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At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Factors causing patients to delay seeking treatment after suffering a stroke.

Many studies have looked at issues surrounding why people delay in accessing healthcare after they have experienced a stroke, but no published studies on this subject have been conducted in West Virginia. To identify the factors causing patients to delay treatment for a stroke, we conducted a concurrent chart review of 64 acute stroke and TIA patients presenting at Charleston Area Medical Center from April 1, 2003 to July 21, 2003. Results showed that the majority of patients arrived beyond the critical three-hour limit for tissue plasminogen activator (tPA) medication. The patients who reported speech problems and confusion as their initial symptoms, those who lived within 15 miles of the hospital, and those who used ambulance transport, were most likely to arrive at the hospital in less than two hours. On the other hand, the patients who were less likely to arrive within two hours were those who were alone at symptom onset, those who had weakness as a prominent symptom, as well as those were younger and had commercial insurance. We recommend educating the community about the symptoms of stroke and focusing on the fact that stroke is a medical emergency and calling 911 is necessary.

Acute Disease↗
PubMed1985

Inhibition of oral contraceptive effectiveness by concurrent antibiotic administration. A review.

The use of antibiotics in periodontal therapy has received increasing attention in recent years. Although generally safe, certain antibiotics, including tetracycline and ampicillin, have been shown to interact indirectly with oral contraceptives, with a resultant decrease in oral contraceptive efficacy. This paper reviews the nature of antibiotic-oral contraceptive inter-actions, as well as the precautions that have been suggested for patients taking oral contraceptives for whom certain antibiotics have been prescribed.

Ampicillin↗
PubMed1994

Interactions in developmental toxicology: a literature review and terminology proposal.

Developmental toxicologists have investigated the interactive effects from concurrent exposures to a variety of chemical and physical agents, including therapeutic drugs, industrial agents, and some biological organisms or their toxins. Of approximately 160 reports of concurrent exposures reviewed in this paper, about one third report no interactive effects (including additive effects--usually referring to response--as opposed to dose-additivity); another one third report antagonistic effects, and the final third report potentiative or synergistic effects. The quality of the studies is highly variable. Frequently, only small numbers of animals were included, and very few dose levels were evaluated. Maternal toxicity was rarely discussed. Time-effect relationships were examined infrequently. In addition, these studies are also inconsistent in the use of terms to describe interactive effects, and more than 90% of the terms were not in harmony with currently accepted definitions in toxicology. Because interaction studies will continue to be important in the future, this paper proposes uniform usage of terms for additivity and interactions in developmental toxicology: additivity (the combined effect of two or more developmental toxicants approximates the sum of the effects of the agents administered separately); antagonism (the combined effect of two or more agents, one or more of which are present at doses that would be developmentally toxic if given individually, is significantly less than the sum of the effects of the agents administered separately); potentiation (the increased effect of a developmental toxicant by concurrent action of another agent at a dose that is not developmentally toxic); synergism (the combined effect of two or more developmental toxicants is significantly greater than the sum of the effects of each agent administered alone); and, interaction if more precise terminology does not apply.

Animals↗
PubMed1998

Concurrent cervical and craniofacial pain. A review of empiric and basic science evidence.

Because many patients present themselves for treatment with both craniofacial and craniocervical pain, 2 questions arise: (1) What are the sensory and motor consequences of dysfunction in either of these areas on the other? (2) Do craniofacial and craniocervical pain have a similar cause? These questions formed the impetus for this review article. The phenomenon of concurrent pain in craniofacial and cervical structures is considered, and clinical reports and opinions are presented regarding theories of cervical-to-craniofacial and craniofacial-to-cervical pain referral. Because pain referral between these 2 areas requires anatomic and functional connectivity between trigeminally and cervically innervated structures, basic neurophysiologic and neuroanatomic literature is reviewed. The published data clearly demonstrate neurophysiologic and structural convergence of cervical sensory and muscle afferent inputs onto trigeminal subnucleus caudalis nociceptive and non-nociceptive neurons. Moreover, changes in metabolic activity and blood flow in the brainstem and cervical dorsal horn of the spinal cord in both monkeys and cats have been demonstrated after electric stimulation of the V1-innervated superior sagittal sinus. In conclusion, the animal experimental data support the findings of human empiric and experimental studies, which suggest that strong connectivity exists between trigeminal and cervical motor and sensory responses.

Animals↗
PubMed2002

The use of dedicated methodology and statistical reviewers for peer review: a content analysis of comments to authors made by methodology and regular reviewers.

STUDY OBJECTIVES: In 1997, Annals of Emergency Medicine initiated a protocol by which every original research article, in addition to each regular review, was concurrently evaluated by 1 of 2 methodology and statistical reviewers. We characterized and contrasted comments made by the methodology and regular peer reviewers. METHODS: After pilot testing, interrater reliability assessment, and revision, we finalized a 99-item taxonomy of reviewer comments organized in 8 categories. Two authors, uninvolved in the writing of reviews, classified each comment from a random sample of methodology reviews from 1999. For 30 of these reviews (15 for each methodology reviewer), the 2 authors also scored all (range 2 to 5) regular reviews. RESULTS: Sixty-five reviews by methodologist A, 60 by methodologist B, and 68 by regular reviewers were analyzed. Comments by methodologist A most frequently concerned the presentation of results (33% of all comments) and methods (17%). Methodologist B commented most frequently on presentation of results (28%) and statistical methods (16%). Regular reviewers most frequently made non-methodology/statistical comments (45%) and comments on presentation of results (18%). Of note, comments made by methodology and regular reviewers about methods issues were often contradictory. CONCLUSION: The distributions of comments made by the 2 methodology and statistical reviewers were similar, although reviewer A emphasized presentation and reviewer B stressed statistical issues. The regular reviewers (most of whom were unaware that a dedicated methodology and statistical reviewer would be reviewing the article) paid much less attention to methodology issues. The 2 dedicated methodology and statistical reviewers created reviews that were similarly focused and emphasized methodology issues that were distinct from the issues raised by regular reviewers.

Peer Review, Research↗
PubMedDate not supplied

A national perspective on UR (utilization review).

Quality of care is the responsibility of each and every attending physician. There are many definitions of quality, none of which encompasses the universe of medical practice. Care that is neither medically necessary nor appropriate can never be considered good, no matter who renders it or how good the outcome. It is upon these premises that utilization review firms focus.

Concurrent Review↗
PubMed1998

The association between Crohn disease and the myelodysplastic syndromes. Report of 3 cases and review of the literature.

We report 3 patients who developed Crohn disease and myelodysplastic syndrome concurrently and review 9 previously reported cases of this association. Demographic and clinical features, treatment, and outcome are presented from previous reports and our own 3 cases. Of the 12 patients, 8 were men, and the mean age was 68.8 years (range, 28-83 yr). The geographic origin was heterogeneous. Pancytopenia was found in 5 patients, anemia in 5, and bicytopenia in 2. The classification types of myelodysplastic syndrome were variable. The marrow karyotype was reported in 10 patients: it was abnormal in 5, with chromosome 20 abnormalities in 3. Crohn disease and myelodysplasia were diagnosed simultaneously in 5 patients, whereas Crohn disease antedated myelodysplasia in 4 patients (interval, 8 mo-30 yr) and myelodysplasia antedated Crohn disease in 3 patients (interval, 2 mo-4 yr). Signs and symptoms of Crohn disease improved in most patients upon specific medical treatment. However, the outcome of myelodysplastic syndrome was not favorable in 10 of 11 patients in whom it was reported, with 4 deaths due to myelodysplasia-related complications. Notably, the activity of myelodysplasia in 1 of our own patients paralleled the clinical activity of Crohn disease, and hematologic abnormalities of the myelodysplasia resolved upon successful treatment of the Crohn disease, thus strengthening the hypothesis of a pathogenetic link between the disorders. The possibility of myelodysplastic syndrome should be considered in patients with Crohn disease over the age of 50 years who have peripheral blood cytopenias. Likewise, a diagnosis of Crohn disease should be considered in patients with myelodysplastic syndrome who develop gastrointestinal symptoms such as chronic and/or bloody diarrhea. In patients with such an association, the possibility of improvement of the myelodysplasia upon successful therapy of Crohn disease should not be ruled out.

Aged↗
PubMedDate not supplied

Using quality service analysts to streamline record reviews.

By using registered nurse quality service analysts (RN-QSAs), the United States Air Force Medical Center in Wiesbaden, Germany, which closed in 1993, reduced physician reviews of medical records in 1991-1992 to only the records that did not meet the preestablished screening criteria. The authors relate how the screening of records by RN-QSAs increased the number of records reviewed, reduced the number of people reviewing records, established the quality services department as a repository of patient care information, and markedly improved the quantity, quality, and reproducibility of patient care reviews.

Concurrent Review↗
PubMed1995

Appropriateness of admissions: the French experience.

The French studies using the Appropriateness Evaluation Protocol (AEP) were developed within the framework of medical audit by local teams, analysing their own practice, in order to improve the quality of care. Four studies were analysed in this review. They were performed in emergency departments and data were collected concurrently. The reliability and validity of this French version of the AEP was assessed. The high reliability of the AEP was found to be useful to measure trends or differences between groups. The percentages of inappropriate admissions observed in the studies ranged from 18 to 25%. The hypothesis that the rate of inappropriate admissions would be highest among the elderly was not confirmed in Paris. Homelessness was the only social factor related to a high rate of inappropriate admissions in three of the studies. In one study, age and lack of social support were found to be risk factors for inappropriate admissions. The study of the causes of inappropriate admissions was important, since they were to be used as an indicator of systemic problems in the organization of health care delivery. A distinction was made between appropriate and justified admissions on both a systemic and an individual level. In conclusion, AEP was found to be an indicator that was both reliable and useful to identify quality of care problems. Among the factors found to be related to inappropriate admissions, the internal organization of the hospital proved to be one of the main reasons and a target for improvement.

Age Factors↗
PubMed2005

[Effects of concurrent therapy for patients with osteoporosis].

In the WHO technical report, vitamin D metabolites have been suggested to have a role as an adjunctive therapy when given with an antiresorptive agent. Beneficial effects on BMD have been reported following the addition of calcitriol to alendronate, etidronate, and HRT, but no data on fracture rates are available. Here we summarize our clinical study on the concurrent therapy and review reports on the concurrent treatments.

Aged↗
PubMed2000

A systems approach to medication error reduction.

An interdisciplinary process for the reduction of medication errors was implemented at East Jefferson General Hospital in Metairie, Louisiana, a suburb of New Orleans. The Medication Administration Review and Safety Committee expanded the error reporting system with a comprehensive concurrent chart review process. Safe administration of medications through a systems approach has led to a reduction of documentation deficiencies, a new follow-up process, and an increase in reported errors.

Adverse Drug Reaction Reporting Systems↗