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At least 289 records · Page 16Linked to original sources
PubMed1993

Economic/reimbursement issues in MR imaging with gadolinium contrast agents.

Implementation of an accurate, reliable index of cost effectiveness would help to advance technology assessment and reimbursement of MR imaging procedures, including gadolinium enhancement. To this end, an objective, consensual measure that satisfies the need for "gold-standard" confirmation of diagnostic impressions in routine clinical practice and limits interpreter bias has been developed. Eponymously termed Diagnostic Merit, this barometer is expressed as the percentage of independent judges confirming diagnostic impressions entered by case-blinded radiologists assigned unenhanced and enhanced image sets for interpretation. The judges, who are informed of clinical indications, clinical follow-up, and unblinded diagnostic interpretation of the MR scans, confirm only those case-blind interpretations deemed "close enough for diagnostic utility" to actual clinical profiles. According to this method, gadopentetate dimeglumine has been shown to be cost effective by promoting optimal diagnostic performance. This improvement in utility offsets the cost of the gadolinium contrast agent. Efficacies of gadodiamide and gadoteridol, two other contrast agents in development, have been demonstrated by other measures but are probably also evaluable through the Diagnostic Merit method. CPT-4 codes for contrast-enhanced MR imaging are reviewed.

Cost-Benefit Analysis↗
PubMedDate not supplied

Nutritional recommendations for patients with heart failure.

Promoting optimal nutritional intake may play an important role in the management of patients with heart failure. Unfortunately, no nutritional guidelines are currently available to assist clinicians in assuring adequate nutritional intake of these patients. The purposes of this article are to review currently available information on nutrition in heart failure and outline initial recommendations for micronutrient, protein, and omega-3 fatty intake. In addition, implications regarding the recent data showing improved health outcomes in obese patients are also addressed.

Body Mass Index↗
PubMedDate not supplied

The effects of rhinitis, asthma, and acute respiratory distress syndrome as acute or chronic pulmonary conditions during pregnancy.

Pulmonary complications from both obstetrical and non-obstetrical causes contribute to a mortality rate as high as 80% in the pregnant population. The effect of numerous mechanical and biochemical physiologic alterations during pregnancy can influence the maternal and fetal outcomes in a woman with a pulmonary complication. Progesterone, the primary hormone of pregnancy, is a respiratory stimulant that enhances carbon dioxide release and alters the maternal pH in favor of releasing oxygen to the fetus. During systemic compromise, which may be experienced as an acute asthmatic attack or respiratory distress syndrome, desaturation and carbon dioxide retention ensue. Under these conditions, the fetus is at risk for perinatal hypoxemia. Although prompt recognition and treatment are important to minimize maternal, fetal, and neonatal morbidity and mortality, evidence-based literature regarding critical care techniques that promote optimal obstetrical outcomes is limited. Therefore, a collaborative approach to the care of these women is warranted. In addition to critical care, emergency medicine, and obstetrical nurses, the medical team may include an obstetrician, a perinatologist, a neonatologist, a pulmonologist, an intensivist, and an immunologist.

Acute Disease↗
PubMedDate not supplied

While You Are Waiting: a family-focused antepartum support program.

While You Are Waiting is an antepartum support program developed for hospitalized, high-risk pregnant women. The goal of the program is to provide an atmosphere for the mother that will minimize the adverse effects of long-term activity restrictions and prolonged hospitalization. The program focuses on 4 key opportunities to promote optimal outcomes: education, support, recreation, and outreach. Details of the program and preliminary outcome data are provided.

Bed Rest↗
PubMed1998

Airway management in children with major craniofacial anomalies.

OBJECTIVES: Delineation of clinical characteristics affecting the airway in a cohort of craniofacially deformed children. What factors differ between patients requiring and those not requiring surgical airway intervention? What factors predispose to the need for tracheotomy? When can decannulation be expected if tracheotomy is required? What interventions aid decannulation? STUDY DESIGN: Five-year retrospective chart review at tertiary center. METHODS: Two hundred fifty-one patients met the following entry criteria: enrollment in the New York University Institute of Reconstructive and Plastic Surgery's Craniofacial Clinic and admission to Tisch Hospital in Manhattan for surgery from 1990 to 1994. Hospital, clinic, and departmental office records were reviewed. All patients had major craniofacial bony anomalies and underwent administration of general anesthesia at least once. RESULTS: Nearly 20% of all children required tracheotomy (47/251). Craniofacial synostosis patients (Crouzon, Pfeiffer, or Apert syndrome) had the highest rate of tracheotomy (48% [28/59]). Mandibulofacial dysostoses patients (Treacher Collins or Nager syndrome) had the next highest rate (41% [28/59]). Patients with oculo-auriculo-vertebral sequence were less likely to undergo tracheotomy (22% [9/41]). Children with craniosynostosis rarely required a surgical airway, unless there was marked associated facial dysmorphism (1% [1/72]). The duration of cannulation was related to the age at tracheotomy in a bimodal distribution. Generally, tracheotomies required before age 4 years remained for several years, whereas those placed after age 4 were removed after several weeks. The presence of a cleft palate correlated with reduced risk for tracheotomy, but the presence of a ventriculoperitoneal shunt correlated with an increased risk for tracheotomy. Procedures selectively used to improve the airway included midface advancement, mandibular expansion, tonsillectomy and adenoidectomy, uvulopalatopharyngoplasty, anterior tongue reduction, and endoscopic tracheal granuloma excision. CONCLUSIONS: The likelihood for surgical airway management is related to specific craniofacial diagnosis. The length of tracheal cannulation is greatest for infants and young children who manifest severe airway compromise, often because of nasal obstruction in combination with other anatomic factors. Early tracheotomy is advocated for these patients to promote optimal growth and development. Choanal atresia is often misdiagnosed in these infants; nasal obstruction is actually secondary to midface retrusion. Staged surgical interventions can allow eventual successful decannulation in nearly all cases of craniofacial syndromes.

Adolescent↗
PubMedDate not supplied

Creative strategies for teaching statistical concepts in nursing education.

Helping students efficiently learn critical concepts and understand the personal and professional relevance of statistics are important activities when teaching nursing research or related courses. The authors describe some creative teaching approaches used to elucidate abstract concepts and promote optimal learning of statistical analytic procedures. Appropriate for both undergraduate and graduate levels, these strategies are designed to influence the attitude that many students have about statistics, support active learning, and ignite the metacognitive abilities nursing students bring to the learning experience.

Attitude↗
PubMedDate not supplied

Concept mapping. Navigating the learning process.

Critical thinking, meaningful learning, and concept synthesis are key phrases pervading nursing literature as educators strive to promote optimal learning and improve clinical instruction and problem solving across levels of nursing education. Concept mapping offers a state-of-the-art metacognitive approach to achievement of these important goals. The author explores concept mapping from the perspective of cognitive theory, analyzes its strengths and drawbacks, presents examples of various concept maps and graphic organizers, and suggests pragmatic applications to nursing clinical, classroom, curriculum, and research situations.

Clinical Competence↗
PubMed1993

Psychological adjustment to hand injuries: nursing management.

Traumatic hand injuries can be devastating experiences both physically and psychologically. The plastic surgery nurse who can identify the various responses that routinely occur with hand injured patients is better prepared to normalize their experiences and implement the necessary interventions toward overall rehabilitation. This article will provide an overview of specific characteristics and emotional reactions following hand injuries, factors that influence adjustment, and nursing management that promotes optimal recovery.

Adaptation, Psychological↗
PubMed1997

Infant nutrition: implication for somatic growth, adult onset diseases, and oral health.

The gold standard for assessing the adequacy of nutrient intake in pediatrics is that diet which promotes optimal growth and development. Thus, it is crucial that our methods for measuring these outcomes be valid, reliable, and widely accepted. A review of the recent medical literature in the field of clinical nutrition indicates that both growth data and dietary standards continue to evolve as more data accrue concerning their applicability in both health and disease. In addition, oral nutrition is clearly a determinant of perhaps the most prevalent infectious disease in pediatrics: dental caries. Research in this field stresses the importance of oral fluoride intake in the prevention of caries, as well as the fact that current efforts at reducing milk-bottle tooth decay are inadequate.

Adult↗
PubMed2003

Atopic diseases of childhood.

PURPOSE OF REVIEW: The incidence of atopic diseases, including atopic dermatitis, allergic rhinitis, and asthma, has increased in developed countries over the past several decades. These diseases comprise a large component of general pediatric practice. This review will highlight some of the recent advances in understanding the pathogenesis and natural history of these diseases, as well as the current approaches to the treatment of children with atopic diseases. RECENT FINDINGS: Recent studies have identified multiple risk factors for the development and progression of atopic diseases. As a result, much research is focused on identifying therapies that can be initiated at a young age to prevent disease progression. New treatment options have become available in recent years, such as topical immunomodulators for atopic dermatitis, leukotriene antagonists for seasonal allergic rhinitis, and alpha-immunoglobulin E therapy for asthma. The importance of viewing allergic rhinitis and asthma as disorders of a single airway has been emphasized. Finally, an update on the national asthma guidelines was recently released in an effort to promote optimal asthma care. SUMMARY: This review summarizes many of the recent advances in the diagnosis and treatment of atopic diseases in children. Although not intended to be a comprehensive review of this broad field, it provides a framework for appreciating the complexity of these diseases and for effectively managing them.

Acetates↗
PubMedDate not supplied

Creation of a geriatric workshop for nursing assistants and patient-care associates.

This article explores the development of a geriatric workshop to enhance the knowledge base of patient-care associates and nursing assistants to promote optimal geriatric nursing care. The unlicensed support staff plays an integral role in delivering a large percentage of nursing care. Therefore, it is essential to cultivate and foster their knowledge and skills, so that the older adult population will receive exemplary care.

Aged↗
PubMed2002

ASCCP Patient Management Guidelines: Pap Test Specimen Adequacy and Quality Indicators.

OBJECTIVES: To provide management guidelines according to Pap test specimen adequacy based on literature review and expert opinion. METHODS: A task force named by the American Society for Colposcopy and Cervical Pathology conducted a literature review and discussed appropriate management. The steering committee of the American Society for Colposcopy and Cervical Pathology and other experts reviewed the guidelines. RESULTS: The guidelines recommend a repeat Pap test in 12 months for most women who are undergoing routine annual/biennial screening if the current Pap test is negative but either lacks an endocervical/transformation zone component or is partially obscured. Indications for considering an earlier repeat are also provided. The preferred management for unsatisfactory Pap tests is a repeat Pap test within a short interval of 2 to 4 months. CONCLUSIONS: The management guidelines will help promote optimal and uniform follow-up of women's Pap tests, according to Pap test specimen adequacy.

Journal Article↗
PubMed2005

Epidemiology of cat-scratch disease hospitalizations among children in the United States.

BACKGROUND: Cat-scratch disease (CSD), caused by infection with Bartonella henselae, affects both children and adults but is principally a pediatric disease. Typical CSD is generally benign and self-limited and is characterized by regional lymphadenopathy with fever. Infections can, however, be accompanied by focal or diffuse inflammatory responses (atypical CSD) involving neurologic, organ (liver/spleen), lymphatic or skeletal systems. METHODS: Pediatric hospitalizations with CSD listed as a diagnosis were examined using the Kids' Inpatient Database for the year 2000. National estimates of CSD-associated hospitalizations, hospitalization rates and various hospitalization statistics were examined for patients younger than 18 years of age. RESULTS: During 2000, an estimated 437 (SE 43) pediatric hospitalizations associated with CSD occurred among children younger than 18 years of age in the United States. The national CSD-associated hospitalization rate was 0.60/100,000 children younger than 18 years of age (95% confidence interval, 0.49-0.72) and 0.86/100,000 children younger than 5 years of age (95% CI 0.64-1.07). Accompanying diagnoses included neurologic complications (12%), organ (liver/spleen) involvement (7%) and "other" (5%). Atypical CSD accounted for approximately 24% of the CSD-associated hospitalizations. The median charge for a CSD-associated hospitalization was 6140 dollars with total annual hospital charges of approximately 3.5 million dollars among children in the United States. CONCLUSIONS: The CSD-associated hospitalization rate among children during 2000 appeared similar to those estimated for the 1980s in the United States, despite significant increases in cat ownership in the intervening time. Early serologic and molecular testing for CSD in children is suggested to minimize unnecessary interventions and promote optimally effective care when supportive measures are required.

Adolescent↗
PubMed2005

Implications of cyberspace communication: a role for physicians.

Through the presentation of three clinical case reports and subsequent discussion, it is demonstrated that physicians must begin to familiarize themselves with the health-related implications of online communication, and must proactively address Internet use as it relates to health and well-being. Included case presentations highlight the following: the established association between those seeking sexual partners through the Internet and an increased risk for sexually transmitted disease; the implications of cyber-communication for young people and concerns related to unsafe online behaviors including sharing identifying information with strangers; the potential use of strategically constructed virtual identities to facilitate sexual exploitation; the impact of accelerated intimacy and disinhibition evident in online communication; and the invasive nature of Internet sexual harassment or bullying. Although it is recognized that most online activities do not negatively affect health, doctors must be prepared to ask patients about Internet use and become involved in educating children, teenagers, and parents about safe online relationships to promote optimal physical, mental, and social health.

Adolescent↗
PubMed2003

The 1.2 A structure of the human sulfite oxidase cytochrome b(5) domain.

The molybdenum- and iron-containing enzyme sulfite oxidase catalyzes the physiologically vital oxidation of sulfite to sulfate. Sulfite oxidase contains three domains: an N-terminal cytochrome b(5) domain, a central domain harboring the molybdenum cofactor (Moco) and a C-terminal dimerization domain. Oxidation of the substrate sulfite is coupled to the transfer of two electrons to the molybdenum cofactor. Subsequently, these electrons are passed on, one at a time, to the b(5) heme of sulfite oxidase and from there to the soluble electron carrier cytochrome c. The crystal structure of the oxidized human sulfite oxidase cytochrome b(5) domain has been determined at 1.2 A resolution and has been refined to a crystallographic R factor of 0.107 (R(free) = 0.137). A comparison of this structure with other b(5)-type cytochromes reveals distinct structural features present in the sulfite oxidase b(5) domain which promote optimal electron transport between the Moco of sulfite oxidase and the heme of cytochrome c.

Amino Acid Sequence↗
PubMed1989

Efficacy of a standard United Kingdom oral rehydration solution (ORS) and a hypotonic ORS assessed by human intestinal perfusion.

Human triple-lumen intestinal perfusion was used to compare water and solute absorption from the oral rehydration solution (ORS) most widely used in the United Kingdom and a new experimental hypotonic ORS (HYPO-ORS). HYPO-ORS (osmolality 210 mOsm/kg) promoted significantly greater water absorption than UK-ORS (7.03 +/- 1.1 vs 2.73 +/- 1.0 ml cm-1 h-1; P less than 0.01). HYPO-ORS produced net sodium and chloride absorption whereas the low sodium UK-ORS produced a net secretion of these ions. Bicarbonate absorption was also greater from HYPO-ORS although potassium and glucose absorption were similar from both solutions. This study suggests that UK-ORS may not promote optimal water and solute absorption and that clinical studies with HYPO-ORS are indicated.

Adult↗
PubMed2006

Short birth intervals and the risk of school unreadiness among a Medicaid population in South Carolina.

BACKGROUND: Communities across the United States have become more involved in enhancing school readiness. Many of the predictors of school readiness relate to conditions prior to and following the birth of the child, including a child's birthweight. Shortened birth intervals are related to a variety of health and social consequences that affect child development, yet no formal research has examined the association between birth intervals and school readiness. METHODS: This study was a secondary data analysis of de-identified pregnancy-related vital record information, matched to selected items from the Department of Health and Human Services Medicaid records on mothers and children and to the Cognitive Skills Assessment Battery score in South Carolina for the year 2000 for the child of interest (N = 6915). Analysis of covariance and logistic regression were used to determine if there was a statistically significant relationship between birth interval and school readiness. RESULTS: Results showed that birth interval is a significant predictor of school readiness with a P-value <0.001 even after controlling for various socio-demographic factors. Children born with inadequate birth intervals (less than 24 months) are more likely to fail the Cognitive Skills Assessment Battery compared with those with adequate birth intervals. Potential implications of this research include promoting optimal birth spacing to improve the likelihood that future first graders will come to school ready to learn.

Adult↗
PubMed2006

A mechanical role for the chemotaxis system in swarming motility.

The chemotaxis system, but not chemotaxis, is essential for swarming motility in Salmonella enterica serovar Typhimurium. Mutants in the chemotaxis pathway exhibit fewer and shorter flagella, downregulate class 3 or 'late' motility genes, and appear to be less hydrated when propagated on a surface. We show here that the output of the chemotaxis system, CheY approximately P, modulates motor bias during swarming as it does during chemotaxis, but for a distinctly different end. A constitutively active form of CheY was found to promote swarming in the absence of several upstream chemotaxis components. Two point mutations that suppressed the swarming defect of a cheY null mutation mapped to FliM, a protein in the motor switch complex with which CheY approximately P interacts. A common property of these suppressors was their increased frequency of motor reversal. These and other data suggest that the ability to switch motor direction is important for promoting optimal surface wetness. If the surface is sufficiently wet, exclusively clockwise or counterclockwise directions of motor rotation will support swarming, suggesting also that the bacteria can move on a surface with flagellar bundles of either handedness.

Bacterial Proteins↗