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Biomedical subjects

A Barrocas

Publications and source records attributed to A Barrocas.

At least 19 recordsLinked to original sources
PubMed1996

Assessing health status in the elderly: the nutrition screening initiative.

The recent dramatic growth in the population aged 65 and over is projected to continue well into the 21st century. While improved health status of most aging Americans is also expected, such is not the case in certain vulnerable subgroups at risk for poor health. This includes older women; minority groups; those aged 85 and above; older persons with limited economic resources, those isolated from family and friends; and older persons with impaired physical, cognitive, or emotional status. These factors, plus the cost implications of caring for a rapidly aging population, provided the impetus for the development of the Nutrition Screening Initiative (NSI). Established in 1990, the goal of the NSI is to promote the incorporation of routine nutrition screening and nutritional care into America's health services delivery system. The NSI has devoted its activities toward increasing the awareness of nutritional factors as they relate to the older population.

Aged↗
PubMed1995

Nutrition assessment practical approaches.

Because of the insidious nature of malnutrition in the elderly and its mimicking the usual aging process, it is important to recognize early warning signs of risks for malnutrition. Because the majority of individuals are encountered at times of a specific event (i.e., illness, injury, surgery, or annual examination) the physician needs to be cognizant of the triggers or alerts of poor nutritional health during history/physical and laboratory examinations for the particular event. Only then will early detection and applicable interventions provide a salutary paradigm shift towards prevention, whether primary, secondary, or tertiary. A high degree of suspicion, a thorough history, and physical examination coupled with pertinent laboratory data can identify the elderly at risk. Those in need of more comprehensive nutrition screen and assessment are examined with the tools developed by the NSI, which encompass not only the routine medical and dietary history and physical exam but also an expansive look at the older individual's psychosocial, functional, socioeconomic, and drug use aspects that are more indirect and significant determinants of risk. Based on parameters from a Level II Screen, measurable indicators are available that provide the nutrition assessment necessary for an overall healthcare plan of selected interventions. Future research should provide more practical, age, sex, and culturally specific nutrition parameters. The main factor in the implementation of a practical, comprehensive geriatric nutrition screening and assessment program is the clinician's imagination and motivation.

Aged↗
PubMed1994

Nutrition support, supplementation, and replacement.

Nutrition support in acute, chronic, or home care settings can be implemented successfully by the well-informed primary care physician, who often is the first to identify poor nutritional health in his or her patients. Using established protocols for the identification or of risk factors and indicators of malnutrition, specific alerts to the need for nutrition support are presented. The logical approach to nutrition support interventions through four stages representing the gradual increase in complexity and cost, paralleling the progressive inability to use regular foods and the gastrointestinal tract are discussed. Specific, practical measures that can be recommended and implemented by the primary care physician managing the older person are presented. The ethical, legal, and home health aspects of nutrition support in the care of the older American by the primary care physician are also reviewed.

Aged↗
PubMed1990

Collodion as a safe, cost-effective dressing for central venous catheters.

Catheter-related sepsis continues to be a major problem with the use of central venous catheters. Controversy exists with respect to dressing material and frequency of dressing changes. Collodion is a solution of pyroxylin in a solution of 75% ether and 25% alcohol. Camphor and castor oil are added to create a flexible noncontracting dressing when applied to the skin. We retrospectively reviewed the charts of 34 patients requiring central venous catheters between 1986 and 1988. All catheters were placed via the subclavian approach. Collodion was used as a dressing on all patients. Dressings were not routinely changed. The catheters remained in position an average of 16.5 days. No insertion site became infected; one episode of catheter-related sepsis occurred, and two catheters were inadvertently dislodged. The overall incidence of catheter-related sepsis was 2.9%.

Bacterial Infections↗
PubMed1982

Nutritional considerations in the critically ill.

The total care of the critically ill patient must include attention to his nutritional status from the onset of illness. The essential role of protein in body functions must be stressed; unfortunately, it is this essential compartment that will be called upon for gluconeogenesis in stress or starvation. Simple technics of bedside nutritional assessment have been developed and should be familiar to all those who deal with critically ill patients. The multiple technics of optimal nutritional support should become a standard component of the therapeutic armamentarium of those who provide intensive care. The goal must always be to use the GI tract whenever possible, avoiding the numerous complications associated with intravenous nutrition. Care must be taken to avoid CO2 overload of an embarrassed respiratory system by the nutritional support. Whether nutritional or pulmonary support should take priority can usually be resolved by a team approach toward the patient. It is hoped that this superficial review of nutritional support will stimulate the desire for further knowledge of this rapidly changing and interesting aspect of critical care.

Carbon Dioxide↗
PubMed1982

Medical, legal and ethical issues in critical care.

This report is intended to familiarize the reader with the current legislation concerning state definitions of death, the pertinent judicial decisions concerning termination of life support and the current status of medical/ethical committees. However, it is of paramount importance to all health care personnel to become involved in the resolution of these problems. Current information regarding legal clarity to these issues leaves much to be desired. Unless we wish major decisions that will affect us all to be decided by others, it is strongly suggested that we become directly involved in this process and accept the challenge and the opportunity to influence major legal, ethical, and medical decisions.

Critical Care↗
PubMed1980

Nutritional assessment in the community hospital.

Innovative technics in the recognition and treatment of malnutrition in hospitalized patients have blossomed in the past decade. A comprehensive nutritional assessment program available in larger institutions has been adapted for use in a community hospital. The procedure of nutritional assessment and its interpretation as employed in 50 hospitalized patients is presented, and therapeutic implications of the assessment are summarized.

Female↗
PubMed1980

Nutritional assessment: indications and applications.

The application of objective measures of protein and caloric compartments as well as immunocompetence reveal that approximately 50 percent of hospitalized patients are malnourished. The performance of a nutritional assessment, by a joint effort of hospital personnel, in patients with subclinical or early clinical malnutrition obviates potential complications through early institution of nutritional support. Prudent, logical decisions based on objective data can then be made regarding future patient care resulting in decreased hospitalization, and lower septic and mortality rates.

Hospitalization↗
PubMed1979

Catamenial pneumothorax: case report and a review of the literature.

Catamenial pneumothorax, a rare but well documented syndrome of recurrent perimenstrual pneumothorax, is being reported with increasing frequency, probably because of increased awareness. Its pathogenesis remains enigmatic but may be associated with hormonal influcences, including the prostaglandins. Its right-sided predilection remains a mystery. the experience of 42 cases in the literature as well as a new case is presented. A rational approach to this interesting syndrome is discussed. Ovulatory suppression should be attempted before thoracotomy and pleurodesis are considered.

Adult↗
PubMed1979

The use of stapling devices in the management of postgastrectomy syndromes.

By the use of the stapling devices, a large spectrum of postgastrectomy syndromes can be managed with minimal manipulation and dissection, shortened operative time, decreased blood loss and spillage, and reduced morbidity while attaining uniformly good amelioration of symptoms. As others have recommended, the application of these techniques at the primary procedure should be considered. The author's experience in ten primary procedures has been quite gratifying to date.

Esophagus↗