PubMed Health⌕ Search

Biomedical subjects

K R Simpson

Publications and source records attributed to K R Simpson.

35 records · Page 2Linked to original sources
PubMed1991

Dramatic oligoclonal paraproteinaemia following a pneumococcal septicaemia.

We describe a case of paraproteinaemia in which there were high concentrations of four monoclonal bands shown on qualitative, and confirmed by quantitative, techniques. The disorder followed a pneumococcal infection and resolved spontaneously with the complete disappearance of all four bands.

Electrophoresis, Agar Gel↗
PubMedDate not supplied

Nonsurgical management of gastric or duodenal perforation from a Wills-Oglesby-type gastrostomy tube.

PURPOSE: To describe the clinical and radiologic appearance of gastrointestinal perforation related to a Wills-Oglesby-type gastrostomy tube, as well as techniques for nonsurgical management. MATERIALS AND METHODS: Five patients with a previously placed 14-F modified Wills-Oglesby-type gastrostomy catheter experienced viscus perforation by the distal limb of the catheter during a 30-month period. RESULTS: The average interval between tube placement and perforation event was 4.3 months. Three patients had migration of the gastrostomy tube into the duodenum and subsequent duodenal perforation. One patient had posterior perforation of the stomach, and one patient developed a gastrocolic fistula. Generalized peritonitis was not present in any patient. All patients were treated successfully without surgery, and tube feedings were re-established in 4-14 days. CONCLUSIONS: Gastrostomy tube-related perforation is an uncommon, delayed complication of percutaneous gastrostomy with the modified Wills-Oglesby-type catheter. Nonsurgical management is feasible in select instances. Because of these gastrointestinal perforations, the gastrostomy tube has been modified (eliminating the distal tip), and no gastrostomy-associated gastrointestinal perforation has been experienced since.

Adolescent↗
PubMedDate not supplied

Interventional radiologic placement of chest wall ports: results and complications in 161 consecutive placements.

PURPOSE: To review the technical results and long-term follow-up of the first 157 consecutive patients undergoing placement of 161 chest wall ports at the authors' institution. PATIENTS AND METHODS: All ports were placed in the interventional radiology suite with use of fluoroscopic and/or ultrasound guidance with a combination of standard interventional radiology and surgical techniques. The hospital records of all patients were reviewed, and telephone contact made when possible. Patients ranged in age from 21 to 87 years (average, 57 years). The most common indication for port placement was chemotherapy (88%). RESULTS: Placement was technically successful in all 161 procedures. Minor procedural complications occurred in eight patients (5%). There were no major complications related to the procedure. Cumulative follow-up to date includes 35,992 port-days (average, 226 days per patient). The long-term complication rate was 8.7% or .39 per 1,000 access days, which includes nine infections and five migration-related complications. CONCLUSION: Interventional radiologic placement of chest wall ports is safe and has a high technical success rate, in large part due to the integration of interventional radiology techniques to the procedure. The short and long-term complication rates are equal to or less than those of current surgical series.

Adult↗
PubMedDate not supplied

Strategies for developing an evidence-based approach to perinatal care.

Today more than ever perinatal care providers must work together to develop practice patterns that will contribute to the best possible outcomes for women and newborns. Financial and human resource allocation are under intense scrutiny in most hospitals. Although the fundamental goals of health care institutions are to maximize health while conserving resources, unfortunately, these goals are often in conflict. Perinatal practice must be based on the combined weight of all available evidence rather than "the way we've always done it." Health care institutions that continue doing business as usual are not likely to survive. Using both clinical and financial data, routine perinatal practices without a scientific basis that establish a contribution to improved outcomes can be reevaluated, while practices that have been shown to be beneficial can be enhanced and supported. The first step in developing a standards and evidence-based approach to perinatal care is the establishment of a practice committee in which communication is open and direct and there exists a respect for the contributions of members from all related disciplines. True collaboration and communication between physicians and nurses is the foundation for establishing and implementing best practices. Fortunately, a growing body of research regarding the pros and cons of various perinatal practices is beginning to emerge; this research can be used by knowledgeable, informed perinatal professionals to advocate for a clinically appropriate approach to fiscal prudence. Commitment to practice based on standards and evidence is an ongoing process and may require substantial changes and more professional energy than the usual methods of implementing and evaluating changes in patient care routines. However, the initial investment in time to collaborate and become oriented to this process is worth the effort.

Cost Control↗
PubMedDate not supplied

Shoulder dystocia. Nursing interventions and risk-management strategies.

Shoulder dystocia is unpredictable; however, once identified there are reasonable steps that perinatal providers will be expected to take to attempt to dislodge the impacted shoulder. Be aware of these interventions and have a plan for what to do should dystocia occur. Stay calm and help the woman and physician or CNM through the crisis. Call for additional help as appropriate. Provide emotional support to the woman and her family. Ensure that the medical record reflects the events as accurately as possible. If an injury results, the nurse can then be sure that the team did the best they could to intervene during the emergency.

Documentation↗
PubMedDate not supplied

A critical evaluation of the past 25 years of perinatal nursing practice: opportunities for improvement.

Changes in perinatal nursing over the past 25 years have been abundant. Nursing advocacy has contributed to the introduction of innovations such as single-room maternity care and family-centered care, and to the end of restrictive practices such as the use of hand and leg restraints during birth, routine use of episiotomy, and routine general anesthesia for normal births. Perinatal nursing involves complex clinical interventions, intensive patient and family education, empathetic support and evaluation of family dynamics, and a wide range of opportunities to make a difference in the lives of mothers, babies, and families. The strengths and weaknesses of perinatal nursing practice at the beginning of the new century are chronicled, and suggestions for improvements are made.

Evidence-Based Medicine↗
PubMedDate not supplied

Fundal pressure during the second stage of labor.

The role of fundal pressure during the second stage of labor is controversial and can result in clinical disagreements between nurses and physicians. Clearly the time for resolution of this issue is not when there is a physician request at the bedside in front of the patient. A prospectively agreed upon plan specifying how this request will be addressed is ideal. In order to develop this plan, risks, benefits, and alternative approaches to the use of fundal pressure should be reviewed by an interdisciplinary perinatal team. Much of the data about maternal-fetal injuries related to fundal pressure are not published for medical-legal reasons; however, anecdotal reports suggest that these risks exist. Unfortunately, it is therefore difficult to quantify with any degree of accuracy the exact number of maternal-fetal injuries that are directly related to use of fundal pressure to shorten an otherwise normal second stage of labor. However, there is enough evidence to suggest that if injury does occur when fundal pressure is used, there are significant medical-legal implications for the health care providers involved. This article will review what is currently known about fundal pressure including risks, benefits, and alternative approaches. In that context, suggestions will be offered for a safe approach to managing the second stage of labor.

Delivery, Obstetric↗
PubMedDate not supplied

Acute fatty liver of pregnancy.

Acute fatty liver of pregnancy is a serious complication of the 3rd trimester associated with high rates of maternal-fetal morbidity and mortality. Prompt diagnosis and treatment are essential to achieve optimal maternal-fetal outcomes. Collaboration between critical-care and perinatal nursing staffs is a crucial component of managing patient care. A recent case of acute fatty liver of pregnancy is reported. A team approach resulted in the survival of the patient and the delivery of healthy twins.

Acute Disease↗
PubMedDate not supplied

Sepsis during pregnancy.

The incidence of maternal mortality related to sepsis has decreased during the past 2 decades because of the availability of broad spectrum antibiotics and advances in critical care. However, sepsis continues to account for approximately 7.6% of maternal deaths in the United States. This article focuses on intraamniotic infection as a source of maternal sepsis. Common causative pathogens, typical sources of sepsis, and related pathophysiology are reviewed. Nursing and medical management strategies are included. A case study is presented to illustrate the typical clinical course from infection, to bacteremia, sepsis, and septic shock.

Adult↗
PubMedDate not supplied

A specialty certification incentive program. Costs versus benefits.

Certification benefits nurses and their institution of employment. Although certification seems costly initially, it can be used to help reduce hospital expenditures in the areas of staff retention and recruitment, liability, and quality of patient care. The financial implications of certification and the development of a successful hospital incentive program to assist nurses to obtain certification is reported. Staff development educators can use this information to evaluate the cost-to-benefits ratio of specialty certification and to determine if a similar program could work in their institution.

Certification↗