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PubMed2001

[Effectiveness and safety of catheter ablation of the heart conduction tracts in tachyarrhythmia].

An analysis of 490 operations of radiofrequency catheter destruction in 442 patients aged from 5 to 83 years has been made. 284 patients (64.3%) had congenital and "idiopathic" character of rhythm disturbances. The greater part of operations--459 (93.7%)--were performed on patients with supraventricular tachycardias, 31 operations (6.3%)--on patients with ventricular arrhythmias. Efficacy of operations on patients with congenital diseases of the conducting system of the heart was 94.8-100%, frequency of recurrences being 3.3-8%. Successful rhythm correction in 78% of patients with atrial flutter was due to the risk of appearance of recurrences and development of atrial fibrillation at late periods. Creation of atrio-ventricular blockade abolishes tachysystole in patients with ciliary arrhythmia, but life quality depends on the adequate system of stimulation. The frequency of complications after the catheter destruction is associated with the complex character of the intervention and increases when the manipulations are to be performed in the left chambers of the heart.

Adolescent↗

PubMed2001

Randomized controlled trial of general practitioner tutor visit or mailing to encourage general practice-based education.

OBJECTIVES: Evaluation of a general practitioner tutor visit, or mailing, with regard to the amount of practice-based education occurring in general practices. DESIGN: An initial survey of all practices in the Mersey Deanery was undertaken. General practices which replied were randomly allocated to receive a GP tutor visit (n=38), to receive a mailing (n=38) or to a control group (n=36). Visits carried out by tutors covered a loosely agreed format. All practices were sent a follow-up survey identical to the original one at 6 months after the intervention. SETTING: General practices in the Mersey Deanery, north-west England. SUBJECTS: General practices which had replied to an initial survey. RESULTS: The amount of both specifically arranged and informal practice-based meetings increased in all groups. No changes were statistically significant. CONCLUSIONS: This study illustrates the difficulty of assessing educational interventions by randomized controlled trials. Such interventions are often expensive, complex and difficult to standardize. A substantial amount of practice-based education is taking place.

Education, Medical, Continuing↗

PubMed2002

Impact of the third cholesterol report from the adult treatment panel of the national cholesterol education program on the clinical laboratory.

BACKGROUND: The US National Cholesterol Education Program has recently released the third report of the Adult Treatment Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Incorporating new evidence and more consistent with other international intervention programs, these more complex guidelines will considerably expand indications for treatment. The implications for clinical laboratories are summarized in this report. CONTENT: LDL-cholesterol (LDL-C) remains the major focus for classification and treatment, whereas diabetes, the presence of multiple risk factors, including the metabolic syndrome, and increased triglycerides (TGs), will now require more intensive management. For screening, a fasting lipoprotein profile is recommended, adding LDL-C and TGs to the previous measurements of total cholesterol and HDL-cholesterol (HDL-C). Lowering the cutpoints defining optimal LDL-C [100 mg/dL (2.58 mmol/L)] and normal TGs [150 mg/dL (1.70 mmol/L)] and raising the cutpoint for low HDL-C to 40 mg/dL (1.03 mmol/L) will select more patients for treatment. A new marker, non-HDL-C, becomes a secondary target in treating high TGs. CONCLUSIONS: Laboratories will need to adjust reporting formats and interpretations and can expect more requests for tests to characterize secondary causes of dyslipidemia, e.g., diabetes, and for the so-called "emerging risk factors", e.g., lipoprotein(a), homocysteine, and C-reactive protein.

Adult↗

PubMed2002

Thrombus formation at the neck of cerebral aneurysms during treatment with Guglielmi detachable coils.

BACKGROUND AND PURPOSE: Thromboembolic events are a common source of complications during Guglielmi detachable coil (GDC) treatment of intracranial aneurysms. Thrombus formation at the coil-parent artery interface is not commonly reported but is an important potential source of emboli. We describe nine cases in which thrombus propagated from GDCs into the parent artery during coil therapy of cerebral aneurysms and subsequent treatment of the thrombus. METHODS: A retrospective review of a procedural database was performed to identify cases in which thrombus occurred during GDC treatment of cerebral aneurysms during a 30-month period. All images were reviewed at the time of the procedure. Nine cases of thrombus forming at the coil-parent artery interface and five cases of distal emboli were identified among 210 cases. All patients underwent anticoagulation with heparin during GDC treatment procedures. RESULTS: Thrombus was identified at the coil-parent artery interface during GDC treatment in nine (4.3%) of 210 cases. In each case, the thrombus was recognized before distal embolic complication occurred and was successfully treated with heparin alone (five patients) or with heparin plus a glycoprotein IIb-IIIa inhibitor (four patients). CONCLUSION: Potential clinical complications can be avoided by early recognition of thrombus at the coil-parent artery interface and by administering appropriate medical therapy.

Abciximab↗

PubMed2002

[Analysis of efficacy of complex treatment of patients with differentiated forms of the thyroid gland cancer using distant radiation therapy].

Retrospective analysis of efficacy of complex treatment, including surgical intervention, radioiodine therapy (RITH), suppressive hormonotherapy of differentiated forms of the thyroid gland cancer (DFTHGC) was done in 281 patients with positive effect of postoperative distant radiation therapy (PDRTH) application as a component of the treatment. Positive effect of therapy was estimated basing on the dynamic scintigraphy data with 131I and determination of thyroglobulin level in blood serum. The PDRTH conduction does not improve prognosis of the disease, does not lower the tumor metastasizing frequency to regional lymph nodes and remote organs and does not replace RITH. To achieve positive result in 12.8% of patients with PDRTH more than two courses of RITH were performed, enhancing so the total radiation dosage on the organism. To provide protracted nonrecurrent survival of patients with DFTHGC the radical approach is necessary, envisaging performance of thyroidectomy, the timely conduction of RITH with subsequent suppressive therapy using L-thyroxin.

Adult↗

PubMed2000

[Central venous catheter - related infections]

Central venous catheters are essential in complex medical and surgical interventions. It is estimated that 200,000 nosocomial bloodstream infections occur each year; 90% of these infections are related to the use of central venous catheters with increased morbidity and mortality, prolonged hospitalization and intensive unit stay, and greater hospital cost. The cause of the increased incidence of bacteremia and intravascular catheter infections is multifactorial and a source of ongoing debate. The skin, parenteral nutritional mixtures or hematogenous seeding accounted for 70% of the catheter-related bloodstream infections (CBI); the remaining 30% were traced to the hub. The three most common types of organisms causing CBI are coagulase negative staphylococci (usually S. epidermidis), S. aureus, and Candida spp. More rarely, gram-negative bacilli (Pseudomonas spp, Acinetobacter spp), enteric organisms and enterococci are implicated. Treatment includes catheter withdrawal and appropriate antibiotic coverage. For patients requiring only short-term access, the most effective approach is catheter removal, administration of parenteral antibiotics and replacement of the catheter at a different site. However, critically ill patients in hemodynamic monitoring or in TPN or chemotherapy require continuous central venous access, and the approach is to change the potentially infected line over guidewire, intravenous antibiotics and "catheter antibiotic lock" for 24 hours. If a patient's clinical course fails to improve after 28-48 hours of antimicrobial therapy, the catheter should be removed and replaced at a new site.

Journal Article↗

PubMed2003

Physiotherapy, including quadriceps exercises and patellar taping, for knee osteoarthritis with predominant patello-femoral joint involvement: randomized controlled trial.

OBJECTIVE: To design and carry out a randomized controlled trial of a complex, physical therapy based intervention for patello-femoral joint (PFJ) osteoarthritis (OA) of the knee, examining medium to longterm outcomes. METHODS: The participants, who had knee pain and predominant PFJ OA, were recruited from a large population based study. The study design was a controlled trial using prerandomization and a blind observer, comparing the intervention package with standard nonphysiotherapy treatment. The physiotherapy intervention was delivered in local community health centers and clinics and comprised education, quadriceps and functional exercises, and patellar taping delivered by a single physiotherapist in nine 30-minute sessions over 10 weeks, with advice to continue thereafter. The outcome measures were pain in the worse knee by 100 mm visual analog scale score, the disability domain of the Western Ontario and McMaster University OA index (WOMAC), and quadriceps muscle strength by maximum voluntary contraction. RESULTS: Eighty-seven patients were recruited to the study, 43 were randomized to the treatment arm. At 5 months post-baseline (10 weeks post-treatment) the treatment group had a small decrease in pain and a significant increase in quadriceps strength of the index knee. After one year there were no significant differences in any outcome measure, most of which had returned towards pretreatment levels. CONCLUSION: The treatment package produced small improvements in knee pain scores and quadriceps muscle strength 10 weeks after the end of the treatment period. There was no difference between the 2 groups at 12 months.

Aged↗

PubMed2003

Inhibitors of the entry of HIV into host cells.

The development of mechanistic insight into the process by which HIV enters host cells has revealed a panoply of targets that offer considerable potential as sites for pharmacological intervention. The gp120/gp41 protein complex, expressed on the virion surface, mediates HIV entry by a process initiated by the engagement of the host cell receptor CD4. Subtle conformational changes triggered by this interaction expose elements of gp120 to the seven-transmembrane, G protein-coupled chemokine receptors CCR5 or CXCR4 expressed on host cells, a contact that relieves constraints imposed on gp41 by gp120. This leads to a major conformational rearrangement of gp41, which results in the insertion of the fusion peptide into the host cell membrane and the assembly of the amino terminus heptad repeat into a trimeric form that is subsequently recognized by the carboxy terminal heptad repeat. The latter process leads to juxtaposition of the viral and host cell membranes, a prelude to fusion. The most prominent strategies and targets that are actively being exploited as drug discovery opportunities are inhibition of the attachment of HIV to host cells, blockade of chemokine receptors and interference with the function of gp41. Inhibitors of each of these steps in the HIV entry process with potential clinical relevance are reviewed in the context of their status in the drug development process. The most significant entity to emerge from this area of research to date is enfuvirtide, a 36-amino acid derivative that interferes with the function of gp41. Enfuvirtide is the first HIV entry inhibitor to be granted a license for marketing (it was approved in the US and Europe in March 2003), and its introduction portends the beginning of what promises to be an exciting new era of HIV therapy.

Anti-HIV Agents↗

PubMed2002

Cost-benefit analysis of ambulance and rescue helicopters in Norway: reflections on assigning a monetary value to saving a human life.

This paper reports the results of a cost-benefit analysis undertaken in 1996 for a public commission set up to plan the future operation of state-owned ambulance and rescue helicopters in Norway. The analysis indicates that the benefits of ambulance missions flown by helicopters exceeds the costs by a factor of almost six. To do this analysis it was necessary to assign a monetary value to human life. Traditionally this has not been done in medicine, and may be widely regarded as inconsistent with medical ethics. The results of the cost-benefit analysis serve as the starting point to a more general discussion surrounding the economic value of activities designed to reduce human mortality. It is concluded that human preferences for the provision of health care or other life-saving interventions are probably too complex to be adequately represented by means of a single monetary value expressing the benefits of life-saving. The task of developing an inclusive framework for a normative approach to priority setting in injury prevention is daunting, and may be insoluble. It is important to assess the extent to which current value-of-life estimates depend on study methods and social context.

Air Ambulances↗

PubMed2003

Teen pregnancy in South Carolina: a local needs assessment of Charleston County.

Although there has been recent improvement, teen pregnancy continues to be a significant problem, especially in South Carolina where the birth rate to adolescents is higher than the national average. As this is a complex issue, many different interventions including both primary and secondary prevention as well as modification of programs to fit each individual community will be necessary. One initial approach to pregnancy prevention program implementation is a needs assessment of current interventions compared with teen birth rates in a community. This report of a needs assessment for Charleston County revealed a discrepancy between the location of most pregnancy prevention programs (urban areas of the county) and the higher teen birth rates (rural areas of the county,) establishing areas that will be targeted for additional services. Other counties throughout South Carolina may find this approach useful in coordination of community efforts to reduce teen pregnancy.

Adolescent↗

PubMedDate not supplied

[Memory. An introduction to the study of the cognitive disorders in normal and pathological aging].

INTRODUCTION: As the life expectancy of the population rises, there is also an increase in the frequency of the diseases that appear in the elderly. Aging can be healthy or pathological, but the borderline between the two is still a bit fuzzy. DEVELOPMENT: With the increase in the longevity of the population, Alzheimer's Disease (AD) and other illnesses linked to the aging process have become more common, above all in people between 65 and 85 years of age. The cognitive aspects that, in clinical practice, are most frequently seen to be involved are memory, attention, executive functions and the speed at which information is processed; these are the most common in these patients but the most severe and insidious as well as the first to appear are problems affecting memory. The physiological mechanism behind memory has still not been wholly explained. The modulation of many of the cognitive processes given by the cerebellum expands the borders in the study of the different mnemonic processes. The prefrontal cortex plays an essential role in controlling attention and in the mnemonic filing system required to supervise and modulate sensory motor processing and the basic complex actions of cognition, emotion and human behaviour. CONCLUSIONS: The neuroanatomical, psychological and neurophysiological foundations of memory are very complex and involve the intervention of a number of structures that, within a single integrated context, each contribute to the overall functioning.

Age of Onset↗

PubMed2003

Creating partnership synergy: the critical role of community stakeholders.

While there are compelling reasons for professionals in health and human services administration to collaborate with other stakeholders in the community, the experience with such partnerships thus far has generated more frustration than results. Recent research on partnership synergy--a key indicator of a successful collaboration process--suggests that many of these partnerships are inadvertently compromising their own success by the way they involve community stakeholders. Applying research findings to current practice, this article shows how the ability of a partnership to understand and address complex problems--and sustain interventions over time--is related to who is involved in the partnership, how community stakeholders are involved, and the leadership and management of the partnership. The article addresses key challenges that health and human services administrators face when they seek to optimize the role of community stakeholders in partnership.

Community Health Planning↗

PubMed2004

The Angiomax Peripheral Procedure Registry of Vascular Events Trial (APPROVE): in-hospital and 30-day results.

BACKGROUND: High-risk patient characteristics and complexity of percutaneous peripheral intervention (PPI) procedures suggest a need for predictable and reliable anticoagulation. We undertook this study to assess the safety and efficacy of bivalirudin as the procedural anticoagulant in patients undergoing PPI of the renal, iliac, or femoral artery. METHODS: This was a prospective, open-label, single arm study inpatients undergoing PPI of the renal, iliac, or femoral vessels to assessbivalirudin as the sole procedural anticoagulant (0.75 mg/kg bolus/1.75 mg/kg/hr infusion). The primary endpoint was procedural success defined as residual stenosis < 20%. Secondary endpoints included ischemic events (death, myocardial infarction, unplanned revascularization, and amputation), and bleeding complications, as well as ACT values and times to sheath removal, ambulation, and discharge. RESULTS: 505 patients were enrolled at 26 sites. Procedural success was achieved in 95.0% of patients. Ischemic events were low (1.4%) and similar between vessel types. Protocol-defined major hemorrhage and TIMI major hemorrhage rates were 2.2% and 0.4%, respectively. Mean ACTs were similar among treatment groups (renal 353.8 seconds(s); iliac 335.9s, femoral, 343.5s). CONCLUSION: Bivalirudin provided consistent anticoagulation and similar outcomes in all vessel types treated at the dose tested. Ischemic and bleeding event rates were low, demonstrating the safe use of bivalirudin as a procedural anticoagulant in PPI.

Aged↗

PubMed2004

The costs, effects and cost-effectiveness of strategies to increase coverage of routine immunizations in low- and middle-income countries: systematic review of the grey literature.

Evidence-based reviews of published literature can be subject to several biases. Grey literature, however, can be of poor quality and expensive to access. Effective search strategies also vary by topic and are rarely known in advance. This paper complements a systematic review of the published literature on the costs and effects of expanding immunization services in developing countries. The quality of data on the effectiveness and cost-effectiveness of strategies to increase immunization coverage is shown to be similar across literatures, but the quality of information on costing is much lower in the grey literature. After excluding poorer quality studies from this review we found the quantity of available evidence almost doubled, particularly for more complex health-system interventions and cost or cost-effectiveness analyses. Interventions in the grey literature are more up to date and cover a different geographical spread. Consequently the conclusions of the published and grey literatures differ, although the number of papers is still too low to account for differences across types of interventions. We recommend that in future researchers consider using non-English keywords in their searches.

Cost-Benefit Analysis↗

PubMed2006

Management options in blunt aortic injury: a case series and literature review.

Blunt aortic injury (BAI) is a devastating consequence of high-energy trauma. The majority of its victims do not survive; those who do generally have significant associated injury. The standard treatment of BAI has been emergent replacement or repair of the damaged aorta via a posterolateral thoracotomy, with or without perfusion adjuncts. In addition to the substantial morbidity and mortality secondary to multisystem traumatic injuries, patients surviving to reach the operating room have been exposed to the risks related to their surgical treatment, namely death, paraplegia, hemorrhage, transfusion, organ dysfunction, prolonged intensive care unit stays, and extensive rehabilitation requirements. Contributions to the literature over the past several years have provided support for changing practice patterns in the management of BAI. Aggressive control of blood pressure has made it safe to delay high-risk interventions in patients with complex injuries. Advanced perfusion strategies using little or no anticoagulation appear to have positively affected bleeding complications and neurologic risk. Finally, endovascular stent grafting, though not yet rigorously evaluated in BAI, has been shown to be feasible and effective in the short term. This case presentation and literature review will examine treatment options and propose a management algorithm.

Adult↗

PubMed2006

[Transposition of the great arteries: long-term follow-up].

The management of transposition of the great arteries has changed importantly over the last decades. New techniques are employed for the diagnosis and surgical intervention has improved. This has lead to an increasing number of long-term survivors, who require specialised and focussed follow-up, depending on their type of surgical repair Mustard/Senning of arterial Switch. The long-term problems vary for each type of repair and require a specific approach, pharmacotherapy, catheter intervention or surgery. These complex sequellae implicate that transposition patients are never completely cured and probably will have a limited life span.

Cardiac Surgical Procedures↗

PubMed2006

[Surgical treatment of the brain ischemic disease].

There were examined 825 patients, in whom affection of extracranial arteries was revealed, including 340 (41.2%) men and 485 (58.8%) women, 27 to 73 years old. Atherosclerotic stenosis and occlusion of extracranial arteries was diagnosed in 305 (40.0%), pathologic kinking of vessels on atherosclerosis and hypertonic disease background--in 196 (23.8%), pathological kinking, caused by aortoarteriitis and fibrose--muscular displasia--in 197 (23.9%), hypoplasia of arteries--in 54 (6.5%), aortoarteriitis--in 73 (8.8%) patients. Stages I-IV ischemia together with proven affection of extracranial arteries served as indication for surgical treatment of chronic cerebro-vascular insufficiency. Depending on character of the arteries affection 11 kinds of operative interventions were conducted, using complex intraoperative program of the brain defense. Total number of reconstructive operations performed was 967. In 752 (91.2%) patients immediate good and satisfactory results were noted. In the late period 450 patients were examined: good results were achieved in 64.9%, satisfactory--in 22%, in 30 (6.7%) improvement did not occur and 28 (6.2%) died. Introduction of the proposed complex examination and surgical treatment program have permitted to improve the results of treatment of the patients, suffering chronic brain ischemia.

Adult↗

PubMed2006

[Strategy for treatment of acute myocardial infarction after coronary revascularization with integrative medicine].

Since 1980s, the treatment of acute myocardial infarction (AMI) has entered the era of revascularization of infarction-related artery. There is still shortness of ideal strategy in modern medicine for comprehensive intervention aiming at the complex pathological links such as myocardial no-reflow, slow-reflow and reperfusion injury after revascularization. Therefore, combining traditional Chinese medicine with modern medicine, selecting effective drugs or prescriptions, and exploring their effective ingredients and portions of them as well as the mechanisms of the combinations in promoting myocardial capillary angiogenesis and cardiac muscle cell differentiation, and regulating the repairing process of inflammatory reaction will provide new intervening target directions and comprehensive intervening patterns for the prevention and treatment of AMI.

Angioplasty, Balloon, Coronary↗