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Biomedical subjects

J G Stevenson

Publications and source records attributed to J G Stevenson.

At least 37 records · Page 2Linked to original sources
PubMed1995

Role of intraoperative transesophageal echocardiography during repair of congenital cardiac defects.

Intraoperative epicardial echocardiography has been available for several years, and has been demonstrated to be very useful in intraoperative echocardiography. With the availability of small pediatric transesophageal (TEE) probes, it has become possible to perform intraoperative TEE in infants and children of all sizes. With advantages of serial assessment of anatomy, function and flow, and lack of interference in the operative field, TEE has become routine in many surgical centers. Our experience supports its routine use in nearly all patients undergoing repair of congenital heart disease. We generally use pediatric probes in patients less than 15 kg and adult size probes for those over 15 kg. Examinations are performed before and after bypass for use in surgical planning, anesthetic and hemodynamic management, and in evaluation of repairs. In 44 of 667 (6.6%) cases, TEE findings prompted a return to bypass for further surgery or revision of surgery. In 75% of these patients, the problem identified by TEE was relieved, and patients had a good outcome. The benefit obtained by avoiding later reoperation in these patients has also proved cost-effective, supporting the use of TEE on a routine basis. Complications have been few (24/667, 3.5%), without long-term sequelae. They include failure to insert the TEE probe (1.2%), airway obstruction (0.9%), vascular compression (0.7%), tracheal extubation (0.6%) and gastric incision (0.1%); several of these complications are now considered avoidable. Intraoperative TEE offers major advantages in intraoperative assessment and management of patients undergoing repair of congenital heart disease.

Child↗
PubMed1994

Intraoperative transesophageal echocardiography of coronary artery fistulas.

Coronary artery fistula is a rare abnormality but one with substantial surgical importance, as operation abolishes the fistulous shunt volume, progressive coronary dilatation, and potential coronary steal. Prior reports emphasize the utility of direct inspection on cardiopulmonary bypass, with visualization of drainage of blood or cardioplegia from the fistulous connection, to define the drainage site. We report 3 patients in whom intraoperative transesophageal echocardiography was used for precise localization of the fistulous drainage site, selective demonstration of vessels feeding the fistulas, and documentation of abolition of fistulous flow, all without need for cardiopulmonary bypass. In addition, the technique provides for continuous monitoring of ventricular function, providing the opportunity to detect inadvertent ischemic effects of ligation. This approach appears to have considerable utility.

Child, Preschool↗
PubMed1994

Evaluation of cilazapril versus captopril in patients with mild to moderate essential hypertension.

OBJECTIVE: Cilazapril, a long-acting angiotensin converting enzyme (ACE) inhibitor, was evaluated against captopril for safety and efficacy in the treatment of mild to moderate essential hypertension. METHODS: One hundred thirty-two patients were randomly assigned to receive cilazapril, 2.5 mg once daily; 62 patients were randomly assigned to receive captopril, 25 mg twice daily. If necessary, dosage was increased to 5.0 mg cilazapril, once daily or 50 mg captopril, twice daily. Adjunctive hydrochlorothiazide (12.5 mg once daily) was later added to this higher dosage, if required. RESULTS: After eight weeks of monotherapy, sitting diastolic blood pressure (SDBP) had decreased 7.5 mm Hg from baseline for cilazapril-treated patients, versus 5.6 mm Hg for captopril-treated patients. These decreases were 7.6 mm Hg and 6.8 mm Hg for cilazapril and captopril, respectively, at Week 12. At Week 8, 36.5% of patients receiving cilazapril had achieved a SDBP of 90 mm Hg or less, versus 26.0% of captopril-treated patients. The overall responder rate at Week 8 was 47.1% for cilazapril and 34.0% for captopril. None of these differences between the two treatment groups were statistically significant. Both drugs alone or in combination with hydrochlorothiazide were well tolerated during the 12-week treatment period. CONCLUSION: The results of this study indicate that cilazapril, alone or with adjunctive hydrochlorothiazide, is effective and well tolerated as treatment for mild to moderate hypertension.

Adult↗
PubMed1992

Atypical Kawasaki disease: coronary aneurysms and thrombocytopenia.

The patient we have described had coronary artery aneurysms pathognomonic for Kawasaki disease after a nonspecific febrile illness not meeting the classic clinical criteria. The child had significant thrombocytopenia, which in the past has been thought to militate against the diagnosis of Kawasaki disease. Echocardiography should be considered in febrile infants with thrombocytopenia of uncertain etiology.

Coronary Aneurysm↗
PubMed1992

Quality improvement in the use of medications through a drug use evaluation service.

Continuous quality improvement methods have the potential to improve processes that cross several disciplines. The medication system is one in which coordination of activities between physicians, pharmacists, and nurses is essential for optimal therapy to occur. DUE services can play an important role in helping to ensure that patients receive high-quality pharmaceutical care. It is necessary for pharmacy managers to review the structure, goals, and outcomes of their DUE programs to ensure that they are consistent with a philosophy of continuous improvement in the quality of drug therapy.

Adverse Drug Reaction Reporting Systems↗
PubMed1990

Therapeutic drug monitoring: improved performance through educational intervention.

A pilot study done at our institution and previous studies in the literature indicate that therapeutic drug monitoring (TDM) is frequently performed without a proper indication. In addition, samples are often improperly collected or interpreted by physicians. The purpose of this study was to determine if a pharmacy-based educational intervention could positively influence the performance of TDM in a teaching institution. A cost-savings analysis on the reduction of drug levels not indicated or improperly sampled was also performed. The study consisted of a preliminary data collection period, an educational intervention, and a postintervention data collection period. The pre- and posteducational intervention periods consisted of a 1-month concurrent review of aminoglycosides, digoxin, and theophylline serum levels. The educational intervention consisted of in-service programs and newsletter. There were 188 and 211 serum drug levels analyzed during the pre- and postintervention periods, respectively. Overall, the educational intervention significantly increased the number of drug levels obtained for rational indications, correctly sampled and appropriately interpreted by physicians (p less than 0.001, chi 2 analysis). Cost savings associated with this program was +2,788 in patient charges (+559 in hospital costs) per month. This study demonstrated that TDM may be significantly improved through education.

Aged↗
PubMed1990

Assessing the quality of pharmacist answers to telephone drug information questions.

A quality assurance (QA) program is described in which frontline pharmacists were asked test drug information questions via anonymous telephone calls. The program was instituted at a university hospital that began providing decentralized pharmaceutical services in 1985. Questions were developed on the basis of a pilot study conducted to determine the types and complexity of drug information questions received by frontline pharmacists at the hospital. Data on departmental clinical productivity were used to determine the number of questions that would be posed during each shift in the various service areas. The questions were posed during a 10-day period; the pharmacists were aware of the program, but the callers did not identify their affiliation with it. In response to 105 questions asked, 86 were judged to have been answered correctly, 13 answers were deemed incomplete, and 6 were judged incorrect. Pharmacists were more likely to respond incorrectly to complex questions and questions posed during the night shift. As a result of the audit, staff members with advanced clinical knowledge were asked to help less experienced pharmacists, the position of assistant director for drug information and staff development was created, and educational programs were instituted. The QA audit has been repeated twice. Posing test drug information questions via anonymous telephone calls is effective in assessing the quality of drug information provided by pharmacists in patient-care areas.

Drug Information Services↗
PubMed1987

Guidelines for optimal physician training in echocardiography. Recommendations of the American Society of Echocardiography Committee for Physician Training in Echocardiography.

Over the past few years, the clinical use of echocardiography has continued to expand. Echocardiographic techniques are used widely to define normal and abnormal cardiac anatomy, evaluate cardiac chamber sizes and dynamics, assess valvular and pericardial diseases, detect intracavitary masses, measure pressure gradients across discrete stenoses, determine flow volumes, detect and assess the severity of valvular regurgitation, demonstrate and quantitate intracardiac shunts, and measure the timing of cardiac events. These and related applications have led to the increasing use of echocardiography in the diagnostic evaluation of many cardiac disorders. Echocardiography requires considerable theoretical knowledge, technical skill and practical experience to be used in an optimal manner. Previous publications have suggested guidelines for physician training in the techniques of M-mode and 2-dimensional echocardiography. The clinical applications of echocardiography continue to grow, however, and Doppler techniques for evaluating blood flow have become an established component of the echocardiographic evaluation of many disorders. This article presents the current recommendations of the American Society of Echocardiography as to the background knowledge, the nature and amount of practical experience, and the type of training site that are optimal for the training of physicians who take responsibility for the conduct and interpretation of echocardiographic studies.

Cardiology↗
PubMed1987

Lymphedema in Noonan syndrome: clues to pathogenesis and prenatal diagnosis and review of the literature.

The Noonan syndrome (NS) is a true multiple congenital anomalies (MCA) syndrome with numerous manifestations. An association with lymphedema has been noted, but its pathogenesis is not fully understood. Nine new cases and a review of the literature explore the role of lymphedema in NS, including its pathogenesis, presentations, and phenotypic effects. Consideration is given to developmental stage at time of onset, chronicity, resolution, and anatomic site. It appears likely that lymphedema is a much more frequent concomitant in NS than previously realized. The major source of lymphedema in NS appears to be a presently undefined dysplasia of lymphatic vessels of unknown cause. Further study of lymphedema may provide an understanding of its role in shaping the NS phenotype. Comparison with other MCA syndromes and animal models is made in this regard. Relevance to prenatal diagnosis and treatment is discussed.

Adult↗