SEARCH · PubMed Health
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.
We report two cases of acute myocardial infarction treated by primary percutaneous transluminal coronary angioplasty (PTCA) in which femoral arterial access was either contraindicated or impossible. In both, emergency PTCA was successfully performed via the left radial artery. Including stent implantation in one patient, without entry site complication.
Over the counter (OTC) analgesics are products which are widely available and publicly accessible. Contemporary healthcare policy encourages patients to take greater control over their health care and recovery [Department of Health and Children 2001. Quality and Fairness - A Health System for You, Health Strategy. Dublin, Stationery Office.]. Over the counter medication offers injured patients a degree of control over their pain experience, preventing unnecessary pain on transit to an Accident and Emergency (A&E) department. In terms of availability, the range and variety of analgesics available is ever increasing, as more and more ingredients are downgraded from prescription only medicine (POM) to OTC status. However, despite the increase in the availability of OTC analgesia and an emphasis on patient empowerment, the majority of patients continue to present to A&E without taking any prior analgesia. In a study of 391 patients, 81% of patients took no analgesia prior to attending the A&E department [Emergency Nurse 9 (2002) 36]. Pain, as Cooper [Cooper, A., 1994. Pain Assessment in accident and Emergency. Accident and Emergency Nursing 2(1) (1994) 103] has noted, prompts people to make a rational decision to attend the A&E department. This literature review explores possible explanations as to why patients do not take OTC analgesia as a first line step in pain management.
STUDY OBJECTIVE: To compare the speed of IV access and the rate of infusion for saphenous venous cutdown and percutaneous femoral catheterization. DESIGN: Prospective, randomized, multicentered trial. Patient enrollment occurred from September 1990 through September 1991. SETTING: Patients were enrolled at three urban Level I trauma centers. TYPE OF PARTICIPANTS: Seventy-eight critically ill trauma patients. INTERVENTIONS: Participants were randomized to one of two groups: saphenous cutdown or percutaneous femoral line. After successful cannulation of the vein, 1 L of crystalloid was infused by gravity. RESULTS: The mean procedure time for the cutdown group was 5.63 +/- 2.58 minutes compared with 3.18 +/- 1.19 minutes for the femoral line group (P < .0001). The mean infusion time for the cutdown group was 6.65 +/- 4.29 minutes compared with 4.56 +/- 2.47 minutes for the femoral line group (P < .03). The mean overall time for the cutdown group was 11.76 +/- 4.81 minutes compared with 7.67 +/- 2.78 minutes for the femoral line group (P < .0002). CONCLUSION: Percutaneous femoral catheterization can be performed more rapidly than saphenous cutdown in the critically ill trauma patient with a palpable femoral pulse and allows for more rapid fluid administration. We support the use of a percutaneous femoral line as an acceptable alternative to saphenous venous cutdown in the initial resuscitation of trauma patients.
The incidence of mechanical and infectious complications of totally implantable central venous access devices (TIDs) must be related to underlying disease, intensity of the chemotherapy, and frequency of manipulations. Records of the patients hospitalized from January 2002 to May 2005 were evaluated. Patients with TIDs were matched with patients without TIDs having the same malignancy and the same anti-neoplastic chemotherapy. Catheter-related complications were documented and corresponding phases of the chemotherapy in matched pairs were compared with regard to infections. TIDs were inserted in 31 patients with a median age of 4.3 years (22 acute leukemia, 1 NHL, and 8 solid tumors). Total number of catheter days was 5268, with a median catheter life of 174 days (range 9-493 days). Nine catheters (29%) were removed due to mechanical and infectious complications. There was 13 catheter-related infections with a rate of 2.46/1000 catheter days. Total number of mechanical complications was 5 and overall rate of complications was 3.41/1000 catheter days. The rate of febrile episodes was 54 and 41 in the TID and no TID group, respectively (p: .11). Duration of neutropenia was 9.6 and 7.4 days and duration of fever per febrile attack was 5.6 and 4.4 days in the TID and no TID group, respectively (p: .047 and .56). Although most of the patients in this study had hematological malignancy and required frequent manipulation, the results were similar to those in developed countries. TIDs are essential for management of chemotherapy in pediatric malignancies with acceptable complications.
People have very different levels of comfort and experience in traveling the information superhighway. In the following column, Part I will provide an overview for beginners from two experts with the Boston Computer Society, the oldest and largest computer user organization in the world. Part II provides information to those with previous Internet experience who want to access specialized mental health information resources. It is written by an expert in this area who has served as a member of the Information System Committee of the American Psychiatric Association.
BACKGROUND: Arteriovenous (AV) fistulas are crucial in patients requiring long-term hemodialysis (HD). Dysfunctions of these fistulas are the most common causes of recurrent hospitalizations. This study aimed to evaluate the feasibility, safety and usefulness of contrast-enhanced magnetic resonance angiography (CE-MRA) in the evaluation of HD fistulas complications, and the condition of the central veins before HD access. METHODS: This study comprised 30 consecutive patients (15 females, 15 males; age range 25-66 yrs, mean +/- SD 51.2 +/- 9.9 yrs). Of 30 patients, 26 had native AV fistulas and the remaining four patients, who had a history of previous subclavian vein catheterization, were candidates for HD fistulas. Nine patients had a radiocephalic fistula, 15 had a brachiobasilic fistula, one had a saphenous vein graft, and one had brachiobasilic vein transposition. To observe the fistula complications in these cases, three-dimensional (3-D) CE-MRA using gadolinium was performed. RESULTS: The results were considered normal in three patients (10%), who were candidates for AV fistula construction; one patient had central vein occlusion due to previous catheterization. Thirteen patients (43.3%) had venous stenosis or occlusion; three of them (10%) had low CE arteries distal to fistula region, leading to ischemic complications, and six (20%) had stenosis at the fistula region. Seven patients (23.3%) had venous pseudoaneurysms, whereas two of them had both pseudoaneurysms and fistula region stenosis, and one had both venous stenosis and pseudoaneurysm. There were no adverse or allergic-like reactions or heat and taste sensations observed in our series. CONCLUSIONS: 3-D CE-MRA is a useful, safe and a practical imaging modality in complicated fistula diagnosis with fewer complications and side-effects in comparison to fistulography.
Intraosseous infusion is widely used in children, but its use in adults is much less common. This is probably because another vascular access can usually be achieved, and also because of lack of knowledge of the technique. Placement in adults is a quick procedure with a high rate of success. Drugs and fluids do not change the pharmacodynamics or pharmacokinetics of intraosseous administration, and anything can be given. Infusion rates have been achieved that in part make fluid resuscitation possible. Its uses are many and the contraindications few; complications are rare when simple guidelines are followed.
The purpose of this study was to develop a protocol which allows for improved access cavity preparation in all clinical circumstances. From radiographic and clinical evaluation a systematic organization of 10 burs was found to be optimal for all cases encountered. This standard arrangement makes burs available for use in situations with varying loss of coronal tooth structure and provides an orderly approach to endodontic therapy. A complete protocol accompanies the standardization of instruments making the techniques widely available. The standardization of this phase of endodontic therapy permits foreseeable and reproducible results. The use of a rational protocol in the form of systematically organized burs results in improved root canal therapy because of better patient and instrument management.
Chronic indwelling catheters are used increasingly for outpatient and inpatient therapy. Because more patients care for indwelling devices at home, indwelling lines are available to emergency department staff to draw blood and administer medications, blood products, and intravenous fluids. This article discusses the indications, complications, and methods of accessing chronic indwelling venous catheters.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The Electronic Health Record (EHR) will become a major support tool in health care delivery. This leads to heavy requirements for its quality and security. The EHR not only has to present the medical data of the patient as they are at the present time, we can anticipate that in situations of medical audit, law suits, quality control and self-assessment it may be necessary to be able to replay the EHR output as it was or would have been at a certain moment in the past. This facility could be required in order to be able to judge whether the behaviour of the health care practitioner was adequate in view of the information in the EHR as it was presented or could have been obtained from the EHR. First the need for such facility is discussed. Next the question is posed how sufficient interest for this aspect of the EHR can be raised and what role IMIA might play here. The technical consequences of the implementation of such facility are explored and they are found to be huge. The conclusion is that for a successful implementation of an EHR that (at least partly) replaces the paper record the facility is a must. However, in order to implement it, significant investments have to be made especially in development and adaptation of software. If we do not take action now the facility will not be available in time and the lack of such facility will become a road-block for EHR implementation.
Explore the source record for details and available documents.
OBJECTIVES: We sought to identify factors contributing to racial disparity in the receipt of coronary angiography (CA). BACKGROUND: Numerous studies have demonstrated that African American patients are less likely to receive needed diagnostic and therapeutic coronary procedures than white patients. This report summarizes the methods and findings of a study linking medical records with patient and physician interviews to address racial disparities in the utilization of CA. METHODS: This is a retrospective, cross-sectional study conducted in three urban hospitals in Maryland. A total of 9,275 medical records were reviewed, representing all 7,058 cardiac patients admitted in a two-year period. We identified 2,623 patients who, according to American College of Cardiology guidelines, were candidates for receiving CA. A total of 1,669 patients (721 African Americans and 948 whites) and 74% of their physicians were successfully interviewed. Multivariate and hierarchical multivariate logistic regression were used to construct a model of receipt of CA within one year of the hospitalization. RESULTS: The unadjusted odds of white patients receiving CA was three times greater than the odds for African American patients (odds ratio [OR] 3.0, 95% confidence interval [CI] 2.4 to 3.7). Adjusting for patients' clinical and social characteristics resulted in a 13% reduction in the OR for race. Adjusting for physician and health care system characteristics reduced the OR by 43%, to 1.7 (95% CI 1.3 to 2.4). CONCLUSIONS: Racial disparity in the utilization of CA is a function of differences in the health care system "context" in which African American and white patients obtain care, combined with differences in the specific clinical characteristics of patients.