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PubMed2003

Comparison of thermodilution bolus cardiac output and Doppler cardiac output in the early post-cardiopulmonary bypass period.

OBJECTIVE: To evaluate the accuracy of measuring cardiac output (CO) in the early post-cardiopulmonary bypass (CPB) period by comparing thermodilution with Doppler methods. DESIGN: Prospective and blinded human trial. SETTING: Academic medical center. PARTICIPANTS: Thirty adult patients undergoing elective coronary artery bypass graft surgery. MEASUREMENTS AND MAIN RESULTS: Thermodilution CO (TCO) was obtained in triplicate. Doppler CO (DCO) in triplicate was obtained at the left ventricular outflow tract (LVOT), aortic valve (AV), and right ventricular outflow tract (RVOT). CO measurements were made (1). before CPB (baseline), (2). immediately after CPB, (3).15 minutes after CPB, and (4). 30 minutes after CPB. Before CPB, the DCO at LVOT, RVOT, and AV showed good correlations (r = 0.87, r = 0.88, and r = 0.84, respectively) with TCO. Bias analysis showed no significant difference among TCO and 3 DCOs (p > 0.05 each). Correlation between DCO and TCO decreased but remained significant after CPB (r between 0.57 and 0.85, p < 0.001). The bias among TCO and each of the DCOs at the LVOT, RVOT, and AV increased immediately after CPB (p < 0.01, p < 0.01, and p < 0.05, respectively) and remained significant at 15 minutes and 30 minutes post-CPB except for DCO at the AV. TCO exceeded DCO by 0.44 to 0.72 L/min immediately after CPB. The CO measured by both thermodilution and Doppler methods gradually decreased over time post-CPB. The decrease in CO was significant at 30 minutes post-CPB (p < 0.01). CONCLUSION: This study adds further support that DCO is a clinically acceptable method to accurately assess the CO in patients even during periods of uneven regional body temperatures as may occur in the early post-CPB period.

Aged↗

PubMed1975

[Motivation and education].

It was thought for many years that successful motivation in oral health should be based on the knowledge of epidemiology of caries and periodontal diseases and the methods of prevention. One should learn from mistakes: 95 per cent of the Swiss population "suffers" from caries and periodontal disease but apparently this had little impact on prevention. Simple, world-wide accepted methods of prevention are not used by the majority although they provide a pronounced reduction of caries and gingivitis. The number of Swiss communities which offer adequate preventive programs to schoolchildren ranges between 5 to 10 per cent. Although the budgets of school dental services could be lowered by 75%. Reasons for such failures may be inadequate information of dentists, authorities and the population. Not enough information is spread regarding sugarless sweets, or prevention by fluoride. Unsuccessful motivation probably also lies in the inadequate assignment of the roles ofthe patient, his dentist and the social security. So far only the dentist has formulated oral health duties to the patient, e.g. a better oral hygiene, a reasonable healthy nutrition. In the future the patient should have the right to ask the dentist some questions. Is his dentition at the end of a treatment, healthy and ready to render hygienic efforts effective? Patient, doctor and insurances should know that disease still exists if gingival papillae bleed upon using a toothpick. Absence or presence of gingival bleeding are the criteria for health or disease. A check list of the state of oral health and a signed questionnaire concerning the patient's knowledge of oral health are used to improve motivation of both patient and dentist.

Dental Hygienists↗

PubMedDate not supplied

Pseudoephedrine absorption from controlled release formulations: absorption rate constant estimation methods.

Five methods of absorption rate (Ka) estimation were compared using data from a previously reported bioavailability study: Wagner-Nelson (WN), asymptotic WN (AWN), the Hendeles-Weinberger modification of the WN (HW), nonlinear regression performed on plasma concentration vs time data with fixed elimination rates (NL), and nonlinear regression performed on the cumulative sum of AUCs obtained during WN analysis (AUCNL). The maximum plasma concentration (Cmax) and the time at which Cmax occurred (Tmax) were predicted with each method's respective Ka's, and these were compared to observed values. The WN and HW were consistently biased in their predictions of Cmax and Tmax, providing slower Ka's than any of the other methods. AWN could only be used for the reference treatment. Both NL and AUCNL provided unbiased estimations, but AUCNL had a high level of imprecision. With this set of data, only NL was an acceptable method for accurately estimating Ka.

Adult↗

PubMed2002

Women at high risk for breast cancer: preventive strategies.

Prevention of breast cancer is a high priority for women at risk for the disease. Management options for this group include close surveillance, chemoprevention, and prophylactic mastectomy (surgical prophylaxis). The optimal method remains to be determined. However, at the present time, close surveillance, which include breast self-examination, annual or semiannual physical examinations, and annual mammography starting at age 30, remains the most widely accepted method.

Anticarcinogenic Agents↗

PubMed1999

Minimally invasive vascular surgery: review of current modalities.

The concept of a minimally invasive approach to the treatment of vascular pathology was realized nearly 30 years ago when Charles Dotter described dilatation of atherosclerotic stenoses. Since that time biotechnology and therapeutic innovation have progressed to the point where entire medical subspecialties are based on the endoluminal treatment of diseases of the blood vessels. The most rapid progress has been made in the area of endoluminal treatment of vascular lesions, with angioplasty, stent, and stent graft deployment becoming an increasingly common method of treating various vascular lesions. Extraluminal endoscopic treatment of vascular disease has been gaining popularity, particularly for management of perforator vein incompetence associated with venous stasis disorders. Endoscopic saphenous vein harvest has become an accepted method for minimizing the length of incision required for saphenectomy. Vascular imaging has followed similar trends, with more detailed information being derived from tiny intravascular ultrasonic catheters. This article summarizes the current state of minimally invasive vascular surgery to provide the reader with an understanding of the efficacy of the various modalities. It also discusses future directions in the field.

Angiography↗

PubMed1998

Assessing strength of preference for abortion method using 'willingness to pay': a useful research technique for measuring values.

Policy makers and practitioners need to differentiate between patient preferences which are strongly held, and those which are not. This study measured not only women's preferences for medical abortion versus surgical vacuum aspiration, but also the strength of these preferences, using a 'willingness to pay' (WTP) technique. Fifty women were recruited and interviewed prior to and following termination of early pregnancy. Due to the sensitivity of the situation, the WTP approach was administered by interview. Results revealed that 34 (64%) preferred to have the medical method. The amounts offered for each method were similar; however, a minority gave higher values for the medical method, thus for those women their strength of preference for that method was more intense. Validity of the technique was supported by the finding of a positive association with social class and the importance women attached to having choice. It is argued that WTP is an acceptable method for the elicitation of strength of treatment preferences. Its further use by nurses and midwives to assess health care preferences should be explored, particularly when considering aspects of care which are traditionally difficult to identify and measure.

Abortion, Induced↗

PubMed1979

Determination of vitamin D in foods: a review.

Determining vitamin D content in foods is difficult because in natural foods of highest vitamin D activity, and even in vitamin D-fortified foods, only small quantities are present, and many other compounds are extracted along with vitamin D that cause difficulties in purifying the extract or in the spectrophotometry or colorimetry that follows. Several physicochemical methods--such as spectrophotometric, colorimetric, thin-layer chromatographic, adsorption, partition, gas-liquid, and high-performance column chromatographic--have been tried for assay foods for vitamin D, but none of them have been accepted for official or routine use; they are time consuming and expensive, or lack the required sensitivity, precision, or accuracy. Curative biological assays, based on degree of healing of a leg bone of rats previously made rachitic, is the generally accepted method to determine vitamin D content of foods. However, that method also requires too much time and is expensive. The recently developed high-performance liquid chromatographic method may offer the most for establishing a satisfactory physicochemical method for determining vitamin D in foods. Many of the difficulties and problems in assaying foods for vitamin D are discussed.

Animals↗

PubMed1998

Energy expenditure in children predicted from heart rate and activity calibrated against respiration calorimetry.

The purpose of this study was to predict energy expenditure (EE) from heart rate (HR) and activity calibrated against 24-h respiration calorimetry in 20 children. HR, oxygen consumption (VO2), carbon dioxide production (VCO2), and EE were measured during rest, sleep, exercise, and over 24 h by room respiration calorimetry on two separate occasions. Activity was monitored by a leg vibration sensor. The calibration day (day 1) consisted of specified behaviors categorized as inactive (lying, sitting, standing) or active (two bicycle sessions). On the validation day (day 2), the child selected activities. Separate regression equations for VO2, VCO2, and EE for method 1 (combining awake and asleep using HR, HR2, and HR3), method 2 (separating awake and asleep), and method 3 (separating awake into active and inactive, and combining activity and HR) were developed using the calibration data. For day 1, the errors were similar for 24-h VO2, VCO2, and EE among methods and also among HR, HR2, and HR3. The methods were validated using measured data from day 2. There were no significant differences in HR, VO2, VCO2, respiratory quotient, and EE values during rest, sleep, or over the 24 h between days 1 and 2. Applying the linear HR equations to day 2 data, the errors were the lowest with the combined HR/activity method (-2.6 +/- 5.2%, -4.1 +/- 5.9%, -2.9 +/- 5.1% for VO2, VCO2, and EE, respectively). To demonstrate the utility of the HR/activity method, HR and activity were monitored for 24 h at home (day 3). Free-living EE was predicted as 7,410 +/- 1,326 kJ/day. In conclusion, the combination of HR and activity is an acceptable method for determining EE not only for groups of children, but for individuals.

Body Composition↗

PubMed1999

[Evaluation of an educational course for pregnant adolescents].

The pregnancy among adolescent women in Mexico is close than half million by year, this problem could be attended through health education in the Mexican medical care system. Since 1995 the Instituto Nacional de Perinatologia has a free training program only for adolescents designed to improve the health care medical procedures and reduces some perinatals health risks. This paper shows the structural design, functioning strategies and results of its application. Through a pre codificated 48 item list, were analyzed transversally the clinical records of 234 adolescents engraved themselves to the course. Two groups were formed: the "A" group with the patients attended at least to three sessions (106) and the group "B" with the ones who did not (128). The data analysis was made by contrasting each item between the groups using the appropriate statistical tests. The group "A" had greater average in scholarship, the moreover socioeconomic characteristics and gynecoobstetric background did not show significant differences. Group "B" had a higher proportion of adolescent with aggregated pathology to the pregnancy. We too observed significant differences in the proportions of complications during the pregnancy evolution and in the postpartum period. The acceptance on the pregnancy by the adolescent, her family and by her couple also showed significant differences. The average weight of the newborns were greater statistically in the "A" group. The proportions of family planning methods acceptance was higher in the same group, who has too shorter intra-hospitalary stay. This evaluation shows good fitness with the adolescents education expectatives and performance and favorable associations with some perinatals health risks.

Adolescent↗

PubMed2001

A review of therapeutic ultrasound: effectiveness studies.

BACKGROUND AND PURPOSE: Therapeutic ultrasound is one of the most widely and frequently used electrophysical agents. Despite over 60 years of clinical use, the effectiveness of ultrasound for treating people with pain, musculoskeletal injuries, and soft tissue lesions remains questionable. This article presents a systematic review of randomized controlled trials (RCTs) in which ultrasound was used to treat people with those conditions. Each trial was designed to investigate the contributions of active and placebo ultrasound to the patient outcomes measured. Depending on the condition, ultrasound (active and placebo) was used alone or in conjunction with other interventions in a manner designed to identify its contribution and distinguish it from those of other interventions. METHODS: Thirty-five English-language RCTs were published between 1975 and 1999. Each RCT identified was scrutinized for patient outcomes and methodological adequacy. RESULTS: Ten of the 35 RCTs were judged to have acceptable methods using criteria based on those developed by Sackett et al. Of these RCTs, the results of 2 trials suggest that therapeutic ultrasound is more effective in treating some clinical problems (carpal tunnel syndrome and calcific tendinitis of the shoulder) than placebo ultrasound, and the results of 8 trials suggest that it is not. DISCUSSION AND CONCLUSION: There was little evidence that active therapeutic ultrasound is more effective than placebo ultrasound for treating people with pain or a range of musculoskeletal injuries or for promoting soft tissue healing. The few studies deemed to have adequate methods examined a wide range of patient problems. The dosages used in these studies varied considerably, often for no discernable reason.

Humans↗

PubMed1994

PIC lines save money and hasten discharge in the care of children with ruptured appendicitis.

UNLABELLED: With the need for physicians to help control the rising cost of health care, consideration should be made, when appropriate, to shift more expensive inpatient care (IPC) to the less costly home care (HC) setting. The management of ruptured appendicitis (RA) includes appendectomy and intravenous (IV) antibiotics. Although patients' gastrointestinal function often returns by postoperative day 3 to 5, 10 to 12 days of IPC may be required for completion of the IV antibiotics. A new method of IV access, appropriate for pediatric patients and HC, is the PIC line--a peripherally inserted, centrally placed, intermediate-term silastic catheter. The purpose of this study is to compare the use of short plastic cannulas (SPC) and IPC tl PIC lines and HC in the management of patients with RA with respect to cost, length of hospitalization, morbidity, and patient/family acceptance. METHODS: All children under the care of a single surgeon for RA underwent appendectomy and received IV antibiotics. The antibiotics were continued for a minimum of 10 days postoperatively, or until the patient was afebrile and the white blood cell count was less than 10,000/mm3. Group I (n = 8) had IV access via SPC and IPC care. Group II (n = 8) had a PIC line placed and was discharged to HC when intestinal function returned. The two groups were compared for: number of inpatient days (IPD), home care days (HCD), total care days (TCD), inpatient costs (IP$), home care cost (HC$), total care costs (TC$), number of IVs needed (#IV), catheter related complications, patient/family acceptance of the PIC line/HC concept, and overall morbidity. RESULTS: The children with PIC lines (group II) were all discharged to HC by the seventh postoperative day and received an additional 5 days of antibiotics. The children on conventional inpatient therapy (group I) stayed in the hospital an additional 6 days (P = .002). Both groups had equivalent TCD. The children with PIC lines had lower IP$ (P = .002) and significantly lower (40%) TC$ than did IPC patients (P = .004). The children in group I required placement of more than five IV catheters during their hospitalization. In contrast, the PIC lines were successfully placed in group II patients, and no further IV access was necessary (P = .001). There were no complications from the PIC lines. Neither group experienced recurrent infections or required readmission. The patients' and families' acceptance of the PIC line/HC concept was unanimously favorable. CONCLUSION: When compared with SPC/IPC, PIC line/HC is a safe, efficacious, and significantly cost-effective method for the care of the patient with RA. As experience with PIC line/HC grows, it may become the preferred method of treatment for a variety of illnesses that currently require intermediate-length courses of IV therapy and IPC.

Anti-Bacterial Agents↗

PubMedDate not supplied

Methods of cost-effectiveness analysis: areas of consensus and debate.

Methods of evaluating socioeconomic relationships have evolved over many years, and a number of specific approaches have been developed. Among the techniques available, cost-effectiveness analysis (CEA) has emerged as the most widely used and accepted method. Yet, despite considerable effort by the analytical community to refine this technique into one more useful for making health policy decisions, much debate and confusion still persist among analysts, readers, and policy-makers concerning methods standards and the overall usefulness of CEA in resource allocation decision making. Thus the purpose of this paper is to summarize, critically examine, and comment on existing recommended methods for socioeconomic evaluation of health care interventions. In particular, we examine an exhaustive set of component methods within the general area of cost-effectiveness and comment on areas of apparent consensus and debate. Our review reveals many areas of agreement and many yet to be resolved. Analysts generally agree on the components of the overall framework for an analysis; basic methodologic principles; the general treatment of costs; the principle of marginal analysis; the need for and general approach to discounting; the use of sensitivity analysis; the extent to which ethical issues can be incorporated; and the importance of choosing appropriate alternatives for comparison. The principal areas in which disagreement still persists are choice of study design, measurement and valuation of health outcomes including conversion of health outcomes to economic values, transformation of efficacy results into effectiveness outcomes, and the empirical measurement of costs.

Cost-Benefit Analysis↗

PubMed1994

Photography without film: low-cost digital cameras come of age in dermatology.

BACKGROUND: Photography is integral to the practice of dermatology. Digital imaging techniques have only recently been used to assess cutaneous disorders. Previously reported imaging systems have been both expensive and cumbersome. Consequently, they have failed to gain wide-spread acceptance. METHODS: We describe our experience using an inexpensive digital camera. Photographs taken with this portable digital camera (FotoMan) compare favorably to those obtained with conventional 35 mm cameras. RESULTS: This inexpensive digital camera provides photographs of acceptable quality for a variety of dermatologic applications. Images created with this system are available within minutes and are less expensive than traditional photographs. CONCLUSIONS: Digital imaging is a new and exciting development. The digital camera described is simple to operate and provides a useful alternative or adjunct to conventional photography.

Adult↗

PubMed2002

[Early and late complications in patients treated with hysteroscopic surgery].

In the last couple of years operative hysteroscopy has become a very popular surgical method. It provides us with the possibility to visualize the uterine cavity and explore it with absolute accuracy. In the majority of world centers, it is performed in ambulance. This is a very simple and financially acceptable method, for it does not require special pre and post operative treatments. Of course, simplicity of the procedure, the result, as well as the possibility of complications, depends on the surgeon as well as the preceeding diagnostics. In the period from September of 1997, to September of 1998., 320 operative hysteroscopies were performed in the Clinic for Gynaecology and Obstetrics in Sarajevo. All 320 patients were submitted for infertility. Detailed anamnesis was taken for each patient (HSG, diagnostic laparoscopy, operative laparoscopy, IVF). Each patient in our program was also subject to transvaginal Color Doppler diagnostics before the operation. This form of diagnostics turned out to be highly sensitive and highly specific. We used "Stortz" equipment, including an 8 mm resectoscope and OTV endocamera. Uterine distension was achieved through constant flow of "Purisol" solution. Prior to hysteroscope introduction, we dilated the cervical tube using Hegar metal dilatator. All patients were in general ET anesthesia. We divided complications in two groups: early and late complications. Depending on the sort of complication, patients were hospitalized from 1 to 7 days. Early complications occurred in 7 patients: unsuccessful cervical dilatation--2 patients; uterus perforation--1 patient; uterine bleeding--3 patients; intravasation--1 patient. Impossibility to finish the operation was also considered a complication: impossibility of septum incision--1 patient; incomplete myoma enucleation--1 patient; impossibility to reconstruct womb in the whole--1 patient. Late complications are those that appeared 12-24 hours after the operation: post-operative bleeding--2 patients; increased body temperature--2 patients; pain in lower abdomen--4 patients.

Female↗

PubMedDate not supplied

A comparison of two techniques for weighing young children.

PURPOSE: To compare the direct weight of children when weighed on an infant scale to their indirect weight when weighed on an adult scale while being held by a nurse. METHOD: Ninety children who weighed less than 31 pounds were weighed using a set protocol. Analysis used matched t-test and product-moment correlation. The averages of the weights were then plotted against the weight differences to determine the degree of scatter. FINDINGS: There were no significant differences between the means of the two methods of weighing. The correlation coefficient was 0.995 between the two approaches. Four sets of weights fell outside of two standard deviations of difference. The discrepancies appear to be random. CONCLUSIONS: Indirect weight generally is an acceptable method to assess a child's weight unless highly precise or frequent serial weights are needed.

Adult↗

PubMedDate not supplied

[Breath tests as a noninvasive diagnostic method in Helicobacter pylori infection].

There are several diagnostic methods for Helicobacter pylori infection, some of them need an endoscopic procedure and biopsy to be performed (invasive) like the rapid urease test, culture and histology. Recently non invasive, specific, sensible, easy to perform and patient's well accepted methods had been developed known as breath test, based on the hydrolysis of labelled urea by Helicobacter pylori urease enzyme, to release ammonia and bicarbonate. Labelled CO2 reaches the bloodstream and the lungs, from where can be collected into the breath for quantification. Labelled urea has to options: 13C stable, non-radioactive and 14C unstable, radioactive. Breath test with 13C is based on the atomic mass difference between 12C and 13C and it is necessary a mass spectrometer and 40 minutes to perform it. Breath test with 14C has 1 uCi (one micro-curie) of radioactivity (1/300 of total radiation received in one year from the environment); the test takes 10 minutes and the samples are read in a beta counter. Both non-invasive tests had demonstrated sensitivity and specificity comparable to established "gold standards" for Helicobacter pylori infection diagnosis.

Breath Tests↗

PubMed1994

Construction of an artificial vagina with sigmoid colon in vaginal agenesis.

OBJECTIVES: The study of 15 cases of colonic reconstruction for absent vagina. The outcome in cases of reconstruction of an artificial vagina using the colon is evaluated. METHODS: Fifteen female patients with congenital absence of vagina who were evaluated and treated with sigmoid colonic reconstruction at the Korle-Bu Teaching Hospital in Accra, Ghana were studied. RESULTS: This reconstructive method is successful in patients having a functioning vagina without progressive shrinkage or other symptoms. Disfigurement of the thighs and labia are avoided as is the need for active manipulation. CONCLUSION: Sigmoid colonic reconstruction for vaginal agenesis is an acceptable method especially in the developing world.

Adolescent↗

PubMed1999

Determination of inferior vena cava diameter in the angiography suite: comparison of three common methods.

PURPOSE: Significant inferior vena cava (IVC) filter migration has been associated with deployment of some filter types in IVCs measuring more than 28 mm in diameter at inferior vena cavography. The purposes of this study were to (a) determine if significant differences exist between IVC measurements obtained using a gold standard technique and two other widely accepted methods, and (b) if differences exist, how often do these differences cause incorrect IVC sizing around a diameter of 28 mm, with its associated filter migration issues. MATERIALS AND METHODS: One hundred thirteen consecutive inferior vena cavograms were retrospectively reviewed. The transverse diameter of the infrarenal IVC was determined by using a calibrated intravascular catheter (the gold standard), subtraction of 20% from the measured transverse IVC diameter on a cut-film radiograph, and a radiopaque ruler placed immediately posterior to the patient. RESULTS: The concordance correlation of the 20% magnification method versus internal calibration was 0.94. Kappa analysis to determine agreement at a diameter of 28 mm yielded a Kappa coefficient of 0.490. The concordance correlation of an external ruler versus internal calibration was 0.43, with a Kappa coefficient of 0. CONCLUSION: The poor Kappa correlations for both methods demonstrate that they are unreliable in identifying megacava. Inferior vena cavography prior to IVC filter placement should be performed with a calibrated intravascular catheter.

Angiography↗