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At least 73 records · Page 4Linked to original sources

PubMed2003

Open-access endoscopy: are age-based guidelines justified? An audit of experience of 1000 open-access endoscopies at a district general hospital.

BACKGROUND AND STUDY AIMS: Open-access endoscopy has been developed to meet the increasing demand for endoscopy, and guidelines have been produced for selecting suitable patients. This study was designed to assess the appropriateness of these guidelines in patients referred to open-access endoscopy services at a district general hospital. PATIENTS AND METHODS: A series of 1000 consecutive patients referred for open-access endoscopy was audited. The waiting time was 18 weeks and patients continued to take any acid-suppressing medication prescribed by their general practitioner. The endoscopy findings were compared in those who met and did not meet currently accepted guidelines. In addition the outcome for all patients in whom gastro-oesophageal malignancy was detected was reviewed. RESULTS: 301 patients (30.1 %) did not meet accepted guidelines for open-access endoscopy. No cases of malignancy would have been missed if the guidelines had been implemented. Gastro-oesophageal malignancy was detected in 17 patients, all of whom died. When malignancy was excluded, there were no statistically significant differences between the detection rates for pathology in the two groups. The commonest finding, in 32.3 % of patients, was of a normal endoscopic appearance. CONCLUSIONS: If current guidelines are applied, all cases of malignancy may be picked up, but identification of patients with curable disease is poor. Use of the guidelines did not select patients with other upper gastrointestinal disease, although many patients were receiving acid-suppression therapy at the time of their endoscopy. Implementation of test-and-treat strategies would result in a significant reduction in the workload of open-access endoscopy.

Adult↗

PubMed1992

Transcervical access and intra-luminal imaging of the fallopian tube in the non-anaesthetized patient; preliminary results using a new technique for fallopian access.

A study was performed to evaluate a new transcervical, Fallopian tube access system for use in falloposcopy procedures without the need for conventional hysteroscopy or uterine distension. Visualization was accomplished by the use of a 0.5 mm falloposcope which was delivered to the Fallopian tube by a new linear everting catheter. The linear everting catheter allows access to the Fallopian tube by means of a flexible, tubular rolling membrane which can safely negotiate the tortuous anatomy from the ostium to the ampulla. Concurrent laparoscopy was performed solely for supervision purposes and not for tubal manipulations in 13 Fallopian tube access procedures in 10 patients. The ostia were visualized in 12 cases and the Fallopian tube was accessed in all 12 without complications. As a precursor for future gamete and embryo transfer procedures, intra-tubal insemination was performed by visualizing the ostia, accessing the Fallopian tubes, and obtaining successful isthmic-ampullary, intra-luminal images.

Catheterization↗

PubMedDate not supplied

Predictive value of access blood flow in detecting access thrombosis.

The aim of this study was to evaluate whether repeated measurement of access blood flow (Qac) using the ultrasound dilution technique could predict access failure in patients on hemodialysis. One hundred thirty-one patients were evaluated at intervals of 8 weeks for a period of 6 months. The incidence of thrombosis was determined within each study period. During the 6 month follow-up, 36 thrombotic events occurred in 27 of 68 polytetrafluoroethylene (PTFE) grafts, and only six thrombotic events in 5 of 63 arteriovenous (AV) fistulas. The relative risk for access thrombosis for patients with PTFE grafts was 5.6 times greater than for patients with AV fistulas. Qac was significantly lower in thrombotic compared with patent PTFE grafts (958 +/- 506 ml/min vs 1141 +/- 482 ml/min, p < 0.05). A significant relationship was found between the incidence of subsequent PTFE graft thrombotic events and Qac (p < 0.001). Compared with accesses with high blood flow (1100-1400 ml/min), the risk for subsequent thrombosis tripled in grafts with a Qac of less than 500 ml/min. This relationship was not seen with AV fistulas. In patent PTFE grafts, Qac remained unchanged within each 2 month interval, whereas it decreased in thrombotic PTFE grafts. Thus, repeated measurements of Qac have the potential to predict future access failure in PTFE grafts; however, an increased measuring frequency might improve the predictive value of graft failure with high Qac.

Female↗

PubMed2006

Percutaneous drainage of postoperative abdominal abscess with limited accessibility: preexisting surgical drains as alternative access route.

PURPOSE: To retrospectively assess the effectiveness and safety of postoperative percutaneous drainage of abdominal abscesses with limited accessibility by using a preexisting surgical drain as an access route. MATERIALS AND METHODS: The study was approved by the institutional review board, and informed consent was not required. The authors reviewed the medical records of 92 patients (62 male, 30 female; median age, 59 years; age range, 3-79 years) with postoperative abdominal abscesses in whom percutaneous drainage was performed by using surgical drains as an access. Factors evaluated included the location and size of the lesion; time between surgery and the drainage procedure; distance between the lesion and surgical drain; presence of fistula; duration of drainage; type of surgical drain; size, type, and length of drainage catheter; and complications. Technical success was defined as adequate placement of a new drainage catheter into the target abscess. Midterm success was defined as avoidance of surgery or additional percutaneous drainage during the 6 months of follow-up. Univariate analysis and multiple logistic regression analysis were performed to determine factors that affected the technical or midterm success of the procedure. RESULTS: Of 92 postoperative abscesses for which the technique was attempted, 56 (61%) had a subphrenic location and 36 (39%) had a peripancreatic location. Technical success was achieved in 87 of the 92 patients (95%). Technical success was not significantly associated with any of the factors tested. Midterm success was achieved in 75 of the 87 patients (86%) in whom technical success was achieved. Midterm failure showed a statistically significant relationship with the presence of fistula (P = .04). No procedure-related complications were identified. CONCLUSION: Percutaneous drainage by using the surgical drain as an access route is an effective and safe alternative for draining postoperative abdominal abscesses that are less accessible with direct puncture..

Abdominal Abscess↗

PubMed1990

Clinical evaluation of a side entry access port: a novel dual-lumen venous access device.

The initial clinical experience with a low-profile side entry access (SEA) dual-lumen implantable venous access port for cancer chemotherapy administration is summarized in this report. The catheter material is polyurethane. The overall experience in 35 patients in this study was a total of 6,224 patient days, with a mean of 178 days per patient. A variety of chemotherapeutic agents, biologic response modifiers, and antibiotics were administered. In 26% of the patients, the device chambers were in simultaneous use during the treatment period. A 6% incidence of clinical subclavian vein thrombosis was noted. There was no infectious complications. Inconsistencies in blood withdrawal and temporary catheter dysfunction were comparable to other access ports in clinical use. The novel design of this side entry port and the catheter material of low thrombogenicity make this device a good option in patients requiring a low-profile system and dual access. Nursing staff should be made aware of the side entry design and that in-service training for accessing the septum is required in centers where such devices are not routinely used.

Adult↗

PubMed1998

Accessible content and accessibility experiences: the interplay of declarative and experiential information in judgment.

Recall tasks render 2 distinct sources of information available: the recalled content and the experienced ease or difficulty with which it can be brought to mind. Because retrieving many pieces of information is more difficult than retrieving only a few, reliance on accessible content and subjective accessibility experiences leads to opposite judgmental outcomes. People are likely to base judgments on accessibility experiences when they adopt a heuristic processing strategy and the informational value of the experience is not called into question. When the experience is considered nondiagnostic, or when a systematic processing strategy is adopted, people rely on accessible content. Implications for the operation of the availability heuristic and the emergence of knowledge accessibility effects are discussed.

Journal Article↗

PubMed2001

[Evaluation of vascular access for hemodialysis using combined measurement of recirculation in normal and inverted needle placement and determination of blood flow through the access].

The article describes novel method of vascular access quality assessment by means of combined measurement of recirculation with normal and inverse needles placement and calculation of vascular access blood flow from the recirculation data. Blood flow values seen in a large group of patients ranged from as low as 200 ml/min up to as high as 2 l/min. Females and diabetics exhibited lower values as compared to males and non-diabetics. The method enables to detect a number of anomalous sates which cannot be detected by conventional means based on monitoring of pressures or recirculation measurement at normal needles placement only (stenosis between both needles, uintentionally erroneous placement of needles in accesses with a loop). Assessment of access blood flow is suitable also for evaluation of interventions on the access, such as percutaneous transluminal angioplasty or surgical narrowing of anastomosis in case of too high blood flow.

Arteriovenous Shunt, Surgical↗

PubMed2002

[Cephalic vein access for implantable venous access devices. Technique and long-term follow-up].

OBJECTIVE: To evaluate 1) the advantages and drawbacks of the cephalic vein access for totally implantable venous access devices (TIVAD); 2) the complications of such devices at long-term follow-up. PATIENTS AND METHODS: A retrospective study of a series of 107 cephalic vein accesses attempted on 105 patients from January 1997 to December 2001, in our department. They were 87 men and 18 women, aged from 25 to 85 years (mean: 59). The authors evaluated in each case the surgical technique, the preoperative incidents, the side of surgery, and the short-term and long-term complications. The total follow-up reached 41 284 days. RESULTS: The cephalic vein access attempt failed in 12 cases (11%). These failures were due to intravenous blockade of the flexible catheter or to misroutine of the catheter in 5 cases and to a too thin vein in 7 cases. There was no statistically significant difference between the right and left sides. There was no technique-related complication. There were 18 postoperative complications (19%) out of the 95 devices that were implanted: 6 venous thrombosis, 7 infections, 4 catheter disconnections including 3 intra-cardiac migrations, 1 catheter occlusion. In 12 of these cases, the whole device had to be withdrawn. In the whole series, the devices were withdrawn at mean of 435 days after implantation. CONCLUSION: The use of a TIVAD is necessary when a chemotherapy must be delivered for treatment of a cancer. Cephalic vein access appears to be easy, quick and relatively safe. Postoperatively, serious complications can be encountered like with any type of TIVAD. These complications must be well-known if one wants to manage them well.

Adult↗

PubMedDate not supplied

A comparison of methods for the measurement of hemodialysis access recirculation and access blood flow rate.

The ability to accurately measure access recirculation (AR) is of importance because its presence indicates access dysfunction and may explain why a prescribed Kt/V (urea) has not been delivered. The ability to measure access flow (Qa) allows access monitoring and the detection of impending access dysfunction. AR can be measured by indicator dilution or conductivity tracer techniques. Qa calculation is simple if AR can be detected. The previous techniques are used while the patient's blood lines are reversed to induce AR, and the Krivitski equation gives: Qa = Qb [1-r/r] where Qb = dialyzer blood flow and r = proportion of AR induced. Three methods for AR and Qa measurements were directly compared: 1) ultrasound dilution (Transonics Hemodialysis Monitor, Transonics Systems Incorporated) (TRANS); 2) hematocrit dilution (Crit-Line Monitor, In-Line Diagnostics) (CRIT); and 3) differential conductivity (Hemodynamic Monitor, GAMBRO Healthcare Incorporated) (HDM). Patients were cannulated in a standard fashion and dialysis commenced with lines in normal configuration. A HDM test was performed and, if AR = zero, the lines were reversed to induce AR. HDM, TRANS, and CRIT tests for AR were next done in rapid succession for direct comparison. Each test was repeated three times in succession, the device in random order, to assess test repeatability. Qb was taken from the 1) dialysis machine pump, and 2) directly from TRANS and Qa calculated, using 1) and 2) AR results. In comparison to TRANS, AR results were virtually identical for HDM (TRANS AR = 1.04 HDM-AR + 0.02, r = 0.98, p = 0.0000), and good for CRIT (CRIT-AR = 0.84 TRANS-AR - 0.2, r = 0.81, p = 0.001), but CRIT underestimated the values. Repeatability was assessed by normalizing (%) the SD of repeated measurements; values were 7.5% (HDM), 9.1 % (TRANS), and 17.4% (CRIT). Qa value comparisons were similar (minimal r = 0.83) regardless of Qb source, but CRIT overestimated the value; repeatability data showed 10.6% (HDM), 13.0% (TRANS), and 25.2% (CRIT) (n ranged from 15-64). In summary, TRANS and HDM appear equal as far as accuracy and repeatability of measurements; CRIT results correlated well, but tended to underestimate AR and overestimate Qa, and was less reproducible.

Arteriovenous Shunt, Surgical↗

PubMed2006

Universal access -- but when? Treating the right patient at the right time: access to electrophysiology services in Canada.

The Canadian Cardiovascular Society Access to Care Working Group has published a series of commentaries on access to cardiovascular care in Canada. The present article reviews the evidence for timely access to electrophysiology services. Using the best available evidence along with expert consensus by the Canadian Heart Rhythm Society, the panel proposed a series of benchmarks for access to the full scope of electrophysiology services, from initial consultation through to operative procedures. The proposed benchmarks are presented herein.

Canada↗

PubMed2006

Universal access: but when? Treating the right patient at the right time: access to cardiac rehabilitation.

The Canadian Cardiovascular Society formed an Access to Care Working Group ('Working Group') in the spring of 2004. The mandate of the group was to use the best science and information to establish reasonable triage categories and safe wait times for access to common cardiovascular services and procedures. The present commentary presents the rationale for benchmarks for cardiac rehabilitation (CR) services. The Working Group's search for evidence included: a full literature review of the efficacy of CR, and the factors affecting access and referral to CR; a review of existing guidelines for access to CR; and a national survey of 14 CR programs across Canada undertaken in May 2005 to solicit information on referral to, and wait times for, CR. The Working Group also reviewed the results of The Ontario Cardiac Rehabilitation Pilot Project (2002) undertaken by the Cardiac Care Network of Ontario, which reported the average and median wait times for CR. Some international agencies have formulated their own guidelines relating to the optimal wait time for the onset of CR. However, due to the limited amount of supporting literature, these guidelines have generally been formed as consensus statements. The Canadian national survey showed that few programs had guidelines for individual programs. The Cardiac Care Network of Ontario pilot project reported that the average and median times from a cardiac event to the intake into CR were 99 and 70 days, respectively. The national survey of sampled CR programs also revealed quite remarkable differences across programs in terms of the length of time between first contact to first attendance and to commencement of exercise. Programs that required a stress test before program initiation had the longest wait for exercise initiation. Some patients need to be seen within a very short time frame to prevent a marked deterioration in their medical or psychological state. In some cases, early intervention and advocacy may reduce the risk of loss of employment. Or, there may be profound disturbances in the patient's family as a result of the cardiac event. For other patient groups, preferable wait times vary from one to 30 days, and acceptable wait times vary from seven to 60 days. All cardiovascular disease patients require core aspects of CR services. Patients who would derive benefit from formal CR programs should be provided the opportunity, given the proven efficacy and cost effectiveness of CR.

Benchmarking↗

PubMed2002

Overview of the ACCESS Program. Access to Community Care and Effective Services and Supports.

The authors provide an overview of the ACCESS program (Access to Community Care and Effective Services and Supports), which evaluated the integration of service systems and its impact on outcomes for homeless persons with severe mental illness. The ACCESS program provided funds and technical assistance to nine community sites to implement strategies for system change that would promote systems integration. These experimental sites, along with nine comparison sites, also received funds to support outreach and assertive community treatment for 100 clients a year for four years at each site. Data on the implementation of system change strategies were collected from 1994 to 1998 during annual visits to the sites. Data on changes in systems integration were obtained from interviews with key informants from relevant organizations in each community. Client outcome data were obtained at program entry and three and 12 months later from 7,055 program participants across the four annual client cohorts at all sites. Detailed findings from the ACCESS evaluation are presented in two accompanying articles, and overall conclusions are offered in a fourth article.

Community Mental Health Services↗

PubMed2002

Service systems integration and outcomes for mentally ill homeless persons in the ACCESS program. Access to Community Care and Effective Services and Supports.

OBJECTIVE: The authors evaluated the second of the two core questions around which the ACCESS (Access to Community Care and Effective Services and Supports) evaluation was designed: Does better integration of service systems improve the treatment outcomes of homeless persons with severe mental illness? METHODS: The ACCESS program provided technical support and about $250,000 a year for four years to nine sites to implement strategies to promote systems integration. These sites, along with nine comparison sites, also received funds to support outreach and assertive community treatment programs to assist 100 clients a year at each site. Outcome data were obtained at baseline and three and 12 months later from 7,055 clients across four annual cohorts at all sites. RESULTS: Clients at all sites demonstrated improvement in outcome measures. However, the clients at the experimental sites showed no greater improvement on measures of mental health or housing outcomes across the four cohorts than those at the comparison sites. More extensive implementation of systems integration strategies was unrelated to these outcomes. However, clients of sites that became more integrated, regardless of the degree of implementation or whether the sites were experimental sites or comparison sites, had progressively better housing outcomes. CONCLUSIONS: Interventions designed to increase the level of systems integration in the ACCESS demonstration did not result in better client outcomes.

Community Mental Health Services↗

PubMed2005

General commentary on access to cardiovascular care in Canada: universal access, but when? Treating the right patient at the right time.

In 2004, the Canadian Cardiovascular Society formed an Access to Care Working Group with a mandate to use the best science and information available to establish reasonable triage categories and safe wait times for common cardiovascular services and procedures through a series of commentaries. The present commentary is the first in the series and lays out issues regarding timely access to care that are common to all cardiovascular services and procedures. The commentary briefly describes the 'right' to timely access, wait lists as a health care system management tool, and the role of the physician as patient advocate and gatekeeper. It also provides advice to funders, administrators and providers who must monitor and manage wait times to improve access to cardiovascular care in Canada and restore the confidence of Canadians in their publicly funded health care system.

Canada↗

PubMed2001

Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insurance.

Governments are constantly faced with competing demands for public funds, thereby necessitating careful use of scarce resources. In Egypt, the School Health Insurance Programme (SHIP) is a government subsidized health insurance system that targets school children. The primary goals of the SHIP include improving access and equity in access to health care for children while, at the same time, ensuring programme sustainability. Using the Egyptian Household Health Utilization and Expenditure Survey (1995), this paper empirically assesses the extent to which the SHIP achieves its stated goals. Our findings show that the SHIP significantly improved access by increasing visit rates and reducing financial burden of use (out-of-pocket expenditures). With regard to the success of targeting the poor, conditional upon being covered, the SHIP reduced the differentials in visit rates between the highest and lowest income children. However, only the middle-income children benefitted from reduced financial burden (within group equity). Moreover, by targeting the children through school enrollment, the SHIP increased the differentials in the average level of access between school-going children and those not attending school (overall equity). Children not attending school tend to be poor and living in rural areas. Our results also indicate that original calculations may underestimate the SHIP financial outlays, thereby threatening the long run financial sustainability of the programme.

Adolescent↗

PubMed2003

Developing a measure of patient access to primary care: the access response index (AROS).

Access to appointments in primary care is not routinely measured, and there is no one standardized method for doing so. Any measurement tool has to take account of the dynamic status of appointment availability and the definitional problems of appointment types. The aim of this study was to develop and trial a method for measuring access that is valid, reliable, quick and provides a daily longitudinal record of access on an organizational basis (not for individual clinicians). Using the results of a literature review and following discussions with clinicians and managers a tool was designed following agreed specifications. After initial adjustments of the tool a feasibility study tested the acceptability of a data collection exercise on 11 practices of varying types, over a 4- to 8-week period. The development phase led to the design of a tool named the access response index (AROS). The method was well received in the practices, with a low incidence of missed days and only one practice failing to return data. The index measures the number of days' wait to the next available appointment with any general practitioner. The inclusion in the score of urgent appointments was abandoned due to definitional problems. A 5-day moving average was chosen to represent the data in graph form to demonstrate overall trends. AROS is a useful tool usable in any practice, and our feasibility study points to it being widely acceptable in the field. Data are represented in clear graphical daily format, either just for one practice or as an anonymous composite graph with other practices in the locality.

Appointments and Schedules↗

PubMed2003

Improving access to capital for health care infrastructure: the experience of the Southern Rural Access Program's revolving loan fund.

Lack of access to affordable capital is a formidable barrier that compromises rural health care infrastructure development in poor rural areas. Commercial lending institutions are often limited in their ability to respond to those needs due to traditional lending criteria: creditworthiness, equity, management ability, experiences, and cash flow or profits. In the Southern Rural Access Program, a development model more frequently used in other sectors has been successfully applied to health care to help clear these hurdles. This paper describes the 5 operational loan funds in Arkansas, Louisiana, Mississippi, South Carolina, and West Virginia receiving support from the Southern Rural Access Program. Two models of loan funds have evolved: those led by health agencies and those led by community development finance institutions whose mission is rural economic development. This paper outlines major distinctive features of these 2 approaches and describes major implementation challenges these loan funds face. Key accomplishments are high-lighted, including the ability to leverage additional resources from state, federal, philanthropic, and private sources through these funds. These loan fund programs provide models for other states interested in improving access to capital to help build the rural health care infrastructure while making health care more economically viable through integration with other community development initiatives.

Capital Financing↗

PubMedDate not supplied

The Public Health Service action plan to improve access to immunization services. The Interagency Committee to Improve Access to Immunization Services.

The Public Health Service's Interagency Committee to Improve Access to Immunization Services (ICI) has responsibility for improving the immunization protection of the nation's children and other vulnerable populations. ICI's Action Plan to Improve Access to Immunization Services sets 14 goals with 120 action steps for improving immunization services nationwide by (a) increasing coordination among Federal health, income, housing, education, and nutrition programs; (b) reducing policy and management barriers that limit access to delivery systems, and (c) strengthening the delivery infrastructure. To accomplish the goals of the plan, there is a $72.0 million increase in funding appropriated in fiscal year 1992 specifically for this purpose. The President's Budget for fiscal year 1993 includes a $24.5 million increase for continued program implementation. The additional resources will be used to address delivery and access problems, which have been determined to be the primary factors limiting immunization for many children.

Child↗