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Results for “Complex intervention”

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At least 1,135 records · Page 63Linked to original sources

PubMed2006

Filter-protected carotid stenting via a minimal cervical access with transitory aspirated reversed flow during initial passage of the target lesion.

PURPOSE: To evaluate the preliminary results of filter-protected carotid artery stenting (CAS) via a minimal cervical access, with temporary common carotid artery (CCA) occlusion and aspiration in selected high-risk candidates for carotid endarterectomy. METHODS: Since February 2002, 26 patients (17 men; mean age 73.7 years, range 54-98) at high surgical risk according to the SAPPHIRE eligibility criteria underwent 29 transcervical CAS procedures under filter protection. Under general anesthesia, a 6-F short introducer sheath was directly mounted in the CCA through a small (2-4 cm) laterocervical cutdown. The CCA was briefly clamped, and blood was aspirated while the filter device was positioned above the target lesion. With the filter in place and the clamp released, nitinol stents were deployed under filter protection. Hemostasis was achieved by direct suture. RESULTS: Twenty-eight (96%) interventions were technically successful; 1 complex lesion could not be crossed and was converted to surgery. Mean clamping time was 1.7 (range 1.0-3.5) minutes. Combined 30-day stroke/mortality was 0%. Ultrasound surveillance demonstrated a < 60% asymptomatic in-stent restenosis in 1 (4%) patient with radiation-induced arteritis after 28 months. During a mean follow-up of 11.6 months (range 3-38), 1 (4%) minor ipsilateral stroke was noted at 6 months in a patient whose antiplatelet therapy was transitorily interrupted. CONCLUSION: Our preliminary observations from this small early experience suggest that this variant CAS technique is feasible and probably diminishes the neuroembolic risk during initial navigation of the ICA target stenosis.

Aged↗

PubMed1996

Angiotensin in progressive renal diseases: theory and practice.

Experimental studies indicate that Angll is involved in the process of tissue destruction in chronic renal diseases. This notion has been verified in a number of small-to large-scale clinical studies using angiotensin (ANG) I converting enzyme inhibitors (ACEI). Although the repertoire of the pathophysiologic cascade underlying the progressive destruction of renal tissue has continued to expand over recent years, from proteinuria and physical forces to growth factors and metalloproteinase disregulations, studies now suggest that Angll is involved in many, if not all, of these processes. Because these expanded pathophysiologic potentials of Angll are based primarily on observations in vitro, their significance in vivo, and in humans in particular, needs to be established. Recent studies in animals and humans indicate that the role of Angll in renal tissue destruction is subject to the modulation of multiple environmental and genetic factors, such as dietary habit and ACE genotype. Further delineation of the role of Angll in this respect for specific renal diseases and patients will enable us to design an efficient therapeutic intervention for this otherwise most complex problem of today's nephrology.

Angiotensin II↗

PubMed1992

Epidemiological evidence of relationships between dietary polyunsaturated fatty acids and mortality in the multiple risk factor intervention trial.

This evaluation of the Multiple Risk Factor Intervention Trial database investigated the effects of dietary PUFA on disease outcomes that may relate to polyunsaturated fatty acid (PUFA) biochemistry. The Multiple Risk Factor Intervention Trial was a randomized clinical trial in coronary heart disease (CHD) primary prevention involving 12,866 middle-aged men determined to be at high risk of CHD. They were assigned to either a special intervention group or a usual care group and returned to clinics on an annual basis for assessment of risk factor status. Only data on the usual care men (n = 6,250) are presented, since the multi-intervention effects on the special intervention group introduce considerable analytic complexities. Mean PUFA intake estimates were calculated from four dietary recall interviews at baseline and follow-up Years 1, 2, and 3 and estimates for PUFA were established using absolute grams, percentage of total kilocalories, and ratios. Proportional hazards regression analysis controlling for age, race and baseline diastolic blood pressure, smoking, high and low density lipoprotein cholesterol levels, and alcohol was used to analyze dietary PUFA intakes on 10.5-year mortality rates. Results were more significant when PUFA were expressed as percentage of total kilocalories. No significant associations with mortality were detected for linoleic acid (18:2n-6), the predominant dietary PUFA.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗

PubMed1997

Patient self-mutilation: when nursing becomes a nightmare.

1. Patients who demonstrate self-wounding behaviour require behavioral, pharmacological, and psychotherapeutic interventions to meet their highly complex needs. 2. Nurses caring for patients who wound themselves will experience frustration related to the safety needs of the patients and guilt whenever an injury occurs. 3. Staff members managing the patient who wounds himself or herself need administrative support, education, and counseling to relieve guilt, personal and professional conflict, and stress.

Adaptation, Psychological↗

PubMedDate not supplied

Risk factors and behaviors associated with adolescent violence and aggression.

OBJECTIVE: To explore risk factors and behaviors associated with aggressive and violent behaviors among adolescents. METHODS: A comprehensive review of research literature from various disciplines associated with improving the health and well-being of adolescents. RESULTS: Risk factors and behaviors associated with adolescent aggression and violence are discussed via 6 major factor categories: individual, family, school/academic, peer-related, community and neighborhood, and situational. CONCLUSION: Adolescent aggression and violence develops and manifests within a complex constellation of factors. Prevention intervention efforts should be theory based, multicomponent, and multisystem; they should begin in middle school and continue into high school with a comprehensive evaluation design.

Adolescent↗

PubMed1998

Extracorporeal lithotripsy of intrahepatic stones with associated strictures of intrahepatic biliary ducts.

BACKGROUND AND AIMS: Intrahepatic stones are a frequent disease in the Eastern world but rare in Western countries. Treatment is complex and often requires surgical intervention. Extracorporeal shock wave lithotripsy is a relatively recent technique, widely used in the treatment of stones in the gallbladder and common bile duct. It can also be used in the treatment of intrahepatic stones. The present study analyses the efficacy of extracorporeal shock wave lithotripsy in intrahepatic stones. PATIENTS AND METHODS: In our study, we used extracorporeal lithotripsy in six cases of intrahepatic stones (mean age 53 years). In five of these cases deformities of the intrahepatic bile ducts were also present: stenoses and angulated strictures. The stones were in the right lobe of the liver in 5 patients, and in both lobes in 1 patient. Four patients had multiple stones and 2 a single stone, all varying in diameter from 6 to 25 mm. The stones were localized radiologically with contrast medium through a drainage tube. The technique does not require anaesthesia. An average of three lithotripsy sessions were necessary, with a mean total of 8050 shock waves per patient. RESULTS: Successful fragmentation was obtained in 5 out of 6 patients, while the remaining subsequently underwent surgery. No complications were observed. CONCLUSIONS: Extracorporeal shock wave lithotripsy proved to be effective, easy to perform and safe for the treatment of intrahepatic stones.

Adult↗

PubMed1976

[Suppurative-necrotic pancreatitis and its surgical treatment].

Purulent-necrotic processes in the pancreas may arise against the background of different forms of acute pancreatitis. Biological tamponade of the pancreas with the greater omentum and hermical closure of the abdomen result in a reduced number of cases of the gland suppuration. The treatment of purulent pancreatitis should be complex, comprising an early surgical intervention with subsequent rational conservative therapy.

Abscess↗

PubMed1999

[Organ-salvaging surgeries for highly differentiated thyroid cancer in children].

Retrospective analysis of results of organpreserving operations for the thyroid gland cancer (TGC) in 55 children and juveniles for 1981-1997 yrs period was done. The informativity of preoperative cytological (96.4%) and intraoperative express--histological (95.6%) investigations was determined. In cases of the cytological and express--histological diagnosis complexities the possibility of organpreserving intervention of hemithyroidectomy with the isthmus extirpation was noted. Primary thyroidectomy is operation of choice in the established diagnosis of TGC.

Adolescent↗

PubMed2000

If I shouldn't spank, what should I do? Behavioural techniques for disciplining children.

OBJECTIVE: To provide family physicians with a guide for evaluating discipline problems, giving suggestions for parental guidance, and diagnosing problems when discipline guidance fails. QUALITY OF EVIDENCE: A MEDLINE and PsycINFO search from 1990 to the present produced articles reviewing research on aspects of discipline. Case-control studies, expert opinion, and position statements published by the American Academy of Pediatrics and the Canadian Paediatric Society were chosen as a basis for this article. In a special supplement in 1996, a pediatric journal reviewed the controversy of spanking as an effective disciplinary method, with comments by noted researchers and clinicians. Other authors reviewed research evaluating discipline techniques. MAIN MESSAGE: Discipline problems require evaluation of children, parents, and parent-child relationships, including assessment of child development and evaluation of parenting skills and parental stressors. Parents can learn techniques more effective than spanking. Physicians can review discipline strategies and guide parents through difficult situations. Monitoring progress is important, and immediate reassessment of the situation if techniques are failing or referral to a specialist will increase the chances of a successful intervention. CONCLUSION: Discipline problems are complex and require careful assessment. Guiding parents during these types of problems requires close follow up and reevaluation when methods do not have the expected effect.

Child↗

PubMed2001

Are Maori under-served for cardiac interventions?

AIMS: To examine hospitalisation rates for selected heart-disease-related diagnoses by age, gender, ethnicity and deprivation. METHODS: Four years' data on publicly-funded hospital discharges for: (i) heart failure and (ii) cardiac interventions were cross-classified by age group, gender, ethnicity (Maori/non-Maori) and deprivation (NZDep96). Population hospitalisation rates were calculated and displayed in multi-dimensional trellis graphs. RESULTS: The graphs show patterns of hospitalisation for chosen variables simultaneously. The expected increase in heart failure with age is found, as is an increase for the cardiac group up to ages 65-74 years. Clear gender differences were found. A further increase of heart failure with higher deprivation is evident throughout. For cardiac interventions, the relationship with deprivation is complex. Differences by ethnicity are disturbing. Hospitalisation rates for heart failure for Maori are typically more than double the non-Maori rates. In contrast, for the cardiac group Maori intervention rates are much lower. CONCLUSIONS: Graphical analysis that displays age, gender, ethnicity and deprivation simultaneously provides great insight into hospitalisation rates. Ethnic differences are particularly concerning and raise important questions about how well Maori needs are being met and how equitable is access to cardiac interventions for Maori.

Adult↗

PubMed2002

[Initial experience of thoracic surgery in Klaipeda regional Hospital].

OBJECTIVES: Study and profound analysis of primary clinical results of the recently established department of Thoracic surgery. Klaipeda Regional Hospital currently functions as a multiprofile facility and covers Western area of Lithuania. More than 274 patients were cured here within the past 8 months. Majority of patients, i.e. 205 (74.82%) were operated; 26 (12.68%) of them underwent surgery urgently and 179 (87.32%) - on planned basis. A large scale of different interventions was performed: 156 (76.1%) - complex operations of lungs, pleura, esophagus, mediastinum and others. All the rest - 49 (23.9%) - operations with minimally invasive procedures, i.e. thoracoscopy, mediastinoscopy, tracheostomy, esophagus stenting etc. CONCLUSIONS: Primary experience of thoracic surgery in Klaipeda regional hospital has good basis for the future development of this activity.

Emergencies↗

PubMed2003

An exploration of the concept of directly observed treatment (DOT) for tuberculosis patients: from a uniform to a customised approach.

Tuberculosis (TB) management has moved from chaotic systems and low patient adherence with treatment regimens to the directly observed therapy, short course (DOTS) strategy, which has been described as a new paradigm of TB control. Directly observed treatment (DOT) is only one component of the full DOTS strategy. DOT versus self-administered treatment (SAT) has been the subject of extensive debate, particularly about what approach improves treatment adherence. This debate has been complicated by different case-holding rates and cure outcomes in different contexts where DOT is in place. The increasing range of DOT applications in different settings, including the choice of provider, place, target population, and the extent to which DOT is part of a wider approach, has not been sufficiently taken into account. However, the concrete reality of DOT is an important determinant of the overall success or failure of the programme, and has implications in terms of equity and accessibility of care during treatment. This article aims to go beyond the frequently polarised debate of DOT versus SAT and document the diversity of ways in which DOT has been implemented internationally. We also aim to raise key issues for further discussion, including 1) viewing DOT as part of a complex and lengthy set of interventions that are context-specific, 2) incorporating an equity approach that discusses individual patients' needs and the relationship between the patient and provider, and 3) the role of incentives and enablers. It is anticipated that this exchange of opinion and experiences from different parts of the world will be useful for those involved in the policy formulation and practice of TB management.

Directly Observed Therapy↗

PubMedDate not supplied

[How to improve clinical competence].

Every day there are many patients that suffer or undergo more or less serious damage to their health because of the poor quality of healthcare they receive. Most of these injuries could be avoided by improving the professional quality of healthcare. This presentation outlines an ideal pathway by providing methodological indications and practical tools to clinicians and healthcare workers who wish to increase their skills in planning, supporting and evaluating initiatives of professional quality improvement in their organizations. In particular, the article indicates how clinical competence can be expressed, measured, evaluated and improved. To this end we introduce some basic concepts relative to efficacy (is what I do for my patients useful?), appropriateness (am I doing it to the right persons?) and effectiveness (does the treatment, when transferred to a local operating context, improve the health of the patients receiving it?). The article gives some suggestions to measure quality through process indicators (what has been done to the patients during the process of caring) and outcome indicators (the benefits obtained by the patients from the treatments received), highlighting both advantages and limitations. We then introduce four increasingly complex models for evaluating health interventions: descriptive evaluation, process evaluation, outcome evaluation and experimental designs. Finally, we describe Shewhart's cycle of continuous improvement, which is a useful tool for implementing, directing and spreading continuous quality improvement into an healthcare organisation.

Clinical Competence↗

PubMed1992

Improving home health care for the Navajo.

Home health care clients on the Navajo reservation present complex nursing problems that require interventions that are culturally sensitive. A collaborative project was developed that used the skills of researchers, clinicians, and members of the Navajo culture to develop culturally appropriate nursing care. Traditional life themes, values, and beliefs of the Navajo related to health and illness are described with examples of how the project facilitated home health care for Navajo clients.

Arizona↗

PubMedDate not supplied

[The clinical, radiological and therapeutic aspects of endotracheobronchial foreign bodies in children].

During about 30 years of activity in the Bronchology room of the Phthisiopediatrics Unit-Braşov, 87 children having inhaled a foreign body (FB) in their airways were assisted. A number of 85 of them were solved through endoscopic interventions, performed by simple or complex (with ORL and intensive care) teams. The 85 FB were mostly (55) of vegetable nature (grains of beam and maize, seeds of pumpkin and sun flower), fragments of bone (10), of metal (10), and of plastic (8). FB localisation was: tracheal (30), in the right side bronchi (31), and left ones (26). Infancy was quite often interested: 60 children under 3 years of age and 9 aged less than 1 year. Clinical-radiological manifestation of FB were grouped in: without clearcut syndrome, well tolerated; with a clinical picture of acute pneumonia; with syndrome of complete or incomplete ("with valve") obstruction. Early diagnosis and prompt endoscopy solving prevent immediate or late complications.

Acute Disease↗

PubMed2003

Skin aging 2003: recent advances and current concepts.

In developed countries, interest in cutaneous aging is in large part the result of a progressive, dramatic rise over the past century in the absolute number and proportion of the population who are elderly. The psychosocial, as well as physiologic, effects of skin aging on older persons have created a demand for a better understanding of the aging process and particularly for effective interventions. Skin aging is a complex process determined by the genetic endowment of the individual and by environmental factors. The appearance of old skin and the clinical consequences of skin aging have been well-known for centuries, but it is only in the past 50 years that mechanisms and mediators have been pursued systematically. Still, within a relatively short time, there has been tremendous progress, a progress greatly enhanced by basic gerontologic research using immunologic, biochemical, and in particular, molecular biologic approaches.

DNA Repair↗

PubMed2003

Confronting America's most ignored crime problem: the Prison Rape Elimination Act of 2003.

Prisoner sexual assault has plagued American corrections since its infancy in the 19th century. Although the incidence of prisoner sexual assault is unknown, recent studies reliably suggest the problem is widespread, often affecting the most vulnerable prisoners. The mental health and public health consequences, both within institutions and the community, are complex and devastating, requiring comprehensive intervention and treatment. These crimes have been largely ignored by correctional managers, compromising the safety and security of correctional institutions. The Prison Rape Elimination Act of 2003 could play a vital role in managing a national scandal.

Crime Victims↗

PubMed1992

Neurogenic electrocardiographic abnormalities in subarachnoid hemorrhage.

ECG abnormalities are a frequent, potentially life-threatening complication of subarachnoid hemorrhage. Yet, the mechanism behind these ECG abnormalities is poorly understood. Nursing literature has given this phenomenon little attention. However, neurogenic ECG abnormalities have implications for critical care nursing practice and research. In this article the most frequently documented neurogenic ECG abnormalities occurring in patients with subarachnoid hemorrhage have been discussed. The proposed pathophysiologic mechanisms and nursing implications were also discussed. Patients with neurogenic ECG abnormalities require complex, multifaceted nursing assessment and intervention. Only with a better understanding of the phenomenon will the critical care nurse be able to meet the needs of these patients.

Arrhythmias, Cardiac↗