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Biomedical subjects

G M Amundson

Publications and source records attributed to G M Amundson.

At least 19 recordsLinked to original sources
PubMed2000

Clinician satisfaction with a preventive services implementation trial. The IMPROVE project.

OBJECT: To discover how attempts to increase the delivery of preventive services affect clinician satisfaction. METHODS: The IMPROVE project was a randomized clinical trial conducted in 44 clinics in and around Minneapolis-St. Paul, Minnesota. Personnel were trained in continuous quality improvement techniques to organize preventive services delivery systems. Satisfaction with delivery of these services and with the sponsoring organizations was measured before the intervention (Time 1), at the end of the intervention (Time 2), and 1 year post-intervention (Time 3). RESULTS: At no time was the intervention associated with a change in the respondents satisfaction with their places of work or with their job roles. Satisfaction with preventive services delivery increased from Time 1 to Time 3 among intervention-clinic respondents. Satisfaction with the IMPROVE project and the efforts of the two managed care organizations to help the clinics deliver preventive services peaked at Time 2 and declined toward baseline at Time 3. Satisfaction with preventive services delivery tended to increase more in the 13 intervention clinics that implemented a preventive services delivery system than in the nine intervention clinics that did not implement a preventive services delivery system (p = 0.15). CONCLUSIONS: Planned organizational change to create systems for preventive services delivery can be associated with increased clinician satisfaction with the way these services are delivered. However, increased satisfaction with preventive services does not necessarily indicate that service delivery rates have increased.

Adult↗
PubMed1998

IMPROVE: bridge over troubled waters.

BACKGROUND: The original collaborative project was described in a 1995 Journal article titled "Competing HMOs Collaborate to Improve Preventive Services." IMPROVE (IMproving PRevention through Organization, Vision, and Empowerment) was a large randomized controlled trial using continuous quality improvement to implement clinical systems to improve the delivery of adult preventive services in primary care settings. The project was funded by the Agency for Health Care Policy and Research and initiated as a collaboration between two health maintenance organizations (HMOs) in the Twin Cities: Health Partners and Blue Plus. METHODOLOGY: Forty-four clinics were recruited for the study. Initially the 22 intervention clinics received the multifaceted intervention of leadership support, training on CQI and prevention systems, and consultation and networking opportunities. Next, the comparison clinics received similar assistance, and other clinics were invited into the collaboration. Ultimately, 57 clinics were involved in the project. Multiple collaborations--among clinics, leaders, and HMOs--developed during the project. STATUS: Despite turmoil in the environment during the project, many benefits have been described, including enhanced leadership, growth of systems thinking, better change management skills, and collaboration of competing organizations. SUMMARY: The IMPROVE collaboration survived and flourished in a very competitive market. It was viewed positively by clinicians, medical clinics, and HMOs, and its benefits have extended into the community.

Adult↗
PubMed1994

Pediatric ultrasound cost-effective in ER.

To provide emergency ultrasound service, there must be 24-hour access to state-of-the-art equipment, including high-resolution transducers and color-flow Doppler. The radiologist must be available to monitor the ultrasound and scan the patient, since attention to real-time aspects, rather than just anatomy, requires a hands-on approach.

Abdominal Injuries↗
PubMed1993

The use of primary internal fixation in spondylolisthesis.

A prospective randomized study was designed to examine differences in the primary fusion rate between two surgically treated groups of patients with spondylolisthesis. Twenty-seven patients underwent L5 laminectomy (Gill procedure) and L5 nerve root decompression. Fourteen patients (group I) underwent in-situ posterolateral fusion, thirteen patients (group II) received internal stabilization with the Steffee plate and screw system. All patients were followed for a minimum of two years. Ten of fourteen (72%) patients treated with non-instrumented fusion went on to union. Ten of thirteen (78%) patients treated with internal fixation achieved union. No statistically significant increase in the primary fusion rate occurred with addition of internal fixation compared to non-instrumented posterolateral grafting alone.

Adult↗
PubMed1992

Color flow imaging in children with clinically suspected testicular torsion.

32 boys with symptoms of an acute scrotum had testicular sonography with color flow imaging (CFI). Patients ranged in age from 4-15 years (avg = 11 yrs). Symptoms were present from 12 h to 5 days (avg = 42 hrs). CFI correctly predicted presence or absence of testicular perfusion in 11 boys who had surgical exploration of the scrotum. 8 of these 11 patients had hemorrhagic infarction of the testicle, 1 had torsion of the appendix epididymis, 1 had epididymitis, and 1 had bilateral incomplete torsions with normal testicular perfusion. The remaining 21 patients did not have an operation. At least a 1 year follow-up of all patients has shown no clinical evidence of testicular atrophy to suggest a missed diagnosis of torsion. Absence or markedly decreased testicular flow was easily identified and indicates testicular ischemia/infarction. Conversely, hyperemia of the testis and/or epididymis is usually associated with trauma or infection. However, incomplete torsion or spontaneous detorsion may demonstrate normal testicular flow on CFI. Only close correlation of clinical symptomatology and gray scale findings with CFI can identify these patients, who remain at high risk for subsequent complete torsion and infarction.

Adolescent↗
PubMed1991

Real-time US guidance during renal biopsy in children: a different approach. Technical note.

To minimize procedural failures and complications, a real-time ultrasound (US) approach was developed for percutaneous renal biopsy in the pediatric population. With use of a 3- or 5-MHz transducer, the medial border of the kidney is localized and a line, which parallels the renal axis, is drawn on the skin. The lower pole and renal hilum are identified, and lines are drawn perpendicular to the long axis. After the patient is sedated, the entry site is selected above the lower pole. The transducer is placed on the child's side in an oblique transverse plane parallel to the axis of the kidney, the needle is guided into the renal cortex, and a specimen is obtained. Sixty-five biopsies were performed in 63 children. Fifty-five specimens were obtained from native kidneys. Success was achieved in all cases with only three minor complications. This approach appears to be an easy, safe, and accurate guide for renal biopsy in the pediatric population.

Adolescent↗
PubMed1990

Percutaneous transgastric drainage of the lesser sac in children.

In four children (5-14 years old), lesser sac fluid collections (3 pseudocysts and 1 abscess) were externally drained using a percutaneous transgastric approach. With ultrasound or CT guidance and fluoroscopic monitoring, a sheathed needle is inserted through the stomach into the lesser sac fluid collection, the catheter is exchanged, secured in place and connected to external drainage. All four fluid collections were complications of pancreatitis (3 acute post-traumatic, 1 post-surgical). All four fluid collections were successfully drained without need for surgical intervention. There were no major complications. Three minor complications occurred as a result of reinsertion of catheters: transient gastric venous bleeding, hematuria, and bleeding into the pseudocyst. Percutaneous transgastric drainage can be performed successfully in children, and provides an alternative to surgical intervention of lesser sac fluid collections. Drainage early in the course of pancreatic pseudocysts may lessen the morbidity, potential mortality, and prolonged hospitalization usually necessary for standard medical and surgical management of these patients.

Abscess↗
PubMed1990

Evaluation of current extrication orthoses in immobilization of the unstable cervical spine.

An experiment was designed to evaluate the comparative stabilizing efficacy of several widely used semi-rigid orthoses applied to unstable fresh cadaver cervical spines subject to load. Cadaver specimens were surgically destabilized at the C4-5 segment. Lateral radiographs of the destabilized spine were obtained before and after collar placement and after the application of a 5-pound flexion force. Data analysis employing a one-way analysis of variance showed no statistically significant difference in the Necloc's, Philadelphia Collar's, or the Stifneck's ability to stabilize the cervical spine against a deforming flexion force (P greater than 0.05). They all provide translational stability while allowing angular changes to occur with application of the flexion force. The Philadelphia Collar Halo System is statistically superior to all three of the aforementioned collars in prevention of both translation and sagittal rotation (P less than 0.05).

Cadaver↗
PubMed1988

Acute scrotal abnormalities in children: diagnosis by combined sonography and scintigraphy.

Both scintigraphy and real-time sonography have been used to assess acute symptoms involving the scrotum. However, because of its high sensitivity and ability to document physiologic abnormalities, scintigraphy has been the procedure of choice. Scintigraphy, however, lacks specificity; its value lies mainly in serving to distinguish torsion from nontorsion. The purpose of this study was to supplement scrotal scintigraphy with sonography to determine if the combination improves diagnosis and management compared with scintigraphy alone. Forty-three scrotal scintigrams and sonograms were performed on 40 consecutive patients with acute scrotal symptoms. The interpretation of the scintigram was altered by sonography in six (14%) of the combined scans, directly affecting clinical management. In three patients with acute hydroceles diagnosed by sonography, exploratory surgery was avoided despite scintigraphic findings suggesting testicular torsion. Scintigraphy was normal in two patients with spontaneous testicular detorsion, whereas sonography showed recent spermatic-cord torsion that required subsequent orchiopexy. In a patient with epididymitis and orchitis, sonography showed a complicating scrotal abscess, which was not apparent on scintigraphy and which required antibiotic treatment. The addition of sonography to the scintigraphic evaluations of children with acute scrotal abnormalities changed the diagnosis and clinical management in 14% of the patients studied.

Acute Disease↗
PubMed1987

Neurotoxic complications of contrast computed tomography in children.

Four children with brain tumors had marked alterations in levels of consciousness and vital signs after contrast-enhanced cranial computed tomography (CT). Each had clinical evidence of increased intracranial pressure but was alert and coherent before CT. During the procedure, 2 to 2.5 mL/kg 60% diatrizoate meglumine was administered intravenously, and within hours the patients became progressively lethargic and disoriented and bradycardia and hypertension developed; two had generalized seizures. Two children died immediately after the CT procedure. Contrast-enhanced CT may produce grave neurologic complications in children with brain tumors, and this study should be reserved for those patients in whom the probability of obtaining additional information is high. Use of low-osmolality agents or nonionic contrast agents may decrease the morbidity and mortality associated with the procedure.

Brain Neoplasms↗
PubMed1987

Neuroblastoma: a specific sonographic tissue pattern.

Previous attempts to determine a sonographic appearance characteristic of neuroblastoma have had diverse results. Sonograms of 53 abdominal tumors, including 10 neuroblastomas, imaged during 1982-1986 were reviewed. Four of the patients with neuroblastoma had a distinctive sonographic "lobule" of increased echogenicity in a part of the larger tumor mass. This sonographic appearance was secondary to the growth pattern of the tumor and was not cell specific. Correlative CT scans in two of the four patients did not differentiate this lobule. Histologically, the lobule was an aggregate of uniform neuroblastoma cells (marginated by reticulin and collagen) without hemorrhage, necrosis, or calcification. This tissue pattern was not seen in any of the other 43 neoplasms, including 12 Wilms' tumors. When identified sonographically, the lobule identified in this study seems specific for neuroblastoma and is a valuable diagnostic sign in children with an abdominal mass.

Abdominal Neoplasms↗
PubMed1987

Ultra-low-dose routine pediatric radiography utilizing a rare-earth filter.

Clinical evaluation of the usefulness of primary beam filtration with erbium to achieve marked reductions in radiation exposure and dosage was undertaken. We evaluated 250 routine pediatric radiographic and 100 contrast examinations. An additional 52,727 radiographic and 4745 fluoroscopic examinations were analyzed prospectively by evaluation of subjective film quality. Radiation exposure and dosage reductions ranged from 57% at 50 kVp to 36% at 80 kVp and 39% at 120 kVp. These reductions were obtained in addition to those previously attained by using a 600-speed gadolinium oxysulphide screen/film system (Trimax 12, XDL). The erbium filter requires that the tube current be increased to approximately double that without the filter (in the most commonly used range of 60-100 kVp). However, tube loading is already so low with the 600 system that this effect on wear is considered inconsequential. This ultra-low-dose rare-earth beam filter and screen/film combination results in films with no demonstrable loss of overall quality, plus a subjective slight improvement in contrast definition for iodine and barium contrast studies. The addition of erbium foil beam filtration to existing rare-earth screen/film technology results in what is currently the ultimate in low-dose conventional radiographic imaging.

Child↗