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Biomedical subjects

Karl Nelson

Publications and source records attributed to Karl Nelson.

6 recordsLinked to original sources

Resident physician attire: does it make a difference to our patients?

OBJECTIVES: This study was performed to examine the preferences of patients regarding physician attire, and if their perception of physician competence was influenced by the physicians' clothing style. METHODS: Patients attending the obstetrics and gynecology clinic in which residents provided the majority of direct patient care were invited to participate in this study by completing a questionnaire. Patients were first asked to respond to 3 questions about their preference regarding physician attire. They were then asked to examine a series of photographs illustrating a variety of physician clothing styles worn by a model. Patients were asked to respond to 2 questions: 1). If your doctor is dressed in this outfit, would that make you more or less comfortable talking to your physician?, and 2). If your doctor is dressed in this outfit, would it make you feel more or less confident in his/her abilities? RESULTS: The majority of the respondents expressed no preference for their physician wearing a white coat (60%/110/183), or they did not respond that a physician's dress influenced their comfort level (63%/111/179) or the confidence (62%/114/181) they had in their physician. However, for both male and female physician models, the comfort level of patients and their perceptions of physician competence were the highest in response to images of physicians dressed in scrubs with a white coat, and least for casual dress. CONCLUSION: Resident physician attire makes a difference to patients. Our patients prefer the white coat with surgical scrubs. Casual clothing is less well liked by our patients.

Attitude of Health Personnel↗

Nursing education and implications for left ventricular assist device destination therapy.

The HeartMate VE Left Ventricular Assist Device (vented electric abdominally positioned pulsatile blood pump; Thoratec Corp., Pleasanton, CA), approved as a permanent support, or destination therapy, by the US Food and Drug Administration in 2002 and Medicare in 2003, is now a potential therapy for numerous patients. Postimplantation nursing care is crucial to the success of left ventricular support device therapy and long-term recipient outcome. Nurses also contribute to cost containment, making this a viable treatment for the facility and the patient. Consequently, nurses must be educated about left ventricular assist device concepts and challenges, the benefits of device placement, intensive care unit and postintensive care unit daily care requirements, and outpatient preparation. This knowledge will enable nurses to provide necessary care and to educate recipients, families, and community health care providers on how to give appropriate posthospital care.

Certification↗

Modeling unipolar depression as a chaotic process.

This study inspected the deterministic structure of unipolar depression. Two women self-monitored sadness hourly 10 times a day for 6 months. One woman had a recurrent history of unipolar depression, and the other did not. Data were analyzed by visual inspection, examination of the Fourier transforms of the time plots, and the correlation dimension. Results suggested that in addition to a strong periodic component that existed only within the depressed subject's mood time series, a low-dimensional chaotic process might have been operating. In the nondepressed control subject, no such periodicity or process could be identified. The findings support maladaptive deterministic theories of mood disorders and have implications for the assessment of unipolar depression.

Adult↗

The left ventricular assist device.

Of the 400,000 people in the United States who develop end-stage heart failure each year, 60,000 are unresponsive to medical therapy and 2,500 undergo heart transplantation. Surgically implanted pumps, called LVADs, are extending many lives.

Aged↗

Left ventricular assist devices as permanent heart failure therapy: the price of progress.

BACKGROUND DATA: The REMATCH trial evaluated the efficacy and safety of long-term left ventricular assist device (LVAD) support in stage D chronic end-stage heart failure patients. Compared with optimal medical management, LVAD implantation significantly improved the survival and quality of life of these terminally ill patients. To date, however, there have been no analyses of the cost related to the LVAD survival benefit. This paper addresses the cost of hospital resource use, and its predictors, for long-term LVAD patients. METHODS: Detailed cost data were available for 52 of 68 REMATCH patients randomized to LVAD therapy. We combined the clinical dataset with Medicare data, standard billing forms (UB-92), and line item bills provided directly by clinical centers. Charges were converted to costs by using the Ratio-of-Cost-to-Charges for each major resource category. RESULTS: The mean cost for the initial implant-related hospitalization was $210,187 +/- 193,295. When implantation hospitalization costs are compared between hospital survivors and nonsurvivors, the mean costs increase from $159,271 +/- 106,423 to $315,015 +/- 278,713. Sepsis, pump housing infection, and perioperative bleeding are the major drivers of implantation cost, established by regression modeling. In the patients who survived the procedure (n = 35), bypass time, perioperative bleeding, and late bleeding were the drivers of cost. The average annual readmission cost per patient for the overall cohort was $105,326. CONCLUSIONS: The cost of long-term LVAD implantation is commensurate with other life-saving organ transplantation procedures like liver transplantation. As an evolving technology, there are a number of opportunities for improvement that will likely reduce costs in the future.

Aged↗

Perianal versus anorectal specimens: is there a difference in Group B streptococcal detection?

OBJECTIVE: To investigate whether specimens obtained from the perianal area have a Group B streptococcal culture detection rate similar to anorectal specimens. METHODS: This is a prospective cohort study at a tertiary care university-affiliated teaching hospital. A total of 136 pregnant women between 33 and 40 weeks' gestation were recruited. Three samples for Group B streptococcal culture detection were obtained from each subject in the following order: perianal sample, vaginoperianal sample, and an anorectal sample. The women were asked to rank their pain or discomfort with obtaining the anorectal sample. The vaginoperianal specimen is the standard sample obtained from antepartum patients in this clinic, and, therefore, it serves as the control. RESULTS: Of the 136 subjects, 26.5% of the control, vaginoperianal samples were positive for Group B streptococcal culture. In comparison, 27.2% of the anorectal specimens and 28.7% of the perianal specimens were positive for Group B streptococcal culture. There was no statistically significant difference in the detection of Group B streptococcal culture among the three sample sites. Evaluation of the pain experienced with an anorectal sampling showed that 68% of subjects ranked their pain between mild to moderate, and 5% noted severe pain. CONCLUSION: The Group B streptococcal detection rate was not different among the three sampling sites. Therefore, pregnant women do not need to be subjected to the additional pain of anorectal sampling to detect Group B Streptococcus.

Adult↗