PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Complex intervention”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources
PubMed2000

[The clinical use of the GPIIb/IIIa inhibitors eptifibatide and tirofiban in the treatment of acute coronary syndromes of the "non-ST elevation" type].

Acute coronary syndromes not associated with ST-segment elevation, i.e. unstable angina and non-Q wave myocardial infarction, represent a heterogeneous group of clinical disorders sharing similar pathogenic mechanisms, clinical presentation and medical management. Current guidelines recommended an early anti-thrombotic and anti-ischemic treatment in these patients, as well as their prompt risk evaluation based on easily available clinical and instrumental data, to identify those subjects at greater risk in whom a more aggressive management is warranted. Despite the association of aspirin, heparin and anti-ischemic drugs, the 30-day rate of death or myocardial infarction remains high (9-15%) in patients with markers of greater risk (i.e. Braunwald class III, ST-segment depression, abnormal creatine kinase or troponin values). Moreover, in patients with acute coronary syndromes undergoing percutaneous coronary interventions (PCI), complex coronary lesions increase the peri-procedural risk of thrombotic complications. Regardless of the agonist responsible for platelet activation and aggregation, platelet glycoprotein (GP) IIb/IIIa receptor activation is the key factor in thrombosis formation. Several clinical trials in the past few years have documented the beneficial value of GP IIb/IIIa inhibitors in patients treated with aspirin and heparin, with a significant reduction in the cumulative end-point of death and/or myocardial infarction at 48-96 hours (odds ratio--OR 0.81, 95% confidence interval--CI 0.71-0.92, p < 0.01). Such therapeutical benefit is still present at 30 days (OR 0.88, 95% CI 0.81-0.97, p < 0.001) and 6 months (OR 0.88, 95% CI 0.79-0.97, p < 0.001). In patients treated with abciximab, eptifibatide or tirofiban, undergoing early PCI, a remarkable relative reduction in the risk of death and non-fatal acute myocardial infarction was shown before PCI (-34%, p < 0.001). The pre-PCI administration of GP IIb/IIIa inhibitors is associated with a significant reduction in peri-procedural complications (-41% relative reduction of death or acute myocardial infarction in the 48 hours after PCI, p < 0.001). In this subset of patients the benefit correlates with abnormal pre-PCI values of troponin, a reliable surrogate marker of active thrombosis. The greatest clinical benefit from GP IIb/IIIa inhibitors is expected in patients presenting high-risk features (early post-infarction angina; older age with a history of left ventricular dysfunction or diabetes; heart failure symptoms, ST-segment depression, abnormal troponin, creatine kinase, and C-reactive protein values at admission) as well as in patients with recurrent ischemic attacks and those undergoing early PCI. Although the combination of GP IIb/IIIa inhibition and standard doses of unfractionated heparin is associated with an increased risk of major bleeding, such risk can be remarkably reduced adopting simple technical suggestions.

Acute Disease↗
PubMed1999

Utility of bilateral coronary injections during complex coronary angioplasty.

We describe a technique useful in complex coronary interventions wherein timed bilateral contrast injections are given in both coronary arteries. This technique is useful in chronic total occlusions in which the distal coronary vessel is not visualized except by collateral filling via the contralateral artery. This technique was applied in 12 patients; 11 with native coronary occlusion and one in whom the target site was visualized by contrast injections into a vein graft supplying competitive flow to an otherwise patent native vessel. With this technique, the distal coronary artery segment can be better visualized, which helps to aim and track the guide wire across the occluded segment.

Aged↗
PubMed1977

[Pain-sensation following classic neck-dissection (author's transl)].

Resulting neck-dissection surgery (including curative or conservative intervention) very complex pain-syndromes are next to losses of function at the top of complaints stated. The discussion of the case-reports of 242 patients with unilateral neck-dissection and the reexamination of 28 patients free of recurrence revealed several causes of head- and facial pain. The close relationship of functional disability and pain-sensation is discussed. The recommendation of elective neck-dissection - by critical indication - is supported. Resection of nervus accessorius may be necessary in some cases, immediate reconstruction by nerve sutures is recommended. By post-operative treatment the complaints often can be relieved.

Accessory Nerve↗
PubMed1992

Process measures in interventions for drug-abusing women: from coping to competence.

As a guide to the selection of process and outcome measurement in interventions with drug-abusing women, we have offered a model of fundamental coping processes. Three coping processes--reinforcer management, challenge management, and affect management--appear critical to women's competence and physical hardiness. When these processes go awry, substance abuse is a likely result. For successful recovery from substance abuse, good fortune or purposeful intervention must promote these coping processes. To measure the impact of any intervention with drug-abusing women, methods of assessing fundamental coping processes during intervention (process measures) and repeatedly after intervention (outcome measures) are needed. We have described multiple methods of measuring fundamental coping processes from diverse vantage points: self-report, behavioral observation, biochemistry, and physiology. We have discussed how these measures relate to the theoretical model. Finally, we have indicated measures favored and used in our longitudinal and intervention research on adolescent and perinatal substance abuse. The final set of measures, as summarized in the list of recommended process and outcome measures on pages 324-325, is somewhat lengthy because the process of intervention is complex. Given the financial and structural limitations of research in drug treatment settings, it may not be possible for a single investigator to employ all the recommended measures. An adequate research design would employ two measures from each of the domains outlined. If resources allow, more extensive measurement procedures would be possible.

Adaptation, Psychological↗
PubMed1991

[Value of studying pain in objective assessment of the clinical status of patients after spinal surgery].

The author demonstrates the role of algologic studies (projective Stewart's test scale), scales of verbal and visual analogs) in objective evaluation of the clinical status of patients who underwent spinal surgery for lumbar pains. Differences have been revealed in the algologic status of patients who suffered restricted interventions and complex decompression stabilizing operations with posterior spondylodesis.

Back Pain↗
PubMed1991

[Management of radiation-induced injuries of the intestine].

Radiation-induced injury of the intestine (RII) is a chronic iatrogenic disorder which often necessitates complex surgical intervention. We describe our experience with the surgical management of 9 patients with RII, 8 of whom suffered injuries of the small bowel and 1 of the rectosigmoid. There were 3 deaths, 2 from postoperative complications of ongoing RII and 1 from recurrence of the original tumor. 3 of the survivors continued to suffer from complications attributed to active RII, while only 3 remained symptom-free during follow-up. Our study emphasizes the fundamental role of good nutritional support during the perioperative period in these patients. It also indicates the desirability of using nonirradiated bowel for the anastomosis, and of a bypass procedure instead of resection and primary anastomosis in cases of radiation-induced frozen pelvis. Creating a barrier between the peritoneal cavity and the lower pelvis by an omental flap or other means, should be considered in patients operated on for pelvic cancer who might need adjuvant radiotherapy. This procedure shields the bowel from the radiation field, thus hopefully reducing the incidence of RII.

Humans↗
PubMed1990

[Methods to improve the delivery of hospital ophthalmological care to children in the Ukrainian SSR].

On the material of Children Eye Department the Filatov Institute, changes in the structure of eye pathology for the period of 1947-1989 are analysed. It is shown that for the last years, among all eye diseases, the incidence of inflammatory eye diseases fell to 7.5%. The incidence of eye traumas and their outcomes reaching 26.2% remained stable. The incidence of congenital pathology (35.4%) and new-formations in the eye (10.8%) with predominance of malignant tumors, complex pathology of oculomotor apparatus (23.5%) reached high values. Organization of centers, of ophthalmic microsurgery in children allowed to introduce into ophthalmological practice complex surgical interventions requiring special devices and instruments. Surgical activity of the Center of Ophthalmic microsurgery in Children on the basis of the Filatov Institute made up 84.5% in the last five years. In order to optimize the rendering of stationary ophthalmological aid to children, the authors consider it necessary to improve continuity between a microsurgical center and regional children eye hospitals, to increase qualification of children ophthalmologists, to create a Republic Center for Rehabilitation of Children with eye diseases on the basis of a sanatorium with a good ophthalmological equipment.

Child↗
PubMed1988

Future growth and development of hysteroscopy.

In less than two decades, hysteroscopy has evolved into a practical technique for the evaluation of the uterine cavity, with well-established indications such as evaluation of abnormal uterine bleeding and abnormal hysterograms as well as the treatment of intrauterine adhesions or the septate uterus, the removal of misplaced or embedded intrauterine devices, and the removal of submucous leiomyomas. As the use of hysteroscopy increases and more practitioners utilize it, new instrumentation and techniques are beginning to evolve, simplifying and facilitating not only a diagnostic examination, but also the more difficult and complex surgical interventions. Flexible endoscopes are being tested for possible use in the uterine cavity, and operative hysteroscopes with practical inflow and outflow accessory channels have been introduced. The accessory operative instrumentation has also been expanded and refined, and portable units for office examinations have been developed. The trend in the development of instrumentation is toward simplicity, effectiveness, and refinement in lenses with wider fields of view and accessory channels without compromising the total outer diameter of the endoscopes. As clinical applications expand as a result of increased use and proficiency in hysteroscopy, new applications undoubtedly will follow, such as closer study of the endometrium with and without additional magnification. This latter may permit a better understanding of the receptivity of the endometrium to the embryo, which may help in predicting successful nidations. Portable laser units with the capability to use the CO2 fiber undoubtedly will increase laser use through hysteroscopy, and in the near future, photodynamic therapy may become the best approach to the selective treatment of intrauterine lesions. The uterotubal junction will remain an attractive area for endoscopists to approach the fallopian tubes transcervically and eventually to accomplish tubal closure safely and effectively with the possibility of future reversibility. The hysteroscope will play an important role in new reproductive technologies, particularly those related to the gamete intrafallopian transfer via the uterine side and perhaps also for direct embryo transfers under visual control. The future of hysteroscopy thus is promising. The present diagnostic and therapeutic applications will not only become a standard of treatment but will expand as gynecologists will gain proficiency and confidence in this endoscopic method.

Endoscopes↗
PubMed1979

[Treatment of peritonitis in abdominal injuries].

According to the author's data, peritonitis occurred in 250 (20.8%) out of 1200 cases of abdominal injuries, 69 of these 250 patients died (27.6%). The main means combating this complication was an early surgical intervention. A complex of postoperative therapeutic procedures, aimed at the prophylaxis and treatment of peritonitis in these patients, is described.

Abdominal Injuries↗
PubMed1995

[Methods for preventing periodontal diseases and their validation].

The paper presents fundamentals of comprehensive prophylaxis of periodontal diseases, based on the author's own epidemiological, experimental, and clinical findings; confirms the principal of individual differentiated complex of interventions as the only effective method for prevention of chronic destructive diseases in the periodontium.

Adolescent↗
PubMedDate not supplied

[Congenital kyphosis with neurological disorders].

The paper outlines the results of examination and surgical treatment of a large group of patients with congenital sternolumbar kyphoses complicated by development of neurological symptoms. The results of radioopaque investigations showed there was a relationship of the magnitude of intracanal changes to the size of kyphotic deformity. The comparative study of the outcomes of surgical management of patients with congenital kyphoses demonstrated the high efficiency of interventions, whose complex included central spondylosis. This operation decreases spinal deformity, yields decompression of intracanal nervous structures and ensures further stability of the vertebral column.

Adolescent↗
PubMed1993

[Dermatoplasty in the treatment of necrotic mastitis and breast erysipelas].

The authors had 15 female patients aged from 20 to 35 years with various diseases of the breast which were marked by necrosis of the skin and subcutaneous fat with involvement of 18 to 100% of the breast surface. The necrosis was caused by phlegmonous and infiltrative abscess producing forms of mastitis in 18 and by erysipelas in 7 cases. Necrotic mastitis and erysipelas developed in the first 2 weeks after delivery, as a rule, in patients with marked concomitant diseases of the heart and vessels. The patients were hospitalized 7 to 29 days after the onset of the disease. The development of severe forms of breast diseases was promoted by intensive manual abstraction of milk from the breast and retromammary antibiotic-novocaine blockades. After an operative intervention a complex of therapeutic measures was applied including semisynthetic antibiotics, agents containing protein globulin fractions, and dry and native blood plasma, and artificial polyuria with preceding hemodilution was produced. All patients underwent dermatoplasty with the use of a free split perforated skin graft. Lactorrhea in the region of the granulations was not a contraindication for surgical closure of the wound. Perforation of the skin graft was regarded a forced measure because the secretion of milk led to inevitable rejection of the transplant. The applied treatment produced quite satisfactory cosmetic and functional results.

Abscess↗
PubMed1978

The effect of mercury derivatives of fluorescencein on allotransplant kidney in experiment.

Mercurascan (MSC), a mercury derivative of fluorescein, was studied as to its effect on the survival of allogeneic kidney grafts in dogs. A single perfusion of the donor's kidney with saline solution with MSC added in a ratio of 1 mg/100 ml was found to have significantly extended the graft survival time from 10.8 days (SE +/- 0.6) to 15.4 days (SE +/- 1.6). Graft survival time extension proved to be even more significant after a single dose of MSC given to the donor (0.5 mg/kg b.w.) and repeated administration of an equal MSC dose to the recipient twice weekly. Listed are detailed morphological changes in tissue specimens from the kidney, lymph nodes, spleen, and many other organs of a dog surviving for 42 days. A very moderate rejection lesion with merely tiny lymphocytic infiltrates was proved in the kidney. Lymph node structure was almost entirely obliterated with lymphoid tissue extinction. There was loss of white pulp in the spleen. The absence of morphological changes in the other organs suggested good tolerance of the preparation. More studies are called for to elucidate the complex MSC intervention in the process of rejection.

Animals↗
PubMed1994

Complement, neutrophils and free radicals: mediators of reperfusion injury.

Myocardial ischemia of sufficient duration produces irreversible myocardial injury and cell death. Associated with the direct ischemic insult, there is the indirect attack on the jeopardized tissue through activation of the complement system. The latter, occurring in response to ischemia, facilitates neutrophil-endothelial cell interactions, neutrophil migration into and across the vascular wall, along with the formation of cytotoxic oxygen metabolites and release of proteolytic enzymes. The neutrophil dependent actions participate in extending the tissue injury beyond that due to ischemia alone. The invading neutrophils injure the myocardial vasculature and sarcolemma through the generation of oxygen free radicals. Components of the complement system can damage tissue indirectly through formation of neutrophil chemoattractants as well as directly through assembly of the "membrane attack complex." Pharmacologic interventions that prevent complement activation, modulate neutrophil function or scavenge oxygen radicals, can reduce the extent of myocardial injury associated with ischemia reperfusion. The inflammatory reaction of cell injury mediated by neutrophil invasion of the affected tissue is an important site for pharmacologic intervention. Specific adhesive glycoprotein receptors are expressed on the neutrophil in conjunction with corresponding endothelial cell ligands. Recognition of these events has led to the development of specific antibodies having the potential to prevent cell-cell interactions essential for promoting and maintaining the inflammatory response. Therefore, neutrophil-independent extension of irreversible cell death that occurs upon reperfusion, is additive to the component of cell death attributed to the ischemic interval. As is the situation with any organ, function and cellular viability are dependent upon a blood supply, which if interrupted for a sufficiently long period, will lead to irreversible cellular changes and necrosis. Reperfusion is essential for arresting the otherwise progressive injury due to ischemia. The accelerated inflammatory response upon reperfusion contributes to an extension of the injury, a phenomenon known as "reperfusion" or "reoxygenation" injury.

Animals↗
PubMed1993

[Specialized medical care in diffuse peritonitis].

The authors present a report concerning the system of operational and medico-evacuation measures during the treatment of 168 patients with generalized peritonitis. During hospitalization the reactive phase was marked in 37 patients (22.1%), toxic and terminal--in 95 (56.5%) and 36 (21.4%) patients correspondingly. As a result of an adequate surgical and anesthetic intervention and complex therapy for generalized peritonitis the number of complications was diminished by 2.5 times (p 0.001), and lethal cases by 4.5 times (p 0.1). Realization of the principle of immediate specialized care is possible only in combination of adequate organizational and medical measures.

Adolescent↗
PubMed1995

[With problem of applying modern systems theories in clinical practice].

In this paper the tension between "practice" and "theory" is reflected concerning modern system theories and psychosocial practice. Focusing the limits of predictability and manageability these theories contrast with practitioners need for easy-to-use advices for acting. Reframing the well-known dilemma of the discrepancy between theory and practice the usefulness of the difference between theory and practice is accentuated. Others reflected these topic in more fundamental or philosophical way (cf. Krohn & Küppers 1990; Schiepek 1991; Schiepek, Fricke & Kaimer 1992; Willke 1989). In a more "pragmatic turn" attention is drawn to some methods of orientation and intervention in complex systems. System game and system competence are new ways in training and evaluating the management of complex systems.

Communication↗
PubMed1996

Identification and assessment of students with disabilities.

Students with disabilities or suspected disabilities are evaluated by schools to determine whether they are eligible for special education services and, if eligible, to determine what services will be provided. In many states, the results of this evaluation also affect how much funding assistance the school will receive to meet the students' special needs. Special education classification is not uniform across states or regions. Students with identical characteristics can be diagnosed as disabled in one state but not in another and may be reclassified when they move across state or school district lines. Most disabilities with a clear medical basis are recognized by the child's physician or parents soon after birth or during the preschool years. In contrast, the majority of students with disabilities are initially referred for evaluation by their classroom teacher (or parents) because of severe and chronic achievement or behavioral problems. There is evidence that the prevalence of some disabilities varies by age, the high-incidence disabilities such as learning disabilities and speech-language disabilities occur primarily at the mild level, the mild disabilities exist on broad continua in which there are no clear demarcations between those who have and those who do not have the disability, and even "mild" disabilities may constitute formidable barriers to academic progress and significantly limit career opportunities. Problems with the current classification system include stigma to the child, low reliability, poor correlation between categorization and treatment, obsolete assumptions still in use in treatment, and disproportionate representation of minority students. Both African-American and Hispanic students are disproportionately represented in special education but in opposite directions. The disproportionately high number of African Americans in special education reflects the fact that more African-American students than white students are diagnosed with mild mental retardation. Though poverty, cultural bias, and inherent differences have been suggested as reasons for this disproportionate representation, there are no compelling data that fully explain the phenomenon. In most states, classification of a student as disabled leads to increased funding from the state to the school district. This article suggests a revised funding system that weights four factors (number of deficits, degree of discrepancy, complexity of intervention, and intensity of intervention) in a regression equation that would yield a total amount of dollars available to support the special education of a particular student.

Adolescent↗