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At least 199 records · Page 11Linked to original sources
PubMed1998

[The rehabilitation of patients following the surgical treatment of ischemic heart disease at a low-altitude health resort].

We developed well grounded differentiated methods of rehabilitation treatment in low mountains for patients after surgery for ischemic heart disease. Evaluation of the results was carried out with due account for variety of clinical course of the disease, condition of coronary and myocardial reserves of the heart and concomitant diseases. 475 males aged 22-65 years who underwent aorto-coronary bypass surgery for CAD were examined. As a result of spa treatment significant improvement of general patients condition was observed in 22.7% and condition improved in some way--in 70.2; no change of general condition was detected in 6.7% patients. It is established that condition of contractile activity of the myocardium of left ventricle is of much importance for effectiveness of the spa treatment stage of rehabilitation of cardiosurgical patients. Differentiated methods of the usage of terrain cure in the complex of sanatoria and health resort treatment are developed and introduced into practice. Severity of the principal disease, extended scar formations in the myocardium and concomitant diseases are the reasons influencing low effectiveness of the treatment.

Adult↗
PubMed1997

Palliative options of last resort: a comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia.

Palliative care is generally agreed to be the standard of care for the dying, but there remain some patients for whom intolerable suffering persists. In the face of ethical and legal controversy about the acceptability of physician-assisted suicide and voluntary active euthanasia, voluntarily stopping eating and drinking and terminal sedation have been proposed as ethically superior responses of last resort that do not require changes in professional standards or the law. The clinical and ethical differences and similarities between these 4 practices are critically compared in light of the doctrine of double effect, the active/passive distinction, patient voluntariness, proportionality between risks and benefits, and the physician's potential conflict of duties. Terminal sedation and voluntarily stopping eating and drinking would allow clinicians to remain responsive to a wide range of patient suffering, but they are ethically and clinically more complex and closer to physician-assisted suicide and voluntary active euthanasia than is ordinarily acknowledged. Safeguards are presented for any medical action that may hasten death, including determining that palliative care is ineffective, obtaining informed consent, ensuring diagnostic and prognostic clarity, obtaining an independent second opinion, and implementing reporting and monitoring processes. Explicit public policy about which of these practices are permissible would reassure the many patients who fear a bad death in their future and allow for a predictable response for the few whose suffering becomes intolerable in spite of optimal palliative care.

Beneficence↗
PubMed1995

Responding to cough: Boholano illness classification and resort to care in response to childhood ARI.

A qualitative study into the health seeking behaviour of caretakers in response to ARI in children under five years of age was conducted in the province of Bohol, the Philippines. The study was designed to compliment survey data generated from a long running ARI intervention project, specifically to explain behaviours identified as problematic by the project. Results indicate the importance of folk diagnosis as a basis for selection of first resort for care in the management of childhood ARI. A cultural category, piang, was identified as a major factor influencing health seeking behaviour and delay in consulting the biomedical system where serious ARI exists. In addition, caretakers' financial situation and social contacts are important in their decision to seek biomedical assistance and are often implicated in delay in presentation and acting upon referral to hospital.

Acute Disease↗
PubMedDate not supplied

Investigation of sudden death from Mycobacterium tuberculosis in a foreign-born worker at a resort hotel.

A 60 year-old man born in Central America died suddenly in the hallway of his residence on the grounds of a resort hotel where he worked as a dishwasher. The dishwashing station was in a large, poorly ventilated area where a substantial number of food service workers (cooks, wait staff, bus persons, dishwashers, supervisors, etc.) shared air space with the index patient. Several social contacts of the patient reported that he had been coughing for many months before his death. The County Department Of Health conducted a contact investigation, which identified 171 individuals in need of follow-up. Thirty-six percent of those tested in the first round were tuberculin skin test-positive; a second round of testing yielded a 15% (8 of 52) conversion rate.

Central America↗
PubMed2001

Outbreak of Norwalk virus in a Caribbean island resort: application of molecular diagnostics to ascertain the vehicle of infection.

In 1998, an outbreak of gastroenteritis affected at least 448 persons including 122 staff at a resort hotel in Bermuda. A survey among staff indicated that gastroenteritis was associated with eating or drinking at the hotel (OR = 60, 95% CI = 2.4-15.1). Multiple specimens of drinking water had elevated faecal coliform levels and Escherichia coli present, suggestive of faecal contamination. Stools from 18 of the 19 persons with gastroenteritis that were tested were positive for genogroup-II Norwalk-like viruses (NLVs). RT-PCR analysis of a 31 specimen of water produced a genogroup-II NLV genome with a sequence identical to that of NLVs in the stools of three ill persons. This outbreak shows the value of new molecular diagnostics to link illness with a contaminated source through the use of sequence analysis. The risk of outbreaks such as these could be reduced in tourism dependent regions like Bermuda and the Caribbean by regular evaluation of data from the inspection and monitoring of drinking water supplies and waste water systems, by ensuring the chlorination of supplemental drinking water supplies and by establishing food-safety initiatives.

Base Sequence↗
PubMed2004

[Quality management in a combined clinic - the quality management system according to DIN EN ISO 9001 of the The German Association of Spa Accommodation Resorts e. V. (VdKB)].

The implementation of a quality system in health care organizations offers huge potentials for improvement and development. But the realization of such systems necessitates high investments, which small companies and family businesses often are unable to raise. The German Association of Spa Accommodation Resorts (VdKB) commissioned two consultants to develop a reasonably priced implementation concept of a DIN EN ISO 9001 quality system specially adjusted to small companies and family businesses in medical spa and rehabilitation services, which was successfully accredited in May 2003. This paper describes fundamental requirements in combine management systems, considers the pros and cons of management combines and demonstrates the practical realization of combine requirements on the example of the VdKB-combine system.

Balneology↗
PubMed1996

Endoscopic hemostasis of upper gastrointestinal bleeding with histoacryl: last resort before surgery.

Five patients presented with acute upper gastrointestinal bleeding, underwent diagnostic and therapeutic endoscopy. The source of bleeding was identified in each case. Two patients had a large chronic gastric ulcer, one had a stress ulcer, one had a gastric ulcer with hypertrophic gastropathy, and one had a malignant infiltration of the second part of the duodenum. Conventional first-line therapeutic modalities failed to induce hemostasis in these bleeding lesions. Hemostasis was successfully achieved in each case using an endoscopic intralesional injection of Histoacryl. This agent may represent a last resort for endoscopic hemostasis before surgery.

Aged↗
PubMedDate not supplied

Child psychiatric hospitalization: the last resort.

The purpose of this study was to describe how parents manage the experience of hospitalizing their school-aged child in a psychiatric unit. Grounded theory methodology was used. Thirty-eight parents participated. Data were collected by interviews. Analysis was done using the constant comparative method. The basic social problem identified was the escalating behavior of the child. The child's behavior included self-injurious behavior or violence toward others. The core concept was "hospitalization, the last resort." Parents' management of the experience varied based on many factors including whether this was the child's first psychiatric hospitalization, the distance from the hospital to their home, their trust of staff members, sources of support, and their definition of the situation.

Attitude to Health↗
PubMed2005

Risky sexual behaviors associated with recreational drug use among men who have sex with men in an international resort area: challenges and opportunities.

South Florida is home to a highly transient population of approximately 145,000 men who have sex with men (MSM) and annually hosts over 1.8 million gay and bisexual visitors. To develop more effective interventions for HIV/sexually transmitted infections (STI) prevention in this setting, we conducted a cross-sectional study of recreational drug use and risky sexual behaviors among MSM. A standardized, self-administered questionnaire, reviewed and approved by a university Institutional Review Board, was offered to men 18 years of age and older who reported ever having sex with a man. Men were approached on weekends in five diverse locations in Miami-Dade County and five in Broward County in winter 2004. An honorarium of $10 was offered to those who completed and returned a questionnaire. Of 407 participants, 115 men (28%) lived in Miami-Dade, 147 (36%) lived in Broward, 46 (11%) lived in another county in south Florida, and 99 (24%) lived elsewhere. Overall, 32% reported using one or more "club drugs" in the past year. Club drug use was highly associated with unprotected anal intercourse (UAI) (P < .001). MSM residing outside of south Florida were more likely than local residents to report using cocaine and ketamine and engaging in unprotected receptive anal intercourse (URAI) in the past month (P = .03). Tourists may be even more likely than residents to engage in risky sexual behaviors and use certain recreational drugs. Interventions must be developed, implemented, and evaluated that take into account the unique characteristics of international resort areas.

Adolescent↗
PubMed2002

Changing safety net of last resort: downsizing general assistance for employable adults.

General assistance (GA) has served as an income support program of last resort for people not eligible for other programs. Because each state has complete discretion to design its program, the GA services model parallels Temporary Assistance for Needy Families (TANF) in its reliance on decentralized government decision making. Thus, GA programs can provide lessons about services variability and common program features that have arisen in a decentralized income support system. This study examined the characteristics of state GA programs across several program dimensions--eligibility criteria, work requirements, time limits, administrative arrangements, and caseloads. The authors show that GA programs have changed from 1989 to 1998. Although most states retained GA programs in some form, caseloads declined as a result of tightening eligibility requirements for people considered employable. This casts doubt on the viability of GA as a safety net program for economically vulnerable people, including those who do not qualify for or exceed time limits under TANF.

Adult↗
PubMed1996

Promoting breastfeeding in rural communities: breast is best and bottle is a last resort.

'Breast is best and bottle is a good second best' has been a common infant nutrition axiom in Australia in recent times. The impact of the widespread recognition of breastfeeding as the most appropriate form of infant nutrition for the first six months of life has been softened by this almost favourable premise about the suitability of artificial feeding. The promotion of breastfeeding becomes that much more difficult if bottle feeding is seen to be, and promoted as, a comparable alternative to breastfeeding by health professionals and the broader community. There is accumulating evidence to suggest that this is not the case, and that infant feeding with artificial formulas increases the risk of short- and long-term morbidity and mortality. This review of breastfeeding promotion challenges health professionals in rural Australia to adopt the more appropriate axiom that 'breast is best and bottle is a last resort'.

Adult↗
PubMed1989

An evaluation of Bennett's method for determining the equivalent powers of the eye and its crystalline lens without resort to phakometry.

Refraction and optical components have been measured in 36 eyes using objective optometry, keratometry, ophthalmophakometry and A-scan ultrasonography. A computing scheme was used to confirm that the accumulated experimental errors for a phakometric technique tend to exceed the inherent errors of a new method which calculates the equivalent powers of the eye and its crystalline lens without resort to phakometry. Bennett's method was shown to be a valuable technique in biometric studies which obviates the need for lengthy experimental investigations.

Adult↗
PubMed2004

A last resort modality using cryofiltration apheresis for the treatment of cold hemagglutinin disease in a Veterans Administration hospital.

Cold hemagglutinin disease is a cold autoimmune hemolytic anemia (cAIHA) caused by an autoantibody, such as IgM, directed against the I-antigen present on the surface of erythrocytes. Cold exposure can activate this system causing hemolysis, hemagglutination, microvascular thrombosis, or acrocyanosis. Thus, surgical procedures requiring hypothermia, such as coronary artery bypass surgery, present a significant problem in patients with cAIHA. The purpose of this study was to evaluate the safety and effectiveness of cryofiltration apheresis (CFA), used as a last resort, for the treatment of cAIHA. Effectiveness was evaluated by clinical assessment and laboratory evaluations of cold agglutinin titer, immunoglobulins, and other plasma proteins. Safety was evaluated by vital signs, monitoring, and laboratory measurements of complements, hematology and blood chemistry. Five patients with cAIHA were treated by CFA using the cryoglobulin (CG) filter (Pall Medical, Ann Arbor, MI, USA). Four patients received only one CFA procedure, while one patient received four CFA treatments. The cold agglutinin titers were fairly low, ranging from 1 : 1 to 1 : 2048. However, a wide thermal amplitude(4-37 degrees C) was observed in most patients. Two out of five patients responded favorably with reduction in titer. The two responders had acute forms of cAIHA with serum positive for cryoglobulins. The three non-responders had chronic forms of cAIHA with negative cryoglobulins. CFA effectively removed cryoprotein precipitates while conserving other plasma components. The CG filter was biocompatible with no complement activation or observed complications due to CFA or CG filter. While the mechanism of action in treating this type of patient population with CFA is unknown, the plausible theories are discussed.

Aged↗
PubMedDate not supplied

Ski injury statistics, 1982 to 1993, Jackson Hole Ski Resort.

A retrospective analysis was conducted on injury statistics compiled over 12 seasons, from 1982 to 1993 (2.55 million skier-days), at a Wyoming ski resort. The population at risk was determined by ticket sales per year. A total of 9749 skiing injuries was indexed by anatomic region and severity according to diagnosis on initial evaluation. Injury rates were then analyzed as a function of time. The injury rate remained constant at 3.7 injuries per 1000 skier-days during the 12 seasons. The rate of lower extremity to upper extremity injury decreased from 4:1 to 2:1 during the study period (P < 0.03). The ankle injury rate also decreased with time (P < 0.04). Ulnar collateral ligament sprains make up 7% of all injuries. Knee sprains in general account for 30% of all injuries. The incidence of anterior cruciate ligament tears increased as a function of time (P < 0.04) and accounted for 16% of all skiing injuries during the study period. The medial collateral ligament sprain was the most common injury, making up 18% of skiing injuries. Forty-seven snowboard injuries from the 1992 to 1993 season are also presented. Our injury statistics mirror those currently reported in North America, except our data reflect a higher incidence of knee sprains.

Ankle Injuries↗
PubMedDate not supplied

The ethics of palliative sedation as a therapy of last resort.

Many patients nearing the end of life reach a point at which the goals of care change from an emphasis on prolonging life and optimizing function to maximizing the quality of remaining life, and palliative care becomes a priority. For some patients, however, even high-quality aggressive palliative care fails to provide relief. For patients suffering from severe pain, dyspnea, vomiting, or other symptoms that prove refractory to treatment, there is a consensus that palliative sedation is an appropriate intervention of last resort. In this report, the National Ethics Committee, Veterans Health Administration examines what is meant by palliative sedation, explores ethical concerns about the practice, reviews the emerging professional consensus regarding the use of palliative sedation for managing severe, refractory symptoms at the end of life, and offers specific recommendations for institutional policy.

Procedural Sedation↗
PubMed2005

The last resort? Staff and client perspectives on physical intervention.

This study provides feedback from research with staff and clients of a medium secure learning disability service in north-west England. Participants were asked about incidents which required the use of physical intervention, using unstructured interviews within a participatory research framework. The article explores clients' and staff accounts of aggressive incidents and the consequences of physical intervention. Clients cited other clients and the ward atmosphere as the main reasons for aggressive behaviour. Some clients said that the use of physical intervention made them more frustrated and brought back memories of frightening experiences. Staff reported that incidents of aggression and the use of physical intervention were upsetting and traumatic, causing feelings of guilt and self-reproach. Staff said that they always used physical intervention as a last resort, although clients often reported otherwise. Time out and post-incident discussions were valued by both groups, as were strong staff/client relationships.

Aggression↗
PubMed1988

Suicide and parasuicide in a hill resort in Malaysia.

Ninety-five cases of suicide and 134 cases of parasuicide that occurred between October 1973 and September 1984 in the hill resort district of Cameron Highlands in Malaysia were analysed. Eighty-one per cent of suicides and 78% of parasuicides were of Indians, although they only form 25% of the population. The average annual suicide rate for Indians (over 10 years of age) was 157 per 100,000. About 94% of suicides and 66% of parasuicides were by ingesting agricultural poisons. The age- and sex-specific suicide rates for women were highest in the 20-24-year-old age group. Some possible reasons for high suicide rates among Indians are discussed.

Adult↗
PubMed1995

A case of unprotected left main coronary stenosis rescued by directional coronary atherectomy as a last resort.

The prognosis of left main coronary stenosis complicating cardiogenic shock is very poor. Unprotected left main coronary stenosis usually preclude percutaneous transluminal coronary angioplasty because of the appearance of elastic recoil and the risk of hemodynamic collapse after acute closure of the artery. An 85-year-old woman with no history of heart disease developed cardiogenic shock. Coronary arteriography showed an unprotected left main coronary stenosis. Due to her advanced age, her family opposed coronary artery bypass surgery. We report here the successful treatment of this case of unprotected left main coronary stenosis by directional coronary atherectomy as a last resort.

Aged↗