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PubMed1997

Alcohol early intervention: a nursing model for screening and intervention strategies.

This paper presents the background policy directions in Australia that are encouraging nurses to initiate alcohol early intervention strategies. The current clinical initiatives that are supporting screening and early intervention strategies are critically reviewed and presented in the form of an Alcohol Early Intervention Model to guide nursing practice. The model is compatible with current directions in nursing which encourage more independent, empowering and educationally focused strategies. This model also provides direction for undergraduate and graduate nursing curricula and offers opportunities for future research.

Alcoholism↗
PubMed1998

[European Program for Intervention Epidemiology Training (EPIET): a training epidemiologic intervention in Europe].

The European programme for interventional epidemiology training (EPIET) offers a two year practical training in European national institutes mandated for the surveillance and control of communicable diseases. The training, closely supervised by senior epidemiologists, allows each EPIET fellow to learn while serving and conducting tasks devoted to intervention epidemiologists (surveillance, investigation, research, aid to decision making, and communication with the public, the media, the health authorities and the scientific community). The programme is equally funded by the European Commission, the 15 member states, Norway and the World Health Organisation. This training, derived from the North American and British experiences offers a practical complement to knowledge acquired from European universities. EPIET fellows, their supervisors and colleagues from training institutes have rapidly formed a network of intervention epidemiologists necessary for conducting and coordinating the surveillance of communicable diseases in Europe.

Communicable Diseases↗
PubMed2006

Breast interventions: a primer for interventional radiologists.

Breast cancer is the second leading cause of cancer related deaths in the United States. The area of breast interventions has benefited from recent advances in devices and imaging quality. Ultrasound, MRI, and stereotactic guided vacuum assisted and mechanical rotating stick freeze biopsy are the preferred methods for histologic diagnosis of breast lesions. Ablation techniques are available for the treatment of benign and malignant breast disease. The MammoSite balloon catheter can be placed percutaneously for delivering high dose short term brachytherapy. Interventional Radiologists can and should perform all of these procedures to improve the quality of women's health.

Biopsy↗
PubMed2004

Assessment of coronary intervention in Japan from the Japanese Coronary Intervention Study (JCIS) Group.

BACKGROUND: The first nationwide survey of the situation in Japan (the 1997 SJ) regarding percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) was conducted by the Japanese Coronary Intervention Study (JCIS) group and the results of the second nationwide, continuous survey of Japan in 2000 (the 2000 SJ) are presented here. METHODS & PROCEDURES: A questionnaire was collected from 8,268 facilities (99.93%). In the 2000 SJ, the total number of coronary arteriography (CAG) performed was 543,046 (428 CAGs per 105 population). The estimated ratio of CAG to patients with coronary artery disease (CAD) in Japan is approximately 1.4-fold that in the US. Total numbers of PCI and CABG performed were 146,992 and 23,584, and increased to 134% and 130%, respectively, over the 3 years. PCI facilities with an annual number of PCIs performed of more than 100 were 40.2%, and the respective CABG facilities were 8.3%. The ratio of PCI to CABG was 6.23 in the 2000 SJ, and was several times higher than the ratio in Western countries. CONCLUSION: The situation in Japan regarding the number of CAG, PCI, and CABG procedures performed is very different from that in Western countries. This provides important information for diagnosis, treatment and guidelines for Japanese patients with CAD.

Aged↗
PubMed1990

Interventional radiology of the biliary tract. Transcholecystic intervention.

Diagnostic and therapeutic biliary intervention by percutaneous access to the gallbladder is an important new area in interventional radiology. The anatomy of the gallbladder, biliary tree, and surrounding viscera is reviewed in this article as a preliminary to discussion of the diagnostic techniques of aspiration, cholangiography, biopsy, and the therapeutic techniques of gallbladder drainage and cholelithotomy. Recently there has been a bewildering proliferation of procedures aimed at removal, fragmentation, and dissolution of gallbladder stones. Several of these are discussed in this article. Removal of common bile duct stones by percutaneous cholecystostomy also is discussed.

Cholecystitis↗
PubMed2000

Interventions for treating scabies.

BACKGROUND: Scabies is a common public health problem with an estimated prevalence of 300 million. Infestation can cause considerable discomfort and intense itching. Severe adverse effects have been reported for some drugs used to treat scabies. OBJECTIVES: The objective of this review is to assess the effects and toxicity of topical and systemic drug treatment for scabies. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Embase, military records, traditional medicine databases. We also contacted international specialist centres and drug manufacturers. SELECTION CRITERIA: Randomised controlled trials of any drug treatment for scabies. Tolerability and toxicity were sought in any study of humans taking any drug treatments for scabies. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data. MAIN RESULTS: Eleven trials were included (7 compared drug treatments, 2 compared treatment regimes, 1 compared the drug vehicle and 1 was a community intervention). Compared with placebo in one small trial, ivermectin was associated with a significant higher clinical cure rate at seven days. Permethrin appeared to be more effective than crotamiton for clinical and parasitic cure rates. Permethrin appeared to be better than gamma benzene hexachloride for clinical cure rates in two small trials but had no advantage in the largest trial (test for heterogeneity p< 0.001). Permethrin also appeared more effective in reducing itch persistance than gamma benzene hexachloride. There appeared to be no difference in clinical cure rates between crotamiton and gamma benzene hexachloride. Single trials assessed: the effectiveness of oral versus topical treatment (ivermectin versus benzyl benzoate); treatment vehicle (pork fat versus cold cream); and mass community treatment (ivermectin) but were too small to demonstrate an effect. No randomised trials of malathion were identified. Serious adverse drug reactions (including death and convulsions) have been reported in other studies of scabies drugs, most notably gamma benzene hexachoride and ivermectin. REVIEWER'S CONCLUSIONS: The evidence that permethrin is more effective than gamma benzene hexachloride is inconsistent. Permethrin appears to have less potential serious drugs reactions than gamma benzene hexachloride although this is not derived from trial data. More research is needed of the safety and effectiveness of ivermectin and malathion compared to permethrin, on community management, and on different regimes and vehicles for topical treatment.

Hexachlorocyclohexane↗
PubMed2000

Multidisciplinary team interventions for delirium in patients with chronic cognitive impairment.

BACKGROUND: Delirium is common in hospitalized elderly people. In the frail elderly, delirium may occur in 60% of those hospitalized. In the cognitively impaired, 45% have been shown to develop delirium and these patients have longer lengths of stay and a higher rate of complications which, amongst other things, together contribute to an increase in cost of care. The combination of being elderly and chronically cognitively impaired leads to a high risk of delirium with the associated increased risk of prolonged hospital stay, complications, and poor outcomes. The management of delirium has commonly been multifaceted - the primary emphasis has always been on the diagnosis and therapy of the precipitating factors, but as this may not be immediately resolved, symptomatic and supportive care may become of major importance. OBJECTIVES: The objective of this review is to assess the available evidence for the effectiveness, if any, of multidisciplinary team interventions in the coordinated care of patients with delirium superimposed on an underlying chronic cognitive impairment compared with the usual care of older cognitively impaired patients. SEARCH STRATEGY: The Cochrane Controlled Trials Register (Cochrane Library, up to and including Issue 1, 1998) was searched using the terms 'delirium, controlled trial, cognitive'. MEDLINE, EMBASE and Psychlit (Ovid via Winspirs up to Feb 1998) were also searched with the same terms. Other sources including personal communications, ongoing trials, conference proceedings, handsearching and reference lists of published papers and books were all searched for relevant randomized controlled trials. The total yield from searching was 157 from which 8 (eight) were retained for consideration in the review. SELECTION CRITERIA: From the initial search yields, all randomised controlled trials involving the management of elderly patients with delirium were identified. A single reviewer (AMB) discarded irrelevant publications based on the title of the publication and its abstract. In the event that the article could possibly be relevant, it was retrieved for further assessment. All references were compiled in a list with a commentary on type of article, eg review, prospective study etc and this was independently considered by the second reviewer (RR) who agreed to review all randomised controlled studies reported on patients with delirium. Selection for possible inclusion in this review was then made on the basis of the participants reported as having chronic cognitive impairment, who then developed incident delirium and were randomly assigned to either coordinated multidisciplinary care or usual care. The outcomes of interest were length of stay in hospital, morbidity (including complications), patient distress & impact on care environment, mortality, discharge arrangements and follow-up including assessment of cognitive function at 6 months. Studies in which patients with chronic cognitive impairment or dementia, managed for incident delirium, according to ICD 9 criteria (see note) were considered eligible for inclusion in the review. Studies of risk factors and non-randomized studies were excluded. Note: this classification has been widely utilised throughout the English speaking medical literature over the past 20 years: ICD 10 is still being incorporated into clinical coding systems and has not been utilised in studies published in 1996. (ABSTRACT TRUNCATED)

Delirium↗
PubMed2000

Interventions for isolated diaphyseal fractures of the ulna in adults.

BACKGROUND: Isolated fractures of the shaft of the ulna, which are often sustained when the forearm is raised to shield against a blow, are generally treated on an out-patient basis. OBJECTIVES: To assess the effects of various forms of treatment for isolated fractures of the ulnar shaft in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE (1976 to August 1999), EMBASE (1981 to September 1999), the Cochrane Controlled Trials Register (up to Issue 4, 1999), and bibliographies of trial reports. Date of the most recent search: August 1999. SELECTION CRITERIA: Randomised or quasi-randomised trials of conservative and surgical treatment of isolated fractures of the ulnar shaft in adults. Excluded were fractures of the proximal ulna and Monteggia fracture dislocations. DATA COLLECTION AND ANALYSIS: Independent quality assessment and data extraction were performed by all reviewers. Requests for more information were sent to trialists. Given the limited and poor quality evidence available, quantitative analysis was kept to a minimum. MAIN RESULTS: Two small trials of conservative treatment, involving a total of 106 patients were included in this review. Both trials were of poor quality. One randomised trial compared short arm pre-fabricated functional braces with long arm plaster casts. There was no statistically significant difference in the time it took for fracture union. Patient satisfaction and return to work were better in the brace group. The other quasi-randomised trial compared Ace Wrap elastic bandage, short arm plaster cast and long arm plaster cast. The large loss to follow-up in this trial makes any data analysis tentative. However the need for replacement of the Ace wrap by other methods due to pain does indicate the potential for a serious problem with this intervention. REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomised trials to determine which method of treatment is the most appropriate for isolated fractures of the ulnar shaft in adults. There is a need to establish the incidence of this injury and the outcome and associated costs of the various forms of treatment. Well designed randomised trials of current forms of conservative treatment are recommended.

Adult↗
PubMed2000

Interventions for treating tuberculous pericarditis.

BACKGROUND: Tuberculous (TB) pericarditis is becoming more common. The infection can result in fluid around the heart, which can be fatal. OBJECTIVES: To evaluate evidence from trials about the effects of medical and surgical treatments for TB pericarditis on death and life-threatening conditions. SEARCH STRATEGY: The Cochrane Infectious Diseases Group trials register, the Cochrane controlled trials register, Medline, Embase and reference lists of articles; contact with experts in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials of treatments for TB pericarditis. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Meta-analysis using fixed effects models calculated summary statistics, provided there was no significant heterogeneity, and expressed results as relative risk. MAIN RESULTS: Three trials met the inclusion criteria, with a total of 411 participants. Treatments were adjuvant steroids and surgical drainage. Two small trials tested steroids. There were fewer deaths (all causes) in the intervention group, but the numbers were small and the result could have occurred by chance (relative risk [RR] 0.65, 95% confidence interval [CI] 0.36 to 1.16, n = 350). In one trial studying patients with effusion, "cure" was higher in the steroid group (alive and free of disability at 2 years (RR 0.69, 95% CI 0.29 to 0.80, n = 221). One trial examined open surgical drainage compared with conservative management, and showed no impact of surgery on death, but a protective effective against cadiac tamponade (RR 0.04, 95% CI 0.00 to 0.64). REVIEWER'S CONCLUSIONS: Steroids have potentially large impacts on survival, but trials are too small to test this. We believe further placebo controlled trials of steroids are warranted, exploring whether the presence of effusion or fibrosis modifies effects. Surgical options also require further evaluation.

Adrenal Cortex Hormones↗
PubMed2000

Interventions for preventing and treating backache in pregnancy.

BACKGROUND: More than a third of women experience back pain during pregnancy. OBJECTIVES: The objective of the review was to assess the effects of preventive interventions and treatments for backache in pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials of any treatment to reduce the incidence or severity of back pain in pregnancy, or to prevent back pain arising in pregnancy. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. MAIN RESULTS: One trial of 109 women was included. This cross-over trial compared the use of a special shaped pillow to fit under the woman's abdomen (Ozzlo pillow) with a standard pillow. Women experienced less pain in the week when they used the Ozzlo pillow than in the week with the standard pillow (odds ratio 0.32, 95% confidence interval 0.18 to 0.58). REVIEWER'S CONCLUSIONS: Specially shaped pillows appear to help reduce back pain in late pregnancy and improve sleep.

Back Pain↗
PubMed2005

Facilitated primary coronary intervention with abciximab and very low dose of alteplase during off-hours compared with direct primary intervention during regular hours.

In patients with acute myocardial infarction (AMI), the off-hour presentation is one of the major determinants of door-to-balloon delay. Moreover, the nighttime presentation is associated with increased mortality after primary coronary intervention (PCI). The prompt starting of a therapy able to start recanalization of the infarct-related artery before intervention might improve the results of off-hour primary PCI. We compared the outcome of 212 consecutive patients with AMI undergoing either direct or facilitated PCI according to the hour of presentation. Patients arriving off-hours were pretreated with alteplase (20 mg) and abciximab and underwent facilitated PCI. Patients presenting on-hours underwent direct PCI. A basal Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 was observed in 1.0% of patients undergoing direct PCI and in 44% of patients undergoing facilitated PCI (P = 0.001). More patients starting PCI with a TIMI 3 flow achieved a postinterventional fast TIMI frame count (72.0% vs. 38.8% direct PCI group vs. 34.9% facilitated PCI group with basal TIMI 0-2; P = 0.001) and a TIMI perfusion grade 3 (66.0% vs. 38.8% direct PCI group vs. 39.7% facilitated PCI group with basal TIMI 0-2; P = 0.004). Preinterventional TIMI flow grade 3 was associated with a higher gain in left ventricular ejection fraction at 1 month (10.9% +/- 6.4% vs. 7.0% +/- 9.6% direct PCI group vs. 6.1% +/- 6.0% facilitated PCI group with basal TIMI 0-2; P = 0.005). No significant difference was observed in major bleedings, although there was a trend toward a higher risk in the facilitated PCI group. Patients in the facilitated PCI group achieving a basal TIMI 3 flow showed improved myocardial reperfusion and better left ventricular function recovery. Bleeding complications associated with combination therapy remained an important concern.

Abciximab↗
PubMed2002

Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention).

The nonoperative management (NOM) of abdominal trauma has gained increasing acceptance over the past decade. This approach has been extended to severe trauma patients previously considered as candidates for surgery. Consequently, the incidence of delayed and uncommonly encountered complications has increased. Causes of delayed complications are multiple and include: (a) abnormal or insufficient injury healing process; (b) retention of necrotic tissue; (c) secondary infection of initially sterile collections; and (d) underestimation of injury severity. The purpose of this review article is to explain the role of various imaging modalities in detecting post-traumatic delayed complications and to highlight the usefulness of minimally invasive techniques, including laparoscopy, biliary endoscopy, therapeutic angiography and image-guided drainage. Subsequent complications, which do not necessarily negatively influence the final outcome, are often predictable, virtually obligatory consequences of the successful NOM of high-grade or complex abdominal injuries. Between 50 and 60% of those patients with grade-IV or grade-V liver or splenic lacerations require some type of interventional treatment; therefore, indiscriminate discharge of patients with solid organ injury managed conservatively may be potentially harmful. As the incidence of complications is higher for more severe grade-IV or grade-V liver, spleen, or kidney injuries, scheduled follow-up CT scans may be rational in this subset of patients to identify potential complications amenable to early application of interventional techniques. Follow-up CT scans are unnecessary in stable adults or children with low-grade injury. Delayed splenic or hepatic rupture is one of the major concerns because this type of complication remains difficult to predict and historically often requires emergent surgery. These ruptures may benefit from NOM, should the same criteria as for primary rupture be respected. Conversely, parenchymatous focal pooling of contrast on initial CT is a good predictor for the development of delayed vascular malformation. In children, as a large part of splenic and hepatic vascular malformations resolve spontaneously, expectant observation may be indicated provided that a strict imaging follow-up is performed until complete disappearance of these lesions. If needed, embolization of parenchymal vascular lesions should be performed as selectively as possible in order to avoid functional parenchyma loss and to reduce the risk of secondary infection of hematoma or ischemic tissue. Technical improvements, such as microcatheter systems and direct percutaneous approach to targeted lesions, have widened the potential for safe endovascular management of acquired vascular malformations. Advantages and disadvantages relative to the different embolic agents are explained. Endoscopic retrograde pancreatography is the chief investigational tool for detecting biliary and pancreatic ducts injuries. The respective roles of endoscopic, percutaneous and surgical approaches in the management of these complications are discussed. The CT scan and ultrasound-guided drainage provide effective nonoperative options in the management of post-traumatic parenchymatous and (retro)-peritoneal collections. Treatment modalities of less common complications, such as bowel stricture or perforation, mesenteric vascular injuries and renal trauma-induced hypertension, are reviewed.

Biliary Tract Diseases↗
PubMed1984

Responses of black and white males to the special intervention program of the Multiple Risk Factor Intervention Trial.

Of the 12,866 males aged 35 to 57 years who were randomly assigned to the special intervention (SI) and usual care (UC) groups of the Multiple Risk Factor Intervention Trial (MRFIT), 931 (7.2%) were black. With use of a multivariate score from the Framingham study, all were assessed to be in the upper 10% to 15% of coronary risk because of their diastolic blood pressure, serum cholesterol level, and/or cigarette use. Blacks in the MRFIT were of lower educational and income levels and were less often employed in professional-technical-managerial or other white-collar jobs than whites. At baseline, blacks had higher mean blood pressures and a higher prevalence of hypertension than whites, were more often smokers but smoked fewer cigarettes per day, and had a higher prevalence of ECG abnormalities. Dietary lipid composition was similar for black and white males; so also were weight and body mass index, plasma total cholesterol levels, and low-density lipoprotein (LDL) cholesterol levels. High-density lipoprotein cholesterol levels were higher and triglyceride levels lower for blacks than whites. Attendance rates over the years of the trial were similarly high for blacks and whites. Among males in the SI group, smoking cessation rates, changes in dietary lipid composition and in plasma total and LDL cholesterol, and achievement of normotensive diastolic pressure with antihypertensive stepped-care treatment were comparable for black and white males. This MRFIT experience indicates ability to induce extensive changes in life-styles (eating and smoking habits) of both black and white American males of varying educational and socioeconomic backgrounds and also to achieve long-term effective adherence to programs for the treatment and control of hypertension.

Adult↗
PubMed1995

The history of interventional cardiology: cardiac catheterization, angioplasty, and related interventions.

The histories of cardiac catheterization, angioplasty, and other catheter interventions are spectacular journeys marked by undeterred genius, serendipity, and the vindication of the scientific method. Cardiac catheterization began with Hales's 1711 equine biventricular catheterization, other early experimental catheterizations in the nineteenth century, and Forssmann's dramatic 1929 right-heart self-catheterization. Cournand, Richards, and others finished unlocking the right heart in the 1940s; Zimmerman, Cope, Ross, and others unlocked the left heart in the 1950s; and the coronary arteries were inadvertently unlocked by Sones in 1958, leading to the advent of percutaneous femoral coronary angiography by Judkins and by Amplatz in 1967. Dotter's accidental catheter recanalization of a peripheral artery in 1963 ushered in the era of intervention, crowned by Gruentzig's balloon angioplasty in the mid-1970s and leading to today's panoply of devices used percutaneously to revascularize the coronary arteries in a variety of clinical settings.

Angioplasty↗
PubMed1985

Baseline rest electrocardiographic abnormalities, antihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group.

The overall results of the Multiple Risk Factor Intervention Trial (MRFIT) showed a nonsignificant 7% lower coronary artery disease (CAD) mortality rate in the special-intervention (SI) as compared to the usual-care (UC) group. The initial results also suggested that the SI program was more effective than UC in the community in reducing the CAD mortality rate in nonhypertensive persons than in hypertensive persons, and that the SI program used was more effective in reducing CAD deaths among men without than men with electrocardiographic (ECG) abnormalities at rest. Furthermore, an unfavorable mortality trend in hypertensive SI men with ECG abnormalities at rest compared with UC men was noted (adjusted relative risk of 1.67). Further analyses in baseline-defined subgroups indicated that (1) the most common ECG abnormalities at rest were high R waves and ST-T changes, (2) the CAD mortality differential (SI/UC) was similar in the subgroup with these abnormalities and in the subgroup with other abnormalities at rest, (3) the apparent excess CAD mortality among hypertensive SI men with ECG abnormalities at rest was manifested chiefly as sudden death within 1 hour, and (4) the association between ECG abnormalities at rest and the CAD mortality rate among hypertensive men was independent of the baseline level of blood pressure or of the findings on the exercise electrocardiogram. However, CAD mortality in those with abnormalities on the electrocardiogram both at rest and during exercise was lower in the SI than the UC group. A possible explanation for the difference in outcome in the baseline-defined subgroup was an unexpectedly low UC mortality rate. However, within-group analysis revealed an interaction between ECG abnormalities at rest and diuretic treatment in the SI group, with the risk of CAD death for men prescribed diuretic drugs relative to men not prescribed diuretic drugs estimated as 3.34 among men with baseline ECG abnormalities at rest and as 0.95 among men without such abnormalities. No such effect was found in the UC group, in which men generally were prescribed lower doses of hydrochlorothiazide and chlorthalidone than SI men. However, analyses do not suggest an effect of diuretic dose or of hypokalemia on the CAD mortality rate in treated SI participants. Although subgroup analyses must be interpreted with caution, particularly those that go beyond the randomized clinical trial design by the MRFIT, these findings pose hypotheses for investigation by other researchers in systemic hypertension and may have implications for therapy.

Antihypertensive Agents↗
PubMed1990

Fetal intervention in obstructive uropathy: prognostic indicators and efficacy of intervention.

Management of the fetus with bilateral hydronephrosis is controversial; ability to predict outcome and efficacy of prenatal intervention are unknown. We studied 40 fetuses referred for ultrasonography, examination of fetal urine, and possible therapy. We retrospectively assigned fetuses to a good prognosis group if fetal urine was hypotonic (sodium less than 100 mEq/L, chloride less than 90 mEq/L, osmolarity less than 210 mOsm/L) and there was no ultrasonographic evidence of dysplasia; we assigned fetuses to a poor prognosis group if even one criterion was abnormal. Survival was greater in the good prognosis group than in the poor prognosis group (81% vs 12.5%; 87% vs 30%, excluding abortions) (p less than 0.005). We then attempted to assess the efficacy of prenatal urinary decompression by comparing outcome within the good and poor prognosis groups. Survival with intervention was greater in both the good prognosis group and the poor prognosis group (89% vs 70% and 30% vs 0%). In 6 of the 8 survivors in the good prognosis group, severe oligohydramnios was reversed by decompression. We conclude the fetal urine electrolyte levels and ultrasonographic appear helpful in predicting residual fetal renal function and neonatal outcome and that prenatal decompression may prevent the development of fatal pulmonary hypoplasia.

Amniotic Fluid↗