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At least 1,747 records · Page 97Linked to original sources

PubMed2000

[Treatment of constipation and different laxative requirements in palliative medicine].

The significance of constipation with its variety of possible complications is often underestimated in the context of the tumour patient's complaints although difficulties in stool management are more common in patients with advanced cancer than in those with other terminal diseases. Without treatment constipated patients will suffer from nausea and emesesis and will possibly develop small bowel paralysis. About half of all patients admitted to specialist palliative care units report constipation, but about 75% of the patients will require laxatives. Unlike for pain, no generally accepted and widely disseminated management guidelines are available. Effective prophylaxis and cause-based therapy do improve the alimentary condition and can help to prevent the transition to ileus situations. Effective symptom management presupposes exact knowledge of the pharmacokinetics.

Cathartics↗

PubMed2000

Farm and slaughter survey of bovine tuberculosis in captive deer in Switzerland.

In 1998, a survey was conducted by postal questionnaire to gather basic knowledge about the management, health and productivity of captive deer in Switzerland. In addition, lymph nodes were collected from slaughtered deer from 124 of the 262 holdings surveyed, and tested for Mycobacterium bovis and Mycobacterium tuberculosis. The total farmed deer population was 8389 animals kept on 485 holdings; 87 per cent were fallow deer, 8 per cent red deer, 4 per cent sika deer, and there were small numbers of other species. The median herd sizes were 12 for fallow deer and eight for red deer. Few owners had handling facilities or crushes. In none of the lymph nodes examined were lesions typical of bovine tuberculosis observed, and neither M bovis nor M tuberculosis was cultivated from any of the samples.

Animal Husbandry↗

PubMed2000

Malignant hyperthermia. Update 2000.

MH is a life-threatening crisis that can be controlled if promptly recognized and appropriately treated. Identification of patients at risk for MH is an ongoing crusade. Preparedness with needed supplies available at hand facilitates optimal treatment. All perioperative personnel should remain current in their knowledge of MH management and treatment to ensure the best possible outcome for their patients.

Critical Care↗

PubMedDate not supplied

Overcoming barriers to breastfeeding: suggested breastfeeding promotion programs for communities in eastern Nova Scotia.

The 1994 rate of initiation of breastfeeding in eastern Nova Scotia was 41%. The purpose of this study is to assess both perceived barriers to breastfeeding as well as the need for programs to promote breastfeeding in this region. Seventy randomly selected subjects (67 F, 3 M) responded to a questionnaire about regional breastfeeding practices. Results showed that perceived barriers to breastfeeding included lack of knowledge about breastfeeding management (35.8%) and lack of support (29.9%). Barriers to exclusive breastfeeding for 6 months included going back to work (76.5%) and lack of support (39.2%). To promote exclusive breastfeeding for 6 months, participants recommended access to: prenatal classes (98.5%), nurse follow-up following hospital discharge (95.3%), and availability of lactation consultants (88.3%). When proposed promotion programs were implemented, breastfeeding initiation increased to 60.5% and duration rates increased to 4 months (90.2%). Regional barriers to breastfeeding can be partly alleviated through educational and support programs.

Adult↗

PubMed2001

[Neonatal conventional ventilation guidelines].

Respiratory pathology is a frequent problem in Neonatal Intensive Care Units; the last few years, our knowledge about its management has improved enormously. Conventional Ventilatory support is a high-specialized technique that maintains a correct alveolar gas exchange while the primary aetiology is to present some clinical guidelines for every professional working with newborns who have respiratory failure improves. The aim of this document is to present some clinical guidelines for every professional working with newborns who have respiratory pathology

Humans↗

PubMed2002

A survey of albuterol administration practices in intubated patients in the neonatal intensive care unit.

INTRODUCTION: Aerosolized albuterol is commonly used in the treatment of neonatal respiratory illnesses. Clinical and in vitro studies have identified numerous factors that affect aerosol drug delivery during neonatal mechanical ventilation, including the choice of metered-dose inhaler (MDI) or nebulizer, the use of a holding chamber, time between actuations, the volume of nebulized solution, and the position and placement of the nebulizer or MDI. Because there is no consensus on the optimal method of administration, there is probably substantial variability among institutions in how aerosolized albuterol is administered to mechanically ventilated infants in the neonatal intensive care unit (NICU). OBJECTIVE: Survey academic medical centers in the United States regarding their practices of administering aerosolized albuterol to intubated newborns in the NICU. METHODS: A survey instrument was developed that queried 18 aspects of albuterol administration in mechanically ventilated infants, including the frequency of MDI and nebulizer use, the average and maximum dose, the time between MDI actuations and following the final actuation, the use of a holding chamber, and the placement location of the holding chamber or nebulizer. Respiratory therapists and respiratory therapy managers having direct knowledge of neonatal clinical practices in their neonatal fellowship program NICUs were surveyed via telephone. Those who did not respond via telephone were surveyed via fax. RESULTS: Eighty institutions were surveyed and there were 68 respondents (85% response rate). Responders averaged 35 +/- 13 NICU beds and 11 +/- 5 ventilators/d. Nineteen percent of the respondents reported administering albuterol via MDI 100% of the time; 22% use MDIs 75-99% of the time; 9% use MDIs 50-74% of the time; 4% use MDIs 25-49% of the time; and 43% never use MDIs to deliver albuterol. The average dose via MDI was: 1 puff: 30%; 2 puffs: 65%; and 4 puffs: 5%. The maximum dose via MDI was: 2 puffs: 30%; 3 puffs: 14%; 4 puffs: 36%; 6 puffs: 11%; and 8 puffs: 6%. Thirty-one percent of the respondents place the holding chamber in-line with the ventilator circuit, 56% administer the aerosol via manual ventilation, and 13% use both methods. Fifty-six percent place the in-line holding chamber between the endotracheal tube and ventilator circuit, and the other 44% place the in-line holding chamber in the inspiratory limb. The time between MDI actuations depended on whether the holding chamber was placed in-line or the aerosol was administered via manual ventilation (MV): < or = 0.5 min: 18% in-line and 28% MV; 1 min: 47% in-line and 43% MV; 2 min: 6% in-line and 4% MV; 3 min: 6% in-line and 0% MV. Eighty-three percent of respondents indicated that dead space introduced by a holding chamber/spacer was not a concern. Forty-three percent use nebulizers exclusively to administer albuterol to mechanically ventilated patients. Seventy-four percent of centers that nebulize albuterol use a dose of 1.25-2.5 mg. Eighty-eight percent of the surveyed institutions place nebulizers in-line with the ventilator circuit, and the other 12% use manual ventilation to administer the nebulized aerosol. Of those that use in-line nebulization, 95% place the nebulizer in the inspiratory limb of the circuit, and the other 5% place the nebulizer between the endotracheal tube and circuit Y-piece. Among centers that place the nebulizer in the inspiratory limb, 52% place it adjacent to the circuit Y-piece, 36% place it midway upstream in the inspiratory limb, and 12% place it near the humidifier. CONCLUSION: There is substantial variability among NICUs in albuterol administration to mechanically ventilated infants, with the majority of institutions now administering albuterol via MDI.

Academic Medical Centers↗

PubMed2001

[Genetic predisposition to arterial and venous thrombosis].

Thrombosis is a multifactorial pathology. In addition to the environmental factors, there are genetic components which either predispose or protect against its occurrence. Some are common to only a small number of subjects: these are the high risk families to thrombotic disease. Others are present in a larger percentage of the general population: this is called polymorphism and its clinical expression is usually modest. The role of these genetic factors in the development of thrombosis is not easy to demonstrate, especially as there are many gene-gene and gene-environment interactions. Nevertheless, the genetic basis of venous thrombosis is well established and the value of this knowledge in the management of these patients is becoming recognised. On the other hand, there are many genetic factors in arterial pathology and the role of each taken in isolation is small. Well-targeted large scale trials are required to determine their effects.

Anticoagulants↗

PubMed1981

Training health personnel in the area of breast-feeding.

One of the key factors in the prevalence and duration of breastfeeding is the position taken by health personnel, and the practices adopted in hospitals and health centers. It is thus important that health personnel be made aware of their crucial influence in this domain, and be prepared to provide the necessary information and support 1st to pregnant women in their choice of mode of infant feeding, and then to those who choose to breastfeed. The author analyzes the moments which are critical in the decision to breastfeed and in successful lactation, and recommends on this basis the various elements which should be included in the training of the different categories of health personnel. The successful promotion of breastfeeding depends not only on their acquisition of knowledge in the management of breastfeeding, but also on their attitudes.

Ambulatory Care Facilities↗

PubMed2002

Opioid "mythstakes": opioid analgesics--current clinical and regulatory perspectives.

Barriers to appropriate prescribing of opioids include the deficit in educating medical students in core curricula. Other barriers include physicians' lack of knowledge of pain management, failure to educate their patients or include them in treatment options, and failure to take adequate medical histories and obtain records of their patients' previous treatment. In addition, physicians often lack the ability to distinguish the patient who is suffering pain from the addict. Patients, too, may fear that opioid therapy may cause addiction. This article provides an overview of guidelines and federal regulations for prescribing opioids, along with some caveats, in the hope that physicians and patients alike will appreciate that pain management is an integral part of treatment. And, that treatment is aimed at decreasing or eradicating pain and maintaining patients' function to the greatest possible degree while monitoring and treating side effects.

Analgesics, Opioid↗

PubMed2002

A needs assessment for southern Manitoba physicians for palliative care education.

Recent calls for increased palliative care education of physicians and a need to improve the effectiveness of palliative care delivery in rural areas are the stimuli for this study. The needs assessment evaluated educational needs and preferences of physicians practicing in three Regional Health Authorities in southern Manitoba in 2000, as well as semi-structured interviews with health care workers in seven rural communities. Physicians report their knowledge of symptom management issues as adequate, although for other issues in palliative care such as bereavement, psychosocial aspects of dying, and professional issues, they have less confidence. Physicians prefer learning through case studies, lectures, and self-directed learning, in settings close to their community, on the weekend. Qualitative analysis from the semi-structured interviews revealed themes related to the role of physicians in rural palliative care: i) a need for physician education, ii) physician participation within the palliative care team, and iii) physician involvement in patient-centered care.

Curriculum↗

PubMed2003

Type 2 diabetes in family practice. Room for improvement.

OBJECTIVE: To further knowledge of diabetes management in family practice. DESIGN Retrospective, observational chart audit study. SETTING: Southwestern Ontario. PARTICIPANT: A random sample of non-academic family physicians and a random selection of their patients with type 2 diabetes mellitus. MAIN OUTCOME MEASURES: Glycemic control as measured by HbA1c and adherence to recommendations in clinical practice guidelines (CPGs). RESULTS: Eighty-four percent of patients had at least one HbA1c test ordered in the previous year. Overall mean HbA1c was 0.079 and half-the patients had levels deemed acceptable by 1992 CPGs. Screening for microvascular complications was disappointing; only 28% were tested for microalbuminuria, and 15% were examined for diabetes-related foot conditions. Screening for macrovascular complications was more comprehensive; blood pressure was measured in 88%, and lipid profiles documented in 48%, of patient charts. CONCLUSION: Management of glycemic control and screening for microvascular and macrovascular disease in family practice can be improved.

Adult↗

PubMed2003

[ERAP, a pharmaco-epidemiologic survey on perennial allergic rhinitis in every day medical practice in France].

OBJECTIVE: In order to gain knowledge on the management of perennial allergic rhinitis by the practitioners in France, a survey (Enquête épidémiologique sur la rhinite allergique per-annuelle en pratique quotidienne--ERAP) was developed. METHODS: In the year 2000, 1 346 doctors (including 689 general practitioners) enrolled 3 507 patients consulting for a fall/winter exacerbation of allergic rhinitis. Both doctors and patients filled out a specific questionnaire on the care networks, clinical characteristics, diagnostic modalities and treatment of allergic rhinitis, together with the patients'personal feelings. RESULTS: The patients were bothered on average 6 days a week (5.8 +/- 1.8 days) and 3 months a year (9.2 +/- 7.7 consecutive weeks) by symptoms largely exceeding the ENT area, with frequent ocular symptoms (36.7%), cough (31.9%), sleep disturbances (35.2%) or dyspnea (9.4%). In 70.3% of the patients rhinitis affected their professional life and 90.9% their daily life. The nose was examined in 63.3% of patients and a search for asthma was conducted in 39.3%. In 45.3% subsequent skin prick tests were scheduled and in 53.5% specific IgE measurements and in 33.5% subsequent specialized consultation. Prescribed drugs were mainly oral antihistamines (75.3%) and local glucocorticosteroids (48.5%). Prescriptions were written for a mean duration of 8 weeks. 78.6% considered that the information that they had received was adequate and easy to understand, but 61.1% of patients would have liked to have received more advice. Furthermore, only 48.7% followed their doctor's prescription scrupulously, and 34.3% adapted the prescription. CONCLUSION: Perennial allergic rhinitis indeed impairs quality of life and its management in France is now better understood.

Administration, Topical↗

PubMed1992

General practice based diabetes surveillance: the views of patients.

Forty three patients with non-insulin dependent diabetes registered at two suburban practices were interviewed at least one year after the introduction of an organized general practice based system of diabetic surveillance and the results compared with data gathered from interviews administered before the introduction of the system. Structured data from the two interviews were compared in relation to the importance which patients attached to diabetes and its medical review, patients' preference for place of future review and the health professionals from whom they wished to receive diabetes care. Patients' ratings of the performance of health professionals on various aspects of care were compared with the ratings given before the introduction of the new service. At the follow-up interviews the reasons behind patients' responses to the structured questions were explored using a qualitative method. The introduction of a general practice based diabetes service was marked by an improvement in attendance for diabetes monitoring (56% before introduction, 98% in the year following introduction). This was associated with an increase in the importance which patients attached to diabetes and its medical review. After experience of diabetes care in general practice, patients remained enthusiastic about general practice involvement and confident in their general practitioners' knowledge about diabetes management. In spite of an improvement in the patients' ratings of hospital doctors' communication skills, they continued to rate general practitioners significantly more highly in these skills (P < 0.01) and in terms of convenience and accessibility (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Hand tendon injuries in athletics.

Hand tendon injuries may be caused by acute trauma or chronic overuse. Although these injuries are common in athletics, specific diagnoses can be difficult to make and are often delayed. Early diagnosis is the key to a good outcome. Most hand tendon injuries do well with nonoperative treatment when initiated early. Long-term disruption of the delicate balance of muscle forces in the hand will lead to secondary changes that are often difficult to correct. Delay in treatment of overuse injuries may produce chronic inflammation that does not respond to conservative care and requires operative management. A sound knowledge of hand anatomy, awareness of the differential diagnosis, and a high index of suspicion are needed for proper care of the athletic hand injury.

Acute Disease↗

PubMed2003

The use of inhaled and related respiratory medications in Christchurch rest homes.

AIM: To describe the use of inhaled and related respiratory medications ('asthma medications') and associated management amongst Christchurch rest-home residents. METHODS: Fifty per cent of Christchurch rest homes were randomly selected. All residents on asthma medications, the rest-home managers, care-giving staff, and the residents' general practitioners were interviewed using specific questionnaires. RESULTS: All of the rest homes, residents using asthma medications and senior staff members participated. Seventy five per cent of caregivers and 73% of general practitioners took part. Asthma medications were used by 13% of 1416 rest-home residents. Eighty four per cent of these used a preventer medication, mostly inhaled steroids. Some daily doses exceeded current treatment guidelines. One third of residents using inhalers had an inadequate technique. Some staff and residents chose the wrong inhaler to manage 'shortness of breath'. Regular bronchodilator dosing, rather than 'as required', was common. Those using a spacer device usually had a good technique. Residents appreciated non-pharmacological strategies for breathlessness. Staff identified a need for clear written management plans. CONCLUSIONS: There were significant deficiencies in the staff and residents' knowledge of obstructive airways management and medications. Regular review of inhaler technique, greater use of spacers, and regular staff education may improve residents' respiratory management. Inhaled corticosteroids may be used in too high a dose. Inconsistent management of acutely deteriorating asthma/chronic obstructive pulmonary disease may be addressed by greater use of written management plans in residents' notes.

Administration, Inhalation↗

PubMed2002

How to build an information system application to the health domain.

Computer based information systems aim at improving knowledge, evaluation and management processes. Such tools are still developing in the non-profit sector. This paper aims at: a) reminding how to evolve from data to management information systems b) describing how to build a population based health information system c) describing the concepts required for conceiving a retrieval system and a system for inserting data d) documenting the importance of conceiving the system not only from a user driven perspective, but also taking into account the requirements of an information management system.

Community Health Planning↗

PubMed2004

Crossing the quality chasm: implications for health services administration education.

Programs in Health Services Administration (HSA) should respond to the mandate to improve patient care as put forth by the Institute of Medicine (IOM) and other reports on the proliferation and consequences of medical errors. This article will identify a framework to base curriculum change, competency areas, and educational methods to impart quality improvement knowledge and skills. The first six competency areas reflect the six redesign imperatives from the IOM report, Crossing the Quality Chasm: A New Health System for the 21st Century (2001): redesign of the care process; use of information technologies; knowledge and skills management; development of effective teams; coordination of care; and use of performance and outcomes measurement. Based on a literature review, five additional areas were identified: strategic quality planning; programs for patient safety and risk management; change management; roles of stakeholders, payers and regulators; and development of a learning environment and blame-free culture. Examples of curriculum content are provided from HSA programs at Georgetown University, University of Washington, and University of California at Berkeley.

Clinical Competence↗

PubMed2004

Hereditary haemorrhagic telangiectasia with pulmonary arteriovenous malformations: a treatable cause of thromboembolic cerebral events.

Hereditary haemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu syndrome is associated with mucocutaneous telangiectases and iron deficiency anaemia caused by epistaxis or blood loss from the gastrointestinal tract. We describe a 41-year-old Chinese man who presented with amaurosis fugax secondary to emboli from pulmonary arteriovenous malformations associated with HHT. He was diagnosed with the disorder in adolescence but follow-up in the outpatient setting was incomplete. Early screening and regular follow-up of patients with HHT are important to minimise the risk of development of serious sequelae, such as thromboembolic strokes and cerebral abscesses. Appropriate management demands a knowledge of the risks and benefits of asymptomatic screening and treatment in the rapidly-evolving evidence base for this disease.

Adult↗