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At least 685 records · Page 38Linked to original sources

PubMed2003

Patient perceptions of MRSA.

Drug-resistant nosocomial infections are an increasing problem. This issue has received considerable media coverage. To our knowledge there have been no studies investigating patient awareness and perceptions of nosocomial infections. A total of 113 surgical out-patients completed a questionnaire stating whether they had heard of either superbugs or MRSA. A series of questions were asked about the source of any information; methods of transmission and prevention; the consequences of infection and their emotional response if they were to acquire MRSA. Fifty patients (44%) had heard of superbugs or MRSA mainly via the media (58%) or from hospital staff (44%). The majority would feel either angry or afraid if they acquired MRSA in hospital, but there was good awareness of both methods of infection control and the consequences of infection. From our study, we conclude that the media is at least as important as health professionals in providing information. Concerns regarding nosocomial infection may need to be addressed prior to admission.

Adult↗

PubMed1999

The effects of managed care and prospective payment on the demand for hospital nurses: evidence from California.

OBJECTIVE: To examine the effects of managed care and the prospective payment system on the hospital employment of registered nurses (RNs), licensed practical nurses (LPNs), and aides. DATA SOURCES: Hospital-level data from California's Office of Statewide Health Planning and Development (OSHPD) Hospital Disclosure Reports from 1976/1977 through 1994/1995. Additional information is extracted from OSHPD Patient Discharge Data. STUDY DESIGN: Multivariate regression equations are used to estimate demand for nurses as a function of wages, hospital output, technology level, and ownership. Separate equations are estimated for RNs, LPNs, and aides for all daily services and for medical-surgical units. Instrumental variables are used to correct for the endogeneity of wages, and fixed effects are included to control for unobserved differences across hospitals. PRINCIPAL FINDINGS: HMOs are associated with a lower use of LPNs and aides, and HMOs do not have a statistically significant effect on the demand for RNs. Managed care has a smaller effect on nurse staffing in medical-surgical units than in daily service units as a whole. The prospective payment system does not have a statistically significant effect on nurse staffing. CONCLUSIONS: HMOs have affected nursing employment both because HMOs have reduced the number of discharges and because of a direct relationship between HMO penetration and the demand for LPNs and aides. Contrary to press reports, LPNs and aides have been affected more by HMOs than have registered nurses.

California↗

PubMed1993

[Gamma knife].

The term "radiosurgery" was defined by Lars Leksell, a Swedish neurosurgeon, as the closed-skull destruction of a precisely defined intracranial target using high-dose radiation with stereotactic technique in a single session. For this purpose, the Gamma Knife was developed in 1968. It was equipped with multiple cobalt 60 sources and delivered collimated narrow radiation beams precisely concentrated to the focus. The dose gradient in the periphery of the treatment volume is extremely steep, so a high dose can be delivered to the small target volume sparing the surrounding normal tissue. Treatment planning was directed using a computer program developed for Gamma Knife and stereotactically obtained imaging database. The treatment procedure may be completed in only one day. The Gamma Knife makes it possible to treat deep-seated and surgically inaccessible lesions with low mortality and morbidity, and to control conventionally radioresistant lesions. Up to now, over 10,000 patients have undergone radiosurgery with a Gamma Knife around the world. The indications were primarily functional disorders, then expanded to include arterio-venous malformation (AVM), benign and a few malignant brain tumors. Excellent results were noted in the treatment of AVM. The two-year total obliteration rate of the nidus was 71-87%, and the adverse effect rate was 3-12%. The control rates of acoustic tumors was reportedly 85-89% with a lower incidence of facial nerve injury and a higher rate of hearing preservation. Gamma Knife radiosurgery has also been used to treat meningioma, pituitary adenoma and metastatic brain tumors. Its application for the treatment of malignant glial tumors or other tumors is developing. The capability of this technique is growing, and radiosurgery will be one of the important treatment modalities for selected neurosurgical or other pathological conditions.

Arteriovenous Malformations↗

PubMed1993

Superior mesenteric arteriovenous fistula in vascularized whole organ pancreatic allografts.

Despite improved results in vascularized pancreatic transplantation, the incidence of technical complications continues to be high. Vascular complications are an important source of morbidity. Previously undescribed is the occurrence of an arteriovenous fistula (AVF) in the transplanted mesenteric bundle. We have identified this unusual complication in three of 90 consecutive recipients of pancreatic transplant. The first patient presented with severe and protracted endocrine insufficiency, which was effectively reversed by direct surgical ligation of the AVF. The second patient presented with hematuria, which likewise, resolved with correction of the AVF. The third instance was diagnosed immediately after transplant and was successfully corrected by direct surgical ligation. The operative approach with establishment of proximal vascular control differed in each instance. Clinical presentation was variable and diagnosis was suggested by physical examination, duplex ultrasonography and radionuclide perfusion scanning. Arteriography was confirmatory. Mesenteric AVF can be easily identified and corrected at the time of reoperation without compromising allograft function.

Adult↗

PubMed1994

The natural history of disc herniation and the influence of intervention.

The natural history of lumbar disc herniation must be considered when evaluating the influence and outcome of intervention. The combination of clinical signs and symptoms and corresponding radiologic findings permits a more certain diagnostic conclusion compared with many other obscure back disorders. The relationship between low back pain and a herniated disc is unclear. Mechanical compression and chemical changes may be the source of nerve root symptoms. Studies have shown that the natural course of acute radiculopathy has a good prognosis. Bed rest, information, and analgesics usually are sufficient therapeutic measures. Prolongation of symptoms requires radiologic examination. The decision regarding continued conservative therapy versus surgical intervention must be evaluated. Chemonucleolysis and percutaneous nucleotomy are being used, but the indications are uncertain.

Adult↗

PubMedDate not supplied

Current concepts in the management of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis.

During the past five years, continuous ambulatory peritoneal dialysis (CAPD) has become recognized as a major form of therapy for end-stage renal disease. Despite continued advances, peritonitis remains a major limiting factor in the widespread application of CAPD. The pathogenesis of CAPD peritonitis is strikingly different from that of surgical peritonitis. Not only are the sources of infection and the microbiologic findings dissimilar, but the severity of infection is markedly different. Moreover, in CAPD peritonitis, both biofilms (extracellular slime substances) associated with microbial growth on the implanted silicone catheter and compromised local defenses (depletion of opsonins and intracellular survival of certain microorganisms) are of pathogenic importance. Once the diagnosis of peritonitis is suspected, therapy should be instituted immediately. However, the optimal antibiotic regimen and the best route, dose, and duration of antibiotic administration remain unknown because of a paucity of randomized, controlled studies. New approaches to the prevention and treatment of CAPD peritonitis are being evaluated; if this infection can be successfully managed, CAPD promises to become increasingly popular for the treatment of chronic renal failure.

Anti-Bacterial Agents↗

PubMed1999

Reduction of leg wound infections following coronary artery bypass surgery.

OBJECTIVE: To reduce the rate of infection at the saphenous vein harvest site after coronary artery bypass surgery, to identify predictors of infection and to determine the best method for leg wound closure. DESIGN: A randomized clinical trial was undertaken to determine the best technique for reducing the postoperative leg wound infection rate. Patients were allocated to one of four leg wound closure methods: staples, close immediately; staples, close after protamine administration; subcuticular sutures, close immediately; and subcuticular sutures, close after protamine. Risk factors evaluated were age, sex, diabetes, obesity, peripheral vascular disease, reoperation, time in surgery, wound length, wound depth, time that the wound was open, wound quality and harvest site. SETTING: The Walter C Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta. PATIENTS: All consenting patients undergoing elective coronary artery bypass surgery involving saphenous vein harvesting were considered for the study. Exclusion criteria were insertion of a drain, insertion of an intra-aortic balloon pump in the index limb and inability to complete follow-up at the authors' centre. Eighty patients were initially enrolled, with 77 completing the study. INTERVENTIONS: Patients underwent standard saphenous vein harvesting followed by wound closure as indicated by the study group. MAIN RESULTS: The major infection rate was reduced from 13% to 3% (P = 0.02). Each closure method was equally effective, and wound depth was the only factor related to infection. CONCLUSIONS: Leg wound infections continue to be a major source of morbidity after coronary bypass surgery.

Aged↗

PubMedDate not supplied

[Profhylaxis and treatment of hereditary and acquired angioedema at HUB; use of the C1-esterase inhibitor].

INTRODUCTION: Hereditary and acquired angioedema result from a deficiency in first complement component esterase (C1-esterase) inhibitor. It is characterized by transient subcutaneous tissue, intestinal wall, and upper airway swelling, which may lead to asphyxia and death. The pathophysiology, classification, diagnosis, and treatment of this condition are discussed, as is the follow-up of patients diagnosed with angioedema who received 1 vial of concentrated C1-INH (Berinert); the contribution of the Pharmacy Department in the dispensation and control of said drug is also assessed. MATERIAL AND METHODS: PubMed and other relevant sources were searched. Patient, dispensation, and Berinert(R) indication data were collected from controlled prescriptions; follow-up was completed by performing a medical history, collecting laboratory data, and patient interview when needed. RESULTS: Eight out of 9 cases were of hereditary angioedema, and 1 case was of acquired angioedema. Danazol was used as long-term prophylaxis in 8 patients, but side effects forced discontinuation in some of them. The C1-INH concentrate was effective in 6 acute episodes that were detected during the study, as well as in 3 surgical prophylaxis cases (overall use 6,500 U). CONCLUSION: Danazol was effective as prophylactic treatment, but had severe side effects. The C1-INH concentrate was effective both as prophylactic therapy and treatment for acute episodes. An adequate stock of this product will be available at the Pharmacy Department.

Adult↗

PubMed1996

Elastin and collagen remodeling in emphysema. A scanning electron microscopy study.

The relationship between elastin degradation and emphysema is well known. Recent evidence suggests that a complex process of pulmonary remodeling occurs within the emphysematous lung. The aim of this study was to assess the extent of extracellular matrix remodeling in emphysema by ultrastructural examination of elastin and collagen templates in an animal model of emphysema and in human emphysematous lungs. Emphysema was induced in rats by the intratracheal administration of porcine pancreatic elastase. Human lung samples were obtained at surgical resection for lung carcinoma. Emphysema was confirmed morphometrically and quantitated using the mean linear intercept. Matching sections were treated with sodium hydroxide and formic acid to expose collagen and elastin templates, respectively. Scanning electron microscopy with stereo-pair imaging allowed three-dimensional visualization of the exposed templates. In emphysematous lungs from both sources, sheets of elastin were disrupted and perforated with multiple fenestrations. In elastase-induced emphysema, this disintegration was accompanied by a marked increase in thickness of collagen fibrils, which contrasted with the fine fibrillar network of control lungs. Similarly, a pattern of thickened fibrils and disorganized deposition of collagen was observed in human lungs. In conclusion, these findings support the novel concept of increased collagen deposition and aberrant collagen remodeling in the pathogenesis of emphysema.

Animals↗

PubMed1996

[Severe pelvic injury with pelvic mass hemorrhage: determining severity of hemorrhage and clinical experience with emergency stabilization].

The blood loss during the acute period after complex pelvic trauma is finally responsible for the high mortality associated with this specific type of injury. Several protocols have been published for optimized management, but up to now comparable data are not available as no exact definitions exist judging the severity of trauma and blood loss. As part of a prospective study 19 patients after unstable pelvic injuries with unstable circulation underwent emergency stabilization by the pelvic C-clamp. Beside standard clinical parameter the initial hemoglobin value was converted into a "blood volume equivalent". 18 of the 19 patients had an injury severity according to group III and IV of the Hannover Polytrauma Score (PTS). Concommitant abdominal injuries were seen in 12 cases (23 injuries), concommitant urological injuries in 12 cases (14 injuries). In 13 cases the pelvis was the major source of bleeding in 9 cases an additional intraabdominal hemorrhage was observed. 11 patients died due to sequelae of their injury, 8 patients survived. Although the initial blood loss was comparable both in the group of the deceased patients and the survivors, a 44% higher subsequent blood substitution (= 10089 ml) was observed in the nonsurvivor group. In conclusion the data proofed that early control of hemorrhage is fundamental for the prognoses after complex pelvic trauma. The estimation of the blood loss may help in indicating aggressive emergency procedures like emergency stabilisation, pelvic clamps, surgical exploration and tamponade. This calculation may be a basis for a more detailed analyses of this devastating injury and judging the benefit of different management protocols.

Blood Loss, Surgical↗

PubMed1981

Left ventricular aneurysms associated with intraoperative venting of the cardiac apex in children.

Left ventricular (LV) apical aneurysms were observed in 16 of 50 (32%) children (average age 8 years) consecutively catheterized after surgical repair of congenital heart disease. The LV apex was vented by a sump during cardiopulmonary bypass in each. The aneurysms varied in size, but were generally small. Average dimensions were 7.5 X 6.8 mm in the anteroposterior projection and 8.9 X 5.7 mm in the left anterior oblique projection. The LV apex wall was thinner in patients with aneurysms than in age- and lesion-matched controls. All of the LV aneurysm patients were asymptomatic during average follow-up of 4 years. Nevertheless, such aneurysms are anticipated to represent a potential source of cardiovascular complications and, when possible, alternate methods for venting the left ventricle are recommended.

Adolescent↗

PubMedDate not supplied

High-dose rate brachytherapy in the treatment of carcinoma of uterine cervix: twenty-year experience with cobalt after-loading system.

This retrospective analysis aims to report results of patients with cancer of uterine cervix treated with external-beam radiotherapy (EBR) and high-dose rate (HDR) brachytherapy, using manual treatment planning. From 1975 to 1995, 237 patients with FIGO stages IIB-IVA and mean age of 54.31 years were treated. EBR dose to the whole pelvis was 50 Gy in 25 fractions. Brachytherapy with HDR after-loading cobalt source (Cathetron) was performed following EBR completion with a dose of 30 Gy in three weekly fractions of 10 Gy to point A. Survival, local control, and genitourinary and gastrointestinal complications were assessed. In a median follow-up of 60.2 months, the 10-year overall and disease-free survival rate was 62.4%. Local recurrence was seen in 12.2% of patients. Distant metastases to the lymph nodes, peritoneum, lung, liver, and bone occurred in 25.3% of patients. Less than 6% of patients experienced severe genitourinary and/or gastrointestinal toxicity that were relieved by surgical intervention. No treatment-related mortality was seen. This series suggests that 50 Gy to the whole pelvis together with three fractions of 10 Gy to point A with HDR brachytherapy is an effective fractionation schedule in the treatment of locally advanced cancer of cervix. To decrease the complications, newer devices and treatment planning may be beneficial.

Adult↗

PubMed1987

Gram-negative bacilli as nontransient flora on the hands of hospital personnel.

The possibility that gram-negative bacilli (GNB) are part of the nontransient flora on hands was examined by using a broth rinse technique to detect low titers of GNB after a hygienic hand wash with soap and water. A total of 100 nurses who had direct patient contact and 40 controls without patient contact had a similar rate of recovery of GNB (46 and 55%, respectively). GNB persisted on the hands of 10 nurses throughout five successive hand washes with soap and water. Hand cultures were obtained daily from 12 nurses before and after a work shift in a surgical intensive care unit. GNB were recovered from 57% of individuals before patient contact and from only 24% after the work shift. Nontransient GNB on the hands of hospital personnel are a potential reservoir for hospital strains, and patient contact is not an obvious source for the acquisition of nontransient GNB.

Acinetobacter↗

PubMed2006

The sacroiliac joint: anatomy, physiology and clinical significance.

The sacroiliac joint (SIJ) is a putative source of low back pain. The objective of this article is to provide clinicians with a concise review of SIJ structure and function, diagnostic indicators of SIJ-mediated pain, and therapeutic considerations. The SIJ is a true diarthrodial joint with unique characteristics not typically found in other diarthrodial joints. The joint differs with others in that it has fibrocartilage in addition to hyaline cartilage, there is discontinuity of the posterior capsule, and articular surfaces have many ridges and depressions. The sacroiliac joint is well innervated. Histological analysis of the sacroiliac joint has verified the presence of nerve fibers within the joint capsule and adjoining ligaments. It has been variously described that the sacroiliac joint receives its innervation from the ventral rami of L4 and L5, the superior gluteal nerve, and the dorsal rami of L5, S1, and S2, or that it is almost exclusively derived from the sacral dorsal rami. Even though the sacroiliac joint is a known putative source of low back and lower extremity pain, there are few findings that are pathognomonic of sacroiliac joint pain. The controlled diagnostic blocks utilizing the International Association for the Study of Pain (IASP) criteria demonstrated the prevalence of pain of sacroiliac joint origin in 19% to 30% of the patients suspected to have sacroiliac joint pain. Conservative management includes manual medicine techniques, pelvic stabilization exercises to allow dynamic postural control, and muscle balancing of the trunk and lower extremities. Interventional treatments include sacroiliac joint, intra-articular joint injections, radiofrequency neurotomy, prolotherapy, cryotherapy, and surgical treatment. The evidence for intra-articular injections and radiofrequency neurotomy has been shown to be limited in managing sacroiliac joint pain.

Biomechanical Phenomena↗

PubMed1991

Axial pattern flap based on the caudal auricular artery in dogs.

An axial pattern flap that was based on the sternocleidomastoideus branches of the caudal auricular artery and vein was developed. Control flaps, which included ligation and division of the caudal auricular artery and vein, were similarly developed on the contralateral aspect of the neck. Mean survival of caudal auricular artery axial pattern flaps (85.2%), compared with control flaps (63.9%), was significantly different (P less than 0.05). On the basis of results of this study, an axial pattern flap based on the sternocleidomastoideus branches of the caudal auricular artery and vein may be a source of skin for reconstructive procedures of the head and neck.

Animals↗

PubMed2004

Chronic Intestinal Pseudoobstruction.

Patients with chronic intestinal pseudoobstruction (CIP) experience a constellation of symptoms including abdominal pain, nausea, fullness, and malaise which fluctuates in severity and invariably result in a diminished quality of life. Though surgical resection or transplantation may be an option for some, there currently is no cure for CIP. Thus, management strategies utilize pharmacologic, intravenous, endoscopic, and surgical techniques to promote transit, minimize painful bloating, reduce complications of stasis, and improve quality of life. Prokinetic agents such as erythromycin, metoclopramide, cisapride, neostigmine, and tegaserod may be effective for acute exacerbations. Octreotide may reduce symptoms of bacterial overgrowth and bloating by stimulating migrating motor complexes. Enteral tubes for venting and nutritional support may reduce hospitalizations. Total parenteral nutrition (TPN), fraught with well-known complications, may be the only tolerated source for nutrients and fluid. Advanced disease may magnify nutritional problems, difficulties of long term intravenous and intestinal access, and poor symptom control. Because the initial process may manifest in other intestinal regions following surgery, resection of involved segments should be performed with caution. Small intestinal transplantation is a high-risk surgery performed in persons unable to tolerate intravenous (IV) nutrition. Optimal management for persons with CIP should not only provide nutritional and symptom focused care but should be part of a supportive network which links patients to their appropriate healthcare needs.

Journal Article↗

PubMed1996

Fetal tissue transplantation for the treatment of Parkinson's disease: a review of the literature.

Parkinson's disease is a degenerative neurologic disorder that currently affects half a million Americans. There is no known medical treatment that stops or reverses the dopaminergic neuronal degeneration that causes the symptoms. Investigators are searching for new surgical treatments that may provide better control of symptoms for longer periods of time. Reinnervating the basal ganglia with dopaminergic neurons is the theory behind fetal neural tissue transplantation. A review of the clinical trials of fetal neural tissue transplants performed in Mexico, Sweden, England and the United States shows some improvement in motor function in patients with severe idiopathic Parkinson's disease. Comparing the results of the different clinical trials is difficult due to a number of varying factors between the groups. There is still no consensus regarding patient selection, optimal fetal tissue source, optimal site of implantation, the use of immunosuppression or optimal method of assessing patient response. Much research is still required before fetal neural tissue transplantation can be offered as a therapeutic option for patients with Parkinson's disease.

Fetal Tissue Transplantation↗

PubMed1999

Patient expectations and anticipated responses to postsurgical pain.

This descriptive study investigated the factors that influenced the intended pain management behaviors of a sample of 186 patients awaiting major surgical procedures. Pain management behaviors were defined as those related to reporting of postsurgical pain and seeking postsurgical pain management. Less than 44% of respondents specified the type of sensation, duration, similarity to previous pain, and source of pain as factors affecting the decision to seek help for pain. Only 9% expected complete relief with appropriate treatment, and 19% of respondents would wait for treatment to be given or offered, if pain returned following treatment. Moreover, less than 5% of respondents identified physicians or nurses as ways "by which you have learned about pain control." These findings underscore the need for comprehensive, individualized pain education protocols throughout the period of care delivery. Special emphasis should be placed on patient empowerment and decision making to seek appropriate pain management.

Adult↗