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PubMed2000

Diagnostic reference levels in interventional radiology.

Following the release of European Directive EU 97/43, radiodiagnostic facilities within the European Union are required to implement a system of patient dose reviews based on comparisons with European, national and local diagnostic reference levels (DRLs). Establishing these levels for typical interventional radiology examinations presents a problem as definition of 'typical' examinations can be difficult, patient numbers are limited and these procedures are often performed at a few specialist centres. This paper uses dose-area product (DAP) gathered over a period of 3 years from 40 fluoroscopy rooms to investigate potential difficulties when it comes to forming diagnostic reference levels for interventional radiology. Comparison of DAP distributions with standard complex (fluoroscopy based) examinations such as barium enema reveals considerably more variation for interventional procedures. Two methods of forming a DRL are compared: pooled patient DAP distributions versus a distribution of DAP per room. The bootstrap resampling method is then applied to DAP distributions to form a confidence interval for the chosen DRL statistic. Potential error on a DRL formed at a local level from a limited number of patient dose readings and x-ray rooms is significant. The results are reviewed in the wider context of DRLs in general radiology. For complex examinations, it is suggested that the function of the DRL is best served by setting DRLs based on pooled size-corrected patient DAP distributions rather than distributions of average DAP per room.

Dose-Response Relationship, Radiation↗
PubMed1997

Thromboxane A2 interferes with a disposal process of aggregated protein in glomeruli.

Immune complexes in glomeruli are involved in development of diverse glomerulonephritis. The disposal process of glomerular immune complexes has been unclarified. The present studies were undertaken to determine if thromboxane A2 (TXA2) is associated with the disposal of macromolecules in the glomeruli using mice injected with aggregated bovine serum albumin (a-BSA). A-BSA promptly accumulated in the glomeruli, the level reaching a plateau at 6 hr after the injection of a-BSA, and then decreased by 48 hr. The production of glomerular TXA2, prostaglandin E2 (PGE2) and prostaglandin I2 concomitantly increased with the decrease of a-BSA in the glomeruli. TXA2 synthase inhibitors and TXA2 receptor antagonists accelerated clearance of glomerular a-BSA without enhancing renal tissue blood flow. They did not affect a-BSA level in the plasma. In contrast, aminophylline, dopamine and mannitol significantly increased renal tissue blood flow, but did not decrease glomerular a-BSA. TXA2 synthase inhibitors decreased TXA2 production in the glomeruli. TXA2 synthase inhibitors and TXA2 receptor antagonists did not influence the generation of PGE2. The TXA2 analogue U-46619 significantly increased the accumulation of a-BSA in the glomeruli. We propose that TXA2 interferes with the disposal process of aggregated protein in the glomeruli. We also postulate that interception of glomerular activity of TXA2 may be an effective intervention for managing immune complex-mediated glomerulonephritis and glomerulosclerosis.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
PubMedDate not supplied

Attenuation of blood parameters in smokers and non-smokers after intake of a complex food additive.

This report describes an intervention study with healthy volunteers (20 smokers, 28 non-smokers) taking a food additive mainly containing vitamin C (ascorbic acid), vitamin E (alpha-tocopherol), ubiquinone (Q10), vitamin A and zinkoxide for four weeks in a double blind, randomized and placebo controlled manner. Before and after the intervention blood was withdrawn and general blood parameters were analyzed. In addition, lipid soluble antioxidants were analyzed in blood plasma by HPLC and the water soluble antioxidative properties were tested with the enzymic xanthin/xanthinoxidase-reaction. In summary the results show that the smoker-verum group exhibit a significant down regulation of the leukocyte counts. The test for antioxidants show the following significant differences after intervention: Smokers exhibit an increase of both vitamin E and coenzyme Q10 and an attenuation of their (before intervention) clearly increased water soluble-antioxidative potential, non-smokers showed only an increase of vitamin E and trends of an increase of Q10 and water soluble-antioxidative potential. These results may contribute to the discussion of the intrinsic deficiency brought about by smoking and the possible attenuation of part of these deficiency by increasing the intake of certain vitamins or food additives.

Ascorbic Acid↗
PubMed2001

Youth violence: understanding and prevention: strategies of intervention. Part II.

Youth violence is a complex problem. The recent youth related violent incidents are of great impact taking in consideration the emotional costs to victims, their families and to the health and safety of citizens; as well as the economic cost to society. It is a major public health concern that requires participation, collaboration and integration of efforts from parents, citizens and professionals from different disciplines.

Adolescent↗
PubMed1991

Perry v. Louisiana: medical ethics on death row--is judicial intervention warranted?

The following note considers the complex case of Perry v. Louisiana, in which the Louisiana Supreme Court ordered an insane defendant on death row to be medicated against his will in order to render him sane, and therefore capable of being executed. In so doing the court pit judicial interests in effecting punishment of certain murderers against the physician's Hippocratic Oath, "first do no harm." In considering this conflict, the note identifies "first do no harm" as a guiding principle, explores the societal values underlying this basic principle, and concludes the judiciary must provide legal support for this medical ethical imperative. Similarly the legal profession must identify its organizing principles, its "first do no harm" proscriptions, and consider the application of those principles in the context of representing the insane. Some of the conflicts confronting the physician in the Perry situation have parallels for the attorney representing an insane client. Should the client be medicated in order to proceed to trial? Is it in the best interests of the client to remain a prisoner of her mental illness rather than to risk the possibility of conviction? How should the attorney address the paradoxical reality that a heavily medicated client may indeed become more lucid without becoming more competent? By publishing this note, the Journal hopes to engender discussion and clarification of the vague and sometimes incoherent guidance offered by the Medical Rules of Professional Responsibility, the Model Code of Professional Conduct, and the Criminal Justice Mental Health Standards for legal work with mentally disturbed clients.

Beneficence↗
PubMed1995

Relaxation therapy: its potential as an intervention for acute postoperative pain.

Given the complexity of pain processes, pain relief requires a creative and varied approach. Professional and governmental groups are supporting a holistic approach to pain that results in more positive outcomes for patients. Relaxation techniques provide clients with a strategy for reducing the stress, anxiety, and muscle tension related to pain. Understanding pain, anxiety, and relaxation provides the postanesthesia nurse with an alternative, nonpharmacological method of pain management.

Acute Disease↗
PubMed2004

Congenital heart surgery in Belgium. State of the art in 2003.

Congenital heart surgery has evolved from its pioneering days to a multidisciplinary speciality with important scientific contributions from different fields. Progress became obvious in different fields. Surgical results improved considerably: immediate survival as well as long-term outcome. Interventional cardiology emerged and took care of a large number of easy surgical cases. It allowed the surgeon to address the more complex cardiac deformities, often in combination with interventional techniques. Therefore the daily surgical practice of the congenital heart surgeons has changed to more complex pathology and procedures. Very recent fields of evolution are the generation of knowledge in genetic predisposition and prenatal diagnosis. Both give additional information to improve parent information and to optimise treatment.

Belgium↗
PubMed1998

Silicone oil in the repair of complex retinal detachments. A prospective observational multicenter study.

OBJECTIVE: This study aimed to report anatomic and visual acuity outcomes and complications after 1000-centistoke silicone oil was used as a retinal tamponade for the treatment of complex retinal detachments. DESIGN: Prospective observational multicenter study conducted at community and university-based ophthalmology clinics. PARTICIPANTS: The study cohort consisted of 2439 patients (2573 eyes) treated for complex retinal detachments associated with cytomegalovirus (CMV) necrotizing retinitis or a non-CMV etiology, including proliferative diabetic retinopathy, giant retinal tears, proliferative vitreoretinopathy, or ocular trauma. INTERVENTION: Vitrectomy surgery was performed for complex retinal detachment with 1000-centistoke silicone oil as the retinal tamponade. MAIN OUTCOME MEASURES: Anatomic outcomes were complete retinal attachment and macular attachment. Visual acuity outcomes were ambulatory vision (> or = 4/200) and preservation of preoperative visual acuity. Complications were rates of secondary intraocular pressure elevation (> or = 30 mmHg), hypotony (< or = 5 mmHg), corneal opacification (including band keratopathy, corneal edema, and corneal abrasions), oil emulsification, and cataract. Outcomes were assessed 6, 12, and 24 months after surgery. RESULTS: At the 6-month examination, the retina was completely attached in 178 (78%) of 228 CMV eyes and in 855 (70%) of 1219 non-CMV eyes. The macula was attached in 216 (95%) of 228 and 1062 (89%) of 1189 CMV and non-CMV eyes, respectively. Ambulatory vision was noted in 151 (65%) of 234 CMV eyes and in 480 (38%) of 1251 non-CMV eyes. Visual acuity was preserved in 106 (46%) of 230 and 1035 (84%) of 1229 CMV and non-CMV eyes, respectively. The corresponding rates of complications for CMV and non-CMV eyes were: elevated intraocular pressure, 0 (0%) of 196 and 35 (3%) of 1196; hypotony, 11 (6%) of 196 and 228 (19%) of 1196; corneal opacity, 13 (6%) of 229 and 326 (26%) of 1248; emulsification, 3 (1%) of 211 and 29 (3%) of 959; and cataract in phakic eyes, 118 (64%) of 185 and 50 (63%) of 80. CONCLUSIONS: Retinal reattachment was achieved in the majority of eyes using vitrectomy and silicone oil retinal tamponade. Complication rates generally were less frequent in CMV eyes, but follow-up was shorter in this group of patients, largely because of reduced life expectancy. Cataract frequently developed in phakic eyes of study patients. Use of 1000-centistoke silicone oil can be considered in the management of complex retinal detachments associated with multiple etiologies.

Adult↗
PubMed2006

Generalizing results of randomized trials to clinical practice: reliability and cautions.

BACKGROUND: Well designed randomized controlled trials provide reliable evidence of treatment effects, but there is no consensus on how best to apply these results to clinical practice. The main concerns are that populations enrolled in trials are more selected than those treated in a clinical setting, and whether the treatment effects observed in trials will also be observed in clinical practice. METHODS: An informal literature review was undertaken to find studies analysing the issue of generalizing trial results (external validity) to clinical practice. RESULTS: Most of the studies focused on differences in patients characteristics (age, gender, severity of disease, concomitant treatments and so on) between the clinical trial population and a 'real world' clinical population. None provided good evidence of a reduction in the treatment effect in the trial compared to what might happen in clinical practice for simple pharmacological treatments. However complex treatments like surgery or percutaneous interventional procedures, had a greater potential for variation. Extrapolating treatments to different health care settings from the trial can result in important variations in treatment effects. CONCLUSIONS: Complex therapies need careful consideration before they can be applied routinely from trials into practice, and applying results from one health care environment to a different one should be carried out with caution. Generalizing results from well conducted trials to clinical practice can mostly be carried out with confidence, especially for simple therapies with good evidence of benefit.

Humans↗
PubMed2003

[Nicotine dependence therapy: medical counselling and other non pharmacological interventions].

Cigarette smoking and nicotine dependence represent a complex disease. In the treatment program design the combination of non pharmacological and pharmacological therapy, the concurrence of physicians and other health professionals has been demonstrated the most successful therapeutic approach. This article reviews the main evidence based non pharmacological interventions. Social support request, self-monitoring and smoking behaviour modification are cornerstones of the preparation to quit. Post cessation counselling is mainly focused on problem solving activities. The complementary use of exercise and relaxation training is also evaluated.

Complementary Therapies↗
PubMed2005

A randomized, controlled trial of a patient/caregiver symptom control intervention: effects on depressive symptomatology of caregivers of cancer patients.

In this study, we investigated whether a clinical nursing intervention focusing on teaching family caregivers and their cancer patients skills to better manage the patients' symptoms would reduce caregiver depressive symptomatology. Two hundred thirty-seven patient/caregiver dyads were recruited for the study. These dyads were randomized into either the 10-contact, 20-week experimental intervention group (n=118), which focused on assisting the patient and caregiver in managing patient symptoms and reducing emotional distress, or to a conventional care control group (n=119). A longitudinal random effects regression analysis did not indicate that the clinical nursing intervention was effective in decreasing caregiver depression over the 20-week course of the study. The relationship of the intervention to caregiver depressive symptomatology seems to be a complex one. We recommend further research to explore whether a lengthened intervention and/or delayed follow-up might reveal delayed positive effects of such interventions.

Adaptation, Psychological↗
PubMed2006

Signalling network with a bistable hysteretic switch controls developmental activation of the sigma transcription factor in Bacillus subtilis.

The sporulation process of the bacterium Bacillus subtilis unfolds by means of separate but co-ordinated programmes of gene expression within two unequal cell compartments, the mother cell and the smaller forespore. sigmaF is the first compartment-specific transcription factor activated during this process, and it is controlled at the post-translational level by a partner-switching mechanism that restricts sigmaF activity to the forespore. The crux of this mechanism lies in the ability of the anti-sigma factor SpoIIAB (AB) to form alternative complexes either with sigmaF, holding it in an inactive form, or with the anti-anti-sigma factor SpoIIAA (AA) and a nucleotide, either ATP or ADP. In the complex with AB and ATP, AA is phosphorylated on a serine residue and released, making AB available to capture sigmaF in an inactive complex. Subsequent activation of sigmaF requires the intervention of the SpoIIE serine phosphatase to dephosphorylate AA, which can then attack the AB-sigmaF complex to induce the release of sigmaF. By incorporating biochemical, biophysical and genetic data from the literature we have constructed an integrative mathematical model of this partner-switching network. The model predicts that the self-enhancing formation of a long-lived complex of AA, AB and ADP transforms the network into an essentially irreversible hysteretic switch, thereby explaining the sharp, robust and irreversible activation of sigmaF in the forespore compartment. The model also clarifies the contributions of the partly redundant mechanisms that ensure correct spatial and temporal activation of sigmaF, reproduces the behaviour of various mutants and makes strong, testable predictions.

Adenosine Diphosphate↗
PubMed1991

Some aspects of family interventions in schizophrenia. I: Adherence to intervention programmes.

Although family intervention programmes to instruct relatives in management and coping skills are often effective in reducing schizophrenic relapse, many families either fail to be engaged or withdraw from treatment at an early stage. Some possible reasons for this are described and some suggestions for increasing adherence are made. Adherence with interventions may be viewed as a complex behaviour pattern, and factors increasing or decreasing the probability of such behaviour occurring and being maintained can and should be investigated to maximise the clinical potential of family intervention programmes.

Caregivers↗
PubMed1999

Strategies for reconstruction after unsuccessful or unsatisfactory primary treatment of patients with bladder exstrophy or incontinent epispadias.

PURPOSE: Following unsuccessful or unsatisfactory primary treatment in patients with the epispadias/exstrophy complex, the options for a surgical solution to preserve the upper urinary tract, to achieve complete continence, and to reconstruct the external and female internal genitalia are limited. We reviewed the records of the patients treated at our institution to determine a surgical compromise between ingenious operative constructions and patient desires, both of which are secondary to stabilization of renal function. MATERIALS AND METHODS: From 1967 to December 1997, 128 patients with bladder exstrophy/epispadias complex were treated, of 80 whom had received previous unsuccessful or unsatisfactory treatment. Of these patients 72 were followed for an average of 22.4 years after the first surgical intervention. There were 40 patients referred to our institution after primary bladder closure and bladder neck reconstruction, 10 after rectal bladder, 7 after ureterosigmoidostomy and 5 after incontinent diversion. RESULTS: At the latest followup 19 patients had a rectal reservoir, 38 an ileocecal pouch, 12 a conduit diversion and 3 an augmented Young-Dees procedure. The upper urinary tract remained stable in 95% of the renal units with rectal reservoir, 95% with ileocecal pouch, 96% with a colonic conduit and 100% with an augmented Young-Dees procedure. Day and night continence was achieved in 95% of the patients with a rectal reservoir and 97% of those with an ileocecal pouch were continent, whereas only 2 of the 3 patients with an augmented Young-Dees procedure were continent. Of the women 16 were satisfied with the cosmetic results and 6 delivered 8 children by cesarean section. Only 1 man was dissatisfied with the final cosmetic result. All adults but 1 engaged in sexual intercourse. CONCLUSIONS: The first operative intervention in patients with bladder exstrophy/epispadias complex determines their fate. After failure of primary treatment, the upper urinary tract must be stabilized. In patients with severely impaired renal function the colonic conduit is our method of choice while in those with a normal or slightly dilated upper urinary tract and intact anal sphincter we performed a rectal reservoir. In the remaining patients an ileocecal pouch guarantees continence day and night. The results of genital reconstruction are satisfactory.

Adult↗
PubMed1994

Surgical intervention in children with HIV infection.

AIDS is a complex disease with variable manifestations. Effective care can significantly impede the progression of this disease. Understanding the complexities of this illness allows nurses to develop an appropriate plan of care with sensitivity and acknowledgment of infected children's individual needs. Surgical intervention often is required for diagnosis and symptom management of AIDS-related conditions. With good preparation and postoperative care, surgical interventions can be a successful means of enhancing quality of life. In our institution, the pediatric nurse practitioner for infectious diseases and the clinical nurse specialist for pediatric surgery work together to manage the surgical issues of these children.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Using nursing diagnoses and interventions in an inpatient amputee program.

The purpose of this study was to provide a descriptive analysis of an inpatient amputee program at Spaulding Rehabilitation Hospital (SRH) in Boston; the analysis focused on nursing diagnoses and interventions documented in the medical record. The study was based on a retrospective chart review conducted for 96 inpatient lower-extremity amputees who were admitted from October 1988 through September 1989. The results of the study identified common nursing diagnoses and interventions used for a medically complex population of people who had had amputations. In addition, the study showed that most subjects improved in functional status, thus confirming the success of the program. All subjects were either discharged to their homes or transferred to an acute care facility. The study results will be used to develop a standardized nursing care plan, as well as creative new modalities for patient and family education, at SRH.

Amputees↗