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At least 217 records · Page 12Linked to original sources
PubMed2002

Collaboration by use of the Internet yields data of high quality and detects non-uniform management of patients with Helicobacter pylori infection.

BACKGROUND: The benefits of new technology steadily being introduced in medicine should be documented. In this study, remote entry of a set of data from the daily routine was submitted via the Internet to a common database. The usefulness and quality of the information are evaluated. METHODS: Fourteen hospitals reported a common data set on consecutive Hp+ve patients handled in accordance with daily practice. Participants submitted their data via the Internet to a database. There was no monitoring or other surveillance. No audit was planned or expected, but was nevertheless possible. Doctor compliance with the common agreement was checked, differences in medical practice were noted and quality was assessed comparing the most important source data with the data in the final database. RESULTS: Four-hundred-and-forty patients were included. The quality of the reported data was high, only 1.3% showing a discrepancy between source data and the database. Overall treatment success was 89%, with no significant differences between hospitals. There were significant differences in clinical practice between the centres, the proportion of patients treated for ulcer disease varying from 36% to 96% (P < 0.001). Doctor compliance with the agreed collaboration varied significantly (P < 0.001). CONCLUSION: Internet collaboration through remote data entry in a common database yields data of high quality without monitoring, and is a powerful and resource economic tool for clinical multicentre trials and quality assurance.

Clinical Trials as Topic↗
PubMed2006

Possibilities for cost containment in intensive care.

An intensive care unit (ICU) is valuable but consumes a disproportionately high amount of health-care resources. Accordingly, cost containment has been deemed a mandatory task. A review of the literature from many countries was completed to determine the strategies for reducing the cost of care in the ICU. The results of this review show that cost reduction can be achieved by using a variety of the following strategies: (i) instituting a closed ICU, where all the patient care is directed by intensivists or full-time critical care trained physicians; (ii) the utilization of interdisciplinary approaches to the care of patients in the ICU; (iii) developing and implementing a program of television-guided remote intensivists; (iv) the use of an alerting and reminding system; and (v) increasing the number of intermediate care beds for patients who require only monitoring and intensive nursing. The conclusion reached is that many of these strategies provide evidence for hospital manager decisions regarding cost containment strategies for the delivery of health care in the ICU.

Cost Control↗
PubMed2006

Heart period variability in trauma patients may predict mortality and allow remote triage.

INTRODUCTION: The high frequency to low frequency ratio (HF/LF) derived from analysis of heart period variability is elevated and associated with mortality in severely injured patients monitored in a hospital. The purpose of this study was to test the utility of heart period variability measurements as indicators of injury severity in patients prior to definitive medical intervention. We tested the hypothesis that survival is associated with low relative HF/LF, and death is associated with high relative HF/LF. METHODS: We performed retrospective analyses of 84 pre-hospital trauma patient records (n=42 non-survivors; n=42 survivors) collected during helicopter transport to a Level 1 urban trauma center. R-waves from 2-min segments of ECG waveforms were converted to the frequency domain with a Fourier transform. Spectral power was separated into low (LF; 0.04-0.15 Hz) and high (HF; 0.15-0.4 Hz) frequency bands for analysis and derivation of frequency ratios. RESULTS: Absolute HF, LF, and HF/LF were not distinguishable statistically between groups (p > or = 0.26), but HF/LF was higher (p = 0.04) for non-survivors (140 +/- 26) than survivors (74 +/- 19). After normalization to account for large intersubject variability, HFnu (43 +/- 3 vs. 28 +/- 2) and HF/LFnu (248 +/- 50 vs. 73 +/- 19) were higher (both p < 0.001), and LFnu (42 +/- 4 vs. 64 +/- 3) was lower (p = 0.0001) for non-survivors [19 h (median) before death] compared with survivors. CONCLUSIONS: Our results show that heart period variability analyses separate patients who die from patients who survive traumatic injury. We propose that such analyses could be employed for remote triage of injured patients in austere environments.

Adult↗
PubMed2006

Multicenter phase II study of antimicrobial prophylaxis in low-risk patients undergoing distal gastrectomy for gastric cancer.

BACKGROUND: In Japan, antimicrobial prophylaxis (AMP) is typically administered for 3 to 4 days postoperatively for clean-contaminated operations such as distal gastrectomy. This far exceeds the recommended 2h or less laid out by the Centers for Disease Control (CDC) guidelines for the prevention of surgical-site infections (SSIs), after a clean-contaminated operation. METHODS: Patients with gastric cancer, which was curable by distal gastrectomy with D2 lymphandectomy, were assigned to a multicenter phase II study. One gram of cefazolin within 3 min of the first surgical incision and intraoperative supplements of g of cefazolin every h were administered. AMP was not administered after skin closure unless postoperative infection occurred. The occurrence of SSIs was monitored until postoperative day 30 as the primary endpoint of this study. RESULTS: In 56 patients, three SSIs (5.4%) and one remote site infection (1.8%) developed. No other postoperative infections were observed. CONCLUSION: Our data indicate that the CDC guidelines regarding AMP may also be sufficient for patients undergoing clean-contaminated operations in Japan.

Anti-Bacterial Agents↗
PubMed2005

Early-onset heparin-induced thrombocytopenia after a 165-day heparin-free interval: case report and review of the literature.

Early- or abrupt-onset immune-mediated heparin-induced thrombocytopenia (HIT) is defined as HIT that occurs less than 5 days after exposure to heparin in patients who have received heparin within the previous 100 days. We identified no reports in the literature of early-onset HIT in patients who had a heparin-free interval longer than 100 days. However, we report a case of early-onset immune-mediated HIT illustrated by a positive HIT result with serotonin release and enzyme-linked immunosorbent assays, and a decrease in platelet count to less than 100 x 10(3)/mm3 with no evidence of thrombosis, approximately 165 days after the patient's last exposure to heparin. We conclude that clinicians should choose alternative forms of anticoagulation in patients with even a remote history of HIT. If clinicians are compelled to reexpose patients to heparin, they should confirm a negative HIT assay result, monitor for clinical signs of HIT, and provide appropriate treatment if HIT is suspected.

Aged↗
PubMed1993

Oligohydramnios: problems and treatment.

Oligohydramnios is a severe and common complication of pregnancy. The finding of oligohydramnios can be associated with fetal anomalies, PROM, uteroplacental insufficiency (eg, growth retardation, postdatism, abruptio placenta, significant maternal illness), abnormalities of twinning, and idiopathic oligohydramnios. Ultrasound detection of this complication should prompt the clinician to thoroughly evaluate the gravida for hypertension, diabetes, or other significant illness. In addition, a thorough fetal anatomic survey focusing on the genitourinary tract and an attempt at visualizing free amniotic bands should be performed with ultrasound. Karyotype should be considered. The role of amnioinfusion to assist in diagnosis should be considered. Once diagnosed, oligohydramnios with or without associated conditions should lead to intensive fetal biophysical surveillance including frequent ultrasound evaluation. Delivery in the term patients must be considered. The role of amnioinfusion as an adjunct to continuous fetal monitoring in labor to improve neonatal outcome appears beneficial in select series. The role of repetitive amnioinfusion in the preterm patient remote from term may offer marginal clinical benefit to neonatal outcome and is considered experimental at this time.

Congenital Abnormalities↗
PubMed1976

Bio-behavioral monitoring: a method for remote health measurement.

The treatment of chronic disease has been severely limited by the failure to develop a technology of self-measurement. To examine and validate remotely acquired data from ambulatory patients, 13 cirrhotic subjects were asked to make daily measurements of medically and behaviorally significant variables. Subjects transmitted data for six months on variables such as weight, alcohol consumption, medications, hours worked, liquid consumed and general activity, complying with 90.4% (10,078) of the requests for data. Highly significant relationships were found between patients' reports and criterion measures of weight data and alcohol consumption. Significant negative relationships between hours worked and alcohol consumption were found for several patients (P less than 0.001). The results suggest that ambulatory patients can systematically measure and communicate medically and behaviorally significant information.

Absenteeism↗
PubMed1990

Surgical treatment of epilepsy: three- to six-year follow-up of eleven patients with pharmacologically uncontrolled complex partial seizures.

There are an estimated 100,000 epileptic patients whose response to pharmacologic treatment is unsatisfactory. We report 11 patients with complex partial seizures who were selected for surgical treatment after adequate trials on antiepileptic medication failed. Immediate improvement-no further seizures or reduced frequency of occurrence and severity-was sustained at 3- to 6-year follow-up, and 7 patients were driving, 10 were working, and all were enjoying a better quality of life. Likely candidates for temporal lobectomy or resection of epileptogenic cerebral cortical lesions are those with a single focus of seizure discharge on video-EEG monitoring. If this focus is remote from language or motor areas, and if there is no interference with memory and recall after intracarotid amobarbital injection ipsilateral to the intended surgery, good results can be expected in the majority of such patients. We discuss patient selection and evaluation, and encourage surgical treatment where the indications can be established.

Adolescent↗
PubMedDate not supplied

Flexible monitoring in the management of patient care processes: one year after the pilot study.

A pilot study at a large metropolitan hospital in Auckland identified a specific group of patients that can be safely monitored outside the Coronary Care Unit using Flexible Monitoring technology. This article describes the project management processes used to further develop the remote monitoring system into a hospital network of remote monitoring. The educational and staff support resources required throughout the project are described as are the strategies adopted to meet those needs including the utilization of online learning. Outcomes from the introduction of the system include improved electrokardiogram interpretation by nursing staff and improved ECG resource allocation.

Aged↗
PubMed2005

Multimodality monitoring and telemonitoring in neurocritical care: from microdialysis to robotic telepresence.

PURPOSE OF REVIEW: This review will highlight the state-of-the-art in brain monitoring in neurointensive care and define methods of integrating this technology into patient care using telemedicine methods. RECENT FINDINGS: Several new methods of brain monitoring have been established over the last several years including continuous EEG monitoring, brain tissue oxygenation, jugular venous oxygenation, and cerebral microdialysis. Observational research using these monitors has documented that the brain metabolism, blood flow and function are dynamic after a primary insult. The dynamic nature of the brain can predispose the brain to secondary insults that can occur in the setting of intensive care. Several variables of brain metabolism and function can be monitored and directly impact treatment decisions as well as provide diagnostic and prognostic information. General treatment guidelines for brain injury and brain hemorrhage were developed, in part, prior to implementation of use of these monitors, and there is a trend away from adoption of a one-size-fits-all approach and a trend towards monitor-guided therapy. Dealing with the data provided by multimodality monitoring can be overwhelming. Efficient use of such information requires methods to integrate diverse sets of information, and methods to access the online monitoring information remotely and at any time, day or night. Such remote access integration methods will be reviewed. SUMMARY: Multimodality and telemedicine techniques have advanced the state of knowledge about brain function in critically ill patients, and are presently being implemented to direct therapy. Increasing complexity of care will become commonplace, but will be facilitated by computer-enhanced tools that permit the intensivist to integrate this information into an improved treatment regimen.

Brain Injuries↗
PubMed2006

Mobile telecare system for intensive insulin treatment and patient education. First applications for newly diagnosed type 1 diabetic patients.

The aim of the work was to develop and to evaluate the clinical efficiency of a mobile telecare system implementing teleconsultations based on the continuous transmission of patient-collected data directly to the physician and to the clinic. The developed TeleMed system consists of the patients' and the diabetologist's mobile units, the diabetologist's clinic and home workstations and the clinical server. The evaluation of the system was performed on a group of 13 newly diagnosed type 1 diabetic patients, during a single-arm study with 3-days run-in period, including a one-day intensive educational program, and 3-week study period, when the intensive insulin treatment was conducted without visits of patients to the clinic. The MBG dropped from 7.2 +/- 1.7 mmol/L before the study to 6.1 +/- 1.0 mmol/L in the third week of the study (P = 0.02) and the J-index from 30.2+/-19.2 to 19.7+/-7.7 (P = 0.04). Hemoglobin A1c decreased from 11.8 +/- 3.3% to 8.6 +/- 1.2% (P = 0.0002) in one month. The total daily insulin dose declined from 39.9 +/- 8.5 U to 20.0 +/- 9.6 U (P = 0.000006). The number of hypoglycemia episodes per patient per day decreased by 66% (P = 0.08) and the number of hyperglycemia episodes was reduced by 47% (P < 0.0001). The TeleMed facilitates not only efficient realization of the intensive insulin treatment but also successful remote patient training and education. No formal patient satisfaction study was done. However, some of the findings indicate that the application of the developed system increases patient self-confidence and quality of life.

Diabetes Mellitus, Type 1↗
PubMedDate not supplied

[X-ray monitoring in dental implantology].

The authors analyze x-ray findings in 268 patients before, immediately after implantation, and in the course of subsequent orthodontic treatment and in remote periods after it. Methods of examination and the principal x-ray parameters are discussed that were taken into consideration in the treatment making use of artificial implants.

Adult↗
PubMed2006

Effects of ketamine on precipitated opiate withdrawal.

OBJECTIVE: N-methyl-D-aspartate antagonists were shown to be effective in suppressing the symptoms of opiate withdrawal. Intravenous anesthetic, ketamine, is the most potent N-methyl-D-aspartate antagonist available in clinical practice. The present study was designed to evaluate the effects of subanesthetic ketamine infusion, as little human data are available on ketamine in precipitated opiate withdrawal. MATERIALS AND METHODS: A total of 58 opiate-dependent patients were enrolled in a randomized, placebo-controlled, double-blind study. Patients underwent rapid opiate antagonist induction under general anesthesia. Prior to opiate antagonist induction patients were given either placebo (normal saline) or subanesthetic ketamine infusion of 0.5 mg/kg/h. Further evaluations were divided into three phases: anesthetic, early postanesthetic (48 hours), and remote at 4 months after procedure. Cardiovascular, respiratory, renal, and gastrointestinal responses to opiate antagonist induction were monitored during anesthesia phase. Changes in plasma cortisol concentrations were measured as stress-response markers. Evaluations during early postanesthetic phase were based on Subjective and Objective Opiate Withdrawal Scales. Remote effects were assessed according to questionnaire based on Addiction Severity Index. RESULTS: Altogether, 50 patients were included in the final analysis. Ketamine group presented better control of withdrawal symptoms, which lasted beyond ketamine infusion itself. Significant differences between Ketamine and Control groups were noted in anesthetic and early postanesthetic phases. There were no differences in effects on outcome after 4 months. CONCLUSION: In this study, subanesthetic ketamine infusion was an effective adjuvant in the correction of acute precipitated opiate withdrawal although it had no long-term effects on treatment of opiate dependence.

Adolescent↗
PubMed1998

Double-blind comparison of single-dose alatrofloxacin and cefotetan as prophylaxis of infection following elective colorectal surgery. Trovafloxacin Surgical Group.

BACKGROUND: Alatrofloxacin, the prodrug of trovafloxacin, is a novel fluoroquinolone antimicrobial agent with a broad spectrum, including activity against gram-positive and gram-negative aerobes and anaerobes. Its pharmacokinetic properties (long half-life, excellent tissue distribution, and good safety profile) suggest a role in surgical prophylaxis. This prospective, multicenter, double-blind trial compared alatrofloxacin with cefotetan, an approved drug for surgical prophylaxis, in reducing postoperative infections. METHODS: The efficacy and safety of a single 200-mg intravenous dose of alatrofloxacin were compared to a single 2-g intravenous dose of cefotetan in 492 patients undergoing elective colorectal surgery. The efficacy of alatrofloxacin as a prophylaxis for wound, intra-abdominal, or remote-site postoperative infectious complications was compared with cefotetan in 317 clinically evaluable patients; 161 received alatrofloxacin and 156 received cefotetan. The patients were monitored for infections and safety for 30 days postoperatively. RESULTS: No statistically significant between-treatment difference was detected in successful clinical response rates at the end of the study (72% for each group). The incidence of primary wound infections at the time of hospital discharge was also similar: 21% in patients treated with alatrofloxacin and 18% in those treated with cefotetan. Safety, established by the incidence of adverse events, did not differ statistically between the groups. CONCLUSIONS: A single intravenous dose of alatrofloxacin given within 4 hours prior to surgery was as effective as an intravenous dose of cefotetan in the prevention of postoperative infectious complications in patients undergoing elective colorectal surgery. The safety profiles of the two medications were similar.

Adolescent↗
PubMed2006

Wireless health care service system for elderly with dementia.

The purpose of this paper is to integrate the technologies of radio frequency identification, global positioning system, global system for mobile communications, and geographic information system (GIS) to construct a stray prevention system for elderly persons suffering from dementia without interfering with their activities of daily livings. We also aim to improve the passive and manpowered way of searching the missing patient with the help of the information technology. Our system provides four monitoring schemes, including indoor residence monitoring, outdoor activity area monitoring, emergency rescue, and remote monitoring modes, and we have developed a service platform to implement these monitoring schemes. The platform consists of a web service server, a database server, a message controller server, and a health-GIS (H-GIS) server. Family members or volunteer workers can identify the real-time positions of missing elderly using mobile phone, PDA, Notebook PC, and various mobile devices through the service platform. System performance and reliability is analyzed. Experiments performed on four different time slots, from three locations, through three mobile telecommunication companies show that the overall transaction time is 34 s and the average deviation of the geographical location is about 8 m. A questionnaire surveyed by 11 users show that eight users are satisfied with the system stability and 10 users would like to carry the locating device themselves, or recommend it to their family members.

Activities of Daily Living↗
PubMed2003

Neurointensive care unit system for continuous electrophysiological monitoring with remote web-based review.

There is a need in the neurological intensive care unit for a single integrated bedside monitor for continuously monitoring the function of the patient's central nervous system. In this paper, we demonstrate the feasibility of building such a system and operating it in the intensive care environment. We have developed a fully automated system that samples electrophysiological waveforms of various modalities according to a schedule of predefined intervals along with routinely monitored cardiac and respiratory parameters. The system provides stimulation and acquires responses without requiring supervision. The electrophysiological data include brainstem auditory and somatosensory evoked potentials and epochs of the electroencephalogram. The system applies peak detection and spectral analysis to extract salient parameters from the raw waveforms. The results are made available immediately in real time on the local network for local review and further analysis. A web-based interface makes review by a qualified neurologist possible anywhere within the hospital's secure intranet during and after monitoring. This system could potentially give an early warning of impending herniation, subclinical seizures, and brain or spinal cord ischemia. We demonstrate its application in a few diverse neurological intensive care cases and a case in the interventional neuroradiology suite.

Aged↗
PubMed2000

Epilepsy surgery in children with tuberous sclerosis complex: presurgical evaluation and outcome.

PURPOSE: Children with tuberous sclerosis complex (TSC) benefit from excisional surgery if seizures can be localized to a single tuber. We evaluated the role of noninvasive studies to localize the epileptogenic tuber/region (ET/R) and the outcome of focal resection. METHODS: We identified 21 children with TSC, ages 3 months to 15 years (mean 4.8 years). All had video-(electroencephalogram) EEG and magnetic resonance imaging (MRI) scans, and 18 also had ictal single photon emission-computed tomography (SPECT) studies. An ET/R was localized in 17 patients. Thirteen patients underwent resection guided by intraoperative electrocorticography (n = 7) or subdural monitoring (n = 6). RESULTS: Interictal EEG revealed a principal spike focus (PSF) that corresponded to the ET/R in 14 children. In seven, PSFs occurred in rhythmic runs. PSFs were not observed remote from the ET/R. Focal polymorphic slowing and attenuation occurred in the region of the PSF in 11 patients. Sixteen patients demonstrated an ictal focus corresponding to the ET/R. Ictal SPECT revealed focal hyperperfusion correlating with the ET/R in 10 patients. Although the MRIs in all children revealed multiple tubers, the ET/R corresponded to a large discrete tuber in 8 patients and a calcified tuber in 13 patients. Patchy calcified tubers were also seen elsewhere in six patients. At a mean follow-up of 26 months, 9 of the 13 children who underwent surgery were seizure-free, one had greater than 75% reduction in seizures, two were unchanged, and one was lost to follow-up. New seizures developed in one child from a contralateral tuber. CONCLUSIONS: Surgical resection of an ET/R alleviates seizures in most children with TSC and intractable epilepsy. The scalp EEG and MRI help define the ET/R and improve case selection when ictal SPECT is nonlocalizing.

Adolescent↗