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At least 19 recordsLinked to original sources

PubMed1998

Factors associated with elevated rates of adverse outcomes after cyclodestructive procedures versus drainage device procedures.

OBJECTIVE: To identify factors associated with an increased risk of adverse outcomes after cyclodestructive or drainage device procedures. DESIGN: Retrospective, cohort analysis. PARTICIPANTS: A total of 5570 Medicare patients who were older than 65 years of age and who underwent cyclodestructive or drainage device procedures in 1994 participated. INTERVENTION: The authors identified cyclodestructive and drainage device procedures from claims to the Health Care Finance Administration (HCFA) by International Classification of Diseases (ICD-9) procedure codes, Current Procedural Terminology procedure codes, and HCFA Common Procedural Classification System codes. The authors analyzed adverse outcome rates using hierarchical logistic regression. Race, age group, gender, length of observed follow-up, state in which surgery took place, ocular procedures performed before and at the same time as the index surgery, and ocular diagnosis were included as covariates in the model. MAIN OUTCOME MEASURES: The authors defined an adverse outcome as the occurrence after the index surgery of at least one of the following: repeat cyclodestructive or drainage device procedure, retinal hole-tear repair, retinal detachment repair, surgery for endophthalmitis, vitrectomy, enucleation, evisceration, surgery for ocular hypotony, and/or extrusion or revision of drainage device. Adverse outcomes were also defined without the inclusion of repeat cyclodestructive or drainage device procedures. RESULTS: When repeat cyclodestructive or drainage device procedures were not included in the definition of an adverse outcome, eyes with a drainage device procedure were 3.8 times more likely to have an adverse outcome than eyes with a cyclodestructive procedure (odds ratio [OR], 3.8; 95% confidence interval [CI], 3.07, 4.67). Subjects with concurrent corneal transplant had increased odds of an adverse outcome compared to subjects without a concurrent corneal transplant (OR, 2.00; 95% CI, 1.27, 3.15). When the definition of an adverse outcome included repeat cyclodestructive or drainage device procedures, the odds of an adverse outcome were similar for both cyclodestructive and drainage device procedures (OR, 0.94; 95% CI, 0.79, 1.13). CONCLUSIONS: Cyclodestructive procedures need to be repeated more frequently than drainage device procedures. However, if the patient has a drainage device procedure, then that patient is more likely to have other types of adverse ophthalmic events than if he or she had a cyclodestructive procedure. Because the average follow-up of subjects in this study is 5 months (range, 0-12 months), outcomes that might take longer to manifest themselves would be excluded from this study.

Aged↗

PubMed2006

Single ventricle palliation: greater risk of complications with the Fontan procedure than with the bidirectional Glenn procedure alone.

BACKGROUND: This study was performed to evaluate and compare the early, intermediate, and long-term outcomes of the bidirectional Glenn procedure and Fontan procedure in patients who live at moderately high altitude. METHODS: The outcome of each method of palliation for patients with a functionally single ventricle was retrospectively evaluated from a review of medical records. RESULTS: The bidirectional Glenn procedure was performed in 177 patients from October 1984 to June 2004. The Fontan procedure was performed in 149 patients from June 1978 to June 2004. Cardiovascular death or heart transplantation occurred in 8% of patients after the bidirectional Glenn procedure and 17% of patients after the Fontan procedure. Complications of systemic thromboembolic events, bleeding associated with anticoagulation therapy, protein losing enteropathy, and arrhythmias requiring implantation of a pacemaker, cardioversion, or radiofrequency ablation occurred in 7% of patients after the bidirectional Glenn procedure and 47% of patients after the Fontan procedure. Cardiovascular deaths and heart transplantation occurred less frequently when the Fontan procedure was performed in patients with a previous bidirectional Glenn procedure. However, the actuarial transplant-free survival and freedom from complications was not superior for a subgroup of patients who had a Fontan procedure after a bidirectional Glenn procedure in comparison to a subgroup of patients who had a bidirectional Glenn procedure alone. CONCLUSIONS: The bidirectional Glenn procedure can be used for long-term palliation of patients with a functionally single ventricle. Additional palliation with a Fontan procedure may increase the risk of stroke, protein losing enteropathy and arrhythmias without improving survival.

Altitude↗

PubMed2000

Interventional radiologic procedures: patient anxiety, perception of pain, understanding of procedure, and satisfaction with medication--a prospective study.

PURPOSE: To prospectively assess patient anxiety, understanding of the procedure being performed, perception of pain level, and satisfaction with medication given for a variety of diagnostic and therapeutic vascular and visceral (nonvascular) interventional procedures. MATERIALS AND METHODS: The authors interviewed 204 patients before and after they underwent an interventional radiologic procedure. Patients responded to a series of questions by using a visual analog scale. Patients were grouped according to (a) their level of experience with the procedure and (b) the type of procedure performed (diagnostic or therapeutic visceral procedure or diagnostic or therapeutic vascular procedure). RESULTS: Patients who had previous experience with a procedure, whether visceral or vascular, were less anxious, had more understanding, and anticipated less pain than did those who did not have experience with a procedure. Patients who had only local anesthesia for visceral biopsy experienced greater pain than did those who had both local and intravenous anesthesia. Satisfaction scores, however, were similar throughout all groups. CONCLUSION: Patients have a moderate amount of anxiety about interventional procedures and anticipate some discomfort. Most patients have a high level of satisfaction despite the amount of pain they experience during the procedure. Patients experienced with a procedure tend to have a greater understanding of the procedure and less anxiety.

Adult↗

PubMed2006

Procedure lab used to improve confidence in the performance of rarely performed procedures.

OBJECTIVES: The objective of this study is to assess the efficacy of an animal procedure lab in improving the level of comfort in performing important emergency medicine procedures. The procedures included central venous line, chest tube, cricothyrotomy, pericardiocentesis, venous cutdown, and thoracotomy. METHODS: The students were physicians participating in the Tuscan Emergency Medicine Initiative as part of a certificate program in emergency medicine. They attended a 1-h lecture discussing the procedures to be performed. Participants filled out a questionnaire before and after the lab, which asked how many times they had performed each procedure, how comfortable they felt, on a five-point scale, performing each procedure, and whether they felt comfortable performing it by themselves, with assistance or whether they would not feel comfortable performing the procedure. Differences in rated numerical values for each procedure before and after the lab were analyzed using a two-tailed t-test. Alpha was set at 0.95. RESULTS: In all, there were 20 participants with a wide range of experience. A statistical improvement was observed in comfort level and willingness to perform the procedures independently (P<0.01). The only non-significant change was in willingness to perform central lines. CONCLUSIONS: The use of an animal lab improves the comfort level of practitioners in performing procedures. Although procedures are best learned on patients with supervision, this is not always feasible. This lab is a useful adjunct to teaching in emergency medicine and allows participants exposure to critical procedures.

Clinical Competence↗

PubMed1998

An indirect revascularization method in the surgical treatment of moyamoya disease--various kinds of indirect procedures and a multiple combined indirect procedure.

The indirect non-anastomotic bypass procedures for moyamoya disease are herein reviewed, and our multiple combined indirect procedure, i.e. a fronto-parieto-temporal combined indirect bypass procedure, is also introduced. Direct procedures such as superficial temporal artery-middle cerebral artery anastomosis are able to form collaterals with a high reliability, but these procedures are often difficult to technically perform in small children, and complications, when they occur, tend to be severe. Indirect procedures, such as encephalo-duro-arterio-synangiosis (EDAS), encephalo-myo-synangiosis (EMS), and encephalo-myo-arterio-synangiosis (EMAS) etc., are safe and easy and also successfully form collaterals especially in children with moyamoya disease. However, there are a few drawbacks with such procedures. They do not always form sufficient collaterals. The area where the original EDAS using the posterior branch of the superficial temporal artery can be done is also limited. Moreover, because the area covered by each single procedure is small, the collateral formation obtained by a single procedure is not always satisfactory. For these reasons we developed a fronto-temporoparietal combined indirect bypass procedure for child patients in order to overcome these problems. This multiple combined indirect procedure can cover a wider area of the ischemic brain through the EMAS in the frontal and the EDAS and EMS in the temporo-parietal regions. It is also safe and easy to perform, and one or two of these three procedures form sufficient collaterals with a relatively high reliability. This technique is described and the results are presented.

Cerebral Revascularization↗

PubMed1996

[The practical theory of occupational health planning: Part Two--The theoretical background from the priority setting procedure to the post project appraisal making procedure (OPST research report 3)].

This report focuses on the final six procedures of the 8-stage OPSS. The first two procedures were covered in an earlier report. This paper examines the theoretical underpinnings of these six procedures. In the Priority Setting procedure, three factors are compared (TCP; Time/timing, cost, and population) for the OPSS in the general community, and also those in industry. These sometimes differ, especially with respect to responsibility and implementation. TCP allows the appropriate factors to be considered for a more objective prioritization of the various factors. As discussed earlier, the first TCP is used for prioritizing occupational health problems through the Needs assessment procedure. The second TCP prioritizes the countermeasures of those problems selected in the first TCP. In the Program Design procedure, we discuss the MIO (Merit, Impact, Outcome). Merit is defined as the effectiveness of a program as viewed by the company, taking into account the managerial and social merits. Impact refers to the behavioral effectiveness and behavioral change from the viewpoint of the program designer. Outcome refers to the effectiveness of the program from the traditional medical and epidemiological view-point. The study goes on to discuss the relationship amongst participation level, program development, and the subject's compliance, as a means to ensure that subjects participate indirectly through both steps of OHQ. In the Presentation procedure, we summarize the flow of effective presentations in the company setting. This covers initial understanding of the target audience wants, together with what the planner wants to focus on. In this way common issues and themes can be developed. Further assistance is given with strategy formation, presentation aids, time category presentations, evaluation and feedback. In the Process and Final Evaluation procedures, we discuss the objectives, and their significance to the overall process. In the Post Project Appraisal Making procedures, the previous three procedures are strongly affected by each proceeding procedure. In OPSS, we did not include the program development step in the Program Design procedure because the development skills can be referred from behavioral sciences methodologies. In the final part of this paper, we discuss the merits of the underlying theories of behavioral sciences, which have potential to apply to the occupational health settings.

Health Planning↗

PubMed2003

Procedural outcomes of repeated transradial coronary procedure.

We evaluated the changes in radial arterial diameter and the procedural outcomes of repeated transradial procedures through the same radial artery in 117 cases. No significant differences were found in the mean diameter of the radial artery between preprocedure and 1 day after procedure on initial and repeated procedures. However, the mean radial arterial diameter was significantly decreased from 2.63 +/- 0.35 to 2.51 +/- 0.29 mm during follow-up after the initial procedure (P = 0.01). There was no significant difference in the vascular access times of the initial and repeated procedures (2.9 +/- 3.1 vs. 3.3 +/- 3.6 min; P = 0.08), and procedural success of repeated procedure was similar to those of the initial procedure. However, the incidence of radial arterial occlusion was higher for repeated procedures (2.6% vs. 0%; P = 0.01). We conclude that the repeated use of the radial artery is feasible in most patients with a high procedural success rate and low vascular complications.

Aged↗

PubMed2000

Should interventional cardiac catheterization procedures take place at the time of diagnostic procedures?

BACKGROUND: In many cardiac catheterization laboratories interventional procedures are performed at a date later than the diagnostic study, causing increased hospital days and costs. Few data exist which compare procedural success, complications, and costs between procedures performed at the time of diagnostic study and those performed later. HYPOTHESIS: The purpose of this study was to evaluate the safety and success of same-day interventional procedures and to quantitate hospital cost savings with this strategy. METHOD: In all, 357 consecutive patients who underwent an elective interventional procedure of a native coronary artery either at the time of diagnostic study (same day, n = 244) or later (delayed, n = 113) were reviewed. Procedural success [< 30% residual lesion post-percutaneous transluminal coronary angioplasty (PTCA) or 0% residual lesion post-stent], major complications [death, emergent coronary artery bypass grafting (CABG), myocardial infarction, and ventricular fibrillation], hospital days, and costs were analyzed. Procedural expense, including the diagnostic and interventional procedure in the cardiac catheterization laboratory, and hospital expense were analyzed. RESULTS: Both groups were similar in terms of age, gender, coronary risk factors, indications (myocardial infarction, unstable angina, abnormal stress test), the culprit coronary artery, type of intervention (PTCA, stent), and lesion complexity (type A, B, C). The average hospital stay for the two groups was 4.37 +/- 2 and 6.55 +/- 2.4 days, respectively (p < 0.0001). The procedural charges were $8,207.99 and 10,581.87, respectively (p < 0.0001). CONCLUSION: Catheter intervention performed at the same time as the diagnostic cardiac catheterization procedure is as successful and as safe as that performed at a later date. Hospital stay and costs, as well as procedural expenses are significantly reduced by this practice.

Adult↗

PubMed1993

Restenosis rate after multiple percutaneous transluminal coronary angioplasty procedures at the same site. A quantitative angiographic study in consecutive patients undergoing a third angioplasty procedure for a second restenosis.

BACKGROUND: Several studies suggest that repeated percutaneous transluminal coronary angioplasty procedures at the same site are associated with a progressively increasing risk of further restenosis and that short time intervals between successive procedures are predictive of future restenosis. METHODS AND RESULTS: We assessed by quantitative coronary angiography the angiographic probability of restenosis when repeat percutaneous transluminal coronary angioplasty was performed at a site where restenosis had occurred after two previous angioplasty procedures. Of 99 consecutive patients who underwent a third angioplasty procedure, 96 had successful procedures. Uncomplicated failure (residual stenosis > or = 50%) occurred in 3 patients. No major complications occurred. Follow-up angiography was routinely advised; it was performed in 83 patients (86%) with successful procedures. Restenosis (recurrence of > or = 50% stenosis determined by quantitative coronary angiography) occurred in 32 patients (39%). An interval of < 3 months between the second and third angioplasty was strongly associated (P < .005) with the occurrence of further restenosis after a third procedure. CONCLUSIONS: The angiographic probability of further restenosis after three successive angioplasty procedures at the same site is similar to that reported after a first angioplasty procedure in studies that used a similar definition of restenosis. Patients who undergo a third angioplasty procedure within 3 months of a previous procedure at the same site have a much higher risk of subsequent restenosis. This easily identified subgroup may benefit from an alternative therapeutic approach.

Angioplasty, Balloon, Coronary↗

PubMed1992

[Operation of female stress incontinence--comparison between Raz procedure and Gittes procedure].

We performed Raz procedure and Gittes procedure for female stress incontinence since October 1986. Raz procedure was performed on 19 patients between October 1986 and February 1990, and Gittes procedure was performed on 18 patients between June 1990 and May 1991. We followed up 17 patients who underwent Raz procedure and all the patients who underwent Gittes procedure at the time August 1991. Disappearance or marked improvement of incontinence was confirmed in 12 patients by Raz procedure, and 16 patients by Gittes Procedure. No serious complications were recognized. The reason why the result of Raz procedure was not sufficient was due to our immature operative technique and incorrect patient selection in our early experience. From this experience, we believe that both procedures can be very useful and minimal invasive operation for female stress incontinence.

Adult↗

PubMed2000

Sucrose for analgesia in newborn infants undergoing painful procedures.

BACKGROUND: Management of pain for neonates is less than optimal. The administration of sucrose with and without non-nutritive sucking (pacifiers) has been the most frequently studied non-pharmacological intervention for relief of procedural pain in neonates. OBJECTIVES: To determine the efficacy, effect of dose, and safety of sucrose for relieving procedural pain as assessed by physiologic and/or behavioural indicators. SEARCH STRATEGY: Standard methods as per the Neonatal Collaborative Review Group. A MEDLINE search was carried out for relevant randomized controlled trials (RCTs) published from January 1966 - November 1, 1997; EMBASE from 1993-1997; Reference Update search on November 11, 1997 and search of the Cochrane Library Issue 4 on November 11, 1997. Key words and (MeSH) terms included, infant/newborn, pain, analgesia and sucrose. Personal files, bibliographies, the most recent relevant neonatal and pain journals and conference proceedings were searched manually. Unpublished studies were not included. Language restrictions were not imposed. SELECTION CRITERIA: RCTs in which term and/or preterm neonates undergoing heel lance, venepuncture or intramuscular injection (immunization) received sucrose or water/placebo or no intervention. DATA COLLECTION AND ANALYSIS: Trial quality was assessed according to the methods of the Neonatal Collaborative Review Group. Quality measures included; blinding of randomization, blinding of intervention, completeness of follow up and blinding of outcome measurement. Data were abstracted and independently checked for accuracy by the two investigators. The inconsistency in outcome measures and differences in the statistical reporting of results made meta-analysis impossible. We were not able to identify two studies in which the same physiologic and/or behavioral outcomes following a noxious stimulus (heel-lance, venepuncture, intramuscular injection) were measured and reported in an identical fashion using means and standard deviations (or standard errors). The results are therefore reported for each accepted study separately. MAIN RESULTS: Fifteen studies were identified for possible inclusion in this systematic review. Five studies were excluded; three RCTs were excluded as in these trials the number of infants randomized to treatment vs. placebo groups were not reported; one study was not an RCT, and in one RCT the neonates did not undergo a painful procedure. Ten RCTs were included in this review. Sucrose in a wide range of dosages was generally found to decrease univariate physiologic (heart rate) and behavioural (the mean percent time crying, total cry duration, duration of first cry, and facial action) pain indicators and multivariate [Premature Infant Pain Profile (PIPP)] pain outcomes in neonates undergoing heelstick or venepuncture. An optimal dose of sucrose to reduce pain associated with procedures in preterm and term neonates could not be identified through this systematic review. REVIEWER'S CONCLUSIONS: Sucrose reduces physiologic and/or behavioral indicators of stress/pain in neonates following procedural pain stimuli (heel lance, venepuncture, immunization). There was inconsistency in the dose of sucrose that was effective and an optimal dose to be used in preterm and/or term infants could not be identified. Considerations for future research are to describe the painful procedure and intervention in detail, to use appropriate sample size to show a statistically significant reduction in pain, to use a multidimensional conceptualization of pain, to select outcome measures that are reliable and valid pain indicators and to account for the variation in the infant's response and context in which the pain is experienced. The use of repeated administrations of sucrose in neonates needs to be investigated. Use of sucrose in neonates that are very low birth weight, unstable and/or ventilated also needs to be addressed. (ABSTRACT TRUNCATED)

Analgesics↗

PubMed2003

The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures.

BACKGROUND: For the last decade, the Cox maze III procedure has been available for the treatment of atrial fibrillation. It is unknown whether the operation has similar efficacy in patients with lone atrial fibrillation compared with that in patients with atrial fibrillation associated with coronary, valve, or congenital heart disease. This study examined the long-term outcome of patients who underwent this procedure either as a lone operation or as a concomitant procedure. METHODS: From 1988 to 2001, 198 patients underwent a Cox maze III procedure; 112 were lone operations, and 86 were concomitant procedures. Major complications included renal failure, reoperation for bleeding, mediastinitis, stroke, and balloon pump insertion. Follow-up was performed by means of mail and telephone questionnaires with both the patients and their cardiologists. All patients who had any history of arrhythmia or who were taking medication had their rhythm documented by means of electrocardiography. RESULTS: The lone operation group was significantly younger (51.3 +/- 10.5 vs 58.8 +/- 9.9 years) and had a higher male/female ratio (4:1 vs 2:1). There was no difference in operative mortality between groups (1.8% vs 1.2%). At a follow-up of 5.4 +/- 2.9 years, 96.6% (172/178) of all patients were free of atrial fibrillation. There was no difference between the lone operation and concomitant procedure groups (95.9% vs 97.5%). CONCLUSION: The Cox maze III procedure has equivalent operative risk and long-term efficacy in patients undergoing both lone operations and concomitant procedures. The Cox maze III procedure remains the standard against which alternative procedures for atrial fibrillation must be judged.

Adult↗

PubMed2003

Resource utilization and procedure parameters for the Stretta procedure: comparison with endoscopic ultrasonography and colonoscopy.

BACKGROUND: No data are available regarding resource utilization of the Stretta procedure and its impact on endoscopy units in comparison with other endoscopy procedures. METHODS: This observational cohort study compared the demographic data and procedural parameters for our first 13 cases undergoing the Stretta procedure, with similar endoscopic colonoscopy and ultrasonography (EUS) cases. RESULTS: The characteristics of the patients were similar among these groups. The patients undergoing the Stretta procedure required significantly more sedative medication than those undergoing colonoscopy or EUS. The Stretta procedure time and recovery time were significantly longer than the colonoscopy procedure time and recovery time. The Stretta procedure time was also significantly longer than the EUS procedure time, but the Stretta recovery time was not significantly longer than the EUS recovery time. CONCLUSIONS: Although this study is small and not randomized, it provides useful information regarding how endoscopic procedures compare with one another. Furthermore, these findings have implications for determining endoscopy unit staffing, work equivalency, and appropriate reimbursement.

Adjuvants, Anesthesia↗

PubMed2002

Emergency department resuscitative procedures: animal laboratory training improves procedural competency and speed.

UNLABELLED: Certain resuscitative procedures can be lifesaving, but are performed infrequently by emergency medicine (EM) residents on human subjects. Alternative training methods for gaining procedural proficiency must be explored and tested. OBJECTIVE: To test whether animal laboratory training (ALT) is associated with sustained improvement in procedural competency and speed. METHODS: After watching an educational videotape of saphenous cutdown (SAPH), thoracotomy (THOR), and cricothyroidotomy (CRIC), EM residents were randomized to receive either a tutored ALT session on live anesthetized pigs (Group A) or no ALT session (Group B). Residents were tested six months later by performing procedures on live anesthetized pigs. Videotaped procedures were evaluated by blinded examiners for the number of critical steps, complications, and procedure times. RESULTS: Group A (n = 10) achieved a higher number of critical steps compared with Group B (n = 8) for SAPH (15.4 +/- 0.7 vs. 9.0 +/- 1.8, p = 0.03) and THOR (17.4 +/- 0.6 vs. 12.3 +/- 1.6, p = 0.009), but not CRIC (18.1 +/- 0.4 vs. 16.2 +/- 1.0, p = 0.1). Group A completed procedures in less time than Group B for SAPH (Wilcoxon chi(2) = 4.0, p = 0.04) and THOR (chi(2) = 4.4, p = 0.04), but not CRIC (chi(2) = 0.9, p = 0.3). There was no difference in the number of complications for any of the procedures. CONCLUSION: Residents with animal laboratory training six months prior to testing demonstrated improved procedural competency and speed in the performance of resuscitative procedures.

Adult↗

PubMed2000

Effect of the learning process on procedure times and radiation exposure for CT fluoroscopy-guided percutaneous biopsy procedures.

PURPOSE: To assess if the learning process associated with computed tomography fluoroscopy (CTF) technology influences procedure and fluoroscopy times for percutaneous biopsy procedures. MATERIALS AND METHODS: Prospective analysis of the initial 250 consecutive patients who underwent percutaneous biopsy with use of a CT scanner equipped with rapid image reconstruction and fluoroscopic capabilities in a 24-month period. All procedures were performed with both continuous and spot fluoroscopic technique, with typical radiation parameters of 50 mA, 120 kV, and a 10-mm-slice thickness. The procedures were all performed by a single experienced interventional radiologist to limit the variables of physician expertise, interventional materials used, and biopsy approach. The subject group was divided into five equal consecutive groups of 50 patients. In each subgroup, the authors recorded mean lesion size, success, and complication rates, as well as mean procedure and fluoroscopy times. RESULTS: The five subgroups were similar patient populations as documented by the absence of statistically significant differences when comparing mean lesion size, procedure success, and complication rates (P > .05; ANOVA test). A statistically significant decrease in mean fluoroscopy (groups 1-5: 50.26 vs 45.24 vs 33.86 vs 32.68 vs 25.8 sec/patient) and mean procedure times (groups 1-5: 30.08 vs 27.9 vs 26.34 vs 25.6 vs 21.6 min/patient) was recorded between the patient subgroups (P < .0001; ANOVA test). CONCLUSION: The learning process associated with CTF technology impacts procedure parameters by decreasing both mean procedure and fluoroscopy times, thereby increasing patient turnover and decreasing radiation exposure to the patient and the operator.

Adult↗

PubMed2005

Clinical and procedural predictors of nurse workload during and after invasive coronary procedures: the potential benefit of a systematic radial access.

BACKGROUND: Invasive coronary procedures are increasing in number and complexity over time. This trend translates in an increased need for economical and human resources, among which is nurse staffing the most affected. AIMS: To identify possible predictors of nurse workload, during and after diagnostic and interventional procedures. METHODS: Two hundred and sixty consecutive patients were included: 52 and 208 patients underwent femoral and radial access, respectively. Nurse workload was calculated with a self-developed model. RESULTS: Cathlab nurse workload was 103 [63--156] min. Independent predictors of increased Cathlab nurse workload were: femoral access, failed radial access and cross-over, interventional procedures, procedural time, urgent procedures. Cathlab nurse workload was 174 [134--218] and 86 [58--126] min, for femoral and radial access, respectively (p<0.001). Among the overall population, 174/260 patients (44 females, mean age 66+/-11 years) were hospitalised at our Center after the procedure. Fifty-six and 118 patients had femoral and radial access, respectively. Ward nurse workload was 457 [226--954] min. Independent predictors of increased Ward nurse workload were: access-site complication, length of in-hospital stay, admission to CCU, interventional procedures. Ward nurse workload was 386 [226--652] and 720 [314--1375] min, respectively for radial and femoral access (p<0.001). CONCLUSIONS: A systematic radial access is an effective strategy for reducing nurse workload, both during, by simplifying nurse tasks in the CathLab, and after coronary invasive procedures, by preventing access-site complications, shortening in-hospital stays, and reducing admissions to CCU.

Aged↗

PubMedDate not supplied

Anterior modification of Delorme procedure provides equivalent results to Delorme procedure in treatment of rectal outlet obstruction.

BACKGROUND: This study was designed to assess the results of the standard Delorme procedure versus an anterior modification of the Delorme procedure in the treatment of patients with rectal outlet obstruction secondary to internal intussusception with or without rectocele. STUDY DESIGN: A descriptive retrospective study from October 1997 to May 2001 was undertaken. Twenty-seven patients with symptoms of rectal outlet obstruction assumed to be caused by internal rectal prolapse or a combination of internal rectal prolapse and rectocele underwent surgical repair. Twenty-two patients had preoperative defecography and anal manometry. Thirteen patients had an anterior Delorme repair; 14 patients had a standard Delorme repair. Selection of procedure was chronologic with the standard Delorme undertaken in the earlier group. Preoperative and operative data were collected retrospectively. RESULTS: Twenty-seven women, aged 29 to 94 (mean, 62.0 for anterior Delorme, 66.3 for Delorme) years were followed up for the duration of the study (mean follow-up, 15.9 months for anterior Delorme and 32.1 months for Delorme). Twelve patients (92.3%) reported a good to excellent overall result after the anterior Delorme procedure versus 14 patients (100%) in the Delorme group. Symptomatic improvement was observed in 85.7% of patients who had incomplete evacuation in the anterior Delorme group versus 90.9% in the Delorme group. Symptoms of constipation, bleeding, and the need to manually assist in defecation by pushing in the perineum or vagina improved in 100% of patients in both groups. Discontinuation of laxative use after the procedure was reported by 75% of patients in the anterior Delorme group versus 100% in the Delorme group. Eight patients experienced minor complications, 4 of these being urinary retention. In the postoperative period, no patients in the modified group experienced incontinence. Sixty three percent of the Delorme group experienced some sort of incontinence within the first 2 to 3 months (p = 0.038). CONCLUSIONS: An anterior modification of the Delorme procedure, which requires less operative dissection, can be performed with results nearly equivalent to those of the established Delorme procedure in the treatment of rectal outlet obstruction secondary to internal intussusception with or without rectocele.

Adult↗

PubMed2001

A new procedure for chronic atrial fibrillation: bilateral appendage-preserving maze procedure.

BACKGROUND: Atrial transport and atrial natriuretic peptide secretion is severely reduced from normal after the maze III procedure. To improve these factors, we developed a bilateral appendage-preserving maze procedure (BAP-maze). METHODS: Forty-six patients with chronic atrial fibrillation who underwent the BAP-maze procedure were compared with 40 patients who underwent the maze III procedure. The ratio of the peak velocity of the A and E waves of transmitral flow (transthoracic pulsed Doppler echocardiography), the left atrial appendage ejection fraction (transesophageal echocardiography), and the atrial natriuretic peptide secretory reserve during treadmill exercise test were measured at 6 months postoperatively. RESULTS: Sinus rhythm was restored in 44 patients (95.7%) by the BAP-maze procedure and in 39 patients (97.5%) by the maze III procedure. The ratio of the peak velocity of the A and E waves was 0.52 +/- 0.22 in the BAP-maze group and 0.25 +/- 0.19 in the maze III group (p < 0.0001). The left atrial appendage ejection fraction was 44.7% +/- 11.5%, and the atrial natriuretic peptide secretory reserve was greater in the BAP maze group (p = 0.037). CONCLUSIONS: The BAP-maze procedure improved atrial transport and atrial natriuretic peptide secretion as well as simplifying the maze operation, without decreasing its effectiveness against atrial fibrillation.

Aged↗