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At least 1,729 records · Page 96Linked to original sources
PubMed1999

[Approach in acute respiratory tract disfunction]

OBJECTIVE: To present a review of the current diagnostic and therapeutic approach to the major conditions found in pediatric emergency department, which course with acute respiratory tract disfunction, stressing some clinical and epidemiological characteristics that are useful to the pediatrician in the differential diagnosis.METHODS: Outstanding articles related to the subject were selected after literature review of the last 20 years, using Md Consult, Medline and Lilacs databases.RESULTS: Many diseases can produce respiratory disfunction. Taking into account only those with acute symptoms, infectious and/or inflammatory causes predominate. History, examination findings and at least a chest X-ray are almost always sufficient for the diagnosis, but, sometimes other complimentary tests are necessary.CONCLUSIONS: If not properly treated, acute respiratory emergencies can result in significant morbidity and mortality. Any pediatrician taking part in an emergency team has to obtain respiratory management skills and knowledge concerning distinctive aspects and severity estimation of the several respiratory diseases.

Journal Article↗
PubMed2000

Evaluation of HbA1c determination methods in patients with hemoglobinopathies.

OBJECTIVE: To evaluate commercially available determination methods for HbA1c in patients with hemoglobin variants. RESEARCH DESIGN AND METHODS: HbA1c values were determined with various commercially available methods, including ion-exchange high-performance liquid chromatography (HPLC), boronate affinity assay, and immunoagglutination in patients with the hemoglobin mutations Hb Graz, Hb Sherwood Forest, Hb O Padova, Hb D, and Hb S. RESULTS: The effect of hemoglobinopathies on glycohemoglobin measurements was highly method dependent. The HPLC methods for HbA1c determination lacked the resolution necessary to differentiate hemoglobin variants. They demonstrated additional peaks in the chromatograms and HbA1c results either too low or too high compared with the nondiabetic reference range. With all immunoassays, Hb Graz demonstrated falsely low values. The other hemoglobinopathies in our study caused falsely low and/or high HbA1c results in immunoagglutination methods. The boronate affinity method showed values in an acceptable range for all hemoglobin variants. CONCLUSIONS: Because of the local occurrence of Hb variants and the ethnic origin of a given population, every individual laboratory must establish and validate its own assay method. In managing diabetic patients, knowledge of hemoglobinopathies influencing HbA1c determination methods is essential because hemoglobin variants could cause mismanagement of diabetes resulting from false HbA1c determinations.

Biomarkers↗
PubMedDate not supplied

Long-term gastrostomy in children: insights from expert nurses.

Beyond its technical implications, long-term gastrostomy in children represents a multifaceted social and psychological challenge to families caring for medically complex children at home. In the context of a study of gastrostomy devices in children, the authors interviewed nurses nominated as experts in the care of such children and families. In this article, a secondary analysis of themes arising from those interviews reveals the considerable clinical practice knowledge involved in managing and coordinating this care. The insights from these expert nurses reveal strategies and approaches that have not been systematically reported in the literature on nursing roles in relation to gastrostomy. By documenting and reporting such insights, the authors hope to make accessible the reasoning that these experts have developed through experience, innovation, and education, and thereby to encourage nurses caring for families with such children to broaden and extend the scope of their traditional practice roles.

Child↗
PubMed1997

Comparison of traditional and non-traditional baccalaureate nursing students on selected components of Meichenbaum and Butler's model of test anxiety.

The purpose of this study was to compare traditional and non-traditional baccalaureate student nurses on test anxiety and major contributing factors using the model proposed by Meichenbaum and Butler. Instruments used to measure the model variables were the Test Anxiety Inventory, the Effective Study Test, the Self-Concept of Academic Ability Scale, the Cognitive Interference Questionnaire and students' admission GPAs. Analysis of data revealed no significant difference between the groups on test anxiety. A significant difference was found between the two groups on knowledge of effective test-taking skills. Significant differences were found between the two groups on two correlations: 1) academic self-concept and knowledge of time management and study organization skills and 2) academic self concept and worry. Pearson correlations indicated that for both groups cognitive interference was the strongest variable associated with test anxiety.

Adult↗
PubMed1995

Nurses helping nurses. Development of internal specialists in long-term care.

The prevalence of psychiatric disorders and behavioral disturbances among nursing home residents, combined with observed deficits in geriatric mental health/illness expertise among LTC staff, supports the need for creative approaches to improve the knowledge, understanding, and management of such problems among LTC providers. The train-the-trainer model described in this article proved to be a viable method to providing geriatric mental health consultation and training that targets both improved quality of life for residents and quality of work life for the staff in charge of residents' care. More collaborative efforts among nursing specialists, subspecialists, and generalists are needed to empower those who work in LTC to utilize strengths and abilities inherent to their positions. Nursing homes nurses, who are all too familiar with the problems and challenges of their patient population, may act not only as mental health trainers but also as resource persons, role models, liaisons with geropsychiatric specialists, and leaders in the application of geropsychiatric care principles to residents within their facility, thus promoting improved resident and staff care alike.

Aged↗
PubMed2002

Latin as the language of medical terminology: some remarks on its role and prospects.

The present paper offers an up-to-date view of the status of Latin as the language of medicine, namely in its terminological component. It is concerned in greater detail with the three basic terminological vocabularies in which a doctor cannot so far manage without its knowledge. In this sense a primary rank is occupied by anatomical nomenclature whose international version remains Latin in the full extent. A more varied picture is presented by the clinical disciplines where, apart from Latin terms, expressions of ancient provenance have been applied in a large measure in the form of ethnic languages. At the same time, particularly in view of the needs of computerisation, repeated attempts have appeared to support English, which has the greatest chance of becoming a new language in the particular region of clinical medicine. In pharmaceutical terminology Latin has, for the time being, remained a functioning means of international communication, guaranteed by the European Pharmacopoeia (1996) and by the corpus of International Non-proprietary Names (1992, 1996), even though in the future an ever stronger competition of national languages should be taken into account.

Attitude of Health Personnel↗
PubMed1993

Gastrointestinal motility disorders during pregnancy.

PURPOSE: To review the pathophysiology of gastrointestinal motility disorders during pregnancy, their clinical manifestations, and their management. DATA SOURCES: Studies published from 1963 to 1992 identified by computerized literature searches of Index Medicus and MEDLINE; hand searches; contact with pharmaceutical representatives for information on drug therapy during pregnancy; and selected texts on drugs and obstetrics. STUDY SELECTION: Selected studies were those involving controlled design of physiology related to pregnancy or to hormonal effects on the gastrointestinal tract or both, and clinical studies or previous reviews that contributed to the understanding of the gastrointestinal effects of pregnancy. DATA EXTRACTION: Data concerning the epidemiology, causes, clinical manifestations, and complications of altered gastrointestinal motility during pregnancy as well as the strength of association between gastrointestinal disorders of pregnancy and hormonal changes were evaluated and used to develop a practical approach to evaluate and manage these patients. RESULTS OF DATA SYNTHESIS: Effects on the gastrointestinal tract during pregnancy are caused primarily by hormonal changes and not the physical effects of the gravid uterus. Motility changes occur throughout the gastrointestinal tract, including a reduction in lower esophageal sphincter pressure and its physiologic function with resulting gastroesophageal reflux and the risk for aspiration; alterations in gastric motor function associated with nausea and vomiting; and a decrease in the rate of small-bowel and colonic transit manifested primarily as abdominal bloating and constipation. These effects are mediated by progesterone, with estrogen probably acting as a primer. CONCLUSIONS: Given the large number of pregnancies each year complicated by gastrointestinal motility disorders, many physicians (including internists and gastroenterologists) must manage these problems. Knowledge of the underlying physiologic alterations in gastrointestinal motility during pregnancy and of safe treatment options is essential to the care of the pregnant patient.

Animals↗
PubMed1998

[Viral hepatitis: preventable illnesses].

The availability of vaccines had made on Hepatitis A as well as Hepatitis B an avoidable illnesses. However, there is a lack of knowledge referring to the epidemiological situation. This might be due to the physician's as well as the patient's underestimation of the risk of a new infection but also insufficient knowledge about indication, management of vaccination, adverse events and cost effectiveness might. Vaccination against Hepatitis A and B produce a longlasting immunisation which is indicated in every age. A combined vaccination for both infectious diseases are effective and support the compliance. The role of the family physician is decisive in the management of a sufficient vaccination strategy.

Adult↗
PubMed1991

Health insurance in the health administration curriculum.

Managers and policymakers knowledgeable in the delivery and financing of health care are needed in the health care industry, and health administration programs can meet this need by expanding course offerings which consider the role and operations of insurers. This paper surveys the major topics in the field of health insurance and presents a course overview for an introduction to the field of health insurance for health administration students.

Actuarial Analysis↗
PubMed1992

CIO takes on larger role, even at smaller hospitals.

Today's hospital CIOs must have more than computer, data analysis and technical skills. They must be knowledgeable about hospital management techniques, how hospitals interact with patients and their medical staff, and broad health care issues, such as community health standards and the role of managed care. Finding qualified CIOs will be increasingly difficult.

Hospital Administrators↗
PubMedDate not supplied

Boldly going where no one has gone before.

With all the changes occurring in the U.S. health care system come new opportunities for physician executives willing to boldly go where no one has gone before. These positions are being newly created and thus are somewhat undefined and uncharted. Health care organizations want individuals for high-risk positions with unique skill sets and bright, new ideas. Organizations want to find people who can do what has never been done before-for them, at least, if not anywhere in the universe. How does that translate into experiences that you might want to acquire? Most organizations today are looking for individuals with some networking experience, but analogous experience (such as in a multi-site medical group or active involvement in formation of IPAs) is often a good alternative. In addition, true line experience in one or more organizations is a solid credential. Knowledge of where managed health care dollars begin and end is a necessity. As always, executive style and presence are expected.

Personnel Selection↗
PubMedDate not supplied

The RN first assistant. Professional advancement in an expanded role.

In today's changing health care climate, patients need the continuity of care that an RNFA can provide. Becoming an RNFA takes years of experience, built upon an established foundation of broad clinical experience, highly developed technical skills, and knowledge gathered both inside and outside of the operating room. An extensive knowledge of case management, anatomy, physiology, wound healing, and physical assessment affirms the RNFA as a multicompetent team member. This, in addition to some sound business sense, can lead to various employment opportunities.

Certification↗
PubMed1999

[MRI evaluation of placenta accreta treated by embolization. Apropos of a case. Review of the literature].

Placenta accreta results from an abnormal attachment of the placenta to the uterine myometrium. The reported incidence in literature is variable, with an average of 1/7000 pregnancies. This condition is associated with a significant risk of bleeding at the time of delivery, usually requiring hysterectomy. Sonography associated with color Doppler is useful for diagnosis, but MRI can be used successfully to evaluate the degree of placental tissue invading into the myometrium, the serosa, and for follow-up after conservative management. To our knowledge, only two cases of placenta accreta evaluated with MR and six cases of placenta accreta treated by embolization have been reported in the literature. The authors report one case of placenta accreta treated successfully by embolization, and followed-up by MRI.

Contrast Media↗
PubMed1999

[French National Institute for observation of prescriptions and consumption of medicines. Prescription and consumption of antibiotics in ambulatory care].

The National Research Institute for Prescriptions and Consumption of medicines which was founded under the authority of the Minister of Health, is charged with the following missions: improved evaluation of the therapeutic needs of the population; more precise knowledge of therapeutic management; the identification of possible deviations in relation to systems of reference; recommendations in favor of correct use of medicines; and the optimization of patient management. Its first report concerned the antibiotic therapy of respiratory infections. In France, the average annual increase rate of the frequency of antibiotics consumption was in the region of 3.7%, between the periods 1980-1981 and 1991-1992. It essentially concerned cephalosporins and quinolones. Between 1991 and 1996 antibiotics sales increased on average by 2.1%, in units, per year. The increase of this consumption, which was not justified by any epidemiological evolution, is partly explained by the high frequency of antibiotic prescriptions during respiratory or ENT affections presumed to be of viral etiology: in 40% of rhinopharyngitis, 80% of acute bronchitis and more than 90% of anginas, whatever the age. Moreover the antibiotic treatments were not prescribed optimally: too long duration, insufficient dosages. Such phenomena are disturbing with regard to their consequences on the evolution of bacterial resistances. A comparison between French practices and those of Germany and the United Kingdom suggests that recourse to treatment is more frequent in France for the infectious diseases mentioned above, with more intensive utilization of antibiotics, in particular broad-spectrum penicillins. Recommendations have been made in favor of a rationalisation of practices.

Ambulatory Care↗
PubMed1975

Survival of an oral surgery patient with malignant hyperthermia.

Malignant hyperthermia is a life-threatening complication of general anesthesia. Its cause is not precisely known but it appears to be related to a genetic defect that allows increased release or decreased reaccumulation of calcium by the sarcoplasmic reticulum whech then results in a hypermetabolic state. As with any unexpected complication when a patient is under general anesthesia, early diagnosis and treatment are essential. The early clinical signs that the surgeon and anesthesiologist shoulc be alert to are unexplained tachycardia, unexplained tachypnea, muscular rigidity, and increased temperature. Therapy should be accurate and immediate. The essentials of therapy are discontinuance of the anesthetic agent; immediate, active, and aggressive cooling; administration of procaine or procaine amide, 1 mg/kg/min until the pulse slows; correction of electrolyte and acid-base imbalances; maintenance of urinary output with furosemide and large volumes of fluids, intravenously; and supportive care. A thorough knowledge of the management of malignant hyperthermia ahd the pathophysiology of the complications that may occur with general anesthesia will allow the oral surgeon to fully meet his obligations to his patients.

Acid-Base Equilibrium↗
PubMed1999

[Clinical and paraclinical diagnosis in psychiatry].

Alzheimer's disease patient can be addressed sometimes in psychiatry. At the early stage of the disease, the reason can be depressive symptoms or paranoiac reactions. Later, agitation associated with psychotic symptoms is the principal reason of hospitalization in psychiatry. The knowledge of the management of dementia has dramatically progressed, by example, antidepressant agents are not used as a diagnostic method. Psychiatric and behavioral assessment, neuropsychological tests, assessment of activities of daily life are very useful during the first consultation. Before the second consultation with the neuropsychological assessment, the stop of negative treatment, the treatment of depressive mood and the CT-scan must be realized. When the patient is hospitalized for agitation, the global assessment must be conducted after the hospitalization during consultation or day-hospital. Now, the psychiatrist must treat not only behavioral signs but specifically the disease too.

Activities of Daily Living↗
PubMed1999

[Obstetricians and pediatricians: experience with breastfeeding in their residency programs].

A prior study had the objective of identifying knowledge and experience on breastfeeding of obstetricians and pediatricians in two private hospitals of the Metropolitan Area of San Juan, Puerto Rico. This study presents the experience of those physicians regarding breastfeeding education during their residency training. An exploratory research design was used, the sample was non-probabilistic and was selected according to availability for participation among the physicians who visited those hospitals during June, 1997. The studied sample included 29 pediatricians and 26 obstetricians. Descriptive statistics and crosstab tables were used to describe the results. It was found that participating physicians had little or no exposition to breastfeeding related topics during their respective residency programs. They are aware of the importance of their role in the achievement of successful breastfeeding. They perceive themselves as effective in stimulating breastfeeding although they recognize that they should have received better training on the subject. This attitude is worrisome in face of the fact that this same group presented significant deficiencies in a previous study with regards to knowledge in the management of breastfeeding.

Adult↗