PubMed Health⌕ Search

Biomedical subjects

D Caswell

Publications and source records attributed to D Caswell.

10 recordsLinked to original sources
PubMed1999

Endovascular, transperitoneal, and retroperitoneal abdominal aortic aneurysm repair: results and costs.

PURPOSE: Contemporary treatment of abdominal aortic aneurysms (AAA) includes transabdominal (TA), retroperitoneal (RP), and endovascular (EV) repair. This study compares the cost and early (30-day) results of a consecutive series of AAA repair by means of these three methods in a single institution. METHODS: A total of 125 consecutive AAA repairs between February 1993 and August 1997 were reviewed. Risk factors, 30-day morbidity and mortality rates, and hospital stay and cost were analyzed according to method of repair (TA, RP, EV). Cost was normalized by means of a conversion factor to maintain confidentiality. Cost analysis includes conversion to TA repair (intent to treat) in the EV group. RESULTS: One hundred twenty-five AAA repairs were performed with the TA (n = 40), RP (n = 24), or EV (n = 61) approach. Risk factors among the groups (age, coronary artery disease, hypertension, diabetes, chronic obstructive pulmonary disease, and cigarette smoking) were not statistically different, and thus the groups were comparable. The average estimated blood loss was significantly lower for EV (300 mL) than for RP (700 mL) and TA (786 mL; P>.05). Statistically significant higher cost for TA and RP for pharmacy and clinical laboratories (likely related to increased length of stay [LOS]) and significantly higher cost for EV in supplies and radiology (significantly reducing cost savings in LOS) were revealed by means of an itemized cost analysis. Operating room cost was similar for EV, TA, and RP. There were six perigraft leaks (9.6%) and six conversions to TA (9.6%) in the EV group. CONCLUSION: There were no statistically significant differences in mortality rates among TA, RP, and EV. Respiratory failure was significantly more common after TA repair, compared with RP or EV, whereas wound complications were more common after RP. Overall cost was significantly higher for TA repair, with no significant difference in cost between EV and RP. EV repair significantly shortened hospital stay and intensive care unit (ICU) use and had a lower morbidity rate. Cost savings in LOS were significantly reduced in the EV group by the increased cost of supplies and radiology, accounting for a similar cost between EV and RP. Considering the increased resource use preoperatively and during follow-up for EV patients, the difference in cost between TA and EV may be insignificant. EV repair is unlikely to save money for the health care system; its use is likely to be driven by patient and physician preference, in view of a significant decrease in the morbidity rate and length of hospital stay.

Aortic Aneurysm, Abdominal↗
PubMed1995

Case study: when the nurse and physician don't agree.

Nurses and physicians by virtue of their roles as health care professionals must work together to provide care for their patients. Decisions regarding life support and death and dying are made almost daily in most intensive care units. Conflicts frequently arise among health care providers when decisions of this nature are made. Nurses and physicians, despite having similar value systems, operate under a different frame of reference. Understanding the differences and how they play themselves out in the clinical setting can alleviate much of the stress and frustration common when these issues are encountered. This article examines the value systems and perspectives of nurses and physicians using a case study format.

Adult↗
PubMed1995

Transplant nurses: concerns and opportunities.

Nurses caring for patients undergoing liver transplants were surveyed to identify specific needs and concerns. Previously identified issues in regard to orthotopic liver transplantation also were addressed: high mortality rates, time-consuming care, emotional factors and ethical issues. Nurses need to be represented on selection and ethics committees and to participate in clinical decisions.

Attitude of Health Personnel↗
PubMed1991

Reperfusion injury.

The paradigm of reperfusion is one that will test the skills of the critical care practitioner. This syndrome has been implicated in many of the disorders commonly encountered in the intensive care unit. As research continues and more knowledge is gained into the evolution of this process, many of the complications caused by this affliction will be eliminated. In the interim, understanding of the pathophysiology and the components of this syndrome will assist in providing quality care for the patient unfortunate enough to have encountered this potentially devastating malady.

Critical Care↗
PubMed1990

The dying patient in the critical care setting: making the critical difference.

Death is an inevitable fact in the critical care setting. This fact does not make it more comfortable for the nurse who is caring for a critically ill patient who is dying. Some health care providers have recommended that the critical care resources are better utilized for the patient whose prognosis is not death. This position can be countered with the perspective that there may be no better place to provide the intensive nursing care that the dying patient may need than the critical care setting. A new nursing diagnosis, Terminal Syndrome related to the dying process is introduced to assist the nurse in providing comprehensive care for what is often a complex patient care situation. The goal is to achieve for each dying individual in the critical care setting what she or he truly desires, an end to the life process, a death achieved with comfort and dignity.

Adult↗
PubMed1989

Brain resuscitation. Ethical perspectives.

Brain resuscitation is the newest in a long line of treatment protocols that is designed to aid us in sustaining not just life, but quality life in the critical care setting. Like other, previously established protocols, it is not value free. Its implementation brings ethical considerations that must be addressed. If the issues are not addressed, there is the real danger that the resulting moral dilemmas will overwhelm the nurse. In brain resuscitation, there are at least three ethical issues that must be recognized. These are the role of resuscitation in the life process, allocation of scarce resources, and participation in research. To address these issues, nurses will have to be aware of the ethical principle and/or perspectives involved. For some of these issues, the solutions will have to come from nursing's national organizations, such as the American Association of Critical Care Nurses. Other solutions presented will require the nurse to come to an individual decision regarding the ethics of brain resuscitation. The journey to the conclusion of this discussion will end with disappointment for those who sought an algorhythm or decision tree with which to make definitive decisions in regard to ethical decisions about brain resuscitation. To have assumed that such an absolute discussion in regard to the ethical perspectives related to brain resuscitation is possible or even desirable would have been to deny the moral/ethical responsibilities of the nurse who practices in a critical care setting. While these ethical responsibilities can be overwhelmingly burdensome, they can also be opportunities. They can be positive opportunities for our health care colleagues, our patients, and ourselves.

Beneficence↗
PubMed1988

A nursing perspective of the ethical issues surrounding liver transplantation.

Nurses who care for patients undergoing liver transplantation increasingly face a variety of ethical issues. These issues include but are not limited to consent, selection of recipients, and allocation of scarce resources. Nurses have ethical concerns related to these issues that are specific to nursing. These nursing concerns differ in perspective, context, and content from the concerns of fellow health professionals or the lay public. For the nurse, the concern regarding consent may be not whether the consent was informed, but rather whether the consent was freely given. The scarce resource about which the nurse is most concerned is not so much the organ as it is professional nursing care. For the nurse to address these ethical concerns, strategies will have to be implemented at the unit, institutional, and professional level.

Beneficence↗
PubMed1976

Studies on the effect of feeding nitrite and secondary amines to Wistar rats.

1. When 1 000 mg/l sodium nitrite are added to drinking-water, nitrosamines are formed in the stomachs of Wistar rats at levels greater than the background only if the concentrations of added DMA or pyrrolidine exceed 1 000 mg/kg. Once this concentration is exceeded there is a rapid increase in nitrosamine formation up to 2 000 mg/kg added amine; however, for pyrrolidine, the rate of increase of NPy decreases when the dietary level of amine exceeds 2 000 mg/kg. This threshold level of 1 000 mg/kg amine is one which is rarely reached in normal human dietary patterns. 2. Due to the presence of this threshold it is unrealistic to extrapolate from high experimental dietary concentrations of secondary amines to those found in practice when considering nitrosamine formation in vivo. 3.The concentration of dietary amine has a greater influence on nitrosamine formation in the stomachs of rats than does the concentration of nitrite in drinking-water (up to 1 000 mg/l). This finding is in contradiction to the current kinetic theory of nitrosamine formation, in which formation is predicted to be proportional to the square of the nitrite concentration.

Animals↗