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Biomedical subjects

P Erwin-Toth

Publications and source records attributed to P Erwin-Toth.

17 recordsLinked to original sources
PubMed2000

Management of patients with Bacilli Calmette-Guérin-refractory carcinoma in situ of the urinary bladder: cost implications of a clinical trial for valrubicin.

OBJECTIVE: This study was undertaken to identify the expected first- and second-year clinical costs associated with intravesical valrubicin therapy, using a decision analytic model, for patients with Bacilli Calmette-Guérin (BCG)-refractory carcinoma in situ (CIS) of the urinary bladder. BACKGROUND: Cancer of the urinary bladder is the fourth most common malignancy in men and the sixth most common noncutaneous carcinoma overall. One histopathologic stage of bladder cancer is CIS, for which BCG intravesical immunotherapy is the first-line therapy. Radical cystectomy has been recommended for patients with CIS who do not respond to or become refractory to therapy with BCG. Surgery, however, may not be appropriate for all patients, especially those who are ineligible for the lengthy procedure because of advanced age or comorbidities and those who prefer alternative nonsurgical management. For these groups, intravesical valrubicin therapy is a plausible alternative. METHODS: Models were developed and populated with data from 1 open-label study of 90 patients, information from the medical literature, and input from clinical experts. The analysis was conducted from the payor perspective for direct costs only. RESULTS: Our data indicate that first- and second-year expected costs for valrubicin therapy are $19,912 and $23,496, respectively. Expected cost for radical cystectomy was also evaluated, since some patients may have no other option if drug therapy fails. CONCLUSION: Our cost-consequence analysis and clinical data provide decision-makers with tools to aid in global budgetary projections of fractional and total expected health care costs associated with the management BCG-refractory CIS of the urinary bladder.

BCG Vaccine↗
PubMed1999

Ostomy care: foundation for teaching and practice.

Current approaches to ostomy management evolved from the extensive experience of surgeons, enterostomal therapy nurses, staff nurses, patients, and manufacturers. Advances in surgical techniques in the 1950's led to decreased morbidity and mortality previously associated with ostomy surgery. With these advances, a corresponding demand emerged to meet the rehabilitative needs of these patients by providing significant physical and psychological support. The birth of enterostomal therapy in 1958 focused interest, energy, and resources on this important area of patient care. Today's tradition-based practice continues to go a long way in meeting the physical and psychological needs of individuals undergoing ostomy surgery. However, in this era of managed care, shrinking healthcare dollars, and standardized guidelines, care practices not derived from evidence or consensus may jeopardize a patient's access to appropriate interventions and supplies. An exhaustive review of the literature revealed a paucity of ostomy-related research. The effectiveness of preoperative stoma site selection, prevention, care, and treatment of peristomal skin problems; and pouch selection and wearing times revealed a wealth of empirical evidence, but little or no objective data supporting commonly accepted interventions. The care of individuals with urinary and fecal diversions is both an art and a science. Evidence-based practice is needed to provide a firm foundation from which the art of individualized patient care can flourish. Research related to pre- and postoperative care and rehabilitation of individuals with ostomies can only serve to improve education, continuity of care, reimbursement, and most importantly, optimize patient care.

Education, Nursing, Continuing↗
PubMed1999

G-tube site care: a practical guide.

Effective care of your patient's gastrostomy site is key to her recovery--even after she's been discharged. Here we'll zero in on the prevention and treatment of skin problems and tube dislodgement, and review which anchoring device best suits your particular patient's needs.

Enteral Nutrition↗
PubMed1999

The effect of ostomy surgery between the ages of 6 and 12 years on psychosocial development during childhood, adolescence, and young adulthood.

OBJECTIVE: To investigate the effect of ostomy surgery performed between the ages of 6 and 12 years on psychosocial development during subsequent childhood, adolescence, and young adulthood. DESIGN: Ethnographic. SETTING AND SUBJECTS: Six women and 4 men (mean age 30.7 years) who responded to a notice in a chapter newsletter of the United Ostomy Association. METHODS: Spradley's Ethnographic interview format was used for this study. One interview was conducted with each informant over a 4-week period, and a second, more detailed interview was conducted with 2 subjects who were identified as key informants. The interviews were audiotaped and transcribed, and the transcripts were analyzed to detect shared patterns in the informants' language. INSTRUMENTS: The Ethnograph computer software program was used as an aid in analyzing the interview transcripts. MAIN OUTCOME MEASURES: The informants' subjective experiences during childhood, adolescence, and young adulthood. RESULTS: Nine of the 10 informants adjusted well in the first years after surgery. Key factors in good adjustment were support from family and a perception of "normalcy," including managing one's own ostomy care. All informants reported that their ostomy had a negative impact on their lives during adolescence and that they would have appreciated contact with other teens facing the same dilemma. The age at which an informant underwent ostomy surgery did not influence the difficulties reported during adolescence. CONCLUSION: Ostomy surgery performed between the ages of 6 and 12 years can have long-term effects on psychosocial development. Nurses should promote normalization, teach self-care of the ostomy as soon as possible after surgery, and refer children and parents to mutual support groups as appropriate.

Adaptation, Psychological↗
PubMed1998

Nursing management of multiple enterocutaneous fistulae located in the center of a large open abdominal wound: a case study.

Large abdominal wounds complicated by enterocutaneous fistulae require creative pouching techniques and wound care. Knowledge of containment devices, principles of pouching and appropriate wound management can promote an optimal level of care. After undergoing debridement and drainage of intra-abdominal and pelvic abscesses, a 55 year old surgical patient was left with a large ECF/wound requiring a creative pouching technique. Because the abdominal area was quite extensive, the larger drainable pouches and wound management devices would not accommodate the width of the wound bed. An effective pouching method was achieved using various skin barriers, adhesives and a bowel isolation bag. This system enabled the patient to ambulate and perform many other ADLS while containing moderate to large amounts of effluent. Most of all, this method provided comfort and a sense of dignity while preventing post surgical complications.

Abdomen↗
PubMed1997

Stoma site marking: a primer.

The purpose of pre-operative stoma site marking is to select an appropriate location in an area of the abdomen for surgical placement of a stoma. A poorly located stoma may result in pouching problems, increase potential for leakage, and place undue hardship and emotional trauma on the patient. The type of ostomy surgery must be known to select the appropriate abdominal quadrant to be marked. The ideal stoma site is located below the umbilicus, within the rectus muscle, away from scars, creases, bony prominences, umbilicus, and belt line, on the summit of the infraumbilical fat mound, and visible to the patient. It is vital for the clinician to be aware of any extenuating circumstances of the patient that may alter the site selection. Optimal stoma site placement will promote self-care and rehabilitation of the patient.

Anthropometry↗
PubMed1997

Nursing issues in the management of urinary diversions in women.

Cancer and urinary diversion via orthotopic or cutaneous stomas in women result in significant physiological and psychosocial issues. Patient counseling, education, and follow-up care are best achieved by the intervention of a multidisciplinary health care team. Urologic and enterostomal therapy nursing support in these endeavors can contribute to facilitating a positive outcome.

Carcinoma, Transitional Cell↗
PubMed1996

The pelvic pouch procedure and continent ostomies: overview and controversies.

The pelvic pouch and the continent ostomy provide reservoirs for fecal contents and avoid the need for traditional pouches. Patients with ulcerative colitis or familial polyposis coli now have the option of undergoing one of these procedures rather than a traditional ostomy. This article describes both procedures and covers preoperative and postoperative management, with emphasis on coordinated management by the ET nurse and surgeon.

Bandages↗
PubMed1996

Closer to home.

Explore the source record for details and available documents.

Enterostomy↗
PubMed1995

Cost-effective pressure ulcer management in extended care.

Annual care of pressure ulcers in the United States is estimated to cost $1.3 billion, so it is essential to provide the most cost effective pressure ulcer care. This need is particularly urgent in long term and home care, which are seeing increasing numbers of pressure ulcers. Cost effectiveness can be improved by using appropriate dressing sizes, shapes, and positioning, as well as by combining specialized primary and secondary dressings. Standardized research-based pressure ulcer prevention and treatment protocols also significantly reduce costs of materials and labor and prevalence of pressure ulcers. These measures can help provide higher quality care at lower costs while improving patient quality of life and caregiver morale.

Aged↗
PubMedDate not supplied

Cost effectiveness of pressure ulcer care in the United States.

The United States has seen an increase in management of pressure ulcers in extended care. The experiences of an expert wound care nurse providing consultation in an extended care facility are described. As a result of this consultation and implementation of protocols, pressure ulcer prevalence rate decreased from 12% to 4%.

Consultants↗