[Complex treatment of ischemic paralyses and contractures with surgical intervention as the main factor].
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Adolescent↗
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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.
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[Mass spectrometry in the complex study of brain life support systems after neurosurgical interventions].
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Brain↗
Self-complexity and health promotion: promising but premature.
Self-complexity, the number of nonredundant aspects by which the self is cognitively represented, was reported in 1987 by Linville to function as a buffer against the adverse consequences of stress under conditions of high stress. An attempt was made to increase the self-complexity of 110 undergraduates through the use of psychoeducational interventions, with the goal of decreasing physical symptoms. None of four interventions produced an increase in self-complexity or a decrease in physical symptoms. Using multiple regression, the previously reported buffering interaction was evident only among those experiencing the strongest intervention, and Linville's results were not replicated when the entire data set was analyzed. The hypothesis of a relationship between self-complexity and individuals' sense of meaning and purpose in life was not corroborated by correlational analysis. It is concluded that the relationship between self-complexity and health remains intriguing but inadequately tested.
Adaptation, Psychological↗
[Transcutaneous transhepatic cholangiography and endobiliary interventions in patients with obstructive jaundice].
Complex of rational investigation and treatment of the patients with hepatic portal tumor, including transcutaneous transhepatic cholangiography, was proposed. In 285 patients with obstructive jaundice various endobiliary interventions were performed. External cholangiostomy was done to 98 patients, external-internal drainage--in 92, endostenting--in 18, cholecystostomy--in 76. Endobiliary intervention was applied solely in 31.5% of patients, and in the rest--as the preparation to laparotomy.
Biliary Tract Surgical Procedures↗
Staged initial percutaneous coronary intervention followed by valve surgery ("hybrid approach") for patients with complex coronary and valve disease.
OBJECTIVES: The goal of this study was to determine if a "hybrid" approach to the treatment of complex combined coronary and valve disease is superior to the results predicted by a Society of Thoracic Surgeons' (STS) algorithm with conventional coronary artery bypass graft (CABG)/valve surgery in high-risk patients. BACKGROUND: With advancements in percutaneous coronary interventions (PCIs), some patients requiring coronary revascularization and valve surgery may benefit from a hybrid approach involving initial planned PCI followed by valve surgery, rather than conventional CABG/valve surgery. METHODS: We retrospectively analyzed 26 consecutive patients with coronary artery and valve disease who underwent planned initial PCI followed by valve surgery during the same hospital stay between September 1997 and August 2003. We calculated the predicted mortality at the time of PCI and compared it with the observed mortality. RESULTS: There were 12 male and 14 female patients with a median age of 72 years (range 53 to 91 years). Balloon angioplasty was performed in all patients, followed by stenting in 22 (85%) patients. Within a median of 5 days (range 0 to 14 days), 15 patients (58%) underwent primary and 11 patients (42%) underwent re-operative valve surgery. Operative mortality was 1 of 26 patients (3.8%), dramatically lower than the STS-predicted mortality of 22%. Median blood loss was 900 ml, and 22 patients (85%) required blood transfusions. Survival at 1, 3, and 5 years was 78%, 56%, and 44%, respectively. CONCLUSIONS: Hybrid initial PCI followed by staged valve surgery represents an excellent alternative to conventional CABG/valve surgery in some high-risk patients, particularly those who present in shock after myocardial infarction. Lower mortality rates come at the cost of more bleeding and transfusion requirements.
Aged↗
[Stents in the iliac arteries: a minimally invasive method].
AIM: We demonstrate patients to reveal the conditions for good results with respect to acute and long term out-come of interventional therapy of iliac artery occlusion. MATERIAL AND METHODS: 225 Patients with aortoiliacal occlusion who underwent surgery or intervention were evaluated. All patients were discussed in an interdisciplinary angiologic conference. 63 patients primary had an operation, 161 patients primary were treated by intervention. The two cohorts were compared concerning their structure, the primary success and the primary and secondary patency over one year. RESULTS: Both cohorts showed significant differences, the surgical treated patient had a higher clinical stage as well as more complex iliacal occlusion. The interventional treated patients had higher comorbidity. Primary technical success and patency rates did not show any difference. The complication rate was equally low in both cohorts. In percutaneous treated patients after predilatation, embolization into the periphery occurred. With primary stent PTA, there was no embolization. CONCLUSION: The percutaneous recanalization also of long iliac occlusion is a save, successful alternative to surgery. Nevertheless, there are limits. For optimal therapy management an interdisciplinary consultation is necessary. To avoid embolization, after recanalization primary stent PTA should be performed.
Arterial Occlusive Diseases↗
Progression of language complexity during treatment with the Lidcombe Program for early stuttering intervention.
The Lidcombe Program is an operant treatment for early stuttering. Outcomes indicate that the program is effective; however, the underlying mechanisms leading to a successful reduction of stuttering remain unknown. The purpose of this study was to determine whether fluency achieved with the Lidcombe Program was accompanied by concomitant reduction of utterance length and decreases in linguistic complexity. Standardized language tests were administered pretreatment to 4 male preschool children. Spontaneous language samples were taken 2 weeks prior to treatment, at Weeks 1, 4, 8, and 12 during treatment, and 6 months after the onset of treatment. Samples were analyzed for mean length of utterance (MLU), percentage of simple and complex sentences, number of different words (NDW), and percentage of syllables stuttered. Analysis revealed that all participants presented with language skills in the average and above average range. The children achieved an increase in stutter-free speech accompanied by increases in MLU, percentage of complex sentences, and NDW. For these preschool children who stutter, improved stutter-free speech during treatment with the program appeared to be achieved without a decrease in linguistic complexity. Theoretical and clinical implications are discussed.
Child, Preschool↗
Developing surgical intervention criteria for thoracic aortic aneurysms.
In summary, the development of intervention criteria is a complex and challenging endeavor. Specific examination of this issue is crucial to the appropriate clinical care of patients. With these objectives in mind, we have drawn upon our clinical experience to design, by way of statistical analysis, reasoned size criteria for intervention. These intervention criteria must be carefully weighed against the patient's age, overall physical condition, and anticipated life expectancy. We have approached the development of criteria for intervention using statistical methodology from the standpoint of preventing complications (i.e., dissection and rupture). Symptomatic states, organ compression, concomitant aortic insufficiency, and acute ascending aortic dissection are well-accepted general indications for surgical intervention regardless of aortic size. The appendix incorporates the size criteria developed in the present study as an integral component within a comprehensive strategy for managing patients with TAA. This study confirms that aneurysms of the thoracic aorta are potentially lethal, that attentive follow-up is critical, and that adverse events can be anticipated based on size criteria. As we continue to expand our database, we hope to refine further statistically-based recommendations for surgical intervention. Multi-institutional patient enrollment, with the concomitant statistical power of larger patient numbers, would considerably strengthen this type of analysis.
Adolescent↗
Oceans of need in the desert: ethical issues identified while researching humanitarian agency response in Afghanistan.
This paper describes the interventions by the International Committee of the Red Cross to support a hospital in Afghanistan during the mid 1990s. We present elements of the interventions introduced in Ghazni, Afghanistan, and consider a number of ethical issues stimulated by this analysis. Ethical challenges arise whenever humanitarian interventions to deal with complex political emergencies are undertaken: among those related to the case study presented are questions concerning: a) whether humanitarian support runs the risk of propping up repressive and irresponsible governments; b) whether humanitarian relief activities can legitimately focus on a narrow range of interventions, or need to broaden to address the range of challenges facing the health system; and c) whether sustainability and quality of care should be routinely considered in such settings. The paper concludes by highlighting the value of case studies, suggesting mechanisms for extending transparency and accountability in humanitarian health interventions, and highlighting the need of contextualising humanitarian work if the interventions are to be successful.
Afghanistan↗
Molecular genetic basis of tuberous sclerosis complex: from bench to bedside.
Tuberous sclerosis complex is an autosomal dominant disease of benign tumors occurring in multiple organ systems of the body. Either of two genes, TSC1 or TSC2, can be mutated, resulting in the tuberous sclerosis complex phenotype. The protein products of the tuberous sclerosis complex genes, hamartin (TSC1) and tuberin (TSC2), have been discovered to play important roles in several cell-signaling pathways. Knowledge regarding the function of the tuberin-hamartin complex has led to therapeutic intervention trials. Numerous pathogenic mutations have been elucidated in individuals affected with tuberous sclerosis complex. Information on the type and distribution of nearly 1000 mutations in the two genes is discussed. Mosaicism for tuberous sclerosis complex mutations has been documented, complicating provision of genetic counseling to families. Emerging genotype-phenotype correlations should provide guidance for better medical care of individuals with tuberous sclerosis complex.
Animals↗
Possibilities and limitations in the rational design of modified peptides for T cell mediated immunotherapy.
Therapeutic intervention in experimental autoimmune diseases by modulation of the T cell mediated autoimmune response has been accomplished in the past using altered peptide ligands (APLs). These peptides are usually created by applying alterations to the T cell epitope recognized by the autoaggressive T cells. In this study, we investigated whether it was possible to design APLs in a rational way, using knowledge of molecular interaction in the MHC-peptide-T cell receptor (TCR) complex, for the therapeutic intervention in experimental autoimmune encephalomyelitis (EAE). Additionally, the value of peptidomimetic modification and alterations based on posttranslational modifications for the design of APLs was examined. Based on a molecular model of the MHC-peptide complex, the T cell receptor contact residues were identified and selected alterations were applied. The designed APLs were tested for MHC binding capacity, T cell recognition, blocking of the autoreactive T cell response, immunogenicity, encephalitogenicity, and therapeutic activity. Based on the results of the in vitro assays, it was expected that some of our APLs would be able to modulate EAE. Nevertheless, none of these APLs displayed clear therapeutic activity in vivo. Thus, rational design of modified peptides for immunotherapy has to await further insights into the relationships between structure and peptide/peptidomimetic induced T cell activation, and until that, there is no possibility to take advantage of the tailor made origin of peptidomimetics.
Amino Acid Sequence↗
Current developments in interventional treatment of total terminal aortic occlusions--laser, stenting and balloon angioplasty: experience of cardiology clinic of Târgu-Mureş.
UNLABELLED: The importance of interventional procedures in the complex treatment of peripheral arterial diseases is continuously increasing. In the current practice of our clinic, association of balloon angioplasty, laser angioplasty and arterial stenting in reconstruction of iliac arteries led to superior results in the latest years, these methods 11:42 PM 11:42 PM 11:42 PM being proved as an alternative to surgical interventions. In this article, we present several cases in which current indications for laser angioplasty were extended to target occlusions located in the terminal abdominal aorta. METHODS: 106 consecutive primary iliac interventions were performed on 88 patients with iliac or aortoiliac obstructive diseases, in the period September 2001 - October 2005, at the University of Medicine and Pharmacy of Târgu-Mureş, Romania, Clinic of Cardiology. Five of these patients (4 males, 1 female) presented occlusions of terminal aorta, in whom interventional treatment (peripheral transluminal angioplasty, laser angioplasty and stenting) was performed. Three cases presented total occlusion of terminal aorta, without any visualization of iliac arteries, and 2 cases presented occlusion of one aortoiliac axis, starting from terminal aorta. RESULTS: In all cases, complete repermeabilisation of aortoiliac axes was achieved, without complications. In all patients we recorded a significant improvement of symptomatology, and arterial Doppler showed an increase of Doppler ankle/brachial index in average from 0.4 up to 0.95. No complications have been recorded so far. CONCLUSION: Extension of classical indications of interventional treatment for balloon and laser angioplasty to occlusions located in terminal aorta is possible when the procedure is performed by an experienced team. Interventional techniques, having a superior applicability in practice, good results, low complication rates, and decreasing the hospitalization times, could be applied in the future to a larger extent, targeting also aortic occlusions.
Angioplasty, Balloon, Laser-Assisted↗
Behavioral treatments for adult dental avoidance. A stepped-care approach.
The growing research literature dealing with the psychologic treatment of dental fear and avoidance suggests several interventions as effective, but provides little guidance in choosing among them. Under these circumstances, experienced psychologic practitioners may choose among these interventions on the basis of their own clinical impressions as to which treatment might be best suited to each patient they see. An alternative approach is the stepped-care approach in which the least expensive/most practical intervention is implemented, with more costly or complex procedures implemented only if the less expensive intervention proves unsuccessful. Each of the behavioral treatments for dental fear that has received researchers' attention is briefly described, and they are ordered in terms of their costs in professional time. Finally, an account of the special precautions needed to implement a stepped-care strategy for the reduction of dental fear is outlined.
Adult↗
Communication enhancement: nurse and patient satisfaction outcomes in a complex continuing care facility.
AIMS: This paper presents an evaluation of a communication enhancement intervention on staff and patients in a complex continuing care facility. BACKGROUND: The importance of effective communication as a fundamental element of nursing has been emphasized and is regarded as integral to the provision of quality patient care. For people residing in complex continuing care (similar to long-term care facilities), opportunities for socialization occur primarily during interactions or communication with staff, and these interactions have been found to be limited. One way to improve nursing staff communication is through a communication enhancement intervention. METHODS: Twenty-one nursing staff members (Registered Nurses, Registered Practical Nurses and healthcare aides) working in a complex continuing care environment and 16 patients participated in this study, conducted in the summer of 2003. A repeated measures design was used to evaluate the effects of the communication enhancement intervention on outcomes. Data were collected from patients and nurses at baseline, 5 weeks into the intervention and at 10 weeks after the intervention. Nurse outcome variables included nurses' job satisfaction and their relationships with patients; patient outcome variables included two measures of patient satisfaction with care. RESULTS: Nursing staff felt closer to their patients (F(2,40) = 3.0, P = 0.045) following the intervention and reported higher levels of job satisfaction (F(2,40) = 4.1, P = 0.02). No changes were found in the level of patient satisfaction with care. CONCLUSIONS: Our results suggest that nursing staff can feel better about their job and about their patients as they enhance their communication skills. Understanding the barriers to finding time to talk with patients for a few minutes a day, outside of direct hands-on caregiving, requires further exploration.
Attitude of Health Personnel↗
Caring for the graduate from the neonatal intensive care unit. At home, in the office, and in the community.
This article focuses on recent progress in the understanding of optimal care for the neonatal intensive care unit (NICU) graduate in three domains that have relevance to primary care pediatricians: the concept of developmentally supportive care for the immature central nervous system of fragile premature infants; an understanding of the function and systems of community-based early intervention available for medically complex, developmentally challenged and at-risk infants; and the management of technology-dependent children at home.
Aftercare↗
Mechanics of wound healing and importance of Vacuum Assisted Closure in urology.
PURPOSE: We discuss the mechanisms of wound healing and our experience with the Vacuum Assisted Closure device (Kinetic Concepts, Inc., San Antonio, Texas) for complex urogenital wounds. MATERIALS AND METHODS: The literature obtained from a Medline search on wound healing, wound failure and vacuum assisted closure was reviewed. In addition, we reviewed our experience with negative pressure wound therapy. RESULTS: Wound healing is a complex interaction between the reticuloendothelial and immune systems, in addition to correctable internal and external factors. Understanding the healing process improves outcomes and decreases patient morbidity. Negative pressure wound therapy has hastened wound healing and it adds significant improvement in the arsenal of choices available. CONCLUSIONS: Vacuum Assisted Closure is a therapeutic alternative that complements surgical and medical intervention in patients with complex wounds.
Humans↗
Preventing Halloween arson in an urban setting: a model for multisectoral planning and community participation.
Arson is a violent crime and a public health problem that causes injuries and deaths, destroys homes, and destabilizes neighborhoods. During the late 1970s, pre-Halloween pranks in Detroit, Michigan, turned destructive when hundreds of fires were set deliberately throughout the city; in 1984, a record of 810 fires were set during the Halloween period. In 1985, a city wide anti-arson campaign that involved the mobilization and training of thousands of community volunteers was begun in Detroit. This report describes the multiple components of the anti-arson intervention from 1985 through 1996 and changes in the incidence of Halloween fires. Both the decrease in annual Halloween arson fires after the intervention began and the inverse relationship between the number of volunteers and the number of fires suggest a causal effect. This study illustrates the capacity of an urban community to mobilize its residents and stakeholders, the importance of community participation and multisectoral partnerships in program planning and implementation, and the challenges faced in retrospectively evaluating an apparently successful, complex, community-based intervention.
Adolescent↗
Intervention challenges with adolescent mothers and their infants.
Adolescent pregnancy is a major social issue resulting in significant risk for both the infants and young mothers. In this paper, we will describe the effects of an intervention program for adolescent mothers and their infants, including the complexities of evaluating the effects of intervention for risk groups. More than half of the teenagers in the United States are sexually active, and more than 1.1 million become pregnant each year. It has been estimated that in 1981 approximately 22% of sexually active teens 15-19 experienced a pregnancy (Hofferth 1984). Among teen pregnancies, 70-80% are unintended and unwanted (PPFA 1984). Adolescent mothers and their infants appear to be at higher risk than older mothers for a variety of medical complications that may affect subsequent infant health and may impact on infant development and parent-infant interaction. While a number of studies have indicated that the biomedical risk for teenage mothers, especially those ages 15 and older, can be decreased considerably with adequate nutrition and proper prenatal care (Carey et al. 1983; Osofsky 1968; Osofsky and Osofsky 1970), for a variety of reasons, most teens do not receive the type of prenatal care that would most likely minimize risk and optimize outcome. Adolescent mothers are more likely than their nonpregnant peers to have lower education attainment, lesser job and economic success, and less frequent marital stability (Furstenberg 1976; Simkins 1984).
Adolescent↗