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PubMed2001

Mental health nurses' PRN psychotropic medication administration practices.

PRN psychotropic medications (medications given with the aim of changing the patient's mental state on an 'as needed' basis) are frequently prescribed and administered in mental health facilities. Their administration is largely an autonomous nursing role. However, little research has explored this important area of nursing practice in any detail and therefore the use of this intervention by mental health nurses is not fully understood. A descriptive project was undertaken to explore the factors involved in the administration of PRN psychotropic medications. It utilized a retrospective chart audit, conducted at one regional and one urban setting in Queensland, Australia. The results indicate a lack of clarity surrounding psychotropic PRN medication administration practices, confusion surrounding decision-making processes related to this intervention, and poor documentation practices. The study found a high incidence of PRN psychotropic medication administration when compared to similar studies, and an excessive reliance on the use of typical antipsychotics over benzodiazepines. This practice is not supported by contemporary literature. As a result of our findings, we recommend further studies in areas of related importance, in order to increase our understanding of the complexities surrounding this important nursing intervention, and an investigation into documentation practices in inpatient mental health settings.

Adult↗

PubMed1986

Liver atrophy complicating benign bile duct strictures. Surgical and interventional radiologic approaches.

The hepatic atrophy and hypertrophy complex has been described in a selected group of nine patients with benign bile duct stricture. The clinical features common to this group were a high biliary stricture and a long-standing history of cholangitis and intermittent jaundice. A history of multiple surgical procedures and associated vascular damage or portal hypertension is strongly suggestive of the atrophy and hypertrophy complex. The radiologic criteria for the diagnosis of this condition are presented. Computerized tomography and HIDA scintigraphy were valuable as noninvasive means to diagnose lobar liver atrophy. The atrophy and hypertrophy complex described herein poses significant therapeutic problems and demands approaches other than those normally applicable for high biliary strictures. A combined surgical and radiologic approach with additional interventional radiologic procedures may be appropriate in patients in whom hilar anastomosis is difficult or impossible.

Adult↗

PubMed2001

Improving the use of pharmaceuticals through patient and community level interventions.

Pharmaceuticals represent an increasing share of private and public health care expenditures. However, while most governments are interested in ensuring availability and access to drugs, the issue of adequate use of drugs remains a low priority in most third world countries. This paper summarizes the results of interventions conducted in developing countries aimed at improving patients' compliance with the advice of health professionals and/or to decrease the unnecessary use of drugs by the general population. Forty-five studies were identified through literature searches and networking; and only about a third of them fulfilled the eligibility criteria for inclusion in the review. Given the paucity of information available and the importance of the topic the authors report on all 45 studies identified. Although much remains to be explored there are several interventions that deserve to be highlighted. The authors argue that improving the use of pharmaceuticals through interventions directed only to consumers may have a small impact and suggest that in order to obtain meaningful changes it might be necessary to design interventions to modify the behavior of all the actors in the medication cycle (manufacturers, health professionals, retailers, consumers and governments). They suggest that the extraordinary therapeutic effects of antibiotics, coupled with the problems that may arise when they are inappropriately used and with the extraordinary amount of resources spent on antibiotics worldwide justify a global effort to reduce their inappropriate use and promote their adequate administration. The complexity of this type of intervention would require the support of the pharmaceutical industry, governments, private foundations, and international organizations.

Community Health Planning↗

PubMed1999

Hepatocyte isolation stimulates formation of interferon stimulatory response element DNA-protein complexes.

We have examined the relationship between intracellular signalling pathways and loss of differentiated function during hepatocyte isolation and culture. We have shown that isolation induces the activation of the interferon stimulatory response element (ISRE). This activation was transient and peaked at 3 h before it returned to basal by 24 h of culture. Interferon regulatory factor-1 (IRF-1) was shown to be important for generation of ISRE complexes by electromobility shift assays and supershift intervention. IRF-1 was translocated to the nucleus in parallel with changes to ISRE complex formation. The p38 kinase inhibitor, SB 203580, diminished the formation of ISRE binding complexes. Hence p38 kinase may be involved in the activation and binding of IRF-1 or related proteins to the ISRE motif. Changes in ISRE activation levels in cultured hepatocytes may have important implications in primary hepatocyte differentiation and loss of function.

Animals↗

PubMed2000

Hand Hygiene Revisited: Lessons from the Past and Present.

Hand hygiene is the most effective measure to prevent cross-transmission of microorganisms. Adequate hand hygiene can be achieved by standard handwashing--with water alone or with soap--or by the use of an alcohol-based hand-rub solution. Despite considerable efforts, compliance with this simple infection-control measure remains low. Factors predicting non-compliance have been extensively studied, and include physician status, procedures associated with a high risk of cross-transmission, and an important workload. Future interventions to improve compliance should consider complex behavioral theories and the use of multimodal and multidisciplinary strategies. We believe that one of the key components of these interventions should be the wide use of alcohol-based hand-rub, which is microbiologically effective and less time-consuming than standard handwashing.

Journal Article↗

PubMedDate not supplied

Macroglossia: a case study.

UNLABELLED: A young child with macroglossia of unknown cause was seen for treatment to modify resting tongue posture and improve speech sound production. Evaluation of the treatments indicated positive change in resting tongue posture and a modest change in speech sound production. Treatment for such patients can be complex and must consider orthodontic and/or surgical interventions, because an enlarged tongue can influence growth, development, and physiology of the oropharyngeal complex. The speech-language pathologist must be prepared to deal with the complex of problems demonstrated by patients with macroglossia during growth and development. LEARNING OUTCOMES: (1) As a result of this activity, the participant will be able to describe the sequelae of macroglossia. (2) As a result of this activity, the participant will be able to identify appropriate treatment options for children with macroglossia.

Articulation Disorders↗

PubMed2000

An intervention study on screening for breast cancer among single african-american women aged 65 and older.

PURPOSE: Older single African-American women are the population that is least likely to use screening procedures because of cognition-related, income-related, social-support-related and medical care-related barriers. This study aims to evaluate a breast screening intervention program developed according to socioeconomic, cultural, psychological and behavioral characteristics of older single African-American women.METHODS: Ten public housing complexes were randomly assigned to either intervention or control group. African-American women aged 65 and over were recruited into the study if they were widowed, divorced, separated or never-married in the preceding year, and did not have a history of breast cancer (n = 325). Delivered by lay health educators, the intervention program targeted increasing knowledge on breast health and breast screening, reducing emotional or psychological problems, and increasing support from the significant others of study women. Breast screening-related cognition and behavior were measured at pre-intervention and post-intervention.RESULTS: Comparisons of the pre-intervention and post-intervention measurements showed that while the proportion of women who had a clinical breast examination or mammogram in the preceding year was decreased at the post-intervention in the control group, it was increased in the intervention group. However, the differences did not reach a significant level. No consistent patterns could be found in changes of variables in knowledge, attitudes and beliefs. These results remained similar when potential confounding factors were adjusted using mixed model regression analyses.CONCLUSIONS: These results did not suggest significant effects of an intervention program which used lay health educators to promote breast cancer screening in older single African-American women.

Journal Article↗

PubMed1998

Heart disease in diabetes mellitus: a challenge for early diagnosis and intervention.

Most people with diabetes die from thrombotic complications superimposed to degenerative arterial vascular lesions, mostly myocardial infarction. Diabetes is a risk factor per se for such complications, but often clusters with dyslipoproteinemia, hypertension and obesity. In NIDDM (Type-II) patients this is referred to as "metabolic syndrome" and often operates on a genetically programmed susceptibility which accelerates the pathogenesis of coronary artery disease in front of a much wider diabetes specific cardiopathy. From a pathophysiological point of view none of these associated risk factors explains the pathogenetic series of events leading to the precipitation of an occlusive thrombus at sites of complicated coronary plaques. In patients with diabetes the coagulation system is switched towards a prethrombotic state, involving increased plasmatic coagulation, diminished fibrinolysis, decreased endothelial thromboresistance and predominantly platelet hyperreactivity ("diabetic thrombocytopathy"). Some of these factors are associated with an increased coronary risk (e.g. fibrinogen, PAI-1, platelets), but are also directly linked to the pathogenesis of "atherothrombosis". Altered cardiac remodelling together with adhesion and coagulation mechanisms appears suitable to explain decreased functional performance of infarcted organs, decreased success of acute (reduced fibrinolytic response, reperfusion injury) and longterm intervention strategies (PTCA, CABG) in diabetes. Glucose adjustment alone will not adequately neutralize these complex mechanisms. Particularly in diabetes a multidimensional interventional repertoire is required including antihypertensive, antidyslipoproteinemic and antithrombotic drugs, customized according to the individual patients needs as assessed by early diagnostic measures ("early secondary prevention").

Diabetes Complications↗

PubMed1992

The management of subglottic stenosis in patients with Wegener's granulomatosis.

Wegener's granulomatosis (WG) is a multisystem inflammatory disease characterized by vasculitis, granuloma formation, and necrosis. Among 158 patients treated at the National Institutes of Health during the past 24 years, 145 (92%) had an otolaryngologic manifestation of their disease and 25 (16%) had subglottic stenosis (SGS). SGS varied from asymptomatic to life-threatening. Sixteen (80%) of 20 patients with fixed SGS required surgical intervention, including manual dilations, carbon-dioxide laser resections, and laryngotracheoplasty (LTP). LTP was performed with and without microvascular reconstruction. Thirteen of the patients required tracheostomy and all 13 were ultimately decannulated. Five patients who repeatedly failed dilations and/or endoscopic laser surgery underwent LTP. Since 1987, two patients have undergone LTP with microvascular free flaps. Both patients were subsequently decannulated. The authors' experience demonstrates that management of SGS in WG is complex, requiring individualized frequent multimodality interventions to achieve satisfactory results. Microvascular laryngotracheal reconstruction should be considered in the surgical armamentarium for patients with persistent stenoses.

Adolescent↗

PubMed1996

Changes in glucose and lipid metabolism following weight loss produced by a very low calorie diet in obese subjects.

OBJECTIVE: To study the effects of a very low calorie diet (VLCD) on glucose and lipid metabolism in obese subjects, in particular, the effects on insulin sensitivity and the activities of the key enzymes of glucose disposal, glycogen synthase (GS) and the pyruvate dehydrogenase complex (PDHC). DESIGN: Clinical dietary intervention study (1.67 MJ (400 kcal)/day) until weight loss of > 10%. SUBJECTS: 11 (seven male, four female) non-diabetic, obese subjects (age: 27-62 y; BMI: 40.5 +/- 1.4 kg/m2). MEASUREMENTS: Whole body glucose disposal (by euglycemic hyperinsulinemic clamp), respiratory quotient (RQ), resting energy expenditure (REE), glucose and lipid oxidation (by indirect calorimetry), insulin-stimulated PDHC and GS activity (in muscle biopsies) both before and immediately after VLCD (i.e. while still in a hypocaloric state), serum hormone and metabolite levels throughout the dietary period. RESULTS: Weight loss was accompanied by reduced insulin and elevated NEFA levels, improved insulin sensitivity due to increased nonoxidative glycolysis with no increase in PDHC or GS activities. The rate of weight loss was inversely related to the initial RQ. PDHCa was strongly age-related. CONCLUSION: A low RQ may be used as a predictor of the efficacy of VLCD treatment and that while VLCD improves nonoxidative glycolytic flux, changes in oxidative glucose disposal and muscle glucose storage are prevented by high NEFA availability during this catabolic phase of dietary intervention.

Adult↗

PubMed2006

Dose to cardiologists in haemodynamic and electrophysiology cardiac interventional procedures.

Interventional cardiac procedures can be complex and involve extensive use of low dose rate fluoroscopy and high dose rate in image acquisition mode; hence, staff may receive significant radiation exposure. Radiation exposure to operators was assessed in 173 procedures. Fluoroscopy time, number of acquired images and dose-area product were recorded and occupational dose assessed with thermoluminescence dosemeters. The effective dose to the operator was compared with relevant literature data: values found were generally lower than those reported for other interventional cardiology laboratories. This is probably because of the strict radiation protection policy in our centre. Higher effective doses were found for defibrillator implantation and percutaneous transluminal coronary angiography procedures; for other cardiac procedures, effective dose was lower. Yearly extrapolated occupational doses to cardiologists are lower than the regulatory dose limit and in the lower band of doses reported in the literature.

Algorithms↗

PubMedDate not supplied

Resectoscopic surgery may be an alternative to hysterectomy in high-risk women with atypical endometrial hyperplasia.

STUDY OBJECTIVE: Endometrial hyperplasia is found in 2% to 10% of women with abnormal uterine bleeding (AUB). Up to 43% of patients with cytologic atypia harbor coexisting adenocarcinoma, and approximately 20% to 52% of atypical hyperplasias, if untreated, progress to cancer. The objective of this study was to estimate the incidence of atypical endometrial hyperplasia encountered during routine resectoscopic surgery in women with AUB and to evaluate the role of resectoscopic surgery in the management of women with AUB and atypical endometrial hyperplasia who refused and/or were at high risk for hysterectomy. DESIGN: Prospective cohort study (Canadian Task Force classification II-3). SETTING: University-affiliated teaching hospital. PATIENTS: From January 1990 through December 2005, the senior author (GAV) performed primary resectoscopic surgery in 3401 women with AUB. Among these, there were 22 women with atypical (17 complex, 5 simple) endometrial hyperplasia. INTERVENTIONS: All women underwent hysteroscopic evaluation and partial (n = 3) or complete (n = 19) endometrial electrocoagulation and/or resection. Subsequently, 6 women had hysterectomy and bilateral salpingo-oophorectomy (BSO). MEASUREMENTS AND MAIN RESULTS: The median (range) for age, parity, and body mass index were 55 years (24-78 years), 2 (0-4), and 30.1 kg/m2 (22.5-52.2 kg/m2), respectively. Among the 3401 women, there were 22 cases of atypical endometrial hyperplasia, 12 of which were incidentally diagnosed at the time of hysteroscopy (complex 10, simple 2, incidence 0.35%). After hysteroscopic diagnosis or confirmation of diagnosis, 6 women underwent hysterectomy and BSO. Of the remaining 16 women, followed for a median of 5 years (range 1.5-12 years), 1 was lost to follow-up, 1 had only a biopsy to preserve fertility, 1 died from lung cancer after 4 years, and 1 died from colon cancer after 5 years. One patient developed endometrial cancer after 10.5 years with postmenopausal bleeding. She remains alive and well 3.5 years after hysterectomy and BSO. The remaining 11 patients are amenorrheic at a median follow-up of 6 years (range 1.5-12 years). CONCLUSIONS: Resectoscopic surgery in 3391 women with AUB detected 12 incidental cases of atypical endometrial hyperplasia (incidence 0.35%). Skillful resectoscopic surgery may be an alternative to hysterectomy in women with AUB and atypical endometrial hyperplasia, who refuse or are at high-risk for hysterectomy and who are compliant with regular and long-term follow-up.

Adult↗

PubMed2005

Interventional treatment with autoexpandable stents in iliofemoral arterial diseases.

UNLABELLED: The importance of peripheral arterial diseases is revealed by statistical data, which showed a frequency of arterial diseases equal to the one of stable angina Traditional treatment of these patients was the surgical bypass, but an alternative therapy in these cases is the interventional treatment. Arguments for this option could be: it is less expensive, it decreases the hospitalization time, it does not require general anesthesia, and complications are less frequent and less severe. Interventional treatment is recommended especially in cases of short, isolated lesions of great vessels. During the last years, indications for interventional treatment were expanded to more difficult and complex cases, due to the advances in technology of endoluminal treatment products and the recently introduced laser angioplasty technology. MATERIAL AND METHOD: Among the interventional techniques we apply in our clinic, we mention: percutaneous transluminal angioplasty, intraarterial stent implantation, laser angioplasty and intraarterial thrombolysis, some of them peformed with IVUS control. In a period of 14 years we examined a total number of 6,532 patients suffering from peripheral arterial obstructive diseases. In the past 3 years, in our new laboratory of interventional cardiology, new procedures have been introduced in the algorithm of interventional treatment, such as laser angioplasty. Invasive diagnosis performed in the Cardiology Clinic consisted in aortography in 746 cases and peripheral arteriography in 2035 cases. Interventional treatment consisted in percutaneous transluminal angioplasty (1.240 procedures, 756 performed in the latest 3 years), intraarterial thrombolysis (214 procedures), laser angioplasty (since June 2002-130 procedures performed) and stent implant (since 2001-61 cases). Axillar approach was also introduced in 2001 and was applied in 23% of cases. RESULTS: We recorded a 76.5% success rate using only PTA for repermeabilisation of the lower limb arteries. Association of intraarterial thrombolysis increased the success rate to 91%. Using laser angioplasty and autoexpandable stent implantation, the success rate achieved was 100%. CONCLUSION: Interventional treatment is an important alternative in the complex algorithm of treatment in PAOB. Intraarterial stenting significantly improves the immediate and the long term results of interventional treatment, and autoexpandable stents with thermal memory show superior results. Laser angioplasty is an adjuvant method which significantly improves the results of interventional treatment. In all these methods, a very important role plays the good cooperation of the team formed by cardiologist, angiologist and vascular surgeon.

Angioplasty, Balloon, Laser-Assisted↗

PubMed1998

Pathobiologic responses to stenting.

As the interventions available to treat obstructive coronary artery disease become increasingly complex, our understanding of the vascular response to these interventions requires greater sophistication. Molecular and cellular biologic tools have now propelled us into another phase of work with vascular devices. Initially, studies of endovascular implants such as stents focused on developing models of vascular injury. With these models, we could then examine the designs of individual stents and connect structure with performance. Now we are entering a third phase in which stent manufacturers are looking to science to dictate stent design.

Angioplasty, Balloon, Coronary↗

PubMed2004

Behavioral and cognitive aspects of tuberous sclerosis complex.

Tuberous sclerosis complex is a multisystem genetic disorder. Of all the possible manifestations of this complex disorder, the cognitive and behavioral problems represent the area of greatest concern to parents and caregivers. This review outlines the current evidence regarding global intellectual abilities, behavioral problems, psychiatric diagnoses, learning disorders, and specific neuropsychologic deficits for which individuals with tuberous sclerosis complex are at particularly increased risk, and outlines approaches to intervention. Approximately half of individuals diagnosed with tuberous sclerosis complex present with global intellectual impairment and developmental psychopathologies. Those with normal intellectual abilities are also at high risk of specific neuropsychologic deficits and behavioral, learning, and other psychiatric disorders. There is no evidence for an inevitable decline in cognition or behavior, and any such changes should be investigated. The evolving neurocognitive literature suggests that frontal brain systems might be most consistently disrupted by tuberous sclerosis complex-related neuropathology, thus leading to abnormalities in regulatory and goal-directed behaviors.

Brain↗

PubMed2005

Bilateral ethmoidal dural arteriovenous fistulae: a previously unreported entity: case report.

OBJECTIVE AND IMPORTANCE: Ethmoidal dural arteriovenous fistulas (AVFs) are rare intracranial lesions associated with a high risk of intracranial hemorrhage. Reported hemorrhage rates have ranged from 62 to 91%, and an aggressive clinical course is more likely than a benign clinical course. We describe the first case of a patient with bilateral ethmoidal dural AVFs. CLINICAL PRESENTATION: A 50-year-old man presented with posterior fossa subarachnoid hemorrhage and cerebellar intraparenchymal hemorrhage. Angiography revealed a tentorial AVF and a complex anterior ethmoidal dural AVF. INTERVENTION: The tentorial AVF was treated with preoperative embolization and surgical obliteration. On follow-up angiography, the ethmoidal dural AVF was not considered amenable to embolization. A right modified orbitozygomatic approach was performed and the right-sided fistula was interrupted. Intraoperative angiography revealed obliteration of the right-sided fistula, but a persistent fistula on the left. Further surgical exploration revealed this contralateral anterior ethmoidal dural AVF, which was clip ligated. No residual fistula was noted on intraoperative angiography. CONCLUSION: Anterior ethmoidal dural AVFs may occur bilaterally. Given their complex angiographic appearance, their presence bilaterally may not be readily apparent on preoperative angiography. Intraoperative angiography is crucial to identify a contralateral fistula and to verify that ligation has been curative.

Carotid Artery, Internal↗

PubMed1991

Weight reduction interventions for persons with a chronic illness: findings and factors for consideration.

Obesity in persons with a concomitant chronic illness poses complex issues relating to the choice of appropriate interventions. More recent emphasis on modification of risk factors has resulted in the need to prescribe complex therapeutic regimens with multiple treatment goals. The traditional approach to weight reduction in such persons has been nutrition education. Studies have shown, however, that knowledge alone does not translate into self-care behaviors that in turn result in weight loss and weight maintenance. Although the latter outcomes continue to be primary goals of therapy in obese individuals with a chronic illness, improvement in the physiologic parameters associated with the illness is also a desired outcome. Behavior therapy and group support appear to be enabling factors that go beyond knowledge to facilitate behavior change and subsequent changes in health-related indexes. This article describes various approaches to the problem of combined interventions for patients education and weight reduction. Findings and factors are discussed about whether the primary goal of weight reduction interventions for persons with a chronic illness should focus on pounds lost or improvement in metabolic or physiologic status.

Behavior Therapy↗

PubMed2001

Planning strategies for the avoidance of pitfalls in intervention research.

BACKGROUND: With the exception of large clinical trials, few studies in nursing and other social sciences test interventions. The discipline of nursing needs to maintain a full range of research designs for continued knowledge development. Intervention research presents unique opportunities and challenges for the novice as well as the seasoned researcher. Some of these methodological challenges include the complex nature of human subjects and interventions, including many factors that interfere with the study variables. Preliminary studies often reveal challenges that may not always be predicted or reflected in research texts. These challenges may be as important as the study results for success in future research efforts. PURPOSE: Difficulties encountered in intervention research and suggested strategies for maintaining the integrity of the study are addressed. These challenges include maintaining an adequate sample size, intervention demands, measuring variables, timing issues, and experiencing unexpected events. FINDINGS AND CONCLUSIONS: Strategies presented include the importance of extensive planning, minimizing subject expectations and rewarding efforts, attention to control group members, incorporating retention strategies, expanding knowledge of variables and the study population, preliminary studies as well as anticipating unexpected events. The need for enhanced communication among nurse researchers, educators and clinicians is addressed. In the current health care arena, nurse researchers must understand organizational dynamics and marketing strategies. Collaborative research efforts can increase the visibility of nursing research as well as funding opportunities.

Data Collection↗