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Biomedical subjects

J Aker

Publications and source records attributed to J Aker.

16 recordsLinked to original sources
PubMed2001

Safety of ambulatory surgery.

Elective surgical procedures are moving from hospital-affiliated and freestanding ambulatory centers to the physician office. Anesthetic risk has decreased dramatically during the past decade; however, perioperative safety is ill defined when the surgical procedure is performed in the physician office. Perioperative risk may vary depending on the surgical location (hospital, freestanding unit, or physician office). Regulation of office-based surgery is now being addressed by specialty organizations and Departments of Health or Boards of Medical Examiners. A comprehensive study of perioperative risk for patients receiving office-based surgical care is needed.

Ambulatory Surgical Procedures↗
PubMed1999

Sickle cell disease: implications for perioperative care.

Sickle cell disease is an inherited hemoglobinopathy that develops from a genetic mutation and the production of a dysfunctional variant of hemoglobin. A number of physiological disturbances encountered during the perioperative period (blood loss, hypotension, acidosis, and hypoxia) may induce "sickling" of the biochemically altered hemoglobin, producing painful microvascular occlusion, hemolytic anemia, and impaired oxygen delivery. The only available curative therapy requires bone marrow transplantation. The purpose of this article is to review the pathophysiology of sickle cell disease and the pertinent preoperative, intraoperative, and postoperative care of patients with the disease.

Ambulatory Surgical Procedures↗
PubMed1998

The selection and administration of perioperative intravenous fluids for the pediatric patient.

The perioperative administration of intravenous fluids and the maintenance of fluid homeostasis is essential in the comprehensive care of the pediatric patient. Intravascular fluid balance is influenced by a number of preoperative, intraoperative, and postoperative circumstances. The pediatric patient is not simply a small adult, and therefore cannot be treated as such with respect to intravenous fluid administration. The restoration and maintenance of the smaller pediatric intravascular volume is crucial to optimize cardiac output and ensure tissue oxygen delivery.

Adult↗
PubMed1997

Development of a measure of patient satisfaction with monitored anesthesia care: the Iowa Satisfaction with Anesthesia Scale.

BACKGROUND: The authors describe development of the Iowa Satisfaction with Anesthesia Scale (ISAS) for monitored anesthesia care (MAC). Patients complete the self-administered written questionnaire before discharge from the hospital. The authors designed the ISAS to measure satisfaction with MAC itself, not the perioperative experience. Patients respond to eleven statements (e.g., "I felt pain") by placing a mark along a six-choice vertical response column (e.g., "Disagree moderately") below each statement. The mean of their responses to each of the 11 statements gives a single number, which is a quantitative measure of a patient's satisfaction with their MAC. METHODS: Adult, English-speaking patients completed the questionnaires following admission to a phase II postanesthesia care unit after MAC. RESULTS: Response rate for MAC was 92% (86 of 94 patients). Patients completed the questionnaire in 4.6 +/- 2.3 min. Internal consistency, Cronbach's alpha, equaled 0.80. Patients' scores were positively correlated with those predicted by their anesthesia provider (r2 = 0.23) and with responses to the question "I was satisfied with my anesthetic care" (Kendall's tau = +0.41). Scores on initial and repeat questionnaires were positively correlated (r2 = 0.74). Scores on initial questionnaires and those completed within 4.4 +/- 1.7 days postoperatively were positively correlated (r2 = 0.76). CONCLUSIONS: The authors have developed and tested an internally consistent, reliable, and valid measure of patient satisfaction with MAC.

Adult↗
PubMed1997

AANA Journal Course: update for nurse anesthetists-brain death: terminology, clinical criteria, and diagnostic testing.

Developmental strides in biomedical technology and the growth and availability of intensive care units have paralleled the development of organ transplantation programs. The establishment of these programs required the development of a new definition, criteria, and test of death to facilitate the procurement of suitable organs. The historical definition of death, in instances of organ transplantation, is no longer compatible as cardiopulmonary support can be readily applied to individuals without spontaneous circulation and respiration. This AANA Journal course will examine the definitions of death and the evolution of the term "brain death." The essential clinical criteria and confirmatory diagnostic testing for the determination of adult "whole-brain death" will be reviewed.

Adult↗
PubMed1996

How does the peer review process influence AANA journal article readability?

This study examined the readability of the AANA Journal, quantifying the effect of peer review on case and research reports published from 1992 to 1994. Gunning and Flesch index-based computer analysis, as well as human comparative analysis, was undertaken. Computer and human assessment of readability revealed improvement as papers evolved from submitted to published versions; however, at publication the manuscripts remained in the "difficult" readability range. Although this study provides evidence that peer review improves readability, it may be that, due to a professed need for scientific purity and an imposed sense of scholarship, nursing and other biomedical journals may overemphasize a style and approach that paradoxically make transfer of information unreasonably difficult.

Diffusion of Innovation↗
PubMed1995

Clinical dilemmas in neuroanesthesia.

Clinical dilemmas that frequently challenge intraoperative neurosurgical anesthetic management include the use of the sitting position, and the application of monitoring strategies for the detection of venous air embolism. Familiarity with the physiological consequences of anesthetic administration and patient positioning, and the physiological consequences of VAE will enable the anesthetist to choose appropriate alternatives for anesthetic management.

Anesthesia↗
PubMed1992

Nonoperative management of major blunt renal trauma in children: in-hospital morbidity and long-term followup.

The management of 26 children with major renal injury secondary to blunt trauma was reviewed. Emergency computerized tomography (CT) was performed in all instances. Injury ranged from parenchymal laceration to vascular avulsion. Early surgical exploration was done in 5 children due to hemodynamic instability, renal pedicle injury or suspected malignancy. The remaining 21 children were observed. Of these children 5 had associated intra-abdominal organ injuries. The average length of hospitalization was 13.4 days and the average intensive care unit stay was 6.9 days. A third of the children were transfused with an average 10.8 cc/kg. of packed red cells. Ten patients (47.6%) had febrile episodes that lasted an average of 3 days. No foci of infection other than bladder urine were identified and there were no infected perirenal collections. In 2 children ureteral stents were placed cystoscopically. Exploration was performed in 1 child for delayed hemorrhage 2 months after hospital discharge. Followup CT was available in 15 patients and all kidneys functioned, including 3 with residual focal scarring, 2 with parenchymal calcifications and 1 with a cyst. Eleven patients were evaluated clinically at least 1 year after injury and all were asymptomatic, while 1 child had mild diastolic hypertension. In conclusion, nonoperative management results in an excellent long-term outcome in the majority of cases. In-hospital morbidity is minimal and early surgical exploration should be reserved for those with hemodynamic instability or renal pedicle injury. Immediate CT is an invaluable aid in categorizing and managing these patients.

Adolescent↗
PubMed1992

AANA journal course: update for nurse anesthetists--current concepts in cardiopulmonary resuscitation.

Developmental strides in cardiopulmonary resuscitation were paralleled by acquired knowledge of pulmonary and cardiac physiology. The evolution of the current recommendations for cardiopulmonary resuscitation have evolved over the past 40 years as a result of human trial and error and have been authenticated through laboratory research and clinical experience. Current research efforts in cardiopulmonary resuscitation are examining the mechanisms of blood flow during external cardiac massage and techniques to optimize myocardial and cerebral perfusion during the resuscitative period. The restoration of circulation with preservation of myocardial and neurological function is the essential goal during the resuscitative effort. Prior to the 1950s, the occurrence of cardiac arrest was associated with the conduct of anesthesia and surgery. Although infrequent today by comparison, cardiac arrest continues to occur with the conduct of regional and general anesthesia. This course will review the etiology of cardiac arrest during anesthesia, detail the mechanisms of blood flow during resuscitation, and review the pharmacological importance of epinephrine for the preservation of myocardial and neurologic function.

Cardiopulmonary Resuscitation↗
PubMed1990

Review of current research on midazolam and diazepam for endoscopic premedication.

This article reviews the current and past research on the use of midazolam and diazepam as endoscopic premedication. The pharmacology and mechanisms of action, use of the medications for endoscopic procedures, dosing schedules, and monitoring are addressed. Several research studies are cited that have examined and compared the two medications during endoscopy, as well as in related medical fields.

Diazepam↗
PubMed1989

Cytosine methylation in the EcoRI site of active and inactive herpesvirus thymidine kinase promoters.

The herpesvirus thymidine kinase (tk) gene integrated in the human cell line, 2.1-a, can be inactivated by limited de novo methylation. All these TK- clones show partial EcoRI digestion of the recognition site (cGAATTCg) in the tk promoter in contrast to complete digestion of this site in the original cell line. Studies on well-defined substrates prepared in vitro showed that methylation of one cytosine in the EcoRI recognition sequence resulted in partial and methylation of both cytosines in severe inhibition of digestion by EcoRI. This characteristic was used to determine whether no, one or both cytosines in the EcoRI site of the tk promoter were methylated in various TK- clones derived from 2.1-a and in TK+ clones re-expressing the gene after 5-azacytidine treatment. A high correlation was found between inactivity of the tk gene and methylation of only one of the two cytosines in the EcoRI recognition site. The results also show that the tk promoter can be active despite the presence of a methylated cytosine.

Base Sequence↗