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At least 271 records · Page 15Linked to original sources
PubMed2006

A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention early after ST-elevation myocardial infarction: the WEST (Which Early ST-elevation myocardial infarction Therapy) study.

AIMS: Uncertainty exists as to which reperfusion strategy for ST-elevation myocardial infarction (MI) is optimal. We evaluated whether optimal pharmacologic therapy at the earliest point of care, emphasizing pre-hospital randomization and treatment was non-inferior to expeditious primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: Which Early ST-elevation myocardial infarction Therapy (WEST) was a four-city Canadian, open-label, randomized, feasibility study of 304 STEMI patients (> 4 mm ST-elevation/deviation) within 6 h of symptom onset, emphasizing pre-hospital ambulance treatment and participation of community and tertiary care centres. All received aspirin, subcutaneous enoxaparin (1 mg/kg), and were randomized to one of three groups: (A) tenecteplase (TNK) and usual care, (B) TNK and mandatory invasive study < or = 24 h, including rescue PCI for reperfusion failure, and (C) primary PCI with 300 mg loading dose of clopidogrel. Time from symptom onset to treatment was rapid (to TNK for A = 113 and B = 130 min and for PCI in C = 176 min). The primary outcome, a composite of 30-day death, re-infarction, refractory ischaemia, congestive heart failure, cardiogenic shock, and major ventricular arrhythmia, was 25% (Group A), 24% (Group B), and 23% (Group C), respectively. However, there was a higher frequency of the combination of death and recurrent MI in Group A vs. Group C (13.0 vs. 4.0%, respectively, P-logrank = 0.021), yet no difference between Group B (6.7%, P-logrank = 0.378) and C. CONCLUSION: These data suggest that a contemporary pharmacologic regimen rapidly delivered, coupled with a strategy of regimented rescue and routine coronary intervention within 24 h of initial treatment, may not be different from timely expert PCI.

Abciximab↗
PubMed1987

An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. I. Application of the case-control method for development of an intervention.

A case-control study was performed to develop an empirically based intervention for improving water-sanitation practices and rates of childhood diarrhea among families residing in urban Bangladesh. For three months fortnightly, histories of diarrhea were taken for all children under six years of age among 1,350 families to estimate age-specific rates of diarrhea in the population. A total of 247 randomly sampled families, termed sentinel families, were visited once during the study for prolonged observations of water-sanitation practices. Behaviors potentially affecting incidence of diarrhea were compared in a case group (n = 45), defined as sentinel families whose children had rates at least 1.7 times the rates expected for similarly aged children, and in a control group (n = 53), defined as sentinel families without any episodes of childhood diarrhea during the period of observation. Three practices differentiated the two groups: more control (82%) than case (53%) mothers who were observed to prepare food washed their hands before beginning the preparation (p less than 0.01); fewer control families (33%) than case families (80%) had ambulatory children who, when observed to defecate, did so in the family's living area (p less than 0.01); and fewer control (30%) than case (47%) families had children who were observed to place garbage or waste products in their mouth (p less than 0.10). Focus on these three empiric associations enabled the design of a community-specific educational intervention which is simple in construction and based upon naturally occurring, financially feasible, salutory practices.

Bangladesh↗
PubMed2001

Communication interventions and cancer control: a review of the National Cancer Institute's health communication intervention research initiative.

It is evident, based on the description of the projects and on the preliminary reports in this special issue, that this group of studies will help increase understanding about how health communication interventions can be used to promote cancer prevention and control, as well as to reduce the burden of cancer, particularly among those disproportionately affected. The diversity in theoretical approaches and intervention modalities used in these studies also promises to contribute broadly to understanding of the role of communication in health promotion and disease prevention.

Health Education↗
PubMed1995

Validation and coding of the NIC taxonomy structure. Iowa Intervention Project. Nursing Interventions Classification.

Processes for validation and coding of the taxonomy for the Nursing Interventions Classification (NIC) are described. A sample of nurses expert in theory development rated the NIC taxonomy using five criteria. Following identification of a stable structure, the taxonomy was coded with each intervention receiving a unique number. A coded and valid taxonomic structure facilitates use of the classification in computerization and makes possible the collection of comparable data. A coded classification can also be used in reimbursement systems.

Cluster Analysis↗
PubMed2004

Anatomy of coronary disease in diabetic patients: an explanation for poorer outcomes after percutaneous coronary intervention and potential target for intervention.

There are over 1.3 million known diabetic patients in the UK and a similar number who have the disease undiagnosed. Over 90% have non-insulin dependent diabetes mellitus usually characterised by insulin resistance and adult onset. Over half of all diabetic patients die of coronary disease and account for over a fifth of percutaneous coronary intervention (PCI) revascularisation procedures. Despite recent therapeutic advances such as new antiplatelet treatments and drug eluting stents, outcomes for diabetic patients after PCI are still significantly worse than for non-diabetic patients. This article summarises what is known about the pattern and severity of diabetic coronary disease, what mechanisms are responsible for these differences, and whether this information can help explain the poorer prognosis for these patients after PCI and form the basis of interventions to improve outcome.

Angioplasty, Balloon, Coronary↗
PubMed2006

Intervention in acute coronary syndromes: do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE).

OBJECTIVE: To determine whether revascularisation is more likely to be performed in higher-risk patients and whether the findings are influenced by hospitals adopting more or less aggressive revascularisation strategies. METHODS: GRACE (Global Registry of Acute Coronary Events) is a multinational, observational cohort study. This study involved 24,189 patients enrolled at 73 hospitals with on-site angiographic facilities. RESULTS: Overall, 32.5% of patients with a non-ST elevation acute coronary syndrome (ACS) underwent percutaneous coronary intervention (PCI; 53.7% in ST segment elevation myocardial infarction (STEMI)) and 7.2% underwent coronary artery bypass grafting (CABG; 4.0% in STEMI). The cumulative rate of in-hospital death rose correspondingly with the GRACE risk score (variables: age, Killip class, systolic blood pressure, ST segment deviation, cardiac arrest at admission, serum creatinine, raised cardiac markers, heart rate), from 1.2% in low-risk to 3.3% in medium-risk and 13.0% in high-risk patients (c statistic = 0.83). PCI procedures were more likely to be performed in low- (40% non-STEMI, 60% STEMI) than medium- (35%, 54%) or high-risk patients (25%, 41%). No such gradient was apparent for patients undergoing CABG. These findings were seen in STEMI and non-ST elevation ACS, in all geographical regions and irrespective of whether hospitals adopted low (4.2-33.7%, n = 7210 observations), medium (35.7-51.4%, n = 7913 observations) or high rates (52.6-77.0%, n = 8942 observations) of intervention. CONCLUSIONS: A risk-averse strategy to angiography appears to be widely adopted. Proceeding to PCI relates to referral practice and angiographic findings rather than the patient's risk status. Systematic and accurate risk stratification may allow higher-risk patients to be selected for revascularisation procedures, in contrast to current international practice.

Aged↗
PubMedDate not supplied

Learning disabilities identification: primary intervention, secondary intervention, and then what?

A broad consensus has been achieved regarding the importance of early primary and secondary interventions for children in academic domains for the purposes of improving overall academic competencies and preventing low achievement that often leads to a diagnosis of specific learning disability (SLD) and long-term special education placement. The characteristics of effective prevention programs generally are well established. The degree to which these programs prevent SLD is uncertain, and the subsequent procedures for determining SLD eligibility are very much at issue. Issues are discussed regarding what should be done about SLD identification after primary and secondary intervention efforts are proven inadequate for individual children.

Child↗
PubMed2003

Special intervention reduces CVD mortality for adherent participants in the multiple risk factor intervention trial.

BACKGROUND: Patient adherence affects treatment efficacy, and surprisingly, adherence is frequently associated with reductions in mortality for those receiving placebo. METHODS: This study considers the role of trial adherence for men (N = 12,338) in the Multiple Risk Factor Intervention Trial (MRFIT), a prospective study of 9-year follow-up mortality following randomization to Special Intervention (SI) or Usual Care (UC). Annual visit attendance rates were used as a measure of adherence. RESULTS: A significant Adherence x Group Assignment interaction (p =.002) revealed that SI significantly reduced cardiovascular disease (CVD) mortality for highly adherent participants, RR =.91 (95% confidence interval [CI] =.84-.99) but significantly increased CVD mortality for poorly adherent participants, RR = 1.28 (95% CI = 1.05-1.57) when compared to UC. These associations remained after controlling for baseline characteristics (e.g., income), reported illness, or occurrence of a nonfatal CVD event during the trial. The beneficial effect of SI among the adherent participants was partly due to reduced smoking and diastolic blood pressure levels during the trial. CONCLUSIONS: SI significantly reduced the risk of CVD mortality for participants adherent with the MRFIT, and this effect was accounted for by positive changes in CVD risk factors. These findings suggest a method for evaluating treatment efficacy in subgroups determined by patient responses (e.g., adherence to annual assessment visits) to the treatment program after randomization.

Adult↗
PubMed2001

Immediate post intervention effects of two brief youth suicide prevention interventions.

This study evaluated the immediate postintervention effects of two brief suicide prevention protocols: a brief interview--Counselors CARE (C-CARE)--and C-CARE plus a 12-session Coping and Support Training (CAST) peer-group intervention. Subjects were students "at risk" of high school dropout and suicide potential in Grades 9-12 from seven high schools (N = 341). Students were assigned randomly to C-CARE plus CAST, C-CARE only, or "intervention as usual." The predicted patterns of change were assessed using trend analyses on data available from three repeated measures. C-CARE and CAST led to increases in personal control, problem-solving coping, and perceived family support. Both C-CARE plus CAST and C-CARE only led to decreases in depression, and to enhanced self-esteem and family goals met. All three groups showed equivalent decreases in suicide risk behaviors, anger control problems, and family distress.

Adaptation, Psychological↗
PubMed1998

Posttransplant quality of life: a decade of descriptive studies leading to practice interventions. Posttransplant Quality of Life Intervention Study Group.

Following 10 years of descriptive quality-of-life studies, an innovative approach to outpatient care has been developed to decrease adverse events, increase employment, and enhance social support among renal transplant recipients. These 3 variables were found in the authors' previous studies to be predictive of increased quality of life following transplantation. With funding from the National Institute of Nursing Research, a multidisciplinary team has been assembled to implement the interventions identified. This article reviews the previous work that led to the development of the intervention study and demonstrates how research can guide practice.

Adaptation, Psychological↗
PubMed1975

Symposium on sensorineural hearing loss in children: early detection and intervention. The rationale for early identification and intervention.

The normal hearing child utilizes auditory data to trigger his innate propensity for language learning and begins to use these stored auditory images long before he says his first word. The auditory modality appears to provide the input from which he abstracts and regularizes the rule of grammar both from outside sources and in an auditory feedback arrangement from his own utterances. The development of expressive language appears to occur rapidly once the first word is said, and by age three he appears to be using all the basic structures of speech. The child with severe hearing impairment, on the other hand, deprived of auditory input, either does not develop speech or may with some training develop very limited speech. Since most hearing impaired children can benefit from amplification, hearing aids can provide a means to maximize the auditory channel. Many such children, however, do not receive hearing aids until three to four years of age, and so have already been deprived of these key years in language development. They have already missed the critical periods in language learning and thus are apt to remain severely depressed in language skills at best. The results of one study reported in this discussion appear to substantiate the observation that a good program of early intervention, including effective parent training and early use of hearing aids to exploit auditory potential, can help hearing impaired children to generate spontaneous spoken language more comparable to that used by their normal hearing peers in both type and level of utterance. Although this language may be more immature or less syntactically and morphologically correct than that of their normal hearing peers, it compares in syntactical structure much more favorably than does the language of hearing impaired children who have not received such special help until about two years later. The study further demonstrates the importance of early intervention and illustrates the positive effects of a good early management program on the language and resulting educational achievement of hearing impaired children.

Child↗
PubMed2001

Non-interventional and interventional transvaginal ultrasound in present day infertility practice.

The diagnosis of cause and targeted management of infertility has emerged in leaps and bounds over the last few decades. Here the author has described the non-interventional (eg, vascular study in ovulation, ultrasound study in polycystic ovarian disease and other pelvic pathological conditions) and interventional transvaginal ultrasound as evident in infertility practice today. She concluded with the few points as the possible future directions in infertility management.

Adult↗
PubMed2000

The Oral Risk Assessment and Early Intervention System--a clinician's tool for integrating the bio/psycho/social risk into oral disease interventions.

An association between oral diseases and systemic diseases has been suspected for centuries. More recently, investigation has provided insight into the impact of psychologic factors, social value systems, beliefs about disease processes and predictive treatment outcomes. Historically, dentistry has focused primarily on the restoration of physical function rather than broader multifactorial issues that impact long-term health maintenance. Dental patients are a complex interaction of biologic susceptibilities, lifestyle behaviors, values, and disease risk variables, which require an interdisciplinary approach to provide optimal health care. This article provides information-processing tools to assist clinicians in developing appropriate patient interventions by employing on Oral Risk Assessment and Early Intervention System.

Cultural Characteristics↗
PubMed2002

Why diabetics are at risk in percutaneous coronary intervention and the appropriate management of diabetics in interventional cardiology.

The increasing prevalence of diabetes mellitus in the U.S., particularly among younger patients, will place significant additional demands on an already strained healthcare delivery system. The metabolic and hormonal milieu created by diabetes mellitus fosters the development of systemic atherosclerosis, and mortality in these patients is driven largely by complications of cardiovascular disease. Unfortunately, diabetic pathophysiology poses unique challenges to attaining successful coronary revascularization, whether it is by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). In determining the optimal treatment strategy for a diabetic patient with coronary atherosclerotic disease, it is imperative that the treating physician fully understands the following: the inherent limitations to revascularization in diabetics, the pharmacologic therapies of proven benefit in diabetics with atherosclerotic disease, the currently available comparative data of CABG versus PCI in diabetics, and the ongoing medical, surgical, and interventional advances which may render earlier data obsolete.

Abciximab↗
PubMed2006

[No advantage to referring patients with acute myocardial infarction from a general hospital to an intervention clinic for percutaneous coronary intervention; comparison of mortality rates in 2000 and 2003 in the Meander Medical Centre, Amersfoort].

OBJECTIVE: To evaluate whether implementation of the 2000 Netherlands Society of Cardiology guideline 'ST-elevation acute coronary syndromes', which recommends the use ofpercutaneous coronary intervention (PCI), has reduced mortality and complication rates in a general hospital, and whether patient characteristics and outcomes are comparable to those reported in the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT) 2 and 3 trials. DESIGN: Retrospective outcomes study. METHOD: Data from 2003 were compared with data from 2000 regarding patients with acute myocardial infarction who received thrombolysis at the Meander Medical Centre in Amersfoort, the Netherlands, or percutaneous transluminal coronary angioplasty (PTCA) after referral to an intervention clinic. Data included baseline characteristics, type of treatment, outcomes and complications. Age, sex and mortality ofall patients were compared to data from the ASSENT 2 and 3 trials. RESULTS: Data were included from 130/132 patients treated in 2003 and 145/145 patients treated in 2000. Baseline characteristics were comparable, except age: there were significant more elderly patients in 2003 (p = 0.006). After implementation of the guideline, significantly more patients underwent PTCA (odds ratio (OR) 4.41 (95% CI: 2.51-7.75)). After adjusting for confounding factors there was no significant difference in in-hospital mortality (adjusted OR 1.11 (95% CI: 0.48-2.60)), 30-day mortality and 1-year mortality. Significantly more minor complications were reported (OR 2.58 (95% CI: 1.07-6.19)). Significantly more women and patients older than 75 years were treated compared with the ASSENT 2 and 3 trials. The 30-day mortality rate was significantly higher compared with ASSENT 2 (OR 1.60 (95% CI: 1.07-2.41)) and ASSENT 3 (OR1.74 (95% CI: 1.14-2.66)). CONCLUSION: The implementation of new guidelines 'ST-elevation acute coronary syndromes' did not result in lower mortality or fewer complications.

Age Factors↗
PubMed1989

[Non-vascular interventional radiology nonvascular interventional radiology of the urinary tract].

Several kinds of nonvascular interventional radiology of the urinary tract are reviewed. Transurethral balloon dilation of the prostate (TU-DP) is a newly developed nonsurgical treatment for benign prostate hyperplasia, which is performed under local anesthesia with minimal morbidity and requires no hospitalization. The TUDP technique involves dilating the prostatic urethra and bladder neck to 75 F for 10 minutes under fluoroscopic control using a high-pressure dilating balloon. Long-term follow-up studies are required. Percutaneous nephrolithotomy (PNL) and transurethral ureterolithotomy (TUL) have signified a revolution in stone surgery of upper urinary tract. Indications for these treatments, endoscopic manipulation, complications and their clinical features are presented. The procedure of PNL consists of 3 steps, puncture for nephrostomy tract, tract dilation and stone removal. Among these steps the most important is the puncture and it should be effected through the calyx. During the operation, if there is too much bleeding, it can be discontinued at any time while keeping the track open. It is no longer necessary for the kidney to be free of stones at the end of the operation. TUL is performed with a rigid or flexible ureterorenoscope. Dilation of the ureteral orifice and the intramural ureter is necessary for passing the scopes. When they have been sufficiently dilated, the ureterorenoscope can be passed to the level of the renal pelvis through the urethra. Calculi have been removed successfully at a higher rate in lower ureter. Endopyelotomy may be performed safely as an initial procedure to correct congenital obstruction of the ureteropelvic junction. Recent advancements have permitted an approach to percutaneous resection for renal pelvic tumor in a solitary kidney or bilateral synchronous disease. There are great expectations for continuing important innovations in the field of interventional radiology.

Adult↗
PubMed1986

Educational intervention by computer in childhood asthma: a randomized clinical trial testing the use of a new teaching intervention in childhood asthma.

To affect asthma-related knowledge, behavior, and morbidity, researchers tested a new educational intervention for children with asthma: an asthma-specific computer game called Asthma Command, which was specifically designed for this study. Sixty-five children with moderately severe asthma were randomly assigned to one of two groups, and 54 completed the study. Both groups were seen approximately six times during the 1 year of the study. Control subjects (n = 29) played routine computer games. Experimental subjects (n = 25) played Asthma Command. Compared with children in the control group, experimental subjects showed improvement in knowledge about asthma (P less than .001), behavior related to the management of asthma (P less than .008), and a trend toward the reduction of acute visits due to asthma (P less than .13). Children in the experimental group also scored higher on the assessment of behaviors related to the management of asthma that were specifically addressed by the intervention provided by Asthma Command (P less than .01). Differences between the control and experimental groups showed a greater improvement in the experimental group in 21 (84%) of the 25 outcome variables in the study (P = .004, Sign test). The study indicates that an asthma-specific computer game can significantly affect knowledge and behavior and may potentially affect morbidity in childhood asthma.

Asthma↗
PubMed1986

Increasing the use of meatless meals: a nutrition intervention substudy in the Multiple Risk Factor Intervention Trial (MRFIT).

Forty-seven participants from six MRFIT clinical centers were involved in a 3-month intensive dietary intervention program to determine the feasibility of increasing the use of meatless meals. The substudy was conducted late in the trial, and many dietary changes had already been made. The purpose, therefore, was to initiate ways to continue the maintenance of achieved serum cholesterol reductions and possibly effect additional decreases. The program consisted of an introductory session and three follow-up visits. Preplanning, contracting, self-monitoring, regular follow-up, and homemaker involvement were among techniques used to help participants incorporate meatless meals into routine dietary practices. Data collection included scores from a knowledge test administered at the introductory and final visits, number of meatless meals consumed per week as contracted at the first three visits and as reported at the last three visits, and serum cholesterol and weight determinations made at each visit. Knowledge related to meatless meal concepts, such as complementary proteins, appeared to improve as the majority of substudy participants scored higher on the post-test than on the pretest. Over the substudy duration, the mean number of contracted and reported weekly meatless meals in addition to breakfast was approximately four and five, respectively. Mean serum cholesterol drop was 2.6%, and mean weight loss was about 3 lb over the 3-month period. The approach was one of the intervention techniques used to maintain serum cholesterol reductions on a long-term basis, which has not been achieved in any other clinical trial with similar objectives. The described meatless meals program may prove useful to dietetic practitioners who counsel individuals in fat-modified food patterns.

Blood Pressure↗