Biomedical subjects

S R Holtzman

Publications and source records attributed to S R Holtzman.

2 recordsLinked to original sources

PubMed2001

Peripherally inserted central catheters: outcome as a function of the operator.

PURPOSE: To determine the natural history of and outcome involved with peripherally inserted central catheters (PICCs) placed at a single institution and examine potential differences in the natural history of PICCs placed by interventional radiologists (IRs) versus registered nurses (RNs). MATERIALS AND METHODS: A prospective analysis of all patients receiving PICCs at one academic medical center over a period of 6.5 months was conducted. At our institution, PICCs are placed primarily by RN members of the intravenous team. Placement procedures deemed unfeasible or problematic by RNs are referred to an IR for insertion under fluoroscopic guidance. A total of 322 PICCs (130 by IRs, 192 by RNs) were successfully placed in 256 patients. In three patients, placement was attempted but was a technical failure by both RNs and IRS: Seven patients in each group were lost to follow-up. PICCs were classified as successfully completed therapy or as having been prematurely removed, which was further stratified into suspected infection, occlusion, phlebitis, mechanical failure, inadvertent patient removal, and other. RESULTS: Overall rate of premature removal for PICCs placed by IRs versus RNs was not significantly different (30.8% vs 23.4%, respectively). PICCs placed by IRs had an increased rate of occlusion (IRs = 9.2%, RNs = 3.6%; P =.02). Other reasons for premature removal did not differ in incidence. Overall, PICCs were successfully placed in 99.1% of all patients and the course of therapy was completed in 69.3%. CONCLUSION: It is reasonable and cost-effective for trained RNs to place PICCs whenever feasible and refer complicated placements to IRS:

Adolescent↗

PubMed2000

Clinical outcome in female patients with pelvic pain and normal pelvic US findings.

PURPOSE: To understand the clinical outcome in patients with pelvic pain and negative pelvic ultrasonographic (US) findings. MATERIALS AND METHODS: Data from 86 female patients with pelvic pain and normal pelvic US findings seen in a US section over a 15-month period were evaluated 6-21 months after US. Medical chart review follow-up was available in 86 patients, and telephone interview follow-up was conducted in 85 patients. We collected data on the outcome of pain; subsequent imaging, treatment, and surgery; and the duration of pain before US. RESULTS: Pelvic pain improved or resolved in 66 (77%) of the 86 patients. In the group with acute or subacute pain (duration </= 6 months), 62 (86%) of the 72 patients (19 with acute pain and 53 with subacute pain) had improvement or resolution of symptoms. In the group with chronic pain (duration > 6 months), seven (50%) of the 14 patients had improved symptoms. Further imaging (13 studies) was performed in nine patients: Twelve studies were normal, and one computed tomographic scan (1 month after the first US examination) showed diverticulitis. Eleven patients underwent 19 surgical procedures (endometrial sampling, hysteroscopy, laparoscopy, or hysterectomy). Four demonstrated clinically important disease (endometriosis and pelvic varices, endometriosis, adenomyosis, or pelvic adhesions). CONCLUSION: The majority of patients with pelvic pain and normal pelvic US findings had improvement or resolution of their symptoms, and those with acute or subacute pain were more likely to report improvement or resolution of pain than those with chronic pain. The yield of further imaging studies was low, and disease was identified in a minority of patients.

Acute Disease↗