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PubMed2006

Posttraumatic reactions among injured children and their caregivers 3 months after the terrorist attack in Beslan.

This report describes symptoms of posttraumatic stress disorder (PTSD) among a group of Beslan's children (N=22) and their primary caregivers (N=20) 3 months after the children had been taken hostage in their school by a group of terrorists. Attention and memory were also measured. Children and their caretakers showed high levels of ongoing PTSD symptoms. Children also showed difficulties in sustaining attention and in short-term memory (digit span). These scores strongly indicate the need for appropriate interventions and ongoing monitoring of course of recovery.

Adolescent↗

PubMed2000

The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial of the National Cancer Institute: history, organization, and status.

The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial is enrolling 148,000 men and women ages 55-74 at ten screening centers nationwide with balanced randomization to intervention and control arms. For prostate cancer, men receive a digital rectal examination and a blood test for prostate-specific antigen. For lung cancer, men and women receive a posteroanterior view chest X-ray. For colorectal cancer, men and women undergo a 60-cm flexible sigmoidoscopy. For ovarian cancer, women receive a blood test for the CA125 tumor marker and transvaginal ultrasound. Members of the control arm continue with their usual care. Follow-up in both groups will continue for at least 13 years from randomization to assess health status and cause of death. The primary endpoint is mortality from the four PLCO cancers, which accounts for about 53% of all cancer deaths in men and 41% of cancer deaths in women in the United States each year. Blood specimens are collected from screened participants, buccal cell DNA from controls, and histology slides from cases; these are maintained in a biorepository. Participants complete a baseline questionnaire (covering health status and risk factors) and a dietary questionnaire. More than 12,000 participants were enrolled in the pilot phase (concluded in September 1994). Changes in the eligibility criteria followed. As of April 2000, enrollment exceeded 144,500. Data are scanned into designated on-site computers for uploading by participant identification number to the coordinating center for quality checks, archival storage, and preparation of analysis datasets for use by the National Cancer Institute (NCI). Scientific direction is provided by NCI scientists, trial investigators, external consultants, and an independent data safety and monitoring board. Performance and data quality are monitored via data edits, site visits, random record audits, and teleconferences. The PLCO trial is formally endorsed by the American Cancer Society and has been ranked by the American Urological Association as one of the most important prostate cancer studies being conducted. Special efforts to enroll black participants are cosponsored by the U.S. Centers for Disease Control and Prevention.

Aged↗

PubMed2003

Documenting pharmacist interventions on an intranet.

The process of developing and implementing an intranet Web site for clinical intervention documentation is described. An inpatient pharmacy department initiated an organizationwide effort to improve documentation of interventions by pharmacists at its seven hospitals to achieve real-time capture of meaningful benchmarking data. Standardization of intervention types would allow the health system to contrast and compare medication use, process improvement, and patient care initiatives among its hospitals. After completing a needs assessment and reviewing current methodologies, a computerized tracking tool was developed in-house and integrated with the organization's intranet. Representatives from all hospitals agreed on content and functionality requirements for the Web site. The site was completed and activated in February 2002. Before this Web site was established, the most documented intervention types were Renal Adjustment and Clarify Dose, with a daily average of four and three, respectively. After site activation, daily averages for Renal Adjustment remained unchanged, but Clarify Dose is now documented nine times per day. Drug Information and i.v.-to-p.o. intervention types, which previously averaged less than one intervention per day, are now documented an average of four times daily. Approximately 91% of staff pharmacists are using this site. Future plans for this site include enhanced accessibility to the site with wireless personal digital assistants. The design and implementation of an intranet Web site to document pharmacists' interventions doubled the rate of intervention documentation and standardized the intervention types among hospitals in the health system.

California↗

PubMed1987

Digital subtraction angiographic imaging of coronary flow reserve.

Recent studies have demonstrated that subjective assessment of the severity of coronary artery stenoses results in poor interobserver concordance and poor correlation with physiologic significance as determined by Doppler measurements of coronary flow reserve. Use of the coronary flow reserve as an integrated measure of the effect of stenosis geometry has been emphasized within the context of quantitative cinemetric analysis. The comparison of two parametric digital subtraction angiographic flow images obtained before and after hyperemic intervention has led to calculation of flow reserve values that correlate well with electromagnetic flowmeter data in dogs. By means of a similar model relating blood flow and image variables, single flow ratio images have been formed. These parametric images provide a two-dimensional display of the ratio of hyperemic flow to baseline flow. Linear temporal interpolation of data from a sequence of cardiac phase-matched subtraction images is used to improve the resolution of the displayed flow ratios. Summation of flow variables measured within the perfusion bed was used to calculate a value for the overall coronary flow reserve and to characterize the significance of isolated lesions in an open-chest canine preparation. A linear regression calculation relating parametric image flow ratio values to electromagnetic flowmeter measurements resulted in a linear fit of y = .96x - 0.19 with a correlation coefficient of .90. The direct visual representation of flow ratio distribution provided by the parametric imaging method may aid in the interpretation of multiple complex lesions as well as of single lesions.

Angiography↗

PubMedDate not supplied

Fibromuscular dysplasia of bilateral brachial arteries--a case report and literature review.

Fibromuscular dysplasia (FMD) is a noninflammatory, nonatherosclerotic disease of the vascular system, that can affect intima, media, or adventitia. The dysplasia in these layers leads to decrease in the lumen and increased turbulence leading to diminished flow through the affected portion. The treatment of FMD thus far has been either surgical and/or interventional. The authors describe a patient who presented with painful digits and who was found to have bilateral brachial artery FMD and was treated with balloon angioplasty with complete resolution of symptoms.

Angioplasty, Balloon↗

PubMed2005

Evaluation of a community-based handgun safe-storage campaign.

OBJECTIVE: Safe storage of firearms has been recommended as a means of preventing gun-related pediatric injuries, yet few interventions have led to significant improvements in storage practices. This study examined a multifaceted community education campaign to promote safe handgun storage and the campaign's impact on firearm locking and loading practices in households with children. METHODS: Beginning in 1997, a safe-storage campaign consisting of television and radio announcements, educational materials, billboards, and discount coupons for lock boxes was conducted in King County, Washington. The campaign evaluation used a quasi-experimental design and compared the intervention site with 9 control counties outside Washington State and west of the Mississippi River. Cross-sectional, random-digit-dial telephone surveys of handgun-owning households with children were conducted in all study counties both before the intervention in 1996 (n = 302) and again in 2001 (n = 255). The main analyses assessed whether greater improvements in household firearm-storage practices occurred between 1996 and 2001 in the intervention, compared with the control, counties. Primary outcomes were based on up to 3 handguns per household and included (1) all stored with trigger locks, lock boxes, or gun safes (formal locking devices), (2) all stored in lock boxes or gun safes, (3) any stored loaded, (4) any stored loaded without a formal locking device, and (5) any stored loaded and not in a lock box or gun safe. Data were also collected on up to 1 long gun per household; long-gun outcomes included (1) stored with a trigger lock or gun safe and (2) stored loaded. RESULTS: Overall, handguns and long guns were generally more likely to be stored locked and less likely to be loaded in 2001 compared with 1996, with these trends seeming to be more consistent in the intervention county. Even so, more than one quarter of households with children and handguns in 2001 failed to store all of their handguns with a formal locking device, and up to 8% continued to possess at least 1 loaded handgun that was not stored with a formal device. The majority of households that stored their handguns with formal devices used lock boxes or gun safes. Storage of handguns in lock boxes or gun safes became more common in both the intervention (adjusted odds ratio [aOR]: 1.71; 95% confidence interval [CI]: 1.03-2.84) and control households (aOR: 1.66; 95% CI: 1.01-2.72) between 1996 and 2001. None of the other measured changes reached statistical significance, such as storing any household handgun loaded (aOR: 0.71; 95% CI: 0.35-1.42 [intervention]; aOR: 1.08; 95% CI: 0.58-2.00 [control]) or keeping any household handgun loaded and not stored in a lock box or gun safe (aOR: 0.59; 95% CI: 0.22-1.55 [intervention]; aOR: 0.67; 95% CI: 0.30-1.49 [control]). Moreover, the intervention county did not experience significantly greater overall improvements in household storage practices for handguns or long guns than did control counties. CONCLUSIONS: In both the intervention and control counties, households were more likely to lock all handguns in 2001 compared with 1996. After accounting for temporal trends, this educational campaign, combined with economic incentives to purchase lock boxes, did not seem to significantly change safe storage practices in households with handguns and children. Even if the campaign did result in small improvements in firearm safe storage, simultaneous national and state-specific gun-safety activities or legislative efforts may have drawn increasing attention to gun-related issues in the control counties, thereby making it more difficult to identify effects of our specific handgun storage intervention.

Accident Prevention↗

PubMed1997

Effects of high-preference single-digit mathematics problem completion on multiple-digit mathematics problem performance.

The purpose of this study was to examine the effects of a sequence of three single-digit (1 digit x 1 digit) multiplication problems on the latency to initiate multiple-digit (3 digit x 3 digit) multiplication problems for 2 students in an alternative education school. Data showed that (a) during the preference assessment, both students selected the single-digit problems in a majority of the sessions, and (b) intervention resulted in a decrease in latency between problems for both students. Results are discussed in relation to using high-preference sequences to promote behavioral momentum in academic content areas.

Adolescent↗

PubMed1980

Traumatic aneurysms of the ulnar artery.

Aneurysms of the ulnar artery are most common secondary to blunt trauma to the hypothenar eminence. The anatomic relationship between the superficial branch of the ulnar artery and the hook of the hamate exposes this segment of the artery to injury. The clinical, roentgenographic, and pathologic features of two patients, one with an acute traumatic episode and one with chronic trauma are presented. True aneurysms developed in both patients that eventuated in digital ischemia. Thrombosis of the aneurysm and adjacent arterial segment seemed to be related to the onset of the ischemic symptoms. Digital artery embolization can complicate the thrombotic episode. Although surgical intervention may correct the ischemic symptoms, prevention via industrial education seems to be the best form of management.

Adolescent↗

PubMed1994

Beliefs about breast cancer and mammography by behavioral stage.

PURPOSE/OBJECTIVES: To explore the relationships of Health Belief Model (HBM) variables and the Trans-theoretical Model with regard to behavioral stage of mammography adoption. DESIGN: Descriptive, correlational. SETTING: Large midwestern city. SAMPLE: 405 women over age 40 obtained through random digit dialing. Subjects had agreed to participate in a larger intervention study. METHODS: Data were collected during in-home interviews. Subjects completed six scales developed from the HBM and answered questions related to mammography compliance. MAIN RESEARCH VARIABLES: Perceptions of breast cancer susceptibility and seriousness, perceived benefits of and barriers to mammography, motivation to stay healthy, and perceived control over health; degree of mammography compliance. FINDINGS: Women complaint with mammography guidelines had significantly higher scores on seriousness, benefits, health motivation, and control as well as significantly lower scores on barriers. In addition, scores on susceptibility, seriousness, benefits, barriers, and health motivation were significantly different across stages of mammography (precontemplation, contemplation, and action/maintenance). CONCLUSIONS: Interventions should target attitudes about susceptibility and seriousness of breast cancer in women who do not comply with established guidelines for mammography. Women who are not in compliance and have no plans to seek mammography would benefit from additional emphasis on mammography benefits and from removal of barriers. Health motivation also must be addressed in noncompliant women. IMPLICATIONS FOR NURSING PRACTICE: These results promise to expand the understanding of a person's motivation to change health-seeking behaviors, specifically obtaining routine screening mammograms. Further research using this new framework is needed to substantiate these results with a cross section of women.

Adaptation, Psychological↗

PubMed2001

[Diagnosis of cerebral aneurysm using 3-dimensional digital subtraction angiography].

Recent rapid advancement in the technology of magnetic resonance angiography and 3-dimensional computed tomography angiography has opened the door to a less-invasive diagnostic routine for the treatment of cerebral aneurysms. However, from the viewpoint of decision making concerning which treatment to use; conservative therapy; surgical intervention; or endovascular treatment, much more precise information is necessary. Recent progress of rotation digital subtraction angiography has introduced 3-dimensional digital subtraction angiography. In the past year, 28 cases involving 39 aneurysms have been studied using 3-dimensional angiography. This study was carried out, using a rotating C-arm, which rotates 220 degrees in 5.8 seconds. All raw data gathered was transferred to the workstation for image reconstruction. The purpose of this study was to evaluate the clinical potential of 3-dimensional digital subtraction angiography for the diagnosis of the cerebral aneurysms.

Angiography, Digital Subtraction↗

PubMed2004

A deformable digital brain atlas system according to Talairach and Tournoux.

Brain atlases are valuable tools which assist neurosurgeons during the planning of an intervention. Since a printed atlas book has several disadvantages-among them the difficulty to map the information onto a patient's individual anatomy-we have developed a digital version of the well-established stereotaxic brain atlas of Talairach and Tournoux. Our atlas system is mainly dedicated to assist neurosurgical planning, and its benefits are: (i) a three-dimensional (3D) representation of most brain structures contained in the Talairach atlas; (ii) a nonrigid matching capability which warps the standard atlas anatomy to an individual brain magnetic resonance imaging (MRI) dataset in a few minutes and which is able to take deformations due to tumors into account; (iii) the integration of several sources of neuroanatomical knowledge; (iv) an interface to a navigation system which allows utilization of atlas information intraoperatively. In this paper we outline the algorithm we have developed to achieve 3D surface models of the brain structures. Moreover, we describe the nonrigid matching method which consists of two tasks: firstly, point correspondences between the atlas and the patient are established in an automatic fashion, and secondly these displacement vectors are interpolated using a radial basis function approach to form a continuous transformation function. To generate appropriate target structures for the first of these tasks, we implemented a quick segmentation tool which is capable to segment the cortex and ventricles in less than 5 min. An evaluation shows that our nonrigid approach is more precise than the conventional piecewise linear matching, though it should be further improved for the region around the deep grey nuclei. Summarizing, we developed a Win32 program which permits the convenient and fast application of standardized anatomy to individual brains which potentially contain tumors.

Algorithms↗

PubMedDate not supplied

Which population-based interventions would motivate smokers to think seriously about stopping smoking?

OBJECTIVE: To describe what smokers say about the impact of different population-based interventions to motivate them to think seriously about stopping smoking. METHODS: A random-digit dialed cross-sectional telephone survey of adult current cigarette smokers was conducted in Erie and Niagara counties, New York, in October through November 2002. A total of 815 smokers were asked which of eight interventions would motivate them to think seriously about stopping smoking in the next 6 months. RESULTS: The offer of free nicotine patches/gum (53%) and cash incentives (49%) were the most frequently mentioned interventions that smokers said would get them to think seriously about stopping smoking. The degree of motivation to stop smoking was the most consistent and strongest predictor of how respondents answered the question about the influence of the various intervention options. CONCLUSION: Communities need to offer a wide array of interventions that are likely to appeal to different subgroups of smokers in order to have a population-wide impact on smoking behavior.

Adolescent↗

PubMed2002

[Gadolinium in arteriography and interventional radiology: 39 patients].

OBJECTIVE: To report the experience of using various Gadolinium chelates as contrast media in digital subtraction angiography in patients with relative or absolute contraindications for iodinated contrast agents. MATERIAL: and Methods. Forty-two arteriograms were performed in 39 consecutive patients using Gadolinium chelates (gadoteridol, gadodiamide, and gadopentetate dimeglumine). The vasculature of the brain, of the upper and lower limbs and the renal arteries were examined. Among these 39 patients, 17 were treated by various endovascular procedures. RESULTS: In 40 examinations out of 42, the angiographic result was satisfactory, allowing either a diagnostic evaluation or an endovascular therapeutic procedure. Clinical tolerance was excellent. In one case of renal failure that was reported after angiography, the patient had received both iodine and gadolinum-based contrast agents. CONCLUSION: Gadolinium appears to be an interesting alternative for arteriography in patients with absolute or relative contraindication to iodinated contrast agents, and also seems to demonstrate efficacy during endovascular therapeutic procedures.

Aged↗

PubMed1999

Specific intervention for multiplication skill with learning-disabled students.

A multiple baseline design was used to assess the intervention of individual tutoring to help two learning-disabled students (15 and 16 years old) improve their multiplication of 1-digit numbers over nine days of 10-min. instruction. Observation or visual analysis indicated 40 to 50% improvement after the intervention, and a nonparametric test of randomization showed that the students' improvement was retained during the 2-wk. follow-up.

Adolescent↗

PubMed1992

Radiologic methods used in the diagnostics of vasculogenic erectile dysfunction.

Contemporary methods of assessing erectile dysfunction include instrumental registration of nocturnal penile erections, the penile brachial index, Doppler sonography, use of vasoactive substances and various contrast radiologic methods along with studies of the hormonal profile, the neurologic status, examination of prostate excrements, etc. These methods are still not widely used in Bulgaria although their scope of application is quite well known. We report here our own experience in using the contrast radiologic methods for studying this pathological condition, in particular, the technique of digital subtraction pharmacocavernosography with cavernosometry introduced by us and used for this purpose. In some of the cases we used it in combination with digital subtraction angiography of pelvic arteries. Using these methods we can detect not only morphological but also functional disorders. On the basis of the data obtained we determine the particular therapeutic approach, specify the nature of the disorder and the effect of eventual surgical intervention.

Adult↗

PubMed1990

Hemodynamic determinants of subdiaphragmatic venous return during closed-chest CPR in a canine cardiac arrest model.

OBJECTIVE: To assess the hemodynamic determinates of peripheral subdiaphragmatic venous-to-right-heart return during closed-chest CPR. MODEL: Seven anesthetized dogs subjected to electrically induced ventricular fibrillation for five minutes. INTERVENTIONS: Conventional closed-chest CPR and closed-chest CPR with continuous abdominal binding at a chest compression rate of 60 per minute, a compression-to-relaxation ratio of 50:50, and a ventilation-to-compression ratio of 1:5. METHODS: Solid-state catheters were positioned in the ascending aorta, right atrium (RA), and inferior vena cava (IVC). Cannulating electromagnetic flow probes were inserted into the IVC and a carotid artery. Analog-to-digital conversion was performed electronically. Five minutes after ventricular fibrillation was induced, interventions were performed in an alternating sequence. Systolic, diastolic, and mean pressures and flows were measured and compared. STATISTICAL METHODS: Two-tailed, unpaired t test applied to equal sample size, linear regression analysis, and multiple regression analysis. RESULTS: Abdominal binding during CPR significantly increased (P less than .05) all measured systolic and diastolic CPR intravascular pressures compared with CPR without abdominal binding but did not affect IVC-to-right-heart venous return. During conventional CPR without abdominal binding, venous return was dependent on the diastolic IVC pressure (r = .86, P = .014), mean IVC pressure (r = .80, P = .03), and carotid blood flow (r = .99, P = .001) but not on the IVC-to-RA pressure gradient. With abdominal binding, venous return was not correlated with any study hemodynamic variable, including the peripheral venous-to-RA pressure gradient. CONCLUSION: Venous return from the subdiaphragmatic venous bed during CPR is dependent on venous pressure, not on the peripheral venous-to-right-heart pressure gradient. Abdominal binding during CPR does not affect venous return. Venous return during CPR diastole is highly dependent on central venous capacitance (left heart outflow during CPR systole).

Animals↗

PubMed2006

Assessing health consumerism on the Web: a demographic profile of information-seeking behaviors.

The growing diversity of the online health information community is increasingly cited as a limiting factor related to the potential of the Internet as an effective health communication channel and information resource. Public-access Internet portals and decreasing costs of personal computers have created a consensus that unequal access to information, or a "Digital Divide," presents a like problem specific to health care consumers. Access to information, however, is an essential part of the consumer-centric framework outlined in the recently proposed U.S. National Health Information Infrastructure (NHII) and Health Architecture initiatives. To date little research has been done to differentiate the types of health information sought on the Web by different subgroups, linking user characteristics and health-seeking behaviors. Data from a study of consumer Web search activity in a post-intervention era serves as a natural experiment, and can identify whether a "digitally underserved group" persists in the United States. Such an environment would serve to exclude traditionally underserved groups from the benefits of the planned national heath information infrastructure. This exploratory technology assessment study seeks to differentiate and delineate specific behaviors, or lack of desired behaviors, across targeted health care subgroups. Doing so allows the design of more effective strategies to promote the use of the Web as a health education and health promotion tool, under the envisioned shared decision-making, consumer-centric health information model.

Adult↗

PubMed2005

[Vascular complications of percutaneous transradial coronary angiography and coronary intervention].

BACKGROUND AND PURPOSE: Vascular complications following transradial coronary angiography and coronary intervention could severely compromise perfusion of the hand. Drastic complications after cannulation of the radial artery (ischemia of the hand with occlusion of the digital arteries) are published only in brief reports. This study investigates whether percutaneous transradial artery coronary angiography/intervention results in vascular complications. PATIENTS AND METHODS: 93 patients were consecutively studied over a 4-month period. The following data were recorded before and after coronary angiography and/or intervention: diameter of the radial artery, blood volume, flow velocity, and occlusion pressure. Graduation of the stenosis after intervention was done according to the principle of the peak velocity ratio. RESULTS: A transradial coronary angiography/intervention was performed in 93 patients (75 men, mean age 62.5 years) in case of an unremarkable Allen test. Procedural success rate was 97.2%. The intervention could not be completed successfully in three patients (2.8%). Mean vessel diameter increased from 2.46 +/- 1.7 mm (standard deviation [SD]) before intervention to 2.78 +/- 0.69 mm (SD) after intervention; this increase was statistically significant (p = 0.002). Changes in blood flow, flow velocity and occlusion pressure did not reach significance. Vascular complications were seen in nine of 93 patients (10%) after the procedure. No patient mentioned discomfort. No perfusion deficit of the digital arteries was seen. CONCLUSION: The transradial coronary angiography and intervention is a safe method with a high procedural success rate.

Aged↗