PubMed Health⌕ Search

Biomedical subjects

M Coons

Publications and source records attributed to M Coons.

9 recordsLinked to original sources
PubMed1998

Improving patient outcomes through CQI: vascular access planning.

This article reports the use of the continuous quality improvement (CQI) process to improve patient outcomes. The FADE method (focus, analyze, develop, and execute) was used to focus on vascular access planning, analyze data concerning intravenous (i.v.) therapy, develop a vascular access planning algorithm, and execute implementation of the algorithm. An evaluation study revealed that patients whose vascular access planning was consistent with the algorithm reported fewer i.v.s, less difficulty starting i.v.s, and less stress; waited significantly less time until central venous line (CVL) placement (for those who received CVLs); and had significantly shorter lengths of stay.

Algorithms↗
PubMed1991

Successful cardiac xenogeneic transplantation in primates using total lymphoid irradiation.

Combined total lymphoid irradiation (TLI) and cyclosporine (CyA) dramatically prolong cardiac xenografts in small animals. In order to evaluate this immunosuppressive regimen in primates, heterotopic cardiac cervical xenografts were implanted in a monkey-to-baboon model. The following groups evolved: group 1 (n = 2) control, no immunosuppression; group 2 (n = 4) CyA and steroids; group 3 (n = 2) preoperative TLI (800 rad total); group 4 (n = 4) TLI combined with CyA and steroids as in groups 2 and 3. Complement-dependent cytotoxicity, mixed lymphocyte culture, cell mediated cytotoxicity as well as myocardial biopsies were periodically monitored. A Muga scan was performed at 1 year posttransplant to assess ventricular function. Cardiac xenograft survival was best in group 4 animals (108, 184, 480, 540 days) compared with 5 and 7 days in the control group. In group 2, graft survival was 13, 17, 18 and 63 days. TLI alone prolonged survival up to 28 and 29 days. Hemorrhage and myocyte necrosis were seen in all rejected grafts of group 1, 2 and 3 animals. Mononuclear cell infiltrate and fibrosis were present in group 4 grafts at rejection. High antibody titers (1:256 to 1:512) were detected at rejection only in group 1, 2 and 3 animals. This suggests that the combined use of TLI and CyA substantially prolongs xenograft survival in a primate model by preventing early antibody-mediated rejection as well as by limiting cellular response.

Animals↗
PubMed1991

Nurses' attitudes, nurse-patient interactions and adherence to treatment by hemodialysis patients.

Relationships among fluid intake and dietary-adherence of 29 hemodialysis patients, nurses' attitudes (liking-disliking) toward these patients, and selected nurses' and patients' verbalizations during hemodialysis treatment were explored. No significant associations were found. Nurses may be facilitating positive solutions to all patients' health care problems rather than admonishing those whom they dislike and/or who do not adhere to treatment.

Adult↗
PubMed1990

Efficacy of right atrial infusion of PGE1 in sepsis-induced pulmonary hypertension.

In this study we investigated the effects of right atrial infusion of PGE1 (RAIPGE1) in doses from 40 to 500 ng/kg/min on sepsis-induced pulmonary artery hypertension (SIPAH). Thirteen pigs were randomized into a time-course group (n = 6) and a PGE1-treated group (n = 7). Pulmonary hypertension (PAH) was induced with the infusion of Pseudomonas Aeruginosa (PsAr) at a concentration of 2 X 10(8) CFU/20 kg/min in both groups. The infusion of PsAr caused a significant and persistent rise in mean pulmonary artery pressure (MPA), pulmonary vascular resistance (PVRI), right ventricular compliance (RVC), RV dp/dt, and right ventricular stroke work index (RVSWI), 30 min after the onset of infusion (P less than 0.05 vs baseline). Systemic hemodynamics and gas exchange were not affected throughout the 3-hr period of infusion (P = NS); however, left ventricular compliance (LVC) was depressed at a MPA greater than 35 mm Hg. The RAIPGE1 following SIPAH caused a concentration-dependent reduction above 40 ng/kg/min of MPA, PVRI, RVSWI, and RV dp/dt (P less than 0.05, 120 and 500 ng/kg/min vs PAH). RVC returned to baseline values during the infusion of PGE1. Systemic hemodynamics, including oxygen delivery and extraction, were unaffected by the infusion of PGE1, but LVC was improved (P less than 0.05, PGE1 500 vs PAH). The infusion of PGE1 caused a concentration-dependent rise in shunt fraction (Qs/Qt) and alveolararterial oxygen gradients which reached statistical significance during the infusion of 500 ng/kg/min. Our data show that RAIPGE1 is effective in ameliorating RV and pulmonary hemodynamics, but at the largest dose it negatively affects gas exchange.

Alprostadil↗
PubMed1990

Parotid gland and facial nerve trauma: a retrospective review.

Included in this study are all patients with trauma to the parotid region seen at our center from 1979 to 1989. There was a total of five patients with injury to the parotid area: two patients with isolated facial nerve injury; one with isolated parotid duct injury; two with combined duct and nerve injury. There were four males and one female, with a mean age of 34 years (range, 16 to 62 years). The three patients with parotid duct injury required other procedures for associated trauma. A total of eight nerve branches were severed in four patients. Seven of the eight nerve branches (82.5%) were primarily repaired, with excellent functional results. Two of the three ductal injuries were repaired primarily over a stent, and one was ligated. No complications resulted from either treatment. Based on our clinical experience and review of the literature, we suggest that the treatment of parotid region injuries should include: 1) a complete initial assessment; 2) primary repair of parotid duct transection within 24 hours when possible; 3) primary repair of all facial nerve injuries, although delayed nerve repair remains a viable alternative; and 4) nonsurgical treatment of sialoceles and fistulae.

Adolescent↗
PubMed1988

Unit or service standards.

As competition in the health-care market increases, issues such as accountability, patient satisfaction, and evaluation after quality of patient care have become progressively more important. This article describes the evaluation of a quality assurance program from a centralized, retrospective system to a unit-based, concurrent review process. Issues related to problem management, research, and education are identified.

Florida↗