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Biomedical subjects

J M Greep

Publications and source records attributed to J M Greep.

69 records · Page 4Linked to original sources
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Methods of decision analysis: protocols, decision trees, and algorithms in medicine.

Algorithms, decision trees, and protocols are defined and explained since they constitute an accepted part of clinical decision analysis and application to clinical care. Algorithms are particularly useful for common clinical problems where uncertainties are unlikely. Decision trees are helpful when--as usually occurs in difficult clinical decisions--there are problems in probability. Clinical protocols, which, at best, are based on algorithms and decision trees, provide instruction of how to best treat a patient given the strict definitions of the clinical problem. These techniques are, in essence, merely graphic representations of a logical scientific approach to clinical problems. Criticisms of these techniques center on their rigidity and the automatic unthinking cookbook medicine they might sponsor. It is concluded that if these techniques are wisely designed and, even more importantly, wisely administered with an understanding flexibility, they can lead to both economy and patient benefit.

Algorithms↗
PubMedDate not supplied

TPN catheter sepsis: lack of effect of subcutaneous tunnelling of PVC catheters on sepsis rate.

In an effort to diminish the incidence of catheter related sepsis in total parenteral nutrition, the effect of a 10-cm long subcutaneous tunnel was studied in a prospective randomized manner. This tunnel created a longer anatomical distance between puncture site of the catheter and the subclavian vein. In the control group, a direct puncture technique was employed. Eighty-one catheters (group A) were inserted according to the direct technique, 69 (group B) were tunnelled. Catheter sepsis was defined as an episode of clinical sepsis for which no other cause can be identified and which resolves upon removal of the catheter. No significant differences were noted between the two groups, suggesting that tunnelling of subclavian PVC catheters does not diminish the incidence of catheter related sepsis.

Catheters, Indwelling↗
PubMedDate not supplied

24-hour systemic antimicrobial prophylaxis with gentamicin and metronidazole, or metronidazole alone, in elective colorectal surgery after mechanical bowel preparation with mannitol and whole gut irrigation.

In a prospective randomized trial, systemic antimicrobial prophylaxis with metronidazole and gentamicin was compared to the administration of metronidazole alone in elective colorectal surgery. In both groups, an identical mechanical large-bowel preparation was performed. In order to reduce the duration of the whole-gut irrigation, a 10% mannitol solution was administered before the irrigation procedure. Although no serious infections were observed in either group, the incidence of superficial wound infections was relatively high: 19% in the group with metronidazole and gentamicin prophylaxis and 25% in the other group. From all these wounds E. coli was isolated, and no obligate anaerobic bacteria were cultured. This high rate of wound infections is most likely caused by an overgrowth of E. coli after irrigation, due to the residues of mannitol in the colon, which serve as a nutrient for E. coli. It is concluded that mannitol should not be used in the preoperative mechanical preparation of the large bowel before elective colorectal surgery.

Adult↗
PubMedDate not supplied

[Total parenteral nutrition (TPN) in oncology (author's transl)].

The role of TPN in oncology is, in spite of favourable reports, not yet settled. Selected undernourished cancer patients are certainly helped by parenteral nutrition during their course of therapy. Their nutritional status becomes better, their endurance to antineoplastic therapy is enhanced with less complications and more important, their "quality of life" is improved. However, the survival time of the patient is not prolonged. Well designed prospective randomised clinical studies will provide a better insight into this problem. The anorexia of cancer patients might be caused by tumor-induced alterations in the metabolism of the host which might be medically altered by serotonin-antagonists.

Anorexia↗