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Biomedical subjects

R C Sachdeva

Publications and source records attributed to R C Sachdeva.

At least 19 recordsLinked to original sources
PubMed2001

Intensive care--a cost effective option for developing countries?

The estimation of cost-effectiveness of pediatric critical care services is an extremely relevant issue for both developing and industrialized nations. Pediatric critical care is expensive and the long outcomes are still relatively unclear. From the perspective of patients who receive the benefits of these services, there may be little controversy regarding cost-effectiveness. However, the issue becomes very complex when attempts are made to identify which patients will benefit most. This also needs to be considered while developing public policy when decisions for allocation of limited resources need to be made within health care systems, and choices need to be made between the provision of health care and other public services. This article addresses the complex issue of economic evaluations and describes various type of cost analyses. The difference between charges and costs is defined, and a discussion of the measurement of costs and benefits, and their relationship to outcomes research is provided. Although there is not a unique answer to the issue of cost-effectiveness for pediatric critical care services, the available literature particularly from the United States is summarized, and the ethical implications explored.

Child↗
PubMed2001

Measuring the impact of new technology: an outcomes-based approach.

In the current era of decreasing resources, many healthcare organizations are under increasing pressure to evaluate new technology. Advances and innovations in healthcare technology are instrumental in reshaping the healthcare system and in impacting the practice of medicine, including critical care. Healthcare organizations are faced with the following four questions related to adopting a new technology: 1) Should the organization invest in this technology? 2) What are the associated benefits and risks of the capital investment? 3) What is the impact on patient outcomes as a result of adopting the technology? 4) What is the return on investment to the organization? These issues represent challenging areas for the researcher, clinician, manager, and policy maker. New techniques from the business and outcomes research arenas allow for the development of quantitative and qualitative models to facilitate answering these questions. By integrating business and clinical considerations, these models can impact policy at two levels: 1) by identifying optimal capital expenditure decisions for individual healthcare organizations, it can provide a significant competitive advantage for an organization; and 2) by identifying optimal health policies related to technology at a national and international health level, it can impact the healthcare systems and patient outcomes in a favorable manner.

Cost-Benefit Analysis↗
PubMed2000

Development of a survey to measure parent satisfaction in a pediatric intensive care unit.

OBJECTIVE: To use classic survey methodology to develop a specific survey tool that can assess parent satisfaction with medical care in a pediatric intensive care setting. DESIGN: Application of survey design methodology to develop and analyze a parent satisfaction survey. SETTING: A pediatric intensive care unit (PICU) in a large teaching hospital. SUBJECTS: Sixty-six parents of children admitted to a PICU. RESULTS: A four-stage process of item selection, item reduction, pretesting, and test analysis was used to create a 23-item parent satisfaction survey that was statistically analyzed and developed specifically for the PICU setting. The survey tool was developed with the input of parents of children admitted to a PICU, and it was administered to parents in the PICU. The resultant survey was analyzed for validity and reliability. Both test-retest and internal consistency reliability were evaluated. This design yielded a survey with acceptable reliability, as demonstrated by a reliability coefficient of 0.8275. Test-retest reliability also showed good correlation of answers. Validity was partially established by including parents in the identification of survey topics. CONCLUSIONS: Classic survey design methodology was applied to develop a specific satisfaction survey in a pediatric inpatient setting. This stepwise method yielded a parent survey specific to one type of inpatient unit, and the resultant survey tool reliably measured levels of parent satisfaction with medical care in that area. This study demonstrates the feasibility of applying classic survey methodology to develop a statistically analyzed parent satisfaction survey for an inpatient setting.

Adult↗
PubMed1999

Near drowning.

Submersion accidents continue to be a significant cause of morbidity and mortality in children and adults. The key to successful management is prevention of these accidents. Proactive efforts to minimize submersion accidents in the community should be made by medical and legislative groups. Anticipatory guidance by primary care physicians, particularly for families and individuals at increased risk, should be performed. Outcomes of individuals who have become victims of submersion accidents can be optimized by the development of a rapid response system, because successful initial resuscitation efforts clearly improve outcomes. For individuals who have nearly drowned and who have arrived in the emergency department, a systematic and aggressive approach needs to be followed with particular emphasis on cardiorespiratory support to optimize neurologic outcome. Despite many studies aimed at developing predictors of outcomes, there is limited information that can be used in a prospective manner to guide the emergency-room physician in limiting the level of interventions. Thus, all aggressive supportive care and resuscitation should be performed at this stage, except in clearly futile situations. Once patients arrive in the ICU, meticulous care, including monitoring of cardiorespiratory and neurologic status and attention to electrolytes and acid-base status, needs to be continued. Besides providing basic supportive measures, the ICU physician should investigate for other associated trauma and medical conditions that may need to be addressed once the patient is stabilized. Patients who have nearly drowned are likely to have long ICU stays, predisposing them to nosocomial infections. Despite efforts at minimizing barotrauma and volutrauma, many patients who have nearly drowned and who need ventilatory support may develop ARDS. The management of these patients is similar to other patients who have ARDS. However, strategies like permissive hypercapnia that are used commonly in patients who have ARDS may not be suitable in patients who have CNS injury. Despite aggressive care, neurologic injury with long-term sequelae secondary to hypoxic ischemic injury remains a major problem in the management of victims of submersion accidents. It is important for the clinician to keep the pathophysiologic and cellular mechanisms of CNS injury in mind, because future interventions are likely to be based on these pathways. Besides providing care for the patient, it is important for the ICU physician to be sensitive to the needs of the family and to support them through this catastrophe that is likely to place a tremendous financial and emotional burden on most of them.

Adult↗
PubMed1999

Evaluation of the consolidation period during osteodistraction using computed tomography.

The use of distraction osteogenesis offers an alternative approach to the correction of craniofacial deformities. However, little is known with respect to the appropriate length of the consolidation period for the newly formed bone. The objective of this study was to evaluate, by quantitative computed tomography, the regenerate bone produced during osteodistraction of the dog mandible at three different consolidation times. Twelve skeletally mature male beagle dogs were equally separated into three experimental groups. Each dog underwent 10 mm of bilateral distraction osteogenesis to lengthen the mandible. After the distraction period, the bone was allowed to consolidate for 4, 6, or 8 weeks, at which time the animals were sacrificed and the mandibles harvested for computed tomographic imaging. The results demonstrate a significantly lower mean bone density of the regenerate in the 4 week group when compared with either the 6 or 8 week groups (P < .01). There was no significant difference, however, in mean bone density between the 6 and 8 week groups.

Animals↗
PubMed1999

Nonsurgical correction of a class II malocclusion with a vertical growth tendency.

Malocclusion, with a superimposed vertical growth tendency, is often difficult to treat without a combined surgical orthodontic approach. Certain situations, however, may preclude surgery as a treatment option. The following case report demonstrates the use of orthodontic mechanotherapy alone in successfully treating a patient that exhibited a Class II Division I malocclusion with a high mandibular plane angle and vertical growth tendency.

Adolescent↗
PubMed1997

Acute respiratory distress syndrome.

Acute Respiratory Distress Syndrome (ARDS) occurs in a wide range of adult and pediatric critical care settings. This article provides an overview of ARDS including the controversies in definition, a summary of pathophysiology, diagnosis, clinical presentation, and management options. The article also attempts to emphasize new management options in the management of ARDS, and highlights differences between adults and children.

Adrenal Cortex Hormones↗
PubMed1997

Hemoptysis: a 10-year retrospective study.

BACKGROUND: Hemoptysis is uncommon in pediatric practice. We reviewed 10 years of experience with hemoptysis in a tertiary pediatric hospital to identify patient characteristics and predictors of mortality. METHODS: Patients were divided into four age groups (0 to 5, 6 to 10, 11 to 20, and >20 years). Hemoptysis was defined as mild (<150 mL/day), large (150 to 400 mL/day), or massive (>400 mL/day). Fever was defined as >/=38.5 degrees C. RESULTS: A total of 228 patients (115 males and 113 females) with 246 episodes of hemoptysis were identified and grouped according to primary diagnosis. There were 149 patients in the cystic fibrosis (CF) group, 37 in the congenital heart disease (CHD) group, and 42 in the Other group. Age was significantly higher in the CF group compared with the CHD and Other groups. Length of stay was significantly prolonged in the CF group compared with the Other group. The overall mortality was 13%. After initial analysis, mortality predictors were age, amount of hemoptysis, receipt of blood products, and fever. After stratification, we found: 1) in the >20-year age group, there was a difference in mortality when comparing CF patients with CHD patients; 2) for patients who received blood products, there were differences in mortality in patients with CF, CHD, and Other diagnoses; 3) for patients who received blood, there were differences in mortality only for the 0- to 5-year age group; and 4) the amount of hemoptysis was predictive for mortality only in CHD patients. CONCLUSIONS: Hemoptysis presented in young adult CF patients and in adolescent CHD patients. Young adult CF patients with hemoptysis had a higher risk of mortality compared with young adult CHD patients. The amount of hemoptysis predicted mortality only for CHD patients. Receiving blood products was predictive of mortality for all patients.

Adolescent↗
PubMed1996

Resource consumption and the extent of futile care among patients in a pediatric intensive care unit setting.

OBJECTIVES: To estimate resource consumption and the extent of futile care among patients admitted to the pediatric intensive care unit (PICU). STUDY DESIGN: A prospective cohort study of 353 consecutive admissions followed for 1334 patient-days during the PICU stay at the Texas Children's Hospital in Houston, Texas. Participants were 353 children and adolescents who were hospitalized in the PICU during September and October 1993. Three broad operational definitions of futility were developed to capture the maximum extent of resource consumption related to medical futility. Definition 1 (imminent demise futility) was developed by an objective, validated, severity of illness measure (Pediatric Risk of Mortality Score) to identify patients with high mortality risks. Definition 2 (lethal condition futility) was used to identify patients in the PICU whose long-term survival was unlikely. Definition 3 (qualitative futility) was used to identify patients with high morbidity. Resource consumption was measured according to the number of patient-days in the PICU and the Therapeutic Intervention Scoring System. RESULTS: Twenty-three (6.5%) patients representing 36 (2.7%) patient-days met at least one of the definitions of medical futility for some of the days when they were in the PICU. None of the patient-days that met any of the definitions of medical futility were associated with high resource consumption compared with non-futile care patient-days. CONCLUSIONS: Despite our use of broad definitions of medical futility, relatively small amounts of resources were used in futile PICU care. This suggests that attempts to reduce resource consumption in the PICU by focusing on medical futility are unlikely to be successful.

Adolescent↗
PubMed1996

Effects of availability of patient-related charges on practice patterns and cost containment in the pediatric intensive care unit.

OBJECTIVE: To investigate the effects of the availability of daily patient-related charges to healthcare providers on practice patterns and cost containment in the pediatric intensive care unit (ICU) setting. DESIGN: Prospective, nonrandomized, controlled trial. SETTING: Pediatric ICU. PATIENTS: All patients admitted to the pediatric ICU during the study period. This number included a prospective control group (n=325) and an intervention group (n=273). These 598 patients spent 2,274 patient days in the pediatric ICU. INTERVENTIONS: The daily itemized patient charges related to diagnostic studies ordered in the pediatric ICU were made available to healthcare providers during the intervention period of the study. MEASUREMENTS AND MAIN RESULTS: Information was collected prospectively on patients in the control group before the intervention period. This information included data on demographics, daily severity of illness measures, daily resource consumption, intensity of nursing and medical interventions, and daily patient-related charges. Outcome information on survival and length of pediatric ICU stay was also collected. The same data were collected prospectively during the intervention period of the study. Measurements on quality assurance and morbidity were made to ensure that there was no compromise in patient care. There were no significant differences in patient demographics and diagnoses between the control and intervention groups. There was a reduction in the average daily laboratory (16.7%), radiology (9.1%) computerized axial tomography (8.5%), and pharmacy (25.1%) charges in the intervention group as compared with controls. The decreases in laboratory and pharmacy charges were statistically significant (p<.0001). The decreases in laboratory and pharmacy charges remained significant even after adjustment for severity of illness. CONCLUSIONS: The availability of patient-related charges to healthcare providers can result in changes in practice patterns, producing a decrease of patient charges and an improvement in cost containment in the pediatric ICU.

Analysis of Variance↗
PubMed1992

Microanalytical characterization and surface modification of TiNi orthodontic archwires.

Orthodontic archwires (equiatomic TiNi alloy) of both used (4 weeks) and unused conditions were microanalyzed by optical and scanning electron microscopes, energy dispersive X-ray spectroscopy, and electron diffraction to characterize the surface layers. They were also subjected to immersion and polarization corrosion tests in a 0.9% NaCl aqueous solution. Based on results obtained from these analytical and experimental studies, surfaces of TiNi archwires were further electrochemically treated to etch away nickel selectively and reform the surface morphology to uniform and porous surface layers. Main conclusions were: (a) surface layers of used archwires were covered contaminants causing the discoloration, and the contaminants were identified as mainly KCl crystals, (b) surfaces of both used and unused wires were observed to be irregular features characterized by lengthy island-like structures, where nickel was selectively dissolved, (c) corrosion tests in a 0.9% NaCl aqueous solution in immersion and polarization methods indicated that by increasing temperature from 3 degrees to 60 degrees C and acidity from pH 11 to pH 3, calculated corrosion rates increased, and (d) surface layers of TiNi archwires can be electrochemically modified to selectively etch nickel away, leaving a Ti-enriched surface layer and forming a uniformly distributed porous surface that may reduce the coefficient of friction against the orthodontic brackets.

Corrosion↗
PubMed1987

Location of the centers of resistance for anterior teeth during retraction using the laser reflection technique.

The location of the centers of resistance for various symmetric units of the anterior maxillary dentition for a lingually directed force was studied in two dry human skulls. The units investigated were composed of two incisors, four incisors, and six anterior teeth. In addition, the effect of change in force magnitude on the location of the centers of resistance of these units was investigated. The laser reflection technique was used to study both the direction and magnitude of the initial displacement of the consolidated teeth under loading. The results indicated that the center of resistance shifted apically with the incorporation of a greater number of teeth into an anterior segment. With a unit of six anterior teeth, the apical shift of the center of resistance was the greatest. Increasing force levels had little effect on the location of the center of resistance of a given unit. This phenomenon was observed in both the skulls tested, suggesting that general trends may exist in the displacement characteristics of the dentition when subject to controlled force systems.

Cuspid↗
PubMed1986

The center of resistance of anterior teeth during intrusion using the laser reflection technique and holographic interferometry.

The aim of this investigation was to define the location of the center of resistance of various consolidated units of the maxillary anterior dentition using a dry human skull when subject to intrusive forces. The laser reflection technique and the holographic interferometric technique were employed to measure the displacement of the dentition to the applied forces. The units studied consisted of two central incisors, four incisors, and six anterior teeth. The incorporation of the lateral incisors into the upper incisor segment resulted in a small distal shift of the center of resistance (+/- 2 mm). However, when the canines were included into this unit, the center of resistance shifted distally by a significantly larger amount (+/- 7 mm). Increasing the magnitude of intrusive forces applied to the various units appeared to have no effect on the location of the center of resistance.

Cuspid↗
PubMedDate not supplied

Perioperative management of the pediatric transplant patient.

With advances in surgical techniques, an increasing number of children are becoming transplant candidates. Pediatric critical care physicians may need to manage both transplant donors and recipients in the pediatric intensive care unit. Care of such patients needs to be performed aggressively with complete attention to details in order to obtain successful transplant outcomes. The postoperative management of the transplant recipient includes the basic intensive care monitoring and management of postoperative patients who are critically ill. Besides this, there are some unique features among these patients which may complicate the postoperative stay in the pediatric intensive care unit and these are discussed here. It is important to remember that the successful management of a transplant patient includes the pediatric critical care physician's abilities of not only taking care of acute issues but also of coordinating care between subspecialists. The pediatric critical care physician must always continue to provide support to families of these transplant patients during their intensive care unit stay.

Child↗