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Biomedical subjects

J J Sherman

Publications and source records attributed to J J Sherman.

30 records · Page 2Linked to original sources
PubMed1994

Integrating quality assurance and total quality management/quality improvement.

Hospitals have joined other industries in the quest for quality improvement. Most healthcare organizations have processes in place to meet the quality assurance standards of the Joint Commission on Accreditation of Healthcare Organizations. The challenge is to integrate these two similar, but different, structures into one efficient and effective mechanism for quality. One hospital's effort to develop a pilot program to combine total quality management/quality improvement and quality assurance in a cost-effective and efficient manner is described.

Humans↗
PubMed1991

Nursing care management.

Patient satisfaction, patient-perceived quality of life, and nurse satisfaction were compared before and after the implementation of nursing case management in a southeastern acute care hospital. Immune-compromised oncology patients were sampled as proxy for patients with AIDS. Clinical nurse specialists as case managers planned, coordinated, and facilitated patient care on the 36-bed study unit. Patient satisfaction showed a statistically significant increase 6 months after implementation of nursing case management.

Acquired Immunodeficiency Syndrome↗
PubMed1976

Use of a left heart assist device after intracardiac surgery: technique and clinical experience.

A left heart assist device (LHAD) has been employed in 14 patients. All had advanced heart disease and were in low cardiac output after repair, such that they could not be separated from cardiopulmonary bypass despite prolonged support and adjuvant therapy, including drugs, pacing, and use of intraaortic balloon counterpulsation whenever possible. Apart from special cannulas, the equipment necessary for the LHAD is widely available. An asset of the system (left atrial-ascending aorta bypass of the left ventricle) is that it may be terminated without reentering the thorax to remove the cannulas. This is accomplished with precisely fitting obturators that obliterate the cannula lumens and allow the tubes to be permanently implanted. This concept is believed important since critically ill patients requiring support are precisely those in whom added risk would be imposed by a second operation. Of the 14 patients who have had intraoperative and postoperative support (up to 6.8 days), 9 were weaned from the device and 6 were dismissed from the hospital. Four patients remain alive and are improved, the longest at 22 months since operation. The favorable performance of the LHAD suggests that it may prove useful either when intraaortic balloon counterpulsation cannot be successfully deployed or when it has failed to achieve hemodynamic stability.

Assisted Circulation↗
PubMed1976

Postcardiotomy low cardiac output clinical experience with a left heart assist device.

Fifteen patients with advanced heart disease who could not be withdrawn from cardiopulmonary bypass (CPBP) because of low cardiac output were supported with a left heart assist device (LHAD). The system (left atrium to ascending aorta bypass of left ventricle) was not employed until all other measures had failed to allow separation from CPBP, including intraaortic balloon counterpulsation whenever possible. In this experience no attempt was made to totally bypass the left ventricle (LV). Rather, LHAD flow rate was adjusted so that the combined output of the LHAD and depressed LV achieved satisfactory levels of systemic blood flow at acceptable LV filling pressures. With improved cardiac performance patients were separated from the LHAD without need for thoracic reentry. Of the 15 patients having LHAD support (longest 21 days), 10 could be separated from the device and six were dismissed from the hospital. Four remain well, the longest 1.6 years postoperatively. Patients requiring 3 days or less of circulatory assistance had a more favorable prognosis than those needing more extended periods of support.

Adult↗
PubMedDate not supplied

Endogenous opioids inhibit ambulatory blood pressure during naturally occurring stress.

OBJECTIVE: Laboratory experiments suggest that endogenous opioids inhibit blood pressure responses during psychological stress. Moreover, there seem to be considerable individual differences in the efficacy of opioid blood pressure inhibition, and these differences may be involved in the expression of risk for cardiovascular disease. To further evaluate the possible role of opioid mechanisms in cardiovascular control, the present study sought to document the effects of the long-lasting oral opioid antagonist naltrexone (ReVia, DuPont, Wilmington, DE) on ambulatory blood pressure responses during naturally occurring stress. METHOD: Thirty male volunteers participated in a laboratory stress study using naltrexone followed by ambulatory blood pressure under placebo and during the subsequent 24-hour period. Within-subject analyses were performed on ambulatory blood pressures under placebo and naltrexone conditions. RESULTS: Laboratory results indicate no significant group effects of naltrexone on blood pressure levels or reactivity. Ambulatory results indicate that during periods of low self-reported stress, no effect of opioid blockade was apparent. In contrast, during periods of high stress, opioid blockade increased ambulatory blood pressure. CONCLUSIONS: These findings suggest that naltrexone-sensitive opioid mechanisms inhibit ambulatory blood pressure responses during naturally occurring stress.

Adolescent↗
PubMedDate not supplied

A comparison of renal phosphorus regulation in thermally injured and multiple trauma patients receiving specialized nutrition support.

To compare phosphorus intake and renal phosphorus regulation between thermally injured patients and multiple trauma patients, 40 consecutive critically ill patients, 20 with thermal injury and 20 with multiple trauma, who required enteral tube feeding were evaluated. Phosphorus intakes were recorded for 14 days from the initiation of tube feeding which was started 1 to 3 days postinjury. Serum for determination of phosphorus concentrations was collected at days 1, 3, 7, and 14 of the study period. A 24-hour urine collection was obtained during the first and second weeks of nutrition support for urinary phosphorus excretion, fractional excretion of phosphorus, renal threshold phosphate concentration, and phosphorus clearance. Average total daily phosphorus intake during the 14-day study for thermally injured patients and multiple trauma patients was 0.99+/-0.26 mmol/kg/d vs 0.58+/-0.21 mmol/kg/d, respectively, p < .001. Serum phosphorus concentration on the third day of observation was significantly lower in the thermally injured group than those with multiple trauma (1.9+/-0.8 mg/dL vs 3.0+/-0.8 mg/dL, p < or = .01). A trend toward hypophosphatemia in the thermally injured group persisted by the seventh day of feeding (2.7+/-1.2 mg/dL vs 3.3+/-0.6 mg/dL, p < or = .04). Differences in urinary phosphorus excretion was not statistically significant between the thermally injured and multiple trauma groups (271+/-213 mg/d vs 171+/-181 mg/d for week 1, and 320+/-289 mg/d vs 258+/-184 mg/d for week 2, respectively). Urinary phosphorus clearance, fractional excretion of phosphorus, or renal threshold phosphate concentrations were also not significantly different between thermally injured and multiple trauma patients. During nutrition support, serum phosphorus concentrations are lower in thermally injured patients compared with multiple trauma patients despite receiving a significantly greater intake of phosphorus. Renal phosphorus regulation does not significantly contribute to the profound hypophosphatemia observed in thermally injured patients when compared with multiple trauma patients during nutrition support.

Adult↗
PubMedDate not supplied

Circulatory support with a left-heart assist device after intracardiac operation: design concepts and management techniques.

A simple left-heart assist device was developed to reduce left ventricular preload while simultaneously increasing total systemic blood flow. It consists of special cannulas connected to a simple extracorporeal tubing loop and roller pump, designed to permit bypass of as much as 5 liters of blood per minute from left atrium to ascending aorta. Employed in 15 patients with advanced heart disease who were in low cardiac output following repair, the system was proven effective. An asset of the device is the ability to subsequently separate the patient from the device without need to reenter the thorax or abdomen.

Assisted Circulation↗