The healthcare enterprise Web and the future of clinical information systems.
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Capital Expenditures↗
Biomedical subjects
M Wheeler
Publications and source records attributed to M Wheeler.
[High frequency ultrasonography of the gastrointestinal wall].
If an ultrasound probe comes close to the area of interest, high ultrasound frequencies can be applied. Endoscopic ultrasonography is performed by means of echoendoscopes or miniature probes using ultrasound frequencies between 7 and 30 MHz. A high frequency ultrasound image of the normal gastrointestinal wall usually shows five layers corresponding closely to the histological layers of the wall. Corrections have to be made, however, for interface echoes between layers with different acoustic impedances. We describe studies performed with the aim of correlating ultrasound images of the normal and diseased gastrointestinal wall with the histology. Ultrasound images of the normal gastrointestinal wall and pathological changes like ischemia, ulcers, tumours and inflammation are presented.
Gastric Mucosa↗
The Fort McMurray Demonstration Project in social marketing: health- and safety-related behaviour among oil sands workers.
This is the first round in a series of surveys conducted in Fort McMurray as part of the Fort McMurray Demonstration Project in social marketing. This component of the survey was intended to focus on the most prominent group of employed workers in the community and to compare their patterns of response with the community as a whole. Respondents to the survey were overwhelmingly male (96%), married (72.9%) and living in households of two to five persons (87.9%). They were predominantly aged 30-44 (55%) and graduates of high school (53.5%). Younger male workers (below age 30) were more likely to have a high school diploma (78.3%) or some additional technical or vocational training (21.7% compared to 12.5% overall) and to be unmarried or separated. Attitudes toward safety-related behaviours were stronger than for respondents from the community as a whole. Approximately 70-100% of all age groups and both sexes showed strong agreement with attitudes involving child car seats and the unacceptability of drinking and driving. These attitudes include strong advocacy of vigorous enforcement of occupational health and safety standards. However, they showed a variability similar to the community as a whole in behaviour at home compared to work, generally reporting more consistent use of personal protection on the job than in their own homes, particularly hearing protection. Even so, they were much less likely to perform stretching and warm-up exercises prior to exertion than community residents in general. The potential may exist to transfer the technology and attitudes from workplace health and safety to community safety. One possible strategy to accomplish this is to involve workers in this industry directly in community initiatives. This strategy may be generalizable to any community in which there are major employers who place a heavy emphasis on risk control and occupational health and safety.
Adult↗
Intravenous ondansetron in established postoperative emesis in children. S3A-381 Study Group.
BACKGROUND: In pediatric postsurgical patients, postoperative vomiting is a common occurrence that can delay recovery and result in unplanned hospital admissions after outpatient surgery. This randomized, double-blind, placebo-controlled, multicenter study evaluated the efficacy and safety of ondansetron in the control of established postoperative emesis in outpatients aged 2-12 yr. METHODS: Screened for the study were 2,720 ASA physical status 1-3 children undergoing outpatient surgery during general anesthesia, which included nitrous oxide. Children experiencing two emetic episodes within 2 h of discontinuation of nitrous oxide were given intravenous ondansetron (n = 192; 0.1 mg/kg for children weighing < or = 40 kg; 4 mg for children weighing > 40 kg) or placebo (n = 183). RESULTS: The proportion of children with no emetic episodes and no use of rescue medication was significantly greater (P < 0.001) in the ondansetron group compared with placebo for both 2- and 24-h periods after study drug administration (78% of the ondansetron group and 34% of the placebo group for 2 h; 53% of the ondansetron group and 17% of the placebo group for 24 h). Among patients with at least one emetic episode or with rescue medication use, the median time to onset of emesis or rescue was 127 min in the ondansetron group compared with 58 min in the placebo group (P < 0.001). The median time from study drug administration until discharge was significantly shorter (P < 0.01) in the ondansetron group (153 min, range 44-593 min) compared with the placebo group (173 min, range 82-622 min). The incidence of potentially drug-related adverse events was similar in the ondansetron (3% of patients) and the placebo (4% of patients) groups. CONCLUSION: A single dose of ondansetron (0.1 mg/kg up to 4 mg) is effective and well tolerated in the prevention of further episodes of postoperative emesis in children after outpatient surgery. Administration of ondansetron also may result in a shorter time to discharge.
Antiemetics↗
Use of the Olympus LF-P fibreoptic laryngoscope by trainees in paediatric anaesthesia.
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Anesthesiology↗
Relation between insulin-like growth factor-I concentrations, osteoarthritis, bone density, and fractures in the general population: the Chingford study.
OBJECTIVE: To assess the association between serum insulin-like growth factor-I (IGF-1) concentrations and osteoarthritis, and bone mineral density, and fractures in a large group of middle aged women from the general population. METHODS: 761 women aged 44-64 years from the Chingford study had serum IGF-I concentrations measured; hand, hip, spine, and anteroposterior weight bearing knee radiographs taken; and dual energy x ray absorptiometry (DEXA) scans of the hip and spine. X rays were scored using the Kellgren and Lawrence system. In addition knee x rays were scored using a standard atlas for individual features of osteophytes and joint space narrowing (both graded 0-3). IGF-I concentrations were adjusted for the effects of age. RESULTS: In the osteoarthritis analysis results were compared to a constant group of 155 subjects with no evidence of osteoarthritis at any site. There was no significant difference in serum IGF-I between these subjects and 606 subjects with osteoarthritis at any site. When individual sites were analysed, serum IGF-I was higher in those cases with more severe bilateral knee osteoarthritis and in those with distal interphalangeal (DIP) joint disease. There was no significant association between serum IGF-I and other forms of osteoarthritis or milder forms of knee osteoarthritis. There was no correlation between IGF-I concentrations and bone mineral density at the spine or hip, nor any difference between IGF-I concentrations in subjects with and without a history of non-traumatic fracture [22.8 (SD 6.6) v 23.1 (SD 6.6) nmol litre-1, P = 0.6] CONCLUSIONS: There is a modest association between IGF-I concentrations and the development of DIP osteoarthritis and more severe or bilateral knee joint osteoarthritis in women from the normal population, but no association with other forms of osteoarthritis, bone density, or fractures.
Absorptiometry, Photon↗
Fat replacers: their use in foods and role in diabetes medical nutrition therapy.
The scientific literature demonstrates that fat replacers have a reasonable certainty of no harm. Whether they help produce desired health outcomes, i.e., decreased risk of coronary heart disease and certain types of cancer related to excess fat intake, weight reduction, changes in lipid profile, improved glycemic control, etc., depends on how individuals use these foods to change food choices and eating behaviors. As Miller and Rolls conclude, ...the use of fat-replaced foods alone should not be expected to produce spontaneous improvements in weight management. Such improvements will still be dependent on long-term behavioral changes that include not only modifications in fat, but also modifications in overall energy intake and increase in energy expenditure. (53) Though it has not been studied, one may conjecture that encouraging people with diabetes to use foods with fat replacers to achieve nutrition management goals requires sufficient education, continuous counseling, and an individual's conscientious commitment and readiness to change food habits.
Diabetes Mellitus↗
A randomized controlled trial of oral albuterol in acute cough.
BACKGROUND: Beta-agonist agents have been used for bronchospasm and cough in a variety of settings. We sought to evaluate the efficacy of oral albuterol for acute cough in ambulatory adults. METHODS: We performed a prospective, randomized, controlled, double-blind clinical trial comparing albuterol 4 mg by mouth three times daily for 7 days with placebo in 104 adults. Subjects had cough of less than 4 weeks' duration and no evidence of pneumonia, asthma, or chronic obstructive pulmonary disease. All subjects were enrolled at the walk-in clinic of a rural academic medical center. RESULTS: There was no significant difference between treated and control subjects in any measure of efficacy including cough severity score, reduction in sleepless nights, utilization of health care, or return to full activity. There were significantly more reports of "shakiness" and "nervousness" among albuterol-treated subjects than among controls. CONCLUSIONS: Oral albuterol should not be used in unselected patients with acute, nonspecific cough.
Acute Disease↗
The Effects of Daflon on Pelvic Pain in Women with Taylor Syndrome
The syndrome of chronic pelvic pain without an obvious pathology has been described as pelvic congestion (Taylor) syndrome. It is frequently associated with continuous bilateral lower abdominal pain and dyspareunia. Pelvic examination reveals tenderness without induration or masses. Although their importance in the pathophysiology of pain is uncertain, prominent enlarged broad ligament veins are observed at laparoscopy. We evaluated the effects of daflon, a venomimetic agent that regulates the circulatory tonus of the venous system, on pelvic pain and investigated the role of enlarged veins in the pathophysiology of Taylor syndrome. Ten women (age 28-35 yrs) with chronic pelvic pain were diagnosed with the syndrome at laparoscopy. They all had prominent broad ligament and ovarian veins without other pathologies such as endometriosis to explain the etiology of pelvic pain. Five women were randomized in a double-blind fashion to receive daflon 500 mg twice/day for 4 months, and five a vitamin pill placebo; they were crossed over for another 4 months. They scored the frequency and severity of lower abdominal pain and dyspareunia on a scale from 0 to 6, and the results were compared with pretreatment values. At the end of the fourth month the frequency and severity of pelvic symptoms began to decrease with daflon compared with pretreatment and placebo. The mean scores were significantly less at the end of 4 months (9.3 ± 1.1 vs 4.2 ± 1.4, respectively, p <0.05). Based on our preliminary results, we conclude that venous dysfunction and stasis may be pathophysiologic components of pelvic pain in women with Taylor syndrome. Pharmacologic enhancement of venous tonus may restore pelvic circulation and relieve pelvic symptomatology.
Journal Article↗
Effect of recombinant human growth hormone treatment on insulin-like growth factor (IGF-I) levels in insulin-dependent diabetic patients.
Basal and recombinant human growth hormone (rhGH)-stimulated insulin-like growth factor (IGF-I) levels were studied in 19 insulin-dependent diabetic patients and 4 healthy subjects. Diabetic patients were divided according to glucagon test result into CpN (10 patients without residual beta cell activity) and CpP (9 patients with preserved beta-cell activity) and CpP (9 patients with preserved beta-cell activity) groups, and according to age into three groups (A = 21-30 years; B = 31-40 years; C = 41-50 years). All control subjects belonged to group B. Blood glucose and growth hormone were measured at hourly intervals and IGF-I every 6 h during 24 h before and after 7 days treatment with 4 IU of rhGH given subcutaneously at 8 p.m. The age-related decrease in basal IGF-I levels was evident in both CpN and CpP groups of diabetic patients. IGF-I net increase with rhGH treatment was variable and insignificant in comparison with basal value without age-related differences in CpN diabetics. Progressively larger, age-related increases in IGF-I concentrations were observed in CpP diabetic patients. This study indicates impairment of hepatic IGF-I generation capacity in diabetic patients without residual beta-cell activity and the importance of simultaneous actions of portal insulin and GH on hepatic IGF-I production.
Adult↗
Perfect knowledge: the physician's role.
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Computer Communication Networks↗
Comparison of a rigid laryngoscope with the ultrathin fibreoptic laryngoscope for tracheal intubation in infants.
The flexible ultrathin fibreoptic laryngoscope allows placement of endotracheal tubes as small as 2.5 mm internal diameter. The purpose of this study was to document the safety and efficacy of intubation using an ultrathin fibreoptic laryngoscope. Proved safety and efficacy would justify the routine use of fibreoptic laryngoscopy in normal infants to maintain skills needed for management of the difficult infant airway. In this prospective study, 40 infants < 24 mo of age scheduled for elective surgery were randomly divided into two equal groups. After inhalation induction of anaesthesia, in 20 infants the trachea was intubated using direct rigid laryngoscopy, and in 20 using the ultrathin fibreoptic laryngoscope (size 1.8 mm OD) Olympus LFP. Time to successful intubation was recorded, as well as blood pressure, heart rate, end-tidal CO2 and oxygen saturation. Airway trauma in the operating room, the post-anaesthesia care unit, and on the first postoperative day was recorded. The intubation times using rigid laryngoscopy were less than those using fibreoptic laryngoscopy (13.6 +/- 0.9 sec (mean +/- SEM) vs 22.8 +/- 1.7 sec; P < 0.01). Oxygen saturation and end-tidal CO2 readings were not different between the two groups. After intubation, blood pressure and heart rate increased equally in both groups, returning to normal within one to two minutes. There was no difference in the airway trauma between groups. We conclude that the ultrathin fibreoptic laryngoscope is a safe and effective method for tracheal intubation in infants and may be used routinely in order to maintain fibreoptic airway skills.
Anesthesia, Inhalation↗
Nurse in the newsroom: visibility is key.
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Humans↗
The effect of recombinant human growth hormone on regulation of growth hormone secretion and blood glucose in insulin-dependent diabetes.
GH hypersecretion in insulin-dependent diabetes (IDDM) is well documented. Although it has recently been shown that residual insulin secretion determines the magnitude of this GH hypersecretion, the underlying mechanisms of the disorder have not yet been clarified. The 24-h GH and blood glucose profiles, insulin-like growth factor I (IGF-I) concentrations and GH responses to GRF were analyzed in 21 insulin-dependent diabetics and 4 healthy subjects before and after 7 days treatment with recombinant human GH (rhGH) (4 IU given sc at 0800 h). According to C-peptide response to glucagon IDDM patients were subdivided into C-peptide negative (CpN, n = 12) patients without endogenous pancreatic beta-cell activity and C-peptide positive (CpP, (n = 9) patients with endogenous insulin secretion. No significant difference could be observed between the mean 24-h blood glucose profile before and after rhGH treatment in any treated group. Before and on rhGH treatment the highest 24-h GH values were observed in CpN patients when compared to CpP and controls. The rhGH treatment induced a similar increase in the mean 24-h GH concentrations in all groups studied which was statistically significant only in CpP diabetics. Mean pretreatment serum IGF-I concentrations were not significantly different between CpN, CpP patients and controls. The net increase in IGF-I concentrations after rhGH treatment was however, significantly lower in CpN patients than in CpP and control subjects. GRF-induced GH response before and after rhGH treatment was significantly greater in diabetics than in controls. The response of GH to GRF in CpN diabetics was however, almost unchanged after treatment whereas it became lower in CpP diabetics and controls. The dose of 4 IU of rhGH increased significantly GH levels in diabetics with preserved beta-cell function with consequent increase in IGF-I levels and attenuation of GRF induced GH response. In contrast, the same dose of rhGH failed to induce significant increase in GH levels in diabetics without residual beta-cell activity, most probably due to already high pretreatment levels. In addition, neither increase in IGF-I levels nor suppression of GH response to GRF on rhGH treatment was observed in CpN diabetics. The results are in keeping with an important role of portal insulin in GH-induced hepatic IGF-I secretion.
Adult↗
Genetic disorders of the skin and eye.
This article discusses some of the most uncommon diseases ever seen by the ophthalmologist or dermatologist. Some of these conditions can cause irreparable eye damage if not recognized and treated early after their inception.
Eye Diseases, Hereditary↗