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Joseph D. Tobias - One of the best experts on this subject based on the ideXlab platform.
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Tolerance, Physical Dependency, and Withdrawal
Pediatric Critical Care Medicine, 2014Co-Authors: Joseph D. TobiasAbstract:As clinicians in the Pediatric ICU, we have become increasingly aware of the potential adverse effects related to inadequate sedation and poor pain control. These concerns combined with ongoing humanitarian needs to provide appropriate sedation and analgesia during critical illness have led to the increased use of sedative and analgesic agents. These initiatives have also led to new consequences that must be addressed including Physical Dependency, tolerance, and withdrawal. Strategies are needed to identify those patients at risk for withdrawal followed by appropriate interventions to prevent or treat it. These may include a gradual tapering of the infusion rate or switching to oral or subcutaneous administration. As this is an increasing problem in the PICU setting, newer strategies to prevent its occurrence such as the use of NMDA antagonists or rotating sedation regimens warrant further investigations. With these caveats in mind, the goal of providing effective and safe sedation and analgesia for all of our patients is within reach.
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Tolerance, withdrawal, and Physical Dependency after long-term sedation and analgesia of children in the pediatric intensive care unit.
Critical care medicine, 2000Co-Authors: Joseph D. TobiasAbstract:ObjectiveTo describe the consequences of the prolonged administration of sedative and analgesic agents to the pediatric intensive care unit (PICU) patient. The problems to be investigated include tolerance, Physical Dependency, and withdrawal.Data SourcesA MEDLINE search was performed of literature
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Sedation and Analgesia in Paediatric Intensive Care Units
Pediatric Drugs, 1999Co-Authors: Joseph D. TobiasAbstract:The indications for sedation in the paediatric intensive care unit (PICU) patient are varied ranging from short term use for various procedures to prolonged administration to provide comfort during mechanical ventilation. When faced with the decision to institute sedation, the healthcare provider must make three decisions: the agent to be used, the route of delivery, and the mode of administration (intermittent versus continuous). There are several agents that have been used to provide sedation in the PICU patient including the inhalational anaesthetic agents, benzodiazepines, opioids, ketamine, propofol, chloral hydrate, phenothiazines, and the barbiturates. This review describes the various agents for sedation and discusses their advantages and disadvantages as they pertain to the PICU. Consequences of and treatment strategies for long term problems with prolonged sedation including tolerance, Physical Dependency, and withdrawal are reviewed.
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Sedation and analgesia in paediatric intensive care units: a guide to drug selection and use.
Paediatric drugs, 1999Co-Authors: Joseph D. TobiasAbstract:The indications for sedation in the paediatric intensive care unit (PICU) patient are varied ranging from short term use for various procedures to prolonged administration to provide comfort during mechanical ventilation. When faced with the decision to institute sedation, the healthcare provider must make three decisions: the agent to be used, the route of delivery, and the mode of administration (intermittent versus continuous). There are several agents that have been used to provide sedation in the PICU patient including the inhalational anaesthetic agents, benzodiazepines, opioids, ketamine, propofol, chloral hydrate, phenothiazines, and the barbiturates. This review describes the various agents for sedation and discusses their advantages and disadvantages as they pertain to the PICU. Consequences of and treatment strategies for long term problems with prolonged sedation including tolerance, Physical Dependency, and withdrawal are reviewed.
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Opioid Withdrawal Presenting as Stridor
Journal of Intensive Care Medicine, 1997Co-Authors: Joseph D. TobiasAbstract:Following the prolonged administration of opioids for sedation in the PICU, tolerance and Physical Dependency may occur. In patients who have become tolerant, Physical signs of withdrawal may occur when these agents are discontinued. The actual signs and symptoms of withdrawal vary from patient to patient, but the majority of the literature documents problems such as hyperactivity of the sympathetic nervous system included tachycardia, hypertension, diaphoresis, and tremulousness. The author presents two patients who developed symptoms of upper airway obstruction, including stridor, as the major manifestation of opioid withdrawal. Operative inspection of the airway with rigid bronchoscopy and direct laryngoscopy demonstrated no airway abnormalities. Reinstitution of opioid therapy resulted in a prompt resolution of symptoms and a more gradual tapering of the opioid dose prevented recurrence of the problem.
Clelia Volpe - One of the best experts on this subject based on the ideXlab platform.
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tighter glycemic control is associated with adl Physical Dependency losses in older patients using sulfonylureas or mitiglinides results from the dimora study
Metabolism-clinical and Experimental, 2015Co-Authors: Angela Marie Abbatecola, Fabio Armellini, Giovambattista Desideri, Paolo Falaschi, Antonio Greco, Gianbattista Guerrini, Fabrizia Lattanzio, Clelia Volpe, Ferdinando Damico, Giuseppe PaolissoAbstract:Abstract Background There is growing evidence that tight glycemic control may be more harmful than beneficial in older persons with Type 2 diabetes (T2DM). It remains controversial if tight glycemic control (lower glycated hemoglobin A1c (A1c)) is associated with functional impairments in older frail patients with T2DM. We explored associations between A1c and losses in Activities of Daily Living (ADLs) in diabetic nursing home (NH) patients and tested for differences according to anti-diabetic treatment: diet, anti-diabetic oral drug (AOD), insulin, combined insulin+AOD. Methods We conducted a cross-sectional study on 1845 older NH patients with T2DM from 150 sites across Italy. Complete evaluations on ADLs, glycemic control, anti-diabetic treatments, comorbidities, and clinical data were recorded. ANOVA was applied to compare clinical characteristics across A1c tertiles. Multivariate regression models evaluated associations between A1c and ADL losses. Results Patients had a mean age [SD]=82 [8] years; BMI=25.5kg/m 2 [4.7]; Fasting Plasma Glucose (FPG)=7.4 [3.0] mmol/l; Post-prandial glucose (PPG)=10.3 [3.6] mmol/l; A1c=7.0% (54mmol/mol), ADL losses=3.7 [1.8]. Compared to higher A1c tertiles, patients in the lower tertile had greater ADL losses, were more likely to use AODs, while less likely to use insulin or insulin+AOD. After adjusting for multiple confounders, impairments in ADLs were associated with tighter A1c levels ( B =−0.014; p=0.002). Regression models according to anti-diabetic treatment showed that tighter A1c levels continued as independent determinants of ADL losses in patients using AODs ( B =−0.023; p=0.001), particularly in those using sulfonylureas ( B =−0.043; p B =−0.044; p=0.050). Conclusions Tighter glycemic control was associated with ADL Physical Dependency losses, especially in those using sulfonylureas and mitiglinides.
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Tighter glycemic control is associated with ADL Physical Dependency losses in older patients using sulfonylureas or mitiglinides: Results from the DIMORA study.
Metabolism: clinical and experimental, 2015Co-Authors: Angela Marie Abbatecola, Fabio Armellini, Ferdinando D'amico, Giovambattista Desideri, Paolo Falaschi, Antonio Greco, Gianbattista Guerrini, Fabrizia Lattanzio, Clelia VolpeAbstract:There is growing evidence that tight glycemic control may be more harmful than beneficial in older persons with Type 2 diabetes (T2DM). It remains controversial if tight glycemic control (lower glycated hemoglobin A1c (A1c)) is associated with functional impairments in older frail patients with T2DM. We explored associations between A1c and losses in Activities of Daily Living (ADLs) in diabetic nursing home (NH) patients and tested for differences according to anti-diabetic treatment: diet, anti-diabetic oral drug (AOD), insulin, combined insulin+AOD. We conducted a cross-sectional study on 1845 older NH patients with T2DM from 150 sites across Italy. Complete evaluations on ADLs, glycemic control, anti-diabetic treatments, comorbidities, and clinical data were recorded. ANOVA was applied to compare clinical characteristics across A1c tertiles. Multivariate regression models evaluated associations between A1c and ADL losses. Patients had a mean age [SD]=82 [8] years; BMI=25.5 kg/m(2) [4.7]; Fasting Plasma Glucose (FPG)=7.4 [3.0] mmol/l; Post-prandial glucose (PPG)=10.3 [3.6] mmol/l; A1c=7.0% (54 mmol/mol), ADL losses=3.7 [1.8]. Compared to higher A1c tertiles, patients in the lower tertile had greater ADL losses, were more likely to use AODs, while less likely to use insulin or insulin+AOD. After adjusting for multiple confounders, impairments in ADLs were associated with tighter A1c levels (B=-0.014; p=0.002). Regression models according to anti-diabetic treatment showed that tighter A1c levels continued as independent determinants of ADL losses in patients using AODs (B=-0.023; p=0.001), particularly in those using sulfonylureas (B=-0.043; p<0.001) or mitiglinides (B=-0.044; p=0.050). Tighter glycemic control was associated with ADL Physical Dependency losses, especially in those using sulfonylureas and mitiglinides. Copyright © 2015 Elsevier Inc. All rights reserved.
Angela Marie Abbatecola - One of the best experts on this subject based on the ideXlab platform.
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tighter glycemic control is associated with adl Physical Dependency losses in older patients using sulfonylureas or mitiglinides results from the dimora study
Metabolism-clinical and Experimental, 2015Co-Authors: Angela Marie Abbatecola, Fabio Armellini, Giovambattista Desideri, Paolo Falaschi, Antonio Greco, Gianbattista Guerrini, Fabrizia Lattanzio, Clelia Volpe, Ferdinando Damico, Giuseppe PaolissoAbstract:Abstract Background There is growing evidence that tight glycemic control may be more harmful than beneficial in older persons with Type 2 diabetes (T2DM). It remains controversial if tight glycemic control (lower glycated hemoglobin A1c (A1c)) is associated with functional impairments in older frail patients with T2DM. We explored associations between A1c and losses in Activities of Daily Living (ADLs) in diabetic nursing home (NH) patients and tested for differences according to anti-diabetic treatment: diet, anti-diabetic oral drug (AOD), insulin, combined insulin+AOD. Methods We conducted a cross-sectional study on 1845 older NH patients with T2DM from 150 sites across Italy. Complete evaluations on ADLs, glycemic control, anti-diabetic treatments, comorbidities, and clinical data were recorded. ANOVA was applied to compare clinical characteristics across A1c tertiles. Multivariate regression models evaluated associations between A1c and ADL losses. Results Patients had a mean age [SD]=82 [8] years; BMI=25.5kg/m 2 [4.7]; Fasting Plasma Glucose (FPG)=7.4 [3.0] mmol/l; Post-prandial glucose (PPG)=10.3 [3.6] mmol/l; A1c=7.0% (54mmol/mol), ADL losses=3.7 [1.8]. Compared to higher A1c tertiles, patients in the lower tertile had greater ADL losses, were more likely to use AODs, while less likely to use insulin or insulin+AOD. After adjusting for multiple confounders, impairments in ADLs were associated with tighter A1c levels ( B =−0.014; p=0.002). Regression models according to anti-diabetic treatment showed that tighter A1c levels continued as independent determinants of ADL losses in patients using AODs ( B =−0.023; p=0.001), particularly in those using sulfonylureas ( B =−0.043; p B =−0.044; p=0.050). Conclusions Tighter glycemic control was associated with ADL Physical Dependency losses, especially in those using sulfonylureas and mitiglinides.
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Tighter glycemic control is associated with ADL Physical Dependency losses in older patients using sulfonylureas or mitiglinides: Results from the DIMORA study.
Metabolism: clinical and experimental, 2015Co-Authors: Angela Marie Abbatecola, Fabio Armellini, Ferdinando D'amico, Giovambattista Desideri, Paolo Falaschi, Antonio Greco, Gianbattista Guerrini, Fabrizia Lattanzio, Clelia VolpeAbstract:There is growing evidence that tight glycemic control may be more harmful than beneficial in older persons with Type 2 diabetes (T2DM). It remains controversial if tight glycemic control (lower glycated hemoglobin A1c (A1c)) is associated with functional impairments in older frail patients with T2DM. We explored associations between A1c and losses in Activities of Daily Living (ADLs) in diabetic nursing home (NH) patients and tested for differences according to anti-diabetic treatment: diet, anti-diabetic oral drug (AOD), insulin, combined insulin+AOD. We conducted a cross-sectional study on 1845 older NH patients with T2DM from 150 sites across Italy. Complete evaluations on ADLs, glycemic control, anti-diabetic treatments, comorbidities, and clinical data were recorded. ANOVA was applied to compare clinical characteristics across A1c tertiles. Multivariate regression models evaluated associations between A1c and ADL losses. Patients had a mean age [SD]=82 [8] years; BMI=25.5 kg/m(2) [4.7]; Fasting Plasma Glucose (FPG)=7.4 [3.0] mmol/l; Post-prandial glucose (PPG)=10.3 [3.6] mmol/l; A1c=7.0% (54 mmol/mol), ADL losses=3.7 [1.8]. Compared to higher A1c tertiles, patients in the lower tertile had greater ADL losses, were more likely to use AODs, while less likely to use insulin or insulin+AOD. After adjusting for multiple confounders, impairments in ADLs were associated with tighter A1c levels (B=-0.014; p=0.002). Regression models according to anti-diabetic treatment showed that tighter A1c levels continued as independent determinants of ADL losses in patients using AODs (B=-0.023; p=0.001), particularly in those using sulfonylureas (B=-0.043; p<0.001) or mitiglinides (B=-0.044; p=0.050). Tighter glycemic control was associated with ADL Physical Dependency losses, especially in those using sulfonylureas and mitiglinides. Copyright © 2015 Elsevier Inc. All rights reserved.
Fabrice Valois - One of the best experts on this subject based on the ideXlab platform.
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Virtualized Local Core Network Functions Placement in Mobile Networks
2019Co-Authors: Jad Oueis, Razvan Stanica, Fabrice ValoisAbstract:A novel trend in mobile networks is to co-locate the base stations with virtualized core network functions, such as session management and routing. The goal is to lose the long-standing Physical Dependency between the radio access and the core network, and improve network resiliency. In this work, we focus on the placement of virtualized core functions within a network of multiple base stations interconnected via a potentially limited backhaul. Since all data and signaling traffic are exchanged on the links interconnecting the base stations, the placement of these functions deeply impacts the backhaul load. We compare centralized and distributed placement strategies, with respect to the overall backhaul bandwidth consumption. Results show that distributing instances of the core functions (e.g., routing) in the network is significantly less costly from a backhaul point of view, and can economize backhaul consumption by 86%.
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WCNC - Virtualized Local Core Network Functions Placement in Mobile Networks
2019 IEEE Wireless Communications and Networking Conference (WCNC), 2019Co-Authors: Jad Oueis, Razvan Stanica, Fabrice ValoisAbstract:A novel trend in mobile networks is to co-locate the base stations with virtualized core network functions, such as session management and routing. The goal is to lose the long-standing Physical Dependency between the radio access and the core network, and improve network resiliency. In this work, we focus on the placement of virtualized core functions within a network of multiple base stations interconnected via a potentially limited backhaul. Since all data and signaling traffic are exchanged on the links interconnecting the base stations, the placement of these functions deeply impacts the backhaul load. We compare centralized and distributed placement strategies, with respect to the overall backhaul bandwidth consumption. Results show that distributing instances of the core functions (e.g., routing) in the network is significantly less costly from a backhaul point of view, and can economize backhaul consumption by 86%.
Giuseppe Paolisso - One of the best experts on this subject based on the ideXlab platform.
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tighter glycemic control is associated with adl Physical Dependency losses in older patients using sulfonylureas or mitiglinides results from the dimora study
Metabolism-clinical and Experimental, 2015Co-Authors: Angela Marie Abbatecola, Fabio Armellini, Giovambattista Desideri, Paolo Falaschi, Antonio Greco, Gianbattista Guerrini, Fabrizia Lattanzio, Clelia Volpe, Ferdinando Damico, Giuseppe PaolissoAbstract:Abstract Background There is growing evidence that tight glycemic control may be more harmful than beneficial in older persons with Type 2 diabetes (T2DM). It remains controversial if tight glycemic control (lower glycated hemoglobin A1c (A1c)) is associated with functional impairments in older frail patients with T2DM. We explored associations between A1c and losses in Activities of Daily Living (ADLs) in diabetic nursing home (NH) patients and tested for differences according to anti-diabetic treatment: diet, anti-diabetic oral drug (AOD), insulin, combined insulin+AOD. Methods We conducted a cross-sectional study on 1845 older NH patients with T2DM from 150 sites across Italy. Complete evaluations on ADLs, glycemic control, anti-diabetic treatments, comorbidities, and clinical data were recorded. ANOVA was applied to compare clinical characteristics across A1c tertiles. Multivariate regression models evaluated associations between A1c and ADL losses. Results Patients had a mean age [SD]=82 [8] years; BMI=25.5kg/m 2 [4.7]; Fasting Plasma Glucose (FPG)=7.4 [3.0] mmol/l; Post-prandial glucose (PPG)=10.3 [3.6] mmol/l; A1c=7.0% (54mmol/mol), ADL losses=3.7 [1.8]. Compared to higher A1c tertiles, patients in the lower tertile had greater ADL losses, were more likely to use AODs, while less likely to use insulin or insulin+AOD. After adjusting for multiple confounders, impairments in ADLs were associated with tighter A1c levels ( B =−0.014; p=0.002). Regression models according to anti-diabetic treatment showed that tighter A1c levels continued as independent determinants of ADL losses in patients using AODs ( B =−0.023; p=0.001), particularly in those using sulfonylureas ( B =−0.043; p B =−0.044; p=0.050). Conclusions Tighter glycemic control was associated with ADL Physical Dependency losses, especially in those using sulfonylureas and mitiglinides.