Catálogo de publicaciones - libros

The diagnosis of pulmonary infection caused by and , and different species of , is often long and challenging although they are the major etiologic agents of pneumonia. For this reason, the treatment of these infections remains probabilistic. Advances in new diagnostic techniques, such as PCR sequencing, show the relative predominance of atypical organisms and serves to identify emerging pathogenic agents. Moreover, these techniques should clarify the correlation between common and atypical pathogens.

There is a worldwide spiraling risk for more frequent catastrophic events involving multiple casualties, not only in terms of acute injury and illness, but also subsequent psychological and public health concerns. Today, such events will likely be multinational in nature, even when localized to a particular venue and this require international cooperation in terms of prevention, mitigation and relief. The best approach to preparing for disasters is to expand, modify and enhance current local ∖Jobname: S34055 Batch number: 00060 infrastructures and capabilities for managing the multiple types of disaster scenarios and create a number of inter-facility cooperative agreements in advance. Aside from safer internal locations for ICUs and surgical theaters, certain structural changes will need to be installed such as modified ventilation systems, protected water supplies, decontamination mechanisms and security renovations. A key strategy will be to proliferate interoperable, multi-disciplinary, all-hazards training initiatives such as the AMA National Disaster Life Support courses. Purchases of cadres of antidotes, antibiotics and hemoglobin-based oxygen carriers should be coordinated regionally, stored in secure locations and made readily-available for the applicable disaster scenario.

As we move from single therapeutic interventions such as new drugs or procedures to complex system interventions aimed at improving the care of the seriously ill we need to familiarize ourselves with the tools made available by HSR and increasingly work with other researchers such as social scientists, health economists and medical anthropologists.

Numerous international governments and federal funding agencies have placed the elimination of healthcare disparities on a spate of agendas targeted for completion in the next 10 to 20 years. Disparities in ICU patients are often less recognized, as efforts to identify and eliminate disparities frequently focus on common clinical conditions. Greater efforts are required to characterize the magnitude of healthcare disparities in critically ill patients and to seek the root causes of these disparities. The elimination of healthcare disparities will require different interventions depending on the type of disparities, the underlying cause(s) and the type of healthcare system in which they occur.

The last several years have seen an accumulation of evidence that TRALI is an important complication of blood transfusion and is likely occurring much more frequently than previously estimated. Most data support a causal relationship though there are admittedly confounders given the prevalence of this disorder in patients with other predispositions to ALI/ARDS, including sepsis, shock, trauma and aspiration. Both massive and submassive transfusion have been implicated as risk factors. It is apparent from the studies to date that each additional unit likely increases a patient’s risk in an additive fashion thus mitigating any false reassurances if no reaction is witnessed after the first few units are transfused.

The implications of this disorder are far and wide given the regular and wide-spread use of blood transfusions around the world. While most attention in the past has focused on the risk of transmitting infectious diseases, it is imperative that some of the light now be shifted to better defining and understanding the true prevalence of TRALI. The moral, ethical and financial issues of potentially preventive strategies (screening or deferral of particular donors, decrease in storage time and pre-storage leukoreduction) are substantial.