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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.

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At least 1,441 records · Page 80Linked to original sources
PubMed1992

Emergency management of the airway outside the operating room.

Successful emergency airway intervention incorporates the anaesthetist's basic skills in airway management with the knowledge of the special nature of the clinical problems that arise outside the operating room. While a thorough but rapid evaluation of the key anatomical and physiological factors of an individual patient may result in an obvious choice for optimal management, clinical problems often arise in which there is not an evident "best approach." In these less clear-cut situations, the anaesthetist may do well to employ those techniques with which she/he has the greatest skills and experience. At times, however, some degree of creative improvisation is required to care for an especially difficult problem.

Anesthesiology↗
PubMed1984

A summer day camp approach to adolescent weight loss.

Twenty-five overweight adolescents completed a summer weight loss day camp program on the Stanford University campus. All participants attended camp four days per week for four hours to learn and practice eating and exercise skills conducive to weight loss. Parents met weekly to discuss the program content and to explore their role in their adolescent's weight management. At posttreatment, reductions were achieved in weight, percent overweight, and skinfold, with greater changes observed for the eight-week group than for the four-week group. Improvements were also evident in participants' self-reported habits and knowledge of weight management concepts. Parent and participant assessment of the camp experience was very positive. The results of the summer weight loss day camp suggest that an intensive program of eating and exercise habit instruction, practice, and monitoring, which allows the participants to remain in the home setting, may provide benefits not found in other more traditional approaches to adolescent weight loss.

Adolescent↗
PubMed1997

Anesthesia for the pediatric patient.

Infants and children have unique anatomic, physiologic, pharmacologic, and psychological issues relating to perioperative management. Combining this knowledge with the technical skills required for instrumentation of children is essential when contemplating anesthesia for thoracic surgery. Experience and versatility with anesthetic induction technique, airway instrumentation, vascular access and monitoring, single-lung ventilation, regional anesthesia, and postoperative pain management allow for the comprehensive management of thoracic surgical patients at any age.

Adult↗
PubMed2006

The management of ductal carcinoma in situ of the breast: a screened population-based analysis.

BACKGROUND: A recent SEER study identified significant variations in the care of women with DCIS, yet several potential confounding variables were not included. We report a patterns of care study of women with DCIS to better understand the gap between evidence-based knowledge and the management of DCIS. METHODS: We studied all cases of DCIS diagnosed through the Ontario Breast Screening Program from 1991 to 2000. Data was obtained by database linkage and chart abstraction. A logistic regression model using generalized estimating equations to adjust for clustering was used. RESULTS: About 320,236 women were screened and 727 individuals were diagnosed with DCIS. The rate of mastectomy was 30% and was associated with multifocality (OR: 3.5 [1.7, 7.1], P = 0.0005), tumor size (OR: >2 cm vs. 1 cm (OR: 2.4 [1.3, 4.4], P = 0.006). Half of cases with margins <1 cm did not receive XRT. CONCLUSIONS: Our study corroborates previous reports on the persistent rates of mastectomy and axillary nodal dissection and the limited use of XRT in the treatment of DCIS.

Age Distribution↗
PubMedDate not supplied

The status of HIV/AIDS nursing in Australia: a specialty in decline?

Since the introduction of highly active antiretroviral therapy (HAART), occasions of service for patients with HIV/AIDS have altered drastically. HIV/AIDS nurses perceived that this change in activity had caused an exodus from the specialty by experienced nurses, and those that remained were rapidly deskilling. A survey of nurses working in HIV/AIDS in Australia and New Zealand was conducted to assess the impact of HAART on nursing skills and retention. More than 72% of respondents reported that they had lost some or many clinical HIV/AIDS nursing skills. About 37% of nurses reported that they were losing confidence in their knowledge of the management of opportunistic infections and cancers. About 27% reported larger numbers of nurses leaving their specialty area than in previous years. To enable nurses to respond rapidly to a potential decline in the effectiveness of HAART, this loss in skills and knowledge must be addressed.

Attitude of Health Personnel↗
PubMed1991

Using conceptual matrices, knowledge maps, and scripted cooperation to improve personal management strategies.

Research in the area of substance abuse suggests that ineffective personal management strategies appear to be a major factor in abuse behavior. In this study, fifty-seven students in an intermediate level psychology class were provided with three tools previously found to enhance academic learning strategies--knowledge maps, scripted peer cooperation, and conceptual matrices--as a means of understanding and improving personal management strategies. Student ratings of the value of these activities were significantly higher than an average or moderate response. Individual differences appear to be an important consideration in predicting participants' perceptions of the value of this approach. Those who felt they had control of whatever happens to them, and those who perceived problems as impactful and had strong desires to change recurring problem situations, had the most positive reactions to the types of activities used in this study.

Adult↗
PubMed1983

Practical management of amblyopia.

Our knowledge on the mechanism of amblyopia has gained in recent years from concerted research efforts in basic science and clinical laboratories. Different clinical forms of amblyopia are reviewed and their diagnostic and therapeutic significance discussed. In spite of etiologic differences there are pathophysiological similarities. The value of the time proven constant occlusion treatment of the sound eye remains unchallenged even though minor modifications have become necessary to prevent occlusion amblyopia in infants and young children. Part-time occlusion and penalization are of ancillary value but cannot be considered equal in effectiveness to constant occlusion. Due to increasing public awareness there is a trend toward earlier diagnosis and thus successful treatment of amblyopia. However, more efforts must be directed toward including newborns in visual screening examinations.

Amblyopia↗
PubMed2002

[Traumatic head injury in children: physiopathology and clinical management].

Traumatic brain injury (TBI) constitutes a major health and economic problem for developed countries, being one of the main causes of mortality and morbidity in children. In a busy traumatology center, a child will be admitted daily in the emergency department with head trauma injury. The anaesthesiologist must have a complete understanding of the pathophysiology and develop a practical knowledge of initial management of such patients. Traumatic brain injury may have intracranial and systemic effects that combine to give global cerebral ischaemia. Injury to the nervous system, irrespective of the primary injury, initiates a multitude of inflammatory cascades resulting in secondary brain injury. The consequence of these secondary brain injuries is most often as important, if not, more important than the primary injury. This period of brain inflammation can last up to three weeks and renders the brain more susceptible to the effects of systemic insults such as hypotension, hypoxia and or pyrexia. It has been shown in post-mortem examination of patients dying from severe traumatic brain injury that more than 91% had evidence of secondary ischaemic damage. These secondary injuries may be responsible for the clinical presentation of the "child who talk and die". The concept of "cerebral protection" has been extended to encompass the active treatment of secondary injury and the prevention of cerebral ischaemia. Initial care focuses on achieving oxygenation, airway control and treatment of arterial hypotension.

Brain Injuries↗
PubMed2002

New concepts in acute and extended postoperative pain management in children.

Increased knowledge of the pathophysiology of pain in children and an improved understanding of the pharmacology and pharmacodynamics of multiple agents have provided the clinician with a wide variety of tools to treat postoperative pain in children. The interest in a multimodal approach is kindled by the realization that the combination of a number of therapies can enhance analgesia with fewer untoward side effects. The expertise of other health care professionals should be tapped to open new avenues of treatment. Many therapies still require critical evidence-based evaluations to assess how well they work in larger patient populations. Dedication to research, compassionate patient care, and a willingness to teach the next generation of clinicians will bring us closer to the goal of safe and pain-free surgery.

Acute Disease↗
PubMed1999

Performance standards in bariatric surgery.

A bariatric surgeon is a fully trained general or gastrointestinal surgeon who has demonstrated specialized knowledge in the management of patients who suffer from morbid obesity and its complications. In addition to appropriate formal surgical training, preceptorships with experienced surgeons, preferably members of international bariatric societies, are highly desirable. Active participation in meetings of these societies, continuing medical education and knowledge of the current literature are necessary to maintain the required skills to treat these complex patients. Bariatric surgery should be performed at institutions that provide the necessary equipment, facilities and support systems for this particular population. When analysing outcomes of obesity surgery, long-term weight loss reports should include the number of patients followed and the time period of follow-up. Complications and re-operations should be presented, as well as modifications of techniques when various operations are compared. Weight loss should not be the only criterion used to define success or failure. Objective assessment of improvement in medical conditions related to obesity, and reliable measurements of quality of life after surgery should also be included in the final outcome analysis.

Clinical Competence↗
PubMed2000

How to manage individualized drug therapy: application of pharmacogenetic knowledge of drug metabolism and transport.

Significant fractions of health budgets must be spent for treatment of drug side effects and for inefficient drug therapy. Hereditary variants in drug metabolizing enzymes, drug transporters, and drug targets are important determinants of drug response and toxicity and may therefore aid in selection and dosage of drugs. Today there is extensive knowledge of genetic polymorphisms of cytochrome P450 (CYP) enzymes 2A6, 2C9, 2C19, and 2D6; of phase-2 enzymes such as thiopurine S-methyltransferase; and more recently of drug transporters such as the MDR-1 gene-product P-glycoprotein, affecting a significant share of currently used drugs. However, application of pharmacogenetic knowledge to clinical routine is limited in current practice. To promote the application of pharmacogenetic knowledge in clinical routine, research on genotype-based dose adjustments is still necessary - as is the promotion of faster and cheaper genotype analyses. Furthermore, the benefits of CYP genotype-directed drug therapy should be evaluated in properly designed prospective studies. Once such steps have been successfully taken, drug therapy could well become more prevention-directed and patient-tailored than it is possible today, replacing the current "one drug in one dose for one disease" strategy by a more individualized approach.

Cytochrome P-450 Enzyme System↗
PubMed2002

Assessment of group versus individual diabetes education: a randomized study.

OBJECTIVES: The current study was conducted to compare the effectiveness of delivering diabetes education in either a group or individual setting using a consistent, evidence-based curriculum. RESEARCH DESIGN AND METHODS: A total of 170 subjects with type 2 diabetes were randomly assigned to either group (n = 87) or individual (n = 83) educational settings. Subjects received education in four sequential sessions delivered at consistent time intervals over a 6-month period. Outcomes included changes in knowledge, self-management behaviors, weight, BMI, HbA(1c), health-related quality of life, patient attitudes, and medication regimen. Changes were assessed at baseline and after the 2-week, 3-month, and 6-month education sessions. RESULTS: Both educational settings had similar improvements in knowledge, BMI, health-related quality of life, attitudes, and all other measured indicators. HbA(1c) decreased from 8.5 +/- 1.8% at baseline to 6.5 +/- 0.8% at 6 months (P < 0.01) in the study population as a whole. Subjects assigned to the individual setting had a 1.7 +/- 1.9% reduction in HbA(1c) (P < 0.01), whereas subjects assigned to the group setting had a 2.5 +/- 1.8% reduction in HbA(1c) (P < 0.01). The difference in HbA(1c) improvement was marginally greater in subjects assigned to group education versus individualized education (P = 0.05). CONCLUSIONS: This study demonstrates that diabetes education delivered in a group setting, when compared with an individual setting, was equally effective at providing equivalent or slightly greater improvements in glycemic control. Group diabetes education was similarly effective in delivering key educational components and may allow for more efficient and cost-effective methods in the delivery of diabetes education programs.

Adult↗
PubMed1995

Clinical management of osteogenesis imperfecta.

Knowledge of the natural history of different types of OI permits planning of rehabilitation goals for children with OI. Notwithstanding this knowledge, rehabilitation will need to be modified to accommodate unexpected fractures and the highly variable chance of deformity in each individual. Immobilisation should be minimized to avoid immobilization osteoporosis. New rehabilitation issues include basilar impression, recommencement of fractures in postmenopausal women with OI, pregnancy related bone loss and sleep apnoea.

Bone Diseases, Metabolic↗