SEARCH · PubMed Health

Results for “Complex intervention”

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

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

At least 523 records · Page 29Linked to original sources

PubMed1995

Assessment of outcome of bifurcation lesions and non-bifurcation lesions treated in the CAVEAT trial. CAVEAT investigator group.

Registry data suggests that bifurcation lesions are associated with reduced success during percutaneous revascularization. We studied 1012 CAVEAT patients to compare procedural outcomes in patients with and without bifurcation lesions whose target vessel was treated with either atherectomy or angioplasty. Bifurcation lesions have increased angiographic complexity and interventions on them are associated with lower acute procedural success rates compared to non-bifurcation lesions. Subgroup analysis suggests that atherectomy treatment of bifurcation lesions improves acute procedural success rates and lowers restenosis rates compared to angioplasty treatment of bifurcation lesions but atherectomy of bifurcation lesions is associated with higher acute complication rates than angioplasty of bifurcation lesions.

Adult↗

PubMed1999

Health-related problems in a vulnerable population: pregnant teens and adolescent mothers.

Childbearing adolescents are susceptible to a myriad of health-related problems. For these youth, health-related problems include both physiological and psychological disease states that negatively impact both their own and their children's lives. Suicide attempts, parenting problems (including child abuse), domestic violence, poor birth outcomes, and sexually-transmitted diseases (including HIV) are just some of the problems encountered. This article focuses on the relationship between lack of social and environmental resources and the risk factors for health problems in adolescent mothers and provides recommendations for nursing assessment and intervention. The complex nature of the relationship between lack of resources and the many risk factors for health-related problems in the lives of childbearing adolescents makes comprehensive health care a requirement. Nurses in school-based clinics and community settings are in a unique position to provide access to the physical and mental health services necessary for pregnant adolescents and teen mothers.

Adolescent↗

PubMed1999

Risk factors of cardiovascular diseases.

BACKGROUND: Cardiovascular diseases are the leading cause of premature mortality of women and men in Slovak republic. THE AIM: The occurrence and mean values of major CVD risk factors were assessed in a population of 2480 Bratislava citizens (2/3 of them were women) interested in health promotion and primary CVD prevention activities in Community Health Promotion Center. METHODS: Major CVD risk factors were assessed, using standard methods, and criteria, in accordance with the guidelines of European and national medical societies. MAIN RESULTS: The greatest proportion of visitors, both women and men, were in their forties. 73% of all women and 70% of all men were aged 30-59 yrs. The most frequent risk factors, were overweight and obesity, present in 64% of men and 59% of women. Of them, central type obesity was found in 30% of men, 15% of women. In 52% of men and 32% of women elevated casual blood pressure was assessed at the first visit. Of the total, in 27% of men and 21% of women, the BP elevation was within the range of borderline hypertension. In 25% of men and 11% women the BP values were within the mild to severe hypertension range. Elevated blood cholesterol was assessed in 53% of men and 54% of women, lowered HDL cholesterol in 55% of men and 43% of women. Elevated TC/HDL-C ratio was found in 60% of men and in 35% of women. Triglyceride level elevation was assessed in 24% of men and in 17% of women, with TGL/HDL-C ratio raised in 66% of these men and in 40% of these women. CONCLUSIONS: In assessment of CVD risk factors clustering, our results are different from the results of CINDI SR screening from 1992. In our study, only 13% persons were free of any CVD risk factors. One risk factor was found in 21.1%, two of them in 29.9%, three in 29.8% and four in 6.2% of the population screened. Evaluation of the effect of complex individual intervention in our center will be the subject of our next study. (Fig. 5, Tab. 5, Ref. 11.)

Adult↗

PubMed2000

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

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

Acute Disease↗

PubMed1999

Utility of bilateral coronary injections during complex coronary angioplasty.

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

Aged↗

PubMedDate not supplied

[Clinical experience in the use of epidural blockade in complex anesthesia in cardiac surgical interventions].

A total of 326 patients were operated on the heart under total and combined epidural anesthesia. Multicomponent total anesthesia in combination with epidural blocking is indicated for patients with coronary disease, aortal and mitral valve failure, arterial and pulmonary hypertension. The dose of fentanyl is decreased 2.98 times, duration of forced ventilation of the lungs 2-fold, and the incidence of cardiovascular and pulmonary complications is reduced in patients subjected to cardiosurgical interventions under total anesthesia in combination with epidural blocking.

Adult↗

PubMed2002

[Comparative efficiency of local anesthetics from the group of complex amides during therapeutic stomatological interventions].

The efficiency of infiltration, conduction, and intraligamental anesthesia with different drugs for dental interventions was evaluated in 331 patients without concomitant somatic diseases. The efficiency of local anesthesia depends primarily on the drug; other essential factors are the route of this drug administration and type of intervention in the oral cavity. The most effective of the studied anesthetics was 4% artisane with epinephrine 1:100,000; 3% prolocaine with epinephrine 1:100,000 ranked second. These anesthetics maximally realized their effects at intraligamental injection during the treatment of caries and periodontitis.

Adolescent↗

PubMed2002

Informatics tools to monitor progress and outcomes of patients with drug resistant tuberculosis in Peru.

Multi-drug resistant tuberculosis (MDR-TB) is an important and growing problem in many developing countries. New strategies have been developed to combat the disease but require complex treatment regimens and close monitoring of patients' bacteriology results. We describe a web-based medical record system deployed in Peru to support the management of MDR-TB. Web-based analyses have been developed to track drug sensitivity test results, patterns of sputum smear and culture results and time to conversion from positive to negative cultures. Individual and aggregate drug requirements can also be monitored in real time. Multiple analyses can be linked together and data can be graphed or downloaded to spreadsheets. Over 1200 patients are currently in the system. We argue that such a web-based clinical and epidemiological management system is an important component for successful implementation of complex health interventions in resource poor areas.

Antitubercular Agents↗

PubMedDate not supplied

[Models, methods, clinical contents in the specialized degree in nursing sciences].

The document presented is the result of a consensus conference where nurses involved in teaching, direct care and management discussed with professionals and experts of other disciplines on the role of the clinical teaching at specialistic level. Nursing education in fact recently underwent a re-organization therefore after the degree (first level) there is a second level (Specialistic degree and PhD) first and second level master courses. The main question of the consensus conference was if there is a role and what are the contents of clinical nursing to be taught at specialistic level. A consensus was reached on the importance of not separating the teaching of the methods from the contents of care, to allow the production of new knowledge relevant for patients' care. A nurse with a specialistic degree should be able to plan and implement innovative models of care based on scientific knowledge; to recognise unexpected and rapidly evolving problems; to plan and implement, in collaboration with other professionals, complex educational interventions; study and explore principles and theories of helping relationship. The differences in contents and methods of clinical teaching between master and specialistic degree need to be further discussed and explored.

Education, Nursing↗

PubMed1977

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

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

Accessory Nerve↗

PubMed2005

Methodological challenges in meditation research.

Like other complex, multifaceted interventions in medicine, meditation represents a mixture of specific and not-so-specific elements of therapy. However, meditation is somewhat unique in that it is difficult to standardize, quantify, and authenticate for a given sample of research subjects. Thus, it is often challenging to discern its specific effects in order to satisfy the scientific method of causal inferences that underlies evidence-based medicine. Therefore, it is important to consider the key methodological challenges that affect both the design and analysis of meditation research. The goal of this paper is to review those challenges and to offer some practical solutions. Among the challenges discussed are the mismatches between questions and designs, the variability in meditation types, problems associated with meditation implementation, individual differences across meditators, and the impossibility of double-blind, placebo-controlled meditation studies. Among the design solutions offered are aptitude x treatment interaction (ATI) research, mixed quantitative-qualitative methods, and practical (pragmatic) clinical trials. Similar issues and solutions can be applied more generally to the entire domain of mind-body therapies.

Clinical Trials as Topic↗

PubMed1992

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

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

Adaptation, Psychological↗

PubMed2006

Working memory and image guided surgical simulation.

We report on a study that investigates the relationship between visual working memory and verbal working memory and a performance measure in endoscopic instrument navigation in MIST and GI Mentor II (a simulator for gastroendoscopy). Integrated cognitive neuroscience in state-of-the-art simulator training curriculum will take safety science in health care one step ahead. Current simulator validation focuses on how to train. In the light of recent research it is now prime time to ask why in search of mechanisms rather than to repeatedly show that training has effect. This will help tailor training to maximize individual output in procedures that require a high level of dexterity. WM training is a unique learning aid in simulator training and should be used alongside clinical practice in order to improve the quality of complex clinical intervention in the field of image guided surgical simulation.

Computer Simulation↗

PubMed2005

[Postoperative chylous ascites in urology].

Postoperative chylous ascites is a rare complication after retroperitoneal surgery. It is a complex problem associated with nutritionnal and immunological consequences. Urologists should be able to manage this complication linked to many urological procedures. Incidence of chylous ascites seems to increase with time probably because more complex surgical interventions. Diagnosis is usually suspected based on clinical abdominal symptoms. Diagnostic paracentesis shows milky fluid with high triglyceride and lymphocyte content. Treatment is classicaly based on dietary interventions with the goal to decrease fistula's lymph flow. Somatostatin analog is a very efficient adjuvant therapy and should be used early in the course of treatment. Surgery is usually attempted in patients who have failed conservative modalities. Because chylous ascites is rare, no clear management guidelines exist. Treatment should be individualized and tailored according to severity of lymphatic leakage, its consequences and the patient health status.

Chylous Ascites↗

PubMed1991

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

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

Back Pain↗

PubMedDate not supplied

Randomized trial of a whole-system ayurvedic protocol for type 2 diabetes.

CONTEXT: Though complementary and alternative medicine (CAM) treatments are popular, evidence to support their application to diabetes care is scarce. Previous CAM diabetes research has generally focused on single modalities, but CAM practitioners more commonly prescribe complex, multimodality interventions. OBJECTIVES: The aims of this study were to determine the feasibility and clinical impact of a whole-system, Ayurvedic intervention for newly diagnosed people with type 2 diabetes. DESIGN: Patients were randomly assigned to either an experimental or control arm. SETTING: Group model health maintenance organization. PARTICIPANTS: We recruited 60 adult patients with baseline glycosylated hemoglobin (HbA1c) values between 6.0 and 8.0. INTERVENTION: Treatment for the experimental group included exercise, an Ayurvedic diet, meditation instruction, and an Ayurvedic herb supplement (MA 471). Control patients attended standard diabetes education classes with primary care clinician follow-up. MEASUREMENTS: Clinical outcomes were assessed at 3 and 6 months and included HbA1c, fasting glucose, lipids, blood pressure, and weight. RESULTS: Ninety-two percent of randomized patients completed the study, and there were no significant adverse study-related events. Using analysis of co-variance (ANCOVA), we found no significant differences for clinical outcomes at 6 months between on-study patient groups, though trends favored the Ayurvedic group. When we included a factor measuring how much baseline HbA1c exceeded the mean (6.5%), however, we found statistically significant improvements in the Ayurvedic group for HbA1c (P = .006), fasting glucose (P = .001), total cholesterol (P = .05), low-density lipoprotein (LDL) cholesterol (P = .04), and weight (P = .035). CONCLUSIONS: These results suggest that the Ayurvedic intervention may benefit patients with higher baseline HbA1c values, warranting further research.

Adult↗

PubMed1991

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

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

Humans↗

PubMed1990

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

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

Child↗