisms of lung disease focusing on lung cell and molecular biology. Trainees in the Program, utilizing emerging technologies and new approaches, will acquire the necessary skills to design and conduct basic research studies in pathobiology. We have developed a formalized 2-year training program (a mentored laboratory research project and a formalized core curriculum) to prepare the trainees to develop a successful and independent academic career in research in lung biology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRAINING IN TRAUMA AND CRITICAL CARE RESEARCH Principal Investigator & Institution: Deitch, Edwin A.; Professor; Surgery; Univ of Med/Dent Nj Newark Newark, Nj 07107 Timing: Fiscal Year 2004; Project Start 01-JUL-2004; Project End 30-JUN-2009 Summary: (provided by applicant): The goal of this program is to develop and prepare skilled, science-based surgeons for productive academic careers focusing on trauma and burn care. To accomplish this goal, we believe that trainees should be placed in basicscience oriented laboratories conducting investigations of clinically pertinent questions. The experience provided is designed to educate the trainee in the rigors of the applied scientific method, instill a respect for biological systems and endow them with the curiosity and tools to explore all potential avenues of investigation for problem-solving. We believe that the principles of scientific research and experimental methodology can best be taught in a setting where these are the primary activities of the participants, while providing experiences which can be incorporated into their already established, clinically applicable framework. We also will stress that all trainees will be exposed to a wide array of techniques and approaches, including, but not limited to animal models, molecular biology, immunology and physiology. This proposal requests five years of support for post-doctoral fellows to spend two years in an academic environment to develop physician-scientists interested in trauma / critical care research. We are requesting 3 trainees with two years' relevant postdoctoral experience to enter the program in the first year, with 3 more to be added in the second year, for a total of 6. Candidates for the program will be recruited nationally and from various NJMS departments, generally after their second post-graduate year. Trainees will work and study with a multidisciplinary group of faculty members, most of whom have been working together for many years. The basic training core consists primarily of course work, seminars, lectures, trainee presentations and meetings. For the bench research component, a trainee is directly responsible for a primary project that he or she may propose or may be assigned. Trainees also participate in research projects of other trainees and investigators, and cooperation in research is emphasized. All projects proceed under the close tutelage of a scientific mentor, and with the collaboration of other program faculty members. This training grant will take advantage of a diversified set of projects led by funded and established investigators, all of whom are intimately related to trauma and inflammation research. There is an Executive Advisory Committee to provide the principal investigator with advice and reviews of all aspects of the program. The training faculty has worked together for many years as evidenced

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by joint publications and grants and is enthusiastically looking forward to developing physician-scientists in the important area of trauma and critical care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRAINING PROGRAM IN BURNS, TRAUMA AND CRITICAL CARE Principal Investigator & Institution: Horton, Jureta W.; Professor; Surgery; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 01-JUL-1996; Project End 30-JUN-2006 Summary: (taken from the application): The specific aim of this competitive renewal of our training program in Burns, Trauma and Critical Care is to develop physicians/scientist who are well grounded in physiology, molecular biology and molecular genetics; in addition this program is designed to teach interested individuals to develop hypothesis based research plans, enabling the trainees to transfer developments in new information from bench research to the clinical arena, leading to the development of novel and innovative therapeutic strategies in trauma and critical care. This training program is devoted to two years research training, and candidates for the training program must have an M.D. or Ph.D. degree from an accredited medical or graduate school, only United States citizens or permanent residents are eligible. A twoyear research commitment is required, and M.D. trainees are expected to have completed at least three years of post-doctoral training prior to beginning the fellowship. To achieve an understanding of the cellular and molecular mechanisms underlying organ failure in trauma and sepsis, trainees are placed in laboratories under the direction of scientific preceptor where state-of-the-art scientific methods are available and preceptors are committed to the training of physician/scientists. The academic resources of the University of Texas Southwestern Medical Center and Graduate School as well as the Howard Hughes Medical Institute have produced an exciting cadre of outstanding scientific preceptors for this training program. Individuals selected for participation as potential preceptors are nationally/internationally recognized scientists who have a long-term history of collaboration with investigators in the Department of Surgery and in the Divisions of Pediatric Critical Care. The inclusion of faculty from numerous departments across campus has produced a diverse program, allowing trainees to pursue studies in molecular biology/gene therapeutics, cytokine/mediator biology, neurobiology, tissue engineering/repairs/biomaterials, applied cardiopulmonary and microvascular physiology. The diversity of research areas that revolve around injury and inflammatory responses available to potential trainees should enable candidates to examine pathophysiologic mechanisms of trauma, burns and critical care leading to clinical innovations that will ultimately improve outcome of critically ill patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TRAINING PROGRAM IN PEDIATRIC CARDIOPULMMONARY RESEARCH Principal Investigator & Institution: Strauss, Arnold W.; Professor and Chair; Pediatrics; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2002; Project Start 01-JUL-1977; Project End 30-JUN-2007 Summary: (provided by applicant): This competing renewal application requests continued support for a pediatric cardiopulmonary research training program that has been active for almost 30 years. The training program described in this application has been substantially redesigned and enhanced in the following ways: 1) A new Program

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Director, Arnold Strauss, MD, has assumed responsibility for leadership and direction of the training program; 2) In addition to recruitment of trainees from a single Pediatric Division (Neonatology) as in the past, we propose that qualified postdoctoral trainees will be actively recruited from the Divisions of Pediatric Pulmonary Medicine, Pediatric Cardiology, Pediatric Critical Care and other divisions in the Department of Pediatrics; 3) Selected trainees will be encouraged to enroll in formal degree-granting programs leading to a Master of Science degree in either Public Health or Clinical Investigation; 4) Expansion of the research focus to include cardiopulmonary development and diseases; 5) Expansion of the mentor pool beyond the Department of Pediatrics to include proven basic and clinical research mentors in the Departments of Medicine, Pharmacology, Anesthesiology, Cell/Developmental Biology, as well as established multidisciplinary research centers of excellence in Human Genetics, Pharmacogenomics and the Health Services Research Center; 6) Explicit incorporation of a trainee mentoring program; 7) Renewed efforts to recruit underrepresented minorities into the training program via personal contact and via the new formal broad-based alliance between Vanderbilt and Meharry Medical College; and 8) A closer partnership between this pediatric cardiopulmonary training program and the adult-oriented pulmonary training program in the Vanderbilt Center for Lung Research which is substantially housed in the Division of Allergy, Pulmonary and Critical Care in the Department of Medicine. The overall objective of this training program is to produce much-needed investigators and leaders in basic and clinical research relevant to pediatric cardiopulmonary development and diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VEGF AND NITRIC OXIDE IN LUNG VASCULAR DEVELOPMENT Principal Investigator & Institution: Balasubramaniam, Vivek; Pediatrics; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2008 Summary: (provided by applicant): Dr. Vivek Balasubramaniam is a Research Fellow, board certified Pediatrician and board eligible in Pediatric Pulmonology and Pediatric Critical Care at the University of Colorado Health Sciences Center. His interest in developmental biology began during his undergraduate education at the University of California, Los Angeles, where he studied cellular, molecular and developmental Biology and performed research on plant embryonic gene expression. His interest in developmental biology continued at the University of Pittsburgh School of Medicine where he proposed a model for the origin and differentiation of gamma delta T-cells. His interests focused on pulmonary vascular and alveolar development during his fellowship training at UCHSC. He has extensive experience in whole animal studies of postnatal lung growth and development and has developed a focused interest on angiogenesis and alveolarization and the role of growth factors during these processes. His immediate goal is to learn the theories and application of molecular and cell biology to understand the mechanisms that are involved in pulmonary angiogenesis and alveolarization. His long-term goal is to integrate whole animal, molecular and cell culture techniques to help focus independent investigations of the role of pulmonary angiogenesis in alveolarization. Dr. Balasubramaniam proposes to elucidate interactive mechanisms of angiogenesis and alveolarization with in vivo and in vitro models that will help us better understand the pathogenesis of bronchopulmonary dysplasia (BPD), the chronic lung disease of infancy that follows premature birth. In this proposal, he will use a transgeneic mouse model that is deficient in endothelial nitric oxide synthase that develops pulmonary hypoplasia with exposure to mild neonatal hypoxia. In this model,

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he will combine techniques of morphometry, molecular biology and cell culture to elucidate the mechanisms by which nitric oxide preserves lung angiogenesis and alveolarization. He hopes to combine these different approaches to develop a career as an independent clinician scientist. UCHSC will provide an environment for career development with more than adequate equipment and resources to enable Dr. Balasubramaniam develop into an independent investigator. Dr. Steven Abman (mentor) has broad experience in both animal and clinical studies of pulmonary development. Dr. Carl White's focus has been on the mechanisms of oxidative lung injury in bronchopulmonary dysplasia. Dr. Kurt Stenmark's work has been extensive in the field of pulmonary vascular biology, especially at the cellular and molecular level. Guidance from this advisory board coupled with coursework in molecular and cellular techniques will allow him to advance his studies of pulmonary angiogenesis and alveolarization. In addition, Dr. Balasubramaniam will continue to work with Dr. Charles Plopper (UC Davis) to learn more sophisticated techniques of morphometric analysis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: WOMEN'S HEALTH IN CYSTIC FIBROSIS Principal Investigator & Institution: Billings, Joanne L.; Medicine; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 05-JUL-2001; Project End 30-JUN-2006 Summary: Dr. Billings is a fourth year pulmonary and critical care fellow at the University of Minnesota who will become an Instructor of Medicine on July 1, 2000. Her long term goal is to develop an independent academic career combining clinical research with clinical medicine. Her primary research and clinical field will be in cystic fibrosis (CF). The proposed career development plan combines an intense interdisciplinary patient-- oriented research experience in association with a comprehensive structured didactic curriculum. The candidate is particularly interested in the health of women with CF. Data from patients seen at the University of Minnesota CF Center demonstrate greater mortality in women compared to men which appears to increase near the time of puberty. Dr. Billings will explore the hypothesis that estrogen and progesterone may have a negative impact on CF lung disease. The present study will examine lung function during the follicular and luteal phases of the menstrual cycle in normally menstruating young women with CF. Lung function of women with CF on birth control pills will be compared to those who are not. Pilot information on the effect of menopause on lung function, bone health, lipid levels and cardiovascular disease will also be obtained. If there is evidence of hormonal influence on pulmonary function, there may be future therapeutic implications and the potential to improve survival in women with CF. The Mentored Patient-Oriented Development Award affords the opportunity for the PI to translate existing knowledge of cohort study design into the practical application of study conduct and implementation. The applicant will pursue additional courses in the School of Public Health in the areas of clinical research, biostatistics and ethics. She will have the opportunity to expand her knowledge of endocrinology and metabolism as well as research methodology with this study of women's health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “critical care” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for critical care in the PubMed Central database: •

13th Annual Congress of the European Society of Intensive Care Medicine, Rome, Italy, 1-4 October 2000. by Smith D.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137262

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22nd International Symposium on Intensive Care and Emergency Medicine, Brussels, Belgium, 19 --22 March 2002. by Ball J, Venn R, Williams G, Forni L.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137453

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Adherence to advance directives in critical care decision making: vignette study. by Thompson T, Barbour R, Schwartz L.; 2003 Nov 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=261651

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Alarms in the intensive care unit: how can the number of false alarms be reduced? by Chambrin MC.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137277

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Application of typing by pulsed-field gel electrophoresis to the study of Clostridium difficile in a neonatal intensive care unit. by Kato H, Kato N, Watanabe K, Ueno K, Ushijima H, Hashira S, Abe T.; 1994 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=263943

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Assessment of performance of four mortality prediction systems in a Saudi Arabian intensive care unit. by Arabi Y, Haddad S, Goraj R, Al-Shimemeri A, Al-Malik S.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=111184

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Assessment of six mortality prediction models in patients admitted with severe sepsis and septic shock to the intensive care unit: a prospective cohort study. by Arabi Y, Shirawi NA, Memish Z, Venkatesh S, Al-Shimemeri A.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=270727

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Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled trials. by Messori A, Trippoli S, Vaiani M, Gorini M, Corrado A.; 2000 Nov 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27516

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Blending science and compassion: The 30th educational symposium of the Society of Critical Care Medicine, San Francisco, USA, 10-14 February 2001. by Smith D.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137270

3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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•

Canada has its first chair in critical care medicine. by [No authors listed]; 2000 Aug 22; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80386

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Candida tropicalis in a Neonatal Intensive Care Unit: Epidemiologic and Molecular Analysis of an Outbreak of Infection with an Uncommon Neonatal Pathogen. by Roilides E, Farmaki E, Evdoridou J, Francesconi A, Kasai M, Filioti J, Tsivitanidou M, Sofianou D, Kremenopoulos G, Walsh TJ.; 2003 Feb; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=149715

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Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database. by Harrison DA, Brady AR, Rowan K.; 2004; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=420043

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Characteristics and outcome for admissions to adult, general critical care units with acute severe asthma: a secondary analysis of the ICNARC Case Mix Programme Database. by Gupta D, Keogh B, Chung KF, Ayres JG, Harrison DA, Goldfrad C, Brady AR, Rowan K.; 2004; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=420044

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Clinical review: Complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. by Scheer BV, Perel A, Pfeiffer UJ.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137445

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Clinical review: Hemodynamic monitoring in the intensive care unit. by Boldt J.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137397

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Comparative analysis of serum antibody responses to Pseudomonas aeruginosa exotoxin A by cystic fibrosis and intensive care unit patients. by Cukor G, Blacklow NR, Nowak NA, Rich CM, Braverman LE, Fischer RA.; 1983 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=270833

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Comparison of Strategies Using Cefpirome and Ceftazidime for Empiric Treatment of Pneumonia in Intensive Care Patients. by Wolff M.; 1998 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=105451

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Comparison of sufentanil with sufentanil plus magnesium sulphate for sedation in the intensive care unit using bispectral index. by Memis D, Turan A, Karamanlijoglu B, Oguzhan N, Pamukcu Z.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=270723

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Computerized clinical documentation system in the pediatric intensive care unit. by Menke JA, Broner CW, Campbell DY, McKissick MY, Edwards-Beckett JA.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=57982

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Consensus guidelines on analgesia and sedation in dying intensive care unit patients. by Hawryluck LA, Harvey WR, Lemieux-Charles L, Singer PA.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=122088

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Continuous haemofiltration in the intensive care unit. by Bellomo R, Ronco C.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137261

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Cost of intensive care in a Norwegian University hospital 1997 --1999. by Flaatten H, Kvale R.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=154120

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Costs and risk factors for ventilator-associated pneumonia in a Turkish University Hospital's Intensive Care Unit: A case-control study. by Erbay RH, Yalcin AN, Zencir M, Serin S, Atalay H.; 2004; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=419357

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Critical care at the electronic frontier of the 21st century: Report from the 29th Educational and Scientific Symposium of the Society of Critical Care Medicine, Orlando, USA, 11-15 February 2000. by Smith D.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137333

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Echocardiography: a fundamental part of the intensive care curriculum. by Ribeiro JP, Marcelino P, Marum S, Fernandes AP.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137297

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Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. by Ball C, Kirkby M, Williams S.; 2003 Nov 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=261652

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Eighth World Congress of Intensive and Critical Care Medicine, 28 October-1 November 2001, Sydney, Australia: Harm minimization and effective risk management. by Ramakrishnan N.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137401

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Emergency airway management by intensive care unit nurses with the intubating laryngeal mask airway and the laryngeal tube. by Dorges V, Wenzel V, Neubert E, Schmucker P.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=29051

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Ethics and critical care in the new millennium. by Hawryluck L, Crippen D.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137385

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European Society of Intensive Care Medicine 14th Annual Congress, 30 September-3 October 2001, Geneva, Switzerland. by Preiser JC.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137382

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Gamma radiation-sterilized, triple-lumen catheters coated with a low concentration of chlorhexidine were not efficacious at preventing catheter infections in intensive care unit patients. by Sherertz RJ, Heard SO, Raad II, Gentry L, Bowton D, Scuderi P, Hu J, Carruth W, Satishchandra B, Pepe J, Mosenthal A, Burke T, Dupuis J.; 1996 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=163461

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Helium oxygen mixtures in the intensive care unit. by Chevrolet JC.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137275

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ICUs worldwide: An overview of critical care medicine in South Africa. by Mathivha LR.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137393

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Informed consent and research design in critical care medicine. by Truog RD.; 1999; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137230

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Instruments for monitoring intensive care unit sedation. by Carrasco G.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=150039

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Introducing Critical Care Forum's ongoing review of medical statistics. by Whitley E, Ball J.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137386

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Life-sustaining treatment decisions in Portuguese intensive care units: a national survey of intensive care physicians. by Cardoso T, Fonseca T, Pereira S, Lencastre L.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=374362

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Life-threatening brain failure and agitation in the intensive care unit. by Crippen D.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137331

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Managing death in the intensive care unit: bringing back the humanity. by Hawryluck L.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137298

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Need for critical care in gynaecology: a population-based analysis. by Heinonen S, Tyrvainen E, Penttinen J, Saarikoski S, Ruokonen E.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=125319

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On the Edge of Life, I: Assessment of, Reaction to, and Management of the Terminally Ill Recorded in an Intensive Care Unit Journal. by Sekeres MA, Stern TA.; 2002 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=327132

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Optimizing antibiotic therapy in the intensive care unit setting. by Kollef MH.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137278

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Outbreak of Infections Caused by Enterobacter cloacae Producing the IntegronAssociated [beta]-Lactamase IBC-1 in a Neonatal Intensive Care Unit of a Greek Hospital. by Kartali G, Tzelepi E, Pournaras S, Kontopoulou C, Kontos F, Sofianou D, Maniatis AN, Tsakris A.; 2002 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=127152

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Paper reports: Combating the invasion of intensive care literature. by Venn R, Philips B.; 1999; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137241

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Patient-to-patient spread of a single strain of Corynebacterium striatum causing infections in a surgical intensive care unit. by Brandenburg AH, van Belkum A, van Pelt C, Bruining HA, Mouton JW, Verbrugh HA.; 1996 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=229195

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Performance of the score systems Acute Physiology and Chronic Health Evaluation II and III at an interdisciplinary intensive care unit, after customization. by Markgraf R, Deutschinoff G, Pientka L, Scholten T, Lorenz C.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=29054

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Predisposing factors for delirium in the surgical intensive care unit. by Aldemir M, Ozen S, Kara IH, Sir A, Bac B.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=83853

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Prior antimicrobial therapy in the hospital and other predisposing factors influencing the usage of antibiotics in a pediatric critical care unit. by Briassoulis G, Natsi L, Tsorva A, Hatzis T.; 2004; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=419365

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Protocol-driven care in the intensive care unit: a tool for quality. by Wall RJ, Dittus RS, Ely EW.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137367

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Rational use of computerized protocols in the intensive care unit. by Morris AH.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137284

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Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model. by Daly K, Beale R, Chang RW.; 2001 May 26; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=31921

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Research ethics in the intensive care unit: current and future challenges. by Hawryluck L.; 2004; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=420023

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Stability and Compatibility of Ceftazidime Administered by Continuous Infusion to Intensive Care Patients. by Servais H, Tulkens PM.; 2001 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=90707

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Survival of patients transferred to tertiary intensive care from rural community hospitals. by Surgenor SD, Corwin HL, Clerico T.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=30715

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The 21st International Symposium on Intensive Care and Emergency Medicine, Brussels, Belgium, 20-23 March 2001. by Ball J, Venn R.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137274

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The 26th Congress of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine, Tromso, Norway, 13-17 June 2001. by [No authors listed]; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137280

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The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. by Cook DJ, Griffith LE, Walter SD, Guyatt GH, Meade MO, Heyland DK, Kirby A, Tryba M.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=83859

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The World Trade Center Attack: Is critical care prepared for terrorism? by Kvetan V.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137380

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Toronto Critical Care Medicine Symposium, 18 --20 October 2001, Canada: Research breakthroughs are not enough. by Needham D, Santos CD.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=137383

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Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. by BalcI C, Sungurtekin H, Gurses E, Sungurtekin U, Kaptanoglu B.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=154110

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Utility of postintubation chest radiographs in the intensive care unit. by Lotano R, Gerber D, Aseron C, Santarelli R, Pratter M.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=29036

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Utility of routine chest radiographs in a medical --surgical intensive care unit: a quality assurance survey. by Chahine-Malus N, Stewart T, Lapinsky SE, Marras T, Dancey D, Leung R, Mehta S.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=83854

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Variation in red cell transfusion practice in the intensive care unit: a multicentre cohort study. by Hebert PC, Wells G, Martin C, Tweeddale M, Marshall J, Blajchman M, Pagliarello G, Sandham D, Schweitzer I, Boisvert D, Calder L, for the Transfusion Requirements in Critical Care (TRICC) Investigators and the Canadian Critical Care Trials Group.; 1999; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=29015

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Ventilator-associated pneumonia in a surgical intensive care unit: epidemiology, etiology and comparison of three bronchoscopic methods for microbiological specimen sampling. by Woske HJ, Roding T, Schulz I, Lode H.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=31581

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What factors are associated with decisions to withdraw mechanical ventilation in the intensive care unit? by Mahambrey T, Fowler R.; 2004 Feb 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=332711

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with critical care, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “critical care” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for critical care (hyperlinks lead to article summaries): •

A blueprint for obstetric critical care. Author(s): Zeeman GG, Wendel GD Jr, Cunningham FG. Source: American Journal of Obstetrics and Gynecology. 2003 February; 188(2): 532-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12592267

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A method of transporting critical care mass casualties. Author(s): Hudson TL, Weichart T. Source: Disaster Management & Response : Dmr : an Official Publication of the Emergency Nurses Association. 2002 September; : 26-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12685464

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A response to 'Consent for observational studies in critical care: time to open Pandora's box', Reade MC, Young JD, Anaesthesia 2003; 58: 1-3. Author(s): Shaw A, Riedel B. Source: Anaesthesia. 2003 June; 58(6): 617. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12846656

6

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A response to 'Impact of an outreach team on re-admissions to a critical care unit', Leary T, Ridley S, Anaesthesia 2003; 58: 328-32. Author(s): Brown C, Edwards G, Baker P. Source: Anaesthesia. 2003 August; 58(8): 828. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12859514

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A response to 'Impact of an outreach team on re-admissions to a critical care unit', Leary T, Ridley S, Anaesthesia 2003; 58: 328-32. Author(s): Brown J. Source: Anaesthesia. 2003 August; 58(8): 828. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12859513

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A response to 'Syringe labelling in critical care areas', Souter A, Anaesthesia 2003; 58: 713. Author(s): Puttick N. Source: Anaesthesia. 2003 November; 58(11): 1149. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14616643

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Absence of ageism in access to critical care: a cross-sectional study. Author(s): Hubbard RE, Lyons RA, Woodhouse KW, Hillier SL, Wareham K, Ferguson B, Major E. Source: Age and Ageing. 2003 July; 32(4): 382-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12851180

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Achieving collaborative workplace learning in a university critical care course. Author(s): Manias E, Aitken R. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2003 February; 19(1): 50-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12590894

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Adherence to advance directives in critical care decision making: vignette study. Author(s): Thompson T, Barbour R, Schwartz L. Source: Bmj (Clinical Research Ed.). 2003 November 1; 327(7422): 1011. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14593032

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Adult toxicology in critical care: part I: general approach to the intoxicated patient. Author(s): Mokhlesi B, Leiken JB, Murray P, Corbridge TC. Source: Chest. 2003 February; 123(2): 577-92. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12576382

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Adult toxicology in critical care: Part II: specific poisonings. Author(s): Mokhlesi B, Leikin JB, Murray P, Corbridge TC. Source: Chest. 2003 March; 123(3): 897-922. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12628894

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Advances in critical care hepatology. Author(s): Marrero J, Martinez FJ, Hyzy R. Source: American Journal of Respiratory and Critical Care Medicine. 2003 December 15; 168(12): 1421-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14668256

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Advances in the understanding of clinical manifestations and therapy of severe sepsis: an update for critical care nurses. Author(s): Ely EW, Kleinpell RM, Goyette RE. Source: American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. 2003 March; 12(2): 120-33; Quiz 134-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12625170

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All nurses should have an understanding of critical care. Author(s): Scott H. Source: British Journal of Nursing (Mark Allen Publishing). 2003 February 27-March 12; 12(4): 204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12671563

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An appraisal of multivariable logistic models in the pulmonary and critical care literature. Author(s): Moss M, Wellman DA, Cotsonis GA. Source: Chest. 2003 March; 123(3): 923-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12628895

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An evaluation of critical care lecturer practitioners. Author(s): Richardson A, Turnock C. Source: Nursing in Critical Care. 2003 November-December; 8(6): 240-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14725389

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An outcomes approach to skill mix change in critical care. Author(s): Ringerman ES, Ventura S. Source: Nursing Management. 2000 October; 31(10): 42-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15127557

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Analysis of end-of-life content in critical care nursing textbooks. Author(s): Kirchhoff KT, Beckstrand RL, Anumandla PR. Source: Journal of Professional Nursing : Official Journal of the American Association of Colleges of Nursing. 2003 November-December; 19(6): 372-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14689394

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Antimicrobial strategies in surgical critical care. Author(s): Imahara SD, Nathens AB. Source: Current Opinion in Critical Care. 2003 August; 9(4): 286-91. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12883283

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Applying personal reflective critical incident reviews in critical care. Author(s): Ihlenfeld JT. Source: Dimensions of Critical Care Nursing : Dccn. 2004 January-February; 23(1): 1-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14734893

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Bacterial meningitis in children: critical care needs. Author(s): Singhi S, Singhi P, Baranwal AK. Source: Indian J Pediatr. 2001 August; 68(8): 737-47. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11563252

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Basic research on respiratory mechanics related to anaesthesia and critical care. Author(s): Zin WA. Source: Minerva Anestesiol. 2000 September; 66(9): 603-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11070959

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Bedside chest radiography as part of a postcardiac surgery critical care pathway: a means of decreasing utilization without adverse clinical impact. Author(s): Leong CS, Cascade PN, Kazerooni EA, Bolling SF, Deeb GM. Source: Critical Care Medicine. 2000 February; 28(2): 383-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10708171

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Benchmarking in critical care: the road ahead. Author(s): Glance LG, Szalados JE. Source: Chest. 2002 February; 121(2): 326-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11834638

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Best evidence in critical care medicine: Therapeutic hypothermia to improve neurologic outcome after cardiac arrest. Author(s): Olafson K, Selaman M, Easton DW. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2004 January; 51(1): 76-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14709466

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Best evidence in critical care medicine: Treatment: Adrenal replacement therapy improves survival in patients with septic shock. Author(s): Meggison H, Jones G. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2004 March; 51(3): 264-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15010411

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Beyond morbidity and mortality: quality of life outcomes in critical care patients. Author(s): Grady KL. Source: Critical Care Medicine. 2001 September; 29(9): 1844-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11547004

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Beyond the essentials. Teaching critical care to undergraduate and graduate students in nursing. Author(s): Fontaine DK, Norton C. Source: Critical Care Nursing Clinics of North America. 2001 March; 13(1): 13-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11863135

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Beyond the golden hour: avoiding the pitfalls from resuscitation to critical care. Author(s): Schinco M, Tepas JJ 3rd. Source: The Surgical Clinics of North America. 2002 April; 82(2): 325-32, Vi-Vii. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12113369

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Billing, coding, and documentation in the critical care environment. Author(s): Fakhry SM. Source: The Surgical Clinics of North America. 2000 June; 80(3): 1067-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10897279

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Bioethical issues in critical care nephrology. Author(s): Zamperetti N, Ronco C, Bellomo R, Reiter K. Source: Nephron. 2002 May; 91(1): 2-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12021512

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Bioterrorism and critical care. Author(s): Karwa M, Bronzert P, Kvetan V. Source: Critical Care Clinics. 2003 April; 19(2): 279-313. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12699324

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Blending science and compassion: the 30th educational symposium of the Society of Critical Care Medicine, San Francisco, USA, 10-14 February 2001. Author(s): Smith D. Source: Critical Care (London, England). 2001; 5(2): 72-6. Epub 2001 March 07. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11299065

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Blood cultures in the critical care unit: improving utilization and yield. Author(s): Shafazand S, Weinacker AB. Source: Chest. 2002 November; 122(5): 1727-36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12426278

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Blood management strategies for critical care patients. Author(s): Vernon S, Pfeifer GM. Source: Critical Care Nurse. 2003 December; 23(6): 34-41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14692170

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Botulism in critical care: a case study in wound botulism. Author(s): Baymiller S. Source: American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. 2001 May; 10(3): 172-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11340740

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Brain tissue oxygen monitoring in severe brain injury, I. Research and usefulness in critical care. Author(s): Littlejohns LR, Bader MK, March K. Source: Critical Care Nurse. 2003 August; 23(4): 17-25; Quiz 26-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12961780

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Brain tissue oxygen monitoring in severe brain injury, II. Implications for critical care teams and case study. Author(s): Bader MK, Littlejohns LR, March K. Source: Critical Care Nurse. 2003 August; 23(4): 29-38, 40-2, 44. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12961781

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Bringing health services research to (and from) critical care. Author(s): Lavis JN, Keenan SP. Source: Journal of Critical Care. 2001 December; 16(4): 127-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11815896

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Building a framework for getting evidence into critical care education and practice. Author(s): Thomson P, Angus NJ, Scott J. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2000 June; 16(3): 164-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10859625

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Care bundles in critical care: a practical approach to evidence-based practice. Author(s): Fulbrook P, Mooney S. Source: Nursing in Critical Care. 2003 November-December; 8(6): 249-55. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14725390

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Challenges of implementing pharmacogenetics in the critical care environment. Author(s): Freeman BD, McLeod HL. Source: Nature Reviews. Drug Discovery. 2004 January; 3(1): 88-93. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14708023

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Children with cancer, fever, and treatment-induced neutropenia: risk factors associated with illness requiring the administration of critical care therapies. Author(s): West DC, Marcin JP, Mawis R, He J, Nagle A, Dimand R. Source: Pediatric Emergency Care. 2004 February; 20(2): 79-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14758303

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Choosing a volume expander in critical care medicine. Author(s): Kissoon N, Bohn D. Source: Indian J Pediatr. 2003 December; 70(12): 969-73. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719786

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Control group selection in critical care randomized controlled trials evaluating interventional strategies: An ethical assessment. Author(s): Silverman HJ, Miller FG. Source: Critical Care Medicine. 2004 March; 32(3): 852-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15090973

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Creativity: an essential element of critical care nursing practice. Author(s): Albarran JW. Source: Nursing in Critical Care. 2004 March-April; 9(2): 47-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15068053

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Critical care and emergency medicine neurology. Author(s): Hanley DF, Hacke W. Source: Stroke; a Journal of Cerebral Circulation. 2004 February; 35(2): 365-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14757881

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Critical care aspects of lung transplantation. Author(s): Lau CL, Patterson GA, Palmer SM. Source: Journal of Intensive Care Medicine. 2004 March-April; 19(2): 83-104. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15070519

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Critical care infectious disease. Author(s): Gainer JA, Yost NP. Source: Obstetrics and Gynecology Clinics of North America. 2003 December; 30(4): 695709, Vii. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719846

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Critical care lessons from severe acute respiratory syndrome. Author(s): Lapinsky SE, Granton JT. Source: Current Opinion in Critical Care. 2004 February; 10(1): 53-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15166850

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Critical care medicine as a distinct product line with substantial financial profitability: the role of business planning. Author(s): Bekes CE, Dellinger RP, Brooks D, Edmondson R, Olivia CT, Parrillo JE. Source: Critical Care Medicine. 2004 May; 32(5): 1207-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15190974

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Critical care medicine in AJRCCM 2003. Author(s): Tobin MJ. Source: American Journal of Respiratory and Critical Care Medicine. 2004 January 15; 169(2): 239-53. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14718238

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Critical care medicine mailing list: growth of an online forum. Author(s): DeWitt AL, Gunn SR, Hopkins P, Streat S. Source: Bmj (Clinical Research Ed.). 2004 May 15; 328(7449): 1180. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15142927

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Critical care myopathy: an emerging medical catastrophe. Author(s): Mozaffar T, Mozaffar FH. Source: J Pak Med Assoc. 2003 December; 53(12): 608-11. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14765943

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Critical care outreach team's effect on patient outcome: more information is needed. Author(s): Parker MR. Source: Bmj (Clinical Research Ed.). 2004 February 7; 328(7435): 347; Author Reply 347. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14764506

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Critical care outreach team's effect on patient outcome: other conclusions are possible. Author(s): Subbe CP. Source: Bmj (Clinical Research Ed.). 2004 February 7; 328(7435): 347; Author Reply 347. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14764507

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Critical care outreach--the story so far. Author(s): Welch J. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2004 February; 20(1): 1-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14726248

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Critical care teams managing floor patients: the continuing evolution of hospitals into intensive care units? Author(s): Szalados JE. Source: Critical Care Medicine. 2004 April; 32(4): 1071-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15071404

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Critical care: you are the future. Author(s): Parker MM. Source: Critical Care Medicine. 2004 May; 32(5): 1097-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15190956

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Cruel choices: autonomy and critical care decision-making. Author(s): Meyers C. Source: Bioethics. 2004 April; 18(2): 104-19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15146851

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Declining critical care research publications by authors from U.S. Institutions, 19901999. Author(s): Powner DJ, Kellum JA. Source: Academic Medicine : Journal of the Association of American Medical Colleges. 2001 December; 76(12): 1261-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11739055

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Defining the nursing contribution in critical care. Author(s): Ball C. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2001 April; 17(2): 65-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11817443

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Delays in implementing admission orders for critical care patients associated with length of stay in emergency departments in six mid-Atlantic states. Author(s): Clark K, Normile LB. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 2002 December; 28(6): 489-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12509725

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Delirium in the critical care patient: what the professional staff needs to know. Author(s): Litton KA. Source: Critical Care Nursing Quarterly. 2003 July-September; 26(3): 208-13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12930035

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Demystifying critical care: a new series provides a succinct, modern approach aimed at primary care physicians. Author(s): Rodriguez R. Source: The Western Journal of Medicine. 2001 December; 175(6): 366-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11733417

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Descriptive epidemiology of adult critical care transfers from the emergency department. Author(s): Gray A, Gill S, Airey M, Williams R. Source: Emergency Medicine Journal : Emj. 2003 May; 20(3): 242-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12748139

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Determination of medical necessity for air and critical care medical transportation. Author(s): Air Medical Physician Association. Source: Prehosp Emerg Care. 2003 July-September; 7(3): 400-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12879394

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Developing a competency framework for critical care to match patient need. Author(s): Bench S, Crowe D, Day T, Jones M, Wilebore S. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2003 June; 19(3): 136-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12765633

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Developing and evaluating critical care follow-up. Author(s): Cutler L, Brightmore K, Colqhoun V, Dunstan J, Gay M. Source: Nursing in Critical Care. 2003 May-June; 8(3): 116-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12859082

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Developing best practice in critical care nursing: knowledge, evidence and practice. Author(s): Fulbrook P. Source: Nursing in Critical Care. 2003 May-June; 8(3): 96-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12859079

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Developing postgraduate awards for critical care. Author(s): Saggs P. Source: Nurse Education Today. 2003 May; 23(4): 307-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12727098

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Development and evaluation of the critical care practitioner role. Author(s): Tripp C, Screaton M, Sharples LD, Kearsley N, Caine N. Source: Nursing in Critical Care. 2002 September-October; 7(5): 227-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12448504

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Development and implementation of a multi-centre information system for paediatric and infant critical care. Author(s): Maybloom B, Champion Z. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2003 December; 19(6): 326-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14637293

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Discrepancies between ordered and delivered concentrations of opiate infusions in critical care. Author(s): Parshuram CS, Ng GY, Ho TK, Klein J, Moore AM, Bohn D, Koren G. Source: Critical Care Medicine. 2003 October; 31(10): 2483-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14530755

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Discrepant attitudes about teamwork among critical care nurses and physicians. Author(s): Thomas EJ, Sexton JB, Helmreich RL. Source: Critical Care Medicine. 2003 March; 31(3): 956-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12627011

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Does caring for displaced specialty unit patients affect the critical care nurse's perceptions of ability and job satisfaction? Author(s): McGlory G, Burney M, Hargrave J, Luna S, Smith I, Wakhu D. Source: International Journal of Trauma Nursing. 2002 July-September; 8(3): 76-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12094157

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Double filtration plasmapheresis in critical care. Author(s): Mineshima M, Akiba T. Source: Therapeutic Apheresis : Official Journal of the International Society for Apheresis and the Japanese Society for Apheresis. 2002 June; 6(3): 180-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12109939

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Editorial overview: current opinion in critical care-renal problems. Author(s): Lameire N. Source: Current Opinion in Critical Care. 2003 December; 9(6): 465-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14639064

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Editorial: safety and critical care. Author(s): Etchells E, Baker R. Source: Journal of Critical Care. 2002 June; 17(2): 76-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12096369

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Education, training, and use of unlicensed assistive personnel in critical care. Author(s): Spencer HA. Source: Critical Care Nursing Clinics of North America. 2001 March; 13(1): 105-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11863133

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Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. Author(s): Ball C, Kirkby M, Williams S. Source: Bmj (Clinical Research Ed.). 2003 November 1; 327(7422): 1014. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14593033

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Eighth World Congress of Intensive and Critical Care Medicine, 28 October-1 November 2001, Sydney, Australia: Harm minimization and effective risk management. Author(s): Ramakrishnan N. Source: Critical Care (London, England). 2002 February; 6(1): 89-91. Epub 2001 November 28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11940273

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Emergence of resistant microbes in critical care units is transient, despite an unrestricted formulary and multiple antibiotic trials. Author(s): Franklin GA, Moore KB, Snyder JW, Polk HC Jr, Cheadle WG. Source: Surgical Infections. 2002 Summer; 3(2): 135-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12519480

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Empathy: a challenge for critical care. Author(s): Dracup K, Bryan-Brown CW. Source: American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. 1999 July; 8(4): 204-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10392218

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Enteral naloxone reduces gastric tube reflux and frequency of pneumonia in critical care patients during opioid analgesia. Author(s): Meissner W, Dohrn B, Reinhart K. Source: Critical Care Medicine. 2003 March; 31(3): 776-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12626983

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Ethical issues from critical care to rehabilitation. A challenge for specialty nurses. Author(s): Bjarnason D, Lehman C. Source: Critical Care Nursing Clinics of North America. 2001 September; 13(3): 341-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11855264

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Ethical problems in pediatric critical care: consent. Author(s): Zawistowski CA, Frader JE. Source: Critical Care Medicine. 2003 May; 31(5 Suppl): S407-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12771592

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Ethics and critical care in the new millennium. Author(s): Hawryluck L, Crippen D. Source: Critical Care (London, England). 2002 February; 6(1): 1-2. Epub 2002 January 11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11940254

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Ethics, science, and oversight of critical care research: the Office for Human Research Protections. Author(s): Koski G. Source: American Journal of Respiratory and Critical Care Medicine. 2004 May 1; 169(9): 982-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15107303

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Etomidate, adrenal dysfunction and critical care. Author(s): Roberts RG, Redman JW. Source: Anaesthesia. 2002 April; 57(4): 413. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11940006

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Evacuation of a critical care unit. Author(s): Cybulski P. Source: Dynamics. 2003 Fall; 14(3): 21-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14725143

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Evaluation of a noninvasive method for cardiac output measurement in critical care patients. Author(s): Murias GE, Villagra A, Vatua S, del Mar Fernandez M, Solar H, Ochagavia A, Fernandez R, Lopez Aguilar J, Romero PV, Blanch L. Source: Intensive Care Medicine. 2002 October; 28(10): 1470-4. Epub 2002 September 04. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12373473

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Evidence based practice: are critical care nurses ready for it? Author(s): Bucknall T, Copnell B, Shannon K, McKinley D. Source: Aust Crit Care. 2001 August; 14(3): 92-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11899640

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Evidence-based education and the evaluation of a critical care course. Author(s): Wynd C. Source: Journal of Continuing Education in Nursing. 2002 May-June; 33(3): 119-25; Quiz 142-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12046713

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Examining critical care nurses' critical incident stress after in hospital cardiopulmonary resuscitation (CPR). Author(s): Laws T. Source: Aust Crit Care. 2001 May; 14(2): 76-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11899445

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Expanding a performance improvement initiative in critical care from hospital to system. Author(s): Dlugacz YD, Stier L, Lustbader D, Jacobs MC, Hussain E, Greenwood A. Source: Jt Comm J Qual Improv. 2002 August; 28(8): 419-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12174407

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Exploring the critical care nurses' experiences regarding moonlighting. Author(s): Bhengu BR. Source: Curationis. 2001 May; 24(2): 48-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11885476

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Factors influencing job valuation: a comparative study of critical care and non-critical care nurses. Author(s): Chaboyer W, Najman J, Dunn S. Source: International Journal of Nursing Studies. 2001 April; 38(2): 153-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11223056

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Families and critical care. Interview by Alison Paladichuk. Author(s): Stannard D. Source: Critical Care Nurse. 1998 August; 18(4): 86-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9814191

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Families in pediatric critical care: the best option. Author(s): Giganti AW. Source: Pediatric Nursing. 1998 May-June; 24(3): 261-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9987428

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Family and pet visitation in the critical care unit. Author(s): Cullen L, Titler M, Drahozal R. Source: Critical Care Nurse. 1999 June; 19(3): 84-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10661096

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Family member presence during cardiopulmonary resuscitation: a survey of US and international critical care professionals. Author(s): McClenathan BM, Torrington KG, Uyehara CF. Source: Chest. 2002 December; 122(6): 2204-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12475864

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Family presence during cardiopulmonary resuscitation and invasive procedures: practices of critical care and emergency nurses. Author(s): Maclean SL, Guzzetta CE, White C, Fontaine D, Eichhorn DJ, Meyers TA, Desy P. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 2003 June; 29(3): 208-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12776076

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Family presence during cardiopulmonary resuscitation and invasive procedures: practices of critical care and emergency nurses. Author(s): MacLean SL, Guzzetta CE, White C, Fontaine D, Eichhorn DJ, Meyers TA, Desy P. Source: American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. 2003 May; 12(3): 246-57. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12751400

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Family-centered critical care: a practical approach to making it happen. Author(s): Henneman EA, Cardin S. Source: Critical Care Nurse. 2002 December; 22(6): 12-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12518563

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Final version of the Critical Care Family Satisfaction Survey questionnaire. Author(s): Wasser T, Matchett S. Source: Critical Care Medicine. 2001 August; 29(8): 1654-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11505160

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Financing critical care medicine in 2010. Author(s): Gipe B. Source: Cost Qual. 1999 December; 5(4): 14-26. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11066611

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Fluid resuscitation in critical care. Author(s): O'Neill D, Perrin D. Source: Nurs Times. 2002 September 10-16; 98(37): 39-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12271714

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Fluorescent optical sensors for critical care analytes. Author(s): Tusa JK, Leiner MJ. Source: Annales De Biologie Clinique. 2003 March-April; 61(2): 183-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12702473

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Forging links in critical care. Interview by Janis Smy. Author(s): Harriss S. Source: Nurs Times. 2004 March 16-22; 100(11): 26-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15060963

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Fostering hope in the elderly congestive heart failure patient in critical care. Author(s): Roberts SL, Johnson LH, Keely B. Source: Geriatric Nursing (New York, N.Y.). 1999 July-August; 20(4): 195-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10711090

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Frequency and methodologic rigor of quality-of-life assessments in the critical care literature. Author(s): Heyland DK, Guyatt G, Cook DJ, Meade M, Juniper E, Cronin L, Gafni A. Source: Critical Care Medicine. 1998 March; 26(3): 591-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9504591

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Frequency of heparin-induced thrombocytopenia in critical care patients. Author(s): Verma AK, Levine M, Shalansky SJ, Carter CJ, Kelton JG. Source: Pharmacotherapy. 2003 June; 23(6): 745-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12820817

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From the family perspective: critical care nurses are a critical link in organ donation. Author(s): Moritsugu KP. Source: Critical Care Nurse. 1999 April; 19(2): 14, 18, 112. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10401298

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From ward-based critical care to educational curriculum 1: a literature review. Author(s): Cutler LR. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2002 June; 18(3): 162-70. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12405271

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From ward-based critical care to educational curriculum 2: a focussed ethnographic case study. Author(s): Cutler LR. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2002 October; 18(5): 280-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12487434

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Fundamental critical care support: another merit badge or more? Author(s): Dellinger RP. Source: Critical Care Medicine. 1996 April; 24(4): 556-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8612403

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Gaining funding for critical care nursing research. Author(s): McKinley S. Source: Aust Crit Care. 2003 November; 16(4): 124-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14692156

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Gastric tonometry and enteral nutrition: a possible conflict in critical care nursing practice. Author(s): Marshall AP, West SH. Source: American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. 2003 July; 12(4): 349-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12882066

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Gastrointestinal promotility drugs in the critical care setting: a systematic review of the evidence. Author(s): Booth CM, Heyland DK, Paterson WG. Source: Critical Care Medicine. 2002 July; 30(7): 1429-35. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12130957

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Gender influences handwashing rates in the critical care unit. Author(s): van de Mortel T, Bourke R, McLoughlin J, Nonu M, Reis M. Source: American Journal of Infection Control. 2001 December; 29(6): 395-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11743487

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General anaesthesia for dental treatment in a hospital setting with critical care facilities. A letter from the Department of Health, 31 May 2001. Author(s): Seward M; Department of Health. Source: Saad Dig. 2001 July; 18(3): 20-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11862650

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Genomics and critical care: do the right thing! Author(s): Stuber F. Source: Critical Care Medicine. 2003 June; 31(6): 1869-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12794437

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Geriatric critical care. Author(s): Nagappan R, Parkin G. Source: Critical Care Clinics. 2003 April; 19(2): 253-70. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12699322

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Giving postanesthesia care in the critical care unit. Author(s): Wilson M. Source: Dimensions of Critical Care Nursing : Dccn. 2000 March-April; 19(2): 38-43. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10876499

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Global presence: USAF aeromedical evacuation and critical care air transport. Author(s): Pierce PF, Evers KG. Source: Critical Care Nursing Clinics of North America. 2003 June; 15(2): 221-31. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12755188

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Guidance for nurse staffing in critical care. Author(s): Galley J, O'Riordan B; Royal College of Nursing. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2003 October; 19(5): 257-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14584502

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Guidelines for critical care and the elderly: the search continues. Author(s): Rush P. Source: Critical Care Medicine. 1997 October; 25(10): 1619-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9377866

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Guidelines for critical care medicine training and continuing medical education. Author(s): Dorman T, Angood PB, Angus DC, Clemmer TP, Cohen NH, Durbin CG Jr, Falk JL, Helfaer MA, Haupt MT, Horst HM, Ivy ME, Ognibene FP, Sladen RN, Grenvik AN, Napolitano LM; American College of Critical Care Medicine. Source: Critical Care Medicine. 2004 January; 32(1): 263-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14707590

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Guidelines for critical care services and personnel-Innovations and improvements in patient care? Author(s): Graf J. Source: Critical Care Medicine. 2003 November; 31(11): 2709-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14605552

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Guidelines on admission and discharge for adult intermediate care units. American College of Critical Care Medicine of the Society of Critical Care Medicine. Author(s): Nasraway SA, Cohen IL, Dennis RC, Howenstein MA, Nikas DK, Warren J, Wedel SK. Source: Critical Care Medicine. 1998 March; 26(3): 607-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9504593

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Guidelines on critical care services and personnel: Recommendations based on a system of categorization of three levels of care. Author(s): Haupt MT, Bekes CE, Brilli RJ, Carl LC, Gray AW, Jastremski MS, Naylor DF, PharmD MR, Md AS, Wedel SK, Md MH; Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Source: Critical Care Medicine. 2003 November; 31(11): 2677-83. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14605541

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Haemodynamic monitoring with pulse-induced contour cardiac output (PiCCO) in critical care. Author(s): Cottis R, Magee N, Higgins DJ. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2003 October; 19(5): 301-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14516759

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Hand carried echocardiography in the critical care setting. Author(s): Spevack DM, Spevack DM, Tunick PA, Kronzon I. Source: Echocardiography (Mount Kisco, N.Y.). 2003 July; 20(5): 455-61. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12848868

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Handheld computers in critical care. Author(s): Lapinsky SE, Weshler J, Mehta S, Varkul M, Hallett D, Stewart TE. Source: Critical Care (London, England). 2001 August; 5(4): 227-31. Epub 2001 July 02. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11511337

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Health care support workers in the critical care setting. Author(s): Hind M, Jackson D, Andrewes C, Fulbrook P, Galvin K, Frost S. Source: Nursing in Critical Care. 2000 January-February; 5(1): 31-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11111636

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Heart rate variability in critical care medicine. Author(s): Gang Y, Malik M. Source: Current Opinion in Critical Care. 2002 October; 8(5): 371-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12357103

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Heart rate variability in critical illness and critical care. Author(s): Buchman TG, Stein PK, Goldstein B. Source: Current Opinion in Critical Care. 2002 August; 8(4): 311-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12386491

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Heat stroke: implications for critical care and anaesthesia. Author(s): Grogan H, Hopkins PM. Source: British Journal of Anaesthesia. 2002 May; 88(5): 700-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12067009

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Heel ulcers in critical care units: a major pressure problem. Author(s): Burdette-Taylor SR, Kass J. Source: Critical Care Nursing Quarterly. 2002 August; 25(2): 41-53. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12211335

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Hemoadsorption in critical care. Author(s): Ikeda T. Source: Therapeutic Apheresis : Official Journal of the International Society for Apheresis and the Japanese Society for Apheresis. 2002 June; 6(3): 189-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12109941

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Herpes simplex virus in the respiratory tract of critical care patients: a prospective study. Author(s): Bruynseels P, Jorens PG, Demey HE, Goossens H, Pattyn SR, Elseviers MM, Weyler J, Bossaert LL, Mentens Y, Ieven M. Source: Lancet. 2003 November 8; 362(9395): 1536-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14615108

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High-Tech home care: an expanding critical care frontier. Author(s): McNeal GJ. Source: Critical Care Nurse. 1996 October; 16(5): 51-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9004588

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How critical care nurses identify and meet the needs of visitors to intensive care units. Author(s): Priestley M. Source: Nursing in Critical Care. 1999 January-February; 4(1): 27-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10358541

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How to keep up with the critical care literature and avoid being buried alive. Author(s): Cook DJ, Meade MO, Fink MP. Source: Critical Care Medicine. 1996 October; 24(10): 1757-68. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8874317

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How will certification in critical care be of benefit to an organization? Author(s): Rashotte J. Source: Dynamics. 2003 Spring; 14(1): 14. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12800766

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Human factors: imperative concepts for information systems in critical care. Author(s): Staggers N. Source: Aacn Clinical Issues. 2003 August; 14(3): 310-9; Quiz 397-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12909799

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Humor in critical care: no joke. Author(s): Buxman K. Source: Aacn Clinical Issues. 2000 February; 11(1): 120-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11040558

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Humour--a critical faculty in critical care nursing? Author(s): Ashworth P. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 1999 October; 15(5): 245-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10808820

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ICUs worldwide: critical care in India. Author(s): Prayag S. Source: Critical Care (London, England). 2002 December; 6(6): 479-80. Epub 2002 August 06. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12493068

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Impact of an outreach team on re-admissions to a critical care unit. Author(s): Leary T, Ridley S. Source: Anaesthesia. 2003 April; 58(4): 328-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12648113

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Impact of body mass index on outcomes following critical care. Author(s): Tremblay A, Bandi V. Source: Chest. 2003 April; 123(4): 1202-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12684312

Studies

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Implementation of preoperative visiting for critical care patients. Author(s): Daykin S. Source: Nurs Times. 2003 October 14-20; 99(41): 26-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14603654

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Implementing a critical care course for ward nurses. Author(s): O'Riordan B, Gray K, McArthur-Rouse F. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2003 January 29-February 4; 17(20): 41-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12629887

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Implementing clinical IT in critical care: keys to success. Author(s): Meadows G. Source: Nursing Economic$. 2003 March-April; 21(2): 89-90, 93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12739200

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In response to 'Syringe labelling in critical care areas', Souter A, Anaesthesia 2003; 58: 713. Author(s): Russell WJ. Source: Anaesthesia. 2003 November; 58(11): 1149. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14616642

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Incorporating educational theory into critical care orientation. Author(s): Rashotte J, Thomas M. Source: Journal of Continuing Education in Nursing. 2002 May-June; 33(3): 131-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12046715

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Incorporation of a computerized human patient simulator in critical care training: a preliminary report. Author(s): Hammond J, Bermann M, Chen B, Kushins L. Source: The Journal of Trauma. 2002 December; 53(6): 1064-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12478029

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Induced hypothermia in critical care medicine: a review. Author(s): Bernard SA, Buist M. Source: Critical Care Medicine. 2003 July; 31(7): 2041-51. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12847402

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Innovation to research: some transitional obstacles in critical care units. Author(s): Morgenweck CJ. Source: Critical Care Medicine. 2003 March; 31(3 Suppl): S172-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12626964

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Integrated critical care: an approach to specialist cover for critical care in the rural setting. Author(s): O'Leary MJ. Source: The Medical Journal of Australia. 2003 November 3; 179(9): 510-2; Author Reply 512. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14583089

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Integrated critical care: an approach to specialist cover for critical care in the rural setting. Author(s): Hore CT, Lancashire W, Roberts JB, Fassett R. Source: The Medical Journal of Australia. 2003 July 21; 179(2): 95-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12864721

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Integration of critical care and palliative care at end of life. Author(s): Pattison N. Source: British Journal of Nursing (Mark Allen Publishing). 2004 February 12-25; 13(3): 132-6, 138-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14997074

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Interpretation of digital radiographs by pediatric critical care physicians using Webbased bedside personal computers versus diagnostic workstations. Author(s): Sterling L, Tait GA, Edmonds JF. Source: Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2003 January; 4(1): 26-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12656538

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Intravenous proton pump inhibitors in the critical care setting. Author(s): Morgan D. Source: Critical Care Medicine. 2002 June; 30(6 Suppl): S369-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12072664

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Introduction: theme articles on technology assessment in critical care. Author(s): Sibbald WJ. Source: Journal of Critical Care. 2003 March; 18(1): 38-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12640612

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Is critical care outreach proving to be a success? Author(s): Hartley J. Source: Nurs Times. 2003 October 28-November 3; 99(43): 10-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14626038

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Is propofol safe for procedural sedation in children? A prospective evaluation of propofol versus ketamine in pediatric critical care. Author(s): Vardi A, Salem Y, Padeh S, Paret G, Barzilay Z. Source: Critical Care Medicine. 2002 June; 30(6): 1231-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12072673

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Issues in preparedness for biologic terrorism: a perspective for critical care nursing. Author(s): O'Connell KP, Menuey BC, Foster D. Source: Aacn Clinical Issues. 2002 August; 13(3): 452-69. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12151997

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Judicious use of antimicrobials in the critical care setting. Author(s): Horner M. Source: Journal of Infusion Nursing : the Official Publication of the Infusion Nurses Society. 2004 March-April; 27(2): 79-84. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15085034

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Keeping 'care' in critical care nursing. Author(s): Blanchard D. Source: Nurs N Z. 2002 August; 8(7): 2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12244837

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Ketamine sedation for pediatric critical care procedures. Author(s): Green SM, Denmark TK, Cline J, Roghair C, Abd Allah S, Rothrock SG. Source: Pediatric Emergency Care. 2001 August; 17(4): 244-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11493822

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Knowledge and attitudes of critical care nurses regarding organ donation. Author(s): Molzahn AE. Source: Can J Cardiovasc Nurs. 1997; 8(2): 13-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9281922

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Knowledge attainment, perceptions, and professionalism in participants completing the didactic phase of an Army reserve critical care nursing residency program. Author(s): Wynd CA, Gotschall W. Source: Military Medicine. 2000 April; 165(4): 243-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10802992

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Lactic acidosis update for critical care clinicians. Author(s): Luft FC. Source: Journal of the American Society of Nephrology : Jasn. 2001 February; 12 Suppl 17: S15-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11251027

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Leapfrog and critical care: evidence- and reality-based intensive care for the 21st century. Author(s): Manthous CA. Source: The American Journal of Medicine. 2004 February 1; 116(3): 188-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14749164

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Learning to not know: results of a program for ancillary cost reduction in surgical critical care. Author(s): Barie PS, Hydo LJ. Source: The Journal of Trauma. 1996 October; 41(4): 714-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8858034

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Legal basis of decision-making in critical care. Author(s): Cornock M. Source: Nursing in Critical Care. 2002 September-October; 7(5): 235-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12448505

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Leptospirosis as a cause of acute respiratory failure: clinical features and outcome in 35 critical care patients. Author(s): Vieira SR, Brauner JS. Source: The Brazilian Journal of Infectious Diseases : an Official Publication of the Brazilian Society of Infectious Diseases. 2002 June; 6(3): 135-9. Epub 2003 March 06. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12144750

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Lesbian, gay and bisexual experiences within critical care nursing, 1988-1998: a survey of the literature. Author(s): Albarran JW, Salmon D. Source: International Journal of Nursing Studies. 2000 October; 37(5): 445-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10785535

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Lessons for critical care nurses on caring for the dying. Author(s): Brenner ZR. Source: Critical Care Nurse. 2002 February; 22(1): 11-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11852483

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Life support in the intensive care unit: a qualitative investigation of technological purposes. Canadian Critical Care Trials Group. Author(s): Cook DJ, Giacomini M, Johnson N, Willms D. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1999 November 2; 161(9): 1109-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10569086

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Liver failure, transplantation, and critical care. Author(s): Krasko A, Deshpande K, Bonvino S. Source: Critical Care Clinics. 2003 April; 19(2): 155-83. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12699318

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Liver transplantation: a critical care physician's personal odyssey. Author(s): Brandstetter RD. Source: Chest. 1999 September; 116(3): 789-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10492287

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Living, not existing, beyond critical care. Author(s): Yu M. Source: Critical Care Medicine. 2001 August; 29(8): 1640-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11505149

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Location, location, location: regionalization and outcome in pediatric critical care. Author(s): Watson RS. Source: Current Opinion in Critical Care. 2002 August; 8(4): 344-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12386496

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Long-term conditions in the context of critical care nursing. Author(s): Ashworth P. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 1996 October; 12(5): 253. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8938077

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Low inferior vena caval catheters for hemodynamic and pulmonary function monitoring in pediatric critical care patients. Author(s): Fernandez EG, Green TP, Sweeney M. Source: Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2004 January; 5(1): 14-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14697103

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Low-volume peritoneal dialysis in 116 neonatal and paediatric critical care patients. Author(s): Golej J, Kitzmueller E, Hermon M, Boigner H, Burda G, Trittenwein G. Source: European Journal of Pediatrics. 2002 July; 161(7): 385-9. Epub 2002 May 09. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12111191

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Managing critical care casualties on the Navy's hospital ships. Author(s): Boren D, Forbus R, Bibeau P, McKenzie R, McKinsey K. Source: Critical Care Nursing Clinics of North America. 2003 June; 15(2): 183-91. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12755184

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Match critical care situations with savvy devices. High-tech solutions give a new twist to familiar procedures. Author(s): Richards NM, McMannus S. Source: Nursing Management. 2002 December; 33(12): 38-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12488637

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Mathematical modelling and simulation for planning critical care capacity. Author(s): Costa AX, Ridley SA, Shahani AK, Harper PR, De Senna V, Nielsen MS. Source: Anaesthesia. 2003 April; 58(4): 320-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12648112

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Medication errors in acute cardiac care: An American Heart Association scientific statement from the Council on Clinical Cardiology Subcommittee on Acute Cardiac Care, Council on Cardiopulmonary and Critical Care, Council on Cardiovascular Nursing, and Council on Stroke. Author(s): Freedman JE, Becker RC, Adams JE, Borzak S, Jesse RL, Newby LK, O'Gara P, Pezzullo JC, Kerber R, Coleman B, Broderick J, Yasuda S, Cannon C; American Heart Association. Council on Clinical Cardiology Subcommittee on Acute Cardiac Care, Council on Cardiopulmonary and Critical Care, Council on Cardiovascular Nursing, and Council on Stroke. Source: Circulation. 2002 November 12; 106(20): 2623-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12427661

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MedSTAR: airborne critical care at its best. Author(s): Nixon T. Source: Air Medical Journal. 2003 July-August; 22(4): 16-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12847462

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Molecular biology for the critical care physician. Part II: where are we now? Author(s): Santis G, Evans TW. Source: Critical Care Medicine. 1999 May; 27(5): 997-1003. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10362426

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More haste, less speed in critical care. Author(s): Place B. Source: Nurs Times. 2001 July 5-11; 97(27): 33. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11958062

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Moving on from 'patient dependency' and 'nursing workload' to managing risk in critical care. Author(s): Ball C, Walker G, Harper P, Sanders D, McElligott M. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2004 April; 20(2): 62-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15072773

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Multicenter clinical research in adult critical care. Author(s): Cook D, Brower R, Cooper J, Brochard L, Vincent JL. Source: Critical Care Medicine. 2002 July; 30(7): 1636-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12130991

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Multiple trauma in children: critical care overview. Author(s): Wetzel RC, Burns RC. Source: Critical Care Medicine. 2002 November; 30(11 Suppl): S468-77. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12528789

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Naturalistic decision making: a model to overcome methodological challenges in the study of critical care nurses' decision making about patients' hemodynamic status. Author(s): Currey J, Botti M. Source: American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. 2003 May; 12(3): 206-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12751394

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New graduates a precious critical care resource. Author(s): Nibert AT. Source: Critical Care Nurse. 2003 October; 23(5): 47-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14606126

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New graduates in critical care. The success of one hospital. Author(s): Seago JA, Barr SJ. Source: Journal for Nurses in Staff Development : Jnsd : Official Journal of the National Nursing Staff Development Organization. 2003 November-December; 19(6): 297-304. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15027345

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Non-invasive estimation of cardiac output in critical care patients. Author(s): Gerhardt UM, Scholler C, Bocker D, Hohage H. Source: Journal of Clinical Monitoring and Computing. 2000; 16(4): 263-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12578073

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Nurse consultants as higher level practitioners: factors perceived to influence role implementation and development in critical care. Author(s): Fairley D. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2003 August; 19(4): 198-206. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12915109

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Nutrition support in the critical care setting: current practice in canadian ICUs-opportunities for improvement? Author(s): Heyland DK, Schroter-Noppe D, Drover JW, Jain M, Keefe L, Dhaliwal R, Day A. Source: Jpen. Journal of Parenteral and Enteral Nutrition. 2003 January-February; 27(1): 74-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12549603

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Nutritional support in critical care. Author(s): Baudouin SV, Evans TW. Source: Clinics in Chest Medicine. 2003 December; 24(4): 633-44. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14710695

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Olanzapine vs haloperidol: treating delirium in a critical care setting. Author(s): Skrobik YK, Bergeron N, Dumont M, Gottfried SB. Source: Intensive Care Medicine. 2004 March; 30(3): 444-9. Epub 2003 December 19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14685663

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Oral care interventions in critical care: frequency and documentation. Author(s): Grap MJ, Munro CL, Ashtiani B, Bryant S. Source: American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. 2003 March; 12(2): 113-8; Discussion 119. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12625169

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Otolaryngologic critical care. Author(s): Bansal A, Miskoff J, Lis RJ. Source: Critical Care Clinics. 2003 January; 19(1): 55-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12688577

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Out of our reach? Assessing the impact of introducing a critical care outreach service. Author(s): Pittard AJ. Source: Anaesthesia. 2003 September; 58(9): 882-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12911362

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Outreach critical care. Author(s): Hillman K. Source: British Journal of Anaesthesia. 2003 June; 90(6): 808; Author Reply 808-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12765900

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Outreach critical care-cash for no questions? Author(s): Park GR, McElligot M, Torres C. Source: British Journal of Anaesthesia. 2003 May; 90(5): 700-1; Author Reply 701-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12735306

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Outreach critical care-cash for no questions? Author(s): Morgan RJ. Source: British Journal of Anaesthesia. 2003 May; 90(5): 699-700; Author Reply 701-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12735305

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Outreach critical care-cash for no questions? Author(s): Williams E, Subbe CP, Gemmell L. Source: British Journal of Anaesthesia. 2003 May; 90(5): 699; Author Reply 701-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12697603

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Overview of anemia and blood management in critical care. Author(s): Pearl RG, Sibbald WJ. Source: Critical Care Medicine. 2003 December; 31(12 Suppl): S649-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14724461

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Overview of transfusion practices in perioperative and critical care. Author(s): Hebert PC, McDonald BJ, Tinmouth A. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2003 JuneJuly; 50(6 Suppl): S65-75. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14629056

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Pandemic influenza-implications for critical care resources in Australia and New Zealand. Author(s): Anderson TA, Hart GK, Kainer MA; ANZICS Database Management Committee. Source: Journal of Critical Care. 2003 September; 18(3): 173-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14595570

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Part one: Restoring patients to health outcomes and indicators of advanced nursing practice in adult critical care. Author(s): Ball C, Cox CL. Source: International Journal of Nursing Practice. 2003 December; 9(6): 356-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14984072

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Part two: The core components of legitimate influence and the conditions that constrain or facilitate advanced nursing practice in adult critical care. Author(s): Ball C, Cox CL. Source: International Journal of Nursing Practice. 2004 February; 10(1): 10-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14764018

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Perception of stressors by patients and nurses of critical care units in Hong Kong. Author(s): So HM, Chan DS. Source: International Journal of Nursing Studies. 2004 January; 41(1): 77-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14670397

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Pioneering contributions of Peter Safar to intensive care and the founding of the Society of Critical Care Medicine. Author(s): Weil MH, Shoemaker WC. Source: Critical Care Medicine. 2004 February; 32(2 Suppl): S8-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15043226

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Postanesthetic care in the critical care unit. Author(s): Barone CP, Pablo CS, Barone GW. Source: Critical Care Nurse. 2004 February; 24(1): 38-45. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15007891

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Practical management of patient with diabetes in critical care. From a diabetes educator's perspective. Author(s): Hess-Fischl A. Source: Critical Care Nursing Quarterly. 2004 April-June; 27(2): 189-200. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15137361

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Preoperative planning of airway management in critical care patients. Author(s): Rosenblatt WH. Source: Critical Care Medicine. 2004 April; 32(4 Suppl): S186-92. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15064677

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Priority setting in a hospital critical care unit: qualitative case study. Author(s): Mielke J, Martin DK, Singer PA. Source: Critical Care Medicine. 2003 December; 31(12): 2764-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14668612

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Publication, citations, and impact factors of leading investigators in critical care medicine. Author(s): Adams AB, Simonson D. Source: Respiratory Care. 2004 March; 49(3): 276-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15032205

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Quality indicators: the continuing struggle to improve the quality of critical care. Author(s): Zimmerman JE. Source: Journal of Critical Care. 2002 March; 17(1): 12-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12040544

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Quality of life following critical care: moving beyond survival. Author(s): Heyland DK, Kutsogiannis DJ. Source: Intensive Care Medicine. 2000 September; 26(9): 1172-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11089738

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Quality of life for critical care patients: a concept analysis. Author(s): Bond AE. Source: American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. 1996 July; 5(4): 309-13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8811157

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Quality of life in intensive care unit survivors: a place for outcomes research in critical care. Author(s): Orlando R 3rd. Source: Critical Care Medicine. 2000 November; 28(11): 3755-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11098988

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Quality use of medicines (QUM) in critical care: an imperative for best practice. Author(s): Davidson P, Daly J, Romanini J, Elliott D. Source: Aust Crit Care. 2001 August; 14(3): 122-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11899637

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Quantifying learning in medical students during a critical care medicine elective: a comparison of three evaluation instruments. Author(s): Rogers PL, Jacob H, Rashwan AS, Pinsky MR. Source: Critical Care Medicine. 2001 June; 29(6): 1268-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11395619

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Recognizing the link between peripheral edema and voltage attenuation of QRS complexes: implications for the critical care patient. Author(s): Madias JE. Source: Chest. 2003 December; 124(6): 2041-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14665471

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Red cell transfusion practice following the transfusion requirements in critical care (TRICC) study: prospective observational cohort study in a large UK intensive care unit. Author(s): Chohan SS, McArdle F, McClelland DB, Mackenzie SJ, Walsh TS. Source: Vox Sanguinis. 2003 April; 84(3): 211-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12670370

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Remembering September 11, 2001: a global critical care community reaches out. Author(s): International Critical Care Internet Discussion Group (CCM-L). Source: Medgenmed [electronic Resource] : Medscape General Medicine. 2003 September 10; 5(3): 37. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14600673

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Remote critical care consultation: telehealth projection of clinical specialty expertise. Author(s): Berg BW, Vincent DS, Hudson DA. Source: Journal of Telemedicine and Telecare. 2003; 9 Suppl 2: S9-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14728748

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Resiliency of accomplished critical care nurses in a natural disaster. Author(s): Sebastian SV, Styron SL, Reize SN, Houston S, Luquire R, Hickey JV. Source: Critical Care Nurse. 2003 October; 23(5): 24-30, 32-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14606124

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Respiratory care in spinal cord injury with associated traumatic brain injury: bridging the gap in critical care nursing interventions. Author(s): Cook N. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2003 June; 19(3): 143-53. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12765634

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Review of critical care and emergency approaches to stroke. Author(s): Hanley DF. Source: Stroke; a Journal of Cerebral Circulation. 2003 February; 34(2): 362-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12574537

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Revising the critical care family needs inventory for the emergency department. Author(s): Redley B, Beanland C. Source: Journal of Advanced Nursing. 2004 January; 45(1): 95-104. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14675305

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Role of technology in achieving clinical and cost impact in acute and critical care. Author(s): Ahrens T. Source: Critical Care Nursing Clinics of North America. 1999 March; 11(1): 1-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10373819

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SARS among critical care nurses, Toronto. Author(s): Loeb M, McGeer A, Henry B, Ofner M, Rose D, Hlywka T, Levie J, McQueen J, Smith S, Moss L, Smith A, Green K, Walter SD. Source: Emerging Infectious Diseases. 2004 February; 10(2): 251-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15030692

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Severe acute respiratory syndrome: another challenge for critical care nurses. Author(s): El-Masri MM, Williamson KM, Fox-Wasylyshyn SM. Source: Aacn Clinical Issues. 2004 January-March; 15(1): 150-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14767372

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Shifts and drifts in critical care: learning together in order to work together. Author(s): Bullock I. Source: Aust Crit Care. 2004 February; 17(1): 4-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15011991

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Society for neurosurgical anesthesia and critical care: 31st annual meeting report. Author(s): Vavilala MS. Source: Journal of Neurosurgical Anesthesiology. 2004 April; 16(2): 182-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15021299

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Society of Neurosurgical Anesthesia and Critical Care annual meeting. San Francisco, California, October 10, 2003. Author(s): Fahy BG. Source: Anesthesiology. 2004 May; 100(5): 1334-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15114251

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Special safeguards for critical care. New technologies are advancing safety and helping clinicians. Author(s): Hagland M. Source: Healthc Inform. 2004 February; 21(2): 90. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15004918

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Spirit of Marshfield: celebrating 10 years of critical care transport excellence. Author(s): Martin DK. Source: Air Medical Journal. 2004 January-February; 23(1): 20-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14760302

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State of the art: critical care. Author(s): Grounds RM, Bennett ED. Source: Anaesthesia. 2004 May; 59(5): 509; Author Reply 509-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15096246

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Success rates of pediatric intubation by a non-physician-staffed critical care transport service. Author(s): Harrison TH, Thomas SH, Wedel SK. Source: Pediatric Emergency Care. 2004 February; 20(2): 101-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14758307

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Surgical critical care: the Overnight Intensive Recovery (OIR) concept. Author(s): Aps C. Source: British Journal of Anaesthesia. 2004 February; 92(2): 164-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14722163

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The critical care medicine crisis: a call for federal action: a white paper from the critical care professional societies. Author(s): Ewart GW, Marcus L, Gaba MM, Bradner RH, Medina JL, Chandler EB. Source: Chest. 2004 April; 125(4): 1518-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15078768

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The PACU as critical care unit. Author(s): Odom-Forren J. Source: Journal of Perianesthesia Nursing : Official Journal of the American Society of Perianesthesia Nurses / American Society of Perianesthesia Nurses. 2003 December; 18(6): 431-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14730529

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The pulmonary physician in critical care * Illustrative case 8: Acute respiratory failure following lung resection. Author(s): Beddow E, Goldstraw P. Source: Thorax. 2003 September; 58(9): 820-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12947148

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The role of advance directives and family in end-of-life decisions in critical care units. Author(s): Kavic SM, Atweh N, Possenti PP, Ivy ME. Source: Conn Med. 2003 October; 67(9): 531-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14619340

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The value of certification as a critical care nurse. Author(s): Alspach G. Source: Critical Care Nurse. 2003 October; 23(5): 8, 10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14606122

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Top 10 ways to prepare for a pediatric critical care transport. Author(s): Shields R. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 2003 December; 29(6): 574-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14631349

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Treatment of refractory fever in the neurosciences critical care unit using a novel, water-circulating cooling device. A single-center pilot experience. Author(s): Carhuapoma JR, Gupta K, Coplin WM, Muddassir SM, Meratee MM. Source: Journal of Neurosurgical Anesthesiology. 2003 October; 15(4): 313-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14508172

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Trends in critical care planning and design. Panel discussion. Author(s): Beale C, Brideau L, Caldwell K, Fuller P, Hamilton K, Hendrich A, Pangrazio J, Scanlon M, St Andre A, Strohm P, Velez P. Source: Health Facilities Management. 2004 January; 17(1): 24-37. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14750342

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Undergraduate education in critical care. Author(s): Penberthy AJ, Goodchild CS. Source: Anaesthesia and Intensive Care. 1999 June; 27(3): 314. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10389570

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Unintended consequences: the impact of protocol change on critical care nurses' perceptions of stress. Author(s): Dodd-McCue D, Tartaglia A, Myer K, Kuthy S, Faulkner K. Source: Progress in Transplantation (Aliso Viejo, Calif.). 2004 March; 14(1): 61-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15077740

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Unplanned extubation in adult critical care. Quality improvement and education payoff. Author(s): Richmond AL, Jarog DL, Hanson VM. Source: Critical Care Nurse. 2004 February; 24(1): 32-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15007890

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Update in critical care. Author(s): Luce JM. Source: Annals of Internal Medicine. 2003 November 4; 139(9): 748-52. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14597459

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Use of antifungal agents in febrile patients nonresponsive to antibacterial treatment: the current status in surgical and critical care patients in Japan. Author(s): Aikawa N, Sumiyama Y, Kusachi S, Hirasawa H, Oda S, Yamazaki Y. Source: Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy. 2002 September; 8(3): 237-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12373487

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Use of corticosteroids in anesthesia and critical care. Author(s): Wu RS. Source: Acta Anaesthesiol Sin. 2002 June; 40(2): 53-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12194390

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Use of telemedicine to provide pediatric critical care inpatient consultations to underserved rural Northern California. Author(s): Marcin JP, Nesbitt TS, Kallas HJ, Struve SN, Traugott CA, Dimand RJ. Source: The Journal of Pediatrics. 2004 March; 144(3): 375-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15001947

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Use of xenon as a sedative for patients receiving critical care. Author(s): Bedi A, Murray JM, Dingley J, Stevenson MA, Fee JP. Source: Critical Care Medicine. 2003 October; 31(10): 2470-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14530753

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Using wireless technologies to improve information flow for interhospital transfers of critical care patients. Author(s): McGrow KM, Roys R, Maloney RC, Xiao Y. Source: Critical Care Nurse. 2004 April; 24(2): 66-72, 114. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15098312

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Utilization, reliability, and clinical impact of point-of-care testing during critical care transport: six years of experience. Author(s): Gruszecki AC, Hortin G, Lam J, Kahler D, Smith D, Vines J, Lancaster L, Daly TM, Robinson CA, Hardy RW. Source: Clinical Chemistry. 2003 June; 49(6 Pt 1): 1017-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12766018

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Values and critical care--back to basics. Author(s): Ashworth P. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 1999 August; 15(4): 183-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10786502

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Variation in intubation decisions for patients with chronic obstructive pulmonary disease in one critical care network. Author(s): Wildman MJ, O'Dea J, Kostopoulou O, Tindall M, Walia S, Khan Z. Source: Qjm : Monthly Journal of the Association of Physicians. 2003 August; 96(8): 58391. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12897344

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Vasopressin: new uses in critical care. Author(s): Chen P. Source: The American Journal of the Medical Sciences. 2002 September; 324(3): 146-54. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12240712

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Vasopressin--finding a place in critical care? Author(s): Leslie GD. Source: Aust Crit Care. 2004 February; 17(1): 3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15011990

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Vasopressors used in the critical care setting. Author(s): Golembiewski JA. Source: Journal of Perianesthesia Nursing : Official Journal of the American Society of Perianesthesia Nurses / American Society of Perianesthesia Nurses. 2003 December; 18(6): 414-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14730524

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Venous thromboembolism and its prevention in critical care. Author(s): Geerts W, Cook D, Selby R, Etchells E. Source: Journal of Critical Care. 2002 June; 17(2): 95-104. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12096372

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Ventilating in recovery--the way forward: intensive therapy or critical care? Author(s): Ridley S, Nightingale P. Source: British Journal of Anaesthesia. 2002 September; 89(3): 526; Author Reply 526-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12402741

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Ventilator withdrawal: procedures and outcomes. Report of a collaboration between a critical care division and a palliative care service. Author(s): O'Mahony S, McHugh M, Zallman L, Selwyn P. Source: Journal of Pain and Symptom Management. 2003 October; 26(4): 954-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14575056

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Visitation in critical care: processes and outcomes of a performance improvement initiative. Author(s): Roland P, Russell J, Richards KC, Sullivan SC. Source: Journal of Nursing Care Quality. 2001 January; 15(2): 18-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11125694

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Visitor and nurse satisfaction with a visitation policy change in critical care units. Author(s): Ramsey P, Cathelyn J, Gugliotta B, Glenn LL. Source: Dimensions of Critical Care Nursing : Dccn. 1999 September-October; 18(5): 428. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10640044

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Waiting: the experience of persons in a critical care waiting room. Author(s): Bournes DA, Mitchell GJ. Source: Research in Nursing & Health. 2002 February; 25(1): 58-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11807920

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Ward nurses' evaluation of critical care outreach. Author(s): Richardson A, Burnand V, Colley H, Coulter C. Source: Nursing in Critical Care. 2004 January-February; 9(1): 28-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14871007

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What do physicians think about evidence-based antibiotic use in critical care? A survey of Australian intensivists and infectious disease practitioners. Author(s): Sintchenko V, Iredell JR, Gilbert GL, Coiera E. Source: Internal Medicine Journal. 2001 November; 31(8): 462-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11720059

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What's new in general surgery: trauma and critical care. Author(s): Hoyt DB. Source: Journal of the American College of Surgeons. 2002 March; 194(3): 335-51. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11893136

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What's new in trauma and critical care. Author(s): Rozycki GS. Source: Journal of the American College of Surgeons. 2004 May; 198(5): 798-805. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15110814

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What's new in trauma and critical care. Author(s): Fabian TC. Source: Journal of the American College of Surgeons. 2001 February; 192(2): 276-86. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11220729

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Where is critical care medicine in today's undergraduate medical curriculum? Author(s): Qutub HO. Source: Saudi Med J. 2000 April; 21(4): 327-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11533811

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Why are critical care clinicians so powerfully distressed by family demands for futile care? Author(s): Curtis JR, Burt RA. Source: Journal of Critical Care. 2003 March; 18(1): 22-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12640609

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Witnessed resuscitation in critical care: the case against. Author(s): Newton A. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 2002 June; 18(3): 146-50. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12405269

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Wolff Parkinson White (WPW) syndrome: what the critical care nurse needs to consider when administering antiarrhythmics. Author(s): Evans-Murray A. Source: Aust Crit Care. 2001 February; 14(1): 5-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11899759

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CHAPTER 2. NUTRITION AND CRITICAL CARE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and critical care.

Finding Nutrition Studies on Critical Care The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “critical care” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

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Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “critical care” (or a synonym): •

Cultural and ethnic diversity. Unique challenges in critical care education. Author(s): Nursing Administration, Providence Hospital, Washington, DC 20017-2180, USA. [email protected] Source: Shumate P, L Crit-Care-Nurs-Clin-North-Am. 2001 March; 13(1): 63-72 08995885

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Einfluss von Nutriflex 48 auf das Plasmaaminosauren-Muster chirurgischer Intensivpatienten mit Sepsis.[Effect of Nutriflex 48 on the plasma amino acid pattern in surgical intensive care patients with infection] Source: Melzer, A Haldemann, G Reist, K Infusionsther-Klin-Ernahr. 1984 August; 11(4): 190-4 0378-0791

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Enteral nutrition in the critically ill: a prospective survey in an Australian intensive care unit. Author(s): Intensive Care Unit, Royal Adelaide Hospital, North Terrace, SA. Source: De Beaux Chapman, M Fraser, R Finnis, M De Keulenaer, B Liberalli, D Satanek, M Anaesth-Intensive-Care. 2001 December; 29(6): 619-22 0310-057X

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Making changes to improve the intensive care unit experience for patients and their families. Author(s): College of Nursing, State University of New York Health Science Center, Syracuse 13210, USA. Source: Jastremski, C A Harvey, M New-Horiz. 1998 February; 6(1): 99-109 1063-7389

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Pharmacology advances in the neuroscience intensive care unit. Author(s): Section of Neurosurgery, University of Chicago, Illinois 60637, USA. [email protected] Source: Stewart Amidei, Chris Crit-Care-Nurs-Clin-North-Am. 2002 March; 14(1): 31-8 0899-5885

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The integration of complementary therapies in North and South Thames Regional Health Authorities' critical care units. Author(s): University of Hertfordshire, Centre for Research in Primary and Community Care, Hatfield, Hertfordshire, UK. Source: Hayes, J A Cox, C L Complement-Ther-Nurs-Midwifery. 1999 August; 5(4): 1037 1353-6117

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Volume replacement strategies on intensive care units: results from a postal survey. Author(s): Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Germany. Source: Boldt, J Lenz, M Kumle, B Papsdorf, M Intensive-Care-Med. 1998 February; 24(2): 147-51 0342-4642

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMD®Health: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to critical care; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Minerals Magnesium Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND CRITICAL CARE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to critical care. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to critical care and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “critical care” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to critical care: •

A family-centered critical care unit. Author(s): Smith K, Kupferschmid BJ, Dawson C, Briones TL. Source: Aacn Clin Issues Crit Care Nurs. 1991 May; 2(2): 258-69. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2021510

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A stressor identification exercise for the critical care environment. Author(s): Daggett LM. Source: Nurse Educator. 1999 March-April; 24(2): 6-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10410015

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Adult respiratory distress in pregnancy: critical care issues. Author(s): Surratt N, Troiano NH.

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Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1994 November-December; 23(9): 773-80. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7853083 •

Advances in the critical care of poisoned paediatric patients. Author(s): Banner W Jr, Timmons OD, Vernon DD. Source: Drug Safety : an International Journal of Medical Toxicology and Drug Experience. 1994 January; 10(1): 83-92. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8136089

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An innovative approach to pain management in critical care: therapeutic touch. Author(s): Apostle-Mitchell M, MacDonald G. Source: Off J Can Assoc Crit Care Nurs. 1997 Fall; 8(3): 19-22. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9594094

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Cathie Guzzetta & Barbara Dossey: guiding critical care nurses on the body-mindspirit journey. Interview by Michael Villaire. Author(s): Guzzetta C, Dossey B. Source: Critical Care Nurse. 1993 August; 13(4): 104-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8375173

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Complementary therapy in critical care settings: a review of surveys and implications for nurses. Author(s): Sparber A. Source: Critical Care Nursing Clinics of North America. 2003 September; 15(3): 305-12. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943136

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Creating a healing environment for critical care. Author(s): Molter NC. Source: Critical Care Nursing Clinics of North America. 2003 September; 15(3): 295-304. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943135

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Critical care nurses' perception of a bereavement follow-up service. Author(s): Jackson I. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 1996 February; 12(1): 2-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8696020

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Critical care nurses' perceptions of family needs as met. Author(s): Kosco M, Warren NA.

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Source: Critical Care Nursing Quarterly. 2000 August; 23(2): 60-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11853028 •

Critical care outreach teams--a prayer answered? Author(s): Groom P. Source: Nurs Times. 2001 October 25-31; 97(43): 34-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11966081

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Critical care. Sensory imbalance and sleep loss. Author(s): Dootson S. Source: Nurs Times. 1990 August 29-September 4; 86(35): 26-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2395706

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Critical care. The physiology of cardiac massage. Author(s): Newbold D. Source: Nurs Times. 1987 June 24-30; 83(25): 59-62. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3649737

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Critical care. The power of touch. Author(s): Pearce J. Source: Nurs Times. 1988 June 15-21; 84(24): 26-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3393469

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Cultural competence for critical care nursing practice. Author(s): Covington LW. Source: Critical Care Nursing Clinics of North America. 2001 December; 13(4): 521-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11778339

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Cultural related complementary therapies: their use in critical care units. Author(s): Snyder M, Niska K. Source: Critical Care Nursing Clinics of North America. 2003 September; 15(3): 341-6, Viii-Ix. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943140

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Designing humanistic critical care environments. Author(s): Fontaine DK, Briggs LP, Pope-Smith B. Source: Critical Care Nursing Quarterly. 2001 November; 24(3): 21-34. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11858555

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Developing an integrated baccalaureate nursing education program infusing complementary/alternative therapies into critical care curricula. Author(s): Chlan L, Halcon L.

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Source: Critical Care Nursing Clinics of North America. 2003 September; 15(3): 373-9, Ix. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943144 •

Developing critical care skills for nurses in the ward environment: a work-based learning approach. Author(s): Thorne L, Hackwood H. Source: Nursing in Critical Care. 2002 May-June; 7(3): 121-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12226946

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Education for staff who care for cancer patients in the critical care unit. Author(s): Dickinson DC. Source: Journal of Nursing Staff Development : Jnsd. 1990 July-August; 6(4): 202-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2380777

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Effects of massage in acute and critical care. Author(s): Richards KC, Gibson R, Overton-McCoy AL. Source: Aacn Clinical Issues. 2000 February; 11(1): 77-96. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11040555

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Epidemiology of childhood burns in the critical care medical center of Kinki University Hospital in Osaka, Japan. Author(s): Fukunishi K, Takahashi H, Kitagishi H, Matsushima T, Kanai T, Ohsawa H, Sakata I. Source: Burns : Journal of the International Society for Burn Injuries. 2000 August; 26(5): 465-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10812269

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Ethical decision-making in critical care in Hong Kong. Author(s): Ip M, Gilligan T, Koenig B, Raffin TA. Source: Critical Care Medicine. 1998 March; 26(3): 447-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9504570

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Ethical dilemmas in pediatric critical care. Author(s): Todres ID. Source: Critical Care Clinics. 1992 January; 8(1): 219-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1732030

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From beginner to expert: gaining a differentiated clinical world in critical care nursing. Author(s): Benner P, Tanner C, Chesla C.

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Source: Ans. Advances in Nursing Science. 1992 March; 14(3): 13-28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1550330 •

Haemodynamic profiles and the critical care nurse. Author(s): Coombs M. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 1993 March; 9(1): 11-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8485344

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Healing practices: trends, challenges, and opportunities for nurses in acute and critical care. Author(s): Kreitzer MJ, Jensen D. Source: Aacn Clinical Issues. 2000 February; 11(1): 7-16; Quiz 155-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11040548

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Herb use in critical care: what to watch for. Author(s): Lu Y. Source: Critical Care Nursing Clinics of North America. 2003 September; 15(3): 313-9, Viii. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943137

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Holistic care in the critical care setting: application of a concept through Watson's and Orem's theories of nursing. Author(s): Hurlock-Chorostecki C. Source: Off J Can Assoc Crit Care Nurs. 1999 Winter; 10(4): 20-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10889739

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Humanism in critical care: a blueprint for change. Author(s): Rushton CH. Source: Pediatric Nursing. 1991 July-August; 17(4): 399-402. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1861912

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Immediate effects of a five-minute foot massage on patients in critical care. Author(s): Hayes J, Cox C. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 1999 April; 15(2): 77-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10595045

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Independent nursing interventions: relaxation and guided imagery in critical care. Author(s): Tiernan PJ.

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Source: Critical Care Nurse. 1994 October; 14(5): 47-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7859468 •

Integrating nonpharmacological, adjunctive interventions into critical care practice: a means to humanize care? Author(s): Chlan L. Source: American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. 2002 January; 11(1): 14-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11785552

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Interventional nutrition for the critical care patient: optimal diets. Author(s): Michel KE. Source: Clin Tech Small Anim Pract. 1998 November; 13(4): 204-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9842112

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Management of surgical and procedural pain in a critical care setting. Author(s): Summer GJ, Puntillo KA. Source: Critical Care Nursing Clinics of North America. 2001 June; 13(2): 233-42. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11866405

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Meridian therapy: current research and implications for critical care. Author(s): Sutherland JA. Source: Aacn Clinical Issues. 2000 February; 11(1): 97-104. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11040556

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Mobilization of the interdisciplinary critical care team at home and abroad. Author(s): Doherty AM. Source: Critical Care Nursing Clinics of North America. 1998 September; 10(3): 369-76. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9855899

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Music therapy in critical care: indications and guidelines for intervention. Author(s): Chlan L, Tracy MF. Source: Critical Care Nurse. 1999 June; 19(3): 35-41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10661090

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Nurse attitudes towards the use of complementary and alternative therapies in critical care. Author(s): Tracy MF, Lindquist R, Watanuki S, Sendelbach S, Kreitzer MJ, Berman B, Savik K.

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Source: Heart & Lung : the Journal of Critical Care. 2003 May-June; 32(3): 197-209. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12827105 •

Nursing's role in complementary and alternative therapy use in critical care. Author(s): Tracy MF, Lindquist R. Source: Critical Care Nursing Clinics of North America. 2003 September; 15(3): 289-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943134

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Nutraceuticals in critical care nutrition. Author(s): Schmidt H, Martindale R. Source: Nestle Nutr Workshop Ser Clin Perform Programme. 2003; (8): 245-56; Discussion 256-64. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12968458

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Oxidative stress in critical care: is antioxidant supplementation beneficial? Author(s): Oldham KM, Bowen PE. Source: Journal of the American Dietetic Association. 1998 September; 98(9): 1001-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9739800

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Pain management in the culture of critical care. Author(s): Cullen L, Greiner J, Titler MG. Source: Critical Care Nursing Clinics of North America. 2001 June; 13(2): 151-66. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11866399

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Pain: advances and issues in critical care. Author(s): Harrison M, Cotanch PH. Source: Nurs Clin North Am. 1987 September; 22(3): 691-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3302958

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Pastoral care in a critical care setting. Author(s): Gillman J, Gable-Rodriguez J, Sutherland SM, Whitacre RJ. Source: Critical Care Nursing Quarterly. 1996 May; 19(1): 10-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8705696

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Pediatric palliative care: a family-centered model for critical care. Author(s): Gilmer MJ. Source: Critical Care Nursing Clinics of North America. 2002 June; 14(2): 207-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12038509

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Personal use of complementary and alternative therapies by critical care nurses. Author(s): Lindquist R, Tracy MF, Savik K.

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Source: Critical Care Nursing Clinics of North America. 2003 September; 15(3): 393-9, X. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943147 •

Physiologic and psychodynamic responses to the administration of therapeutic touch in critical care. Author(s): Cox C, Hayes J. Source: Complementary Therapies in Nursing & Midwifery. 1999 June; 5(3): 87-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10754826

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Psychological influences in critical care: perspectives from psychoneuroimmunology. Author(s): Caine RM. Source: Critical Care Nurse. 2003 April; 23(2): 60-70. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12725196

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Recognition, assessment, and treatment of anxiety in the critical care setting. Author(s): Clark S, Fontaine DK, Simpson T. Source: Critical Care Nurse. 1994 August; 14(4 Suppl): 2-14, Quiz 15-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7914481

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Relatives' lived experiences of complementary therapies in a critical care department-a phenomenological study. Author(s): Brown B, Barnes J, Clarke M, Medwin L, Hutchinson A, MacMillan K, O'Rourke G, Parkinson C, Pickering A, Roberts K. Source: Aust Crit Care. 1999 December; 12(4): 147-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11271030

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Roman Catholic norms and the allocation of critical care resources. Author(s): Lustig BA. Source: Hec Forum : an Interdisciplinary Journal on Hospitals' Ethical and Legal Issues. 2003 March; 15(1): 100-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12776379

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Shaping the future of complementary and alternative therapies for critical care nursing. Author(s): Disch J, Kreitzer MJ. Source: Critical Care Nursing Clinics of North America. 2003 September; 15(3): 387-92, X. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943146

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Sleep promotion in the critical care unit. Author(s): Richards KC.

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Source: Aacn Clin Issues Crit Care Nurs. 1994 May; 5(2): 152-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7767809 •

Spiritual care: a challenge in multicultural critical care. Author(s): Ashworth P. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 1999 April; 15(2): 63-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10595043

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Spirituality in critical care: patient comfort and satisfaction. Author(s): Nussbaum GB. Source: Critical Care Nursing Quarterly. 2003 July-September; 26(3): 214-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12930036

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Spirituality in health: the role of spirituality in critical care. Author(s): Puchalski C. Source: Critical Care Clinics. 2004 July; 20(3): 487-504. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15183215

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State of the science of music interventions. Critical care and perioperative practice. Author(s): White JM. Source: Critical Care Nursing Clinics of North America. 2000 June; 12(2): 219-25. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11249367

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Support groups: an annotated bibliography for critical care nurses. Author(s): Halm MA, Alpen MA. Source: Critical Care Nurse. 1994 June; 14(3): 118-28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8194334

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Taiwanese nurses' appraisal of a lecture on spiritual care for patients in critical care units. Author(s): Shih FJ, Gau ML, Mao HC, Chen CH. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 1999 April; 15(2): 83-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10595046

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The impact of critical care pharmacists on enhancing patient outcomes. Author(s): Kane SL, Weber RJ, Dasta JF. Source: Intensive Care Medicine. 2003 May; 29(5): 691-8. Epub 2003 March 29. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12665997

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The integration of complementary therapies in North and South Thames Regional Health Authorities' critical care units. Author(s): Hayes JA, Cox CL. Source: Complementary Therapies in Nursing & Midwifery. 1999 August; 5(4): 103-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10754829

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The patient's progress from this world to that which is to come: commentary on the Consensus Statement of the Working Group on Roman Catholic Approaches to Determining Critical Care. Author(s): Schmidt KW. Source: Christian Bioethics. 2001 August; 7(2): 211-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12168629

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The role of the critical care nurse in the delivery of bad news. Author(s): Peel N. Source: British Journal of Nursing (Mark Allen Publishing). 2003 September 11-24; 12(16): 966-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14508420

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The stress-carative model of nursing practice. A contemporary holistic health modality for critical care nursing practice. Author(s): Qamar SL. Source: Focus Crit Care. 1986 December; 13(6): 15-21. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3641752

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Tissue distribution of lidocaine in critical care patients after intubation. Author(s): Moriya F, Hashimoto Y. Source: Forensic Science International. 2003 November 26; 137(2-3): 183-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14609655

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Too important to miss out? Documentation of care in critical care nursing. Author(s): Gittins B. Source: Prof Nurse. 1994 September; 9(12): 820-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7938066

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Use of presence in the critical care unit. Author(s): Snyder M, Brandt CL, Tseng YH. Source: Aacn Clinical Issues. 2000 February; 11(1): 27-33. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11040550

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Use of thrombin inhibitors ex vivo allows critical care clinical chemistry and hematology testing on common specimens. Author(s): Lyon AW, Harding SR, Drobot D, Lyon ME.

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Source: Clinical Biochemistry. 1997 March; 30(2): 121-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9127693 •

Using a critical care simulation laboratory to teach students. Author(s): Morton PG. Source: Critical Care Nurse. 1997 December; 17(6): 66-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9418398

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Using Gordon's functional health patterns to organize a critical care orientation program. Author(s): Recker D, O'Brien C. Source: Focus Crit Care. 1992 February; 19(1): 21-5, 28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1537414

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What behaviors help nurses deliver quality critical care? Author(s): Barr WJ, Bush HA. Source: Nurs Qual Connect. 1995 September-October; 5(2): 23. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8680323

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What criteria should be used for pet therapy in critical care? Are you aware of any hospitals doing this? Author(s): Martin S. Source: Critical Care Nurse. 1993 April; 13(2): 74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8453885

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Workflow: a new modeling concept in critical care units. Author(s): Yousfi F, Beuscart R, Geib JM. Source: Medinfo. 1995; 8 Pt 1: 515-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8591248

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMD®Health: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to critical care; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Anaphylaxis Source: Integrative Medicine Communications; www.drkoop.com Bronchitis Source: Integrative Medicine Communications; www.drkoop.com Burns Source: Integrative Medicine Communications; www.drkoop.com Chronic Obstructive Pulmonary Disease Source: Healthnotes, Inc.; www.healthnotes.com Crohn's Disease Source: Healthnotes, Inc.; www.healthnotes.com Cystic Fibrosis Source: Integrative Medicine Communications; www.drkoop.com Diarrhea Source: Healthnotes, Inc.; www.healthnotes.com Endocarditis Source: Integrative Medicine Communications; www.drkoop.com Gastritis Source: Healthnotes, Inc.; www.healthnotes.com Meningitis Source: Integrative Medicine Communications; www.drkoop.com Muscular Dystrophy Source: Integrative Medicine Communications; www.drkoop.com

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Nausea Source: Prima Communications, Inc.www.personalhealthzone.com Pregnancy and Postpartum Support Source: Healthnotes, Inc.; www.healthnotes.com Shock Source: Integrative Medicine Communications; www.drkoop.com •

Alternative Therapy Hypnotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,706,00.html

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Herbs and Supplements Adenosine Monophosphate Source: Healthnotes, Inc.; www.healthnotes.com Ginger Source: Prima Communications, Inc.www.personalhealthzone.com Glutamine Source: Prima Communications, Inc.www.personalhealthzone.com Lavandula Alternative names: Lavender; Lavandula sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Nitrous Oxide Source: Healthnotes, Inc.; www.healthnotes.com Nitrous Oxide Source: Prima Communications, Inc.www.personalhealthzone.com Probiotics Source: Healthnotes, Inc.; www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON CRITICAL CARE Overview In this chapter, we will give you a bibliography on recent dissertations relating to critical care. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “critical care” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on critical care, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Critical Care ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to critical care. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A COMPARISON OF THE BEGINNING LEVEL OF CLINICAL COMPETENCIES FOR CRITICAL CARE NURSES AS PERCEIVED BY EDUCATORS AND EMPLOYERS by CANFIELD, ARLEEN BRADNA, EDD from UNIVERSITY OF SOUTHERN CALIFORNIA, 1980 http://wwwlib.umi.com/dissertations/fullcit/f1045222

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A dynamic approach to community, dialogue and patient-focused care in a critical care setting by Skain, Mary Marsha Murphy, DMin from UNIVERSITY OF ST. MICHAEL'S COLLEGE (CANADA), 2002, 272 pages http://wwwlib.umi.com/dissertations/fullcit/NQ73450

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AN INVESTIGATION OF THE KNOWLEDGE BASE USED BY CRITICAL CARE NURSES by PODURGIEL, MADELAINE MARY, PHD from THE UNIVERSITY OF CONNECTICUT, 1983, 187 pages http://wwwlib.umi.com/dissertations/fullcit/8329397

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Analysis of perceived values congruence of critical care nurses within a tertiary county regional hospital in South Florida by Gordon, Jean Nancy, DBA from NOVA SOUTHEASTERN UNIVERSITY, 1999, 168 pages http://wwwlib.umi.com/dissertations/fullcit/9938885

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Assisting novice critical care nurses' transition into the intensive care unit by Scott, Wendy Joan, MA from ROYAL ROADS UNIVERSITY (CANADA), 2003, 94 pages http://wwwlib.umi.com/dissertations/fullcit/MQ77770

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EFFECTS OF A STRESS COPING SEMINAR ON BURNOUT EXPERIENCED BY CRITICAL CARE UNIT NURSES by NOBLE, NANCY JOAN, PHD from OHIO UNIVERSITY, 1984, 141 pages http://wwwlib.umi.com/dissertations/fullcit/8504164

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FACULTY PERCEPTIONS OF THE CRITICAL CARE EXPERIENCE AS A PART OF THE GENERIC BACCALAUREATE CURRICULUM IN NURSING by STEPHENSON, CAROL ANN, EDD from UNIVERSITY OF NORTH TEXAS, 1983, 159 pages http://wwwlib.umi.com/dissertations/fullcit/8404339

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LAY MINISTRY TO FAMILY MEMBERS OF PERSONS IN A HOSPITAL CRITICAL CARE UNIT (NORTH CAROLINA, UNITED METHODIST) by PHILLIPS, JAMES DONALD, DMIN from DREW UNIVERSITY, 1987, 182 pages http://wwwlib.umi.com/dissertations/fullcit/8717113

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Organ donation and transplantation: A survey of critical care health professionals by Chernenko, Susan Marie, MN from UNIVERSITY OF ALBERTA (CANADA), 2003, 151 pages http://wwwlib.umi.com/dissertations/fullcit/MQ82236

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PROBLEM-SOLVING, RECALL, AND EXPERTISE IN NICU NURSING (NEONATAL INTENSIVE CARE NURSING) by BOSCH, JONI JACOBSEN, PHD from THE UNIVERSITY OF IOWA, 1993, 142 pages http://wwwlib.umi.com/dissertations/fullcit/9404480

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SELECTED ENVIRONMENT-BEHAVIOR RELATIONS IN CRITICAL CARE UNITS by COHEN, URIEL, ARCHD from THE UNIVERSITY OF MICHIGAN, 1980, 161 pages http://wwwlib.umi.com/dissertations/fullcit/8106077

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STAFF DEVELOPMENT IN INFORMATION-DEPENDENT ORGANIZATIONS: AN APPLICATION OF THE INFORMATION AUDIT CONCEPT TO CRITICAL CARE NURSING by DOMINGUEZ-MATHEWSON, SHEILA EVE, PHD from UNIVERSITY OF CALIFORNIA, LOS ANGELES, 1990, 233 pages http://wwwlib.umi.com/dissertations/fullcit/9117370

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THE EFFECT OF CERTIFICATION ON THE ATTITUDES, WAGES, AND INCOME OF CRITICAL CARE NURSES. by WHYTE, LAURIAN M., PHD from THE UNIVERSITY OF ROCHESTER, 1979, 99 pages http://wwwlib.umi.com/dissertations/fullcit/7922970

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THE EFFECT OF ORGANIZATIONAL SOCIALIZATION PRACTICES IN CRITICAL CARE NURSING ON ORIENTATION PROGRAM OUTCOMES by ERICKSON, VIRGINIA STICKNEY, PHD from UNIVERSITY OF CALIFORNIA, LOS ANGELES, 1995, 210 pages http://wwwlib.umi.com/dissertations/fullcit/9601305

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THE EFFECTIVENESS OF SELF ASSESSMENT GUIDES AS A METHOD OF TEACHING CRITICAL CARE NURSING TO PROFESSIONAL NURSING STUDENTS. by BURRELL, SARA LENETTE OWENS, EDD from UNIVERSITY OF GEORGIA, 1978, 168 pages http://wwwlib.umi.com/dissertations/fullcit/7914018

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THE EFFECTS ON NURSING STAFF'S STRESS APPRAISAL BY THE UTILIZATION OF CRITICAL CARE UNITS BY STUDENT NURSES by MCMORROW, MARY ELLEN, EDD from RUTGERS THE STATE UNIVERSITY OF NEW JERSEY - NEW BRUNSWICK, 1980, 89 pages http://wwwlib.umi.com/dissertations/fullcit/8014247

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THE PERCEPTION OF ENVIRONMENTAL STRESS IN A NEONATAL INTENSIVE CARE UNIT: A CASE STUDY COMPARISON OF FAMILY MEMBERS AND STAFF (INTENSIVE CARE) by BUNKER-HELLMICH, LOU ANN, PHD from THE UNIVERSITY OF WISCONSIN - MILWAUKEE, 1995, 152 pages http://wwwlib.umi.com/dissertations/fullcit/9625588

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USE OF CLINICAL PRACTICE EXPERIENCES IN HOSPITAL CRITICAL CARE SETTINGS BY GENERIC BACCALAUREATE NURSING PROGRAMS by EDWARDS, RUTH BAX, EDD from UNIVERSITY OF KANSAS, 1985, 129 pages http://wwwlib.umi.com/dissertations/fullcit/8529183

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VALUES IN CRITICAL CARE MEDICINE: A STUDY OF PUBLIC AND PHYSICIAN DIFFERENCES IN COLORADO by FOSS, LINDA LOUISE, PHD from UNIVERSITY OF COLORADO AT DENVER GRADUATE SCHOOL OF PUBLIC AFFAIRS, 1989, 208 pages http://wwwlib.umi.com/dissertations/fullcit/9107103

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Walking the line: A qualitative study of critical care nursing and the importance of experiential learning in ethical decision-making in clinical nursing practice by Hough, M. Catherine, PhD from THE FLORIDA STATE UNIVERSITY, 1998, 159 pages http://wwwlib.umi.com/dissertations/fullcit/9839767

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. PATENTS ON CRITICAL CARE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “critical care” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on critical care, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Critical Care By performing a patent search focusing on critical care, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on critical care: •

Advanced tracheostomy tube and oral endotracheal tube holder Inventor(s): Varner; Scott H. (1218 Rembrandt Cir., Charlotte, NC 21211) Assignee(s): none reported Patent Number: 6,105,577 Date filed: October 28, 1998 Abstract: A device for supporting and retaining a tracheostomy tube or an endotracheal tube of the type having a tube including a flexible support flange and an inner cannula having a locking means which connects the inner cannula to the tube. The device includes a holder base having a uniquely shaped tube receiving opening designed to securely retain the tube therein and which includes at least one through-slot extending outward from the opening for receiving the locking means therethrough and preventing contact between the locking means of the inner cannula and the holder base. The device includes a removable tab which extends into the opening, a removable support strap for releasably securing the holder to the patient and an anchor strap for anchoring a circuit in place. In alternate preferred embodiments, the tube receiving opening may be triangular or any number of shapes and include through slots extending outward therefrom, and the body is a narrow portion which allows the face of the support flange to remain visible when the holder base is positioned for use. Excerpt(s): The present invention relates to devices for securing tracheostomy tubes and oral endotracheal tubes and more particularly, relates to an improved tracheostomy tube and oral endotracheal tube holder for retaining such tubes in operational, patient contact. A tracheostomy tube is a curved tube which is inserted into a tracheostomy stoma. While there are several different types of tubes, they all have similar parts. The main parts of a tracheostomy tube are the outer tube, the inner tube or inner cannula and the obturator. The obturator is only used to insert the outer tube and is removed once the outer tube is in place. The outer tube typically has a support base flange and ties to secure around the patient's neck. In use, the inner cannula is inserted and removably locked in place after the obturator is removed. The inner cannula is withdrawn for brief periods to be cleaned and acts as a removable liner for the more permanent outer tube. Tracheostomy tubes may be cuffed, uncuffed or fenestrated. A cuff is a soft balloon around the tracheostomy tube near the distal end that can be inflated to hold the tube in place. Prior to 1983, the only method being used to any extent to secure a tracheostomy tube to a patient's neck was strips of cotton fabric split at either end and then tied through the openings in the flange of the trache. Although reliable, it was extremely time consuming and tended to fray at the ends and roll up in a rope configuration which caused irritation to the patient's neck. Wapner U.S. Pat. No. 4,331,144 addressed these problems. Wapner U.S. Pat. No. 4,331,144 discloses a band which encircles the head and secures to itself using a hook and loop fastener. It also employs strips which thread through the slits in a trache flange and then secures back onto itself using hook and loop fasteners. While certainly functional, the Wapner device is also time consuming and can be extremely difficult to employ if the flange of the trache holder is pulled into folds of flesh as is often the case with overweight patients. To overcome this problem, the inward force normally required to hold trache tube within the trachea must be reduced in order to allow the flanges to ride above the flesh folds. This scenario can result in the trache tube actually coming out of the stoma in the

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trachea. Examples of other tracheostomy tube holders are shown in U.S. Pat. No. 5,529,062 issued to T. N. Byrd on Jun. 25, 1996 and U.S. Pat. No. 5,671,732 issued to M. L. Brown on Sep. 30, 1997. Web site: http://www.delphion.com/details?pn=US06105577__ •

Anatomical simulator and method for tracheostomy tube placement Inventor(s): Scherer; Andrew J. (San Dimas, CA) Assignee(s): Passy-Muir, Inc. (Irvine, CA) Patent Number: 5,846,087 Date filed: September 29, 1997 Abstract: An anatomical simulator useful in training proper tracheostomy and nasogastric tube placement and tracheostomy tube cuff inflation is disclosed. The simulator includes a simulated trachea and simulated esophagus separated by a simulated tracheoesophageal wall. The simulated wall is flexible, such that when a tracheostomy tube is positioned therein and a cuff thereon is overinflated, the wall extends outwardly in the direction of the simulated esophagus. Excerpt(s): The present invention relates to an anatomical simulator and, more particularly, to one which is useful in training proper tracheostomy and nasogastric tube placement and proper tracheostomy tube cuff inflation. In some instances it is necessary to provide an alternate breathing passage other than the mouth or nose for a person. This alternate breathing passage may comprise a passage through the neck of the person in communication with the trachea. This passage or "stoma" provides an air pathway from the outside of the person's neck to the trachea and the lungs therebeyond. A tracheostomy tube may be utilized to maintain the stoma in an open position. This tube is a curved conduit having a first open end and a second open end. The first open end is inserted through the stoma and extends into the trachea. The second open end extends outwardly of the patient's neck. The tube is maintained in position in the stoma with a strap which passes around the patient's neck. Web site: http://www.delphion.com/details?pn=US05846087__

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Apparatus and method for connecting a tracheostomy tube to a neckplate Inventor(s): Stuart; John Michael (Lake Forest, CA) Assignee(s): Mallinckrodt Medical, Inc. (St. Louis, MO) Patent Number: 5,778,877 Date filed: June 5, 1995 Abstract: A tracheostomy system having a neckplate, a tracheostomy tube having an end adapted for insertion into a patient's breathing passage and an end provided with a trach head for swivel connection to the neckplate and a connection mechanism for swivelly connecting the trach head to the neckplate without deformation of the trach head or neckplate and without thermal processing. The present invention also relates to a method for swivelly connecting a trach head to a neckplate without deformation of the trach head or neckplate and without thermal processing.

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Excerpt(s): The present invention relates generally to a tracheostomy device or system, and more particularly, to an apparatus and method for swivelly connecting a tracheostomy tube to the neckplate in such a device or system. A variety of tracheostomy devices and system exist in the prior art for providing a bypass supply of air or mixture of gases to a patient. Such devices are commonly used to bypass an obstruction in a portion of the patient's throat or breathing passage or to otherwise assist in providing oxygen to the patient's lungs. The surgical procedure involved is referred to as a tracheotomy. Typically, an incision is made in front of the patient's neck and trachea so that a tracheostomy tube can be inserted through the opening defined by the incision and into the patient's breathing passage or trachea. A tracheostomy device or system typically includes a tracheostomy tube which extends through the opening in the patient's neck and into the trachea and a neckplate or neck engaging portion which engages the surface of the patient's neck. The proximal end of the tracheostomy tube includes a trach head for connection within an opening provided in the neckplate. Preferably such connection is a swivel connection with means being provided for swivelly connecting the trach head to pins or pivot points positioned on opposite sides of the opening in the neckplate. As used herein, the term trach head is intended to mean that portion at the proximal end of the tracheostomy tube which is connected with the neckplate. Web site: http://www.delphion.com/details?pn=US05778877__ •

Assisted breathing apparatus and tubing therefore Inventor(s): Howe; Stephen L. (5829 E. Bloomfield Rd., Scottsdale, AZ 85254) Assignee(s): none reported Patent Number: 5,617,847 Date filed: October 12, 1995 Abstract: A tubing assembly is disclosed for use between an exhalation valve and a ventilator for providing assisted breathing to a patient. The ventilator has a patient air outlet, a exhalation valve control outlet and a sensor outlet connected to a sensing mechanism. The exhalation valve has a first outlet to a tracheotomy connector, a second outlet to ambient atmosphere, an inlet and a control air inlet. The exhalation valve is switched between an inhalation position and an exhalation position by air pressure at the control air inlet. The tubing assembly comprises an exhalation valve connection, a ventilator-sensor connection, an intermediate tube, a sensor tube and an exhalation valve control tube assembly. The exhalation valve connection is attached at one end to the intermediate tube and at the other end to the inlet. The ventilator-sensor connection is attached at one end to the patient air outlet and at the other end to the intermediate tube. The sensor tube is connected at one end to the ventilator-sensor connection and at the other end to the sensor outlet. The exhalation valve control tube assembly is connected at one end to the control air inlet and at the opposite end to the exhalation valve control outlet whereby the ventilator controls the air pressure at the control air inlet. The exhalation valve control tube assembly extends through the exhalation valve connection, through the intermediate tube and through the ventilator-sensor connection. Excerpt(s): This invention relates to an apparatus which is used to assist individuals in breathing after tracheotomy surgery, and, more particularly, to tubing used in connection with such apparatus. At present, many individuals who have had tracheotomy surgery require assistance in breathing. Such assistance may be temporary or permanent depending on the individual's condition. In either event, apparatus used

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to assist breathing should be portable, safe and easy to use. Present apparatus used to assist individuals in breathing are generally comprised of a control mechanism which forces air into a patient's throat and, hence, lungs. The mechanism controls the inspiratory and expiratory cycles via air pressure directed through a plurality of separate tubes. The entire apparatus is lightweight and portable. Web site: http://www.delphion.com/details?pn=US05617847__ •

Cable particularly for tracheostomy and retrograde-intubation techniques Inventor(s): Bergamaschi; Paolo (Concordia, IT), Gibertoni; Lucio (Mirandola, IT) Assignee(s): Mallinckrodt Inc. (St. Louis, MO) Patent Number: 6,106,489 Date filed: February 16, 1999 Abstract: A cable particularly for tracheostomy and retrograde-intubation techniques, including in combination an elastic guiding wire (2) constituted by a steel wire (3) arranged inside a flexible spring (4) and a traction-resistant steel cord (10) which is rigidly connected to the steel wire (3). Excerpt(s): The present invention relates to a cable particularly for tracheostomy and retrograde-intubation techniques. Conventional nonsurgical or emergency retrogradeintubation and tracheostomy techniques are often based on inserting in the trachea a guiding wire which is inserted through the passage of a needle; dilatation devices are made to slide over said wire, in the case of nonsurgical tracheostomies, or the wire is used as a guiding element for difficult intubations where the tracheal passage is not visible or not easily accessible from the mouth. The guiding wire being used is substantially provided by means of a spring inside which a steel wire is provided which is folded in a U-like shape at one end, so as to provide a highly flexible element which can be inserted in a needle even in a straight configuration and resume immediately thereafter the U-like shape, which is particularly useful during insertion, since it always tends to regain the axial position and, by being extremely flexible, does not damage-the delicate wall of the trachea. Web site: http://www.delphion.com/details?pn=US06106489__

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Clinical critical care path system and method of using same Inventor(s): Haudenschild; Chris A. (La Jolla, CA), Lancelot; Jean Francois (San Diego, CA), Urquhart; Kristopher S. (San Diego, CA) Assignee(s): Clini Comp International, Inc. (San Diego, CA) Patent Number: 6,401,072 Date filed: November 24, 1997 Abstract: A new and improved clinical critical care path system, which can be tailored readily for a given patient diagnosis for either single or combined medical and/or surgical diagnoses. The clinical information system stores critical care information for various patient diagnoses and retrieves them for a given patient. Treatment information is tailored to a given patient by enabling selected treatment information to be edited. Where multiple diagnoses are present, the prescribed or ordered treatment plans for each diagnosis are merged for a given patient, and potential conflicts are determined for

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any ordered activity. Upon determination of a conflict, patient treatment information is repeated on separate display lines to alert the healthcare provider to permit the healthcare provider to analyze the conflict and to determine what order or orders should be entered. Customized multiple diagnosis treatment information can then be entered and stored for a given patient. Excerpt(s): The present invention relates in general to a clinical information system and a method for using it for patient charting or record keeping purposes. The invention more particularly relates to a clinical critical care path system, which facilitates the ability for an improved careful maintenance of patient care. Charting the progress of a patient after being admitted to a medical care facility for medical or surgical reasons has been a traditional practice in the medical profession. Such charting typically involves monitoring the condition of a patient, collecting information relative to the physical condition of the patient, and logging the collected information onto a patient chart for review and analysis by trained medical personnel. To make such charting more efficient and cost effective, various monitoring and information gathering systems have been developed to provide automatic clinical record management. For example, reference may be made to the following United States patents and published articles, as follows: U.S. Pat. Nos. 5,361,202; 5,267,155; 5,077,666; 5,072,383; 4,893,270; 4,878,175; 4,838,275; 4,815,474; 4,803,625; 4,731,726; 4,712,562; 4,695,954; 4,674,652; 4,665,499; 4,622,185; 4,577,638; 4,531,527; 4,519,398; 4,513,294; 4,489,387; 4,473,884; 4,465,077; 4,428,381; 4,422,081; 4,417,306; 4,412,292; 4,363,368; 4,347,213; 4,320,766; 4,296,756; 4,272,878; 4,270,547; 4,227,526; 4,216,462; 4,197,854; 4,173,971; 4,151,831; 4,150,284; 4,130,881; 4,004,577; 3,996,928; 3,963,019; 3,910,257; 3,872,448; 3,872,251; 3,830,896; 3,765,406; 3,726,270; 3,696,805; 3,426,150; 3,302,828; 3,106,701; 2,891,111; and 1,078,090; and Walter A. Shewhart, Ph.D., Statistical Method from the View point of Quality Control,.COPYRGT. 1939; pp. 1-49; Donald Del Mar, George Sheldon, Introduction to Quality Control,.COPYRGT. 1988, pp. 123-143; Irvin W. Burr, Statistical Quality Control Methods,.COPYRGT. 1976, pp. 23-35, Indirect Heart Rate Measuring Device, Wilberger, 1994; American J. of Medical Elec., Light Wt. Carbon Fiber Structures. , Manley et al., 1973; Composites, Data Communications, November 1986, Principi et al., William Beaumont Hospital and Its Generation System, U.S. Healthcare, Vol. 6, No. 3, March 1998, Childs; Evaluating Automated Information Systems, Mowra et al., Vol.5, No. 1, January/February 1987, Nursing Economics: Automated Information Systems in Quality Assurance, Mowra et al., Nursing Economics, September/October 1987; Doctor Office Manager: An IBM Billing Package, Abstract of Article Appearing in M.D. Computing Vol. 2, No. 3, pp. 23-30, 6/85, Abstract from Microsearch File of Orbit AN85026189; J. E. Brimm, Computers in Critical Care, March 1987, pp. 53-63, Critical Care Nursing Quarterly, Hewlett Packard, 78707A; PDMS Clinical User's Guide, January 1982, pp. 1-1 through 1-34, 10-1 through 10-5, 15-1 through 15-2; Hewlett Packard; PDMS System Description, 1982, pp. 1-1 through 2-23; Health Data Science Corp. Ulticare (presumably 10/84), pp. 1-9; Ralph A. Korpman, Patient Care Information Systems--Looking to the Future, Software in Healthcare, Parts 1-5, April/May 1984December/January 1984-1985; An Integrated Bedside Fetal Monitor and Obstetrical Data System, IEEE Eng. In. Med. & Biology Med., September 1984, pp. 22-24; and U.S. Healthcare, Vol. 6, No. 3, March 1989, each of the foregoing patents and published articles being incorporated herein by reference as though fully set forth herein. Web site: http://www.delphion.com/details?pn=US06401072__

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Device for transmitting information via a patient tube in an intensive care or anesthetic machine Inventor(s): Cewers; Goran (Lund, SE) Assignee(s): Siemens Elema AB (Solna, SE) Patent Number: 5,816,242 Date filed: April 23, 1996 Abstract: In a device for transmitting information via a patient tube from a location near the patient to an intensive care or anesthetic machine, at least one signal source is arranged at one end portion of the tube to deliver information-carrying signals which propagate longitudinally through the medium inside the tube. At least one receiver is arranged at the other end of the tube to receive the signals. Excerpt(s): The present invention relates to a device for transmitting information via a patient tube in an intensive care or anesthetic apparatus. When intensive care and anesthetic units are used, they are normally located at a distance from the patient, and the patient is connected to the equipment by one or more tubes. The operator of the machine is often near the patient, making it difficult for her or him to operate the machine and select its functions from the instrument panel. The instrument panel, in turn, is often located at a distance from the machine. Examples of functions which the operator may wish to activate at the same time as she or he is next to the patient are O.sub.2 flushing, alarm check, fast changes in the anesthetic dose or respiratory pattern, etc. Known equipment of this type has hitherto employed some kind of transducer arranged near the patient, e.g. in the Y-piece of the patient's tubes. CO.sub.2 transducers are examples of one such transducer which must be located near the patient. These transducers are connected to the machine itself by a separate cord for transmitting measurement signals. This additional cord complicates the use of the equipment. Web site: http://www.delphion.com/details?pn=US05816242__

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Disposable tracheostomy inner cannula connector Inventor(s): Bell; Craig J. (E. Swanzey, NH) Assignee(s): Medcare Medical Group, Inc. (E. Swanzey, NH) Patent Number: 6,248,099 Date filed: May 14, 1998 Abstract: A disposable tracheostomy inner cannula connector that is compatible with prior art disposable inner cannula tracheostomy tube systems. The connector has an annular ring at a proximal end thereof which allows the inner cannula to snap in the connector and thereby secure the inner cannula in place. A locking mechanism of the connector, located at the distal end, permanently affixes the outer cannula to the connector. Excerpt(s): The present device relates to an improvement concerning tracheostomy tubes. The tracheostomy tubes are generally comprised of an outer cannula and a disposable inner cannula. Tracheostomy tubes are used in the health care field to provide a bypass supply of air or gases to a patient having an obstruction of the larynx or pharynx and who is thus no longer able to breath through the normal route. Tracheostomy tubes are also placed in patients who, because of injury or disease, cannot breath on their own. These patients are chronically dependant on mechanical ventilation

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and the long-term artificial airway of choice is the tracheostomy tube. An incision is made by the doctor below the obstruction and the tube inserted. The tube then acts as a gateway, allowing the patient to breath normally, the proximal end of the tube remaining stationary outside the trachea. Web site: http://www.delphion.com/details?pn=US06248099__ •

Endotracheal tube guide and related tracheostomy surgical procedure Inventor(s): Chelly; Jacques (Houston, TX), Katz; Jeffrey (Houston, TX), Smith; Thomas (Alvin, TX) Assignee(s): The Board of Regents of the University of Texas System (Austin, TX) Patent Number: 6,575,158 Date filed: June 3, 1997 Abstract: An ET guide is provided which is preferably made of polytetrafluoroethylene (PTFE), also known as Teflon.RTM. The distal end is of a reduced profile so that the guide can be left in place, with the ET removed in the operating room just prior to a tracheostomy. If for any reason problems are encountered in the tracheostomy procedure, the guide of the present invention, having been left in after the removal of the ET, can facilitate a reinsertion of the ET to avoid danger to the patient from a decrease in oxygen saturation. At the same time, the reduced distal profile allows the guide to remain in place during the tracheostomy procedure without obstructing the area of the incision for the tracheostomy. The guide can remain in place until the tracheostomy is successfully concluded, at which point it can be optionally removed. Leaving the guide in position as the tracheostomy is being conducted facilitates reinsertion of the ET which is routinely taken out in the operating room prior to the onset of the tracheostomy. In the preferred design, the guide has a circular cross-section until its distal end, which is a reduced-thickness, flattened segment of a predetermined length at the distal portion of the guide. Excerpt(s): The field of this invention relates to endotracheal tube guides and their use in related tracheostomy procedures. Prior to delivery to the operating room, certain types of trauma patients are frequently intubated with endotracheal tubes (ETs) which are inserted into the trachea via a guide. Several issued U.S. patents deal with techniques of insertion of guides and ETs. Such patents are U.S. Pat. Nos. 4,672,960; 5,507,279; 5,235,970; 3,957,055; 4,892,095; and 4,655,214. Various designs of ETs have been used, as well as guides for such tubes. Of general interest in the area of ET and guide construction are U.S. Pat. Nos. 4,685,457; 5,329,921; 4,683,879; 4,919,126; 3,605,751; 5,119,811; 5,429,127; 5,353,787; and 5,546,936. Thus, while guides have been used to insert ETs, when the patient is delivered to the operating room for surgery, the ET is typically removed as an incision is made in the trachea for insertion of the tracheal tube. The guide for the ET has already been removed prior to delivery of the patient to the operating room as part of the insertion procedure for the ET. Accordingly, in the past, if difficulties developed with the access to the trachea for insertion of the tracheal tube, it became necessary to reinsert the ET to prevent a decrease in oxygen saturation in the patient which could potentially lead to cardiac and brain damage, irreversible organ failure, or death. Web site: http://www.delphion.com/details?pn=US06575158__

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Face and tracheostomy neubulizing mask Inventor(s): Wright; Vivian A. (6901 Edgewater Dr. #321, Coral Gables, FL 33133) Assignee(s): none reported Patent Number: 6,698,426 Date filed: June 4, 2003 Abstract: A double-body therapeutics face and tracheostomy mask which functions as both a mask for the nose and mouth of a patient and a mask for the tracheostomy tube area of a patient is disclosed. The mask of the present invention serves as a means for delivering a gaseous medicament or a liquid, such as liquid medication, in the form of a fine spray or mist to the nose, mouth, and trachea of the patient simultaneously. The upper body of the mask fits over the nose and mouth area of the patient and the lower body of the mask fits a patient's tracheostomy tube area. The upper and lower mask bodies are connected to one another and to a nebulizing apparatus by a delivery conduit such as a standard "T" connector. Excerpt(s): The present invention relates generally to apparatus in the field of respiratory therapy. More particularly, the present invention relates to a double-body therapeutics face and tracheostomy mask which functions as both a mask for the nose and mouth, as well as a mask for communication with a tracheostomy tube of a patient. Nebulizers which produce a fine spray or mist have long been used in the treatment of various ailments and in the administration of medication. Masks have been developed which are in fluid communication with nebulizers and which are worn by the patient to more efficiently deliver the spray or mist to the nose and/or mouth of the patient. U.S. Pat. No. 4,938,209 discloses such a nebulizing mask that is equipped for the nose and/or mouth of a patient. Additionally, patients who suffer from an obstruction in the respiratory tract are often treated with surgery to create an opening in the neck through which to breathe. The result of the surgery is a stoma or breathing hole in which the patient is often intubated with a tracheostomy tube. Such patients often require the infusion of a gaseous medicament, such as oxygen, which is supplied into the tracheostomy tube. U.S. Pat. No. 5,749,360 discloses such a tracheostomy mask. Web site: http://www.delphion.com/details?pn=US06698426__

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Intensive care equipment carriage Inventor(s): Wadley; Robert D. (20 S. Sprague, Coldwater, MI 49036) Assignee(s): none reported Patent Number: 5,556,065 Date filed: October 19, 1994 Abstract: An intensive care carriage includes a base frame to which poles are mounted. The carriage includes two sections which are detachably interconnected. Each section includes a pole and a base. A platform is mounted on said carriage base frame to support equipment therein. A transducer support is mounted on said pole and permits a transducer attached thereto to permit adjustment of the height of the transducer and to permit the transducer to rotate around the pole. Excerpt(s): The present invention pertains to a life support equipment carriage for use with intensive care patients or other critical care patients. Carriages for life support equipment are well known. These carriages typically include a pole extending upwardly

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from a base. The pole supports an equipment hanger for IV bags and the like above the patient. The IV bags and transducers are suspended on the equipment hanger or pole, and fluid supply tubes extend from the IV bags and transducers to the patient. The base of the carriage includes wheels on which the carriage rolls to facilitate transport of the equipment with the patient. Such carriages may be interconnected with a hospital bed or gurney, and may include more than one pole. These carriages are often utilized with intensive care patients who require a wide variety of equipment, including intravenous (IV) bags, transducers, monitors, oxygen tanks, and other devices necessary to sustain and monitor the patient. Such carriages are used with intensive care patients because these patients are typically moved frequently for testing, operations and other treatment. Accordingly, at least a portion of the life support equipment necessary for sustaining and monitoring the patient must be moved with the patient. Web site: http://www.delphion.com/details?pn=US05556065__ •

Intensive care information graphical display Inventor(s): Hanson; C. William (Radnor, PA), Marshall; Bryan E. (Wynnewood, PA), Marshall; Carol (Wynnewood, PA) Assignee(s): The Trustees of the University of Pennsylvania (Philadelphia, PA) Patent Number: 5,921,920 Date filed: December 12, 1996 Abstract: This invention describes a patient monitoring system which creates graphical displays of various pulmonary and other patient functions so that physicians and clinicians can quickly and accurately make decisions about the patient's care based on the graphical displays while in the intensive care unit. Patient functions are monitored and pulmonary models are implemented to graphically reveal relationships between the basic information input to the system from monitoring devices and the models so that physicians can utilize the revealed relationships to make informed accurate diagnoses and design therapeutic plans concerning the patient. Excerpt(s): This invention relates generally to methods and apparatus for displaying graphical information. More specifically, this invention relates to interactive information processing systems and methods therefor wherein derived values from information are displayable in relation to the information so that observers of the information and the derived values can easily understand relationships between the information and the derived values which were heretofore unrevealed. Information intensive environments require observers of the information to make quick decisions in short time frames. An example of an information intensive environment is found in medicine in the surgical intensive care unit ("SICU"). In fact, a SICU is among the most information intensive environments in modern medicine. Monitors display vital functions of increasing sophistication but the displays are not uniform in design nor are they integrated, so that it is necessary for the clinician to survey several storage devices (including written records) at one time. Decisions in the SICU are often critical and urgent, and there is increasing pressure to reduce the time an individual is under intensive care and an increasing number of patients requiring such care. These conflicting considerations, that is, increased information and reduced time to assimilate it, create critical junctures in patient care in the SICU which may impair or delay the physician or other care giver from making accurate and safe judgments about the patient's immediate care. Current information visualization techniques are simply inadequate to facilitate the need for quick decisions. Respiratory monitoring is a more specific example of the need in the

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SICU for fast and accurate decision making based on a great deal of critical information assaulting the physician in a short time. A few concepts are fundamental to respiratory care. Some, such as the three compartment model for gas exchange and the pressure/volume relationships for lung ventilation are approximately quantified in every patient as a conceptual basis for representing pathophysiology. Others such as the pulmonary vascular pressure/flow relationships or the effects of the distribution of ventilation/perfusion ratios are understood in theory but seldom quantitatively because they are technically difficult to measure or are approximate. Traditional and selected pulmonary measurements together with the volume-pressure model ("V/Q-P/Q Model") provide a means to estimate all these relationships and, for the first time, permit the interactions between the gas exchange and the blood flow properties of the lung in an individual patient to be assessed. Web site: http://www.delphion.com/details?pn=US05921920__ •

Method and apparatus for assisted breathing Inventor(s): Kallert; Siegfried (Erlangen, DE), Kirchner; Harald (Fuerth, DE), Stroetmann; Brigitte (Nuremberg, DE), Ward; Leif (Dalaro, SE) Assignee(s): Siemens Elema AB (Solna, SE) Patent Number: 6,360,740 Date filed: October 13, 1999 Abstract: A system for assisted breathing has a ventilator delivers a breathing gas to a living creature in order to facilitate, support and/or control the breathing of the living creature. The respiratory musculature is weakened during treatment with a ventilator, long-term treatment in particular, and this results in longer treatment times, especially weaning times. Accordingly, a stimulation apparatus, devised for connection to the living creature, is incorporated into the system for assisted breathing in order to stimulate the respiratory nervous system and/or respiratory musculature of the living creature. Weakening of the respiratory musculature can be reduced by the stimulation apparatus emitting a stimulation signal at specific intervals. Excerpt(s): The present invention relates to a method and a system for assisted breathing of the type having a ventilator which delivers breathing gas to a living patient. A patient may need respiratory assistance as a result of disease and injuries of various kinds. The need can be direct, especially when the injury or illness afflicts the patient's respiratory system. The need can also be indirect, e.g. during anaesthesia and some intensive care. The respiratory assistance can encompass everything from facilitating spontaneous breathing to total control of breathing. A ventilator (respirator) is usually employed to provide the breathing assistance. It should be noted that a "patient" in this context could be any living creature, i.e. human or animal. Web site: http://www.delphion.com/details?pn=US06360740__

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Method and device for evaluating an EEG carried out in the context of anaesthesia or intensive care Inventor(s): Schultz; Arthur (Adelheidsdorf, DE), Schultz; Barbara (Adelheidsdorf, DE) Assignee(s): Arthur Schultz (Adelheidsdorf, DE) Patent Number: 6,011,990 Date filed: April 17, 1998 Abstract: A method of evaluating an EEG carried out in the context of anaesthesia or intensive care is disclosed. To this end, parameters from the time and/or frequency domains are determined from the EEG curves, the parameters determined are used in multivariate classification functions, and on this basis the EEG carried out in the context of anaesthesia or intensive care is automatically divided into stages. Excerpt(s): The invention concerns a method for evaluating an EEG carried out in the context of anaesthesia or intensive care according to the precharacterizing part of claim 1 and a device for evaluating an EEG carried out in the context of anaesthesia or intensive care according to the precharacterizing part of claim 5. Electroencephalography is a method of representing electrical activity generated by the brain. With the conventional way, registration of the EEG is by a multi-channel recorder onto reel paper, as a rule at a registration speed of 30 mm/s. The German EEG Society recommends the use of devices with at least ten channels. In order to be able to properly assess the signals from the various regions of the head, the electrodes are interconnected in various ways in several derivation programs. Increasingly, recording is also computer-assisted. The composition of the wave shapes in the electroencephalogram (EEG) depends on the functional state of the brain. The EEG diagrams of patients in surgical and intensive-care areas are varied; they can be influenced by a large number of endogenous and exogenous factors. Apart from the normal waking state EEG, the following for example have to be expected: elements of the sleep EEG, effects of medication and other exogenously admitted chemical substances, influences due to ventilation and metabolism, temperature effects, consequences of traumatic brain lesions as well as inflammable, vascular, degenerative EEG alterations and EEG alterations caused by neoplasms. Web site: http://www.delphion.com/details?pn=US06011990__

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Method for treatment and prevention of physiological shock Inventor(s): Hugli; Tony (San Diego, CA), Mitsuoka; Hiroshi (Hamamatsu, JP), SchmidSchoenbein; Geert (Del Mar, CA) Assignee(s): The Regents of the University of California (Oakland, CA), The Scripps Institute (La Jolla, CA) Patent Number: 6,534,283 Date filed: November 22, 2000 Abstract: Shock is a life threatening complication in situations associated with trauma including burns, surgery, ischemia, sepsis, and other critical care applications. Shock is induced by pancreatic proteases when they are released into the small intestine when the tissue is compromised due to trauma. Administration of protease inhibitors into the small intestine, either orally, intraveneously, or by direct lavage, was demonstrated to

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prevent shock in rats as determined by both survival time and molecular and histological analysis. Excerpt(s): The present invention is a method for the prevention and treatment physiologic shock involving the inhibition or removal of proteases in the small intestine and in circulation to prevent the generation of the mediators of shock. It is also a method for the identification of the proteases involved in shock to allow for the development of protease inhibitors for use in the treatment of shock. Shock is a life-threatening complication in situations associated with trauma including burns, surgery, ischemia, sepsis, and other critical care applications. Shock is a broad term that describes a group of circulatory syndromes, all of which result in general cellular hypoxia. This leads to a depletion of the adenosine triphosphate (ATP), the failure of the sodium-potassium pump, mitochondrial dysfunction, and ultimately the release of a variety of toxic substances, including superoxides. Superoxides are toxic to essentially all tissues. They react with proteins and cause unfolding and are able to induce DNA damage. Additionally, cellular activation in the circulation can be detected by leukocytes or endothelial cells resulting in superoxide production, pseudopod projections, enzyme release, cytokine release, and expression of membrane adhesion molecules. Cell activation fundamentally alters the biomechanics of microvascular blood flow by a shift in rheological, adhesive, and cytotoxic cell properties. Eventually these stress responses give rise to irreversible cardiovascular collapse because of their combined effects on the microcirculation. The interaction between activated leukocytes, both neutrophils and monocytes, and endothelial cells leads to accumulation of leukocytes in various organs, leading to cytotoxicity and cell death. Although such processes are mediated by humoral activators in the plasma of systemic circulation, an inflammation in organs throughout the body may eventually lead to multi-organ failure. When leukocytes are activated, neutrophil pseudopod formation is upregulated and several membrane adhesion molecules are expressed. This process lowers cell deformability and leads to accumulation of neutrophils in microcirculation. Not only may leukocytes start inflammation, but the abnormal cellular entrapment in the microcirculation also leads to immune suppression because of the reduced numbers of circulating cells. Web site: http://www.delphion.com/details?pn=US06534283__ •

MR compatible patient monitor Inventor(s): Fallon; Joseph R. (Boxford, MA) Assignee(s): Hewlett-Packard Company (Palo Alto, CA) Patent Number: 5,733,247 Date filed: December 20, 1995 Abstract: A MR compatible monitoring system has a fiber optic data link between the patient monitor and the control room display/keyboard in a magnetic resonance imaging suite to allow for continuous monitoring of a patient's vital signs and provides critical care patients with the same diagnostic options as stable patients. The patient monitor is mounted on the far end of a magnetic resonance compatible patient transporter. The patient transporter sends video data and receives control data from the control room. During the imaging, the patient monitor is located within the magnet room. Magnetic resonance imaging systems are very sensitive to radio frequency interference (RFI) from other equipment and may produce image artifacts because of this interference. Using a fiber optic data link between the patient monitor near the magnet and the control room will minimize the potential RFI.

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Excerpt(s): This invention relates to a patient monitoring system that is compatible with an environment having strong electrical and magnetic field levels, such as that found near a magnetic resonance imaging system. Although a patient may physically appear to be in good health, cardiovascular conditions, such as stenosis, are difficult for a physician to confirm with just his five senses and training. Preventive care measures cannot be suggested because the physician has insufficient data to make a diagnosis. A magnetic resonance (MR) scanner is a medical diagnostic tool which can provide this data by imaging the anatomy, as well as performing in-vivo, non-invasive, spectroscopic analysis of stable patients. The patient is positioned in a homogeneous polarizing magnetic field B.sub.o and then briefly excited by irradiation with a radio frequency at the Larmor frequency (f=yB.sub.o, where y=42.57 MHZ/Tesla). The MR signals emanating from the patient in response to the stimulus are observed. The MR scanner includes a magnet, frequently of solenoidal design, which produces the polarizing magnetic field, typically between 0.2 and 2.0 Tesla. The bore of the magnet has a large diameter to accommodate the RF, gradient, and shim coil assemblies, as well as the patient. A sliding patient tray is used to position the patient within the bore. The patient tray is longitudinally aligned with the magnet at a fixed height for patient positioning. If a patient undergoing a MR scan becomes critically ill, he must be quickly moved outside of the MR scanning room. This is necessary because most of the support equipment, (i.e. a defibrillator) used for critical patient care is not compatible with the MR scanning room environment. In the MR scanning room, there are strong magnetic and electric fields which may adversely affect the operation of the support equipment. Conversely, the support equipment may adversely affect the operation of the MR scanner. Web site: http://www.delphion.com/details?pn=US05733247__ •

Multi-purpose multi-parameter cardiac catheter Inventor(s): Ambrisco; William A. (Hayward, CA), Gallup; David A. (Hayward, CA), Hughes; Timothy J. (Palo Alto, CA), Pantages; Anthony J. (Los Altos, CA), Sarge; Jeffrey A. (San Jose, CA), Sperinde; John M. (Saratoga, CA), Tsuchitani; Scott T. (San Francisco, CA) Assignee(s): Abbott Laboratories (Abbott Park, IL) Patent Number: 5,611,338 Date filed: September 29, 1994 Abstract: A multi-lumen, multi-purpose cardiac catheter which incorporates optical filaments and an optical coupler for use with external apparatus for determining the oxygen concentration in the blood of a patient under critical care conditions, as well as incorporating therein a thermal element useable with a second external apparatus for measurement of continuous cardiac output. The thermal element is disposed at a necked down portion of the catheter at the distal end thereof, with at least one of the lumens of the catheter substantially compressed at the necked down portion thereof. The catheter also includes a thermistor and at least one injectate port for enabling the user to also conduct thermal dilution readings and obtain intermittent measurements of cardiac output. The combination of a thermal dilution catheter with a SVO.sub.2 catheter and a continuous cardiac output catheter gives the multi-purpose catheter above described substantial versatility as well as providing the user with a versatile cardiac catheter device which enables him to conduct multiple evaluations of disparate blood-related parameters which require the use of separate apparatus. Simply by switching from one

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external apparatus to the other, the user can obtain readings for different blood-related parameters useful in the treatment of the cardiac patient. Excerpt(s): The present invention relates to multi-purpose catheters and in particular, to multi-purpose multi-parameter cardiac catheters having multiple lumens and useable separately to perform diverse independent procedures including oximetry, thermal dilution and continuous cardiac output to obtain significantly useful blood parameters, such as oxygen saturation values (SvO.sub.2), thermal dilution values and continuous cardiac output values. Multi-lumen cardiac catheters are known. Further, it is known to provide within a multi-lumen catheter a plurality of optical fibers, such optical fibers used in conjunction with a signal processing apparatus to measure the oxygen concentration (SVO.sub.2) in the blood. Thermal dilution catheters have been provided for the measurement of the temperature of mixed fluids in the blood and veins in order to provide important diagnostic information. Exemplary of the patent art relating to such catheters is the patent of H. Khalil, U.S. Pat. No. 4,217,910 and the patents and literature referred to therein. Web site: http://www.delphion.com/details?pn=US05611338__ •

Neck flange for holding a tracheostomy tube in place and allowing limited movement therebetween and tracheostomy procedure using the same Inventor(s): Crandall; Norman (Costa Mesa, CA), Deily; Michael (Tustin, CA) Assignee(s): Mallinckrodt Medical, Inc. (St. Louis, MO) Patent Number: 5,819,734 Date filed: December 16, 1992 Abstract: A neck flange supports a tracheostomy tube inserted into the neck and has a neck engaging portion of a molded thin flexible flat sheet of a transparent polymer. An interconnection positioned centrally within the neck engaging portion and carried thereby has a ring shaped body with an opening and a pair of opposed pivot pins extending inwardly into the opening for carrying the tube passing therethrough. The pair of opposed pins fit for movement within recesses in the tube to permit limited swivel motion. The interconnection is molded of a transparent polymer material that is less flexible than the neck engaging portion and has a stepped cross section so the pair of opposed pivot pins are raised relative to the ring shaped body. The neck engaging portion is molded about the interconnection so the raised pair of opposed pins remain exposed. A method for manufacturing the neck flange has the steps of molding a ring shaped interconnection of a polymer and molding a neck engaging portion about the interconnection by inserting the interconnection into a mold then molding the neck engaging portion thereabout. A method for using the neck flange has the steps of placing the tracheostomy tube in a patient's neck and swiveling the neck engaging portion relative the tube to conform to the neck, flexing the neck engaging portion to conform to the curvature of the neck and observing the condition of the neck under the transparent neck flange. Excerpt(s): This invention relates to a neck flange for a tracheostomy tube that provides comfort and adjustability when used to secure the tracheostomy tube to the patient's neck. The neck flange has a neck engaging portion made of a flexible material and an interconnection positioned centrally within it that is made of a material less flexible than the neck engaging portion. The interconnection supports a tracheostomy cannula having a restricted motion substantially within a plane generally normal to the neck

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engaging portion. The flexible and less flexible materials are molded by the step of preparing a part from one material and then insert molding the other material over it. They may be made of transparent materials. Flexible neck flanges or flanges with pivotal joints to mount them to the tracheostomy tube are commercially available. U.S. Pat. Nos. 3,659,612 and 3,693,624 employ a neck flange of a flat plastic material pivotally connected to a tracheostomy tube. The tracheostomy tube and the neck flange are movably connected by pivots on the neck flange that fit into recesses in the tracheostomy tube. U.S. Pat. No. 4,033,353 describes a neck flange made of a flexible material to which a tracheostomy tube is mounted by flexible portions thereof. Specifically, thin webs of neck flange material between the tracheostomy tube and the part of the flange that is to be secured to the patient's neck provide the flexible portion. U.S Pat. No. 4,906,234 has a holder for medical tubes that provides axial adjustment along the tube for placement of an endotracheal tube within different areas of the oral cavity. A band fitted around the head cooperates with a releasable anchor so the holder may be laterally adjusted. The patent has no description for adapting the device to the curvature near the oral cavity of the patient. An endotracheal tube has no percutaneous intrusion and is not intended to be fitted to the human neck. Web site: http://www.delphion.com/details?pn=US05819734__ •

Obturator and tracheostomy tube containing the obturator Inventor(s): Stuart; J. Michael (24182 Elrond La., Lake Forest, CA 92630), Uding; Jeff G. (27039 Pacific Ter., Mission Viejo, CA 92692) Assignee(s): none reported Patent Number: 5,546,937 Date filed: December 13, 1993 Abstract: A plastic obturator suitable for use in a tracheostomy tube comprising a handle at its proximal end, a bullet-like shaped tip at its distal end, and an outer cannula supporting body between the handle and the tip, which outer cannula supporting body contains sectionalized flex points and laterally extending supporting surfaces along its length. Also described is a tracheostomy tube, preferably one that is flexible, containing the plastic obturator of the invention. Excerpt(s): The invention relates to a flexible obturator of a length sufficient to allow it to extend the length of a tracheostomy tube, i.e., from the proximal to the distal ends thereoff and curving to the shape of the tracheostomy tube. The obturator of the invention possesses a handle at its proximal end and a tip at its distal end, and a plurality of interbonded protrusion and bendable shaft sections sequentially alternating from the handle to the tip. The protrusions extend from obturator's centered elongated longitudinal axis and make contact or come close to making contact with the interior wall of the tracheostomy tube when the obturator is inserted into the tracheostomy tube. Each protrusion is separated from the other by a bendable shaft section and each bendable shaft section is separated by a protrusion. Each bendable shaft section terminates with connections to the protrusions to which it is associated. The distal end of the obturator possesses means for smooth entry of the tracheostomy tube within which it is situated into the trachea. The invention relates to a flexible obturator lodged within a tracheostomy tube possessing flexible walls. Cannula tracheostomy tubes are inserted into the trachea with the assistance of an obturator. The typical obturator has a curved rigid shaft that conforms to the curvature of the cannula within which it is inserted. The obturator is provided with a smooth rounded tip that conforms to the

Patents 141

distal opening of the cannula thereby providing a smooth end to the cannula. The function of the obturator is to block the distal opening of the cannula with a smooth surface that facilitates the inserting of the tracheostomy tube into the trachea without appreciably, or to any extent, traumatizing the lining of the trachea. The conventional shaft of the obturator is angle-ribbed with the ribs extending longitudinally of the shaft's axis. This gives strength to the shaft but also makes the shaft very rigid. As a result, the cannula is assured of being rigid and such rigidity adds to the discomfort to the patient in the insertion of the tracheostomy tube. Web site: http://www.delphion.com/details?pn=US05546937__ •

Patient interface system Inventor(s): Bell; Glenn B. (San Antonio, TX), Hicks; Ronald B. (San Antonio, TX) Assignee(s): Kinetic Concepts, Inc. (San Antonio, TX) Patent Number: 5,664,270 Date filed: May 3, 1996 Abstract: A patient interface system integral with a critical care bed for allowing the acquisition, analysis, display, and conveyance of patient-related data from a variety of transducers. The system is adapted to recognize and interpret each type of signal being received, despite the type and/or make of the particular transducers. The system is also adapted to simultaneously display data traces and representative readings from a variety of transducers simultaneously on a single screen detachably mounted to the bed. The display screen is pivotally mounted for ease of use and may be detached from the bed together with the main processor when the corresponding features are not desired. The bed is adapted with electronic connection sockets along each side of the patient surface to present convenient connections for patient transducer leads. The system has resident memory for storing data to enable trend analysis or downloading for patient data records. Bedside medical devices can either be connected to the device by cable connections or by use of wireless connections and is capable of controlling various medical devices related to the bed or patient, potentially including patient turn actuators, scales, inflation devices and others. Excerpt(s): The present invention relates generally to medical devices and, more particularly, to specialized patient supports interrelated with medical data acquisition devices for optimally monitoring, processing, storing, displaying and utilizing patient data. Patient data is often life-critical, especially in trauma and intensive care settings. It provides caregivers with objective information about the patient's condition. By comparing simultaneous data relating to a variety of strategic physiological parameters, caregivers can not only monitor and diagnose the patient's condition, but they can also evaluate the efficacy (and hence, value) of the patient's treatment. With more technologies being utilized, the critical care room can easily become crowded, complicated and confusing. Each patient will typically have a vital signs monitor, a ventilator, multiple intravenous pumps, and half a dozen or so other ancillary lifesupporting and/or therapeutic devices. The number grows as our understanding of medicine increases and more technologies become available. As for monitors alone, it is not uncommon to have your basic vital signs monitor plus another three or four specialized monitors crowded into any given room, with each unique monitor being mounted on a separate wheeled cart, often recording and displaying only a single vital sign. Patient temperature, blood pressure, EKG, heart rate, and SaO2 (i.e., blood oxygen levels) are routinely monitored, as well as any number of additional vital signs or

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conditions that may be of particular interest with a given patient. A modern critical care room may also utilize a bedside computer terminal for patient charting. The caregiver brings up the patient's chart electronically to determine what procedures have been prescribed and updates it as appropriate. The overall result is a complex network of wires, transducers, displays, bulky cabinets, and device carts surrounding the critical care patient. Web site: http://www.delphion.com/details?pn=US05664270__ •

Pediatric critical care transport system Inventor(s): Norberg; William J. (6805 Rock Rd., San Antonio, TX 78229) Assignee(s): none reported Patent Number: 5,860,176 Date filed: September 24, 1997 Abstract: The present invention is a critical care transport system comprising a transport frame, a transport wrap, and a restraining belt system which is especially useful in interhospital transport of infants and children, or retrieval and transport of critically ill children from remote locations. The transport frame further comprises an upper frame divided into a lower tray and a hingedly adjustable upper tray which allows elevation of the patient's head even when the belt restraining system is fully engaged. The transport frame further comprises various apparatus for securing air and oxygen tanks, instrumentation, and medical care devices for use during transport. The transport wrap further comprises a series of contiguous flaps which, when engaged in a specified order, serve to restrain, comfort, and protect the patient. The belt restraining system comprises a series of buckles and belts which engage at a common locking point for distribution of transport forces over a wide area and comfortable, effective, secure transport of the patient. Excerpt(s): This invention relates to critical care transport apparatus, and more particularly, to improved patient transportation apparatus used to transport critically ill children from the field to a nearby hospital, or between hospitals, by way of airplane, helicopter, or ground ambulances. Emergency patient care of the type discussed herein, generally is that dispensed by rescue squad crews aboard light planes, helicopters, and ground ambulances. Further, the usual rescue situation will involve extraction of an infant or child from a remote location after receiving a critical injury. It is customary for those skilled in this art to refer to a field device for supporting a patient in a horizontal transporting position as a stretcher. Devices in which patient transportation function is performed by two individuals carrying the device and patient are known as litters. While the pediatric critical care transport system of the present invention may be used as both a stretcher and a litter, all further references herein will be to a "stretcher". Web site: http://www.delphion.com/details?pn=US05860176__

Patents 143

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Portable intensive care unit Inventor(s): Grant-Thomson; John Charles (Toowoomba, AU), Hall; David (Umbiram, AU) Assignee(s): Buchanan Aircraft Corporation Ltd. (Toowooba Queensland, AU) Patent Number: 6,195,821 Date filed: April 1, 1999 Abstract: A self contained manually portable intensive care unit for adults has a housing with a first minor compartment holding medical equipment at one end and a second minor compartment holding medical equipment at an opposite end, medical equipment is located between the minor compartments in predetermined positions to provide a generally balanced assembly. Oxygen storage bottles are retained on one side of a longitudinal medial region while other equipment are retained on the other side of the longitudinal medial region. Excerpt(s): The present invention has particular application on premises or sites of operations to provide easy access to a fully equipped life support facility that can be quickly transported by road or air to further services that can provide the ongoing longterm treatment required so that the present invention can be easily returned to the site and partake in further rescue activities. This in turn enables the patient to not only receive emergency medical treatment at the point of accident (where a lack of treatment or suitable equipment may complicate their condition), but will most definitely enhance their recovery for having been treated so quickly and effectively. Prior art solutions are generally unsatisfactory. One solution involves a so called stretcher bridge which holds instruments and straddles a stretcher, thereby bridging over the patient. While this unit has relatively low cost, equipment is exposed to the elements, patient access is restricted, the unit is relatively fragile and because of its small size, is not a fully self-contained unit. The unit lacks oxygen supply or power supply back-up. In addition, the unit does not satisfy air worthiness requirements. Another unit of Israeli origin provides a single enclosure mounted to the rear wall of an aircraft to provide a flight surgeon with a full range of intensive care equipment. However, unfortunately, this system is not portable. Web site: http://www.delphion.com/details?pn=US06195821__

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Smog and dust filter for a tracheostomy tube Inventor(s): Strong; Samuel E. (Toledo, OH) Assignee(s): Culpepper; Steve (Bowling Green, OH) Patent Number: 5,840,091 Date filed: June 9, 1997 Abstract: A smog and dust filter for a tracheostomy tube which easily adapts onto existing tracheostomy tubes to filter out dust and airborne contaminants. The light weight and unobtrusive filter is easily manufactured and quickly installed onto an existing tracheostomy tube. The filter includes a securing device for engaging the outer periphery of an open end of a tracheostomy tube. A filter element, having two or more layers of net material, is attached to the securing device. The layers provide a filtering membrane to separate airborne particles and contaminants from an inhaled air stream. Excerpt(s): This invention relates to a filter apparatus for a tracheostomy tube. More particularly, this invention relates to a filter made from a synthetic net material that

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covers the open end of a tracheostomy tube to prevent dust and airborne particles from entering the lungs of the individual using the tracheostomy tube. Tracheostomy tubes are utilized with patients who have a permanently damaged or obstructed airway. The tracheostomy tube creates an unobstructed airway to permit normal breathing. However, the tube bypasses the natural filters of the nasal cavities in the normal airway. Therefore, ambient air inhaled through the tracheostomy tube travels directly to the lungs without being filtered. In the prior art, tracheostomy tube filters are generally complex filtration devices that require extensive fabrication. The known filtration devices are therefore costly and not readily available to all users of tracheostomy tubes. Additionally, some of the devices require special tracheostomy tubes or adaptors in order to hold the filter. The filtration devices in the prior art do not provide a filter which is easily fitted over the end of an existing tracheostomy tube to prevent the inhalation of airborne contaminants. Web site: http://www.delphion.com/details?pn=US05840091__ •

Supplemental oxygen adapter for tracheostomy speaking valves Inventor(s): Bare; Rex O. (Lake Forest, CA), Scherer; Andrew J. (San Dimas, CA) Assignee(s): Passy-Muir, Inc. (Irvine, CA) Patent Number: 5,806,515 Date filed: March 28, 1997 Abstract: An oxygen adapter for delivering low volume supplemental oxygen to a tracheostomized patient using a conventional tracheostomy speaking valve is provided, the adapter including a tube fitting for receiving conventional tubing thereon, and an outlet section attached to the tube fitting and defining a channel communicating between the tube fitting and an outlet end of the outlet section. The outlet section preferably extends axially from the tube fitting along the outer wall of a speaking valve to which the adapter is connected, the outlet end being located adjacent an inlet of the speaking valve, thereby delivering oxygen from the tubing received on the tube fitting to the inlet of the speaking valve. The adapter may be detachably connectable to the cylindrical wall of the speaking valve, preferably by a pair of semi-rigid gripping flanges adapted to peripherally engage the cylindrical wall of the speaking valve. The adapter preferably comprises injection-molded plastic, such as polycarbonate. Excerpt(s): The present invention relates generally to speaking valves for tracheostomized patients, and more particularly to a device for connecting supplemental oxygen to a conventional tracheostomy speaking valve being used by a patient. Tracheostomy tubes are often used to assist patients and other persons having respiratory problems, due to obstructions in their upper breathing passages or other medical conditions. A tracheostomy tube, generally comprising a small section of tubing, is typically introduced through an incision in the neck of the patient and into the trachea, generally below the larynx. Once in place, an outer end of the tube generally extends from the patient's neck, preferably keeping a relatively low profile, and is fixed in place to prevent movement of the tube, typically by a neck plate attached to the tube that is fastened around the patient's neck by a strap. The outer end of the tube generally includes a hub or tapered fitting that facilitates connecting the patient to a ventilator or that can be left open to allow the patient to breathe freely through the tube. Web site: http://www.delphion.com/details?pn=US05806515__

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Tracheostomy cannula Inventor(s): Waldeck; Franz (Deutschland, DE) Assignee(s): Tracoe Gesellschaft fu medizinische (Neu-Isenburg, DE) Patent Number: 6,053,167 Date filed: October 1, 1997 Abstract: A tracheostomy cannula for use in a tracheostoma is described, which is provided with a hose-like outer cannula into which an inner cannula, which is also hoselike, can be guided and can be locked to the outer cannula at the proximal part in order to form a cannula tube, wherein a cannula plate (3) for application to the neck is fitted in the proximal area of the outer cannula (1), through which the proximal part of the outer cannula reaches (1). It is proposed that the cannula tube is mounted so that it is pivotable about at least two spatial axes (X, Y) with respect to the cannula plate (3). Excerpt(s): The invention relates to a tracheostomy cannula for insertion in a tracheostoma, in accordance with the preamble of claim 1. It is provided with a hose-like outer cannula, inside which an inner cannula, which is also hose-like, can be guided and locked to the proximal part of the outer cannula, whereby in the proximal area of the outer cannula, a cannula plate for placing on the neck of the patient is fitted. The outer cannula and inner cannula together form the cannula tube. Tracheostomy cannulas of this type with a cannula plate pivotable about one axis only have been long known. Reference is made in this connection to U.S. Pat. No. 5,067,496, EP-0 107 779 B1, EP-0 037 719 B1, U.S. Pat. No. 4,852,565 and U.S. Pat. No. 4,009,720 in the patent literature. Tracheostomy cannulas of this type are inserted in a tracheostoma resulting from an operation, in order to keep it open until it heals. There are circumstances, however, in which a tracheostomy cannula must remain permanently in the tracheostoma. In other cases, the tracheostomy cannula assists artificial respiration. Web site: http://www.delphion.com/details?pn=US06053167__

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Tracheostomy length single use suction catheter Inventor(s): Bell; Craig J. (E. Swanzey, NH) Assignee(s): MedCare Medical Group, Inc. (E. Swanzey, NH) Patent Number: 5,653,231 Date filed: November 28, 1995 Abstract: A short, tracheostomy length, single use open suction catheter, made of relatively flexible plastic material such as natural or synthetic rubber, polypropylene, polyethylene, polyvinyl chloride, nylon or like material having the flexibility and resilience necessary for use in the suctioning of the airway of tracheostomized patients in order to remove tracheobronchial secretions from such a patient with a tracheostomy tube in place. The tracheostomy length catheter has a fitting for connecting the proximal end (the end nearest the source of vacuum) to a source of vacuum. There is a valve, such as a thumb controlled valve, at the proximal end used for controlling the extent of the vacuum or low pressure at the distal end of the suction catheter (the end nearest the patient). The valve regulates the vacuum by covering or partially covering a vent port with the thumb of the clinician who is doing the suctioning of the patient. The overall length of the tracheostomy length suction catheter, including the standard thumb valve used to control vacuum (about 4.5 cm in length), is about one-half the length of known

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and commonly used single use suction catheters which are about about 50 cm to about 61 cm or 20 inches to 24 inches. The overall length of the tracheostomy length suction catheter with the standard thumb valve being about 18.50 cm-40.0 cm or about 7.25 inches-15.75 inches. Further the tracheostomy length suction catheter may incorporate one of a variety of tip designs or components at the distal end thereof to improve the effectiveness of the removal of the secretions and to reduce the mucosa damage. Excerpt(s): This invention most generally relates to single use suction catheters. More particularly the invention relates to a construction of a single use open suction catheter for use in the suctioning of the airway of tracheostomized patients in order to remove unwanted tracheobronchial secretions from such a patient with the tracheostomy tube in place. Most particularly, the suction catheter, is about one-half the length of known and commonly used single use suction catheters, having means for connecting the proximal end (the end nearest the source of vacuum) to a source of vacuum, means for controlling the extent of the vacuum or negative/low pressure at the distal end (the end nearest the patient) and further the suction catheter may incorporate one of a variety of tip designs or components at the distal end thereof to improve the patient safety and the effectiveness of the removal of the secretions. The outer surface of the flexible tube and the surface of the lumen running through the tube may be coated with anti-bacterial and/or lubricating materials. The use of suction catheters to remove tracheobronchial fluid from both the intubated and non-intubated patient is well known in the art. These catheters are made of plastic or rubber and are connected to a vacuum line via a connector or a vacuum control valve. This valve regulates the vacuum by covering a vent port with the thumb of the clinician who is doing the suctioning of the patient. The length of the currently known and widely used catheter is typically 20-24 inches. The length has to be long enough to pass through a swivel access port, nasal length endotracheal tube, and reach the carina (bifurcation of the trachea into the right and left lungs). Thus the currently used catheters are long enough to be used both for the suctioning of the nasopharyngeal airway and the tracheobronchial tree. No clinician would dispute that suctioning an airway is hazardous. The procedure can cause hypoxemia, cardiac arrhythmias, hypotension, hypertension, damage to the tracheal mucosa, infection, increased intracranial pressure, cardiac arrest, and even sudden cardiac death. A primary goal is to minimize these risks. Web site: http://www.delphion.com/details?pn=US05653231__ •

Tracheostomy mask with tracheostomy tube alignment stabilizer Inventor(s): Elkins; John (St. James, NY), Lacey; William J. (Stuart, FL) Assignee(s): Hospitak, Inc. (Farmingdale, NY) Patent Number: 5,749,360 Date filed: February 3, 1997 Abstract: A tracheostomy mask for delivering gaseous therapeutics to a patient fitted with an tracheostomy tube includes a mask body and an alignment stabilizer. The mask body has an opening to receive oxygen and humidification to be delivered to a patient. The alignment stabilizer is supported by the mask body and maintains alignment between the mask body and the tracheostomy tube inserted within the neck of a patient. By maintaining this alignment, the tracheostomy mask with alignment stabilizer insures reliable therapeutic delivery to the patient.

Patents 147

Excerpt(s): The present invention relates generally to apparatus in the field of respiratory therapy, and more particularly relates to a tracheostomy mask including a stabilizer for improved alignment with a tracheostomy tube. Medical patients who suffer from an obstruction in the respiratory tract are often treated with surgery to create an opening in the neck through which the patient breaths. The result of the surgery is a stoma or breathing hole in which the patient is often intubated with a tracheostomy tube. As the mouth and nose are bypassed in this procedure, it is desirable to add supplemental humidification to the air which is being introduced through the tracheostomy tube. Also, such patients often require the infusion of a gaseous medicament, such as oxygen, which may also be supplied into the tracheostomy tube. The gaseous medicament and humidification (therapeutics) are typically introduced through a mask which is coupled to a supply of therapeutics. Such a mask is described in U.S. Pat. No. 3,236,236 to Hudson. FIGS. 1A and 1B illustrate a mask formed substantially according to the Hudson patent in cooperation with a patient's neck. The Hudson mask includes a mask body 4 which is formed from flexible plastic in the shape of a concave shell. The mask body 4 has a forward portion and a rear portion. The rear portion of the mask body 4 is engaged about the neck of a patient by a thin elastic strap 6. The forward portion of the mask body 4 has an opening 12 to receive the required therapeutics. A supply tube 8 is affixed to the mask body 4. The supply tube 8 extends away from the patient and transports the therapeutics from the supply to the patient. Web site: http://www.delphion.com/details?pn=US05749360__ •

Tracheostomy tube assembly Inventor(s): Smith; Rory J. M. (Skipton, GB3) Assignee(s): Kapitex Healthcare Ltd. (GB) Patent Number: 5,606,966 Date filed: January 10, 1995 Abstract: A tracheostomy tube assembly comprises a tracheostomy tube (2), a fitting (4) to be mounted on the end of the tracheostomy tube (2), having a bore (6) in which teh end (8) of the tracheostomy tube (2) can be received, a sealing memeber (10) which can be located between the outer surface of the tracheostomy tube (2) adn the inner surface of the bore (6) in the fitting (4), and means (12) for urging the sealing member against the outer surface of teh tracheostomy tube to form a seal between the fitting (4) and the tracheostomy tube (2). The assembly allows a sealed connection to be made to the end of the tracheostomy tube (2), so that a filter (20, 32) or a valve (34) (for example to assist in speech) can be fitted over a tracheostoma. Excerpt(s): This invention relates to a tracheostomy tube assembly, which includes a tracheostomy tube and a fitting which can be mounted on the end of the tube. A tracheostomy is a surgical procedure which creates an opening through the anterior surface of the neck into the trachea. The opening is referred to as a tracheostoma. It is performed to by-pass an upper airway obstruction, or to enable the provision of long term respiratory support via connection to a ventilator, or for some other medical reason. In order to enable the patient to speak it is necessary to provide a means of directing the flow of exhaled air through the larynx. This can conveniently be achieved by the incorporation of a valve. A tracheostomy tube can be provided to extend between the tracheostoma and the trachea. A nasal simulation device serves to simulate some of the functions of the nose, and optionally can include a speaking valve to assist in diverting the flow of exhaled air to permit speech.

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Web site: http://www.delphion.com/details?pn=US05606966__ •

Tracheostomy tube dressing and support device Inventor(s): Shesol; Barry F. (Aurora, CO) Assignee(s): Tapeless Technologies, Inc. (Aurora, CO) Patent Number: 5,918,599 Date filed: August 19, 1997 Abstract: A tracheostomy tube dressing and support device unit used for holding a tracheostomy tube in place and holding a primary wound dressing, such as a sterile gauze pad, next to a tube insertion site in the front of a patient's neck. The unit includes an elastic bi-directional wrap stretchable in opposite directions along a length of the wrap. One end of the wrap includes hook fasteners for engaging an opposite end of the wrap and holding it in place around the neck. The wrap includes a window opening with a pair of hook fastener strips attached to opposite sides of the window opening and on an outside of the wrap. The hook fastener strips are used for releasable receipt through flange openings in opposite sides of a tracheostomy tube flange. When the hook fastener strips are threaded through the flange openings, the strips are secured to loop fastener landing pads thus holding the tracheostomy tube firmly in place. Attached to an inside of the wrap are a plurality of hook fasteners on opposite side of the window opening for holding the wound dressing. The wound dressing is adapted for receipt around and next to a portion of the tracheostomy tube and the tube insertion site. Excerpt(s): This invention relates to the holding of tracheostomy tubes and like medical devices and more particularly, but not by way of limitation, to a tracheostomy tube dressing and support unit. The two concerns of a healthcare provider with reference to a tracheostomy tube and like medical tubes are 1. secure anchorage of the tube and 2. maintenance of the insertion site wound in the neck. To date, these two needs have been addressed by separate devices. This invention relates to a one piece unit which provides for both medical concerns. 1. Danger of constriction of the airway or the blood supply to head by the rope-like tape. Web site: http://www.delphion.com/details?pn=US05918599__

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Tracheostomy tube holder Inventor(s): Bowen; Michael L. (Arlington, TX) Assignee(s): Tecnol Medical Products, Inc. (Fort Worth, TX) Patent Number: 5,671,732 Date filed: September 27, 1995 Abstract: The invention relates to a tracheostomy tube holder having a strap and at least two tabs. The tabs are designed to pass through slots on the tracheostomy tube. The tabs have VELCRO type hook surfaces on their ends for releasable attachment to the exterior surface of the strap which has a soft VELCRO type loop surface. This provides for a tracheostomy tube holder which is inexpensive to make and use and which provides significant flexibility in the initial installation and subsequent replacement of individual components when they become soiled in use.

Patents 149

Excerpt(s): This invention relates to a holder for holding a tracheostomy tube which has been inserted in a patient's neck and into his trachea. More particularly, this holder provides an inexpensive strap and at least two tabs for releasably attaching the tracheostomy tube to the strap, such that the tabs and the strap encircle the patient's neck to hold the tracheostomy tube in place. This invention provides a tracheostomy tube holder which is much more adjustable and flexible in its operation than the prior art devices. Following a tracheotomy, the surgical operation of cutting into the trachea through the skin, generally a tracheostomy tube is inserted through the skin and into the trachea to keep the passage open for the passage of air, tubes, etc. into the patient's trachea and other connecting organs. Generally, the tracheostomy tube has a flange surface which extends parallel to the front portion of the patient's neck. This flange surface has two lateral slots for connecting with a strip or band to encircle the patient's neck to hold the tracheostomy tube in place. It is desired to firmly and securely hold the tracheostomy tube in the desired position. In the past, rolls of cloth strips have been used, where a portion of the strip is cut from the roll to encircle the patient's neck. The two ends of the cloth strip are then placed through the lateral slots in the flange surface of the tracheostomy tube and tied back on itself to hold the tracheostomy tube in position. The cloth strips suffer from several disadvantages. First, they have a tendency to irritate a patient's neck. Second, as they require a knot to hold the tracheostomy tube in place, it is time-consuming and difficult to replace the strip when it becomes soiled. Additionally, the knots tied in the cloth strip may irritate the patient's neck or come undone if not tied properly, releasing the tracheostomy tube. Web site: http://www.delphion.com/details?pn=US05671732__ •

Tracheostomy tube with removable inner cannula Inventor(s): Mongeon; Douglas R. (Orange, CA) Assignee(s): Vital Signs Inc. (Totowa, NJ) Patent Number: 6,135,111 Date filed: August 31, 1998 Abstract: A composite tracheostomy tube or cannula comprising a rigid inner tube and a relatively soft outer tube. One or more ducts or chambers are formed between the outer surface of the inner tube and the inner surface of the outer tube. A sealing or mounting flange is attached to the composite tube adjacent one thereof. A balloon or inflatable cuff is attached to the outer surface of the outer tube adjacent the opposite end of the composite tube. A conduit for connection to a fluid source is provided to selectively inflate and/or deflate the inflatable cuff. An inner tube or cannula is removably inserted into the tracheostomy tube. The inner cannula includes a preferred gripping device at the proximal end thereof. Excerpt(s): The present invention relates to respiratory circuits, in general, and, more particularly, to tracheostomy tubes comprising a composite outer cannula and a removable inner cannula. Tracheostomy tubes are well-known in the art. It is also wellknown that a two part tracheostomy tube is used so that if the tracheostomy should be occluded by mucous or phlegm, the tracheostomy tube airway can be cleaned by removing the inner cannula, see U.S. Pat. No. 4,817,598, to D. LaBombard, for example. In the past, the tracheostomy tube has been made of a relatively rigid plastic material such as ABS plastic or the like. These tubes are made according to ASTM or ISO standards which are well-known in the industry. The existing tracheostomy tubes comprise a bent or arcuate tube with a 15 millimeter (or similar) connection at one end

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which is connected to a breathing circuit or the like. These tubes include flanges at the proximal end thereof for attachment to a neck strap or the like to fasten the tracheostomy tube to the patient. Web site: http://www.delphion.com/details?pn=US06135111__ •

Ventilator tube retaining device for endotracheal tube or tracheostomy Inventor(s): Ess; Steven M. (6864 Minnick Rd., Lockport, NY 14094) Assignee(s): none reported Patent Number: 5,782,236 Date filed: August 9, 1996 Abstract: A retaining clamp device holds a tubular air fitting to an endotracheal tube or tracheostomy, e.g., disposed on the neck of the patient. A C-shaped clamp member is formed of a resilient semi-rigid plastic and has an inside diameter that fits snugly over the air fitting, with one or more legs connected to the C-shaped clamp member. The legs have slots at their free ends to fasten the clamp member to said to the flange of the endotracheal tube assembly, e.g., using the Velcro strips that hold the flange to a neck collar. The legs can include left and right leg members that extend from opposite sides of the C-shaped clamp member. The attendant or patient can snap the C-shaped member on or off the fitting of a ventilator tube, moving the C-shaped member to the side. Excerpt(s): This invention relates generally to medical and surgical devices, and is more particularly concerned with a device for retaining a hose or tube for breathing apparatus onto an endotracheal tube or tracheostomy tube of a patient. The invention is more specifically directed to a device for releasably securing a ventilator tube to a tracheostomy tube or a endotracheal tube. The invention is further concerned with a retaining device which prevents inadvertent decoupling or disconnecting of the ventilator tube from the patient. The medical community is now recognizing the importance to breathing impaired patients of securing the ventilator circuit to the endotracheal tube or to the tracheostomy tube. Respiratory therapists working with both acute and chronic ventilator patients, with either a tracheostomy tube or an oral/nasal endotracheal tube, have observed that such patients oftentimes find themselves disconnected from the ventilator circuit. This may come about simply due to motion when the patients reposition themselves, or when the nurse repositions them. Other common reasons for disconnection may be strong, persistent coughing which allows for secretions to lubricate the connection site and create a loose connection, or disorientation of the patient, i.e., where the patient is turning in bed or pulling on lines and catheters that may cause the circuit to become disconnected. These examples are rather prevalent in a critical care setting, and in a chronic ventilator care rehabilitation setting. However, these problems are also found with home-care patients. Patients who become ventilator-dependent and are living at home generally have at least some limited mobility. Some of these home-care patients require connection to the ventilator only at night while sleeping, and in that case rolling in bed or movement during sleep, e.g., if the patient experiences troubled dreams, can result in disconnection from the ventilator tube. Those who are quadriplegic, i.e., neuromuscularly impaired, can find themselves disconnected from the ventilator tube and with no means to reposition the tube by themselves. In most circumstances an attendant, nurse or caregiver is present. However, if the patient becomes disconnected while the caregiver has stepped away momentarily, even for the short time it takes to check the mail or prepare medication,

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the patient can become tachypneic and cyanotic, risking injury. In the case of higher pressure ventilation, the pressure itself may cause the disconnection. For example, pressure levels may be 15 to 20 cm (H.sub.2 O), with pressure control levels in the range of 30 to 40 cm (H.sub.2 O). These high pressures alone may overcome the friction or press fit that is usually used for a suction-trach connect or wye-trach connect. These connections may become disconnected just from the pressures employed. At somewhat lower pressures, the ventilator connects may come off when the patient coughs. Many patients have large necks or jowls that can interfere with the ventilator-trach connect. Web site: http://www.delphion.com/details?pn=US05782236__

Patent Applications on Critical Care As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to critical care: •

APPARATUS AND METHOD FOR UPGRADING A HOSPITAL ROOM Inventor(s): CATTON, EDWARD W; (NEW PALESTINE, IN), GALLANT, DENNIS J; (HARRISON, OH), GRAY, JOHN C; (GREAT FALLS, MT), RUEHL, JOHN W; (SHELBYVILLE, IN) Correspondence: Barnes & Thornburg; Franklin Tower Bldg; 1401 Eye Street N W Suite 500; Washington; DC; 20005 Patent Application Number: 20020152555 Date filed: June 26, 1998 Abstract: The present invention relates to an apparatus and method to facilitate upgrading of a standard, general care hospital room to a critical room. More particularly, the present invention relates to an improved apparatus and method for providing seamless critical care services to a patient in a hospital room and during transport of the patient within the hospital. Excerpt(s): This is a continuation in-part of U.S. patent application Ser. No. 08/792,881, filed Jan. 31, 1997, which is incorporated herein by reference. Recent trends have caused cost reducing pressures on hospitals. These cost pressures have driven traditional inpatient services to less expensive out-patient and home care settings. Therefore, hospitals tend to have smaller in-patient populations. Future in-patient populations are likely to be older and sicker patients with multiple complications. The population of intermediate care patients is also likely to increase while the med-surg hospital population is decreasing over time. Therefore, the in-patient hospital population has a higher level of acuity. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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This has been a common practice outside the United States prior to December 2000.

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Centralized hospital monitoring system for automatically detecting upper airway instability and for preventing and aborting adverse drug reactions Inventor(s): Lynn, Eric N.; (Villa Ridge, MO), Lynn, Lawrence A.; (Columbus, OH) Correspondence: Lawrence A. Lynn; 1507 Chambers RD.; Columbus; OH; 43212; US Patent Application Number: 20030000522 Date filed: May 17, 2002 Abstract: A system and method for the automatic diagnosis of obstructive sleep apnea in a centralized hospital critical care monitoring system for the monitoring of a plurality of patients in at least one of a critical care, step down, and cardiac ward by telemetry. The system includes a central processor having a display, and a plurality of telemetry units for mounting with patients, each of the telemetry units has a plurality of sensors for connection with each patient, the telemetry unit is capable of the transmission of multiple signals derived from the sensors to the central processor, in one preferred embodiment the method comprising steps of programming the system to analyze the signals and to automatically identify the presence and severity of obstructive sleep apnea and to provide an indication of the identification. Excerpt(s): This application claims priority of provisional application Nos. 60/291,691 and 60/291,687, both filed May 17, 2001 and provisional application No. 60/295,484 filed Jun. 10, 2001, the disclosures and contents of each of which is incorporated by reference as if completely disclosed herein. This invention relates to centralized hospital monitoring systems and particular to the organization, analysis, and automatic detection of patterns indicative of upper airway instability during sleep, deep sedation, and analgesia. This failure of conventional hospital based patient monitors to timely and/or automatically detect cluster patterns indicative of airway instability can be seen as a major health care deficiency indicative of a long unsatisfied need. Because obstructive sleep apnea, a condition derived from airway instability, is so common, the consequence of the failure of conventional hospital monitors to routinely recognize upper airway instability clusters means that many of patients with this disorder will never be diagnosed in their lifetime. For these patients, the diagnostic opportunity was missed and the health implications and risk of complications associated with undiagnosed airway instability and sleep apnea will persist in this group throughout the rest of their life. A second group of patients will have a complication in the hospital due to the failure to timely recognize airway instability. Without recognition of the inherent instability, a patient may be extubated too early after surgery or given too much narcotic (the right drug, the right patient, the ordered dose but unknowingly a "relative drug excess"). Indeed until clusters indicative of airway instability are routinely recognized by hospital monitors, the true incidence of respiratory failure, arrest, and/or death related to the administration of IV sedation and narcotics to patients in the hospital with airway instability will never be known but the number is probably in the tens of thousands each year and airway instability is just one example of the types of physiologic instability which are not automatically characterized by central hospital systems. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Data analysis system Inventor(s): Merrett, Philip Jonathan; (Hampshire, GB), Shaikh, Loua Asad Hanna Al; (Surrey, GB) Correspondence: Nixon & Vanderhye P.C.; 8th Floor; 1100 North Glebe Road; Arlington; VA; 22201; US Patent Application Number: 20030225315 Date filed: August 29, 2002 Abstract: A system and method for gathering and displaying information in data intensive environments. It is particularly concerned with data analysis in a critical care environment to provide a graphical display of derived information, comprising a series of bar charts (a-h) representative of a corresponding series of functions (32). Each bar chart comprises a linear series of time-divided segments (34) wherein each segment (34) of each bar chart (a-h) is assigned a colour corresponding to the status of that function (32). The status of each function (32) is derived by scoring contributory data indicators in accordance with pre-set threshold values, and logically combining to produce a status score for each function. Interventions that affect particular functions may also be recorded and displayed against those functions so that their effect is readily discernible. Excerpt(s): This invention relates generally to systems and methods for information analysis in data intensive environments and to applications thereof for use as an aid in making decisions. It is particularly concerned with data analysis in a critical care environment. Whilst computerisation has clearly been beneficial to numerous aspects of modern life, its increasing use in data capture has given rise to a new problem. Automated monitors and measuring systems can take readings more frequently than was possible with their manually operated predecessors. Whenever a decision or assessment is to be made based on the readings from these systems, there is accordingly a vast amount of data available. The sheer volume of data alone may obscure judgment but, more often than not, the assessment must also be made rapidly. Such situations will be referred to as data intensive environments. One example of a data intensive environment is that encountered in a hospital, in particular in intensive care and high dependency units. Current clinical practice requires that a plethora of specific medical data are measured in the critically ill patient. Different data are collected at various intervals and are traditionally entered onto large paper-based observation charts. Psychological studies have shown that the normal human brain can handle some 20 variables at any one time. There is thus always a danger of information overload, even for skilled staff. Each patient's paper chart must be studied carefully in order to detect important changes in his or her condition. Unfortunately, there is often only recognition of an acute system failure once an adverse trend has been established. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Enhancing organ maturity in neonates and predicting their duration of intensive care Inventor(s): Hanauske, Axel-Rainer; (Hamburg, DE), Hanauske-Abel, Hartmut M.; (Edge Water, NJ) Correspondence: Michael L. Goldman; Nixon Peabody Llp; Clinton Square; P.O. Box 31051; Rochester; NY; 14603-1051; US Patent Application Number: 20030139335 Date filed: July 26, 2002

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Abstract: The present invention is directed to methods of enhancing organ maturity of premature human neonates or increasing collagen type IV formation in a living system by administering a growth factor, a gene encoding a growth factor, or an agent that increases growth factor formation to the living system under conditions effective to increase collagen type IV formation. Another aspect of the present invention relates to a method of predicting a premature human neonate's length of stay in a neonatal intensive care unit as well as the anticipated medical costs incurred during said stay by providing a sample from the premature human neonate and determining biomarkers derived from the extracellular matrix in the sample. The biomarker levels or ratios thereof in the sample are compared to a standard to ascertain the premature human neonate's length of stay in a neonatal intensive care unit as well as the anticipated medical costs incurred during said stay. Excerpt(s): The present application claims benefit of U.S. Provisional Patent Application Serial No. 60/308,143, filed Jul. 27, 2001. The present invention is directed to enhancing organ maturity of premature human neonates and to predicting a premature human neonate's length of stay in a neonatal intensive care unit as well as the anticipated medical costs incurred during that stay. The present invention is also directed to increasing collagen type IV formation in a living system. Premature birth represents a major medical challenge, and for decades has been the focus of research efforts in obstetrics and in pediatrics. Prematurity is also a major societal challenge due to its remarkable economic costs. Infants born prematurely (<37 weeks gestational age) account for only 9% of all live births, yet consume 57% of all acute neonatal intensive care unit (NICU) costs in the United States, or $ 5.8 billion annually (St. John et al., "Costs Of Neonatal Care According To Gestational Age At Birth And Survival Status," Am. J. Obstet. Gynecol., 182:170-175 (2000)). This amount accounts for over 40% of total health care costs for all infants. Over the longer term from birth to age 15, follow-up costs due to the medical sequelae of prematurity exceed an additional $5.4 billion per year, or 10% of the health care costs for all children (Zupancic et al., "Economics Of Prematurity In The Era Of Managed Care," Clin. Perinatol., 27(2):483-497 (2000)). The overall societal expenditures on premature birth therefore are in excess of $11 billion annually. This number does not, of course, include the direct and indirect loss in economic productivity due the long-term physical and mental handicaps experienced by survivors of prematurity and the required allocation of time and resources for their care, nor does it account for the emotional pain and anguish experienced by parents of `preemies`. Of note, there is general agreement that the incidence of prematurity in the United States is increasing. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Fully integrated critical care workstation Inventor(s): Cavallaro, Samuel; (Warner, NH), Elaz, Joseph; (N. Andover, MA), Ortlam, Dieter T.; (Beverly, MA), Scholz, Wolfgang; (Beverly, MA) Correspondence: Siemens Corporation; Intellectual Property Department; 186 Wood Avenue South; Iselin; NJ; 08830; US Patent Application Number: 20020077864 Date filed: November 16, 2001 Abstract: A critical care workstation includes a display device and a processor, coupled to the display device. The processor executes both a general purpose operating system controlling execution of a selected program for displaying images representing non-real-

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time data on the display device, and a real-time kernel, controlling execution of a program for displaying images representing real-time data on the display device simultaneously with the display of the non-real-time data. In addition circuitry, responsive to user input, selects a non-real-time display program to execute under the control of the general purpose operating system from among a plurality of available non-real-time display programs. Excerpt(s): This application is a non-provisional application claiming priority from provisional application 60/249,572 filed Nov. 17, 2000. The present invention relates to a critical-care work-station integrating real-time and non-real-time data displays. In a critical-care environment there are many types of information which a doctor may find important in the treatment of a patient. Currently, each type of information is processed by a separate piece of equipment and displayed on a separate display device. This requires a large amount of space around the patient, and requires the doctor to look at many different display devices to acquire all the information desired. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Integral balloon tracheostomy tube Inventor(s): Fauza, Dario O.; (Wellesley, MA) Correspondence: Patrea L. Pabst; Holland & Knight Llp; Suite 2000, One Atlantic Center; 1201 West Peachtree Street, N. E.; Atlanta; GA; 30309-3450; US Patent Application Number: 20020007833 Date filed: April 27, 2001 Abstract: The present invention relates to a tracheostomy device with an inflatable balloon (1) attached to a hollow tube (2) by means of two areas of adhesion (1a and 1b) whose ortogonal projections are not contiguous or, in other words, are at an angle (.alpha.) other than 180.degree. This balloon (1) communicates with the environment by means of a capped, valved flexible conduit (4). A movable flange (3) allows for extra fixation of the device around a patient's neck. A displaceable inner tube (5) can be removed in case of severe acute obstruction, allowing for immediate establishment of air flow. The design and distribution of the components of this tracheostomy device contribute to increased safety and comfort of tracheostomies by: enhancing the its anchorability, hence better stabilizing it within the trachea; improving its placement within the airway; increasing the volume, hence lowering the pressure inside its balloon (1); enhancing the balloon's (1) volume-to-pressure curve; completely sealing the trachea from the tracheostomy wound, larynx and pharynx; shortening the tube (2) size and providing a movable neck flange (3). Excerpt(s): The present invention generally relates to a surgical device used in a tracheostomy, which is a surgically produced airway introduced directly through the trachea, below the vocal cords. The vast majority of tracheostomy tubes in current use follow a basic concept consisting of a curved tube which serves as an artificial passage for exchange of air between a patient and an air source, typically either atmospheric air or a mechanical respirator. See, for example U.S. Pat. No. 5,983,895 to Turner. The tube often is enveloped at its caudal end by a small, inflatable balloon, also called a cuff, which is fillable with a fluid, such as air, as it is often necessary to employ positive inspiratory pressure by means of a respirator. See for example, U.S. Pat. No. 5,056,515 to Abel and U.S. Pat. No. 4,791,920 to Fauza. The balloon adheres to the internal lining of the trachea in its cross-section in order to prevent air insufflated by a respirator into a

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patient from escaping to the environment through the tracheostomy or the larynx and pharynx, which enables the air to reach the lower airways and eventually the pulmonary alveoli. The balloon also aids in supporting the tube inside the trachea. These conventional tube designs, however, contribute to a variety of frequent complications associated with tracheostomies. Most of these complications are consequences of both the instability of the tube inside the trachea and the pressure inside the balloon. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and system for collecting and circulating data derived from medical appliances, useful in particular in intensive care units Inventor(s): Forrester, Steven; (Paris, FR) Correspondence: Ratnerprestia; P O Box 980; Valley Forge; PA; 19482-0980; US Patent Application Number: 20030158746 Date filed: April 15, 2003 Abstract: This invention relates to a process and system for collecting medical data originating from medical apparatus (1), for example located in intensive care units (2) and to distribute the said data to health practitioners (3);The system comprises at least one data processing device (4) comprising:reception means (4a) to receive data (7) originating from sending apparatus (1),data processing means (4b) to translate the received data into a common format,data sending means (4c) to distribute the data in a common format to users (3);The users (3) have computer equipment (5) comprising:reception means (5d) for reception of data sent by the said data processing device (4);a data analysis software (5e). Excerpt(s): This invention relates to a new process and a new system for collecting data originating from sending apparatus that produces the said data and to distribute the data to users. Each user has at least one computer equipment, particularly a personal microcomputer, connected to a display screen and/or a printer and/or a loudspeaker. Each computer equipment is used with data analysis software. More particularly, the invention relates to a new process and a new system for collecting data originating from medical apparatus, particularly from medical apparatus used in intensive care units, and to distribute the said data to health practitioners. Each health practitioner has at least one computer equipment, particularly a personal microcomputer, connected to a display screen and/or a printer and/or a loudspeaker. The said computer equipment is associated with a clinical analysis software. Medical apparatus is frequently used in intensive care units, including cardiac monitors, ventilators, infusion pumps, etc. Most apparatus available on the market at the present time is provided with a communication port, usually an RS232.Therefore, it can be used to distribute all or some of the collected data to clinical analysis software. This software uses data collected by medical apparatus for a large number of applications, for example for studying the reaction of the patient to a treatment, or a prescription change. This information is obviously valuable for the entire medical community, including the doctor and nurses and the hospital administration, pharmaceutical companies, and government officials responsible for the national health service. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and system for collecting and circulating data derived from medicals appliances, usefil in particular in intensive care units Inventor(s): Forrester, Steven; (Paris, FR) Correspondence: Ratnerprestia; P O Box 980; Valley Forge; PA; 19482-0980; US Patent Application Number: 20030200116 Date filed: May 6, 2003 Abstract: The invention concerns a method and a system for collecting medical data derived from medical appliances (1) for example located in intensive care units, and for distributing said data to health practitioners equipped with computer equipment (5). The method and the system comprise the following software modules: (I) a service module (DS) (21); (II) a data storage module (DDS) (25); (III) control modules (DAC) (26) accessible from all points of said computer communication network and controlling the distribution of said data; (IV) an appliance interface module (DDI) (23), configured according to specific characteristics of said transmitting appliances (1); (V) a communication interface module (DCI) (22); (VI) a configuration interface module (DCP) (28); (VII) a data portal module (DDP) (40) converting the data into a communication format of clinical analysis software (5 e ) of the computer equipment (5) of the user (3). Excerpt(s): This invention relates to a novel method and a novel system for collecting data produced by transmitter devices producing said data and for disseminating same to users. Each user has at least one data processing device, namely a personal computer, connected to a monitor and/or a printer and/or to a speaker. Each computer is associated with data analysis software. More particularly, the invention relates to a novel method and a novel system for collecting data produced by medical devices, namely originating from medical apparatus used in intensive care units, and disseminating said data to health care workers. Each health care worker has access to at least one data processing device, namely a personal computer, connected to a monitor and/or to a printer and/or to a speaker. Said data processing device is associated with software for analyzing clinical data. The medical apparatus currently used in intensive care units include: cardiac monitors, ventilators, infusion pumps, etc. The majority of equipment available on today's market are equipped with a communications port, generally an RS232 port. They allow dissemination of all or part of the data collected to clinical analysis software. Said software use the data collected by the medical devices for several applications; for studying the patient's reaction to a treatment or to a prescription change, for example. This is clearly important information for the whole medical community, from the physician and nursing staff to the hospital administration, pharmaceutical companies and the managers of the national health plan. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method of administering a milk substitute to critical care animals Inventor(s): Lepine, Allan J.; (Lewisburg, OH) Correspondence: Killworth, Gottman, Hagan & Schaeff, L.L.P.; Suite 500; One Dayton Centre; Dayton; OH; 45402-2023; US Patent Application Number: 20020018828 Date filed: April 9, 2001

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Abstract: A method for providing nutrition to critical care animals such as dogs and cats is provided which comprises administering an amount of an artificially produced canine or feline milk substitute composition. The canine milk substitute composition comprises, on a dry matter basis, from about 35 to 45% by weight protein, from about 25 to 35% by weight fat, and from about 10 to 25% by weight carbohydrates. The feline milk composition comprises, on a dry matter basis, from about 30 to 50% protein, from about 25 to 50% fat, and from about 10 to 25% carbohydrates. Excerpt(s): This application is a continuation-in-part of U.S. application Ser. No. 09,163,778 filed Sept. 30, 1998, the disclosure of which is hereby incorporated by reference. This application is also related to commonly assigned U.S. Pat. No. 5,882,714, which is a continuation-in-part of U.S. Pat. No. 5,792,501, the disclosures of which are hereby incorporated by reference. This invention relates to a method for providing nutrition to critical care animals, and more particularly, to a method of administering a milk substitute which substantially supplies the nutritional requirements of critical care animals such as cats and dogs. The importance of administering proper nutrition to critical care animals such as cats and dogs is known. By "critical care", it is meant the medical treatment and supportive care given to animals that have an immediate life threatening condition such as an injury, or have suffered from illness or major surgery. Critical care animals are usually under extreme stress and may be in shock due to extensive trauma, systemic disease, cancer, chemotherapy, malnutrition or ingestion of toxins. For example, trauma may be induced by being hit by an automobile, gunshot wounds, bite wounds, bums, extensive abrasions, infection of the skin, and the like. These conditions may have acute onset as in the case of gunshot wounds, but may also be brought on by more chronic conditions such as malnutrition, neglect, end stages of chronic disease such as parasitic disease, hepatic, respiratory, or cardiac disease. Diseases resulting in critical care situations may be the result of metabolic dysfunction or infections such as fungal, viral, bacterial or parasitic infections. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Non-invasive measurement of pH Inventor(s): Furlong, Steven C.; (Maple Grove, MN), Kimball, Victor E.; (Burnsville, MN), Pierskalla, Irvin; (Prior Lake, MN) Correspondence: Altera Law Group, Llc; 6500 City West Parkway; Suite 100; Minneapolis; MN; 55344-7704; US Patent Application Number: 20040009606 Date filed: July 11, 2002 Abstract: There is a need within the medical community for non-invasive instruments to measure critical physiologic parameters at the point of care. Such a technique may be applicable to a wide variety of commonly monitored physiologic parameters during critical care patient management. The invention is directed to a method of measuring the pH of a patient's tissue. The method includes measuring the optical signal from a specie whose fluorescence is pH sensitive, such as nicotinamide adenine dinucleotide (NADH) and also measuring the optical signal from a second biological marker, such as FAD, the fluorescence from the second marker being substantially insensitive to pH. The method includes determining the patient's pH by using the first and second optical signals.

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Excerpt(s): The present invention is directed generally to medical devices and more particularly to non-invasive optical sensors for physiologic parameters. Optical spectroscopy techniques have been developed for a wide variety of uses within the medical community. For example, pulse oximetry and capnography instruments are in widespread use at hospitals, both in the surgery suites and the post-op ICU's. These technologies have historically been based on absorption-based spectroscopy techniques and have typically been used as trend monitors in critical care environments where it is necessary to quickly determine if a patient's vital parameters are undergoing large physiologic changes. Given this operating environment, it has been acceptable for these devices to have somewhat relaxed precision and accuracy requirements, given the clinical need for real-time point-of-care data for patients in critical care situations. Both pulse oximeters and capnography instruments can be labeled as non-invasive in that neither require penetrating the outer skin or tissue to make a measurement, nor do they require a blood or serum sample from the patient to custom calibrate the instrument to each individual patient. These instruments typically have pre-selected global calibration coefficients that have been determined from clinical trial results over a large patient population, and the results represent statistical averages over such variables as patient age, sex, race, and the like. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Pulse oximeter with motion detection Inventor(s): Kimball, Victor E.; (Burnsville, MN) Correspondence: Altera Law Group, Llc; 6500 City West Parkway; Suite 100; Minneapolis; MN; 55344-7704; US Patent Application Number: 20040034293 Date filed: August 16, 2002 Abstract: There is a need for a technique to compensate for, or eliminate, motioninduced artifacts in patient-attached critical care monitoring instruments. Consequently, the invention is directed to improving pulse-oximetry by incorporating additional signals to aid in the triggering of the pulse-oximeter or in analyzing the data received by the pulse oximeter. This includes detecting when the patient moves and analyzing the pulse-oximetry data in light of the detected movement. Excerpt(s): This application is related to "Improved Pulse Oximeter", filed on even date herewith by V. E. Kimball and P. LaPlante, having attorney docket no. 1535.4US01, which is incorporated herein by reference. The present invention is directed generally to medical devices and more particularly to non-invasive optical sensors for physiologic parameters such as blood oxygen saturation content. Optical spectroscopy techniques have been developed for a wide variety of uses within the medical community. For example, pulse oximetry and capnography instruments are in widespread use at hospitals, both in the surgery suites and the post-op ICU's. These technologies have historically been based on absorption-based spectroscopy techniques and have typically been used as trend monitors in critical care environments where it is necessary to quickly determine if a patient's vital parameters are undergoing large physiologic changes. Given this operating environment, it has been acceptable for these devices to have somewhat relaxed precision and accuracy requirements, given the clinical need for real-time point-of-care data for patients in critical care situations. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Sample introduction device Inventor(s): Sullivan, Kevin J.; (Medfield, MA) Correspondence: Sampson & Associates, P.C.; 50 Congress Street; Boston; MA; 02109; US Patent Application Number: 20040047768 Date filed: September 10, 2002 Abstract: A sample introduction device is provided that is particularly useful in the critical care environment for the anaerobic withdrawal of small volumes of arterial blood from a sample collection syringe and introduction thereof into a sample chamber of a sensor for analysis. The sample introduction device includes a Luer fitting adapted to mate an outlet of the container in a concentric orientation with an input aperture of the sample chamber. A tubular probe is adapted for concentric placement with both the outlet and inlet aperture, with a first end thereof extending into the syringe and a second end adapted for attachment to an air supply. The probe has a predetermined diameter sufficient to provide an annular clearance between the probe and each of the outlet and inlet aperture. A predetermined volume of air is injected through the probe into the container to displace a predetermined volume of sample therefrom, through the annular clearance into the sample chamber. Injecting air into the syringe through the probe to displace the sample therefrom, rather than drawing the sample into the probe, advantageously reduces or eliminates the need for washing the interior of the probe to relatively reduce the use of wash reagents. Excerpt(s): This invention relates to sample handling devices, and more particularly to a device for introducing samples into sample chambers of a test instrument. Chemical analysis of liquids, including biological liquids such as blood, plasma or urine is often desirable or necessary. Sensors that utilize various analytical elements to facilitate liquid analysis are known. These elements have often included components which specifically react to a substance or characteristic under analysis, termed analyte herein. These components, upon contacting a liquid sample containing the analyte, effect formation of a colored or fluorescent material or another detectable response to the presence of the analyte. In this regard, analytical elements such as disclosed in commonly assigned U.S. patent application Ser. No. 08/617,714 (hereinafter, the '714 Patent Application) have been provided. Analytical elements of this type are adapted for use within a sample chamber of an optical sensor assembly. In operation, a fluid sample of unknown analyte content (an "unknown sample") is tested by introducing the sample into the sample chamber where it contacts the analytical element. Any change in the optical characteristics of the analytical element are observed to thus determine characteristics of the analyte of interest in the sample. An example of a sensor assembly of this type is disclosed in commonly assigned U.S. patent application Ser. No. 09/010,096, entitled "OPTICAL SENSOR AND METHOD OF OPERATION" (hereinafter referred to as the "OPTICAL SENSOR" patent application) which is hereby incorporated by reference in its entirety, herein. The sample chambers of this and similar types of sensor assemblies are generally incorporated into multiple use clinical instrumentation which utilize a sample introduction device, including an aspiration probe, to withdraw a sample, such as blood or other fluid, from a syringe or the like and transfer the sample into the sample chamber. An example of instrumentation that utilizes an aspiration probe to withdraw a sample is disclosed in commonly assigned U.S. patent application Ser. No. 60/006,741, entitled "MULTIFUNCTION VALVE" filed on Nov. 2, 1995. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Self-moistening tracheostomy device Inventor(s): Bergamaschi, Paolo; (Concordia sulla Secchia (Modena) Correspondence: Birch Stewart Kolasch & Birch; PO Box 747; Falls Church; VA; 220400747; US Patent Application Number: 20020059934 Date filed: November 20, 2001 Abstract: A self-moistening tracheostomy device [comprising] including a box-like shell [(2), and] having an entry attachment mouth [(4)] disposed on one side thereof for receiving the end of a tracheostomy cannula, [and] an inlet opening [(5)] for oxygen administration, and an exchanger element [(3)] located inside said box-like shell [(2), characterized in that said] wherein an exchanger element [(3) comprises] has a plurality of cellulose-type laminar elements [(6)]. Excerpt(s): The present invention relates to a self-moistening tracheostomy device. As is well known, a tracheostomy is an operation designed to implant a temporary or permanent by-pass of the upper airways, i.e. of the nose, mouth, larynx and pharynx, and is carried out to ease the patient's breathing by reducing inspiration and expiration resistance. Perviousness of the stoma is maintained by means of a cannula inserted into the stoma itself and into the trachea. However, by-passing the upper airways also results in excluding the natural function of these organs, i.e. heating and moistening the air breathed in from the environment before it reaches the lungs. On the other hand, lack of warming and humidification of the air that is breathed in causes in the patients an increase in and a thickening of tracheal secretions with consequent reduction in respiratory efficiency. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Speaking valve for a tracheostomy tube Inventor(s): French, Joseph J.; (Joppatowne, MD), Shikani, Alan H.; (Ruxton, MD) Correspondence: Leonard Bloom & Associates, Llc; Suite 905; 401 Washington Avenue; Towson; MD; 21204; US Patent Application Number: 20020157674 Date filed: February 23, 2001 Abstract: A speaking valve for a tracheostomy tube which is disposed in the first end of the tube protruding from the throat of the patient. The valve has guiding ribs and a retainer to retain a ball within the end of the tube. The flow of air around the ball is unrestricted to reduce the force required to move the ball when the patient inhales and exhales. A spherical chamber is formed in which the ball is disposed. The tracheostomy tube with the valve in the first end presents a low profile. Excerpt(s): The present invention is directed to a valve for a tracheostomy tube and, more specifically, to a speaking valve having substantially unrestricted linear air flow through the valve. Patients who have experienced tracheostomy and the insertion of a tracheostomy tube frequently have difficulties in their perceptual speech because the exhaled air does not produce sufficient vibratory movement of the vocal cords. This is very disturbing to the patient, the patient's family and healthcare personnel. The problem has been recognized for many years and the applicants are aware of efforts to provide a tracheostomy tube with improved speech characteristics. Many of these tubes

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have controlled air leaks, additional cuffs, pneumatic vibrators, springs, diaphragms and valve flaps. Other tubes have a valve with a moving ball such as disclosed in the following U.S. patents. UK Patent No. 1 217 554, Dec. 31, 1970 and German Patent No. DE 3436-777-A, Apr. 25, 1985 also disclose a moving ball speech valve. A moving ball speaking valve is further disclosed in "Otolaryngology-Head and Neck Surgery", pages 103-107, Jul. 2000, "New Unidirectional Airflow Ball Tracheostomy Speaking Valve", Shikani, French and Siebens. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System and method for accessing critical care medical management information Inventor(s): Summerour, Eric A.; (Olathe, KS), White, Paul David; (Shawnee, KS), Winston, Alan D.; (Overland Park, KS) Correspondence: Lathrop & Gage LC; 2345 Grand Avenue; Suite 2800; Kansas City; MO; 64108; US Patent Application Number: 20040034549 Date filed: August 16, 2002 Abstract: A system for providing automated decision support mapping for making referrals to the correct type of medical case manager for critical care patients experiencing catastrophic medical conditions. In one aspect, the system provides a method for integrating medical care management functions for a health care case by receiving a referral form containing referral information and case information related to medical status of a critical care patient; storing the referral information in a referral record in a database; storing the case information in a patient status record in the database; and entering, into the database, updated case information comprising changes in a patient's medical status Excerpt(s): The present invention relates generally to medical, financial and health plan benefits information systems, and more particularly, to a system and method for quickly and accurately accessing the necessary information related to the management of medical services and financial exposure for catastrophic events and out of network claims. The health care payor segment of the healthcare industry incurs substantial risk of major expenditures when dealing with catastrophic events such as severe bums/trauma, organ transplants, and the like. The financial exposure to the risk is not always directly related to just the level of medical severity of the patient's medical condition. A large portion of the financial exposure is directly related to the quality and efficiency of the many disparate and complex communication processes, as well as the financial and employee benefits management and control systems that are used to manage catastrophic events. This phenomenon is known as `process risk variation`. In order to minimize this risk, it is essential to reduce the variations in the time required to complete the administratively complex process of `case` referral to qualified medical care management vendors and in the dissemination of necessary status information to case management staffs. In order to gain assurance that decisions are being made with current information, hosting a central repository where medical, financial and benefits administrative information can be efficiently retrieved on timely basis is critical. Current processes for case referral to the appropriate medical care management program and the look-up of information of medical progress, insurance claim status, and financial exposure are cumbersome and predominantly manual. The cycle time of the case referral process is typically between seven to eleven business days from the point of diagnosis to the completion of the referral. This cycle results from having to accesses

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disparate and complex systems. Furthermore, claim status look-up alone may take up to a few days. What is needed is a system that integrates these disparate processes and allows expeditious tracking of, and access to medical status, benefits administration and financial information throughout the catastrophic event management process. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System and user interface for use in providing medical information and health care delivery support Inventor(s): Bocionek, Siegfried; (Nuernberg, DE), Hanslik, Margot; (Erlangen, DE), Russwurm, Siegfried; (Michelau, DE) Correspondence: Siemens Corporation; Intellectual Property Department; 186 Wood Avenue South; Iselin; NJ; 08830; US Patent Application Number: 20020099273 Date filed: July 5, 2001 Abstract: A medical information system processes information from multiple sources suitable for access by healthcare personnel for use in clinical (e.g., critical) care delivery. The system includes a communication interface for receiving information from patient monitoring devices and for bidirectionally communicating with a hospital information database containing patient records. The system also includes a data processor using the communication interface for acquiring patient record information from the hospital information database and for acquiring information from patient monitoring devices. The data processor updates the acquired patient record information based on the acquired information from the patient monitoring devices and communicates updated patient record information to the hospital information database. A display processor initiates display of the updated patient record information to a user. The data processor may also include a data analysis unit for analyzing stored patient parameters by correlating stored parameters, patient record information, corresponding medical outcomes and medication database information to identify alternative medication options and improve decision processing. The data processor combines acquired medical parameter information and an acquired patient medical image to provide a composite image for display and storage. Excerpt(s): This is a non-provisional application of provisional application serial No. 60/263,790 by S. Bocionek et al. filed Jan. 24, 2001. This invention concerns a comprehensive information system and architecture for use in clinical care delivery and optimization. Critical care delivered in ICUs (Intensive Care Unit), ERs (Emergency Room), ORs (Operating Rooms), for example, and some other specialized clinical settings, is an area of medicine where improvements have significant life or death impact. As a minimum such improvements ameliorate the critical condition of patients treated there. Specialized personnel (doctors, nurses), equipment (monitors, infusion devices, ventilators, vital sign detectors, etc.), highly efficient drugs and special-purpose disposable devices (e.g. catheters) contribute to the success of critical care delivery. An important component in this setting is the information processed. Specifically, information elements of importance include the available data on the patients history and daily improvement, vital signs indicating patient status and stability, medication plans, but also medical knowledge in general and broad personnel experience (i.e. knowledge gained from a large number of cases) by doctors and nurses. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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TRACHEOSTOMY AIR FILTRATION SYSTEM Inventor(s): HAAS, EILEEN; (GIBSONIA, PA) Correspondence: Nagel & Goldstein; 1100 Liberty Avenue; Suite 3; Pittsburgh; PA; 15222 Patent Application Number: 20010013348 Date filed: February 11, 1999 Abstract: In the present invention, personal air filteration unit sold as SmartMouth.TM. has been attached to a column of valve connectors which are connected to a tracheostomy tube to provide a well sealed column of air directly from the air filter to the patient. Excerpt(s): This invention pertains to breathing devices for patients with tracheostomies. Devices exist which may be utilized by patients with tracheostomies to humidify and to filter inhaled air. The prior art seems to be lacking, however, in a device which may be attached to a tracheostomy tube to provide for a well sealed column of air from the patient to the air filter to provide maximum filtered air to the patient. In the present invention, a personal air filtration unit sold as SmartMouth.TM., available through TriPact Enterprises, has been attached to a column of valve connectors, firstly to a cylindrical connector which is available through Instrumentation Industries which is then connected to a conical "multiadaptor" provided by Hudson, which is in turn connected to a trach swivel adaptor, such as a "double swivel elbow" by Intersurgical Co. and "trach swivel adaptor" by Marquest Medical Co., which is in turn connected to a patient's tracheostomy tube to provide a well sealed column of air directly from the air filter to the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Tracheostomy dilator Inventor(s): Frova, Giulio; (Mailand, IT) Correspondence: Polster, Lieder, Woodruff & Lucchesi; 763 South New Ballas Road; ST. Louis; MO; 63141-8750; US Patent Application Number: 20020077655 Date filed: October 31, 2001 Abstract: A tracheostomy dilator comprises a rod which is penetrated by an inner lumen. Both ends of the inner lumen are open, at the end facing the patient and at the end of the tracheostomy dilator facing away from the patient. The end facing the patient is provided with a thread. The tracheostomy dilator is used as screw dilator and can widen the tissue in one single dilation process such that a further tracheostomy cannula can be inserted into the trachea. Excerpt(s): The invention concerns a tracheostomy dilator consisting of a rod having an inner lumen which is open at both ends and extends from the end of the rod facing the patient to the end of the rod facing away from the patient. Tracheostomy dilators of this type have become known in connection with puncture tracheostomy according to Ciaglia et al., "Elective Percutaneous Dilatational Tracheostomy" Chest 1985, volume 6, pages 715-719. In the known puncture tracheostomy, the trachea is transcutanely

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punctured in a bronchoscopically controlled fashion, below the ring-like cartilage, preferably between the second and third tracheal ring, and successively extended via a Seldinger wire with stepped dilators, and after the desired extension, a tracheostomy cannula is inserted into the trachea. This tracheostomy method has been used in the meantime at least for a highly selective part of patients. The known method, however, also bears risks for the patient and consequently only very experienced anaesthetists are supposed to use this method. The known method is time-consuming and every dilation bears the danger of injuring the posterior tracheal wall. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Tracheostomy safety device Inventor(s): Linderoth, Craig D.; (Norwalk, WI) Correspondence: M. Paul Hendrickson; 403 Main Street, P.O. Box 508; Holmen; WI; 54636-0508; US Patent Application Number: 20020029782 Date filed: August 23, 2001 Abstract: Unwanted separation of an inner cannula from an outer cannula in tracheostomy devices can be achieved by installing a retaining ring which prevents the inner cannula from unwantingly being unlatched from the outer cannula. The retaining ring allows the air supply elbow to be separated which, in turn, permits the sensory alarms to properly sound when a disconnection of the air supply arises. Excerpt(s): This non-provisional application claims the benefits of provisional application Serial No. 60/229,622 entitled the same and filed Aug. 31, 2000 on behalf of Craig D. Linderoth. The present invention relates to a medical safety device and, more particularly, to a tracheostomy safety device and its use. Tracheostomy devices are extensively used within the medical field to ventilate or assist patients with respiratory problems. Many patients with advanced stages of gas exchange impairment (e.g. COPD, multiple sclerosis, emphysema, etc.) are dependent upon effective utilization of the tracheostomy devices to supply oxygen and discharge exhaled gases from the respiratory system. Any inadvertent or unwanted cessation of the respiratory exchange by the tracheostomy devices within the medical unit can lead to irreparable injury or death of the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Tracheostomy tube Inventor(s): Nomori, Hiroaki; (Tokyo, JP) Correspondence: Wenderoth, Lind & Ponack, L.L.P.; 2033 K Street N. W.; Suite 800; Washington; DC; 20006-1021; US Patent Application Number: 20030136412 Date filed: January 17, 2003 Abstract: To provide a tracheostomy tube enabling speech. The tube is provided with an inside tube portion to be set in a trachea, an outside tube portion to connected to a ventilator, and a balloon set on the circumference of the outside of the inside tube portion, in which the balloon is set to the inside tube portion so that the inside and

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outside of the balloon cannot communicate with each other and the inside tube portion has a hole for communicating the inside of the inside tube portion with the inside of the balloon. Excerpt(s): The present invention relates to a tracheostomy tube, particularly to a tracheostomy tube enabling speech. The artificial ventilation using a normal tracheostomy tube is a method of supplying oxygen or air through a ventilator by dissecting the trachea of a cervical part, inserting a balloon-provided tube into a trachea to connect the tube with the ventilator, supplying air into the balloon, and contactbonding the balloon with an inner wall so that oxygen or air does not flow toward a mouth. In the case of this method, the balloon is always inflated and thereby the gap between the trachea and the tube is blocked so that the air for respiration reciprocates only between the ventilator and a lung. Otherwise, when supplying air, most air does not reach the lung but it leaks to the mouth, and thus artificial ventilation cannot be performed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Tracheostomy tube and use of a coniostomy tube as a tracheostomy tube Inventor(s): Lindholm, Carl-Eric; (Uppsala, SE) Correspondence: Jacobson Holman Pllc; 400 Seventh Street N.W.; Suite 600; Washington; DC; 20004; US Patent Application Number: 20040074499 Date filed: April 3, 2003 Abstract: A tracheostomy tube includes a tubular element that has a first straight section (62) which forms the patient-proximal end of the tube, a second straight section (61) which forms a machine-proximal end of said tube, and an intermediate curved section (63), wherein the two straight tube sections (61, 62) lie in a common plane. At least that part of the tube which passes through the opening made in the frontal wall of the trachea has a generally oval cross-sectional shape as viewed perpendicular to the long axis of the tube, wherein the minor axis of the oval cross-section is orientated generally in the curvature plane of the tube, and wherein the external ovality of the oval crosssection lies in the range of 1:12-1:1.40. The invention also relates to the use of a coniostomy tube of such design as a tracheostomy tube. Excerpt(s): The invention relates to a tracheostomy tube of the kind defined in the preamble of claim 1. The invention also relates to the use of a coniostomy tube as a tracheostomy tube. It is well known to make an opening through the frontal wall of the larynx between the frontal part of the cricoid cartilage and the thyroid cartilage, and to insert into the opening a tube (a coniostomy tube) that is adapted to the insertion site. The advantage of coniostomy is that it is sometimes easier to open a passage to the respiratory tract by opening the cricothyroid membrane or ligament, which lies close to the skin, and to insert the coniostomy tube between the cricoid cartilage and the thyroid cartilage. One drawback with this is that the tube can cause an alteration to the patient's larynx and therewith affect the patient's vocal tones, even when the tube has an oval cross-section. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Tracheostomy tube apparatus for noninvasive suctioning Inventor(s): Carroll, John B.; (Louisville, KY), Klinberg, Naum; (Louisville, KY) Correspondence: David W. Carrithers; Carrithers Law Office; One Paragon Centre; 6060 Dutchman's Lane, Suite 140; Louisville; KY; 40205; US Patent Application Number: 20030037789 Date filed: August 24, 2001 Abstract: A measured suction system utilizes a tracheostomy tube apparatus includes a tracheostomy tube, Tracheostomy collar, and swivel adapter. The tracheotomy tube includes an internal channel within the Tracheostomy tube allowing for all suctioning of the patient. The system will insure that all negative suction pressure is maintained within the Tracheostomy tube, which eliminates any trauma that may be caused by using excessive negative suction pressures when the standard methods of suctioning are employed. The new system also reduces the risk of infection caused by using the sterile invasive suction techniques. Excerpt(s): This Tracheostomy tube system provides a Tracheostomy tube, Tracheostomy collar, and swivel adapter for measured suctioning of the patient in a non-invasive manner and at a controlled negative suction pressure. A Tracheostomy is an opening through the neck into the trachea through which an indwelling tube may be inserted. An incision is made into the trachea through the neck below the larynx. The opening may be made as an emergency measure or performed as scheduled in an operating room. The incision is made through the skin through the second, third, or fourth tracheal ring. A small hole is made in the fibrous tissue of the trachea, and the opening is then dilated to allow the intake of air. Airway problems that may require the performance of a Tracheostomy could include tumors, such as cystic hygroma; laryngectomy; infection, such as epiglottitis or croup; subglottic stenosis; subglottic web; tracheomalacia; vocal cord paralysis (VCP); laryngeal injury or spasms; congenital abnormalities of the airway; large tongue or small jaw that blocks airway; Treacher Collins and Pierre Robin Syndromes; severe neck or mouth injuries; airway burns from inhalation of corrosive material, smoke, or steam; obstructive sleep apnea, and foreign body obstruction. In addition, lung conditions that could require a Tracheostomy include a need for prolonged respiratory support, such as Broncho pulmonary Dysplasia (BSD); chronic pulmonary disease to reduce anatomic dead space; chest wall injury; or diaphragm dysfunction. Other conditions include neuromuscular diseases that cause paralysis or weakening of the chest muscles and diaphragm, fracture of the cervical vertebrae with spinal cord injury, long-term unconsciousness or coma, disorders of respiratory control such as congenital central hypoventilation or central apnea, and facial surgery of facial burns. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Tracheostomy tube with adjustable quick release and method therefor Inventor(s): Shikani, Alan H.; (Ruxton, MD) Correspondence: Leonard Bloom & Associates, LLC.; 401 Washington Avenue, Suite 905; Towson; MD; 21204; US Patent Application Number: 20020139372 Date filed: March 8, 2001

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Abstract: A tracheostomy tube has a cannula and a neckpiece with bands. The distal ends of the bands are rapidly and releasably connected to one another. At least one of the bands is adjustable in length. The bands and the neck piece may be formed integrally into a unitary member. The bands and neck piece may be formed from a viscoelastic polymer. A method of use is disclosed. Excerpt(s): The present invention relates to a tracheostomy tube and more particularly, to a tracheostomy tube with a means for quickly attaching around the neck of the patient and easily adjusting for the comfort of the patient. The tracheostomy tube has a neck plate and is formed from a soft material which has improved patient comfort and decreases pressure on the skin. Tracheostomy tubes are usually held around the neck of the patient with a relatively thin cotton lacing which has ends tied to slotted openings in the opposite ends of the neck plate. The widely used 4LPC tracheostomy tube marketed by Shiley Incorporated, Irvine, Calif., and the model 60A 160 Adult Tracheostomy Tube Cuffless marketed by Bivona Medical Technologies, Gary, Ind., both this system. The lacing irrates the neck of the patient as it is worn and is difficult to tie so it is not too tight or too loose. In addition, one end of the lacing must be threaded in the slotted opening and tied into a knot while the patient is wearing the tracheostomy tube. In this process, the cannula in the incision may be moved and the patient suffers discomfort if not actual pain. The 8 DCT tracheostomy tube from Shiley, Inc. has a fabric covered foam band with a strip of hook-type fastener attached to each end. The strip of fastener is looped from the neck side of the neck plate through a slot and the hook fastener engages the fabric covering. This is performed while the tracheostomy tube is inserted in the patient and may cause discomfort or pain to the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Tracheostomy tube with cuff on inner cannula Inventor(s): Ortiz, Antonio; (Bronx, NY) Correspondence: Antonio Ortiz, Rrt; 2659 Kingsbridge Terrace; Bronx; NY; 10463; US Patent Application Number: 20030084905 Date filed: January 15, 2002 Abstract: BACKGROUND: Tracheotomy has been used to assist patients who require mechanical ventilation. Tracheostomy is a common surgical procedure for intensive care patients. The goals of tracheotomy are to bypass the upper airway, facilitate removal of tracheobronchial secretions, prevent aspiration of gastric contents, and to control the airway for prolonged mechanical ventilation. METHOD: The hypothesis was to improve the design of the current tracheostomy tube in order to make it easier to use and to eliminate nearly all of the disadvantages found in prior tracheostomy tubes. RESULTS: This device is an improved tracheostomy tube designed with the balloon cuff (18), guide balloon (26), balloon connector (32) and guide balloon valve (24) located on the inner cannula (12). The inner cannula (12) will be inserted into another tube called the outer cannula (14), which has been inserted into an incision or stoma into the patient's trachea between the vocal cords and carina. Both the inner cannula (12) and outer cannula (14) will comprises a set, which will be secured by a strap attached to the outer cannula retainer (16) through the swivel eyelet (30). The user of this newly designed tracheostomy tube, will have a clear alterative to present tracheostomy tubes currently being manufactured today. CONCLUSIONS: A major improvement in this tracheostomy tube, is that the removal of the outer cannula (14) will no longer be necessary, when the balloon cuff (18) is damage or worn. This new tracheostomy tube

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will also enhance the cuff replacement procedure, making it easier and or a simpler task. This tracheostomy tube will also reduce pain and or injury to the stoma, and or airway of a patient by avoiding the complete removal of the outer cannula (14) when the balloon cuff (18) is worn, damaged or soiled. This tracheostomy tube will be used with any medically selected patients, which require mechanical ventilation intervention, in both short-term and long-term care. In addition, this tracheostomy tube provides in the design, an enhanced clearance within the trachea. It is also noticeable that this new tracheostomy tube will also prevent, reduced and or improve a condition called a tracheal-esophageal fistula, when properly selected and fit into the airway, and verified with a lateral tracheal x-ray. A further study will show that these findings are clinically important. Key words: airway, balloon, cannula, cuff, fistula, mechanical, secretions, stoma, trachea, tracheal-esophageal, tracheobronchial, tracheostomy, tracheotomy, valve, ventilation. Excerpt(s): This invention relates to tracheostomy tubes having a curved shape, and oval or round cannulas used in the surgical instruments and accessories field for patients that have respiratory failure, respiratory tract obstructions, restrictions, lung injury and or disease. Tracheotomy has been used to assist patients who require mechanical ventilation. Tracheostomy is a common surgical procedure for intensive care patients. The goals of tracheotomy are to bypass the upper airway, facilitate removal of tracheobronchial secretions, prevent aspiration of gastric contents, and to control the airway for prolonged mechanical ventilation. Tracheostomy tubes provide life-sustaining support for patients who have obstructions, restrictions, injuries and or disease of the airway or lungs. A Physician surgically inserts a tracheostomy tube into a patient's incision or stoma to bypass the upper airway, between the vocal cords and the bifurcation of the carina. Originally, tracheostomy tubes were made of silver such as the Jackson Tracheostomy tubes that are still produced (McPherson S P: Respiratory Care Equipment, ed 5, pp. 118-127, St. Louis, 1995, Mosby). However, metal tracheostomy tubes are difficult to clean and tarnish with time. Metal tracheostomy tubes are also expensive to make and deform or bend out of shape. Also, certain metals are irritating to the patient's tissues. Therefore, natural rubber was used for manufacturing endotracheal tubes of the Jackson type, to U.S. Pat. No. 4,150,676 but not limited to this patent, later giving way to various types of plastics like Polyvinyl chloride (PVC). A thin surgical rubber or silicone sold under the trademark, SILASTIC of Dow Corning Corp., is also used. Current tracheostomy tubes now come in pairs or sets, where an inner cannula is fitted into an outer cannula. There are several devices, which contain a means of locking or connecting the inner cannula to the outer cannula and the cannulas to the ventilation system. These include, but are not limited to U.S. Pat. No. 3,659,612 to Shiley et al., U.S. Pat. No. 4,009,720 to Crandall, et al., and U.S. Pat. No. 3,088,466 to Nichols. Tracheostomy tubes may remain in the airway for long periods of time, and require frequent cleaning of the inner cannula. Unfortunately, wear and tear causes problems with the means of connecting the cannulas to each other, and the ventilator circuit. The inner cannula is also manufactured separately from the set, since it tends to wear out faster than the outer cannula. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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TRACHEOSTOMY VENTILATOR TUBE HOLDER Inventor(s): Kron, Ronald C.; (Louisville, KY) Correspondence: David W. Carrithers; Carrithers Law Office; One Paragon Centre; 6060 Dutchman's Lane, Suite 140; Louisville; KY; 40205; US Patent Application Number: 20040060565 Date filed: October 1, 2002 Abstract: A holder for tracheostomy systems on a patient that can function as a tracheostomy tube holder or as a ventilator tube holder. The holder is a bifurcated strip of flexible material providing a principal portion and a pair of minor portions extending therefrom. The principal portion has a hole therethrough. The strip has portions of a hook and loop fastener adjacent respective opposite ends thereof. Excerpt(s): The present invention relates to an improved ventilator tube holder and more particularly to a holder comprising a strip of flexible material with a hole there through and beyond the hole the strip is bifurcated providing a pair of strips for passing respectively on opposite sides of a ventilator tube, or component of a ventilator system, connected to a tracheostomy tube. Opposite ends of the strip have cooperating portions of a hook and loop fastening means thereon that cooperate with one another for detachable interconnection or detachable interconnection with appropriate portions of corresponding fastening means on a tracheostomy tube holder that goes around the neck of a patient. Tracheostomy patients are fitted with a tracheostomy tube that has a flange, also referred to as a neck plate, intermediate the ends thereof. The plate limits the depth of penetration of one end portion of the tube through a hole in the patients neck into the trachea and an opposite end portion of the tube projects outwardly from the plate. The plate connects to the tube preferably in such a manner as to allow limited movement of the tube relative to the plate, e.g. a pivotal connection. A ventilator tube, or ventilator circuit component, connects to the opposite end portion of the tube that projects outwardly from the patients neck. Straps referred to as holders are used to retain the tracheostomy tube on the patients neck. Furthermore, straps are used to keep the ventilator tube, or ventilator circuit component as the case maybe, connected to the tube projecting from the patients neck. There are a variety of known devices serving these purposes as exemplified by the following United States Patents: U.S. Pat. No. 6,105,577 granted Aug. 22, 2000 to Scott H Varner; U.S. Pat. No. 6,105,373 granted Aug. 22, 2000 to David Delaplane et al; U.S. Pat. No. 6,047,699 granted Apr. 11, 2000 to Sadi Ryatt et al; U.S. Pat. No. 6,008,872 granted Jan. 4, 2000 to David Delaplane et al; U.S. Pat. No. 5,782,236 granted Jul. 21, 1998 to Steven M Ess; U.S. Pat. No. 5,671,732 granted Sep. 30, 1997 to Michael I Bowen; U.S. Pat. No. 5,501,216 granted Mar. 26, 1996 to Timothy N Byrd; U.S. Pat. No. 5,237,988 granted Aug. 24, 1993 to Wesley G McNeese; U.S. Pat. No. 4,331,144 granted May 25, 1982 to Herbert H Wapner; and U.S. Pat. No. 4,313,437 granted Feb. 2, 1982 to Dianne I Martin. The forgoing patents disclose various strap means that loop through a spaced apart pair of slots in a neck plate having a tube attached thereto that projects though a hole in a patients neck into the trachea. The straps go around the patients neck and thereby hold the tube device in position. The '699 patent and the '236 patent additionally have means for ensuring a ventilator tube remains attached to the patient mounted device. In all instances the holder for the patient mounted device and the holder for the ventilator tube are completely unrelated and thus bear no similarity to one another. There is absolutely no way one of the known holders for one purpose could be substituted for one of the known holders serving the other of the two purposes.

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with critical care, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “critical care” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on critical care. You can also use this procedure to view pending patent applications concerning critical care. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON CRITICAL CARE Overview This chapter provides bibliographic book references relating to critical care. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on critical care include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “critical care” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on critical care: •

ENT Secrets: Questions You Will Be Asked On Rounds, In the Clinic, In the OR, On Exams Source: Philadelphia, PA: Hanley and Belfus. 1996. 480 p. Contact: Available from Hanley and Belfus. Medical Publishers, 210 South 13th Street, Philadelphia, PA 19107. (800) 962-1892 or (215) 546-7293; Fax (215) 790-9330; http://www.hanleyandbelfus.com. PRICE: $35.95 plus shipping and handling. ISBN: 1560531592. Summary: This book utilizes a question and answer format to review details of the specialty of otorhinolaryngology (ear, nose and throat, or ENT). In addition to explicating details and specifics, professional training should refine the student's ability to formulate the appropriate questions to ask when making medical decisions. Eightyfive chapters are categorized in the following sections: otology, the nose and sinuses, general otolaryngology, endoscopy, tumors, facial plastic surgery, trauma and

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emergencies, pediatric otolaryngology, related specialties, and critical care issues. Specific topics include the anatomy and physiology of the ear, hearing evaluations, types of hearing loss, otitis media, evaluation of the dizzy patient, vestibular disorders, tinnitus, anatomy and physiology of the nose, rhinitis, sinus anatomy and function, sinusitis, temporomandibular joint disease, oral lesions, facial nerve disorders, esophageal disorders, salivary gland disorders, hoarseness, otolaryngologic manifestations of AIDS, salivary gland tumors, tumors of the nose and paranasal sinuses, laryngeal cancer, head and neck cancer, rhinoplasty, principles of grafts and flaps, principles of skin resurfacing, otoplasty, epistaxis (nosebleed), nasal trauma, upper airway obstruction, tonsils and adenoids, congenital malformations, cleft lip and palate, taste and smell disorders, allergy and immunology, nutritional assessment and therapy, and tracheotomy. Each chapter include line drawing illustrations and references; a subject index concludes the volume. •

Vascular Access: Principles and Practice. 4th ed Source: St. Louis, MO: Mosby, Inc. 2002. 289 p. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: This text reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. The text features 25 chapters that cover: the development of vascular access (VA) surgery, planning and patient assessment, anesthesia, surgical anatomy for VA procedures, physiology for the arteriovenous fistula, biologic properties of VA devices, biologic response to prosthetic dialysis grafts, epidemiology of chronic renal (kidney) failure (CRF) and guidelines for the initiation of hemodialysis, autologous arteriovenous fistulas, basilic vein transposition, vascular interposition (bridge fistulas) for hemodialysis, central venous cannulation for hemodialysis access, vascular access in the neonatal and pediatric patient, revision and outcome of VA procedures for hemodialysis, radiologic intervention and instrumentation for the salvage of hemodialysis access grafts, axillosubclavian vein thrombosis (clotting), thrombosis, venous hypertension, arterial steal, and neuropathy (nerve disease or damage), complications of VA procedures, care and use of VA devices, cardiovascular consequences of rapid hemodialysis, peritoneal dialysis, socioeconomic implications of VA surgery, placement of indwelling VA systems, VA for trauma and emergency surgery, and complications of percutaneous VA procedures and their management. Each chapter includes black and white illustrations and a list of references; a subject index concludes the volume.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “critical care” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “critical care” (or a synonym) in their titles. The

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following is indicative of the results you might find when searching for “critical care” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

AACN Handbook of Critical Care Nursing by Marianne Chulay, et al; ISBN: 0838503462; http://www.amazon.com/exec/obidos/ASIN/0838503462/icongroupinterna

•

Aacn's Clinical Reference for Critical Care Nursing by Marguerite Rodgers Kinney, et al; ISBN: 0815113234; http://www.amazon.com/exec/obidos/ASIN/0815113234/icongroupinterna

•

Advanced and Critical Care Oncology Nursing: Managing Primary Complications by Cynthia C. Chernecky, et al; ISBN: 0721668607; http://www.amazon.com/exec/obidos/ASIN/0721668607/icongroupinterna

•

Bedside Critical Care Manual by Edward D. Chan, et al; ISBN: 1560534311; http://www.amazon.com/exec/obidos/ASIN/1560534311/icongroupinterna

•

Core Curriculum for Neonatal Intensive Care Nursing by Jane Deacon, et al; ISBN: 0721674895; http://www.amazon.com/exec/obidos/ASIN/0721674895/icongroupinterna

•

Core Curriculum for Pediatric Critical Care Nursing by Margaret C. Slota, American Association of Critical-Care Nurses; ISBN: 0721661149; http://www.amazon.com/exec/obidos/ASIN/0721661149/icongroupinterna

•

Core Review for Critical Care Nursing by Joann Alspach, American Association of Critical-Care Nurses; ISBN: 0721652328; http://www.amazon.com/exec/obidos/ASIN/0721652328/icongroupinterna

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Core Review Neonatal Intensive Care Nursing by Robin L. Watson, American Association of Critical-Care Nurses; ISBN: 0721696805; http://www.amazon.com/exec/obidos/ASIN/0721696805/icongroupinterna

•

Current Clinical Strategies Critical Care Medicine, 2002-2003 Edition by Matthew, Md. Brenner, et al; ISBN: 1929622163; http://www.amazon.com/exec/obidos/ASIN/1929622163/icongroupinterna

•

Decision Support Systems in Critical Care (Computers and Medicine) by M. Michael Shabot, Reed M. Gardner; ISBN: 0387977996; http://www.amazon.com/exec/obidos/ASIN/0387977996/icongroupinterna

•

EBCC: Handbook of Evidence-Based Critical Care (CD-ROM for PDA, Palm OS, 1.4 MB Free Space Required, Windows CE/Pocket PC: 1 by Skyscape; ISBN: 1592250149; http://www.amazon.com/exec/obidos/ASIN/1592250149/icongroupinterna

•

Emergency & Critical Care Pocket Guide, ACLS Version by Paula Derr; ISBN: 1890495158; http://www.amazon.com/exec/obidos/ASIN/1890495158/icongroupinterna

•

From Nutrition Support to Pharmacologic Nutrition in the Icu (Update in Intensive Care and Emergency Medicine) by Claude Pichard, et al; ISBN: 3540426043; http://www.amazon.com/exec/obidos/ASIN/3540426043/icongroupinterna

•

Introduction to Critical Care Nursing by Mary Lou Sole, et al; ISBN: 0721686877; http://www.amazon.com/exec/obidos/ASIN/0721686877/icongroupinterna

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Irwin and Rippe's Intensive Care Medicine by Richard S., Md. Irwin, James M., Md. Rippe; ISBN: 0781735483; http://www.amazon.com/exec/obidos/ASIN/0781735483/icongroupinterna

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•

Lippincott's Critical Care Drug Guide (Books) by Marla J. De Jong, Amy Morrison Karch; ISBN: 0781721962; http://www.amazon.com/exec/obidos/ASIN/0781721962/icongroupinterna

•

Manual of Critical Care Nursing: Nursing Interventions and Collaborative Management by Pamela L. Swearingen, Janet Hicks Keen; ISBN: 0323009980; http://www.amazon.com/exec/obidos/ASIN/0323009980/icongroupinterna

•

Manual of Intensive Care Medicine: With Annotated Key References by Richard S. Irwin, James M. Rippe; ISBN: 0781719860; http://www.amazon.com/exec/obidos/ASIN/0781719860/icongroupinterna

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Mosby's Critical Care Nursing Reference by Susan B. Stillwell; ISBN: 0323016448; http://www.amazon.com/exec/obidos/ASIN/0323016448/icongroupinterna

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Neonatal Intensive Care Nursing by Glenys Boxwell; ISBN: 0415203392; http://www.amazon.com/exec/obidos/ASIN/0415203392/icongroupinterna

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Neonatal/Pediatric Respiratory Care : A Critical Care Pocket by Dana F. Oakes, et al; ISBN: 0932887139; http://www.amazon.com/exec/obidos/ASIN/0932887139/icongroupinterna

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Obstetric Intensive Care Manual by Michael R. Foley, et al; ISBN: 0071410554; http://www.amazon.com/exec/obidos/ASIN/0071410554/icongroupinterna

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Oh's Intensive Care Manual by Andrew D. Bersten, et al; ISBN: 0750651849; http://www.amazon.com/exec/obidos/ASIN/0750651849/icongroupinterna

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Oxford Textbook of Critical Care (Oxford Medical Publications) by Andrew R. Webb, et al; ISBN: 0192627376; http://www.amazon.com/exec/obidos/ASIN/0192627376/icongroupinterna

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Perianesthesia Nursing: A Critical Care Approach by Cecil B. Drain; ISBN: 0721692575; http://www.amazon.com/exec/obidos/ASIN/0721692575/icongroupinterna

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Principles and Practice of Intensive Care Monitoring by Martin J.M.D., Tobin; ISBN: 0070650942; http://www.amazon.com/exec/obidos/ASIN/0070650942/icongroupinterna

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Principles of Critical Care Companion Handbook by Jesse B. Hall, et al; ISBN: 007026029X; http://www.amazon.com/exec/obidos/ASIN/007026029X/icongroupinterna

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Priorities in Critical Care Nursing by Linda Urden, et al; ISBN: 0323024815; http://www.amazon.com/exec/obidos/ASIN/0323024815/icongroupinterna

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Quick Critical Care Reference by Susan B. Stillwell, Susan B. Stilwell; ISBN: 0815136943; http://www.amazon.com/exec/obidos/ASIN/0815136943/icongroupinterna

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Springhouse Reveiw For Critical Care Nursing Certification by Joseph T. American Nursing Review for Critical Care Nursing Catalano, Springhouse Corporation; ISBN: 1582551618; http://www.amazon.com/exec/obidos/ASIN/1582551618/icongroupinterna

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Tarascon Internal Medicine & Critical Care Pocketbook- 2nd Edition by Robert J. Lederman; ISBN: 1882742206; http://www.amazon.com/exec/obidos/ASIN/1882742206/icongroupinterna

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•

The Clinical Practice of Critical Care Neurology (Medicine) by Eelco F. M. Wijdicks; ISBN: 019515729X; http://www.amazon.com/exec/obidos/ASIN/019515729X/icongroupinterna

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The Intensive Care Manual by Michael J. Apostolakas, Peter J. Papadakos; ISBN: 0070066965; http://www.amazon.com/exec/obidos/ASIN/0070066965/icongroupinterna

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The Intensive Care Unit Manual by Paul N., MD Lanken, et al; ISBN: 072162197X; http://www.amazon.com/exec/obidos/ASIN/072162197X/icongroupinterna

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Thelan's Critical Care Nursing: Diagnosis and Management by Linda Diann Urden, et al; ISBN: 0323014615; http://www.amazon.com/exec/obidos/ASIN/0323014615/icongroupinterna

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Thelan's Critical Care Nursing: Diagnosis and Management by Linda D. Urden, et al; ISBN: 032302758X; http://www.amazon.com/exec/obidos/ASIN/032302758X/icongroupinterna

Chapters on Critical Care In order to find chapters that specifically relate to critical care, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and critical care using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “critical care” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on critical care: •

Audiological Issues in Critical Care Source: in Mackay, L.E.; Chapman, P.E.; Morgan, A.S. Maximizing Brain Injury Recovery: Integrating Critical Care and Early Rehabilitation. Gaithersburg, MD: Aspen Publishers, Inc. 1997. p. 483-502. Contact: Available from Aspen Publishers, Inc. 200 Orchard Ridge Drive, Suite 200, Gaithersburg, MD 20878. (800) 638-8437. Website: www.aspenpub.com. PRICE: $79.00. ISBN: 0834206552. Summary: This chapter on audiological issues is from a text on integrating critical care and early rehabilitation in order to maximize recovery from brain injury. The authors note that traumatic injury to the brain is frequently accompanied by injury to the peripheral and central mechanisms that control hearing and auditory perception. Therefore, the patient with brain injury must be assessed for risk factors suggesting damage to the auditory mechanical structures, sense organs, and pathways. After risk assessment, the patient is placed in one of several categories regarding the type of assessment required and appropriate timing for intervention. The audiologist then establishes the presence, type, and degree of hearing loss, to whatever extent possible. In conjunction with other trauma team members, the audiologist establishes an appropriate ongoing evaluation or treatment plan to alleviate or compensate for discovered losses. In addition, the audiologist provides the patient's family with information, support, and help with long term follow up when permanent hearing loss is discovered. Audiologists in many institutions may also perform, interpret, or assist

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with auditory evoked potential testing for the purposes of establishing the physiologic functioning status of neural pathways. 1 table. 70 references. •

Contributions of Speech-Language Pathology in Critical Care Source: in Mackay, L.E.; Chapman, P.E.; Morgan, A.S. Maximizing Brain Injury Recovery: Integrating Critical Care and Early Rehabilitation. Gaithersburg, MD: Aspen Publishers, Inc. 1997. p. 444-482. Contact: Available from Aspen Publishers, Inc. 200 Orchard Ridge Drive, Suite 200, Gaithersburg, MD 20878. (800) 638-8437. Website: www.aspenpub.com. PRICE: $79.00. ISBN: 0834206552. Summary: This chapter on speech language pathology is from a text on integrating critical care and early rehabilitation in order to maximize recovery from brain injury. The authors stress that the speech language pathologist plays an integral role in the critical care rehabilitative needs of patients with severe brain injury. Interventions from this discipline should be initiated within 24 hours of admission. The speech language pathologist establishes a functional communication system for the patient and assesses and treats cognitive and linguistic impairments. These impairments can be a major deficit for these patients, manifesting as reduced responsiveness and level of alertness, decreased attention, and difficulties with auditory comprehension, orientation, and memory. Speech language pathology intervention in the intensive care unit (ICU) also includes assessment and treatment of vocal cord function and dysphagia, because patients with severe brain injury are at increased risk for aspiration and pneumonia. The chapter discusses patient equipment and monitoring devices, patient observation, assessment, formal assessment tools, treatment, vocal cord integrity, swallowing, and family involvement. The authors also emphasize the importance of educating staff and family regarding effective ways to interact with the patient and environmental modifications that can be made to optimize communication and safety. 16 figures. 127 references.

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CHAPTER 7. PERIODICALS AND NEWS ON CRITICAL CARE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover critical care.

News Services and Press Releases One of the simplest ways of tracking press releases on critical care is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “critical care” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to critical care. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “critical care” (or synonyms). The following was recently listed in this archive for critical care: •

Recommendations target shortages in critical care services Source: Reuters Medical News Date: March 30, 2004

•

Curative CEO says Critical Care creates new niche Source: Reuters Industry Breifing Date: March 03, 2004

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Curative Health buying Critical Care - profit falls Source: Reuters Industry Breifing Date: February 25, 2004 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “critical care” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “critical care” (or synonyms). If you know the name of a company that is relevant to critical care, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “critical care” (or synonyms).

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Academic Periodicals covering Critical Care Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to critical care. In addition to these sources, you can search for articles covering critical care that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 8. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for critical care. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI® Advice for the Patient® can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with critical care. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to critical care: Acetylcysteine •

Inhalation - U.S. Brands: Mucomyst; Mucomyst-10; Mucosil http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500403.html

Aldesleukin •

Systemic - U.S. Brands: Proleukin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202669.html

Anesthetics, General •

Systemic - U.S. Brands: Amidate; Brevital; Diprivan; E¯thrane; Fluothane; Forane; Ketalar; Penthrane; Pentothal http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203043.html

Midazolam •

Systemic - U.S. Brands: Versed http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202372.html

Riluzole •

Systemic - U.S. Brands: Rilutek http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202792.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult™ Mosby’s Drug Consult™ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html.

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Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

11

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “critical care” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 28881 2483 418 108 69 31959

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “critical care” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

18 Adapted 19

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

195

APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on critical care can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to critical care. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to critical care. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “critical care”:

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Alzheimer's Caregivers http://www.nlm.nih.gov/medlineplus/alzheimerscaregivers.html Choosing a Doctor or Health Care Service http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareservice.html Critical Care http://www.nlm.nih.gov/medlineplus/criticalcare.html Emergency Medical Services http://www.nlm.nih.gov/medlineplus/emergencymedicalservices.html Health Facilities http://www.nlm.nih.gov/medlineplus/healthfacilities.html Infant and Toddler Health http://www.nlm.nih.gov/medlineplus/infantandtoddlerhealth.html Premature Babies http://www.nlm.nih.gov/medlineplus/prematurebabies.html

Within the health topic page dedicated to critical care, the following was listed: •

Coping Taking Care of Yourself While a Loved One Is in the ICU Source: Society of Critical Care Medicine http://www.sccm.org/patient_family_resources/documents/Take_Care.pdf When a Loved One Needs Critical Care Source: American Association of Critical-Care Nurses http://www.aacn.org/AACN/mrkt.nsf/Files/IcuTip/%24file/IcuTip.pdf

•

Children Caring for a Child Dependent on Medical Technology Source: Nemours Foundation http://kidshealth.org/parent/system/ill/machine.html Common DIagnoses in the NICU Source: Nemours Foundation http://www.kidshealth.org/parent/system/ill/nicu_diagnoses.html What Is a Pediatric Critical Care Specialist? Source: American Academy of Pediatrics http://www.aap.org/sections/critcare/WhatisaCritCareDoc.pdf When Your Child's in the Pediatric Intensive Care Unit Source: Nemours Foundation http://www.kidshealth.org/parent/system/ill/picu.html

•

Organizations National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/

Patient Resources

•

197

Statistics Trauma, Burn, Shock, and Injury: Facts and Figures Source: National Institute of General Medical Sciences http://www.nigms.nih.gov/news/facts/traumaburnfactsfigures.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

American Journal of Critical Care Summary: The American Journal of Critical Care (AJCC) is a bimonthly journal produced by the American Association of Critical-Care Nurses. Source: American Association of Critical-Care Nurses http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5098

•

ATS (American Thoracic Society) Journals Online Summary: Links to the American Journal of Respiratory and Critical Care Medicine and the American Journal of Respiratory Cell and Molecular Biology, official Journals of the American Thoracic Society. Source: American Thoracic Society http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5250

•

CHEST: Cardiopulmonary and Critical Care Journal Summary: This monthly journal features cutting edge clinical investigations in the multidisciplinary specialties of chest medicine, such as pulmonology, cardiology, thoracic surgery, transplantation, sleep and Source: American College of Chest Physicians http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1941 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate

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in some way to critical care. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMD®Health: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to critical care. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with critical care. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about critical care. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/.

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Simply type in “critical care” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “critical care”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “critical care” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “critical care” (or a synonym) into the search box, and click “Submit Query.”

201

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.21

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

21

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

22

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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203

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

207

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on critical care: •

Basic Guidelines for Critical Care Tracheostomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002955.htm

•

Signs & Symptoms for Critical Care Coma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Paralysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003190.htm Problems breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm

•

Diagnostics and Tests for Critical Care Erosion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003225.htm

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Background Topics for Critical Care Aspiration Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002216.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Safety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001931.htm Unconsciousness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000022.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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CRITICAL CARE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acoustic: Having to do with sound or hearing. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Acuity: Clarity or clearness, especially of the vision. [EU] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenosine Triphosphate: Adenosine 5'-(tetrahydrogen triphosphate). An adenine nucleotide containing three phosphate groups esterified to the sugar moiety. In addition to its crucial roles in metabolism adenosine triphosphate is a neurotransmitter. [NIH] Adenovirus: A group of viruses that cause respiratory tract and eye infections. Adenoviruses used in gene therapy are altered to carry a specific tumor-fighting gene. [NIH] Adhesives: Substances that cause the adherence of two surfaces. They include glues (properly collagen-derived adhesives), mucilages, sticky pastes, gums, resins, or latex. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually

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referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aeromedical: Pertaining to aviation medicine. [NIH] Aerosols: Colloids with a gaseous dispersing phase and either liquid (fog) or solid (smoke) dispersed phase; used in fumigation or in inhalation therapy; may contain propellent agents. [NIH]

Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Airway Obstruction: Any hindrance to the passage of air into and out of the lungs. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allergy and Immunology: A medical specialty concerned with the hypersensitivity of the individual to foreign substances and protection from the resultant infection or disorder. [NIH]

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Allogeneic: Taken from different individuals of the same species. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Ambulances: A vehicle equipped for transporting patients in need of emergency care. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthesiology: A specialty concerned with the study of anesthetics and anesthesia. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation,

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especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antifungal Agents: Substances that destroy fungi by suppressing their ability to grow or reproduce. They differ from fungicides, industrial because they defend against fungi present in human or animal tissues. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antineoplastic Agents: Substances that inhibit or prevent the proliferation of neoplasms. [NIH]

Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH]

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Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Approximate: Approximal [EU] Aptitude: The ability to acquire general or special types of knowledge or skill. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Archaea: One of the three domains of life (the others being bacteria and Eucarya), formerly called Archaebacteria under the taxon Bacteria, but now considered separate and distinct. They are characterized by: 1) the presence of characteristic tRNAs and ribosomal RNAs; 2) the absence of peptidoglycan cell walls; 3) the presence of ether-linked lipids built from branched-chain subunits; and 4) their occurrence in unusual habitats. While archaea resemble bacteria in morphology and genomic organization, they resemble eukarya in their method of genomic replication. The domain contains at least three kingdoms: crenarchaeota, euryarchaeota, and korarchaeota. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Arteriovenous Fistula: An abnormal communication between an artery and a vein. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Artifacts: Any visible result of a procedure which is caused by the procedure itself and not by the entity being analyzed. Common examples include histological structures introduced by tissue processing, radiographic images of structures that are not naturally present in living tissue, and products of chemical reactions that occur during analysis. [NIH] Asbestos: Fibrous incombustible mineral composed of magnesium and calcium silicates with or without other elements. It is relatively inert chemically and used in thermal

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insulation and fireproofing. Inhalation of dust causes asbestosis and later lung and gastrointestinal neoplasms. [NIH] Asbestosis: A lung disorder caused by constant inhalation of asbestos particles. [NIH] Aspiration: The act of inhaling. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Audiologist: Study of hearing including treatment of persons with hearing defects. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Auditory Perception: The process whereby auditory stimuli are selected, organized and interpreted by the organism; includes speech discrimination. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autosuggestion: Suggestion coming from the subject himself. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving

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chemical reactions in living organisms. [EU] Bioengineering: The application of engineering principles to the solution of biological problems, for example, remote-handling devices, life-support systems, controls, and displays. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biomolecular: A scientific field at the interface between advanced computing and biotechnology. [NIH] Biophysics: The science of physical phenomena and processes in living organisms. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH]

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Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchioles: The tiny branches of air tubes in the lungs. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bronchodilator: A drug that relaxes the smooth muscles in the constricted airway. [NIH] Bronchopulmonary: Pertaining to the lungs and their air passages; both bronchial and pulmonary. [EU] Bronchopulmonary Dysplasia: A chronic lung disease appearing in certain newborn infants treated for respiratory distress syndrome with mechanical ventilation and elevated concentration of inspired oxygen. [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH]

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Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calibration: Determination, by measurement or comparison with a standard, of the correct value of each scale reading on a meter or other measuring instrument; or determination of the settings of a control device that correspond to particular values of voltage, current, frequency, or other output. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capnography: Continuous recording of the carbon dioxide content of expired air. [NIH] Carbohydrates: The largest class of organic compounds, including starches, glycogens, cellulose, gums, and simple sugars. Carbohydrates are composed of carbon, hydrogen, and oxygen in a ratio of Cn(H2O)n. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carboxy: Cannabinoid. [NIH] Carboxy-terminal: The end of any polypeptide or protein that bears a free carboxyl group. [NIH]

Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiac arrest: A sudden stop of heart function. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Resuscitation: The artificial substitution of heart and lung action as indicated for heart arrest resulting from electric shock, drowning, respiratory arrest, or other causes. The two major components of cardiopulmonary resuscitation are artificial ventilation and closed-chest cardiac massage. [NIH] Cardiopulmonary Resuscitation: The artificial substitution of heart and lung action as indicated for heart arrest resulting from electric shock, drowning, respiratory arrest, or other causes. The two major components of cardiopulmonary resuscitation are artificial ventilation and closed-chest cardiac massage. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH]

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Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Caspase: Enzyme released by the cell at a crucial stage in apoptosis in order to shred all cellular proteins. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Physiology: Characteristics and physiological processes of cells from cell division to cell death. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH]

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Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cell Transplantation: Transference of cells within an individual, between individuals of the same species, or between individuals of different species. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Child Development: The continuous sequential physiological and psychological maturing of the child from birth up to but not including adolescence. It includes healthy responses to situations, but does not include growth in stature or size (= growth). [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chlorhexidine: Disinfectant and topical anti-infective agent used also as mouthwash to prevent oral plaque. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public,

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interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Cleft Lip: Congenital defect in the upper lip where the maxillary prominence fails to merge with the merged medial nasal prominences. It is thought to be caused by faulty migration of the mesoderm in the head region. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Communicable disease: A disease that can be transmitted by contact between persons. [NIH] Competency: The capacity of the bacterium to take up DNA from its surroundings. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and

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C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Concentric: Having a common center of curvature or symmetry. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH]

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Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Continuous infusion: The administration of a fluid into a blood vessel, usually over a prolonged period of time. [NIH] Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished. [NIH]

Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Arteriosclerosis: Thickening and loss of elasticity of the coronary arteries. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH]

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Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Cricoid Cartilage: The small thick cartilage that forms the lower and posterior parts of the laryngeal wall. [NIH] Critical Illness: A disease or state in which death is possible or imminent. [NIH] Croup: A condition characterized by resonant barking cough, hoarseness and persistant stridor and caused by allergy, foreign body, infection, or neoplasm. It occurs chiefly in infants and children. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyanotic: Bluish color of the skin due to insufficient oxygen. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cystine: A covalently linked dimeric nonessential amino acid formed by the oxidation of cysteine. Two molecules of cysteine are joined together by a disulfide bridge to form cystine. [NIH]

Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Data Display: The visual display of data in a man-machine system. An example is a cathode ray tube display in which certain data can be called for from the computer and presented on the screen. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH]

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Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developmental Biology: The field of biology which deals with the process of the growth and differentiation of an organism. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic Errors: Incorrect diagnoses after clinical examination or technical diagnostic procedures. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diagnostic Services: Organized services for the purpose of providing diagnosis to promote and maintain health. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilator: A device used to stretch or enlarge an opening. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH]

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Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diuretic: A drug that increases the production of urine. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dreams: A series of thoughts, images, or emotions occurring during sleep which are dissociated from the usual stream of consciousness of the waking state. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Resistance: Diminished or failed response of an organism, disease or tissue to the intended effectiveness of a chemical or drug. It should be differentiated from drug tolerance which is the progressive diminution of the susceptibility of a human or animal to the effects of a drug, as a result of continued administration. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dysphagia: Difficulty in swallowing. [EU] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH]

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Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Eicosanoids: A class of oxygenated, endogenous, unsaturated fatty acids derived from arachidonic acid. They include prostaglandins, leukotrienes, thromboxanes, and hydroxyeicosatetraenoic acid compounds (HETE). They are hormone-like substances that act near the site of synthesis without altering functions throughout the body. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electric shock: A dangerous patho-physiological effect resulting from an electric current passing through the body of a human or animal. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]

Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Emergency Medicine: A branch of medicine concerned with an individual's resuscitation,

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transportation and care from the point of injury or beginning of illness through the hospital or other emergency treatment facility. [NIH] Emergency Treatment: First aid or other immediate intervention for accidents or medical conditions requiring immediate care and treatment before definitive medical and surgical management can be procured. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxemia: A condition characterized by the presence of endotoxins in the blood. If endotoxemia is the result of gram-negative rod-shaped bacteria, shock may occur. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enteral Nutrition: Nutritional support given via the alimentary canal or any route connected to the gastrointestinal system (i.e., the enteral route). This includes oral feeding, sip feeding, and tube feeding using nasogastric, gastrostomy, and jejunostomy tubes. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health.

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[NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epiglottis: Thin leaf-shaped cartilage, covered with mucous membrane, at the root of the tongue, which folds back over the entrance to the larynx, covering it, during the act of swallowing. [NIH] Epiglottitis: Inflammation of the epiglottis. [NIH] Epistaxis: Bleeding from the nose. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Fistula: Abnormal passage communicating with the esophagus. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Ethmoid: An unpaired cranial bone which helps form the medial walls of the orbits and contains the themoidal air cells which drain into the nose. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exotoxin: Toxic substance excreted by living bacterial cells. [NIH] Expander: Any of several colloidal substances of high molecular weight. used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. called also extender. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Extender: Any of several colloidal substances of high molecular weight, used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular

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proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extravascular: Situated or occurring outside a vessel or the vessels. [EU] Extravascular Lung Water: Water present within the lungs; its volume is roughly equal to, or a little less than, the intracellular blood volume of the lungs. Accumulations of extravascular lung water result in pulmonary edema. [NIH] Eye Infections: Infection, moderate to severe, caused by bacteria, fungi, or viruses, which occurs either on the external surface of the eye or intraocularly with probable inflammation, visual impairment, or blindness. [NIH] Facial: Of or pertaining to the face. [EU] Facial Expression: Observable changes of expression in the face in response to emotional stimuli. [NIH] Facial Nerve: The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fasciculation: A small local contraction of muscles, visible through the skin, representing a spontaneous discharge of a number of fibres innervated by a single motor nerve filament. [EU]

Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Febrile: Pertaining to or characterized by fever. [EU] Fentanyl: A narcotic opioid drug that is used in the treatment of pain. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH]

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Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flatus: Gas passed through the rectum. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Formulary: A book containing a list of pharmaceutical products with their formulas and means of preparation. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Fungicides, Industrial: Chemicals that kill or inhibit the growth of fungi in agricultural applications, on wood, plastics, or other materials, in swimming pools, etc. [NIH] Furosemide: A sulfamyl saluretic and diuretic. It has a fast onset and short duration of action and is used in edema and chronic renal insufficiency. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastritis: Inflammation of the stomach. [EU]

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Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrostomy: Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetic Techniques: Chromosomal, biochemical, intracellular, and other methods used in the study of genetics. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genomics: The systematic study of the complete DNA sequences (genome) of organisms. [NIH]

Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH]

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Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Habitat: An area considered in terms of its environment, particularly as this determines the type and quality of the vegetation the area can carry. [NIH] Haloperidol: Butyrophenone derivative. [NIH] Handwashing: The act of cleansing the hands with water or other liquid, with or without the inclusion of soap or other detergent, for the purpose of removing soil or microorganisms. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Heart Arrest: Sudden and usually momentary cessation of the heart beat. This sudden cessation may, but not usually, lead to death, sudden, cardiac. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology,

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and pathology of the blood and blood-forming tissues. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hematopoietic Stem Cells: Progenitor cells from which all blood cells derive. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin C: A commonly occurring abnormal hemoglobin in which lysine replaces a glutamic acid residue at the sixth position of the beta chains. It results in reduced plasticity of erythrocytes. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhagic stroke: A disorder involving bleeding within ischemic brain tissue. Hemorrhagic stroke occurs when blood vessels that are damaged or dead from lack of blood supply (infarcted), located within an area of infarcted brain tissue, rupture and transform an "ischemic" stroke into a hemorrhagic stroke. Ischemia is inadequate tissue oxygenation caused by reduced blood flow; infarction is tissue death resulting from ischemia. Bleeding irritates the brain tissues, causing swelling (cerebral edema). Blood collects into a mass (hematoma). Both swelling and hematoma will compress and displace brain tissue. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Refers to the liver. [NIH] Hepatology: The field of medicine concerned with the functions and disorders of the liver. [NIH]

Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Hoarseness: An unnaturally deep or rough quality of voice. [NIH]

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Holistic Health: Health as viewed from the perspective that man and other organisms function as complete, integrated units rather than as aggregates of separate parts. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hospital Charges: The prices a hospital sets for its services. Hospital costs (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care. [NIH] Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine hospital charges (the price the hospital sets for its services). [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Humour: 1. A normal functioning fluid or semifluid of the body (as the blood, lymph or bile) especially of vertebrates. 2. A secretion that is itself an excitant of activity (as certain hormones). [EU] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH] Hyperoxia: An abnormal increase in the amount of oxygen in the tissues and organs. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions

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upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoplasia: Incomplete development or underdevelopment of an organ or tissue. [EU] Hypotension: Abnormally low blood pressure. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hypoventilation: A reduction in the amount of air entering the pulmonary alveoli. [NIH] Hypoxemia: Deficient oxygenation of the blood; hypoxia. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH]

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In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inferior vena cava: A large vein that empties into the heart. It carries blood from the legs and feet, and from organs in the abdomen and pelvis. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Information Systems: Integrated set of files, procedures, and equipment for the storage, manipulation, and retrieval of information. [NIH] Infuse: To pour (a liquid) into something. [EU] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Infusion Pumps: Fluid propulsion systems driven mechanically, electrically, or osmotically that are used to inject (or infuse) over time agents into a patient or experimental animal; used routinely in hospitals to maintain a patent intravenous line, to administer antineoplastic agents and other drugs in thromboembolism, heart disease, diabetes mellitus (insulin infusion systems is also available), and other disorders. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inpatients: Persons admitted to health facilities which provide board and room, for the

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purpose of observation, care, diagnosis or treatment. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin Infusion Systems: Portable or implantable devices for infusion of insulin. Includes open-loop systems which may be patient-operated or controlled by a pre-set program and are designed for constant delivery of small quantities of insulin, increased during food ingestion, and closed-loop systems which deliver quantities of insulin automatically based on an electronic glucose sensor. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Intensive Care Units: Hospital units providing continuous surveillance and care to acutely ill patients. [NIH] Interferometry: Measurement of distances or movements by means of the phenomena caused by the interference of two rays of light (optical interferometry) or of sound (acoustic interferometry). [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intraocular: Within the eye. [EU] Intraocular pressure: Pressure of the fluid inside the eye; normal IOP varies among individuals. [NIH] Intravenous: IV. Into a vein. [NIH]

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Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ion Transport: The movement of ions across energy-transducing cell membranes. Transport can be active or passive. Passive ion transport (facilitated diffusion) derives its energy from the concentration gradient of the ion itself and allows the transport of a single solute in one direction (uniport). Active ion transport is usually coupled to an energy-yielding chemical or photochemical reaction such as ATP hydrolysis. This form of primary active transport is called an ion pump. Secondary active transport utilizes the voltage and ion gradients produced by the primary transport to drive the cotransport of other ions or molecules. These may be transported in the same (symport) or opposite (antiport) direction. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Jejunostomy: Surgical formation of an opening through the abdominal wall into the jejunum, usually for enteral hyperalimentation. [NIH] Job Satisfaction: Personal satisfaction relative to the work situation. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Ketamine: A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (receptors, NMethyl-D-Aspartate) and may interact with sigma receptors. [NIH] Kinetic: Pertaining to or producing motion. [EU] Lacrimal: Pertaining to the tears. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large

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intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngeal: Having to do with the larynx. [NIH] Laryngectomy: Total or partial excision of the larynx. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Lethal: Deadly, fatal. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Ligase: An enzyme that repairs single stranded discontinuities in double-stranded DNA molecules in the cell. Purified DNA ligase is used in gene cloning to join DNA molecules together. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Litter: Appliance consisting of an oblong frame over which is stretched a canvas or other material, used for carrying an injured or disabled person. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH]

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Localized: Cancer which has not metastasized yet. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Luciferase: Any one of several enzymes that catalyze the bioluminescent reaction in certain marine crustaceans, fish, bacteria, and insects. The enzyme is a flavoprotein; it oxidizes luciferins to an electronically excited compound that emits energy in the form of light. The color of light emitted varies with the organism. The firefly enzyme is a valuable reagent for measurement of ATP concentration. (Dorland, 27th ed) EC 1.13.12.-. [NIH] Lung Transplantation: The transference of either one or both of the lungs from one human or animal to another. [NIH] Luteal Phase: The period of the menstrual cycle that begins with ovulation and ends with menstruation. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphocytic: Referring to lymphocytes, a type of white blood cell. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Lysosome: A sac-like compartment inside a cell that has enzymes that can break down cellular components that need to be destroyed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet.

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[NIH]

Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Maximum Tolerated Dose: The highest dose level eliciting signs of toxicity without having major effects on survival relative to the test in which it is used. [NIH] Mechanical ventilation: Use of a machine called a ventilator or respirator to improve the exchange of air between the lungs and the atmosphere. [NIH] Mechanoreceptors: Cells specialized to transduce mechanical stimuli and relay that information centrally in the nervous system. Mechanoreceptors include hair cells, which mediate hearing and balance, and the various somatosensory receptors, often with nonneural accessory structures. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Errors: Errors or mistakes committed by health professionals which result in harm to the patient. They include errors in diagnosis (diagnostic errors), errors in the administration of drugs and other medications (medication errors), errors in the performance of surgical procedures, in the use of other types of therapy, in the use of equipment, and in the interpretation of laboratory findings. Medical errors are differentiated from malpractice in that the former are regarded as honest mistakes or accidents while the latter is the result of negligence, reprehensible ignorance, or criminal intent. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medicament: A medicinal substance or agent. [EU] Medication Errors: Errors in prescribing, dispensing, or administering medication with the result that the patient fails to receive the correct drug or the indicated proper drug dosage. [NIH]

MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called

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leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mesoderm: The middle germ layer of the embryo. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Millimeter: A measure of length. A millimeter is approximately 26-times smaller than an inch. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH]

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Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Mucociliary: Pertaining to or affecting the mucus membrane and hairs (including eyelashes, nose hair, .): mucociliary clearing: the clearance of mucus by ciliary movement ( particularly in the respiratory system). [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multiple Organ Failure: A progressive condition usually characterized by combined failure of several organs such as the lungs, liver, kidney, along with some clotting mechanisms, usually postinjury or postoperative. [NIH] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle Hypertonia: Abnormal increase in skeletal or smooth muscle tone. Skeletal muscle hypertonicity may be associated with pyramidal tract lesions or basal ganglia diseases. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Myalgia: Pain in a muscle or muscles. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result

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in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardial Reperfusion: Generally, restoration of blood supply to heart tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. Reperfusion can be induced to treat ischemia. Methods include chemical dissolution of an occluding thrombus, administration of vasodilator drugs, angioplasty, catheterization, and artery bypass graft surgery. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing myocardial reperfusion injury. [NIH] Myocardial Reperfusion Injury: Functional, metabolic, or structural changes in ischemic heart muscle thought to result from reperfusion to the ischemic areas. Changes can be fatal to muscle cells and may include edema with explosive cell swelling and disintegration, sarcolemma disruption, fragmentation of mitochondria, contraction band necrosis, enzyme washout, and calcium overload. Other damage may include hemorrhage and ventricular arrhythmias. One possible mechanism of damage is thought to be oxygen free radicals. Treatment currently includes the introduction of scavengers of oxygen free radicals, and injury is thought to be prevented by warm blood cardioplegic infusion prior to reperfusion. [NIH]

Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myopathy: Any disease of a muscle. [EU] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nasal Cavity: The proximal portion of the respiratory passages on either side of the nasal septum, lined with ciliated mucosa, extending from the nares to the pharynx. [NIH] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Nasogastric: The process of passing a small, flexible plastic tube through the nose or mouth into the stomach or small intestine. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatal period: The first 4 weeks after birth. [NIH] Neonatology: A subspecialty of pediatrics concerned with the newborn infant. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis,

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as the neutral arch. [EU] Neural Pathways: Neural tracts connecting one part of the nervous system with another. [NIH]

Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Diseases: A general term encompassing lower motor neuron disease; peripheral nervous system diseases; and certain muscular diseases. Manifestations include muscle weakness; fasciculation; muscle atrophy; spasm; myokymia; muscle hypertonia, myalgias, and musclehypotonia. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurosciences: The scientific disciplines concerned with the embryology, anatomy, physiology, biochemistry, pharmacology, etc., of the nervous sytem. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutropenia: An abnormal decrease in the number of neutrophils, a type of white blood cell. [NIH] Neutrophil: A type of white blood cell. [NIH] Niche: The ultimate unit of the habitat, i. e. the specific spot occupied by an individual organism; by extension, the more or less specialized relationships existing between an organism, individual or synusia(e), and its environment. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or

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incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleic Acid Hybridization: The process whereby two single-stranded polynucleotides form a double-stranded molecule, with hydrogen bonding between the complementary bases in the two strains. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nurse Clinicians: Registered nurses who hold Master's degrees in nursing with an emphasis in clinical nursing and who function independently in coordinating plans for patient care. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nursing Research: Research carried out by nurses, generally in clinical settings, in the areas of clinical practice, evaluation, nursing education, nursing administration, and methodology. [NIH] Nursing Staff: Personnel who provide nursing service to patients in an organized facility, institution, or agency. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Omeprazole: A highly effective inhibitor of gastric acid secretion used in the therapy of gastric ulcers and Zollinger-Ellison syndrome. The drug inhibits the H(+)-K(+)-ATPase (H(+)-K(+)-exchanging ATPase) in a pH-dependent manner. This ATPase is considered the proton pump in the secretory membrane of the parietal cell. [NIH] Oncogenes: Genes which can potentially induce neoplastic transformation. They include genes for growth factors, growth factor receptors, protein kinases, signal transducers, nuclear phosphoproteins, and transcription factors. When these genes are constitutively expressed after structural and/or regulatory changes, uncontrolled cell proliferation may result. Viral oncogenes have prefix "v-" before the gene symbol; cellular oncogenes (protooncogenes) have the prefix "c-" before the gene symbol. [NIH] Oncotic: Pertaining to, caused by, or marked by swelling. [EU] Operating Rooms: Facilities equipped for performing surgery. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an

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analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otitis Media: Inflammation of the middle ear. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Otology: The branch of medicine which deals with the diagnosis and treatment of the disorders and diseases of the ear. [NIH] Otorhinolaryngology: That branch of medicine concerned with medical and surgical treatment of the head and neck, including the ears, nose and throat. [EU] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oximetry: The determination of oxygen-hemoglobin saturation of blood either by withdrawing a sample and passing it through a classical photoelectric oximeter or by electrodes attached to some translucent part of the body like finger, earlobe, or skin fold. It includes non-invasive oxygen monitoring by pulse oximetry. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Paediatric: Of or relating to the care and medical treatment of children; belonging to or

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concerned with paediatrics. [EU] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity. [NIH]

Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parent-Child Relations: The interactions between parent and child. [NIH] Parturition: The act or process of given birth to a child. [EU] Pathogen: Any disease-producing microorganism. [EU] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Patient Transfer: Interfacility or intrahospital transfer of patients. Intrahospital transfer is usually to obtain a specific kind of care and interfacility transfer is usually for economic reasons as well as type of care provided. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH]

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Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Phagocytosis: The engulfing of microorganisms, other cells, and foreign particles by phagocytic cells. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacists: Those persons legally qualified by education and training to engage in the practice of pharmacy. [NIH] Pharmacodynamics: The study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including the correlation of actions and effects of drugs with their chemical structure; also, such effects on the actions of a particular drug or drugs. [EU] Pharmacogenetics: A branch of genetics which deals with the genetic components of variability in individual responses to and metabolism (biotransformation) of drugs. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH]

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Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylated: Attached to a phosphate group. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasmapheresis: Procedure whereby plasma is separated and extracted from anticoagulated whole blood and the red cells retransfused to the donor. Plasmapheresis is also employed for therapeutic use. [NIH] Plasmid: An autonomously replicating, extra-chromosomal DNA molecule found in many bacteria. Plasmids are widely used as carriers of cloned genes. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to

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changes of environment (physiological plasticity). [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumococcal Infections: Infections with bacteria of the species Streptococcus pneumoniae. [NIH]

Pneumoconiosis: Condition characterized by permanent deposition of substantial amounts of particulate matter in the lungs, usually of occupational or environmental origin, and by the tissue reaction to its presence. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Pneumothorax: Accumulation of air or gas in the space between the lung and chest wall, resulting in partial or complete collapse of the lung. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polytetrafluoroethylene: Homopolymer of tetrafluoroethylene. Nonflammable, tough, inert plastic tubing or sheeting; used to line vessels, insulate, protect or lubricate apparatus; also as filter, coating for surgical implants or as prosthetic material. Synonyms: Fluoroflex; Fluoroplast; Ftoroplast; Halon; Polyfene; PTFE; Tetron. [NIH] Polyvinyl Chloride: A polyvinyl resin used extensively in the manufacture of plastics, including medical devices, tubing, and other packaging. It is also used as a rubber substitute. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Positive pressure ventilation: Provision of oxygen under pressure by a mechanical respirator. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done,

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and they may or may not be direct results of the surgery. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Preceptorship: Practical experience in medical and health-related services that occurs as part of an educational program wherein the professionally-trained student works outside the academic environment under the supervision of an established professional in the particular field. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Preoperative: Preceding an operation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Problem Solving: A learning situation involving more than one alternative from which a selection is made in order to attain a specific goal. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Prophylaxis: An attempt to prevent disease. [NIH]

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Propofol: A widely used anesthetic. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protease Inhibitors: Compounds which inhibit or antagonize biosynthesis or actions of proteases (endopeptidases). [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Kinases: A family of enzymes that catalyze the conversion of ATP and a protein to ADP and a phosphoprotein. EC 2.7.1.37. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Proton Pump: Integral membrane proteins that transport protons across a membrane against a concentration gradient. This transport is driven by hydrolysis of ATP by H(+)transporting ATP synthase. [NIH] Proton Pump Inhibitors: Medicines that stop the stomach's acid pump. Examples are omeprazole (oh-MEH-prah-zol) (Prilosec) and lansoprazole (lan-SOH-prah-zol) (Prevacid). [NIH]

Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to

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macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychoneuroimmunology: The field concerned with the interrelationship between the brain, behavior and the immune system. Neuropsychologic, neuroanatomic and psychosocial studies have demonstrated their role in accentuating or diminishing immune/allergic responses. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Alveoli: Small polyhedral outpouchings along the walls of the alveolar sacs, alveolar ducts and terminal bronchioles through the walls of which gas exchange between alveolar air and pulmonary capillary blood takes place. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Circulation: The circulation of blood through the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Quality of Life: A generic concept reflecting concern with the modification and

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enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radar: A system using beamed and reflected radio signals to and from an object in such a way that range, bearing, and other characteristics of the object may be determined. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Ranitidine: A non-imidazole blocker of those histamine receptors that mediate gastric secretion (H2 receptors). It is used to treat gastrointestinal ulcers. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU]

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Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflective: Capable of throwing back light, images, sound waves : reflecting. [EU] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Rehabilitative: Instruction of incapacitated individuals or of those affected with some mental disorder, so that some or all of their lost ability may be regained. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respirator: A mechanical device that helps a patient breathe; a mechanical ventilator. [NIH] Respiratory distress syndrome: A lung disease that occurs primarily in premature infants; the newborn must struggle for each breath and blueing of its skin reflects the baby's inability to get enough oxygen. [NIH] Respiratory failure: Inability of the lungs to conduct gas exchange. [NIH] Respiratory Mechanics: The physical or mechanical action of the lungs, diaphragm, ribs, and chest wall during respiration. It includes airflow, lung volume, neural and reflex

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controls, mechanoreceptors, breathing patterns, etc. [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. [NIH] Respiratory Therapy: Care of patients with deficiencies and abnormalities associated with the cardiopulmonary system. It includes the therapeutic use of medical gases and their administrative apparatus, environmental control systems, humidification, aerosols, ventilatory support, bronchopulmonary drainage and exercise, respiratory rehabilitation, assistance with cardiopulmonary resuscitation, and maintenance of natural, artificial, and mechanical airways. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Rhodopsin: A photoreceptor protein found in retinal rods. It is a complex formed by the binding of retinal, the oxidized form of retinol, to the protein opsin and undergoes a series of complex reactions in response to visible light resulting in the transmission of nerve impulses to the brain. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different

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chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH]

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Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Ships: Large vessels propelled by power or sail used for transportation on rivers, seas, oceans, or other navigable waters. Boats are smaller vessels propelled by oars, paddles, sail, or power; they may or may not have a deck. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silicosis: A type of pneumoconiosis caused by inhalation of particles of silica, quartz, ganister or slate. [NIH] Sinusitis: An inflammatory process of the mucous membranes of the paranasal sinuses that occurs in three stages: acute, subacute, and chronic. Sinusitis results from any condition causing ostial obstruction or from pathophysiologic changes in the mucociliary transport mechanism. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH]

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Social Security: Government sponsored social insurance programs. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectroscopic: The recognition of elements through their emission spectra. [NIH] Sphenoid: An unpaired cranial bone with a body containing the sphenoid sinus and forming the posterior part of the medial walls of the orbits. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Stabilizer: A device for maintaining constant X-ray tube voltage or current. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Sterile: Unable to produce children. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU]

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Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress Ulcer: An upper GI ulcer from physical injury such as surgery, major burns, or critical head injury. [NIH] Striatum: A higher brain's domain thus called because of its stripes. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stridor: The loud, harsh, vibrating sound produced by partial obstruction of the larynx or trachea. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stroke Volume: The amount of blood pumped out of the heart per beat not to be confused with cardiac output (volume/time). [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Substrate: A substance upon which an enzyme acts. [EU] Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acid-binding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sudden cardiac death: Cardiac arrest caused by an irregular heartbeat. [NIH] Sufentanil: An opioid analgesic that is used as an adjunct in anesthesia, in balanced anesthesia, and as a primary anesthetic agent. [NIH] Superoxide: Derivative of molecular oxygen that can damage cells. [NIH] Superoxide Dismutase: An oxidoreductase that catalyzes the reaction between superoxide anions and hydrogen to yield molecular oxygen and hydrogen peroxide. The enzyme protects the cell against dangerous levels of superoxide. EC 1.15.1.1. [NIH]

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Supplementation: Adding nutrients to the diet. [NIH] Supportive care: Treatment given to prevent, control, or relieve complications and side effects and to improve the comfort and quality of life of people who have cancer. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]

Surgical Instruments: Hand-held tools or implements used by health professionals for the performance of surgical tasks. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Telecommunications: Transmission of information over distances via electronic means. [NIH]

Telemedicine: Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thoracic: Having to do with the chest. [NIH] Thoracic Surgery: A surgical specialty concerned with diagnosis and treatment of disorders of the heart, lungs, and esophagus. Two major types of thoracic surgery are classified as pulmonary and cardiovascular. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators

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of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Cartilage: The largest cartilage of the larynx consisting of two laminae fusing anteriorly at an acute angle in the midline of the neck. The point of fusion forms a subcutaneous projection known as the Adam's apple. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonometry: The standard to determine the fluid pressure inside the eye (intraocular pressure). [NIH] Tonsils: Small masses of lymphoid tissue on either side of the throat. [NIH] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the

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vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Tracheostomy: Surgical formation of an opening into the trachea through the neck, or the opening so created. [NIH] Tracheostomy tube: A 2-inch- to 3-inch-long curved metal or plastic tube placed in a surgically created opening (tracheostomy) in the windpipe to keep it open. Also called a trach ("trake") tube. [NIH] Tracheotomy: Surgical incision of the trachea. [NIH] Traction: The act of pulling. [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Triage: The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Tumor suppressor gene: Genes in the body that can suppress or block the development of cancer. [NIH] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities.

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[NIH]

Ubiquitin: A highly conserved 76 amino acid-protein found in all eukaryotic cells. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagal: Pertaining to the vagus nerve. [EU] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilators: Any nerve or agent which induces dilatation of the blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Vena: A vessel conducting blood from the capillary bed to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving

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around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Proteins: Proteins found in any species of virus. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virulent: A virus or bacteriophage capable only of lytic growth, as opposed to temperate phages establishing the lysogenic response. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Vocal cord: The vocal folds of the larynx. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH]

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Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] Xenon: A noble gas with the atomic symbol Xe, atomic number 54, and atomic weight 131.30. It is found in the earth's atmosphere and has been used as an anesthetic. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

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INDEX A Abdominal, 209, 224, 238, 248, 249 Acetylcholine, 209, 245 Acidosis, 86, 209 Acoustic, 209, 237, 266 Acrylonitrile, 209, 258 Acuity, 151, 209 Adaptability, 209, 218, 219 Adaptation, 11, 19, 20, 209, 250 Adenine, 158, 209 Adenosine, 119, 137, 209, 250 Adenosine Triphosphate, 137, 209, 250 Adenovirus, 8, 209 Adhesives, 39, 209 Adjustment, 133, 140, 209 Adolescence, 209, 219, 248 Adrenal Cortex, 210, 222, 252 Adverse Effect, 210, 259 Aeromedical, 79, 210 Aerosols, 210, 257 Afferent, 31, 210, 229 Affinity, 33, 210, 260 Agonist, 27, 210, 244 Airway Obstruction, 147, 174, 210 Albumin, 37, 210, 250 Alertness, 178, 210 Algorithms, 35, 210, 215 Alimentary, 210, 227 Alkaline, 209, 210, 217 Alleles, 19, 210 Allergy and Immunology, 174, 210 Allogeneic, 6, 211 Alpha Particles, 211, 255 Alternative medicine, 180, 211 Aluminum, 211, 261 Alveoli, 211, 265 Ambulances, 142, 211 Amino Acid Sequence, 211, 212 Amino Acids, 211, 248, 251, 253 Amniotic Fluid, 211, 231 Anaerobic, 160, 211 Anaesthesia, 57, 61, 62, 64, 65, 74, 78, 81, 82, 83, 88, 91, 96, 97, 100, 135, 136, 211, 236 Anal, 10, 211, 230 Analgesic, 45, 211, 243, 247, 261 Analogous, 211, 264 Analytes, 76, 211

Anaplasia, 211 Anatomical, 127, 211, 219, 224, 235, 258 Anemia, 91, 211, 232 Anesthesia, 41, 95, 98, 174, 210, 211, 212, 238, 252, 261 Anesthesiology, 6, 33, 42, 54, 95, 97, 104, 211 Anesthetics, 184, 211 Aneurysm, 212, 265 Animal model, 29, 41, 52, 212 Anions, 210, 212, 238, 261 Antibacterial, 98, 212 Antibiotic, 59, 73, 101, 212 Antibodies, 8, 33, 36, 212, 232, 235, 250 Antibody, 57, 210, 212, 220, 232, 234, 235, 236, 238, 241, 243, 255, 260, 267 Anticoagulant, 212, 253, 266 Antifungal, 98, 212 Antifungal Agents, 98, 212 Antigen, 210, 212, 221, 234, 235, 236, 241 Anti-infective, 212, 219, 234 Anti-inflammatory, 29, 212 Antimicrobial, 47, 59, 64, 212 Antineoplastic, 212, 236 Antineoplastic Agents, 212, 236 Antioxidant, 5, 21, 40, 113, 212, 247 Antiseptic, 47, 213 Anus, 211, 213 Anxiety, 114, 213 Aorta, 40, 213, 265 Apnea, 152, 167, 213 Apoptosis, 29, 30, 213, 218 Applicability, 13, 213 Approximate, 135, 213 Aptitude, 43, 213 Aqueous, 213, 214, 223, 227, 234 Arachidonic Acid, 38, 213, 226, 239, 253 Archaea, 213, 242 Arginine, 213, 245 Arterial, 57, 160, 174, 213, 235, 253, 262 Arteries, 213, 215, 216, 222, 238, 243, 254, 262 Arterioles, 213, 216, 217, 242, 243 Arteriovenous, 174, 213, 242 Arteriovenous Fistula, 174, 213 Artery, 212, 213, 226, 238, 244, 254, 256 Artifacts, 137, 159, 213 Asbestos, 213, 214

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Asbestosis, 32, 214 Aspiration, 160, 168, 169, 178, 208, 214 Asymptomatic, 40, 214 Atrial, 214, 266 Atrial Fibrillation, 214, 266 Atrophy, 214, 245 Attenuated, 48, 214, 224 Attenuation, 94, 214 Audiologist, 177, 214 Auditory, 177, 178, 214, 265 Auditory Perception, 177, 214 Autoimmune disease, 214, 243 Autologous, 174, 214 Autosuggestion, 214, 235 B Bacteria, 212, 213, 214, 226, 227, 228, 229, 232, 240, 242, 250, 251, 258, 263, 264, 265 Bacterial Physiology, 209, 214 Bacterium, 48, 214, 220 Base, 25, 51, 126, 133, 134, 209, 214, 224, 238 Basement Membrane, 214, 228 Benign, 214, 232, 244, 255 Bile, 214, 234, 239, 260, 261 Bilirubin, 210, 214 Bioavailability, 23, 214 Biochemical, 43, 210, 214, 215, 231, 249 Bioengineering, 15, 19, 28, 41, 42, 190, 215 Biological therapy, 215, 232 Biological Transport, 215, 224 Biomarkers, 154, 215 Biomechanics, 137, 215 Biomolecular, 32, 215 Biophysics, 14, 21, 34, 42, 215 Biopsy, 215, 249 Biosynthesis, 213, 215, 253 Biotechnology, 56, 61, 180, 191, 215 Biotransformation, 215, 249 Bladder, 215, 221, 243, 253, 265 Blood Cell Count, 215, 232 Blood Glucose, 14, 215, 233, 237 Blood Platelets, 215, 262 Blood pressure, 40, 141, 215, 217, 235, 243, 254, 260 Blood transfusion, 6, 216 Blood vessel, 41, 215, 216, 217, 218, 219, 222, 226, 227, 233, 238, 239, 249, 259, 260, 261, 262, 265 Blood Volume, 216, 229 Body Fluids, 215, 216, 225, 260, 264 Body Mass Index, 82, 216, 247 Bolus, 48, 216

Bolus infusion, 216 Bone Marrow, 22, 216, 231, 240, 243 Bone scan, 216, 258 Bowel, 211, 216, 237, 249 Brachytherapy, 216, 237, 238, 255, 267 Bradykinin, 216, 245, 250 Bronchi, 216, 264 Bronchial, 216, 233 Bronchioles, 211, 216, 254 Bronchitis, 118, 216, 219 Bronchodilator, 11, 216 Bronchopulmonary, 54, 216, 257 Bronchopulmonary Dysplasia, 54, 216 Bupivacaine, 216, 239 Bypass, 128, 131, 168, 169, 216, 244 C Calcium, 213, 217, 220, 244, 253, 259 Calibration, 159, 217 Cannula, 126, 131, 139, 140, 145, 149, 161, 164, 165, 168, 169, 217 Capillary, 24, 38, 216, 217, 254, 265 Capnography, 159, 217 Carbohydrates, 158, 217, 218 Carbon Dioxide, 217, 230, 250, 256 Carboxy, 36, 217 Carboxy-terminal, 36, 217 Carcinogenic, 217, 236, 260 Cardiac, 6, 9, 20, 65, 74, 80, 88, 90, 109, 132, 138, 139, 146, 152, 156, 157, 158, 214, 217, 226, 232, 239, 243, 244, 257, 260, 261 Cardiac arrest, 9, 65, 146, 217, 261 Cardiac Output, 74, 80, 90, 138, 139, 217, 261 Cardiology, 43, 54, 88, 197, 217 Cardiopulmonary, 53, 74, 75, 76, 88, 197, 217, 257 Cardiopulmonary Resuscitation, 74, 75, 76, 217, 257 Cardiovascular, 4, 9, 19, 42, 55, 88, 137, 138, 174, 217, 239, 262 Cardiovascular disease, 55, 217 Carotene, 218, 257 Case report, 218, 220 Case series, 218, 220 Caspase, 24, 218 Catheter, 58, 138, 139, 145, 146, 218, 238 Catheterization, 218, 238, 244 Cathode, 218, 223, 226 Caudal, 155, 218, 251 Cause of Death, 11, 48, 218 Cell Cycle, 49, 218 Cell Death, 24, 29, 137, 213, 218, 244

271

Cell Differentiation, 218, 259 Cell Division, 214, 218, 232, 242, 250 Cell membrane, 215, 218, 224, 238, 250 Cell Physiology, 5, 48, 218 Cell proliferation, 36, 218, 246, 259 Cell Respiration, 218, 256 Cell Survival, 219, 232 Cell Transplantation, 22, 219 Central Nervous System, 31, 209, 219, 226, 230, 231, 232, 239, 243 Centrifugation, 219, 232 Cerebral, 68, 95, 219, 224, 228, 233 Cerebrovascular, 217, 219 Cervical, 166, 167, 219 Cervix, 219 Character, 219, 223 Chemotherapy, 98, 158, 174, 219 Chest wall, 167, 219, 251, 256 Child Development, 16, 219 Chin, 219, 242 Chlorhexidine, 58, 219 Cholesterol, 214, 219, 222, 260 Chromatin, 213, 219, 240 Chromosomal, 50, 219, 231, 250 Chronic Disease, 20, 158, 219 Chronic Obstructive Pulmonary Disease, 11, 99, 118, 219 Chronic renal, 174, 219, 230 CIS, 219, 257 Clamp, 150, 220 Cleft Lip, 174, 220 Clinical Medicine, 28, 55, 220, 252 Clinical study, 38, 220, 222 Clinical trial, 4, 10, 11, 18, 37, 38, 44, 46, 47, 159, 191, 220, 222, 253, 255 Cloning, 21, 215, 220, 239 Coagulation, 215, 217, 220, 250, 266 Cochlear, 220, 263, 266 Cochlear Diseases, 220, 263 Collagen, 7, 154, 209, 214, 220, 251, 252 Collapse, 137, 220, 251, 259 Colloidal, 39, 210, 220, 226, 228 Communicable disease, 39, 220 Competency, 71, 220 Complement, 104, 220, 221, 231, 250 Complementary and alternative medicine, 107, 119, 221 Complementary medicine, 107, 221 Compliance, 25, 221 Compress, 221, 233 Computational Biology, 7, 191, 221 Computed tomography, 221, 258

Computerized axial tomography, 221, 258 Concentric, 160, 221 Concomitant, 47, 221 Cones, 221, 257 Confusion, 221, 225, 235 Congestive heart failure, 77, 222 Conjugated, 222, 223 Conjunctiva, 222, 236 Connective Tissue, 216, 220, 222, 229, 230, 240 Consciousness, 211, 222, 224, 225, 254, 257 Constriction, 148, 222, 238 Consultation, 24, 94, 222 Continuous infusion, 48, 222 Continuum, 22, 222 Contraindications, ii, 222 Control group, 6, 67, 222 Controlled clinical trial, 13, 45, 222, 255 Coordination, 43, 222, 243 Coronary, 217, 222, 243 Coronary Arteriosclerosis, 222, 243 Coronary heart disease, 217, 222 Corpus, 222, 252 Corpus Luteum, 222, 252 Cortical, 222, 258 Corticosteroids, 11, 98, 222 Cortisol, 210, 222 Cranial, 223, 228, 229, 232, 237, 248, 249, 260, 265, 266 Craniocerebral Trauma, 223, 232, 263 Cricoid Cartilage, 166, 223, 266 Critical Illness, 10, 13, 14, 15, 16, 24, 26, 30, 81, 223 Croup, 167, 223 Curative, 179, 180, 223, 262 Cyanotic, 151, 223 Cyclic, 223, 232, 245 Cysteine, 17, 223 Cystine, 223 Cytochrome, 37, 223 Cytokine, 7, 18, 32, 38, 53, 137, 223 Cytoplasm, 213, 218, 223, 232, 240, 243 Cytotoxic, 137, 223, 255, 259 Cytotoxicity, 137, 223 D Data Display, 155, 223 Degenerative, 136, 223 Deletion, 213, 223 Delirium, 45, 59, 70, 90, 224 Delivery of Health Care, 224, 232 Depolarization, 224, 259 Deuterium, 224, 234

272

Critical Care

Developmental Biology, 54, 224 Diabetes Mellitus, 224, 233, 236 Diagnostic Errors, 224, 241 Diagnostic procedure, 125, 180, 224 Diagnostic Services, 224, 262 Dialyzer, 224, 233 Diaphragm, 167, 224, 256 Diastolic, 224, 235 Diffusion, 44, 215, 224, 236, 238 Digestion, 210, 214, 216, 224, 237, 239, 248, 261 Digestive tract, 224, 259 Dilatation, Pathologic, 224, 265 Dilation, 164, 165, 216, 224, 265 Dilator, 164, 224 Dilution, 138, 139, 224 Direct, iii, 5, 6, 11, 35, 37, 42, 44, 50, 51, 135, 136, 154, 183, 220, 225, 234, 252, 256, 262 Discrete, 225, 240 Discrimination, 214, 225 Disorientation, 150, 221, 224, 225 Disposition, 25, 225 Dissociation, 210, 225 Distal, 126, 131, 132, 138, 140, 145, 146, 168, 225, 226, 254 Diuresis, 37, 225 Diuretic, 37, 225, 230 Dorsal, 225, 251 Dreams, 150, 225 Drive, ii, vi, 30, 39, 59, 103, 174, 177, 178, 225, 238 Drug Interactions, 184, 225 Drug Resistance, 225 Drug Tolerance, 45, 225, 263 Duct, 217, 218, 225, 258, 260 Dura mater, 225, 241, 247 Dysphagia, 178, 225 Dysplasia, 55, 167, 225 E Echocardiography, 58, 80, 226 Edema, 37, 94, 226, 230, 233, 237, 244 Effector, 24, 33, 209, 220, 226 Effector cell, 33, 226 Efferent, 31, 226, 229 Efficacy, 5, 6, 9, 27, 29, 37, 48, 141, 226 Eicosanoids, 18, 226 Elastic, 129, 147, 148, 226, 260, 262 Elastin, 220, 226 Elective, 8, 9, 94, 164, 226 Electric shock, 217, 226 Electrode, 39, 218, 226

Electrolyte, 39, 224, 226, 252, 260 Electrons, 212, 214, 218, 226, 238, 247, 255 Electrophoresis, 47, 56, 226 Emboli, 226, 266 Embolism, 226, 254, 266 Embolization, 226, 266 Embryology, 226, 245 Emergency Medicine, 56, 60, 68, 70, 175, 226 Emergency Treatment, 227 Emollient, 47, 227 Emphysema, 165, 219, 227 Empiric, 37, 57, 227 Empirical, 35, 227 Emulsion, 227, 230 Endocrine System, 227, 245 Endocrinology, 14, 55, 227 Endogenous, 136, 226, 227, 264 Endometrium, 227, 242 Endoscopy, 173, 227 Endothelial cell, 7, 17, 137, 227 Endothelium, 227, 245 Endothelium-derived, 227, 245 Endotoxemia, 24, 227 Endotoxin, 24, 227 End-stage renal, 219, 227 Enteral Nutrition, 78, 90, 227 Environmental Health, 25, 32, 190, 192, 227 Enzymatic, 217, 218, 221, 228, 233, 257 Enzyme, 40, 137, 218, 226, 228, 231, 232, 239, 240, 244, 250, 253, 259, 261, 262, 266 Epiglottis, 228 Epiglottitis, 167, 228 Epistaxis, 174, 228 Epithelial, 21, 29, 38, 48, 215, 228 Epithelial Cells, 30, 48, 228 Epithelium, 19, 29, 214, 227, 228 Erythrocytes, 17, 211, 215, 216, 228, 233 Esophageal, 169, 174, 228 Esophageal Fistula, 169, 228 Esophagitis, 228, 261 Esophagus, 127, 224, 228, 249, 256, 261, 262 Estrogen, 55, 228 Ethmoid, 228, 248 Eukaryotic Cells, 228, 235, 247, 265 Evacuation, 74, 79, 228 Evoke, 228, 261 Exogenous, 136, 215, 227, 228 Exotoxin, 57, 228 Expander, 67, 228

273

Expiration, 161, 228, 256 Expiratory, 129, 228 Extender, 228 External-beam radiation, 228, 238, 255, 267 Extracellular, 36, 40, 154, 222, 228, 229, 260 Extracellular Matrix, 154, 222, 228 Extracellular Space, 40, 228, 229 Extraction, 142, 229 Extravascular, 37, 229 Extravascular Lung Water, 37, 229 Eye Infections, 209, 229 F Facial, 167, 173, 229 Facial Expression, 229 Facial Nerve, 174, 229 Family Planning, 191, 229 Fasciculation, 229, 245 Fat, 158, 213, 216, 218, 222, 226, 229, 239, 243, 247, 260, 262 Fatigue, 229, 232 Fatty acids, 210, 226, 229, 253, 263 Febrile, 98, 229 Fentanyl, 23, 229 Fibrin, 15, 229, 262 Fibrinogen, 229, 250, 262 Fibrosis, 4, 7, 18, 29, 32, 51, 55, 57, 118, 229, 258 Filtration, 72, 144, 164, 229 Fistula, 169, 229 Fixation, 155, 230 Flatus, 230 Fluorescence, 158, 230 Flushing, 131, 230 Fold, 34, 230, 247 Forearm, 215, 230 Formulary, 73, 230 Fovea, 230 Free Radicals, 212, 225, 230, 244 Friction, 151, 230 Fungicides, Industrial, 212, 230 Furosemide, 37, 230 G Ganglia, 209, 230, 243, 244, 249 Gas, 135, 165, 217, 224, 230, 234, 245, 251, 254, 256, 257, 261, 265, 267 Gas exchange, 135, 165, 230, 254, 256, 257, 265 Gastric, 73, 78, 168, 169, 230, 233, 246, 248, 255 Gastritis, 118, 230, 261

Gastrointestinal, 60, 78, 214, 216, 227, 231, 239, 255, 261, 264 Gastrostomy, 227, 231 Gene, 24, 30, 31, 32, 33, 51, 53, 54, 154, 209, 210, 215, 231, 239, 246, 250 Gene Expression, 31, 33, 54, 231 Gene Therapy, 32, 51, 209, 231 Genetic Engineering, 215, 220, 231 Genetic Techniques, 37, 231 Genetics, 18, 30, 33, 38, 42, 53, 54, 231, 249 Genomics, 30, 34, 78, 231 Genotype, 18, 231, 249 Gestational, 154, 231 Gestational Age, 154, 231 Gland, 174, 210, 231, 240, 248, 253, 258, 261, 263 Glucose, 14, 215, 224, 231, 233, 235, 237, 258 Glucuronic Acid, 231, 233 Glutamic Acid, 231, 233, 245, 252 Gonadal, 231, 260 Governing Board, 231, 252 Gram-negative, 227, 232 Granulocytes, 232, 259, 266 Growth factors, 54, 232, 246 Guanylate Cyclase, 232, 245 H Habitat, 232, 245 Haloperidol, 90, 232 Handwashing, 78, 232 Haptens, 210, 232 Headache, 232, 235, 236 Health Care Costs, 154, 232 Health Expenditures, 232 Health Services, 13, 26, 43, 54, 67, 224, 232, 262 Heart Arrest, 217, 232 Heart attack, 217, 232 Heart failure, 7, 232 Heartbeat, 232, 261 Hematocrit, 6, 215, 232 Hematology, 116, 232 Hematoma, 233 Hematopoietic Stem Cells, 22, 233 Hemodialysis, 174, 224, 233 Hemodynamics, 37, 233 Hemoglobin, 17, 211, 215, 228, 233, 247 Hemoglobin C, 17, 233 Hemoglobinopathies, 231, 233 Hemorrhage, 44, 223, 232, 233, 244, 261 Hemorrhagic stroke, 36, 233 Heparin, 77, 233

274

Critical Care

Hepatic, 158, 210, 224, 233 Hepatology, 63, 233 Heredity, 231, 233 Heterogeneity, 210, 233 Histamine, 233, 255 Hoarseness, 174, 223, 233 Holistic Health, 116, 234 Homogeneous, 31, 50, 138, 222, 234 Homologous, 210, 231, 234, 262 Hormonal, 31, 55, 214, 234 Hormone, 222, 226, 234, 237, 241, 252, 259, 263 Hospital Charges, 234 Hospital Costs, 6, 234 Humoral, 137, 234 Humour, 82, 234 Hybrid, 36, 234 Hybridization, 31, 234 Hydrogen, 40, 209, 214, 217, 224, 234, 239, 243, 245, 246, 247, 253, 261 Hydrogen Peroxide, 40, 234, 239, 261 Hydrolysis, 215, 234, 238, 249, 251, 253 Hydroxylysine, 220, 234 Hydroxyproline, 220, 234 Hyperglycemia, 14, 234 Hyperoxia, 7, 40, 234 Hypersensitivity, 210, 234, 239 Hypertension, 42, 146, 174, 217, 235, 237 Hypoglycaemia, 224, 235 Hypoglycemia, 14, 235 Hypoplasia, 54, 235 Hypotension, 44, 146, 235 Hypothermia, 65, 83, 235 Hypoventilation, 167, 235 Hypoxemia, 146, 235 Hypoxia, 43, 44, 54, 137, 224, 235 I Iatrogenic, 23, 45, 235 Imidazole, 233, 235, 255 Immune response, 31, 33, 48, 212, 214, 232, 235, 266 Immune system, 29, 215, 226, 235, 239, 240, 243, 254, 265, 266 Immunity, 5, 39, 235 Immunohistochemistry, 36, 235 Immunologic, 231, 235, 255 Immunology, 29, 34, 38, 42, 43, 48, 49, 52, 210, 235 Impairment, 13, 25, 37, 165, 224, 229, 235, 242 Implant radiation, 235, 237, 238, 255, 267 In situ, 21, 31, 36, 136, 137, 235

In Situ Hybridization, 21, 31, 36, 235 In vitro, 7, 18, 21, 30, 36, 48, 54, 231, 235, 236 In vivo, 22, 34, 36, 43, 54, 231, 233, 235, 236, 262 Incision, 128, 132, 144, 167, 168, 169, 236, 238, 264 Induction, 236, 238 Infancy, 54, 236 Infarction, 233, 236, 256 Inferior vena cava, 87, 236 Infiltration, 7, 236, 252 Influenza, 91, 236 Information Systems, 82, 130, 162, 236 Infuse, 236 Infusion, 14, 60, 85, 133, 147, 156, 157, 163, 236, 237, 244, 264 Infusion Pumps, 156, 157, 236 Ingestion, 158, 236, 237, 251 Inhalation, 128, 144, 167, 184, 210, 214, 236, 251, 259 Initiation, 24, 174, 236, 264 Innervation, 229, 236 Inpatients, 30, 236 Insight, 4, 16, 36, 48, 237 Insulator, 237, 243 Insulin, 14, 236, 237 Insulin Infusion Systems, 236, 237 Insulin-dependent diabetes mellitus, 237 Intensive Care Units, 22, 28, 45, 59, 69, 81, 104, 156, 157, 237 Interferometry, 14, 237 Intermittent, 48, 138, 237, 240, 249 Internal Medicine, 25, 32, 33, 39, 44, 48, 49, 98, 101, 176, 227, 232, 237, 244 Internal radiation, 237, 238, 255, 267 Interstitial, 216, 229, 237, 238, 256, 267 Intestinal, 29, 218, 237 Intestine, 29, 136, 216, 237, 238 Intoxication, 224, 237, 267 Intracellular, 48, 229, 231, 236, 237, 241, 245, 252, 259 Intracranial Hypertension, 232, 237, 263 Intraocular, 237, 263 Intraocular pressure, 237, 263 Intravenous, 31, 84, 134, 141, 236, 237 Intrinsic, 210, 214, 238 Intubation, 96, 99, 116, 129, 218, 238 Invasive, 7, 9, 25, 35, 76, 90, 138, 158, 159, 167, 235, 238, 240, 247 Involuntary, 238, 244, 256, 260 Ion Transport, 19, 238

275

Ions, 214, 225, 226, 234, 238, 253 Irradiation, 138, 238, 267 Ischemia, 21, 29, 33, 44, 136, 137, 214, 233, 238, 244, 256 Ischemic stroke, 44, 238 J Jejunostomy, 227, 238 Job Satisfaction, 72, 238 K Kb, 190, 238 Ketamine, 85, 238 Kinetic, 141, 238 L Lacrimal, 229, 238 Large Intestine, 224, 237, 238, 256, 259 Laryngeal, 58, 167, 174, 223, 239 Laryngectomy, 167, 239 Larynx, 131, 144, 147, 155, 156, 161, 166, 167, 228, 239, 261, 263, 264, 265, 266 Length of Stay, 6, 20, 46, 48, 57, 70, 154, 239 Lethal, 37, 239 Leukemia, 231, 239 Leukotrienes, 213, 226, 239 Lidocaine, 116, 239 Ligament, 166, 239, 253 Ligands, 33, 239 Ligase, 49, 239 Linkages, 233, 239 Lip, 220, 239 Lipid, 55, 237, 239, 243, 247 Lipid Peroxidation, 239, 247 Litter, 142, 239 Liver, 40, 87, 209, 210, 213, 214, 227, 231, 233, 239, 243, 258 Liver scan, 239, 258 Localization, 235, 239 Localized, 230, 233, 236, 240, 250, 265 Logistic Models, 63, 240 Long-Term Care, 13, 18, 29, 169, 240 Loop, 126, 148, 170, 237, 240 Luciferase, 30, 240 Lung Transplantation, 68, 240 Luteal Phase, 55, 240 Lymph, 219, 227, 234, 240 Lymph node, 219, 240 Lymphatic, 227, 236, 240 Lymphocytes, 29, 212, 240, 266 Lymphocytic, 29, 240 Lymphoid, 212, 222, 240, 263 Lysine, 233, 234, 240 Lysosome, 48, 240

Lytic, 240, 266 M Macrophage, 7, 40, 48, 240 Magnetic Resonance Imaging, 137, 138, 240, 258 Malnutrition, 158, 210, 214, 240 Manifest, 48, 241 Maxillary, 220, 241, 248 Maximum Tolerated Dose, 225, 241 Mechanical ventilation, 10, 13, 16, 21, 24, 45, 48, 61, 131, 168, 169, 216, 241 Mechanoreceptors, 241, 257 Medial, 143, 220, 228, 241, 260 Mediate, 241, 255 Mediator, 24, 29, 53, 241 Medical Errors, 11, 12, 241 Medical Records, 50, 241 Medicament, 133, 147, 241 Medication Errors, 50, 241 MEDLINE, 191, 241 Membrane Proteins, 241, 253 Memory, 141, 178, 224, 241 Meninges, 219, 223, 225, 241 Meningitis, 64, 118, 241 Menopause, 55, 242 Menstrual Cycle, 55, 240, 242, 252 Menstruation, 240, 242 Mental, iv, 4, 154, 190, 192, 219, 221, 224, 225, 229, 241, 242, 254, 256, 258 Mental Disorders, 242, 254 Mental Health, iv, 4, 190, 192, 242, 254 Mentors, 9, 16, 18, 21, 25, 29, 33, 36, 37, 41, 43, 49, 54, 242 Mesoderm, 220, 242 Meta-Analysis, 56, 242 Metastasis, 242 Microbiological, 61, 242 Microbiology, 33, 47, 48, 209, 242 Microcirculation, 17, 137, 242 Microorganism, 48, 242, 248, 266 Microscopy, 8, 214, 242 Migration, 21, 220, 242 Millimeter, 149, 242 Mitosis, 213, 242 Mobility, 150, 242 Modeling, 10, 35, 117, 242 Modification, 231, 243, 254 Molecule, 212, 214, 221, 225, 226, 227, 233, 234, 243, 246, 247, 250, 255, 256, 259 Monitor, 9, 130, 134, 137, 141, 157, 243, 246 Monoclonal, 238, 243, 255, 267 Monocytes, 137, 243

276

Critical Care

Mononuclear, 243 Morphine, 243, 244, 246 Morphology, 213, 232, 243 Mucociliary, 243, 259 Mucosa, 14, 146, 243, 244, 261 Multiple Organ Failure, 17, 21, 243 Multiple sclerosis, 165, 243 Muscle Hypertonia, 243, 245 Musculature, 135, 243 Myalgia, 236, 243 Mydriatic, 224, 243 Myelin, 243 Myocardial infarction, 243, 244, 266 Myocardial Ischemia, 48, 243 Myocardial Reperfusion, 244, 256 Myocardial Reperfusion Injury, 244, 256 Myocardium, 9, 243, 244 Myopathy, 69, 244 N Naloxone, 73, 244 Narcosis, 244 Narcotic, 152, 229, 243, 244 Nasal Cavity, 244, 248 Nasal Mucosa, 236, 244 Nasogastric, 127, 227, 244 Necrosis, 213, 236, 243, 244, 256 Neonatal, 16, 18, 22, 47, 54, 56, 57, 59, 88, 108, 154, 174, 175, 176, 244 Neonatal period, 16, 244 Neonatology, 5, 54, 244 Neoplasm, 223, 244 Nephrology, 65, 86, 244 Nervous System, 135, 210, 219, 241, 244, 245, 249 Networks, 22, 244 Neural, 31, 178, 210, 234, 241, 244, 245, 256 Neural Pathways, 178, 245 Neuroendocrine, 31, 245 Neurologic, 44, 65, 245 Neurology, 44, 68, 177, 245 Neuromuscular, 167, 209, 245 Neuromuscular Diseases, 167, 245 Neuropathy, 174, 245 Neurosciences, 97, 245 Neurotransmitter, 209, 216, 231, 233, 245, 259 Neutrons, 211, 238, 245, 255 Neutropenia, 67, 245 Neutrophil, 29, 137, 245 Niche, 30, 40, 49, 179, 245 Nitric Oxide, 17, 18, 54, 245 Nitrogen, 40, 230, 245, 264

Nosocomial, 5, 6, 47, 245 Nuclear, 24, 30, 49, 226, 228, 244, 246 Nuclei, 211, 226, 231, 240, 242, 245, 246, 253, 266 Nucleic acid, 234, 235, 245, 246 Nucleic Acid Hybridization, 234, 246 Nucleus, 49, 213, 219, 223, 224, 228, 240, 243, 245, 246, 253, 266 Nurse Clinicians, 8, 246 Nursing Care, 8, 100, 246 Nursing Research, 78, 190, 246 Nursing Staff, 3, 89, 110, 157, 246 O Obstetrics, 33, 61, 68, 154, 246 Omeprazole, 246, 253 Oncogenes, 32, 246 Oncotic, 37, 246 Operating Rooms, 19, 163, 246 Ophthalmology, 230, 246 Opiate, 71, 243, 244, 246 Opium, 243, 246 Opsin, 247, 257 Organelles, 219, 223, 243, 247 Osmotic, 210, 247 Otitis, 174, 247 Otitis Media, 174, 247 Otolaryngology, 162, 173, 247 Otology, 173, 247 Otorhinolaryngology, 173, 247 Outpatient, 20, 22, 247 Overweight, 105, 126, 247 Ovulation, 240, 247 Ovum, 222, 247, 252 Oxidation, 212, 215, 223, 239, 247 Oxidative Stress, 5, 17, 27, 40, 247 Oximetry, 7, 139, 159, 247 Oxygen Consumption, 247, 256 Oxygenation, 9, 37, 233, 235, 247 P Pachymeningitis, 241, 247 Paediatric, 71, 88, 108, 247 Palate, 174, 248 Palliative, 84, 100, 113, 248, 262 Pancreas, 209, 215, 237, 248, 264 Pancreatic, 136, 248 Paralysis, 167, 207, 248 Paranasal Sinuses, 174, 248, 259 Parasite, 248 Parasitic, 158, 248 Parent-Child Relations, 35, 248 Parturition, 246, 248 Pathogen, 33, 48, 57, 248

277

Pathologic, 209, 213, 215, 222, 234, 248, 251 Pathologic Processes, 213, 248 Pathologist, 178, 248 Pathophysiology, 16, 18, 31, 34, 135, 248 Patient Satisfaction, 50, 248 Patient Transfer, 50, 248 Pediatrics, 4, 13, 16, 17, 18, 21, 22, 36, 42, 49, 53, 54, 88, 98, 154, 196, 244, 248 Pelvis, 236, 248, 265 Peptic, 248, 261 Peptide, 36, 248, 251, 253 Perception, 46, 92, 108, 248, 258 Percutaneous, 140, 164, 174, 249 Perfusion, 44, 135, 235, 249 Perioperative, 41, 91, 115, 249 Peripheral Nervous System, 245, 249 Peripheral Nervous System Diseases, 245, 249 Peritoneal, 31, 88, 174, 249 Peritoneal Cavity, 249 Peritoneal Dialysis, 88, 174, 249 Peritoneum, 249 Phagocytosis, 48, 249 Phallic, 230, 249 Pharmacists, 115, 249 Pharmacodynamics, 45, 48, 249 Pharmacogenetics, 37, 67, 249 Pharmacokinetic, 249 Pharmacologic, 16, 17, 175, 211, 249, 263 Pharynx, 131, 155, 156, 161, 236, 244, 249, 265 Phenotype, 18, 249 Phospholipases, 249, 259 Phospholipids, 229, 250 Phosphorus, 217, 250 Phosphorylated, 36, 250 Phosphorylation, 36, 250 Physical Examination, 231, 250 Physiologic, 17, 19, 24, 114, 137, 152, 158, 159, 178, 210, 215, 242, 250, 256 Physiology, 14, 17, 21, 24, 25, 34, 42, 52, 53, 59, 109, 174, 217, 227, 232, 244, 245, 250 Pigments, 218, 250, 257 Pilot study, 6, 44, 46, 250 Placenta, 250, 252, 254 Plants, 217, 231, 243, 250, 258, 263, 264 Plaque, 219, 250 Plasma, 45, 104, 137, 160, 210, 212, 216, 218, 228, 229, 233, 250, 253 Plasma cells, 212, 250 Plasma protein, 210, 250, 253

Plasmapheresis, 72, 250 Plasmid, 21, 30, 250 Plasticity, 233, 250 Platelet Activation, 251, 259 Platelet Aggregation, 245, 251, 262 Platelets, 245, 251 Pneumococcal Infections, 11, 251 Pneumoconiosis, 251, 259 Pneumonia, 5, 30, 56, 57, 58, 61, 73, 178, 222, 251 Pneumothorax, 35, 251 Poisoning, 224, 237, 251 Polyethylene, 145, 251 Polypeptide, 211, 217, 220, 229, 234, 251 Polytetrafluoroethylene, 132, 251 Polyvinyl Chloride, 145, 251 Port, 138, 145, 146, 156, 157, 251 Port-a-cath, 251 Positive pressure ventilation, 25, 251 Posterior, 165, 211, 223, 225, 248, 251, 260 Postnatal, 54, 251 Postoperative, 6, 243, 251 Postoperative Complications, 6, 251 Postsynaptic, 252, 259 Potassium, 137, 252 Potentiation, 252, 259 Practice Guidelines, 192, 252 Preceptorship, 16, 252 Precursor, 213, 226, 228, 252, 253, 264 Pregnancy Tests, 231, 252 Preoperative, 6, 83, 92, 252 Prevalence, 10, 44, 252 Probe, 160, 252 Problem Solving, 12, 252 Procaine, 239, 252 Progesterone, 55, 252, 260 Progression, 7, 24, 36, 49, 212, 252 Progressive, 3, 23, 218, 219, 225, 243, 244, 251, 252, 256 Projection, 94, 252, 263 Proline, 220, 234, 252 Prophylaxis, 252, 266 Propofol, 85, 253 Prospective study, 81, 253 Prostaglandins, 213, 226, 253 Prostate, 215, 253, 264 Protease, 136, 137, 253 Protease Inhibitors, 136, 137, 253 Protein C, 210, 211, 253 Protein Kinases, 246, 253 Protein S, 215, 253

278

Critical Care

Proteins, 36, 137, 211, 212, 218, 219, 220, 234, 241, 243, 245, 248, 250, 253, 259, 264, 266 Proteolytic, 40, 221, 229, 253 Prothrombin, 253, 262 Protocol, 13, 19, 45, 46, 59, 98, 253 Proton Pump, 84, 246, 253 Proton Pump Inhibitors, 84, 253 Protons, 211, 234, 253, 255 Protozoa, 242, 253 Proximal, 24, 128, 131, 132, 140, 145, 146, 149, 150, 166, 225, 244, 254 Psychiatric, 45, 242, 254 Psychiatry, 12, 230, 254, 261, 265 Psychic, 242, 254, 258 Psychoactive, 254, 267 Psychoneuroimmunology, 114, 254 Puberty, 55, 254 Public Health, 5, 11, 15, 30, 38, 54, 55, 192, 254 Public Policy, 191, 254 Publishing, 56, 63, 84, 116, 254 Puerperium, 246, 254 Pulmonary Alveoli, 156, 235, 254 Pulmonary Artery, 215, 254, 265 Pulmonary Circulation, 18, 51, 254 Pulmonary Edema, 37, 229, 254 Pulmonary Embolism, 254, 266 Pulmonary hypertension, 7, 254 Pulmonary Ventilation, 254, 257 Pulse, 7, 80, 159, 243, 247, 254 Pupil, 224, 243, 254 Q Quality of Life, 13, 25, 65, 254, 262 R Race, 159, 242, 255 Radar, 35, 255 Radiation, 58, 228, 230, 237, 238, 255, 258, 267 Radiation therapy, 228, 237, 238, 255, 267 Radioactive, 216, 234, 235, 237, 238, 239, 246, 255, 258, 267 Radiography, 64, 231, 255 Radiolabeled, 238, 255, 267 Radiological, 249, 255 Radiotherapy, 216, 238, 255, 267 Randomized, 6, 13, 14, 18, 24, 25, 27, 37, 45, 67, 226, 255 Randomized clinical trial, 14, 37, 255 Randomized Controlled Trials, 67, 255 Ranitidine, 56, 255 Reagent, 240, 255

Receptor, 24, 32, 33, 49, 209, 212, 256, 259 Recombination, 231, 256 Rectum, 213, 224, 230, 238, 253, 256 Refer, 1, 142, 220, 230, 239, 245, 246, 256, 263, 266 Reflective, 64, 256 Reflex, 256 Reflux, 73, 256, 261 Refractory, 97, 256 Regimen, 226, 256 Rehabilitative, 178, 256 Reliability, 26, 99, 256 Renal failure, 224, 256 Reperfusion, 21, 29, 33, 244, 256 Reperfusion Injury, 33, 256 Research Design, 6, 58, 256 Resection, 97, 256 Respiration, 145, 166, 213, 217, 243, 256, 257 Respirator, 135, 155, 241, 251, 256 Respiratory distress syndrome, 33, 216, 256 Respiratory failure, 13, 17, 18, 25, 26, 45, 86, 97, 152, 169, 256 Respiratory Mechanics, 64, 256 Respiratory Physiology, 21, 43, 257, 265 Respiratory System, 15, 135, 165, 243, 257 Respiratory Therapy, 133, 147, 257 Resuscitation, 9, 65, 76, 101, 217, 226, 257 Retina, 221, 257 Retinal, 22, 257 Retinol, 257 Retrograde, 129, 257 Retroviral vector, 231, 257 Rhinitis, 174, 257 Rhodopsin, 247, 257 Ribose, 209, 257 Rigidity, 141, 250, 257 Risk factor, 5, 13, 15, 23, 57, 58, 67, 177, 240, 253, 257 Rod, 164, 214, 220, 227, 257 Rubber, 145, 146, 169, 209, 251, 257 S Saliva, 258 Salivary, 174, 229, 258 Salivary glands, 229, 258 Saponins, 258, 260 Scans, 35, 258 Schizoid, 258, 267 Schizophrenia, 258, 267 Schizotypal Personality Disorder, 258, 267 Sclerosis, 25, 243, 258

279

Screening, 7, 220, 258 Secretion, 233, 234, 237, 246, 255, 258 Sedative, 45, 48, 98, 258 Seizures, 44, 224, 258 Sensibility, 211, 258 Sensor, 14, 128, 160, 237, 258 Sepsis, 24, 29, 31, 33, 53, 56, 60, 63, 104, 136, 137, 258 Septic, 29, 31, 56, 65, 259 Serum, 57, 159, 210, 220, 259 Sex Characteristics, 209, 254, 259 Ships, 88, 259 Shock, 29, 31, 56, 65, 119, 136, 137, 158, 197, 227, 259, 264 Side effect, 183, 210, 215, 259, 262, 263 Signal Transduction, 32, 36, 38, 259 Signs and Symptoms, 23, 259 Silicosis, 32, 259 Sinusitis, 174, 259 Skeletal, 220, 243, 259, 260 Sleep apnea, 152, 167, 259 Small intestine, 136, 137, 234, 237, 244, 259 Smooth muscle, 216, 233, 243, 259, 260 Social Environment, 255, 259 Social Security, 255, 260 Sodium, 137, 260 Soft tissue, 216, 260 Somatic, 209, 234, 242, 249, 260, 265 Sound wave, 256, 260 Spasm, 245, 260 Specialist, 84, 196, 198, 224, 260 Species, 211, 219, 234, 242, 243, 248, 251, 255, 260, 264, 266, 267 Specificity, 36, 210, 260 Spectroscopic, 138, 260 Sphenoid, 248, 260 Sphincter, 239, 260 Spinal cord, 94, 167, 219, 225, 241, 244, 245, 247, 249, 256, 260 Stabilizer, 146, 147, 260 Staging, 258, 260 Steel, 129, 220, 260 Stenosis, 138, 167, 260, 261 Sterile, 148, 167, 260 Steroid, 11, 27, 222, 258, 260 Stimulus, 24, 138, 225, 226, 236, 256, 261, 262 Stoma, 126, 127, 133, 147, 161, 168, 169, 261 Stomach, 209, 224, 228, 230, 231, 234, 244, 249, 253, 256, 259, 261

Stress, 12, 21, 52, 56, 74, 98, 113, 116, 137, 158, 178, 222, 230, 247, 257, 261 Stress Ulcer, 56, 261 Striatum, 59, 261 Stricture, 260, 261 Stridor, 223, 261 Stroke, 68, 81, 88, 95, 190, 217, 233, 238, 261 Stroke Volume, 217, 261 Stupor, 244, 261 Styrene, 258, 261 Subacute, 7, 236, 259, 261 Subarachnoid, 44, 232, 261 Subclinical, 236, 258, 261 Subcutaneous, 226, 261, 263 Substrate, 36, 261 Sucralfate, 56, 261 Suction, 145, 146, 151, 167, 229, 261 Sudden cardiac death, 146, 261 Sufentanil, 57, 261 Superoxide, 40, 137, 261 Superoxide Dismutase, 40, 261 Supplementation, 113, 262 Supportive care, 158, 262 Suppression, 31, 137, 262 Surfactant, 48, 262 Surgical Instruments, 169, 262 Synapse, 262, 264 Synaptic, 245, 259, 262 Systemic, 5, 11, 17, 23, 37, 44, 137, 158, 184, 213, 215, 224, 233, 236, 237, 238, 255, 261, 262, 266, 267 Systemic disease, 158, 262 Systolic, 235, 262 T Telecommunications, 262 Telemedicine, 50, 94, 98, 262 Therapeutics, 42, 53, 133, 146, 147, 185, 262 Thermal, 127, 138, 139, 213, 225, 245, 262 Thoracic, 15, 197, 224, 262, 266 Thoracic Surgery, 197, 262 Threshold, 35, 153, 235, 262 Thrombin, 116, 229, 251, 253, 262 Thrombocytopenia, 77, 262 Thromboembolism, 100, 236, 262 Thrombosis, 42, 174, 243, 253, 261, 262 Thromboxanes, 213, 226, 262 Thyroid, 166, 263 Thyroid Cartilage, 166, 263 Thyroxine, 210, 263 Tinnitus, 174, 247, 263, 266

280

Critical Care

Tolerance, 21, 23, 209, 263 Tomography, 14, 221, 263 Tone, 41, 243, 263 Tonometry, 78, 263 Tonsils, 174, 263 Tonus, 263 Tooth Preparation, 209, 263 Topical, 219, 234, 263 Toxic, iv, 137, 223, 228, 235, 245, 261, 263 Toxicity, 225, 241, 261, 263 Toxicokinetics, 263 Toxicology, 27, 62, 63, 108, 192, 263 Toxin, 227, 263 Tracheostomy tube, 126, 127, 128, 131, 133, 139, 140, 143, 144, 145, 146, 147, 148, 149, 150, 155, 161, 164, 165, 166, 167, 168, 169, 170, 264 Tracheotomy, 128, 149, 167, 168, 169, 174, 264 Traction, 129, 220, 264 Transcription Factors, 246, 264 Transduction, 259, 264 Transfection, 8, 215, 231, 264 Transfusion, 6, 60, 91, 94, 228, 264 Translational, 5, 32, 37, 264 Translocation, 24, 264 Transmitter, 157, 209, 241, 264 Transplantation, 87, 98, 122, 197, 219, 264 Trees, 257, 264 Triage, 60, 264 Tryptophan, 220, 264 Tuberculosis, 32, 48, 264 Tumor marker, 215, 264 Tumor suppressor gene, 32, 264 Tunica, 243, 264 U Ubiquitin, 49, 265 Ulcer, 261, 265 Ultrasonography, 231, 265 Urethra, 253, 265 Urine, 160, 215, 225, 265 Uterus, 219, 222, 227, 242, 252, 265 V Vaccine, 11, 31, 253, 265 Vagal, 31, 265 Vagus Nerve, 265

Valves, 144, 265 Vascular, 7, 17, 31, 34, 40, 41, 54, 135, 136, 174, 227, 236, 242, 245, 250, 265 Vasodilation, 41, 265 Vasodilators, 245, 265 Vasomotor, 17, 265 Vein, 174, 212, 213, 236, 237, 246, 265 Vena, 265 Venous, 100, 174, 213, 215, 253, 265, 266 Venous Thrombosis, 265, 266 Ventilation, 13, 24, 25, 45, 135, 136, 151, 166, 168, 169, 217, 265 Ventricle, 254, 262, 265 Venules, 216, 217, 242, 265 Vertebrae, 167, 260, 265 Vertigo, 247, 265, 266 Vestibular, 174, 266 Vestibule, 266 Vestibulocochlear Nerve, 263, 266 Vestibulocochlear Nerve Diseases, 263, 266 Veterinary Medicine, 191, 266 Viral, 33, 40, 158, 236, 246, 264, 266 Viral Proteins, 40, 266 Virulence, 214, 263, 266 Virulent, 48, 266 Virus, 81, 231, 250, 257, 264, 266 Vitro, 36, 233, 266 Vivo, 19, 116, 138, 266 Vocal cord, 155, 161, 167, 168, 169, 178, 266 W Wakefulness, 224, 266 Warfarin, 37, 266 White blood cell, 212, 240, 245, 250, 266 Windpipe, 249, 263, 264, 266 Withdrawal, 23, 46, 100, 160, 224, 267 Wound Healing, 21, 33, 267 X Xenograft, 212, 267 Xenon, 98, 267 X-ray, 35, 169, 218, 221, 230, 238, 246, 255, 258, 260, 267 X-ray therapy, 238, 267 Y Yeasts, 249, 267