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Results for “Complex intervention”

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At least 1,153 records · Page 64Linked to original sources

PubMed2005

[Principles of preoperative and postoperative management of patients with hypospadias].

Retrospective analysis of the operated patients (during 1995-2000) with different forms of the hypospadias have been performed. It was shown that early onset postoperative complications as well as remote complications (relapse of a meatostenosis, uric fistulas, a divergence of the lips of the wounds, urethral diverticulum, concrement formation and urethral pilosis) are associated with cutaneal insufficiency of the penis, low-quality suture material, and the age of patients (older than 4-6 years). On the basis of the analysis of unsuccessful surgical interventions authors have developed a complex of activities on prevention of complications at different stages of correction of the defect. At the same time new methods of one-stage surgery using new types of suture material and carrying out of operations in the age under 3-4 years have been introduced. In 309 patients operated during 2001-2004 significant decrease in the frequency of postoperative complications has been noted.

Adolescent↗

PubMed2006

Evaluation of the efficacy of nebulised lignocaine as adjunctive local anaesthesia for fibreoptic bronchoscopy: a randomised, placebo-controlled study.

Optimisation of topical anaesthesia for flexible fibreoptic bronchoscopy (FOB) is becoming increasingly important as a wider range of more complex, and thereby more prolonged, interventional endoscopic procedures are becoming available. Lignocaine is the most commonly used topical anaesthetic agent for bronchoscopy, but there is variability in current practice as to its optimum mode of administration. In this prospective, randomised, placebo-controlled, blinded study, we examine whether there was enhanced effectiveness of additional nebulised lignocaine as compared to our current regime utilising two visual analogue scales as markers of efficacy. Treatment groups were matched in terms of age (p = 0.39), gender, concomitant sedation (p = 0.51 midazolam; p = 0.12 fentanyl) and dose of background administered lignocaine (290 mg). We found no significant additional differences between any of the treatment groups in terms of general ease of procedure (p = 0.09) or in cough severity (p = 0.12). We conclude that this study does not support the hypothesis that additional nebulised lignocaine confers any additional benefit to the ease of procedure or cough severity in patients undergoing fibreoptic bronchoscopy. We suggest that preparation regimes for bronchoscopic examinations need optimization.

Administration, Inhalation↗

PubMed2005

Evidence synthesis and development of guidelines in interventional pain management.

BACKGROUND: The past decade has been marked by unprecedented interest in evidence-based medicine and various types of avenues that can provide valid and reliable information about healthcare, including clinical practice guidelines. Thus, healthcare decisions are purportedly and increasingly being made on research-based evidence rather than on expert opinion or clinical experience alone. The methods describing evidence synthesis or development of guidelines in interventional pain management are scarce. OBJECTIVE: To describe the methods of evidence synthesis and development of guidelines in interventional pain management in practical terms. DESCRIPTION: This review sought to provide an understanding of evidence-based medicine, the importance and synthesis of clinical practice guidelines, and the variety of issues related to rating the quality of individual articles, understanding narrative and systematic reviews, grading the strength of the body of evidence, searching for evidence, and finally, the analytical preparation of guidelines, with a focus on interventional pain management. CONCLUSION: Evidence synthesis and development of guidelines in interventional pain management is a complex and difficult task. It is emphasized that practice guidelines are not intended as standards or absolute requirements. Consequently, practice guidelines may be adapted, modified, or rejected, according to the clinical needs and constraints of each practitioner and patient.

Journal Article↗

PubMed2006

Complex pulmonary atresia in a neonate: successful surgical palliation for right pulmonary artery arising from the right main coronary artery.

We describe the case of a 3-week-old infant who was diagnosed with pulmonary atresia, a ventricular septal defect, and discontinuous pulmonary arteries. The pulmonary artery anatomy was delineated by angiography: the right pulmonary artery arose from the proximal right coronary artery, and the left pulmonary artery arose from a left ductus arteriosus. This case illustrates the importance of careful delineation of the anatomy in complex pulmonary atresia before surgical intervention.

Abnormalities, Multiple↗

PubMed1990

[Diagnosis and treatment of acute pyelonephritis in anuria caused by urolithiasis].

The analysis of observations on 36 patients is presented. Anuria complicated by acute pyelonephritis is considered as an acute surgical pathology requiring emergency operative intervention. The suggested tactics for complex examination and treatment of the patients contributed to decrease in the postoperative lethality down to 5.9%.

Acute Disease↗

PubMedDate not supplied

Lung pathogenesis. VIII. Relationships between alveolar surfactant disorders and development of lung diseases.

The new data concerning the structure and dynamics of the alveolar surfactant, its phospholipid and apoprotein components and their synthesis, storage and secretion by the large granular alveolocytes, the formation and disconnection of lipoprotein complexes, their disorders and pathological relationships were analysed in order to discern the possibility of a more or less important pathogenetic role in the onset and development of lung diseases. Sometimes, surfactant disorders appeared as epiphenomena, like in pulmonary edemas; at other times, they behaved as a turn plate enhancing and centering the development of alveolar lipoproteinosis, microlithiasis alveolaris, hyaline membrane disease of newborns and the adult respiratory distress syndrome. Focusing the pathogenesis on the surfactant disorders and on their causes, a unification of mechanisms became possible with the increase in complexity of processes by the intervention of other complicating factors, mainly the self-perpetuating ones.

Animals↗

PubMed1988

[Use of an electrohydraulic lithotripter in the percutaneous treatment of biliary tract calculi. The preliminary clinical experience in 4 cases].

The results are reported of percutaneous transhepatic treatment with an electrohydraulic lithotripter in 4 cases of bile duct lithiasis. An electric discharge, generated by a bipolar electrode, gives origin to high-amplitude and low-frequency shock waves in the fluid medium which cause the stone to fragment. Complete resolution of lithiasis was obtained in 2 patients with intrahepatic calculosis. In the other 2 cases of massive lithiasis of intra and extrahepatic bile ducts the treatment, however incomplete, proved to be useful, as the biliary flux was rehabilitated and clinical symptoms disappeared. No relevant immediate side-effects were observed, except for well-tolerated pain during the discharges, and transitory hemobilia which solved spontaneously. No complications were observed in this series of patients. Electrohydraulic lithotripsy proves thus to be useful for supporting standard interventional radiology techniques in very complex cases of intra- and extrahepatic bile duct stones.

Aged↗

PubMed1985

[Complex treatment of patients with acute paraproctitis].

Results of the treatment of 3253 patients with acute paraproctitis are analysed. The treatment must be complex, with a radical operative intervention as a decisive measure directed to a radical dissection of the abscess and liquidation of the internal opening of the abscess in the rectum. Positive results were obtained in 88,3% of the patients.

Abscess↗

PubMed1994

Surgical ablation of Wolff-Parkinson-White syndrome in children and young adults.

From 1988 to 1991, nine patients with structural normal heart, aged 10 to 23 (median 13 years), Wolff-Parkinson-White Syndrome patients were operated at National Taiwan University Hospital. The diagnosis was established by surface electrocardiograms recorded during sinus rhythm and tachycardia, and by complete cardiac electrophysiologic studies. The location of accessory pathways (AP) were: 4 left lateral, 3 right lateral, 1 right posteroseptal and 1 right anteroseptal AV groove. In all 6 patients with manifest WPW syndrome, the location of AP could be correctly predicted by the surface EKG delta wave polarity. In all 9 patients with WPW syndrome, intraoperative epicardial and endocardial mappings confirmed their location. Wide endocardial dissection were undertaken. No surgical morbidities or mortality was encountered except in one case which developed transient postpericardiotomy syndrome. During the follow-up (2 to 4 years), all of them were in sinus rhythm, drug free and tachycardia free. In conclusion, (a) the sites of AP and the arrhythmia mechanisms can be reliably predicted by surface EKG and catheter mapping techniques; (b) surgical cure of supraventricular tachycardia could be achieved safely in children; and (c) surgical ablation still is indicated when catheter ablation is unsuccessful, or when coexistent complex cardiac pathology requires surgical intervention in small children.

Adolescent↗

PubMed1993

Electrolyte and drug management in nutritional support.

Interventional nutritional support is a complex therapeutic entity. Metabolic complications associated with this therapy are numerous. It is imperative to monitor electrolytes very closely during parenteral and enteral nutritional support and to correct deficiencies or to compensate for increases in serum concentrations when appropriate. It is also critical to observe patients receiving drug therapy to avoid untoward drug-nutrient interactions and to be able to compensate for adverse metabolic effects of medications. To achieve successful nutritional support, careful monitoring of electrolytes and drugs is necessary.

Critical Illness↗

PubMedDate not supplied

A balancing act: the tension between case-finding and primary prevention strategies in New York State's voluntary HIV counseling and testing program in women's health care settings.

This study sought (1) to identify factors that influence women's willingness to accept voluntary HIV counseling and testing at New York State Family Planning Programs (FPPs) and Prenatal Care Assistance Programs (PCAPs) and (2) to evaluate the effectiveness of such a voluntary counseling and testing program. Telephone interviews elicited organizational-level data from 136 agencies; a combination of telephone and face-to-face interviews was used to gather provider data from 98 HIV counselors; and client data were gathered from 354 women in face-to-face interviews at counseling sites. Slightly fewer than 60% of women agreed to be counseled, and, of those, under half consented to an HIV test at the counseling site. Approximately two thirds of the women who were tested returned for their results and posttest counseling. Clients' recall of pretest counseling content was relatively poor. Bivariate and regression analyses suggest that client, provider, and organizational factors are all associated with rates of pretest counseling and testing. The current voluntary counseling and testing program is achieving only moderate success. Although a substantial number of clients accept HIV counseling, many women remain reluctant to consent to HIV testing, and many who accept testing do not return for their results. Moreover, among those who receive pretest counseling, many do not recall important informational content, which suggests variation may exist in the quality of counseling or that one-time HIV counseling interventions are insufficient to communicate complex information. Medical Subject Headings (MeSH): AIDS, HIV serodiagnosis, women's health, patient education.

AIDS Serodiagnosis↗

PubMed1998

[Acute occlusion of the abdominal aorta].

The Authors report on two cases of acute aortic occlusion, related to cardiac embolism and thrombosis of aortic aneurysm. The singularity of the etiology adds interest to a pathology which is already, in itself, serious and complex and which requires the intervention of the surgeon, anesthesiologist-reanimator, cardiologist, and nephrologist. The diagnosis is mainly clinical. The use of Doppler and CT scan provide to achieve the diagnosis. Surgical treatment included transfemoral embolectomy, with a Fogarty catheter, in the patient with acute aortic occlusion related to cardiac embolism, and aortobifemoral bypass, in the other patient, affected by thrombosis of aortic aneurysm.

Acute Disease↗

PubMed1999

Management of complex breast cysts.

OBJECTIVE: This study was undertaken to evaluate the various strategies currently in use to manage complex cysts and specifically address the need for intervention. MATERIALS AND METHODS: A review of 4562 breast sonograms obtained during an 18-month period revealed 308 complex cysts in 252 women. Data collected from review of patient records included the patient's age and risk factors for breast cancer, aspiration or biopsy results (or both), follow-up imaging studies, and management recommendations. RESULTS: Management recommendations for complex cysts were 1-year follow-up in 13 patients, 6-month follow-up in 148, sonographically guided aspiration in 82, aspiration with possible core biopsy in 62, and excisional biopsy in three. No malignancies were diagnosed in the group treated with follow-up imaging, sonographically guided aspiration, or excisional biopsy. One malignancy, a papilloma with a 3-mm focus of ductal carcinoma in situ, was diagnosed in one of the patients who underwent core biopsy. CONCLUSION: Of the lesions classified as complex cysts, the malignancy rate was 0.3% (1/308). This malignancy rate is lower than that for lesions classified as probably benign using mammographic criteria (i.e., for lesions classified as category 3 lesions using the Breast Imaging Reporting and Data System). Because the accepted standard practice for management of probably benign lesions is follow-up studies, the low yield of malignancy in this series suggests that complex cysts can be managed with follow-up imaging studies instead of intervention.

Adult↗

PubMed1998

Isolated necrotizing arteritis of the female genital tract: a clinicopathologic and immunohistochemical study of 11 cases.

Isolated necrotizing arteritis (INA) of the polyarteritis-nodosa type localized to the female genital tract is rare. Approximately 30 case reports have been published to date. Eleven additional patients are described here, all with a favorable follow-up. INA is usually localized in the uterine cervix, but, when multifocal lesions are present, the latter is almost always involved. Patients most frequently report menorrhagia or postmenopausal bleeding. With immunohistochemical studies, immune-complex deposits (IgM, IgG, and C'3) in 7 of 11 patients with INA of the female genital tract were demonstrated for the first time. The inflammatory cells were composed mainly of T-lymphocytes with macrophages and scarce B-lymphocytes also present. These results suggest that INA is primarily an immune complex-mediated disease, implicating humoral and cellular mediator systems. Possible pathogenetic factors of INA are immune complex-mediated hypersensitivity reactions to drugs, foreign materials (after cone biopsy or curettage), and cancers, or an autoimmune reaction against constituents of the vessel walls caused by tissue injury after local surgical intervention through in situ immune-complex formation.

Adult↗

PubMedDate not supplied

[Reproductive outcome of hysteroscopic lysis of intrauterine adhesions].

OBJECTIVE: To analyze the reproductive outcome in women undergoing hysteroscopic lysis of intrauterine adhesions, according to their localization and severity. STUDY DESIGN: Retrospective study. MATERIALS AND METHODS: Fifty-three patients affected by intrauterine adhesions of different degree, subdivided according to localization and morphologic aspect: three isthmic, thirteen marginal, fourteen central, moreover twenty were complex and three complete. All the interventions were performed by means of the resectoscope. RESULTS: Hysteroscopic surgery restored an acceptable menstrual cycle in almost all the patients affected by intrauterine isolated adhesions, in 52% of women affected by complex incomplete adhesions, and in none of the three patients with entirely obliterated cavity. Concerning fertility, while in isolated, isthmic, central or marginal synechias we observed a pregnancy rate of 73.3% (22 out of 30) with a pregnancy rate to term respectively of 63.3% (19 out of 30 cases) and of 86.3% (19 out of 22 total pregnancies), in case of complex but not complete adhesions we reported, on 20 cases, 5 pregnancies (25%) with only two gone to term. We had no pregnancy in three cases of complex synechias. CONCLUSIONS: The basic parameter to define the functional and reproductive prognosis of the hysteroscopic lysis of intrauterine adhesions is not the menstrual profile or the histological characteristic of the lesions, but rather their extension.

Adult↗

PubMed2003

Nursing interventions for parasuicidal behaviors in female offenders.

Parasuicide refers to the nonfatal, intentional, self-injurious behaviors frequently exhibited by individuals with features of a borderline personality disorder. In correctional systems, the rate of parasuicidal behavior among incarcerated female offenders can be high and intertwined with complex behavioral and social issues. Nursing interventions in the management and treatment of parasuicidal behaviors incorporating the principles of dialectical behavior therapy have been developed and implemented at the authors' institution. This treatment approach provides practical, effective nursing interventions including pretreatment orientation, strategies for use with threats to self-harm and during self-harming episodes, and follow-up treatment.

Adult↗

PubMed1986

Nursing diagnoses and interventions with the acute stroke patient.

The multiple and complex needs of the stroke patient may best be managed by thorough nursing assessment, precise interpretation of clinical signs and symptoms, and identification of individualized nursing diagnoses, etiologic factors, desired outcomes, and nursing interventions. A strong knowledge base of neuroanatomy and cerebral blood flow, together with skillful use of the nursing process, will help the nurse meet the challenge of caring for these complex patients in the acute phase.

Acute Disease↗

PubMed2005

Mental and social health in disasters: relating qualitative social science research and the Sphere standard.

Increasingly, social scientists interested in mental and social health conduct qualitative research to chronicle the experiences of and humanitarian responses to disaster We reviewed the qualitative social science research literature in relation to a significant policy document, the Sphere Handbook, which includes a minimum standard in disaster response addressing "mental and social aspects of health", involving 12 interventions indicators. The reviewed literature in general supports the relevance of the Sphere social health intervention indicators. However, social scientists' chronicles of the diversity and complexity of communities and responses to disaster illustrate that these social interventions cannot be assumed helpful in all settings and times. With respect to Sphere mental health intervention indicators, the research largely ignores the existence and well-being of persons with pre-existing, severe mental disorders in disasters, whose well-being is addressed by the relevant Sphere standard. Instead, many social scientists focus on and question the relevance of posttraumatic stress disorder-focused interventions, which are common after some disasters and which are not specifically covered by the Sphere standard. Overall, social scientists appear to call for a social response that more actively engages the political, social, and economic causes of suffering, and that recognizes the social complexities and flux that accompany disaster. By relating social science research to the Sphere standard for mental and social health, this review informs and illustrates the standard and identifies areas of needed research.

Altruism↗