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At least 685 records · Page 38Linked to original sources

PubMed2004

Postoperative pain management after anterior cruciate ligament reconstruction.

This study compared pain and its management in four groups of patients after anterior cruciate ligament (ACL) surgery. Group 1 consisted of primary ACL reconstruction, group 2 primary ACL reconstruction with meniscal repair, group 3 primary ACL reconstruction with meniscal resection, and group 4 revision ACL reconstruction with patellar tendon allograft. Each patient was instructed to record his or her pain level on a visual analog pain scale (VAS) prior to the procedure and for 7 days postoperatively. All patients received a prescribed narcotic to be taken orally as needed every 4-6 hours. Each patient was instructed to taper its use and supplement with non-narcotic as symptoms allowed. The VAS score for all groups peaked at postoperative day 1 and remained elevated at postoperative day 2. At postoperative day 7, the VAS scores for groups 1, 2, and 3 began to show signs of further decline, whereas group 4 persisted at postoperative day 5 levels. A general trend of decreasing narcotic use over time and increasing non-narcotic use was noted in each group; however, these findings were not statistically significant. All four groups had nearly identical mean VAS scores and corresponding narcotic use for each postoperative day despite the differing levels of complexity of surgical intervention in each group.

Adult↗

PubMed1992

Trust, control strategies and allocation of function in human-machine systems.

As automated controllers supplant human intervention in controlling complex systems, the operators' role often changes from that of an active controller to that of a supervisory controller. Acting as supervisors, operators can choose between automatic and manual control. Improperly allocating function between automatic and manual control can have negative consequences for the performance of a system. Previous research suggests that the decision to perform the job manually or automatically depends, in part, upon the trust the operators invest in the automatic controllers. This paper reports an experiment to characterize the changes in operators' trust during an interaction with a semi-automatic pasteurization plant, and investigates the relationship between changes in operators' control strategies and trust. A regression model identifies the causes of changes in trust, and a 'trust transfer function' is developed using time series analysis to describe the dynamics of trust. Based on a detailed analysis of operators' strategies in response to system faults we suggest a model for the choice between manual and automatic control, based on trust in automatic controllers and self-confidence in the ability to control the system manually.

Adult↗

PubMed1995

Principles of interpretation of coronary velocity and pressure tracings.

The development of quantitative angiography and the introduction of new techniques of intracoronary imaging cannot replace the functional methods for the assessment of stenosis severity. The measurement of the trans-stenotic pressure gradient and of the post-stenotic flow velocity using miniaturized sensors with guidewire technology offers an alternative to the conventional non-invasive methods which is applicable in the catheterization laboratory at the time of the interventional procedure. The complexity of the coronary circulation, however, limits the possibility of establishing simple cut-off criteria to identify the presence of a flow-limiting stenosis. For intermediate lesions, or in the presence of variable haemodynamic conditions, the accuracy of the assessment can be improved by the application of more complex indices, proposed and validated in the animal laboratory and based on the instantaneous relationship between pressure or pressure gradient and flow velocity.

Angioplasty, Balloon, Coronary↗

PubMed2004

Whither health promotion events? A judicial approach to evidence.

This paper reports on a review undertaken for the Health Education Board for Scotland on 'health events'. On the basis of a literature review and interviews with 20 professionals in the UK, it appraised the effectiveness of such activities, assessed their current extent and status, and ultimately considered whether they are useful and relevant within emergent contexts. It suggests that the evidence base for health events is relatively weak, particularly given the scale of such work. At best, all that can be said is that there is some evidence that some of these events have some use within very specific assumptions and values. Consideration is given to possible ways forward. The paper also considers a series of related issues that impinge on the assessment of complex health promotion interventions. From our field interviews, health events are perceived by most to be labour intensive and ineffective. Rather, they are undertaken for a range of pragmatic 'public relations' reasons that exist independent of knowledge, attitudinal or behavioural outcomes. This ambiguity of expectation coupled with a paucity of published high-quality literature led to the use of a judicial approach to evidence appraisal. It considers the ways in which this exercise could be undertaken, ultimately being sceptical of systematic meta-reviews.

Attitude to Health↗

PubMed2000

Delirium in the intensive care unit: are we helping the patient?

The intensive care unit (ICU) represents a dynamic interaction between patient factors and interventional factors. The complexity of this situation can generate an impaired consciousness in the patients. The critical care provider is faced with deducing the etiology and treatment of delirium in the ICU. Many of the therapeutic agents that are used in the ICU may precipitate delirium. Patients may also experience delirium as part of their underlying medical conditions. Withdrawal syndromes, delirium tremens in particular, are known to cause delirium. By a combination of appropriate selection of medications and an awareness of delirium as a side effect, the patient in the ICU may be treated in a manner to minimize the clouding of consciousness. An understanding of the proposed pathophysiology of various types of delirium will allow appropriate clinical measures to be taken.

Alcohol Withdrawal Delirium↗

PubMed2000

Patient problems and nurse interventions during acute care and discharge planning.

Standardization and computerization of medical documentation has provided a method to describe patient care by naming and linking patients' needs with nursing interventions. This study used a standardized nursing classification system to describe the types and frequency of problems experienced by elders hospitalized and discharged to home and the interventions used by staff nurses and advanced practice nurses (APNs) as they provided acute care and discharge planning for these cardiac patients. The patients' hospital records and the APN logs were content analyzed and then coded using the Problem Classification Scheme and Intervention Scheme of the Omaha System. Patients experienced an average of 8.6 problems that required a total of 7,000 interventions in all four Omaha System intervention categories. The results provided a description of the most frequent problems experienced by the patients linked with the most common nursing interventions. The nature, complexity, and prevalence of patient problems and the importance of communication across settings are evident. In addition, the study findings increase understanding of the contribution of nurses to the care of hospitalized elders as they make the transition from hospital to home.

Aged↗

PubMedDate not supplied

Somatosensory evoked potential monitoring during closed humeral nailing: a preliminary report.

OBJECTIVES: To assess the role of intraoperative somatosensory evoked potential (SSEP) monitoring of the radial and median nerves in preventing iatrogenic nerve injury during closed, locked intramedullary (IM) nailing of the humerus. DESIGN: Prospective clinical study. SETTING: Pacific Northwest Level One trauma center and Southern California military medical center. PATIENTS: Thirteen patients with indications for surgical stabilization of fractures of the humeral diaphysis and either unknown neurologic status of the affected limb or anticipated difficult reduction maneuvers due to fracture complexity or displacement. INTERVENTION: Closed, antegrade or retrograde locked IM nailing of the humerus was attempted while intraoperative monitoring of the radial and median nerves with SSEP was performed. MAIN OUTCOME MEASUREMENTS: Intraoperative radial and median nerve SSEP changes during closed fracture manipulation, guide rod insertion, reaming, and humeral nail placement. RESULTS: Baseline recordings were obtained in twelve of thirteen patients for both the radial and median nerves. An absence of radial nerve signal in one patient with a closed head injury prompted an open procedure, revealing entrapment of the radial nerve in the fracture. Intraoperative SSEP changes were observed in two of the twelve remaining patients during fracture manipulation and distal interlocking. The signal amplitude returned after discontinuation of manipulation and traction, and alteration of the interlocking maneuver. No neurologic deficits were noted in these two patients. CONCLUSIONS: Intraoperative radial nerve SSEP monitoring appears to reliably reflect the status of the radial nerve in those patients with a humerus fracture. In three of eleven patients, intraoperative signal changes prompted a change in surgical plan. In no patient did there appear to be evidence of iatrogenic nerve injury.

Bone Nails↗

PubMed2003

Novel anticoagulant activity of polyamino acid offsets bacterial endotoxin-induced extrinsic hypercoagulation: downregulation of monocytic tissue factor-dependent FVII activation.

The extrinsic hypercoagulation often resulting from sepsis could contribute to disseminated intravascular coagulation and cardiovascular complications. The effective prevention and intervention remained largely complex and unclear. In a cell model of human leukemia THP-1 monocytes following bacterial endotoxin (LPS) exposure, we show the novel anticoagulant ability of polyamino acid (polyAA) to suppress the extrinsic hypercoagulation. LPS-induced monocytic tissue factor (mTF) procoagulation was readily offset by poly-L-lysine (PLK), poly-L-arginine (PLR), or poly-L-ornithine (POR) included in single-stage clotting assays. IC50 was estimated at 0.35, 0.30, or 0.58 microM for PLR, POR, or PLK, respectively, whereas, poly-L-asparatic acid (PLD) remained ineffective. In a separate approach, inclusion of cationic polyAA in human plasma significantly prolonged prothrombin time, confirming the depressed extrinsic coagulation. In chromogenic assays dissecting the extrinsic pathway, we further determined the inhibitory site(s). PLK, PLR, or POR significantly inhibited LPS-induced FVII activation, which was consistent with the diminished FVIIa formation shown on Western blotting analysis. In contrast, polyAA did not show any additional effect on either FVIIa/FXa amidolytic activities or mTF/FVIIa-catalyzed FX activation. Nor did polyAA show any effect on FVII activation directly catalyzed by FXa. Taken together, PLK, PLR, or POR preferentially inhibited mTF-dependent FVII activation, accounting for their novel anticoagulant activities. PolyAA might present the specific antagonists to arrest the extrinsic hypercoagulation following inflammation.

Anticoagulants↗

PubMed2000

Universal newborn hearing screening in an inner-city, managed care environment.

OBJECTIVES/HYPOTHESIS: Universal neonatal hearing screening (UNHS) programs aim to identify and treat educationally significant hearing loss in the first months of life. Several states have mandated UNHS for all newborns. Such programs have been successful in small, homogeneous populations. As larger states attempt to implement such programs, important obstacles have arisen, particularly in sparsely populated rural environments and in the inner city, where poverty, unstable living situations, and inadequate access to health care make follow-up of infants failing initial testing difficult. STUDY DESIGN: We performed a prospective longitudinal study examining the effects of increasingly complex and expensive interventions designed to ensure that children failing initial hearing screening returned for complete evaluation and habilitation. METHODS: A UNHS program based on transient evoked otoacoustic emissions testing was implemented at Temple University Hospital, with 2,000 births per year. At 6 months into the program, efficacy was assessed and modifications in follow-up methodology were made in an attempt to improved rate of return of infants failing newborn screening. The effect of these interventions was reassessed 6 months later. RESULTS: In its first 12 months, the Temple University Infant and Young Child Hearing Intervention Initiative successfully screened 95% (2,031) of all newborns using transient evoked otoacoustic emissions. Collecting a complete database profile for each newborn, establishing rapport with the family, and offering immediate follow-up appointments yielded a 61% return rate after discharge. The addition of a dedicated project secretary, free day-care for siblings, and cab vouchers for transportation and the elimination of a requirement for health maintenance organization referrals increased follow-up yield to 75%. CONCLUSION: Given adequate resources and planning, UNHS can be successful, even in economically depressed environments.

Audiometry, Pure-Tone↗

PubMed2001

Emergency nursing care of pediatric sickle cell patients: meeting the challenge.

Emergency care of the pediatric sickle cell patient requires complex nursing care and interventions including patient assessment, pain management, infection control, and appropriate understanding of complex hematological and immunological issues. This article includes two case studies that will illustrate the pathophysiology of sickle cell disease in the context of the bedside emergency nursing of the pediatric patient.

Adolescent↗

PubMedDate not supplied

Advanced practice nursing model for comprehensive care with chronic illness: model for promoting process engagement.

New models of providing care to chronically ill persons are needed that can facilitate a more integrative approach to patient care. The purposes of this article are to describe the utilization of a theory synthesis process for development of a client-focused approach for advanced practice nurse (APN) management of chronic illness and to present the Model for Promoting Process Engagement. The model was developed as a theory-driven intervention to address complexities of chronic illness care. This APN practice model is the direct result of the synthesis of a number of differing theoretical models developed by the authors in previous individual research endeavors.

Caregivers↗

PubMed2004

Systematic review of published multi-practice audits from British general practice.

BACKGROUND: Audit has been a major part of attempts to improve patient care in Britain, with substantial resources devoted to it since the 1990 National Health Service reforms. Systematic reviews have considered audit to be of variable, but often moderate, effectiveness. However, these have included few studies from British primary care, and as quality improvement activities may be context specific, it is hard to judge how effective audit has been here. RESULTS: A search for audits published in peer-reviewed journals revealed 48 two-stage projects carried out in British general practice, of which 27 principally concerned chronic disease management and nine prescribing. Most audits showed some improvements in performance, and those using controls showed 27/56 (48%) parameters had changed significantly (P < 0.05). CONCLUSIONS: This review adds further evidence that audit can often be moderately effective. However, it is frequently used as one of a complex set of interventions making precise evaluation difficult. Those responsible for clinical governance will need to choose carefully the subjects they audit in order to use their limited resources to maximum effect. These projects are illustrative examples but once again do not identify any 'magic bullets' that would be highly likely to improve professional performance.

Family Practice↗

PubMed1993

Signal averaging in patients with coronary artery disease: how helpful is it?

In patients who have survived acute myocardial infarction, the presence of ventricular late potentials using the high resolution signal-averaged ECG indicates areas of slow conduction and delayed activation that may potentially serve as a substrate for malignant ventricular arrhythmias. Although detection of late potentials is technique specific, signal-averaged analysis in the time or frequency domain may be a useful index for risk stratification with regard to ventricular tachycardia or sudden cardiac death. The sensitivity and specificity of late potentials for this purpose may be enhanced by combination with other variables, such as left ventricular ejection fraction and presence of complex ventricular ectopy. Therefore, the presence of ventricular late potentials in postmyocardial infarction patients, particularly in those patients with impaired left ventricular function, identifies those patients who are at high risk of malignant ventricular tachyarrhythmias. However, the strategies for prevention of serious arrhythmia complications during follow-up need to be established. The negative predictive value of late potentials is very high. Thus, the absence of late potentials indicates a low propensity to sustained ventricular tachycardia or sudden death, even in the presence of complex ventricular ectopy. Interventions may therefore not be necessary or should even be avoided. The incidence of late potentials in patients with spontaneous or induced ventricular fibrillation is lower and, if present, less pronounced than in those with sustained monomorphic ventricular tachycardia. This presumably is due to a lower degree of conduction delay, which serves as a substrate for reentry. Therefore, the ability of the signal-averaged ECG to predict a propensity to ventricular fibrillation is limited. Despite these limitations, the signal-averaged ECG may be used as a risk predictor in evaluation of patients after myocardial infarction. Unfortunately, at least as far as time domain analysis is concerned, it cannot be used as an efficacy predictor for response to pharmacologic interventions. Further studies will determine whether other modes of signal-averaged analysis can predict the response to drugs.

Action Potentials↗

PubMed1988

Optical and nuclear magnetic resonance studies of hypoxia in human tissue and tumors.

Correlations of energy state with response to therapy are more difficult to analyze because of the large effect of tumor clearing and oxygenation upon the tumor energy state as detected by PMRS alone. The combination of time-resolved hemoglobinometry using picosecond laser technology and localized PMRS seems appropriate to unravel the complexities of therapeutic intervention, tumor energetics, and oxygenation.

Energy Metabolism↗

PubMedDate not supplied

A new classification system for dental treatment under general anesthesia.

The provision of comprehensive care for patients with special needs using dental general anesthesia (DGA) has changed over time, and now includes more complex procedures and the participation of many services. As a result, it is necessary to integrate, organize and describe all of the procedures that are carried out in different DGA settings. The aim of this study was to propose a systematic classification for dental treatment procedures be delivered under DGA, and to compare this classification system with an existing system. This new classification system has three distinct components: type, frequency and length of time needed to complete dental procedures for both primary and permanent teeth. A wide range of oral surgery procedures and endodontic treatment was also included. A retrospective cohort study utilizing 84 subjects was used to develop and compare the two classification systems. When comparing the different categories of procedures by both classifications, there were significant statistical differences between them (p < 0.05). Oral health care for patients with special needs has evolved, with more complex and extensive interventions that require teamwork by personnel from different dental or medical specialties. The classification system in this study includes detailed information regarding the procedures involved in the DGA. This helps to provide a clear understanding and specific information that enables the comparison of clinical experiences across populations where a DGA has been used for patients with special needs.

Adolescent↗

PubMed1995

New concepts for interpretation of intracoronary velocity and pressure tracings.

The development of quantitative angiography and the introduction of new imaging techniques cannot replace functional methods of assessing the severity of stenosis. Measurement of transstenotic pressure gradient and poststenotic flow velocity using miniaturised sensors with guidewire technology offers an alternative to the conventional non-invasive methods that is immediately applicable in the catheterisation laboratory during interventional procedures. The complexity of the coronary circulation, however, makes it difficult to establish simple cut-off criteria to identify the presence of a flow-limiting stenosis. For intermediate lesions or in the presence of variable haemodynamic conditions, the accuracy of the assessment can be improved by the application of more complex indices proposed and validated in the laboratory animals. Two of these indices are myocardial fractional flow reserve and the slope of the instantaneous relation between pressure or pressure gradient and flow velocity.

Blood Flow Velocity↗

PubMed2006

Guidelines for the diagnosis and management of individuals with neurofibromatosis 1.

Neurofibromatosis 1 (NF1) is a common neurocutaneous condition with an autosomal dominant pattern of inheritance. The complications are diverse and disease expression varies, even within families. Progress in molecular biology and neuroimaging and the development of mouse models have helped to elucidate the aetiology of NF1 and its clinical manifestations. Furthermore, these advances have raised the prospect of therapeutic intervention for this complex and distressing disease. Members of the United Kingdom Neurofibromatosis Association Clinical Advisory Board collaborated to produce a consensus statement on the current guidelines for diagnosis and management of NF1. The proposals are based on published clinical studies and on the pooled knowledge of experts in neurofibromatosis with experience of providing multidisciplinary clinical and molecular services for NF1 patients. The consensus statement discusses the diagnostic criteria, major differential diagnoses, clinical manifestations and the present strategies for monitoring and management of NF1 complications.

Child↗

PubMed2004

Chlamydia and gonorrhoea in pregnancy: effectiveness of diagnosis and treatment in Botswana.

BACKGROUND: Millions of patients are prescribed drugs for sexually transmitted infections (STIs) in developing countries each year, yet the treatment effect of these prescriptions is largely unknown. OBJECTIVES: To determine if the prescribing of erythromycin and ceftriaxone to pregnant women with STI symptoms leads to a reduction in the prevalence among these women of chlamydia and gonorrhoea, respectively. METHODS: We compared the prevalence of chlamydia among 116 pregnant women who had been prescribed erythromycin for a history of STI symptoms in their current pregnancy with the prevalence in a control group of 557 pregnant women who had not been prescribed this drug. Similarly we compared the prevalence of gonorrhoea among 110 pregnant women who had and 561 women who had not been prescribed ceftriaxone. RESULTS: There was no significant difference in the prevalence of chlamydia among the women who had and the women who had not been prescribed erythromycin four times daily for 10 days (7% v 8%). Contrarily, none of the women who had been prescribed a single dose of ceftriaxone had gonorrhoea, whereas 4% of the women who had not had this drug prescribed did have gonorrhoea. CONCLUSIONS: The prescribing of erythromycin seems to have had a limited effect on chlamydia in this population, whereas the prescribing of ceftriaxone led to the curing of gonorrhoea. Ceftriaxone is provided as a single dose injection at the point of care, and the differential effectiveness between the two drugs may reflect low compliance with the complex erythromycin regimen. Interventions to increase compliance could improve cure rates. The use of a simpler drug regimen should be considered when low compliance is likely.

Adolescent↗