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PubMed1993

Prostatic surgery for benign prostatic hyperplasia: meeting the expanding demand.

We describe changes in the pattern of surgery for benign prostatic hyperplasia (BPH) in Scotland between 1971 and 1989. The data are based on an analysis of routinely collected Scottish hospital in-patient statistics for primary prostatic operations on men with a diagnosis of BPH (ICD Code 600.0). Primary operation age-adjusted rates for BPH increased from 8.9 to 15.8 per 10,000 male population from 1971 to 1989. This was accompanied by a reduction in bed day use for BPH surgery from 49,500 bed days in 1971 to 36,000 in 1989. Case fatality for all surgery for BPH also fell steadily and can no longer be regarded as a relevant measure of prostatectomy outcome. Virtually all surgical intervention is now transurethral resection (TUR), forming 94% of surgery for BPH in 1989 compared with only 32% in 1971. The increase in surgical procedures carried out for BPH has been greater in younger age groups. If the pattern of increasing surgical intervention in the management of BPH over the past few years continues and there is an increased demand for treatment, and if the reported demographic changes occur, there will be a need for an additional 9 new consultant urologists in Scotland by 2001. Even if present operation rates hold steady, population changes alone will produce enough work for 2 more urologists.

Age Factors↗
PubMed1996

Access to rat kidney with minimal anesthesia and surgery: a new experimental model.

Chronic surgical explantation of the left rat kidney out of the abdominal cavity under the flank skin enabled easy access to the organ and ipsilateral urine collection under light chloralose anesthesia without virtually any surgical intervention. The glomerular filtration rate, urine flow and osmolality, sodium excretion, and medullary tissue hypertonicity were similar in the explanted and in the contralateral kidney, whereas p-aminohippurate clearance was 14% lower. The function of the explanted kidney was also compared with that of the kidney acutely exposed in rats under thiobutabarbital anesthesia and rendered euvolemic by isoncotic albumin infusion. Again, in both preparations renal function was comparable except that over time urine osmolality remained stable in the former and fell from 1,385 +/- 195 to 835 +/- 167 mosmol/kgH2O (P < 0.02) in the latter, indicating deterioration of urine concentration. Laser-Doppler probes could be easily applied in the explanted kidney to measure cortical and medullary blood flow. The new experimental model offers some advantages, both over studies using conscious rats and over experiments involving deep anesthesia and acute surgery.

Anesthesia↗
PubMed1982

Thrombolysis in acute myocardial infarction using intracoronary streptokinase: assessment by thallium-201 scintigraphy.

Twenty-one patients with acute myocardial infarction, admitted to the hospital within 4 hours after the onset of symptoms, were studied by seven-pinhole thallium-201 scintigraphy before and 1 hour and 24 hours after intracoronary fibrinolysis using streptokinase. The size of the thallium-201 perfusion defect was assessed from myocardial cross sections reconstructed from the original seven-pinhole data and expressed as a fraction of left ventricular circumference. Recanalization was achieved in 16 patients within 3.9 +/- 1.6 hours after onset of symptoms (group A). In these patients, the size of the perfusion defect had decreased from 36 +/- 17% to 19% +/- 15% (p less than 0.001) at 24 hours. No significant change was detected by redistribution at 1 hour after the intervention. In five patients, intracoronary fibrinolysis was unsuccessful, and the vessel remained occluded (group B). The thallium-201 perfusion defect affected 40 +/- 15% of the left ventricular circumference before the intervention; it remained virtually unchanged at 1 hour (37 +/- 16%) and at 24 hours (41 +/- 15%) after fibrinolysis. The perfusion defect was most reduced in patients with extensive collaterals supplying the ischemic area or with subtotal occlusion of the affected coronary artery. We conclude that successful intracoronary fibrinolysis may reduce the size of the thallium-201 perfusion defect in many patients with acute myocardial infarction. One important factor in the final result may be the presence of residual coronary flow supplied by extensive collaterals or by subtotal occlusion of the affected coronary artery when reperfusion is achieved around 4 hours after the onset of symptoms.

Adult↗
PubMed2005

Hostage negotiation: psychological principles and practices.

Resolution of hostage crises may take hours or days of intensely focused and stressful negotiation, requiring the use of virtually every crisis intervention strategy known to psychology and law enforcement. This article describes the nature of hostage crises and the factors that contribute to prospects for a successful resolution. Outlined are basic strategies of hostage negotiation and crisis management culled from the psychological and law enforcement literature. Recommendations are offered to civilians for surviving a hostage crisis. Finally, the article emphasizes the collaborative working relationship between mental health and law enforcement professionals that can have a lifesaving impact for citizens in peril.

Crisis Intervention↗
PubMed1995

Aortic ring abscess and mitral valve aneurysm in aortic valvular endocarditis: enhanced diagnosis with transesophageal echocardiography.

Aortic ring abscess and mitral valve aneurysms complicating infective endocarditis have previously been described as surgical or autopsy findings. More recently, transesophageal echocardiography has been shown to be more sensitive than standard transthoracic echocardiography or other imaging modalities in detecting each of these complications. Since aortic ring abscess and mitral valve aneurysms virtually mandate surgical intervention, their early detection may be crucial. This report describes a 35-year-old male with congenitally abnormal aortic valve which became infected and in whom both an aortic ring abscess and mitral valve aneurysm occurred. These findings are discussed and the pertinent literature is reviewed.

Abscess↗
PubMed2005

Diagnosis of an interstitial pregnancy with 4-dimensional volume contrast imaging.

OBJECTIVE: The purpose of this study was to investigate the use of a new ultrasound technique, termed 4-dimensional volume contrast imaging in coronal-plane to facilitate the early detection of interstitial pregnancy. STUDY DESIGN: A case of interstitial pregnancy was diagnosed accurately at 6 weeks of gestation with 4-dimensional transvaginal volume contrast imaging in coronal plane technology. A scan of the uterus revealed that the eccentric gestational sac was located in the right uterotubal junctional area, lying 1 cm outside the most upper lateral edge of the uterine cavity with thick endometrial echoes. RESULTS: After the appropriate counseling, the patient was treated with an ultrasonographically guided intracardiac injection of 2.5 mEq of potassium chloride followed by aspiration of the gestational sac. A transvaginal scan immediately after the procedure demonstrated a collapsed empty gestational sac. Three months after the conservative treatment, the serum beta-human chorionic gonadotropin level fell to 1.17 mIU/mL, and normal echotexture of the uterus was noted. CONCLUSION: Four-dimensional volume contrast imaging in coronal-plane technology provides scan planes that are not accessible by conventional 2-dimensional scanning, with enhanced tissue contrast resolution in region of interest. This new ultrasound technique has the potential to provide more accurate, inexpensive and less variable virtual reality image-guided interventional options through more realistic interaction with the virtualized in utero condition, particularly when 2-dimensional transvaginal scan fails to differentiate between interstitial, angular, and cornual pregnancies.

Adult↗
PubMed2002

The use of video glasses at ultrasound-guided interventions.

PURPOSE: Video glasses form a virtual image in front of the user. We investigated the utility of video glasses at US-guided interventions. MATERIAL AND METHODS: The video glasses were tested at 75 consecutive US-guided interventions. The operator sees the US image in front of him, and below the glasses, simply by moving his eyes, he can see the patient and the field of intervention. RESULTS: The video glasses could be used at all 75 US-guided interventions. The image quality was below that of the US monitor, but adequate. The working posture was improved, it was easy to get accustomed to using the system, there was no increased time consumption, and the patients felt comfortable with the set-up. CONCLUSION: Use of video glasses facilitates US-guided interventions.

Equipment Design↗
PubMed2003

Technical success from endovascular aneurysm repair in the post-marketing era: a multicenter prospective trial.

Evaluation of post-marketing success with the Ancure Endovascular Graft (AEG) was accomplished by review of a multicenter, prospective trial involving 46 centers and 163 patients. A second cohort of patients (n = 350) treated with the AEG under a controlled-use interval prior to the prospective trial was simultaneously evaluated. Technical success in both groups of patients (96.9% and 97.4%, respectively) was similar to what was reported in pre-market clinical trials. Operative implantation complications unique to the AEG included graft limb stenosis/occlusion in 35.6 and 31.4%, contralateral pull wire being caught on hooks in 33.7 and 28%, failure to seal (type I endoleak) in 17.2 and 18.3%, jacket guard being stuck in 12.9 and 11%, contralateral wire being stuck in 6.8 and 7.1%, high jacket retraction force in 16 and 8.5%, and inability to retract jacket in 1.8 and 0.5% of patients involved in the multicenter trial and controlled-use interval, respectively. One of four patients undergoing conversion in the prospective trial had graft misdeployment as a mode of failure. Three were converted for access failure. The 30-day mortality rate in the prospective trial was 3.7%. Interventions to resolve implantation-related events included stenting, guide catheter manipulations, wire exchanges, and delivery catheter disassembly. These interventions were successful in virtually every case. Open surgical procedures were not needed to correct these operative problems. Results from this study demonstrate excellent technical success with the AEG in the post-market era. Interventions to resolve implantation complications, when utilized, are highly successful in facilitating AEG implantation and providing technical success.

Aortic Aneurysm↗
PubMed1989

Social support intervention studies: a review and prospectus of nursing contributions.

Nurse researchers have contributed some conceptual clarity, measurement devices and empirical studies of support resources and target populations to the social support literature. One apparent deficit, surprising when one considers nursing's practice-orientation, is the virtual absence of empirical intervention studies. Accordingly, potential foci for nursing investigations at five levels of social-support interventions (individual, dyadic, group, social system and community levels) are proposed here. Nurses can not only propose but can also validate concepts of social support in real-life situations with real-world populations. They are qualified to bring a unique perspective to the study of social support. Empirical intervention research conducted by appropriately educated nurses should enhance future theoretical and practical development of the social support field.

Adaptation, Psychological↗
PubMed1993

HIV and serious mental illness: reducing the risk.

Persons with SMI residing in community mental health center group homes received an educational intervention program on HIV/AIDS. As with virtually all such approaches provided for this population, the intervention was generalized from programs used with other populations, for example, users of intravenous drugs, gay men, and adolescents. Assessment of pre- and postintervention knowledge indicated no increase in accurate information. Further, consumers were initially uncertain regarding their risk for HIV infection; this attitude, too, remained unchanged. The research design employed did not compare persons with SMI with a normative sample receiving the same information, and assessed with the same instruments, limiting hypotheses about the generalizability of existing interventions. However, the data seems to suggest its potential inefficacy. Several findings are germane to effective educational intervention techniques.

Adult↗
PubMed2003

Impact of a community-based comprehensive primary healthcare programme on infant and child mortality in Bolivia.

Community-based comprehensive primary healthcare programmes are a widely-promoted strategy for improving child survival in less-developed countries, but limited documentation exists concerning their effectiveness in actually reducing child mortality. This study examined the impact of a community-based comprehensive primary healthcare programme on child survival in Bolivia. Mortality rates from two intervention areas where Andean Rural Health Care (ARHC) had been conducting child-survival activities for 5-9 years were compared with those from two geographically-adjacent comparison areas that lacked such activities and that were virtually identical to the intervention areas in socioeconomic characteristics. Vital events were registered at the time of regular visit to all homes. In the comparison areas, limited services were available which reached only a small percentage of the population, while in the intervention areas, prenatal care, immunizations, growth monitoring, nutrition rehabilitation, and acute curative services were readily available to the entire population. In 1992-1993, the annual rates of mortality of children, aged less than five years, were 205.5 per 1,000 and 98.5 per 1,000 in the comparison and intervention areas respectively. The absolute difference in mortality of 107.0 deaths per 1,000 (95% confidence interval [CI], 72.7-141.3 per 1,000) represented 52.1% (95% CI, 35.2-68.8%) lower mortality of children aged less than five years in the intervention areas compared to the control communities. These results suggest that the provision of community-based, integrated health services can significantly improve child survival in poor countries. Better-designed and larger field trials of community-based comprehensive primary healthcare programmes in multiple regions of the world are needed to provide a stronger scientific basis for developing this approach further in developing countries.

Bolivia↗
PubMedDate not supplied

Health care economic analyses and value-based medicine.

Health care economic analyses are becoming increasingly important in the evaluation of health care interventions, including many within ophthalmology. Encompassed with the realm of health care economic studies are cost-benefit analysis, cost-effectiveness analysis, cost-minimization analysis, and cost-utility analysis. Cost-utility analysis is the most sophisticated form of economic analysis and typically incorporates utility values. Utility values measure the preference for a health state and range from 0.0 (death) to 1.0 (perfect health). When the change in utility measures conferred by a health care intervention is multiplied by the duration of the benefit, the number of quality-adjusted life-years (QALYs) gained from the intervention is ascertained. This methodology incorporates both the improvement in quality of life and/or length of life, or the value, occurring as a result of the intervention. This improvement in value can then be amalgamated with discounted costs to yield expenditures per quality-adjusted life-year ($/QALY) gained. $/QALY gained is a measure that allows a comparison of the patient-perceived value of virtually all health care interventions for the dollars expended. A review of the literature on health care economic analyses, with particular emphasis on cost-utility analysis, is included in the present review. It is anticipated that cost-utility analysis will play a major role in health care within the coming decade.

Cost of Illness↗
PubMed2004

A prototype virtual reality system for preoperative planning of neuro-endovascular interventions.

This paper describes our efforts at creating a system with real time acquisition and geometric processing of the patients vascular anatomy, supplemented by a framework to simulate catheter vasculature interaction. Our system uses biplane angiograms coupled with an algorithm for generation of 3D vascular trees for patient data acquisition. Surface reconstruction and processing of this data is performed to provide novel decision aids to the interventionalist. The processed data can be loaded in a virtual environment to simulate guidance of the catheter through the patient's vasculature. With our combination of techniques, a patient specific visualization and simulation environment can be prepared within the narrow time window available for this procedure.

Algorithms↗
PubMed2005

[Effectiveness of an intervention to improve medical prescription quality in specialized care].

OBJECTIVE: The study was designed to research whether providing doctors with customized reports on prescription indicators,plus a presentation of the project to clinical departments and hospital boards, would improve prescription quality in specialized care. MATERIAL AND METHODS: Quasi experimental intervention study. During three periods of time we observed whether any differences between physicians receiving said reports (intervention group) and physicians not receiving said reports (control group)occurred in three overall quality markers (94 physicians)--generic drugs, low therapeutic value drugs, and irrelevant novel drugs-and two specific indicators--angiotensin converting enzyme inhibitors (109 physicians) and omeprazole (169 physicians). Indicators were assessed using mean values (95% Cl) and differences between groups with the z test. RESULTS: Prior to the intervention, indicators had no significant differences. At 4-6 months after delivering the report, generic drug prescription improved in the intervention group - 3.13%(1.79-4.47) versus 1.81% (1.08-2.54) in the control group,p = 0.041. After 10-12 months the intervention group had significantly improved versus the control group regarding: generic drugs, 4.01% (2.28-5.73) versus 2.22% (1.56-2.87), p = 0.025;ACE inhibitors, 58.89% (47.56-70.21) versus 45.91% (36.03-55.79), p = 0.042; and low therapeutic utility drugs, 8.57%(5.56-11.6) versus 12.35% (8.96-15.74), p = 0.047. Improvement regarding omeprazole did not reach statistical significance,and novel medications remained virtually unchanged. CONCLUSION: The intervention proved effective for the improvement of qualitative prescription indicators in specialized care.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2005

[Non-passable tumor-associated stenosis of trachea and stent-implantation -- an indication for Virtual CT-bronchoscopy].

We report about a male 50-year-old patient with known non-small cell lung cancer and tumor-associated stenosis of the right main bronchus already treated with Neodym-YAG-laser coagulation. Eight months later the patient was readmitted to hospital and revealed complete occlusion of the right main bronchus and subtotal stenosis of the distal trachea and the left main bronchus. Conventional tracheobronchoscopy failed to visualize the post-stenotic parts of the left main bronchus due to the length and degree of stenosis. Multidetector-CT-generated virtual tracheobronchoscopy was able to demonstrate complete intraluminal tumor extent thus making precise pre-interventional measurements for stent implantation possible. Furthermore, post-interventional re-evaluation by virtual tracheobronchoscopy confirmed correct position and patency of the stent located within the distal trachea and the left main bronchus. Our case report demonstrates a non-invasive and easy approach for evaluating the tracheobronchial system in a patient with tumor-associated airway stenosis including the possibility for viewing beyond post-stenotic segments.

Bronchoscopy↗
PubMed2001

Feasibility of quantitative pain assessment in outpatient oncology practice.

PURPOSE: Although physicians view failure to assess pain systematically as the most important barrier to outpatient cancer pain management, little is known about pain assessment in this setting. We sought to determine whether pain is routinely assessed and whether routine quantitative pain assessment is feasible in a busy outpatient oncology practice. PATIENTS AND METHODS: We conducted a pre- and postintervention chart review of 520 randomly selected medical and radiation oncology patient visits at a community hospital-based private outpatient practice. The intervention consisted of training health assistants (HAs) to measure and document patient pain scores by using a visual analog scale. The main outcome measures included HA documentation of patient pain scores, quantitative and qualitative mention of pain in the physician note, and analgesic treatment before and after the intervention. RESULTS: After the intervention, HA documentation of pain scores increased from 1% to 75.6% (P < .0001). Physician documentation increased from 0% to 4.8% for quantitative documentation (P < .01), and from 60.0% to 68.3% for qualitative documentation (not significant). Of all the patients, 23.1% reported significant pain. Subgroups with greater pain included patients actively receiving radiation treatments and patients with lung cancer. Of patients with significant pain, 28.2% had no mention of pain in the physician note and 47.9% had no documented analgesic treatment. CONCLUSION: Quantitative pain assessment was virtually absent before our intervention but easily implemented and sustained in a busy outpatient oncology practice. Pain score collection identified a high prevalence of pain, patient subgroups at risk for pain, and a significant proportion of patients with pain that was neither evaluated nor treated by their oncologists.

Ambulatory Care↗
PubMed1994

Importance of health and family variables related to quality of life in individuals with uncontrolled seizures.

Approximately 2.5 million Americans are epileptic, and nearly 150,000 new cases are diagnosed in the United States each year. While seizures are the most common physical symptom of epilepsy, treatment must include far more than medical intervention for seizure control. Virtually all aspects of life are affected by the disorder including personal relationships, employment, perception of self and overall quality of life. A literature review indicates that, while progress is being made in identifying variables which impact quality of life, little consensus exists regarding their nature. No two patients are necessarily alike, nor are their methods of dealing with the disorder necessarily the same. Arguments have been posed which state that age of onset is a factor, as is the degree to which seizures can be controlled. This is not to say, however, that effective interventions cannot be developed to assist patients in dealing not only with the physical manifestations of epilepsy but other common related factors as well. The purpose of this study was to identify those variables which impact quality of life for persons with epilepsy, and in light of the findings, to make recommendations for nursing interventions.

Adaptation, Psychological↗