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In patients with significant renal impairment asthma treatment breathing exercises proven 100 mcg ventolin, the half-life can be prolonged up to 4 hours asthma treatment cartoon proven 100 mcg ventolin. Argatroban Mechanism and Pharmacology Argatroban is a competitive, reversible, direct thrombin inhibitor that binds directly to the active site of thrombin. Administration and Monitoring Cautious dosing is required in patients with acute or chronic hepatic dysfunction. Lower infusion rates are also recommended in patients with combined hepatic-renal dysfunction, congestive heart failure, or severe anasarca, and after cardiac surgery. Steady state is usually achieved 1 to 3 hours after initiation of therapy, although the need for dose adjustment is not uncommon. The anticoagulant effect of bivalirudin is more reversible than that of other hirudins because of direct inactivation and cleavage from thrombin itself. An advantage of bivalirudin is its significant non­organdependent metabolism, which makes it an attractive option in critically ill patients and in those with renal and/or hepatic insufficiency. Danaparoid has a long anti­factor Xa activity elimination half-life of approximately 25 hours. When given to patients with significant hepatic dysfunction, prolonged anticoagulation should be expected. Adverse Effects Bleeding is the primary adverse effect of argatroban and is at least partially dependent on the duration and intensity of anticoagulation. Gastrointestinal bleeding is the most frequently reported, with major bleeds occurring in 3% or less of treated patients. Excessive anticoagulation may be controlled simply by decreasing the infused dose. If bleeding occurs, the infusion should be discontinued and efforts should be made to correct the underlying defect. Anticoagulation parameters should return to baseline within 2 to 4 hours of stopping the infusion, although it may take significantly longer in patients with liver disease or in critically ill patients who have developed a concurrent vitamin K deficiency from their prolonged illness. Administration and Monitoring Danaparoid is administered intravenously via continuous infusion or by twice-daily subcutaneous administration. The recommended dosing includes an initial bolus of 2250 U (with some weight-based modification if necessary), followed by 400 U/h for 4 hours, 300 U/h for another 4 hours, and then a final dose of 200 U/h for the duration of treatment. Prophylactic dosing is discouraged because it is associated with increased rates of new or progressive thrombosis compared with treatment with other anticoagulants. Adverse Effects As with all anticoagulants, the main adverse event of concern is bleeding. Bleeding events must be dealt with by first discontinuing the infusion, then monitoring hematologic and coagulation parameters, and correcting the source of the bleed when possible. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. The weight-based heparin dosing nomogram compared with a "standard-care" nomogram: a randomized controlled trial. Nomograms for the administration of unfractionated heparin in the initial treatment of acute thromboembolism-an overview. Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Comparison of fixed-dose weight-adjusted unfractionated heparin and low-molecular-weight heparin for acute treatment of venous thromboembolism. A randomized trial comparing activated thromboplastin time with heparin assay in patients with acute venous thromboembolism requiring large daily doses of heparin. Recurrent venous thrombosis and heparin therapy: an evaluation of the importance of early activated partial thromboplastin times. This study is a landmark trial because oligonucleotide therapy had not previously been shown effective. The ability to "control" coagulation factor levels with this technology will be attractive in a number of disease states potentially including hemophilia. Many clinicians have experience in treating patients receiving warfarin and heparin, and comprehensive evidencebased guidelines exist to direct their management. In comparison, there is significantly less experience in the use of more recently developed novel agents and heparin alternatives. Their expanding availability and clinical indications require clinicians to become familiar with them in terms of drug initiation, perioperative management, and urgent reversal mechanisms (if they exist). Long-term low-molecularweight heparin versus usual care in proximal-vein thrombosis patients with cancer. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Treatment with dalteparin is associated with a lower risk of bleeding compared to treatment with unfractionated heparin in patients with renal insufficiency. Two sensitive and rapid chromogenic assays of fondaparinux sodium (Arixtra) in human plasma and other biological matrices. Major bleeding, mortality, and efficacy of fondaparinux in venous thromboembolism prevention trials. Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score-matched study. Evaluation of bivalirudin treatment for heparin-induced thrombocytopenia in critically ill patients with hepatic and/or renal dysfunction.

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Be sure the family performs frequent range-of-motion activities asthma symptoms leg pain purchase ventolin toronto, as taught in the rehabilitation unit asthmanefrin order ventolin without a prescription. Be sure the patient and family understand the importance of maintaining the mobility and selfcare routine developed in the rehabilitation unit. Be sure the social worker or rehabilitation Subarachnoid Hemorrhage 1051 personnel have provided the family with a list of resources for in-home care. Determine whether a home-care agency will be providing in-home supervision and ongoing physical therapy support. The expanding hematoma acts as a space-occupying lesion as it compresses or displaces brain tissue. The bleeding ceases with the formation of a fibrin-platelet plug at the point of the rupture and by tissue compression. As the clot, which forms initially to seal the rupture site, undergoes normal lysis or dissolution, the risk of rebleeding increases. More than 30,000 people in the United States have a ruptured intracranial aneurysm each year, although the annual incidence is probably underestimated because death is attributed to other reasons. The pathophysiology of vasospasms is not clearly understood, but it is believed that they are precipitated by certain vasoactive substances. By decreasing cerebral blood flow, a vasospasm produces complications such as neurological deterioration, cerebral ischemia, and cerebral infarction. Long-term complications include speech and language deficits, weakness or paralysis of the extremities, visual derangements, seizures, headaches, problems with attention or concentration, memory loss, and personality changes. Some types of aneurysms form because the adventitia is very thin in intracranial arteries, which makes them prone to aneurysm formation. Because aneurysm-forming vessels usually lie in the space between the arachnoid and the brain, hemorrhage from an aneurysm usually occurs in the subarachnoid space. There are six known risk-associated loci, although no genes have been definitively identified. The Middle East, China, and India have low reported rates, which may partly be due to the low rates of cardiovascular disease for people living in these regions. Many also report a severe headache associated with exertion but no loss of consciousness. Ask the patient if any visual changes occurred such as photophobia, double vision, or vision loss. The most common symptoms are neck pain, neck stiffness, loss of consciousness, severe headache, and limited neck flexion. Meningeal irritation may lead to nausea, vomiting, stiff neck, pain in the neck Subarachnoid Hemorrhage 1053 and back, and possible blurred vision or photophobia. Examine for symptoms of stroke syndrome, such as hemiparesis, hemiplegia, aphasia, and cognitive deficits. Assess the vital signs for bradycardia, hypertension, and a widened pulse pressure. Other symptoms may result from pituitary dysfunction, caused by irritation or edema, leading to diabetes insipidus (excessive urinary output, hypernatremia) or hyponatremia. Several days after the event, the patient may become febrile because the meninges are irritated from the hemorrhaged blood. Encourage the patient to verbalize his or her fears of death, disability, dependency, and becoming a burden. Be sensitive to the fact that the event is life-changing for the patient and family, and expect stresses and strains on their coping ability. Repair of the ruptured aneurysm may be accomplished by surgical clipping or 1054 Subarachnoid Hemorrhage coiling. The timing of surgery is controversial, but most experts recommend that surgery should take place within 72 hours. Until a decision about surgery is made, however, the management of the patient is focused on preventing secondary injury and relieving symptoms. Endotracheal intubation and mechanical ventilation should be performed for patients who are unresponsive and cannot maintain their own airway. Experts recommend that the mean arterial blood pressure be kept below 130 mm Hg with the use of intravenous beta blockers that can be adjusted minute by minute. Hypotension must be avoided at all costs because it worsens ischemic deficits and can lead to cerebral ischemia. Maintain fluid volume within a normal range because dehydration increases hemoconcentration, which may increase the incidence of vasospasm. Vasospasm is managed with calcium channel blockers such as nimodipine, although transluminal balloon angioplasty may be used if other therapy fails. Complications during the immediate postoperative period include brain swelling, bleeding at the operative site, fluid and electrolyte disturbances, hydrocephalus, and the onset of cerebral vasospasm. Frequently, the first signs of rebleeding and vasospasm are evidenced through subtle changes in the neurological examination. In the postoperative period, unless otherwise indicated, maintain the bed at an elevation of 30 to 40 degrees. Prevent flexion of the head and maintain proper alignment of Subarachnoid Hemorrhage 1055 the head and neck with towel rolls or sandbags. If deep endotracheal suctioning is indicated, hyperventilate and hyperoxygenate the patient before suctioning and limit suctioning to less than 30 seconds. To prevent complications from postoperative immobility, turn the patient often and provide skin care. Perform active or passive range-of-motion exercises and encourage deep-breathing exercises when the patient is able. Inspect the surgical site with all dressing changes for redness, drainage, poor wound healing, and swelling. Global, regional, and national burden of neurological disorders during 1990­ 2015: A systematic analysis for the Global Burden of Disease Study 2015.

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Given the serious nature of the related causes asthma breathing treatment buy 100 mcg ventolin fast delivery, often the patient will have urinary output monitored hourly asthma treatment symptoms best buy ventolin. Ask if the patient has experienced recent signs of hyponatremia such as fatigue, weakness, nausea, anorexia, or headaches. Late signs include nausea, vomiting, muscle weakness, decreased reaction time, irritability, decreased level of consciousness, seizures, and even coma. The severity of hyponatremia determines the severity of findings on physical assessment. Perform a neurological assessment to determine if the patient has experienced changes in the level of consciousness, which can range from confusion to seizure activity. Life-threatening symptoms such as seizures may indicate acute water excess, whereas nausea, muscle twitching, headache, and weight gain are more indicative of chronic water accumulation. If the patient has had seizures, note that Syndrome of Inappropriate Antidiuretic Hormone 1067 family members may have many questions. Treatment involves correction of the underlying cause and correction of hyponatremia. With fluid restriction, the hormone aldosterone is released by the adrenal gland and the patient begins to conserve sodium in the kidneys. The patient needs assistance to plan fluid intake, and a dietary consultation is also required for consistency in fluid management. Correction of hyponatremia is done carefully, because fluid could move rapidly from the brain into the circulation by osmosis, causing damage to the brain. Use caution in administering these hypertonic solutions and always place them on an infusion control device to regulate the infusion rate precisely. Monitor the patient carefully because sodium and water retention may also result, leading to pulmonary congestion and shortness of breath. Diuretics to remove excess fluid volume may be used in patients with cardiac symptoms if they are symptomatic. Insert an oral or nasal airway if the patient is able to maintain her or his own breathing or prepare the patient for endotracheal intubation if it is needed. If the patient is able to maintain airway and breathing, consider positioning the patient so that the head of the bed is either flat or elevated no more than 10 degrees. If thirst and a dry mouth cause discomfort, try alternatives such as hard candy (if the patient is awake and alert) or chewing gum. Work with the patient to determine the amount of fluid to be sent on each tray so that fluid intake is spread equitably throughout the day. Work with the pharmacy to concentrate all medications in the lowest volume that is safe for the patient. Promote range-of-motion exercises for patients who are bedridden and turn and reposition them every 2 hours to limit the complications of immobility. Maintain side rails in the up position to prevent injury if the patient has a decreased mental status. These drug classes included antidepressants, anticonvulsants, antipsychotic agents, cytotoxic agents, and pain medications. Instruct the patient to report changes in voiding patterns, level of consciousness, presence of edema, symptoms of hyponatremia, reduced neurological functioning, nausea and vomiting, and muscle cramping. If the patient is going home on fluid restriction, be sure to discuss methods of limiting fluid intake and encourage the patient to weigh himself or herself daily to monitor for fluid retention. The incubation stage begins with the penetration of the infecting organism, the spirochete Treponema pallidum, into the skin or mucosa of the body. Within 10 to 90 days after the initial infection, the primary stage begins with the appearance of a firm, painless lesion called a chancre at the site of entry. In women, the chancre often forms in the vagina or on the cervix and therefore goes unnoticed. As this primary stage resolves, systemic symptoms appear, signaling the start of the secondary stage. Secondary stage symptoms include malaise, headache, nausea, fever, loss of appetite, sore throat, stomatitis, alopecia, condylomata lata (reddish-brown lesions that ulcerate and have a foul discharge), local or generalized rash, and silver-gray eroded patches on the mucous membranes. These symptoms subside in 1 week to 6 months, and the infected person enters a latent stage, which may last from 1 to 40 years. Approximately one-third of untreated syphilis patients eventually progress to the late or tertiary stage of syphilis; the complications are often disabling and life-threatening. In this stage, destructive lesions called gummas develop in either the skin, bone, viscera, central nervous system, or cardiovascular system. Three subtypes of late syphilis are late benign syphilis, cardiovascular syphilis, and neurosyphilis. Late benign syphilis can result in destruction of the bones and body organs, which leads to death. Cardiovascular syphilis develops in approximately S 1070 Syphilis 10% of untreated patients and can cause aortitis, aortic regurgitation, aortic valve insufficiency, and aneurysm. Neurosyphilis develops in approximately 8% of untreated patients and can cause meningitis and paresis. Transmission usually occurs through direct contact with open lesions, body fluids, or the secretions of infected persons during sexual contact. Blood transfusions; placental transfer; and, in rare cases, contact with contaminated articles are also modes of transmission. Susceptibility to syphilis is universal, but only 10% of exposures lead to active infection. In 2000, the incidence in the United States reached an all-time low, but rates have been gradually increasing since then, with the increase occurring most notably in men who have sex with men and people who live in the southern and western states. Prenatal transmission from an infected mother to her fetus is possible and occurs in at least 50% to 80% of exposed neonates.

Syndromes

• Often occurs at rest
• Medicines such as antidepressants or steroids
• Anal fissues
• Blistering that is present at birth
• Progeria
• Side effects to medication or treatments
• Worsening symptoms or difficulty with controlling your bladder and bowel function
• Bleeding
• Bleeding does not stop after 20 minutes.
• Barium swallow

Pharmacologic Highlights Medication or Drug Class Levothyroxine (Synthroid) Dosage 2 asthma symptoms vs heart attack symptoms purchase ventolin with mastercard. When you prepare patients before surgery asthma youtube order ventolin with american express, discuss not only the procedure and aftercare, but also the methods for postoperative communication such as a magic slate or a point board. Explain that the patient will be able to speak only rarely, will need to rest the voice for several days, and should expect to be hoarse. Maintain the bed in a highFowler position to decrease edema and swelling of the neck. To avoid pressure on the suture line, encourage the patient to avoid neck flexion and extension. Support the head and neck with pillows or sandbags; if the patient needs to be transferred from stretcher to bed, support the head and neck in good body alignment. Before discharge, make sure the patient has a follow-up appointment for a postdischarge assessment. Make sure the patient has the financial resources to obtain all needed medications; some patients require thyroid supplements for the rest of their lives. Refer the patient or family to the American Cancer Society for additional information. Explain any wound care and that the patient should expect to be hoarse for a week or so after the surgical procedure. The tonsils act as a filter to protect the body from bacterial invasion via the oral cavity and also to produce white blood cells. Tonsillitis is generally referred to as an inflammation of a tonsil, particularly a faucial tonsil. When tonsillar involvement is severe, the term tonsillopharyngitis or tonsillitis is used; when the involvement is minor, the term nasopharyngitis is used. Nearly all children have at least one episode of tonsillitis during their childhood. Adenovirus is the most common infecting agent, but other viruses include enteroviruses, herpes virus, and Epstein-Barr virus. Risk factors include childhood and frequent exposure to infectious agents such as often found at a school or day-care center. Recurrent tonsillitis has a prevalence of 10% to 12% in many developed regions; no data are available in developing regions. Expect that the predominant symptom is rhinorrhea (a runny nose), which is the key symptom. Ask parents if the child also demonstrates other common symptoms: sore throat, dysphagia, mild cough, hoarseness, and a lowgrade fever. Generally, parents will describe fever, weakness, sore throat, dysphagia, nausea, abdominal discomfort, and vomiting. Symptoms usually resolve in several days but may last longer than a week in some children. Children with viral and bacterial infections will have symptoms that reflect the infecting organism (Table 1). Common symptoms include sore throat; foul breath; swollen, painful cervical nodes; and difficult, painful swallowing. Usually, fever and sore throat pain can be managed with over-the-counter analgesia. If the child continues to have symptoms in spite of appropriate antibiotic therapy after cultures and sensitivities, the child may represent a "treatment failure" and may need a different antibiotic. If a relapse occurs, a second course of antibiotics may be needed and a family member may be a carrier. Chronic tonsillitis occurs in children with recurrent throat infections (seven in the past year or five in each of the past 2 years). Tonsillectomy and adenoidectomy decrease the incidence of these problems during childhood, although those who do not have surgery also have a decreased incidence of infection as well. Current recommendations generally encourage physicians to avoid surgery in most cases. Watchful waiting, as compared to tonsillectomy, has been shown to have similar outcomes with quality of life. A Cochrane review shows that tonsillectomy and adenoidectomy are most effective with children who are most severely affected with pharyngitis and that some children will get better without surgery. The decision to remove the tonsils relates directly to hypertrophy, obstruction, chronic infection, and parent/child choice. Pharmacologic Highlights Medication or Drug Class Nonnarcotic analgesia and antipyretics Antibiotics Dosage Varies with drug Varies with drug Description Acetaminophen, ibuprofen Benzathine penicillin G, potassium penicillin V, erythromycin, first-generation cephalosporin, amoxicillin, dicloxacillin, cefdinir, cefuroxime Dexamethasone, prednisone, prednisolone Rationale Relieve aches and pains and reduce fever Halt replication of the bacteria in bacterial infections Corticosteroids Varies with drug Reduces inflammation to allow for adequate airway, breathing, and swallowing Independent Children should be allowed to rest as much as possible to conserve their energy; organize your interventions to limit disturbances. Tonsillectomy versus watchful waiting for recurrent throat infection: A systematic review. They reviewed seven studies and evaluated the quality of the studies and the potential for biased results. If the child has a viral infection, explain to the parents why an antibiotic is not indicated. If the child has a bacterial infection, make sure the parents understand the importance of taking the entire prescription and to report new onset of symptoms if they occur. Reassure parents that frequent infections are not unusual, but if the infections persist, they need to report them to a healthcare provider. In the United States, approximately 225,000 cases of toxoplasmosis are reported annually, resulting in 750 deaths. When the organism reaches the eye via the circulation, an infection may begin in the retina, particularly in immunocompromised individuals. These organs include the gray and white matter of the brain, the alveolar lining of the lungs, the heart, and the skeletal muscles. In pregnancy, it can cause stillbirths and miscarriages, and in infants, it can cause seizures, liver and spleen enlargement, jaundice, and eye infections.

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Encourage her to obtain immediate medical attention if fever asthma symptoms vs cold symptoms order generic ventolin from india, increased vaginal discharge asthmatic bronchitis natural cures order ventolin 100 mcg online, or pain occurs. Discuss with the patient when sexual intercourse or douching may be resumed (usually at least 7 days after hospital discharge). Risk of pelvic inflammatory disease in relation to chlamydia and gonorrhea testing, repeat testing, and positivity: A population-based cohort study. Ensure that the patient knows the correct dosage and time that the medication is to be taken and that she understands the importance of adhering to this regimen. Current terminology is to divide the pelvis into anterior, posterior, and middle (apical) compartments to discuss prolapse. Older terminology may refer to the structures themselves: uterus (uterine prolapse) or vaginal apex (apical vaginal prolapse), anterior vagina (cystocele), or posterior vagina (rectocele). A cystocele is a structural problem of the genitourinary tract that occurs in women. The urinary bladder presses against a weakened anterior vaginal wall, causing the bladder to protrude into the vagina. The weakened vaginal wall is unable to support the weight of urine in the bladder, and this results in incomplete emptying of the bladder and cystitis. A rectocele is a defect in the rectovaginal septum, causing a protrusion of the rectum through the posterior vaginal wall. The rectum presses against a weakened posterior vaginal wall, causing the rectal wall to bulge into the vagina. The pressure against the weakened wall is intensified each time the woman strains to have a bowel movement; feces push up against the vaginal wall and intensify the protrusion. Frequently, a rectocele is associated with an enterocele, a herniation of the intestine through the cul-de-sac. Other causes are impaired nerve transmission to the muscles of the pelvic floor from conditions such as diabetes, genital atrophy from low estrogen levels, pelvic tumors, and sacral nerve disorders. Ask about symptoms such as vaginal fullness or pressure, pain or discomfort during sexual intercourse, or lower back or abdominal pain. Ask about the pattern and extent of incontinence: Does incontinence occur during times of stress, such as laughing and sneezing Patients with rectocele may describe a history of constipation, hemorrhoids, low back pain, and problems with evacuation of the bowel. Symptoms may be worse when standing and lifting and are relieved somewhat when lying down. Some report that they are able to facilitate a bowel movement by applying digital pressure along the posterior vaginal wall when defecating to prevent the rectocele from protruding. Patients with a rectocele have a history of constipation, hemorrhoids, pressure sensations, and difficulty controlling and evacuating the bowel. Upon inspection, the bulging of the bladder and/or rectum may be visualized when the patient is asked to bear down. Levator ani muscles are tested by inserting two fingers in the vagina and asking the patient to tighten or close the introitus. Women may describe anxiety about their sexual functioning as they age and changes they experience because of childbirth. The healthcare provider may evaluate blood urea nitrogen, creatinine, glucose, and calcium and may order magnetic resonance imaging, urodynamic testing, or cystoscopy. If the patient is postmenopausal, estrogen therapy may be initiated to prevent further atrophy of the vaginal wall. Sometimes, the bladder can be supported by use of a pessary, a device worn in the vagina that exerts pressure on the bladder neck area to support the bladder. Pessaries can cause vaginal irritation and ulceration and are better tolerated when the vaginal epithelium is well estrogenized. When the symptoms of cystoceles and rectoceles are severe, surgical intervention is indicated. For a cystocele, an anterior colporrhaphy (or anterior repair), which sutures the pubocervical fascia to support the bladder and urethra, is done. A posterior colporrhaphy (or posterior repair), which sutures the fascia and perineal muscles to support the perineum and rectum, is performed to correct a rectocele. A newer surgical technique for rectoceles involves the use of a dermal allograft to augment the defect repair. Newer methods also include the use of a synthetic mesh to strengthen the vaginal wall. While the procedure is associated with success rates of over 75%, rates of complication are relatively high and long-term outcomes are being evaluated. Preoperative care specifically for posterior repairs includes giving laxatives and enemas to reduce bowel contents. If the new allograft technique is used, postmenopausal patients need to be told to apply estrogen cream for 3 to 4 weeks preoperatively to improve intraoperative handling and postoperative healing. In an anterior repair, an indwelling urethral catheter is inserted and left in place for approximately 4 days. After a posterior Pelvic Organ Prolapse 879 repair, stool softeners and low-residue diets are often given to prevent strain on the incision when defecating. Pharmacologic Highlights Medication or Drug Class Stool softeners; laxatives Antibiotics Nonsalicylates; opioid analgesics Dosage Varies with drug Description Drug depends on patient and physician preference Broad-spectrum antibiotic Analgesics Rationale Assist with bowel movement in patients with rectocele Prophylaxis for infection related to surgery Maintain comfort related to mild preoperative pain and more severe postoperative discomfort Varies with drug Varies with drug Independent Preventive measures include teaching the patient to do Kegel exercises 100 times a day for life to maintain the tone of the pubococcygeal muscle. Menopausal women should be encouraged to evaluate the appropriateness of estrogen replacement therapy, which can help strengthen the muscles around the vagina and bladder. If the patient has symptoms that are managed conservatively, teach the patient the use of a pessary- how to clean and store it, how to prevent infections- and to report any complications that may be associated with pessary use, including discomfort, leukorrhea, or vaginal irritation.

References

• Touijer KA, Karnes RJ, Passoni N, et al: Survival outcomes of men with lymph node-positive prostate cancer after radical prostatectomy: a comparative analysis of different postoperative management strategies, Eur Urol 73(6):890n896, 2018.
• Doroshenkova AE, Grebennikov S, Kozhemyakin A, et al. Primary and repeated operations in surgery of TB. VII Congress of the Russian Phthisiatricians: Tuberculosis Today, 2003; Abstract P277.
• Gear JSS, Ware A, Fursdon P, et al. Symptomless diverticular disease and intake of dietary fibre. Lancet 1979;i:511.
• Caraballo RS, Shafer PR, Patel D, et al. Quit methods used by US adult cigarette smokers, 2014-2016.
• Meijboom WB, Mollet NR, Mieghem CAV, et al: 64-slice CT coronary angiography in patients with non-ST elevation acute coronary syndrome. Heart 2007;93:1386-1392.
• Moran GJ, Barrett TW, Mower WR, et al: Decision instrument for the isolation of pneumonia patients with suspected pulmonary tuberculosis admitted through US emergency departments. Ann Emerg Med 53:625-632, 2009.
• Teasdale G, Jennett B. Assessment of coma and impaired consciousness. a practical scale. Lancet. 1974;2:81-84.
• Rotthier A, Baets J, De Vriendt E, et al. Genes for hereditary sensory and autonomic neuropathies: A genotype-phenotype correlation. Brain. 2009;132(Pt 10):2699-2711.