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Biomedical subjects

G Dees

Publications and source records attributed to G Dees.

6 recordsLinked to original sources
PubMed2000

Stroke prevention practices in patients with atrial fibrillation and pacemaker therapy: evidence for under-use of anticoagulation.

This study presents a survey of pacemaker patients followed in a pacemaker clinic. Three hundred and twenty-six patients of mean age 77.7 +/- 9.6 years, 52% female, 75% VVI, 25% dual chamber were analysed. One hundred and forty (43%) were in atrial fibrillation and were older, 80.5 +/- 7.1 years, compared with 75.5 +/- 11.4 years (P = 0.014) for those in sinus rhythm. Temporary pacemaker reprogramming was necessary in 86% in order to determine the abnormal rhythm. Thirty-nine (28%) of those in atrial fibrillation were anticoagulated; 37% were on aspirin; only 10.8% of those in atrial fibrillation who were not anticoagulated had contraindications to this therapy. Prevalence of atrial fibrillation increased with age, whereas that of anticoagulation decreased with age. In conclusion, the majority of pacemaker patients with atrial fibrillation, for whom anticoagulation is indicated, fails to receive it: those caring for these patients are urged to ensure its much wider use.

Aged↗
PubMed1991

Trauma center closure: effects on an adjacent trauma center.

The effects of the closure of a busy trauma center on an adjacent university trauma hospital were analyzed. Significant increases were found in monthly volume (P less than .01) and frequency of penetrating injuries (P less than .05) and significant decreases in patients with insurance coverage (P less than .01) and numbers requiring intensive care (P less than .01). The authors conclude that trauma center closures have significant and measurable effects which influence allocation of scarce resources within remaining hospitals and generate pressures to transfer patients to overburdened public facilities. Transfers undermine continuity of care and education and further threaten the integrity of the trauma system.

Health Facility Closure↗
PubMed1989

Difficult nasogastric tube insertions.

NGT insertion is a procedure that is done frequently in Emergency Departments. A step-by-step procedure has been presented. There are certain circumstances that may make NGT insertion difficult. They are esophageal narrowing, comatose or intubated patients, and patients who have sustained severe facial or skull injuries. A number of strategies have been suggested to facilitate the passage of the NGT. These include generous lubrication, chilling the tube, grasping the alae of the thyroid and lifting anteriorly, using two fingers in the mouth to facilitate passage of the tube, and direct visualization. Complications, although rare, may occur. Examples of complications that are reported in the literature include mucosal ulcerations, submucosal passage of a tube, accidental passage of an NGT into the brain, and esophageal perforation. Generous lubrication, direct visualization, and the use of fluoroscopy, as well as knowledge of these complications, may help to decrease or prevent their incidence.

Coma↗