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Results for “Complex intervention”

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At least 271 records · Page 15Linked to original sources

PubMed2005

[Prevention of cardiovascular diseases by an antihypertensive program in the elderly, a cohort study].

INTRODUCTION: We started on year 2000 a Complex Intervention Program addressed at hypertension control among our patients. AIM: To compare the risk of cardiovascular events and of dying in hypertensive patients under Program care. METHOD: We started follow-up of a cohort of 1922 patients over 65 years in August 2000. Hipertension diagnosis was ascertained if patient reported to be hypertensive, or was under anti hypertensive treatment or if he/she had two blood pressure measurements = 140/90 mm Hg. Cardiovascular events were considered to be admissions due to coronary disease, cardiac insufficiency or stroke. Incidence is reported by 100 person years follow-up. Relative risks between hypertensive and normotensive patients were calculated and Cox regresión was used to adjust for potential confounders. We compared time to first cardiovascular event and to death with Log Rank Test. RESULTS: Fourty eight point three percent of patients were hypertensive and differed from normotensive patients as to age (79 (5) years vs. 77 (5) p < 0.001), proportion of diabetic patients (16.1% vs. 7.6% p < 0.001). Mean follow-up time was 28 months. Mortality RR was 1.04 (95% CI 0.69-1.58). As to incidence of cardiovascular events it was 1.86 in normotensive vs. 3.02 (RR 1.62 95% CI 1.09-2.42). When adjusted by age, sex, smoking, dislipemia and diabetes, OR was 1.3 (95% CI 0.86-1.98). CONCLUSIONS: Hypertension did not increase the risk in cardiovascular events among our hypertensive patients at 2.3 years follow-up.

Aged↗

PubMed2001

EBM in practice: aged care.

Clinical trials often exclude older people, and complex interventions are incompletely studied, making it difficult to implement evidence-based medicine in some areas of aged care. There is good-quality evidence to guide the treatment of many of the common clinical problems encountered in older people. Use of outcome measures in trials (eg, quality-adjusted life-years or disability-adjusted life-years) that are normally applied to the general population may disadvantage older people, for whom regaining independence is the chief concern. There is a gap between the availability of evidence and its application in routine provision of medical care for older people.

Aged↗

PubMed1999

A multicenter randomized trial comparing a percutaneous collagen hemostasis device with conventional manual compression after diagnostic angiography and angioplasty.

OBJECTIVES: A new percutaneous collagen hemostasis device was compared with conventional compression techniques after diagnostic catheterization and angioplasty. Background. Peripheral vascular complications after diagnostic catheterization or more complex interventional procedures, as well as the discomfort of manual compression and prolonged bed rest, represent significant morbidity for invasive cardiac procedures. METHODS: A prospective, multicenter, randomized trial was designed to compare the hemostasis time in minutes and the incidence of vascular complications in patients receiving a vascular hemostasis device with those undergoing conventional compression techniques. RESULTS: After diagnostic catheterization, hemostasis time was significantly less with the vascular hemostasis device than with conventional manual compression (4.1 +/- 2.8 min [n=90 patients] vs. 17.6 +/- 9.2 min [n= 75], p < 0.0001). This difference was greater in patients undergoing angioplasty and was unrelated to the anticoagulation status (4.3 +/- 3.7 min [n = 71 not receiving the heparin], 7.6 +/- 11.6 min [n= 85 receiving heparin], 33.6 +/- 24.2 min [n= 134 control patients not receiving heparin], p < 0.0001 vs. control patients). The time from the start of the procedure to ambulation was slightly less after diagnostic catheterization in patients treated with the device (13.3 +/- 12.1 hours vs. 19.2 +/- 17.8 hours, p < 0.05). It was also less in patients who underwent angioplasty when the device was used after discontinuation of anticoagulation (23.0 +/- 11.1 hours, without heparin), as compared with control compression techniques (32.7 +/- 18.8 hours, p < 0.0001). Time to ambulation was even shorter (16.1 +/- 11.1 h, p < 0.0001) in patients in whom the device was placed immediately after angioplasty while they were still fully anticoagulated with a prolonged activated clotting time (336 +/- 85 s). There were no major complications (surgery or transfusion) after diagnostic catheterization and a low incidence of major complications in patients who underwent angioplasty (0.7% in control patients, 1.4% with the device without heparin, 1.2% with the device and heparin, p = NS). After angioplasty, there was a trend toward fewer hematomas when the device was used in the absence of heparin (4.2% vs. 9.7% in control patients, p = 0.14). CONCLUSION: A new vascular hemostasis device can significantly reduce the puncture site hemostasis time and the time to ambulation without significantly increasing the risk of peripheral vascular complications The role of this technology in reducing complications, length of hospital stay and cost remains to be determined.

Aged↗

PubMed2001

Medical and psychological aspects of infertility and assisted reproductive technology for the primary care provider.

Couples attempting to conceive are requiring more assisted reproductive technology. Infertility may be associated with delayed onset of marriage and childbearing, smoking and alcohol excess, physiological factors such as endometriosis and varicocele, or a cause that is not identified. The psychological needs of couples, however, are often overlooked. Primary care providers can serve as the initial information source and guide for the couple struggling with infertility. In a managed care environment, a primary care provider can provide a considerable amount of education, referral for stress management and counseling, and a small portion of the medical evaluation before referring to a reproductive specialist. This overview is intended to help primary care providers and couples achieve an educated and less stressful assisted reproductive technology experience. It is not meant to circumvent the need for immediate referral to a reproductive specialist for evaluation and treatment of this very complex intervention.

Female↗

PubMed2002

[Tobacco dependence--evidence-based treatment strategies].

One third of German smokers try to stop smoking at least once a year. As smoking is an important risk factor for the development of numerous diseases and a number of smoking-cessation strategies have proved to be effective every smoker should be encouraged to give up smoking and be informed of these methods. A more widespread use of evidence-based smoking-cessation methods should therefore be promoted more vigorously. Evidence based smoking-cessation guidelines summarising the main treatment recommendations suggest that maximum support towards motivating the smoker be made available. Only if other treatments are not available, should this take the form of brief contacts. More complex interventions should be supplemented by behaviour therapy aimed at changing behaviour patterns. Medical support in the form of nicotine replacement (NRT) or bupropion treatment should be offered. Moreover international guidelines (not only German ones but also American, and European ones in general) all recommend as the most effective strategy the combining of smoking-cessation methods based on behavioural treatment with nicotine replacement therapy or bupropion treatment.

Evidence-Based Medicine↗

PubMedDate not supplied

[The nurse's role in the identification and management of alcohol abuser in the Emergency Department].

The emergency department (ED) nurse plays a major role both in recognizing and in the management of the patients affected by alcohol related problems, such-as acute alcohol intoxication (AAI), alcohol withdrawal (AW), traumatic or spontaneous illness due to acute or chronic effects of alcohol abuse. Here are described both the clinical problems and the diagnostic instruments that nurse can use in ED to increase diagnostic sensibility. Furthermore both clinical features of AAI in relation with blood alcohol concentration (BAC), diagnostic criteria and test to evaluate AW severity are reported in this review. Even diagnostic instruments to identify alcohol abuse also in trauma are reported: the alcohol breath test, BAC and laboratory test. Even the Alcohol Use Disorders Identification Test (A.U.D.I.T.) questionnaire is reported to recognize the alcohol abuser. In conclusion acquiring a specific training, nurse can play a major role in the complex intervention net of alcoholics rehabilitation.

Accidental Falls↗

PubMed2003

[Evaluation of disease management programs--current deficits, demands and methods].

The evaluation of disease management programmes is necessary and has been made obligatory in Germany by the Fifth Book of Social Code. So far there has been extensive ambiguity as regards the precise definition of suitable strategies for the evaluation. Considering the scientific evaluation of the diabetes contract in North-Rhine current deficits of the evaluation of already existing programmes for chronically ill patients are exemplarily described. On the basis of international experience reasonable demands are discussed that ought to be accomplished when evaluating the effectiveness and benefit of the programmes. Taking the British Medical Research Council as an example, a four-step model will be suggested as a loophole in the methodological dilemma of varying suitable study designs, which allows for the adequate evaluation of even complex interventions.

Disease Management↗

PubMed2004

[New perspectives in modulation of PPAR nuclear receptors].

Modulation of the function of nuclear receptors PPAR (peroxisome proliferators activated receptors) is one of most attractive fields in pharmacological research. Today it represents an important part of the clinical use of antidiabetic and hypolipidemic drugs (PPAR alpha and gamma). Significant development is expected in PPAR beta modulation and in the complex intervention of several receptor families (double and triple sensitisers). Drugs influencing PPAR will be used in future in dermatology, surgery, obesitology, oncology, gastroenterology and also in neurology and psychiatry.

Cell Nucleus↗

PubMed2006

[Application of non-randomized study in the field of traditional Chinese medicine or integrated traditional Chinese and Western medicine].

Non-randomized studies (NRS) have gradually attracted people's attention in the field of clinical medicine. In this paper, the importance of NRS was emphasized on the viewpoints of the coherence of scientific research, the limitation of randomized control trials (RCTs), the immanent characteristics of TCM clinical practice and the actual requirement of complex intervention in clinical practice. And two main points in evaluation and implementation of NRS differed to those in RCTs were put forward, i.e. the first, the full-scale design of the study with the professional characteristics should be described very explicitly, especially the speciality of the objects, intervention elements and indexes for effectiveness evaluation, etc.; the second, the control of bias and evaluation of effectiveness, and their influence on conclusion induction should be fully taken into consideration. At the same time, the key step in improving the quality of NRS of TCM and integrative medicine was preliminary discussed in this paper.

Clinical Trials as Topic↗

PubMed2006

Simultaneous subacute stent thrombosis of two drug-eluting stents in the left anterior descending and the circumflex coronary arteries. Case report and review of the literature.

In the area of drug-eluting stents (DES), complex interventional procedures are increasing in number. In particular, the number of patients undergoing three-vessel or bifurcation lesion stenting is rising, together with increasing concern about the risk of acute stent thrombosis in the area of the DES. In this paper, we present a patient who underwent multivessel bifurcation stent placement after an acute inferior myocardial infarction over a period of one week, with sudden subacute stents thrombosis of the two drug-eluting stents in the left anterior descending and the circumflex coronary arteries, leading to death. This case report is followed by a review of literature.

Angioplasty, Balloon, Coronary↗

PubMed2006

Hepatitis C infection among injecting drug users in general practice: a cluster randomised controlled trial of clinical guidelines' implementation.

BACKGROUND: Hepatitis C is a common infection among injecting drug users and has important implications for general practice. Although several clinical guidelines concerning the infection have been published, their effectiveness has yet to be tested. AIM: To assess the effectiveness of a general practice-based complex intervention to support the implementation of clinical guidelines for hepatitis C management among current or former drug users attending general practice. DESIGN OF STUDY: Cluster randomised controlled trial. SETTING: General practices in the Eastern Regional Health Authority area of Ireland. METHOD: Twenty-six practices were randomly allocated within strata to receive the intervention under study or to provide care as usual for a period of 6 months. There was screening for patients attending general practice for methadone maintenance treatment for hepatitis C and referral of anti-HCV antibody positive patients to a specialist hepatology department for assessment. RESULTS: At study completion, patients in the intervention group were significantly more likely to have been screened for hepatitis C than those in the control group, odds ratio adjusted for clustering 3.76 (95% confidence interval [CI] = 1.3 to 11.3) and this association remained significant after adjusting for other potentially confounding variables, using multiple logistic regression, with the odds ratio adjusted for clustering 4.53 (95% CI = 1.39 to 14.78). Although anti-HCV antibody positive patients in the intervention group were more likely to have been referred to a hepatology clinic, this was not statistically significant (P = 0.06). CONCLUSION: General practice has an important role in the care of people at risk of hepatitis C and when appropriately supported can effectively implement current best practice.

Adult↗

PubMed2006

The pharmacological management of spasticity.

The spectrum of antispasticity therapies is fairly broad. Familiarity with the various therapies will enable a nurse involved in the care of neurological patients to deliver the effective treatment and minimize adverse events. Referral to specialty care centers may be appropriate for selected patients who require more complex interventions for spasticity control.

Baclofen↗

PubMed1990

Postcatheterization vascular complications associated with percutaneous transluminal coronary angioplasty.

The threat of a vascular complication exists in association with any percutaneous arterial catheterization, but is greater in the more complex interventional techniques. During a 3 1/2-year period from January 1985 through June 1988, 4988 percutaneous transluminal coronary angioplasty procedures were performed at Emory University Hospital. All patients were given heparin during the cardiac intervention, and all had a catheter introducer left in place for several hours after completion of the procedure. Fifty-five iatrogenic vascular complications developed in 52 patients (1%), resulting in 54 corrective operations. Pseudoaneurysm, the most frequent complication, was seen in 35 patients (64%). This was followed by arteriovenous fistula in eight (15%), uncontrolled hemorrhage in six (11%), arterial thrombosis in three (6%), peripheral embolization in two (4%), and bowel ischemia in one patient. The outcome of surgical therapy in the entire group was quite acceptable with no operative mortality, no extremity amputation, and a 7.4% complication rate. Variables that correlated with an increased risk of peripheral vascular problems after percutaneous transluminal coronary angioplasty included advanced age, female gender, thrombolytic therapy, and postprocedural anticoagulation. Variables that did not appear to correlate were hypertension, diabetes, prior percutaneous transluminal coronary angioplasty, antiplatelet therapy, or the size of the guiding catheter used.

Aged↗

PubMed1986

Monitoring of effects of cis-diamminedichloroplatinum (II). Part III. Effect of platinum complexes on PHA-stimulated proliferation of human peripheral blood mononuclear cells in vitro.

The effect of the platinum complexes cis-DDP and CBDCA on the functions of human peripheral blood mononuclear cells (PBMC)--viability, proliferating activity after polyclonal stimulation with phytohemagglutinin is followed in an in vitro study. Both the platinum complexes (at concentrations 10(-5) up to 10(-9) mol/l) inhibit significantly the proliferating activity of PBMC without affecting its viability, i.e. integrity and permeability of the cell membrane structures. As to effectivity, cis-DDP has shown itself a more effective inhibitor of cellular proliferation than CBDCA of which 10-100 times higher concentrations are required to achieve the same inhibitory effect in dependence on the temporal relation to the application of phytohemagglutinin. The highest inhibitory effect is noted when cis-DDP is applied either simultaneously with, or 48 h after PHA, i.e. at the stage of maximum proliferating activity. The results bring support to the assumed mechanism of action of the above platinum complexes--intervention into DNA synthesis. Since the test of blastic transformation of PBMC is held to be an image primarily of the function of T lymphocytes, it may be inferred that platinum cytostatics can affect cell-mediated immunity also in patients.

Adult↗

PubMed1979

[Fatal complications following the implantation of artificial lense (author's transl)].

The number of cataract operations with implantation of artificial lenses has been increasing in recent years. However, there is hardly any information available concerning possible serious consequences. While there are detailed reports on histopathological findings following conventional cataract operations, fatal complications of this technically complex intervention are only mentioned occasionally. There were 9 cases with serious complications in our polyclinic in 1976, and this report deals with the histopathological findings in 6 enucleated eyes. The authors warn against ill-considered decisions to perform a lens implantation.

Adult↗

PubMed1997

[Psychological aspects of erectile dysfunction].

It is widely accepted opinion that male sexuality comprises more than an erected penis. This fact should be considered in the management of erectile dysfunction. Therefore, the valuation of sexual disturbances have to be essentially included in the general examination programme of erectile impotence. Several causes are known to contribute to an erectile dysfunction. The anamnesis can be taken as an important tool for classification of the erectile dysfunction. The following questions are helpful in the clinical practice: erectile dysfunction during sexual intercourse only but also during masturbation; spontaneous erections; dependence of the erectile impotence on special situations, partners and events; questions for somatic and psychosocial risks. Sexual therapy represents a complex intervention will be aim of improvement of the functional disturbances in consideration of the general risks for sexual impairments.

Erectile Dysfunction↗

PubMed1977

[Hepato-biliary-pancreatic lesions in secondary duodenostasis].

The secondary postoperative duodenal stasis (afferent loop syndrome, chronic vicious circle) is underlain by evacuational disturbance of the duodenum. The duodenal stasis and hypertension lead to the stasis of the bile and pancreatic-secretion, which in turn results in inflammatory-dystrophic changes in the hepato-biliary-pancreatic system. In such cases the success of surgical treatment will derive from the application of complex intervention both on the digestive tract and hepato-biliary system.

Afferent Loop Syndrome↗

PubMedDate not supplied

The management of fluid balance.

This is the sixth part in the series Care is Critical, which looks at the more complex interventions nurses now have to deal with on general wards and in the community. This article looks at the clinical assessment and management of fluid-balance disturbances.

Aged↗