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At least 91 records · Page 5Linked to original sources

PubMed2004

Randomized comparison of rapid ambulation using radial, 4 French femoral access, or femoral access with AngioSeal closure.

Radial access and closure devices are associated with improved quality of life (QOL) after cardiac catheterization. Whether this is related to the access site or time to ambulation is unknown. Seventy-five patients undergoing cardiac catheterization were randomized to femoral 6 Fr with AngioSeal closure (F+C), femoral 4 Fr without closure, and radial (R) access. All patients were ambulated at 1 hr. QOL was measured utilizing visual analogue scales and Short Form-36 at baseline, 1 day, and 1 week. Time to ambulation and discharge were equivalent, as was postprocedure QOL. However, angiographic quality was lower in the 4 Fr group (P < 0.0001) and catheterization costs were higher in the F+C group (P < 0.0001). Ambulation 1 hr after catheterization can be accomplished utilizing radial, femoral 6 Fr with closure device, or femoral 4 Fr access with equivalent outcomes and QOL. However, this is achieved at a higher cost with a closure device, or lesser angiographic quality with 4 Fr catheters.

Aged↗

PubMedDate not supplied

Peripheral insertion of a central venous access device under fluoroscopic guidance using a peripherally accessed system (PAS) port in the forearm.

PURPOSE: We describe the technique, efficacy, and complications of fluoroscopy-guided implantation of a central venous access device using a peripherally accessed system (PAS) port via the forearm. METHODS: Beginning in July 1994, 105 central venous access devices were implanted in 104 patients for the long-term infusion of antibiotics or antineoplasmic agents, blood products, or parenteral nutrition. The devices was inserted under fluoroscopic guidance with real-time venography from a peripheral route. RESULTS: All ports were successfully implanted. There were no procedure-related complications. No thrombosis or local infection was observed; however, in six patients catheter-related phlebitis occurred. CONCLUSION: Fluoroscopy-guided implantation of a central venous access device using a PAS port via the forearm is safe and efficacious, and injection of contrast medium through a peripheral IV catheter before introduction of the catheter helps to avoid catheter-related phlebitis.

Adolescent↗

PubMed2002

Dynamic venous access pressure ratio test for hemodialysis access monitoring.

BACKGROUND: Early recognition of arteriovenous graft (AVG) dysfunction in hemodialysis (HD) patients followed by prompt corrective procedures reduces AVG thrombosis rates and lengthens access survival. We developed a method to prospectively monitor AVGs that uses an algorithm to calculate venous access pressure (VAP) during HD from the venous drip chamber pressure (VDP). METHODS: Sham HD with blood was performed using standard blood tubing and a 1-in. 15-G needle. The pressure needed to overcome circuit resistance at an intra-access pressure of zero (VDP(0)) was recorded at blood flow rates (Q(b)s) from 0 to 600 mL/min and hematocrits varied in steps from 38.4% to 18.2%. An equation for VDP(0) was developed. VAP in patients was calculated as VAP = VDP - VDP(0). VAP ratio (VAPR) was defined as VAP/mean arterial pressure (MAP). VAPR was calculated only if MAP was greater than 75 mm Hg, Q(b) was greater than 200 mL/min, and VDP was greater than 20 mm Hg. A positive VAPR test (VAPRT) result was defined as three consecutive treatments with VAPR exceeding 0.55 during a given month. Sensitivity and specificity of VAPRT to predict a graft event, defined by AVG occlusion or requirement for angioplasty, were calculated. RESULTS: During a 3-month interval, 120 HD patients with AVGs underwent 359 VAPRTs while access outcomes were monitored for 6 months. After 3 months, sensitivity and specificity for detection of a graft event were 70% +/- 8% and 88% +/- 2% and increased to 74% +/- 5% and 92% +/- 3% at 6 months, respectively. CONCLUSION: The VAPRT is a valuable tool to prospectively monitor for adverse AVG events.

Algorithms↗

PubMed1991

Derivatives of CAP having no solvent-accessible cysteine residues, or having a unique solvent-accessible cysteine residue at amino acid 2 of the helix-turn-helix motif.

The Escherichia coli catabolite gene activator protein (CAP) is a helix-turn-helix motif sequence-specific DNA binding protein. CAP contains a unique solvent-accessible cysteine residue at amino acid 10 of the helix-turn-helix motif. In published work, we have constructed a prototype semi-synthetic site-specific DNA cleavage agent from CAP by use of cysteine-specific chemical modification to incorporate a nucleolytic chelator-metal complex at amino acid 10 of the helix-turn-helix motif [Ebright, R., Ebright, Y., Pendergrast, P.S. and Gunasekera, A., Proc. Natl. Acad. Sci. USA 87, 2882-2886 (1990)]. Construction of second-generation semi-synthetic site-specific DNA cleavage agents from CAP requires the construction of derivatives of CAP having unique solvent-accessible cysteine residues at sites within CAP other than amino acid 10 of the helix-turn-helix motif. In the present work, we have constructed and characterized two derivatives of CAP having no solvent-accessible cysteine residues: [Ser178]CAP and [Leu178]CAP. In addition, in the present work, we have constructed and characterized one derivative of CAP having a unique solvent-accessible cysteine residue at amino acid 2 of the helix-turn-helix motif: [Cys170;Ser178]CAP.

Base Sequence↗

PubMed2001

Ureteral access for upper urinary tract disease: the access sheath.

Ureteral access with the flexible ureteroscope remains a challenge for the urologist. The routine use of a newly developed, site-specific ureteral access sheath facilitates entry into the ureter for fragmentation and basket extraction of ureteral and renal calculi. The step-by-step technique of ureteral access with the Access Sheath is described.

Equipment Design↗

PubMed1994

Hierarchical Access System for Sequence Libraries in Europe (HASSLE): a tool to access sequence databases remotely.

Sequence databases in biology are growing exponentially. Not only are large sites needed to keep the data, but the number of customers is continuously increasing. Network access plays a key role in utilizing remote resources. However, both synchronous and asynchronous access require tools that are currently non-standard in molecular biology computing. Additionally, information discovery of today frequently focuses on centers rather a hierarchically interconnected facilities. HASSLE (Hierarchical Access System for Sequence Libraries in Europe) is an implementation of an application-independent, user-transparent access tool in molecular biology. It features tools for both clients and information providers to permit accounting and/or prioritization on various levels. HASSLE focuses on the network aspect of the molecular biology computing and assumes that it is possible to have database applications available as remote 'services' (programs, program packages or utilities) which can be started by a simple command script after a suitable feed of datafiles. The current system provides these services for searching with programs like FASTA or BLAST which are compiled as obtained from vendors or servers.

Algorithms↗

PubMed1985

After-hours telephone access to physicians with access to computerized medical records. Experience in an inner-city general medicine clinic.

The authors examined the effect of after-hours telephone access to physicians and physician access to computerized medical records on hospitalizations and emergency room (ER) visits in an inner-city, adult, general medicine clinic. Patients were randomly assigned to a control (C) and two study groups (S1 and S2). Patients in study groups S1 and S2 had after-hours telephone access to physicians. Computerized medical records were accessible to physicians only for callers in study group S2. During the initial 18 months of study, only 7.6% of eligible patients called the after-hours service, a rate of 6 calls/1,000 patients/month (200 calls/1,849 patients/18 months). Repeated promotion of the service was subsequently undertaken, and 19.4% of the patients used the service during the final 12 months of study, a rate of 24.1 calls/1,000 patients/month (467 calls/1,616 patients/12 months). There were no significant differences in hospitalizations or ER visits among the control and two study groups.

Computers↗

PubMed1985

The arm as an alternative site for vascular access for dialysis in patients with recurrent access failure.

Patients with chronic renal failure requiring dialysis and in whom multiple attempts at vascular access have previously failed represent a challenge to vascular surgeons. In these difficult patients the arm offers an excellent site for either an autogenous fistula or a prosthetic shunt because of the relatively unharmed portion of the upper cephalic vein or the protected location of the brachial vein in most individuals. (The anatomic region of the arm by definition is the area between the shoulder and the elbow.) Over the last two years we have studied 15 patients with a mean of 2.5 previously failed shunts or fistulas who subsequently had vascular access procedures in the arm, with the brachial artery as the inflow and the cephalic vein or brachial vein as the outflow. The first choice was the cephalic vein transposition to the brachial artery because it involved only one anastomosis and is autogenous vein. The alternative was a prosthetic graft of polytetrafluoroethylene (PTEE) between the brachial artery and the cephalic vein or brachial vein in the arm. The patency rate of these arm access procedures has been 75%. None of these patients had had congestive heart failure, distal ischemia, or excessive hematoma formation. The arm represents an excellent source for fistula or shunt construction in those difficult patients in whom previous vascular access sites have already failed.

Arm↗

PubMed2005

Open access and openly accessible: a study of scientific publications shared via the internet.

OBJECTIVES: To determine how often reprints of scientific publications are shared online, whether journal readership level is a predictor, how the amount of file sharing changes with the age of the article, and to what degree open access publications are shared on non-journal websites. DESIGN: The internet was searched using an application programming interface to Google, a popular and freely available search engine. MAIN OUTCOME MEASURES: The proportion of reprints of journal articles published between 1994 and 2004 from within 13 subscription based and four open access journals that could be located online at non-journal websites. RESULTS: The probability that an article could be found online at a non-journal website correlated with the journal impact factor and the time since initial publication. Papers from higher impact journals and more recent articles were more likely to be located. On average, for the high impact journal articles published in 2003, over a third could be located at non-journal websites. Similar trends were observed for the delayed or full open access publications. CONCLUSIONS: Decentralised sharing of scientific reprints through the internet creates a degree of de facto open access that, though highly incomplete in its coverage, is none the less biased towards publications of higher popular demand.

Bibliometrics↗

PubMed1992

Intravenous access. Part 3. Venous access devices.

The nursing care of the whole patient, not just the venous access device, should be the focus of the nurse. Venous access devices provide the nurse with the rare opportunity to have assured venous access for blood sampling as well as the administration of intravenous therapies. The meticulous care of venous access devices is essential if complications are to be avoided and their primary function maintained.

Catheterization, Central Venous↗

PubMed2006

Access to tangible research materials in biomedical research: conditions of access and their effect on research.

Biomedical discoveries often provide the basic tools for research. Such discoveries may be patentable or non-patentable products or processes, as well as the materials necessary for further research. Without rapid access to these materials on reasonable terms, there is concern that the progress of science will suffer. In 1995, the National Institutes of Health in the United States published a Master Uniform Biomaterial Transfer Agreement (UBMTA) to improve access to biomedical materials. Guidelines for transfers were published in 1999. This article analyses a survey that the author conducted in the Faculty of Medicine, Nursing and Health Science, Monash University. It observes that a significant minority of respondents experience frustration and/or adverse effects upon their research as a result of restrictions imposed upon their access to materials. It concludes that the extensive experience and precedent material in the United States provides an immediate resource to help improve access to biological materials in Australian universities.

Australia↗

PubMedDate not supplied

Development of a polyurethane percutaneous access device for long-term vascular access.

The percutaneous placement of intravascular devices creates a portal for microbial invasion that can result in local infections or septicemia. In nature, resistance to "exist site" infection in percutaneous organs, such as teeth, is prevented by a dense collagen/epithelial barrier. A new percutaneous access device has been developed that incorporates a porous polyurethane "button" at the subdermal level. This device promotes the development of a collagen/epithelial interface, thus inhibiting sinus formation. Twelve percutaneous access devices (PCADS) were implanted in calves; eight devices were utilized for venting of, and hard wire passage to, an implantable left ventricular assist device (LVAD) and served as controls. Four devices were utilized for long-term vascular access. The PCADS remained in situ for 2-127 days (mean 70). Excellent healing was apparent in all cases, and no exit site or catheter related infections occurred. Histologic examination demonstrated fibroblastic in-growth and collagen deposition within the porous polyurethane, which provides a barrier to epithelial migration and firmly anchors the device. These PCADS appear to reduce exit site infections and may improve upon currently available long-term vascular access catheters.

Animals↗

PubMed2002

Lessons from the evaluation of the ACCESS program. Access to Community Care and Effective Services.

The authors summarize the main findings of the ACCESS (Access to Community Care and Effective Services) program and offer lessons for policy makers. Data from studies at the site level and the client level, which were presented in the two previous articles in this issue of Psychiatric Services, are summarized and synthesized with the authors' collective experience with the ACCESS program. The results of the evaluation suggest that although service systems integration can be improved, targeted efforts to implement strategies for integration do not produce better client outcomes. Efforts to integrate service systems can be supported by their effects on some organizational relationships within the mental health service system but not by their widespread effects across human services or their direct effects on clients.

Community Mental Health Services↗

PubMed2004

Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) programme.

PROBLEM: The hospital based musculoskeletal service in northwest Wales was unable to cope with the demand for referrals from general practitioners. Waiting times were long, duplicate referrals to other departments were common, and general practitioners were reluctant to refer patients with common problems because of the perceived lack of service. Many referrals were made to the inappropriate specialty, especially orthopaedics. At least part of this problem was due to a lack of coordination between the four hospital departments providing musculoskeletal services and the emphasis on district general hospital based rather than community provision. DESIGN: Review over 18 months of impact of the targeted early access to musculoskeletal services (TEAMS) programme on accessibility to musculoskeletal services. SETTING: Northwest Wales. KEY MEASURES FOR IMPROVEMENT: Number of patients referred and seen with musculoskeletal problems, waiting times, number of duplicate referrals, and surgery conversion rates in orthopaedic clinics. STRATEGIES FOR CHANGE: Establishing with central clinical triage a common pathway for all musculoskeletal referrals so that patients attend the appropriate department. A back pain pathway led by extended scope physiotherapists was developed, and general practitioners with special interests and extended scope physiotherapists were trained to provide services for patients with uncomplicated musculoskeletal problems in the community. EFFECTS OF CHANGE: Over 18 months the number of referrals more than doubled. Despite this, waiting times for musculoskeletal services fell; this was noticeable for rheumatology and pain management. Duplicate referrals were abolished. Surgery conversion rates did not, however, change. Questionnaires from the clinics showed a high level of patient satisfaction. LESSONS LEARNT: Integration of hospital services that traditionally have worked in isolation can result in greatly improved access to musculoskeletal services. Community based multidisciplinary clinics run by specially trained general practitioners with special interests and extended scope physiotherapists are an effective way of managing patients with uncomplicated musculoskeletal problems and have been well received by patients and general practitioners. The huge unmet burden of need was reflected by the great increase in musculoskeletal referrals. Other approaches are needed to meet this, including better education of general practitioners and methods for identifying and modifying psychosocial risk factors for chronic pain at an early stage.

Health Services Accessibility↗

PubMed1999

[Access to Danish health care by immigrant women. Access to hospital care among immigrant women with breast cancer compared with Danish women].

The study aim is to measure possible differences in access to health care among immigrant women with breast cancer compared with Danish women. We used tumour size at diagnosis as a proxy measure of access. The Danish Central Personal Register provided information from 1977-1996 on women between 20-75 years born in countries in which Islam is the dominating faith. These data were linked to the Danish Breast Cancer Cooperative Group, which registers data concerning tumour size. Sixty-five immigrant women with breast cancer were identified and matched with a control population of Danish women. The study showed larger tumours at diagnosis among women from ethnic minority groups compared to Danes. However, this tendency was not significant. Furthermore, mammographic screening had a significant effect on the tumour sizes of Danish women, but not on those of immigrants. The study indicates ethnic inequalities related to access to health services as measured by tumour size.

Adult↗

PubMed2006

Access, responsibility, and funding: A systems thinking approach to universal access to oral health.

Universal access to oral health care is a justifiable demand for a number of disparate but morally sound reasons. Nevertheless, that conclusion, however reached, has not solved the problem of the lack of access. Market forces, scarcity of funding, and lack of clarity as to who is responsible for ensuring that oral care is available seem to present insurmountable difficulties. I shall argue that these are not irresolvable problems, but the resolution has to take place through the tool of systems thinking and a systemic approach to moral imagination. Taking the lead from Susan Wolf's and Linda Emanuel's work on systems thinking, and developing ideas from work on mental models and moral imagination, I shall argue that what is often missing in discussions and demands for universal access to oral health care is a morally imaginative systemic approach that takes into account the multi-perspective dynamics involved in health care today. Moral imagination may encourage sound, broad-based, more inclusive moral thinking and moral judgment without ignoring the critical roles and responsibilities each of us has as professionals, providers, payers, or patients, without which change will not take place at all.

Dental Care↗

PubMed2006

A comprehensive dictionary of protein accession codes for complete protein accession identifier alias resolving.

In mass spectrometry-based proteomics, protein identification results usually consist of peptide sequences and database-dependent accession identifiers of the matching proteins. Often certain annotations are only available in particular databases that in turn must be queried by a certain identifier. In order to simplify and unify the tracing of identified proteins back to their original annotation information, a system capable of set-oriented mapping the different accession identifiers of proteins derived from multiple sequence database sources has been developed. This allows unification of the access to protein information and tracing to other online resources providing additional information as well as resolving cross-references of protein identifications. The interface of seqDB is available via http://www.protein-ms.de following the link to seqDB.

Database Management Systems↗

PubMed2006

Sulphonic acid strong cation-exchange restricted access columns in sample cleanup for profiling of endogenous peptides in multidimensional liquid chromatography. Structure and function of strong cation-exchange restricted access materials.

In this work, the pore structural parameters and size exclusion properties of LiChrospher strong cation-exchange and reverse phase restricted access materials (RAM) are analysed. The molecular weight size exclusion limit for polystyrenes was found to be about 17.7 kDa, while for standard proteins, the molecular weight size exclusion limit was higher, at approximately 25 kDa. The average pore diameter on a volume basis calculated from the pore network model changes from 8.5 nm (native LiChrospher) to 8.6 nm (diol derivative) to 8.2 nm (sulphonic acid derivative) to 6.9 nm (n-octadecyl derivative). Additional characterisations were performed on restricted access materials with nitrogen sorption at 77 K, water adsorption at 25 degrees C, intrusion-extrusion of water (in order to evaluate the hydrophobic properties of the pores of the hydrophobic RAM), and zeta potential measurements by microelectrophoresis. For peptide analysis out of the biofluids, the strong cation-exchange functionality seems to be particularly suitable mainly because of the high loadability of the strong cation-exchange restricted access material (SCX-RAM) and the fact that one can work under non-denaturing conditions to perform effective chromatographic separations. For bacitracin, the dynamic capacity of the SCX-RAM columns does not reach its maximum value in the analysed range. For lysozyme, the dynamic capacity reaches a value of 0.08 mg/ml of column volume before column is overloaded. Additionally, the proper column operating conditions that lead to the total effective working time of the RAM column to be equal to approximately 500 injections (depending on the type of sample), is comprehensively described. The SCX-RAM column was used in the same system analysing urine samples for the period of 1 month (approximately 150 injections) with run-to-run reproducibility below 5% RSD and below 10% RSD for the relative fractions.

Cation Exchange Resins↗