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Biomedical subjects

B L Marshall

Publications and source records attributed to B L Marshall.

6 recordsLinked to original sources
PubMed1997

The economics of uncomplicated mitral valve surgery.

BACKGROUND AND AIMS OF THE STUDY: Comparisons of mitral valve (MV) replacement and reconstruction have demonstrated lower overall complication rates, better left ventricular (LV) function, and inferred overall lower cost for the latter procedure compared with the former. However, assessment of economic differences between the two procedures in routine cases, without complications, has not been reported. This study retrospectively evaluates the economic impact of uncomplicated MV repair versus replacement. METHODS: As this study seeks only to evaluate economic comparisons between routine cases of mitral repair versus replacement, those patients having concomitant procedures performed (coronary revascularization or other valve procedure) or postoperative complications (i.e. pulmonary failure, wound infections, new-onset atrial fibrillation, return for bleeding, or neurologic sequelae) were excluded from the study. Among patients who underwent uncomplicated MV procedures, 30 were selected at random and reviewed. RESULTS: Variables for MV replacement versus reconstruction included aortic cross-clamp time (112 +/- 54 versus 92 +/- 20 min; p = NS), cardiopulmonary bypass (CPB) time (189 +/- 70 versus 128 +/- 18 min; p < 0.05), total hospital stay (8.3 +/- 1.6 versus 5.6 +/- 1.6 days; p < 0.0001), and total hospital charges ($44,697 +/- 4903 versus $31,337 +/- 4484; p < 0.0001), respectively. CONCLUSIONS: These data suggest that, beyond the recognized benefits of MV reconstruction, namely preservation of LV function and avoidance of long-term anticoagulation, there is an economic advantage to MV reconstruction for patients and payors, even in uncomplicated cases. These differences may become more apparent with longer follow-up and in patients having poor function or combined procedures. This finding reinforces the idea that MV reconstruction is the option of choice for patients with mitral regurgitation.

Cardiac Surgical Procedures↗
PubMed1995

Esophageal carcinoma metastatic to the brain: clinical value and cost-effectiveness of routine enhanced head CT before esophagectomy.

PURPOSE: To assess the value of screening enhanced head CT before esophagectomy for carcinoma, identify increased risk factor(s) for brain metastases, and determine metastasis incidence. METHODS: Thoracic surgery files of patients undergoing esophagectomies for squamous carcinomas, adenocarcinomas, and undifferentiated carcinomas between January 1984 and March 1993 were reviewed regarding sex, size (length) of neoplasm, and brain metastases. Surgical pathology and tumor registry files also were reviewed. Records of patients with brain metastases were reviewed in detail. RESULTS: Three hundred thirty-four esophagectomies were performed for 230 adenocarcinomas (202 male, 28 female) and 104 squamous carcinomas (61 male, 43 female). In 9 males and 1 female with adenocarcinomas and 1 male and 1 female with squamous carcinomas, brain metastases developed. Surgical pathology files identified 293 additional esophageal carcinomas, including 2 males with adenocarcinomas metastatic to brain. Tumor registry files identified I additional male with brain metastasis from an undifferentiated esophageal neoplasm. No statistically significant preoperative characteristic of esophageal carcinomas with proneness to brain metastases was found, except large size of primary neoplasm. Preoperative screening head CT done on approximately 240 patients who underwent esophagectomies showed no metastases. CONCLUSIONS: Brain metastases from carcinomas of the esophagus are relatively uncommon (3.6% in the esophagectomy cohort). They tend to occur in patients with large primary neoplasm, probably especially adenocarcinomas involving the esophagogastric junction, and with findings of local invasion and lymph node metastases by CT and/or microscopically. It may be reasonable to obtain head CT as a last preoperative staging procedure in such patients. Routine preoperative head CT for staging is not cost effective.

Aged↗
PubMed1991

Dental implants retrieved from humans: a diagnostic light microscopic review of the findings in seven cases of failure.

With the increased use of dental implant systems, an increase in the number of implants removed from patients has also been observed. This investigation attempted to elucidate some underlying causal determinants of implant failure employing light microscopic analyses. Valuable data can be obtained from implants retrieved from patients. Implant success is predicted on proper patient selection and treatment planning, careful surgical procedures, careful prosthodontic management, and continued oral hygiene maintenance.

Aged↗
PubMed1990

Liver fluke (Fasciola hepatica) in slaughtered sheep and cattle in New Zealand, 1984-85.

A total of 17175 lambs livers and 9322 sheep livers randomly selected from animals slaughtered at export meatworks in 1984 were examined for liver fluke infection. Futher sheep livers from some regions were examined in 1985. The origins of the animals examined were recorded and used to estimate regional prevalences of infection. Infection in lambs was first detected in February and the prevalence increased after then; the mean prevalence in July was 2.7% in the North Island and 2.0% in the South Island . In adult sheep in 1984, regional prevalences in the North Island ranged up to 16.9% (>10% in South Auckland, East Coast, Hawkes Bay and Taranaki) and in the South Island up to 29.4% in Westland (18% in Nelson). The overall prevalence in the North Island was 7.5% and in the South Island 1.1%, about double that recorded in 1969. Data for 1985 were incomplete but prevalences tended to be higher than in 1984. From April 1984 to August 1985 the origins of all lines of cattle with fluke-affected livers were recorded in all abattoirs and export meatworks. During 1985, 16 147 infected lines were traced to all countries in the North Island, with over 60% from the Whangarei, Hamilton, Taumarunui, Gisborne and Hastings areas. In the South Island , over 90% of 1585 infected lines originated from Westland, Waimea, Grey, Inangahua and Buller Counties.

Journal Article↗
PubMedDate not supplied

A program design to promote clinical judgment.

This article describes a unique continuing education program designed to enhance critical thinking, clinical judgment, and communication skills of practicing nurses in an acute care setting. The program design and implementation strategies are described in detail. The authors include specific examples for those who want to develop a similar program to improve the practice of registered nurses in the acute care setting.

Acute Disease↗