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Biomedical subjects

R W Chang

Publications and source records attributed to R W Chang.

90 records · Page 5Linked to original sources
PubMed1987

Gastrointestinal dysfunction among intensive care unit patients.

This study used the Acute Physiological and Chronic Health Evaluation (APACHE II) system to select two groups of ICU patients with comparable risk of hospital death to evaluate the importance of GI dysfunction, defined as failure to tolerate enteral nutrition (EN), as a prognostic factor. In our ICU, patients who have not undergone recent bowel surgery are treated by EN. Those patients who cannot tolerate EN are treated by total parenteral nutrition (TPN). One hundred and eleven patients who tolerated EN (functioning gut) and 97 TPN patients who failed to tolerate EN (GI dysfunction) were studied. The mean APACHE II scores of the two groups were 17.7 +/- 6.5 (SD) and 17.7 +/- 5.1, respectively. The observed mortality of patients with GI dysfunction (51%) was significantly higher (p less than .0005) than that of patients with a functioning gut (25%). This was associated with significantly poorer APACHE II mean BP, oxygenation, and creatinine scores among the GI dysfunction patients. Our results suggest that shock, ischemia, and hypoxemia, in addition to causing impairment of renal function, may bring about changes in the GI tract, evident clinically only as a failure to tolerate EN, which have an adverse effect on the prognosis of ICU patients so affected.

Adult↗
PubMed1987

One year's experience with the APACHE II severity of disease classification system in a general intensive care unit.

The APACHE II sickness score was applied prospectively for one year in a general intensive care unit in Saudi Arabia. Two hundred and ten patients were studied, 66 of whom died in hospital. The mean APACHE II score of survivors was 11 (SD 7.1) and of non-survivors, 25.3 (SD 8.8). The mean Risk of Death was 13.3% (SD 13.1) for the survivors and 47.2% (SD 25.8) for non-survivors. The differences in APACHE score and Risk of Death between survivors and non-survivors are highly significant (p less than 0.0005 for both). No patient survived who had a Risk of Death greater than 60% and none died with a Risk of Death less than 7%. The sensitivity of the APACHE II system in predictions of death can be improved if the scores on the day of admission and on the 3rd day are taken into account.

Adult↗
PubMed1987

The role of expectations in patient satisfaction with medical care.

The purpose of this article is to review research about the role of expectations in patients or consumer satisfaction and to identify theories to account for the process by which patient satisfaction is achieved. Studies are examined to suggest how expectations and satisfaction may be defined or measured and to describe the empirical support for an expectation and satisfaction relationship. The application of an expectation and satisfaction model to health care marketing is discussed.

Arthritis↗
PubMed1987

Survival of sub-optimal cadaver renal grafts with prolonged cold ischaemic times using cyclosporin.

Between September 1983 and December 1985, 33 cadaver kidneys with prolonged ischaemic times (mean 47.3 +/- 11.0 h), and frequently in problematic conditions, were received from Europe and transplanted into adults (16 male, 12 female, mean age 34 +/- 11 years) and children (2 male, 3 female, mean age 8.8 +/- 4.0 years), using cyclosporin (CsA) and steroid immunosuppression. Six patients have died (three with functioning grafts) and 12 grafts have been lost. Eighteen grafts remain functioning, with a mean survival of 27 months. The 1 year actuarial patient and graft survivals were 82% and 69% respectively. The mean time to cessation of haemodialysis was 17 +/- 10 days, and to stable graft function was 28 +/- 11 days. At 3 months (27 patients) mean serum creatinine was 191 +/- 88 mumol/l (2.16 +/- 1.0 mg/dl), with a mean CsA dose of 6.7 +/- 2.2 mg/kg per day. There was an association between the immediate post-transplant renographic perfusion index and the serum creatinine at 3 months (r = 0.52, P less than 0.01). At no stage did the serum creatinine correlate with CsA dose or length of ischaemic time. These results demonstrate that despite suboptimal conditions, prolonged cold ischaemic times, and periods of oliguria, cadaver kidney transplants may be managed successfully with CsA and low-dose steroids.

Actuarial Analysis↗
PubMed1986

Use of APACHE II severity of disease classification to identify intensive-care-unit patients who would not benefit from total parenteral nutrition.

The APACHE II severity of disease classification system was tested for its ability to identify intensive-care-unit (ICU) patients who would not benefit from treatment with total parenteral nutrition (TPN). First, the classification was validated in our patient population by testing it on 210 consecutive ICU admissions. Then a retrospective study was done on 89 ICU patients who had received TPN, to define APACHE II selection criteria. When the APACHE II system was tested prospectively on 26 ICU patients treated with TPN, it predicted correctly, with a specificity of 100%, half of the patients who died.

Adult↗
PubMed1986

Total parenteral nutrition: a four-year audit.

A four-year audit was carried out on 278 patients who received 289 courses of total parenteral nutrition (TPN) over 5213 patient days in a Saudi Arabian hospital. One hundred and forty-seven patients were discharged healthy, two of these after home TPN. The overall mortality was 36 per cent. ICU patients had the highest mortality (53 per cent). Among the survivors, 74.8 per cent showed an improvement in nutritional status. The incidences of metabolic complications and catheter sepsis were 2.9 per cent and 3.6 per cent, respectively. As a direct result of the audit, changes have been made in protocols and staffing patterns, and an attempt is being made to address the major problem of better selection of patients.

Catheterization↗
PubMed1984

Clinical characteristics and prognosis of vasculitic mononeuropathy multiplex.

The initial appearance and course of 19 patients with mononeuropathy multiplex due to systemic vasculitis were evaluated. Neuropathy first occurred within one year of the onset of systemic vasculitis in all patients and within one year of the onset of rheumatoid arthritis in four of nine patients. Concurrent cutaneous arteritic lesions and elevated ESRs occurred more frequently in patients with rheumatoid arthritis than in those without it. The overall six-month and five-year survival rates were approximately 80% and 60%, respectively. Significant nerve improvement was noted in 86% of surviving patients after one year. There were no factors at initial appearance predictive of outcome.

Adult↗
PubMed1984

Nutritional assessment using a microcomputer. 1. Programme design.

Nutritional assessment is used to determine the nutritional status, metabolic status and nutritional requirements of patients receiving nutritional support. It is also used to identify patients at risk from the effects of malnutrition. Nutritional assessment uses anthropometric and laboratory data and involves reference to standard tables and equations and is therefore time consuming and tedious. When a large battery of tests is used, consistent interpretation of the results is difficult. This paper describes the design of a computer program which computes nutritional and metabolic status of patients and prescribes the nitrogen and calorie requirements.

Journal Article↗
PubMed1984

Nutritional assessment using a microcomputer. 2. Programme evaluation.

Nutritional assessment ideally should be used to determine the nutritional requirements of a patient taking into account his nutritional and metabolic status. It should also be used to monitor a patient's progress and any alteration in requirements. In addition, nutritional assessment should be able to identify groups of patients at risk from the effects of malnutrition. Finally, the parameters used for assessment should be simple, yet effective and readily available to any hospital. A computer program designed by the Nutrition Support Service, Riyadh Armed Forces Hospital, Saudi Arabia and in use for the past 2 years has been evaluated and found to fulfil these criteria.

Journal Article↗
PubMed1983

Risk-benefit considerations in the management of polymyalgia rheumatica.

Management of the polymyalgia rheumatica syndrome (PMR) is controversial. Gratifying symptomatic response usually occurs after treatment with nonsteroidal antiinflammatory drugs or low doses of corticosteroids. However, some PMR patients are at risk of sudden blindness from an associated disease, giant cell arteritis (GCA). Blindness can be prevented by using higher and more toxic doses of corticosteroids. Temporal artery biopsy can be an aid in diagnosis, though it is not a completely sensitive test for GCA. This study employs decision analysis and derived risk-benefit ratios (equivalent to utility ratios) to evaluate five possible PMR management strategies. The incremental risk-benefit analysis provides a means for weighing intangible trade-offs without a formal utility analysis. Given base case assumptions derived from the literature, empirical treatment with high-dose steroids cannot be justified for PMR patients who have no cranial arteritic symptoms, because the acceptable risk-benefit ratio associated with this strategy is more than 90 cases of severe medication side effects per case of monocular blindness averted.

Adrenal Cortex Hormones↗
PubMed1977

Increased resistance in splenectomized mice to a methylcholanthrene-induced tumour.

Prior splenectomy increased the resistance of BALB/c mice to a syngeneic methylcholanthrene-induced ascitic tumour inoculated i.p. The survival rate of splenectomized mice was 81-6% while those of normal and sham-operated controls were 11-5% and 20% respectively. The effect of splenectomy, however, was seen only within the dose range of 10(3) to 10(4) tumour cells. This effect of splenectomy was abolished by the transfer to mice of serum from tumour-bearing mice, and of spleen cells from normal donors, immediately after the inoculation of tumour cells. Cell-free ascitis fluid did not abolish the effect of splenectomy. The findings suggest that there is a subpopulation of spleen cells which produces a tumour growth enhancing factor which is found in the serum of tumour-bearing mice.

Animals↗
PubMedDate not supplied

Identifying ICU patients who would not benefit from total parenteral nutrition.

This study attempted to improve patient selection for total parenteral nutrition (TPN) by identifying ICU patients whose prognoses were so hopeless that they would not or would no longer benefit from TPN. Computerized trend analysis of daily Apache II scores, corrected for the presence, number, and duration of major organ system failures was used to predict individual hospital outcome among 50 intensive care unit patients treated with TPN. Thirteen of the 18 deaths were correctly predicted without any false predictions. During the study, the results of predictions were not used to influence clinical decision making. If TPN was withheld in the five patients predicted to die before starting TPN, or withdrawn in the eight patients when they were predicted to die, $28,350 or 11.5% of the cost of TPN during the study period would have been saved. This hypothetical study shows that elimination of inappropriate treatment of patients with hopeless prognosis with the aim of avoiding the prolongation of the process of dying and unnecessary suffering is a compassionate patient-selection strategy that can result in major savings in healthcare resources.

Decision Making, Computer-Assisted↗
PubMedDate not supplied

Continuous enteral feeding: a major cause of pneumonia among ventilated intensive care unit patients.

Continuous enteral feeding is widely practiced in intensive care units (ICU). We found that pneumonia developed in 54% of 24 ventilated patients on continuous enteral feeding for more than 3 days. This appeared to affect only patients with a persistently high morning (7:00 am) gastric pH, with 12 of 13 (92%) patients developing pneumonia. In 11 patients the causative organisms were cultured initially from the stomach, oropharynx and trachea before pneumonia supervened. This effect was distinct from that found with the prophylactic use of antacids or H2-receptor antagonists. The mortality (46%) of this group of patients was 1.6 times greater than the expected mortality predicted by the Apache II Severity of Disease Classification System.

Adolescent↗