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Biomedical subjects

P Price

Publications and source records attributed to P Price.

282 records · Page 16Linked to original sources
PubMedDate not supplied

Topical treatment: which dressing to choose.

Wounds have existed since the beginning of time. The interest in this subject has been stimulated in the main by conflict and war that have necessitated the development of new ways of managing wounds. In the 1960s the development of new materials that maintained a moist environment in the wound area encouraged a number of commercial companies to produce a wide variety of new materials with physical and chemical properties that might provide a moist environment. However the data to support the use of such materials are limited if one requires evidence that they have produced more rapid healing in chronic wounds kept moist as to those kept dry. Is this due to a problem with the outcome measure rather than a problem with the materials themselves? Rather than seeing this as justification for not using such materials, it should instead lead clinicians to question the validity of endpoint studies in wound healing experiments. There is a lack of evidence regarding the ability of such materials to improve the speed of healing in chronic wounds. Nevertheless considerable clinical experience, obtained from treating many patients, has indicated that not only are such new treatments cost effective, but that they are also proving to be extremely beneficial and acceptable to patients, on account of their ability to reduce pain, odour or leakage from a wound.

Animals↗
PubMedDate not supplied

Ambulation after sheath removal: a comparison of 6 and 8 hours of bedrest after sheath removal in patients following a PTCA procedure.

OBJECTIVE: To determine whether ambulation of patients at 6 hours after sheath removal, compared with the institution's standard of 8 hours, would produce a change in hematoma formation, bleeding tendencies at the sheath introducer site, and/or patients' perceptions of pain after percutaneous transluminal coronary angioplasty (PTCA). DESIGN: A quasi-experimental research design was used. Each patient was randomly assigned to either the control group, which required 8 hours of bedrest after sheath removal, or the experimental group, which required 6 hours of bedrest after sheath removal. SETTING: Intensive care unit of a 400-bed urban teaching hospital in western Canada. SAMPLE: A convenience sample of 85 male and female patients admitted to the intensive care unit after an elective PTCA between June 1991 and November 1992. METHOD: Each subject was randomly assigned to 6 or 8 hours of bedrest after sheath removal. A demographic data tool, the short form of the McGill Pain Questionnaire, a Hematoma Assessment Instrument, and a Bleeding Tendency Assessment Instrument were used to collect the data. These instruments were administered to the patients at various intervals after sheath removal. DATA ANALYSIS: Results were analyzed to determine if the additional 2 hours of bedrest in the control group contributed to an increase in pain perception. Demographic information was analyzed by use of descriptive statistics. Parametric and nonparametric tests were also used to analyze the data. RESULTS: Ambulation of patients at 6 hours after sheath removal produced no significant increase in hematoma formation at the puncture site when compared with patients who ambulated 8 hours after sheath removal (p = 0.0001). There was a higher probability of a hematoma developing the day after the PTCA procedure if the activated clotting time (ACT) was high (p = 0.0034). Only one subject in the experimental group developed delayed bleeding; therefore, statistical analysis was unable to be performed on this data. When controlling for age, gender, type of procedure, previous PTCA, history of back pain, analgesic during the procedure, analgesic after the procedure, and cardiologist, the experimental group had significantly lower pain scores than the control group at 8 hours after sheath removal (p = 0.0001). CONCLUSION: This study supports our hypothesis that decreasing the amount of time patients are required to remain flat and supine is associated with no increase in hematoma and bleeding tendencies and is associated with a reduction in the perceptions of pain. The results appear to support ambulation of patients at 6 hours after sheath removal.

Adult↗
PubMedDate not supplied

Functional CT imaging of the acute hyperemic response to radiation therapy of the prostate gland: early experience.

PURPOSE: Functional CT can measure perfusion and permeability. We hypothesized that acute changes could be measured in these indexes following radiation therapy (RT) to the prostate gland. METHOD: Twenty-two patients with prostatic cancer were studied before and 1-2 and 6-12 weeks after RT. A single section through the prostate was repeatedly scanned after contrast medium bolus injection. Contrast agent clearance per unit volume (alpha/V) and fractional vascular volume (fvv) were calculated using Patlak graphical analysis. Perfusion was calculated as the ratio between maximal rate of tissue enhancement and peak arterial enhancement. RESULTS: Significant increases in all indexes occurred after RT. Mean perfusion rose from 0.122 to 0.263 ml/min/ml at 1-2 weeks, mean alpha/V increased from 0.0012 to 0.0016 ml/min/ml at 1-2 weeks, and mean fvv increased from 13.7 to 21% at 1-2 weeks. All three indexes remained elevated at 6-12 weeks after the start of RT. CONCLUSION: Functional CT demonstrated an acute hyperemic response following RT to the prostate gland.

Acute Disease↗
PubMedDate not supplied

Recognizing the feet as being at risk from pressure damage.

This article reports the findings of a survey and an audit undertaken to investigate the provision of foot support in a university teaching hospital. Phase I surveyed strategies employed to support feet and phase II audited the use of the Repose Foot Protector, manufactured by Frontier Therapeutics, specifically designed to provide pressure support for the feet. Patients with reduced mobility, nursed out of bed in a chair, have been highlighted as a group potentially at risk of tissue damage to the heels. This survey of current strategies employed to support feet included 289 patients. Patients included were from both hospital and community settings. The survey reported a lack of specialist equipment for the heels of patients with reduced mobility sitting in a chair. Only 67 (23.2%) patients were allocated foot support (typically a stool, with or without a pillow) to use while seated out of bed in a chair. The audit of requests for a new device to protect feet included 100 patients. The main reasons for requesting this device included pressure relief (81 occasions), to treat 'foot drop' (32 occasions) and in promoting comfort (31 occasions). There was a significant improvement in the skin condition of the heels and comfort (P<0.0001) from study entry to exit. This audit indicated a high level of both staff and patient satisfaction.

Adult↗
PubMedDate not supplied

Sustained silver-releasing dressing in the treatment of diabetic foot ulcers.

This study investigated the clinical performance and safety of a sustained silver-releasing foam dressing, Contreet Foam, in the treatment of diabetic foot ulcers. Twenty-seven patients with diabetic foot ulcers of grade I or II (Wagner's classification) were followed for six weeks: one week run-in using Biatain dressings, four weeks' treatment with Contreet dressings. Four ulcers healed during the four-week treatment with Contreet 56% in average. Contreet Foam showed good exudate management properties and was considered easy to use. Only two infections occurred showed that all six of the non-study ulcers developed an infection during the study. All ulcers (study ulcers as well as non-study ulcers) were treated according to good practice of diabetic wound care. There were no directions for the treatment of secondary wounds. No device-related adverse events were observed. This study demonstrated that Contreet Foam is safe and easy to use and effectively supports healing and good wound progress of diabetic foot ulcers.

Adult↗
PubMedDate not supplied

Cholangiocarcinoma and the role of radiation and chemotherapy.

Cholangiocarcinoma is a rare tumor. Many cases are localized while metastatic disease within the liver and abdomen do occur. There is as yet no standard therapy for advanced bile duct tumors. Radiotherapy and chemotherapy are not curative modalities in this condition but are being assessed adjuvantly following surgery, and as palliative treatment in an attempt to either extend progression-free and overall survival or to palliate symptoms. Advances may be made by: (i) The combined use of radiation and chemotherapy, (ii) High dose conformal radiotherapy, (iii) Novel chemotherapeutic agents. Patients should be given the opportunity to participate in clinical trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Developing a rationale and recruitment plan for a nurse researcher.

Hospital administrators are becoming more aware of the valuable contribution of nursing research to the provision of quality nursing care. Research provides objective and tested information on which to base crucial decisions regarding patient care and the wise use of scarce health care resources. A systematic approach used to define the need for, and to prepare a comprehensive proposal for the recruitment of a nurse researcher is outlined. The process described in this article can be applied to the creation of any new position in the health care system.

Humans↗
PubMedDate not supplied

New trends in the treatment of calculus disease of the biliary tract.

BACKGROUND: New treatment methods for calculus disease of the biliary tract offer options that can benefit a variety of patients. Laparoscopic surgery, for example, has revolutionized biliary surgery and is now the preferred approach for the majority of patients. METHODS: Using the key words "biliary tract," "calculus disease," and "cholecystectomy," MEDLINE files were searched from 1982 to the present. Articles dating before 1982 were accessed from the reference lists of the more recent articles. RESULTS AND CONCLUSIONS: This review describes the various procedures that could be effective options for patients with biliary stone disease, including an algorithm showing a proposed scheme for evaluating and treating this disease. Cholecystectomy--either laparoscopic or open--will likely remain the treatment of choice for most patients. The newer options, however, for treatment of both acute and chronic cholecystitis have proved effective in select cases.

Bile Acids and Salts↗
PubMedDate not supplied

Thermodilution cardiac output determinations: a comparison of iced and refrigerated injectate temperatures in patients after cardiac surgery.

OBJECTIVE: To compare cardiac output determinations with two temperatures of injectate: iced (0 degrees to 6 degrees C) and refrigerated (10 degrees to 16 degrees C) in adult patients after cardiac surgery. DESIGN: A quasi-experimental study design was used. The dependent variable was cardiac output. The independent variable was injectate temperature. Each patient served as his or her own control. SETTING: Intensive care unit at a 500-bed urban teaching hospital in Western Canada. SAMPLE: A convenience sample of 40 male and female patients admitted to the intensive care unit after myocardial revascularization and/or valvular surgery between March and August 1991. All patients experienced surgery with the normothermic technique. METHOD: Each subject had cardiac output determinations performed within 12 hours of surgery with both 10 ml refrigerated and 10 ml iced injectate. The capped syringe technique was used. DATA ANALYSIS: A paired t test was performed to determine statistically significant differences between the two sets of measurements. Regression analysis was used to determine strength of agreement between the two techniques. Clinical significance was examined by a difference in mean cardiac output greater than 15% resulting in an alteration in medical therapy. RESULTS: There were no statistically or clinically significant differences between the two methods of cardiac output determinations. Regression analysis showed very good agreement (r = 0.965, p < 0.0001). Clinically, when the two cardiac outputs were reported to the surgeon, medical therapy was not altered based on differences. CONCLUSIONS: The use of 10 ml of refrigerated injectate provides reproducible cardiac output results as compared with iced injectate in normothermic patients after cardiac surgery. Further investigation is required to generalize these results to other patient populations and to determine the reproducibility with a lower volume of injectate.

Adult↗