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Biomedical subjects

A Allen

Publications and source records attributed to A Allen.

At least 127 records · Page 7Linked to original sources
PubMed1996

Long-term results of urolume urethral stent for recurrent urethral strictures.

PURPOSE: We present the long-term results of the first 50 patients treated with a new urethral stent (UroLume) developed in 1985 for recurrent bulbomembranous urethral strictures. MATERIALS AND METHODS: All stents were inserted with the patient under general anesthesia using a standard endoscopic delivery system. Of the patients 27 were followed for 5 years or longer, 5 for 4 years and 18 for shorter periods due to death, illness or other factors. RESULTS: Mean (plus or minus standard deviation) maximum flow rate at last following was 19.7 ml. per second (+/- 6.9), and 93% of the patients were satisfied with the stent. In 8 patients (16%) narrowing developed within the lumen of the stent and in the remaining 84% the stent achieved its purpose of maintaining a good urethral lumen. In 9 patients stricture recurred outside the stent because of inaccurate positioning. All of these complications were satisfactorily treated by an additional overlapping stent. Failures occurred particularly in patients with a long stricture history and extensive periurethral fibrosis. CONCLUSIONS: These results indicate that at 4 to 6 years promising early results with the UroLume stent for urethral strictures are maintained with a low late failure rate. This device is not suitable for all strictures and cases with extensive periurethral fibrosis should be avoided but it remains a useful and successful treatment option for many recurrent bulbomembranous urethral strictures.

Adult↗
PubMed1995

Telemedicine protocols and standards: development and implementation.

Telemedicine is likely to adopt rather than create most of its protocols and standards as it becomes an integral part of medical practice. To optimize this process, it will be necessary to understand how to use existing protocols and standards, and influence the development, evaluation, and modification of new ones. We have identified key participants in standards setting activities under the titles of international government, United States government, professional certifying organizations, and independent institutes. We have reviewed their roles in establishing standards for identification of patients and providers, content and structure of patient records, terminology and codes of medical information and records, and transfer of messages and data. We have addressed requirements for storing and viewing images, the impact of image resolution on accuracy of clinical interpretation, the choice of communications protocols to satisfy transmission requirements, the need to link images and text data, and the evaluation of telemedicine systems.

Computer Communication Networks↗
PubMed1995

Electrophysiologic effects of antiarrhythmic drug therapy in the prediction of successful suppression of induced ventricular tachycardia.

Predictors of a successful outcome of serial electrophysiologic (EP) and drug studies have been identified from among baseline patient characteristics but not from among measures of baseline and drug-related EP effects. Identifying such predictors would be useful in explaining the mechanism of successful drug therapy and in guiding drug development and selection. We prospectively studied EP characteristics in 159 trials in 62 patients with ventricular tachycardia or ventricular fibrillation during antiarrhythmic therapy and compared EP measures between successful (n = 30) and failed trials (n = 129). The average age of the patients was 64 years (range 27 to 78 years); 82% were men and 18% women; and 87% had coronary artery disease. Measurements included R-R, QRS, and QT intervals during intrinsic rhythm and during pacing at cycle lengths of 600 of 400 msec; ventricular effective refractory periods (ERP) during pacing at cycle lengths of 600 and 400 msec; and changes in these measures, comparing treatment with drug-free baseline. Univariate predictors of success (in order of significance) included ERP600/QRS600, sotalol versus other drugs, ERP400/QRS400, delta ERP600, delta R-R, ERP600, QRS400 (negative association), delta ERP400, QRS600 (negative association), ERP400 (all p < 0.1). In two separate multivariate models, one for each drive cycle length, only the ratio ERP600/QRS600 (p = 0.01) in the first model and ERP400/QRS400 (p = 0.01) in the second model were significantly and independently associated with achieving noninducibility with drug therapy. Therefore measures of greater refractoriness and lesser delays in conduction velocity (ie, greater "wavelength") relate to drug success.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Double-blind, randomized, placebo-controlled Canadian multicenter trial of two doses of synthetic surfactant or air placebo in 224 infants weighing 500 to 749 grams with respiratory distress syndrome. Canadian Exosurf Neonatal Study Group.

In a multicenter, double-masked, placebo-controlled rescue trial conducted at 12 Canadian hospitals, two 5 ml/kg doses of a synthetic surfactant or air placebo were administered to 224 infants with birth weights of 500 to 749 gm who had established respiratory distress syndrome and an arterial/alveolar oxygen tension ratio of less than 0.22. The first dose was given between 2 and 24 hours of age; the second dose was given 12 hours later to the infants continuing to receive mechanical ventilation. Infants were stratified at study entry by birth weight and gender. Infants receiving synthetic surfactant showed significant improvements in alveolar-arterial oxygen tension gradient, arterial/alveolar oxygen tension ratio, and oxygen and ventilator requirements through day 7. In the group randomized to synthetic surfactant, significant improvements were seen in oxygen requirements at the first time point measured (2 hours; p = 0.02), in the alveolar-arterial oxygen tension gradient by the second time point measured (6 hours; p = 0.03), and in mean airway pressure after 6 hours. Overall mortality at 28 days was not significantly different in the two groups (50% vs 46%, air placebo group vs synthetic surfactant group; p = 0.586). Similarly, neither the incidence of bronchopulmonary dysplasia (37% vs 30%, air placebo group vs synthetic surfactant group; p = 0.089) nor the incidence of survival without BPD through 28 days (17% vs 26%, respectively; p = 0.070) was significantly different in the two groups. No significant differences in the incidence of safety-related outcomes or in adverse effects such as apnea or pulmonary hemorrhage were noted. These findings indicate that rescue therapy with synthetic surfactant results in physiologic improvements in very tiny premature infants, but improvements in overall mortality or other complications of respiratory distress syndrome were not documented in the sample evaluated.

Air↗
PubMed1995

Analysis of telemedicine from an organizational perspective.

OBJECTIVES: To conduct an in-depth case analysis of the University of Kansas Telemedicine Program in order to identify organizational and communications elements that may be hindering the program's effectiveness. METHODS: A case analysis was done, employing a combination of methodologies (direct observation, interview, and survey) involving extensive data collection from telemedicine program personnel throughout the state of Kansas. Analysis of this program's organizational communication focused on structure and boundaries, definitions and goals, leadership and decision making, and membership and roles. RESULTS: Significant organizational communication deficits were identified. These included a dearth of perceived central leadership, lack of information about the technology itself, poorly designed and cumbersome means for scheduling and utilizing telemedicine technology, absence of explicit strategic goals; and poor communication in introducing this technology to medical personnel and to the public. Other important findings were: organizational members expanded the scope of this organization beyond the providing of a simple consultation; the perception that decision making falls into the hands of almost everyone but the referring physician; and the role that language (or lack of common terminology) plays in confusion about this innovation. CONCLUSION: Organizational factors may be critical determinants of success or failure of a telemedicine program. Innovations in telemedicine technology need to be matched by innovations in organizational communication and structure. Findings from this study can be applied to existing or planned programs. Examples include redefinition of the roles and responsibilities of certain personnel, increasing the efficiency and decreasing the complexity of the consultation scheduling process, clarification and formalization of leadership and decision making, and development of a universal terminology of telemedicine.

Academic Medical Centers↗
PubMed1995

Patient satisfaction with teleoncology: a pilot study.

OBJECTIVE: To assess levels of satisfaction among rural cancer patients being seen for clinic visits by their remote university-based oncologist, using interactive videoconferencing (IAVC). METHODS: A 12-item survey instrument assessing satisfaction with the patient-physician clinical interaction was administered to 39 cancer patients who were seen using IAVC. A similar survey, comprised of 9 of the 12 items used in the initial survey, was administered to 21 of these patients after a subsequent on-site clinical interaction. All items were responded to on a five-point Likert scale. Levels of satisfaction with the two consultation modes (IAVC mediated and on-site) were compared. RESULTS: Relatively high levels of patient satisfaction with the telemedicine encounter were recorded both at the time of the initial IAVC-mediated clinical visit, as well at the follow-up on-site visit. With one exception, for each of the survey items, both initially and on follow-up, mean score was above 3.0 (i.e., positive). CONCLUSION: This small pilot study suggests that rural cancer patients may be satisfied with seeing their oncologist via telemedicine, at least on an occasional basis. Although the accrual numbers are too small to allow the results to be generalizable, the results suggest that patient acceptance is high enough to warrant further investigation of this modality in the care of rural cancer patients with limited access to cancer specialists.

Aged↗
PubMed1995

A pilot study of the physician acceptance of tele-oncology.

During the winter of 1993, medical oncologists from an urban, university-based hospital provided oncology care to rural patients using interactive video clinics (tele-oncology). In order to assess physician satisfaction with this form of outreach, surveys were performed after the video encounters, as well as after a limited number of subsequent clinical encounters on site. Various aspects of satisfaction were evaluated. Although the sample was small (a total of 41 clinical encounters and 3 oncologists), the results suggested that there was a reasonable level of physician satisfaction with, and confidence in, the use of video to replace some on-site oncology consultations. A definitive study of tele-oncology for providing care to rural cancer patients therefore appears to be warranted.

Analysis of Variance↗
PubMed1995

A view from the other side of the bed.

Some of the changes in the care of hospital inpatients are discussed. How are nurses responding to staff downsizing, reorganization, and other cost-cutting measures? The author recounts her personal quest for answers in her roles as a concerned nurse, a nursing instructor, and a hospital patient.

Faculty, Nursing↗
PubMed1995

Women working with women.

More women than ever before are working outside their homes. Many of these women are caught in a conflict between internal needs, desires, and beliefs and external demands. Work can become merely a means to an end, a burden to be endured, or a satisfying aspect of our lives. Some strategies for creating and defining ourselves for ourselves are offered.

Adaptation, Psychological↗