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At least 937 records · Page 52Linked to original sources
PubMed2006

Third ventricle midline shift due to spontaneous supratentorial intracerebral hemorrhage evaluated by transcranial color-coded sonography.

OBJECTIVE: We aimed to assess the clinical usefulness of the third ventricle midline shift (MLS) evaluated by transcranial color-coded sonography (TCCS) in acute spontaneous supratentorial intracerebral hemorrhage (ICH). METHODS: Consecutive patients with acute (<24 hours after symptom onset) ICH were recruited for this TCCS study. Sonographic measurement of MLS and the pulsatility index (PI) of the middle cerebral arteries were compared with head computed tomographic (CT) data, including MLS, and hematoma volume. Poor functional outcome at 30 days after stroke onset was defined as modified Rankin scale greater than 2. RESULTS: There were 51 patients with spontaneous supratentorial ICH who received CT and TCCS studies within a 12-hour window. Correlation between MLS by TCCS (mean +/- SD, 3.2 +/- 2.6 mm) and CT (3.0 +/- 2.4 mm) was high (gamma = 0.91; P < .01). There was also a good linear correlation between hematoma volume and MLS by TCCS (gamma = 0.81; P < .01). Compared with ICH volume less than 25 mL, those with greater volume had more severe MLS and a higher PI of the ipsilateral middle cerebral artery (P < .001). Midline shift by TCCS was more sensitive and specific than the PI in detecting large ICH (accuracy = 0.82 if MLS > or = 2.5 mm), and it was also a significant predictor of poor outcome (odds ratio, 2.09 by 1-mm increase; 95% confidence interval, 1.06-4.13). CONCLUSIONS: Midline shift may be measured reliably by TCCS in spontaneous supratentorial ICH. Our study also showed that MLS on TCCS is a useful and convenient method to identify patients with large ICH and hematoma expansion and to predict short-term functional outcome.

Cerebral Hemorrhage↗
PubMed2000

Quantification of HER2 oncoprotein in fine-needle aspirates of the breast.

Measurements of either HER2 gene overexpression or its gene-coded protein (p185) are clinically useful for predicting prognosis in breast cancer. The measurements are also useful for identifying metastatic breast cancer patients who may benefit from Herceptin treatment. Since fine needle aspiration (FNA) of the breast has become an increasingly popular technique for obtaining tissue specimens, we have developed a sensitive method to quantify p185 in the aspirate. For this procedure, p185 from the cell pellet of FNA is extracted with a buffer containing Triton X-100, and the p185 is measured with an enzyme immunoassay. Most of the malignant breast tumors (N=7) in this study were associated with elevated p185 concentrations (6/7, 319+/-222 U/mg), compared to the p185 concentrations in normal breast tissue (42.8+/-35 U/mg, N=47) or benign lesions (43.1+/-20.2 U/mg, N=22). Quantification of p185 in FNA may improve the assessment of breast cancer patients, revealing whether they are at high risk and may benefit from Herceptin treatment.

Biopsy, Needle↗
PubMed2000

Teaching ethics to students in the University College of Nursing Studies in Maribor.

We wish to present our experiences of the educational process in the teaching of the philosophy of nursing ethics in healthcare to nursing students at the University of Maribor, College of Nursing Studies. Application of professional ethics in the study program: awareness of professional ethics theory and philosophy, and the application of these theories and philosophies in the nursing learning laboratory, the use of Slovenia's nursing code of ethics in clinical practice, the use of combined clinical practice and seminar presentations of situations which are of an ethical nature. Evaluation of the student's understanding and usage of theoretical/philosophical ethics in concrete examples.

Curriculum↗
PubMedDate not supplied

Urban-rural differences in amitriptyline use among nursing facility residents.

OBJECTIVE: To characterize patterns of amitriptyline use across the urban-rural continuum. DESIGN: Retrospective analysis of antidepressant drug codes and demographic and clinical data from the Minimum Data Set (MDS), 1994 to 1997. SETTING: Kansas nursing facilities. PARTICIPANTS: Facility residents aged 65 and older. MEASURES: A four-strata system was used to classify nursing facility location by county, from urban to frontier. We examined admission use and after-admission use of amitriptyline across strata for each year separately. Unadjusted and adjusted odds ratios were determined for each stratum, using the urban stratum as the point of reference. RESULTS: Admission use of amitriptyline occurred in 2.3 to 4% of all admissions, and although such use was highest in the most rural stratum, no clear urban-rural gradient was found. In contrast, amitriptyline use 30 days or more after admission demonstrated modest urban-rural gradients in unadjusted and adjusted analyses. In 1997, when adjusted for demographic factors, odds ratios for amitriptyline use were 2.10 (1.54-2.87), 1.68 (1.33-2.13), and 1.49 (1.17-1.90) for the Frontier, Rural, and Densely Settled Rural categories as compared with the Urban reference group. CONCLUSIONS: After admission to Kansas nursing facilities, rural practice patterns for amitriptyline use are less favorable than those in urban areas, and an urban-rural gradient is identified. Further work is needed to identify explanatory patient, facility, and prescriber factors.

Journal Article↗
PubMed2003

Competence.

Explore the source record for details and available documents.

Clinical Competence↗
PubMed2003

[Dutch Institute for Health Care Improvement's standard code of practice entitled, "Donation of fetal tissue"].

The Dutch Law on Foetal Tissue (Wet Foetaal Weefsel) sets out conditions and regulations concerning the donation, storage and permissibility of use of foetal tissue. Each institution where foetal tissue becomes available has to formulate an in-house code of conduct describing how the law will be applied within that institution. A committee, including abortion physicians and gynaecologists, has formulated a number of rules of conduct within the standard code of conduct under the auspices of the Kwaliteitsinstituut voor de Gezondheidszorg CBO [Dutch Institute for Healthcare Improvement]. Complying with this standard code ensures that the law is upheld. In clinical practice, one may deviate from this standard code in case of solid reasons only. Generally, all women can be asked to donate foetal tissue. A basic prerequisite for the inclusion of non-Dutch women is that oral and written communication is possible. The committee considers the age of 16 as a minimum threshold and mental incompetence as an exclusion criterion. Much attention should be paid to providing the women with information and to requesting permission. The basic principle is that the decision to terminate a pregnancy should be strictly separated from the decision to donate foetal tissue. As a general rule, foetal tissue should be stored anonymously. Adjustment of the abortion method in view of the intended scientific research is not permitted.

Adolescent↗
PubMed2004

Internet use by colorectal surgery patients: a surgeon's tool for education and marketing.

The goal of this study is to understand the role of the Internet in the education and recruitment of patients within colorectal surgery practices. Surveys of Internet use were completed by 298 patients visiting five outpatient colorectal surgery clinics affiliated with the University of Southern California. Data collected included the patient's age, gender, level of education, zip code at home, type of clinic visited, and information on the respondent's Internet use. Overall, 20 per cent of the respondent patients visiting our clinics had used the Internet to research the medical condition that prompted their visit. Highest grade level completed (P < 0.001), age (P < 0.01), type of clinic (P < 0.001), and household income (P < 0.001) were all found to be associated with any prior use of the Internet whereas gender was not (P = 0.58). Among Internet users, only household income and frequent use of the Internet were associated with searching the Internet for medical information (P < 0.001). Ultimately, all of the Internet-using patients surveyed felt the medical information they found was "some what" or "very helpful." Understanding which patients "go online" to search for medical information is essential for surgeons who wish to use the Internet for marketing their practices and educating their patients.

Chi-Square Distribution↗
PubMed2004

Consequences and costs of lower extremity injuries.

Lower extremity injuries resulting from motor vehicle crashes are common and have become relatively more important as more drivers with newer occupant restraints survive high-energy crashes. CIREN data provide a greater level of clinical detail based on coding guidelines from the Orthopedic Trauma Association. These detailed data, in conjunction with long-term follow-up data obtained from patient interviews, reveal that the most costly and disabling injuries are those involving articular (joint) surfaces, especially those of the ankle/foot. Patients with such injuries exhibit residual physical and psychosocial problems, even at one year post-trauma.

Abbreviated Injury Scale↗
PubMed2005

Dutch medical oath.

In the first part of this article, the booklet Dutch Medical Oath is reviewed. The content of the new oath is discussed as are the reasons for revision of the previous version of the oath. This is followed by a short history of the oath. In the second part of the article the oath is compared with the seven competencies of a medical specialist. The new oath contains elements of six of these seven competencies. This demonstrates that the oath is in keeping with the new medical educational demands.

Clinical Competence↗
PubMed2005

[Lipoprotein (a) in a population-based study: more significant in Turkish women than men?].

OBJECTIVE: Serum lipoprotein(a) [Lp(a)] concentrations, determined in 665 persons in the 2003/04 survey of the Turkish Adult Risk Factor Study, were investigated in regard to distribution, determinants and relationship to cardiovascular risk factors, metabolic syndrome (MS) and coronary heart disease (CHD). METHODS: Diagnosis of MS was based on Adult Treatment Panel III criteria, that of CHD on the presence of clinical findings and Minnesota coding of resting electrocardiograms. Metabolic syndrome was observed in 44%, CHD in 14% of the study sample. Behring nephelometry was used for Lp(a) values measurements which were log-transformed for analyses because of skewing. RESULTS: Geometric mean values of Lp(a) in 286 men and 379 women, aged 55.5 +/-12.0 years, were 9.46+/-2.90 mg/dL and 10.46+/-3.00 mg/dL (p>0.2), respectively. Apart from a slight correlation with age, Lp(a) exhibited significant positive correlations with apolipoproteins A-I and B, low density lipoprotein-cholesterol (LDL-C) (r =0.15), total cholesterol, high density lipoprotein-cholesterol (HDL-C), systolic blood pressure and log C-reactive protein, and inverse ones with thyroid stimulating hormone (r =-0.25) in men, and log gamma glutamyltransferase in women. Further 10 variables were not significantly correlated in either gender. In linear regression analyses for independent covariates of Lp(a), positive associations were noted with serum total cholesterol and systolic blood pressure, and inverse ones with waist circumference, triglycerides and (only in women) with gamma glutamyltransferase. Logistic regression analyses revealed in men no association with either MS or CHD likelihood. Among women, age-adjusted Lp(a) was associated inversely at a borderline significance with MS, as did levels of Lp(a) >30 mg/dl vs. the remaining sample, controlled for age and MS, display an odds ratio (OR) of 1.62 for prevalent CHD (p=0.20). An OR of 1.92 (p<0.19) was noted in all adults for the coexistence of Lp(a) >30 mg/dl and LDL-C >150 mg/dl, after controlling for age, MS, smoking status and LDL-C categories. CONCLUSION: Lipoprotein(a), the variance of which is known to be overwhelmingly due to the apo(a) isoforms, proved to have a significant inverse independent association with a measure of abdominal obesity. Lipoprotein(a) levels appeared not to be associated with risk for MS or CHD among men. In women, however, high Lp(a) levels were accompanied with an environment less prone to MS, and - without attaining significance -- tended to be associated with CHD likelihood, independent of age and MS. Further studies are warranted in this area.

Adult↗
PubMedDate not supplied

[Prevalence of risk factors for ischemic heart disease in a northern Italian adult population].

The aim of this study is to measure the prevalence of cardiovascular risk factors in Tavazzano (Lodi) inhabitants, in order to implement efficacious and preventive strategies at community level. In 1998 the target population consisted of 2055 adults (males and females) aged 35-64, living in Tavazzano (Lodi province). The examined population was made of 856 subjects (399 males and 457 females), with a participation rate equal to 41,6%. A questionnaire concerning medical history and life habits such as: smoking, alcohol consumption and physical activity was administered to each participant. Height, Weight, Systolic and Diastolic Blood Pressure, Fasting Blood Glucose, Total Cholesterol and triglycerides were collected. A 12-leads electrocardiogram, evaluated both with standard clinical criteria and Minnesota Code, was done for each subject. The results show a high prevalence of modifiable cardiovascular risk factors: hypertension (25,2%), smoking (26,1%), obesity (14,6%), hypercholesterolemia (27,5%), low physical activity (39,6%) mainly in males and with an increasing trend with age. These data indicate the need of preventive programmes addressed to the general population and to "subjects at risk", according to the National Health Plan 2003-2005.

Adult↗
PubMed2006

[Ethical aspects of resuscitation].

The former typically paternalistic physician-patient relationship has changed gradually toward an autonomy based one in the second half of the 20th century. Patient's autonomy includes the right to refuse life-saving therapy in modern constitutional states. Hungarian law assures the right to refuse life-saving treatment as well. However to our knowledge no such therapy refusal has occurred since the law coming into force likely because of the rather strict regulations. Forgoing resuscitation is basically determined by two factors: autonomy of the patient, and medical futility. The alteration of the law's form can facilitate the lawful Do Not Resuscitate (DNR)orders for the sake of patient's autonomy. Qualitative futility is characterized by quality of life, which only the patient has the right to judge. Resuscitation protocols based on results of controlled studies can significantly improve both the success rate of resuscitations and the quality of life. Education plays a prominent role in this process as it was demonstrated in our prospective comparative study. According to author's study Hungarian DNR orders are paternalistic and patient autonomy plays a secondary role. It was also established that patient's autonomy significantly improved in the subgroup trained according to international standards. Hungarian results were compared to the results of a highly educated group in the second study. The results confirmed the presumption: the education of resuscitation according to international standards improves both the representation of patient's autonomy in DNR decisions, survival rate and quality of life.

Advance Directives↗