PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Complex intervention”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,225 records · Page 68Linked to original sources
PubMed2001

Three-dimensional cephalometry using individual skeletal laser technology models.

When planning operations on the facial skull, transversal asymmetries of the maxillo-mandibular complex cannot be adequately assessed using conventional two-dimensional (2D) x-ray cephalometry. On eight patients who presented with facial skull asymmetries, a three-dimensional (3D) laser technology model (LTM) using CT data was fabricated. Five sagittal plane points and six symmetry points were marked on the LTM, measured with the FlashPoint 3-D Digitizer and then geometrically converted, such that using the sagittal plane points, sella, basion, and nasion, a method could be developed that allowed the localization of each spatial point in the three symmetry planes. Thus one could quantitatively record a patient's specific facial skull asymmetry in all three planes and a 3D measurement became feasible. Based on the measurements, the asymmetry could be assessed with respect to the sagittal, vertical, and horizontal planes. With the 3-D LTM Digitizer measuring system, the surgeon now had precise numerical information regarding the symmetry ratios of the skull at his disposal, information that would have been difficult to evaluate solely using a model analysis. The results from this study show that our measuring system is applicable and useful for complex maxillofacial asymmetries. The planning of surgical interventions was optimized because precise numerical values regarding the degree of the asymmetry were available. With the 3-D LTM Digitizer measuring system, cephalometric analysis of complex asymmetries in the three spatial planes can be pragmatically supported.

Cephalometry↗
PubMed2004

[A vascular surgeon and intervention].

Multisegmental affections of the arteries of the lower extremities are frequently connected with two- or more-step revascularisation--vascular reconstructions and radiological interventions. Recently, due to improvements in radiological visualizing equipment and due to the miniinvasive methods trend, the interest of vascular surgeons in conducting single-step complex revascularisations (joining classical vascular procedures and interventions) has been on increase. The aim of this study was to present the scope of use, the literature data and our experience with introduction of these methods.

Angiography↗
PubMed2000

[Evaluation in the health sector: concepts and methods].

The practice of evaluation has existed in one form or another for as long as one can remember and is central to all processes of learning. Today, evaluation is a popular concept grouping together multiple and diverse realities. This article aims to propose a conceptual framework for evaluation that is broad and universal enough to allow all those concerned with evaluation of health services (regardless of their disciplines and interests) to better understand each other, to perform better evaluations, and to use them in a more pertinent manner. We will begin by defining evaluation as the process which consists of making a judgement on the value of an intervention by implementing a system which can provide scientifically valid and socially legitimate information on regarding this particular intervention (or any of its components) to the different stakeholders concerned, such that they can form an opinion from their perspective on the intervention and reach a judgement which can translate into action. We define "intervention" as any organized system of action (a structure, actors and their practices, processes of action, one or many finalities and an environment) aiming to, in a given environment, during a given time period, modify the foreseeable course of a phenomenon to correct a problematic situation. An intervention can be a technique, a medication, a treatment, an organisation, a program, a policy or even a complex system like the health care system. Various interventions, regardless of their nature, can be the object of two types of evaluation. Normative evaluation is based on appreciation of each component of the intervention according to criteria and standards. This type of evaluation is defined as an activity which consists of making a judgement regarding an intervention by comparing the resources utilized and their organisation (structure); services and goods produced (process) and results obtained to criteria and standards (in other words, summaries of what is good and right). Did the intervention correspond to what should have been done according to the standards utilized? Evaluative research aims to employ valid scientific methods to analyze relationships between different components of an intervention. More specifically, evaluation research can be classified into six types of analysis, which employ different research strategies. Strategic analysis allows appreciation of the pertinence of an intervention; logical analysis, the soundness of the theoretical and operational bases of the intervention; productivity analysis, the technical efficiency with which resources are mobilized to produce goods or services; analysis of effects, effectiveness of goods and services in producing results; efficiency analysis, relations between the costs of the resources (or the services) used and the results; implementation analysis, appreciation of interactions between the process of the intervention and the context of implementation in the production of effects. The official finalities of all evaluation processes are of four types: (1)strategic, to aid the planning and development of an intervention, (2) formative, to supply information to improve an intervention in progress, (3) summative, to determine the effects of an intervention (to decide if it should be maintained, transformed or suspended), (4) fundamental, to contribute to the advancement of empirical and theoretical knowledge regarding the intervention. In addition, experience acquired in the field of evaluation suggests that evaluation is also productive in that it allows actors, in an organized setting, to reconsider the links between the objectives given, practices developed and their context of action. This task of achieving coherence is continuous and is one of the intrinsic conditions of action in an organized setting. In this perspective, evaluation can have a key role, given that it is not employed to legitimize new forms of control but rather to favor debate and th

Cost-Benefit Analysis↗
PubMed1992

Complex angioplasty: a surgeon's perspective.

Surgeons commonly have reacted with skepticism to the introduction of catheter-based interventional approaches to treating coronary artery disease, prompted apparently, by a desire to protect what had been exclusively their turf. Reasonable surgeons now largely accept the concept of nonoperative mechanical treatment of coronary heart disease, and their constructive criticisms regarding amelioration of coronary anatomy without thoracotomy remains valuable. The value of catheter-based techniques compared with operative or noninterventional treatment has not been defined in many clinical settings. The complexity of evaluating these rival technologies increases as the complexity of cases progresses from simple 1-vessel disease to more extensive coronary artery disease. Ongoing randomized trials may help define indications for these procedures, but patients entering these trials represent a highly select subset. Therefore, applications to broader patient populations will likely require analysis of observational data. Newer catheter-based technologies introduce modes of injury to the coronary arterial system that have not been encountered previously in medical practice. As technologies evolve, decisions about the need for operative intervention become increasingly complex. In the many clinical settings resulting from efforts to improve angioplasty, optimal patient care occurs in environments with good communication and cooperation between all physicians involved in interventional treatment of coronary artery disease.

Angioplasty, Balloon, Coronary↗
PubMed2007

The complex dynamics of stroke onset and progression.

PURPOSE OF REVIEW: The aim of this article is to discuss the dynamic nature of cerebrovascular ischemia. RECENT FINDINGS: Acute risk factors are superimposed on chronic risk factors to precipitate plaque rupture in myocardial infarction. The interaction between external triggers, such as stress, with internal triggers, such as vasoconstriction, is mediated to a large part by the autonomic nervous system. Numerous algorithms have been developed to describe physiological time-series data, for example heartbeat variability, and reveal complex structure that has diagnostic and prognostic significance. Much of this structure is mediated by the autonomic nervous system. Recent data on stroke triggers, carotid stenosis, transient ischemic attack, and infarct expansion suggest a similar need for detailed physiological measurement and non-linear dynamics in order to understand stroke onset and progression. SUMMARY: The picture emerging is that stroke arises as a result of multiple processes with different time constants. The nature and timing of interventions should be tailored to these complex interacting processes. This will require more frequent and varied physiological measurement accompanied by non-linear analytical methods. This new approach, which stresses complex within-subject measurements, will likely make 'one size fits all' solutions to stroke care untenable.

Autonomic Nervous System↗
PubMed2000

Smoking cessation and low-income women: theory, research, and interventions.

There is a growing body of evidence indicating women's experiences with smoking and cessation may be unique from those of men. Advanced practice nurses (APNs) in primary care are ideally suited to assess and intervene with this complex addiction. APNs must be competent in interventions that address cigarette smoking. This article will summarize the literature on smoking cessation interventions with an emphasis on women smokers.

Female↗
PubMed2005

[Interventional cardiology. Where are we and where are we going from here?].

This article summarizes 20 years of percutaneous interventional cardiology for coronary angioplasty. During this period, interventional cardiology has evolved faster than any other type of treatment in the field of cardiovascular diseases. We describe the early results of interventional cardiology, the increase in primary success rates and the reduction in complication rates for percutaneous techniques during this period, which coincided with the introduction of technological advances. In the early 1990s, primary success rates for the treatment of coronary lesions stood at 86%-88%, with a restenosis rate of 30%-40% at 6-month follow-up. Current primary success rates have risen to over 95% with a restenosis rate of under 10%, even for many types of lesions classically considered complex. Currently the main limitations in interventional cardiology remain coronary segments that cannot be accessed due to chronic total occlusion, or severe proximal tortuosity or calcification. Rapid improvements have led to broader clinical indications for percutaneous revascularization procedures, and have made frequent updates of clinical practice guidelines necessary. Meanwhile, comparative studies involving other modes of surgical revascularization have become extremely difficult because percutaneous methods used in long-term studies begun 5 to 10 years have become obsolete.

Angioplasty, Balloon↗
PubMed2003

Emergency endovascular treatment of traumatic aortic arch rupture with multiple arch vessel involvement.

PURPOSE: To report successful endovascular stent-graft placement for emergency treatment of a complex traumatic injury involving the aortic arch and multiple arch vessels. CASE REPORT: An 81-year-old man underwent stent-graft placement for a complex traumatic vascular injury. Computed tomography on admission documented a dissection along the course of the aortic arch, intramural hematoma along the ascending aorta, dissection of the innominate artery, and a right subclavian artery pseudoaneurysm. The dissection of the aortic arch and the pseudoaneurysm of the right subclavian artery were treated immediately, the dissection of the innominate artery 7 days later. The patient did not develop any complications. Follow-up studies performed prior to discharge and at 6 and 12 months after the interventions showed successful repair of the complex vascular injuries. CONCLUSIONS: Traumatic injury of the aortic arch with multiple arch vessel involvement can be treated effectively by means of stent-graft placement.

Accidents, Traffic↗
PubMed2006

Statin therapy for native and peri-interventional coronary heart disease.

Atherosclerosis is a slow, complex process involving many different cell types and their interactions producing excessive oxidant stress, increased inflammation, abnormal endothelium-dependent vasodilation, and localized increases in thrombogenic and decreases in fibrinolytic factors. Numerous factors incite these processes, but oxidized LDL particles seem the most essential component of this pathologic cascade. These oxidized particles set up a chain of biochemical events eventually leading to clinical atherosclerotic events. Statins have been shown to reduce such events by 40 to 50% when LDL cholesterol is lowered to less than 80 mg/dL. But in-vitro studies have shown that the provision of mevalonate, not cholesterol, can result in reversal of some of the beneficial effects of statins, suggesting that other mechanisms such as inhibiting the formation of the isoprenoids, farnesyl pyrophosphate and geranylgeranyl pyrophosphate, and thus prenylation of many cell-signaling proteins may be important in the preventive effects of statins. Clinically, these more rapid, non-lipid-altering effects may be more apparent in acute coronary syndromes. Now that we have more LDL-cholesterol lowering agents which lower LDL-cholesterol without blocking HMG CoA reductase, we may be better able to dissect and understand the importance of these non-lipid-altering effects of statins in human disease.

Clinical Trials as Topic↗
PubMed1989

[Quality of life after surgical interventions in pediatrics].

Quality of life is a complex entity without "normal finding" and can be judged by objective and subjective criteria. Quality of life of a child results out of the main factors which are connected to each other and represent the actual specific profile of a personality. The disease or dysplasia itself, personality of the patient, personality of the attending physician as well as of the parents. Quality of life of a child consists of five interwoven spheres: bodily function of the child; psychological well-being; social interactions; physical state; and parents.

Activities of Daily Living↗
PubMed1991

Immunotherapy in autoimmune diseases.

Over the past decade, much progress has been made in our understanding of immunological tolerance of self-antigens and the genetic and molecular basis of T-cell recognition and activation that involves a ternary interaction of foreign or self-antigens with major histocompatibility complex molecules and T-cell antigen receptor gene products. Using this trimolecular complex as a target for immune intervention, animal models of spontaneously occurring and experimentally induced autoimmune diseases have provided opportunities for new immunomodulatory therapeutic approaches. Some of these have encouraging potential and are currently being applied in the immunotherapy of human autoimmune diseases.

Animals↗
PubMed2003

Non-genetic influences on cystic fibrosis lung disease: the role of sociodemographic characteristics, environmental exposures, and healthcare interventions.

Patients with cystic fibrosis (CF) exhibit significant variability in the course and severity of the disease, and this variability is best interpreted in the context of an interaction between genetic and nongenetic determinants. While a small number of patients with "mild" mutations in the CF transmembrane conductance regulator gene clearly have less severe disease, for the general population of patients with CF the strongest predictor of severity of clinical course appears to be socioeconomic status (SES). Low SES probably exerts an influence via the convergence of detrimental environmental influences on outcome such as environmental tobacco smoke, poor nutrition, and stress. Other important predictors that appear to be independent of SES include gender and acquisition of airway pathogens such as Pseudomonas aeruginosa and Burkholderia cepacia complex. Finally, effective provision of medical interventions is an important determinant of outcome, and this is affected primarily by patient adherence (which bears a poorly defined relationship to SES), and attendance at a CF care center that utilizes a system of care that allows optimal delivery of evidence-based interventions.

Journal Article↗
PubMed2002

Challenges to the use of nonpharmacologic interventions in nursing homes.

The Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987, stated that nursing homes should try nonpharmacologic interventions before resorting to pharmacologic agents when addressing problem behaviors among residents. Since that time, the use of pharmacologic agents has decreased, but there is little evidence to suggest that the use of nonpharmacologic interventions has increased. Psychosocial models describe problem behaviors as complex phenomena that require individualized strategies based on a resident's unique characteristics. Categories of intervention include social contact, behavior therapy, staff training, structured activities, environmental interventions, and a combination of therapies. This article discusses internal barriers to the use of nonpharmacologic interventions based on the Porras stream organization model: organizing arrangements, social factors, technology, and physical setting. Also, external barriers related to the regulatory, legal, and economic sectors are discussed. The authors offer recommendations for overcoming these barriers.

Aged↗
PubMed1988

Proximal interphalangeal joint dislocations without fractures.

Injuries to the proximal interphalangeal joint are extremely common. An understanding of the complex anatomy of this joint is essential for diagnosis and treatment of proximal interphalangeal joint sprains and dislocations. Lateral injuries are among the commonest injuries in the hand. These are often stable after reduction, requiring only closed treatment. Occasionally, however, the collateral ligament can be trapped in the joint and require open reduction. Dorsal dislocations represent the most common dislocation in the hand. These, too, are usually stable after reduction and can be treated by closed methods. On occasion, however, these dislocations will be open or irreducible by closed means, requiring surgical intervention and repair of damaged structures. Complex rotary dislocations are exactly that: complex. An exact understanding of the damaged structures and causes of irreducibility frequently makes this an injury often requiring open reduction and selective repair of damaged soft tissue structures. Fortunately, prompt diagnosis, reduction, and institution of appropriate treatment can usually afford the patient good function after these injuries. It must be noted that stiffness is more common than instability, and active range-of-motion exercises instituted at the proper time are essential. These joints will often remain permanently thicker after injury in spite of optimal care, and tenderness and soreness with use may persist for 6 to 12 months.

Adolescent↗
PubMedDate not supplied

Describing an episode of home nursing care for elderly postsurgical cancer patients.

BACKGROUND: While studies have documented the beneficial effect of home care for cancer patients, the actual interventions implemented during these studies have not been well described. OBJECTIVES: Purposes of this study were to analyze interventions documented in narrative form by advanced practice nurses during a four-week episode of home care and describe intervention type, frequency, range, and variation over time in intervention emphasis and dose intensity. METHODS: Chart audits were performed on records kept for 148 postsurgical cancer patients who were assigned to the experimental group in a randomized clinical trial to evaluate the effect of home care on quality of life outcomes (McCorkle et al., 2000). Interventions statements (N = 7,275) were analyzed using Grobe's (1996) Nursing Intervention Lexicon and Taxonomy. RESULTS: Teaching accounted for the highest percentage of interventions documented, followed by provision of psychological support and reassurance, determination of patient needs and nursing care requirements, assessment of current status, and indirect care. Physical care and actions to promote self-care independence were documented least frequently. Differences in nursing care were found by cancer site with the greatest diversity of interventions documented for breast cancer patients. Intervention emphasis and dose intensity varied over time, suggesting that these nurses altered their care in response to the changing needs of their patients. CONCLUSIONS: These nurses responded to complex problems and used a variety of interventions to assist patients and families in management of the illness experience. They also tailored their care to each patient's location along the illness trajectory. These findings provide beginning support for the clinical utility of Nursing Intervention Lexicon and Taxonomy as a way to quantify an episode of nursing care.

Aged↗
PubMed1999

Expression of pattern in plants: combining molecular and calculus-based biophysical paradigms.

Pattern formation in plant meristems occurs across a broad scale. At the topographical level (large scale), tissue folding in the meristem is responsible for the initiation of new organs in specific phyllotactic patterns and also determines organ shape. At the cellular level (small scale), oriented cell division and microtubule-based cellulose reinforcement control cell pattern and growth direction. I argue here that structural specification at each scale is highly efficient if the pertinent gene activity is manifested in two complementary biophysical categories. At large scale, one category is the tendency of the formative tissue to fold with a certain spatial periodicity determined by its material properties (e.g., bending stiffness from cellulose content). This latent tendency is formalized in a differential equation for physical buckling. The second category at this scale comprises boundary conditions that specify how the latent tendency is manifested as topography: whether tissue humps occur as whorls or Fibonacci spirals. This versatile combinatorial format accounts for the relative stability of alternative organ patterning as well as alternative organ shaping (e.g., stamens vs. carpels). It also accounts for the structural shifts seen in normal development and after mutation or chemical/physical intervention. At small scale, the latent differential activity is the tendency for groups of dividing cells to co-align their cytoskeletons. The curvature of the surface opposes this tendency. The least curved part of a new primordium is its quasicylindrical midportion. There, by aligning microtubules and cellulose coherently around the organ, a new growth direction is set. Thus large-scale buckling produces curvature variation, which, in turn, affects the localization and orientation of the cytoskeleton. This scheme for the coherent production of diverse geometrical features, involving calculus at two structural levels, is supported by complex organogenetic responses to simple physical intervention. Also, many morphological alternatives, wild type vs. mutant, reflect single changes in parameters in this differential-integral format.

Journal Article↗
PubMed2005

Is endovascular therapy the preferred treatment for all visceral artery aneurysms?

Endovascular intervention can provide an alternative method of treatment for visceral artery aneurysms. We conducted a retrospective review of all patients with visceral artery aneurysms at a single university medical center from 1990 to 2003, focusing on the outcome of endovascular therapy. Sixty-five patients with visceral artery aneurysms were identified: 39 splenic (SAA), 13 renal, seven celiac, three superior mesenteric (SMA), and three hepatic. Eleven patients (16.9%) had symptoms attributable to their aneurysms, which included a total of four ruptures (6.2%): three splenic and one hepatic. Management consisted of 18 (27.7%) endovascular interventions, nine (13.9%) open surgical repairs, and 38 (58.5%) observations. Mean aneurysm diameter for patients treated expectantly was significantly less than for those who underwent intervention (p = 0.001). Endovascular interventions included 15 (83.3%) embolizations (11 SAA, three renal, one hepatic) and three (16.7%) stent grafts (two SMA, one renal). The initial technical success rate of the endovascular procedures was 94.4% (17/18). However, there were four patients (22.2%) with major endovascular procedure-related complications: one late recurrence requiring open surgical repair, two large symptomatic splenic infarcts, and one episode of severe pancreatitis. These four patients had distal splenic artery aneurysms at or adjacent to the splenic hilum. There were no endovascular procedure-related deaths. Reasons for performing open surgical repair included three SAA ruptures diagnosed at laparotomy and complex anatomy not amenable to endovascular intervention (six patients). One surgical patient had a postoperative small bowel obstruction treated nonoperatively; and there was one perioperative death in a patient operated on emergently for rupture. Endovascular management of visceral artery aneurysms is a reasonable alternative to open surgical repair in carefully selected patients. Individual anatomic considerations play an important role in determining the best treatment strategy if intervention is warranted. However, four of 11 (36.4%) patients with distal splenic artery aneurysms treated with endovascular embolization developed major complications. Based on our experience, traditional surgical treatment of SAA with repair or ligation and concomitant splenectomy when necessary may be preferred in these cases.

Adult↗