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PubMed2006

Comparison of laboratory values obtained by phlebotomy versus saline lock devices.

OBJECTIVES: To assess the utility of a peripheral saline lock device (SLD) as an alternative to a second venipuncture for obtaining selected blood samples. METHODS: This prospective study used a comparative design and was conducted in an urban emergency department (ED). Adult patients with an existing SLD in place who required serial phlebotomy were eligible for inclusion in the study. Each subject had blood samples obtained by venipuncture (control) with a Vacutainer adapter according to standard protocols. Within 5 minutes of obtaining the control samples, a sample was obtained from the patients' SLDs; a tourniquet was applied proximal to the intravenous line, a 5-mL waste portion was obtained, and a Vacutainer adapter was placed to draw specimens for testing. Each of the paired samples was analyzed for hematocrit, electrolytes, and cardiac enzymes. The Bland-Altman method was used to analyze the concordance between each pair of measurements. Paired t-tests for each of the eight laboratory tests were used to assess whether the values were statistically different from each other. The 95% limits of agreement around the mean differences were calculated. Differences between SLD aspirates and venipuncture aspirates also were compared with the federal regulatory standards that ensure reliable and accurate laboratory testing. RESULTS: Eighty-one patients were eligible for the study; in 73 (90.1%; 95% confidence interval [CI] = 81.5% to 95.6%) of the patients, the SLD could be aspirated for testing. The paired t-tests indicated that there were no statistically significant differences between the mean values of the two methods of testing. Of the 584 paired values analyzed, 35 (6.0%; 95% CI = 4.3% to 8.2%) exceeded the Bland-Altman limits of agreement, and 43 (7.4%; 95% CI = 5.4% to 9.8%) fell outside the acceptable range determined by the federal regulation of clinical laboratories. Of those values that exceeded the acceptable Bland-Altman limits of agreement, none would have resulted in clinical intervention. CONCLUSIONS: Aspirating blood via an SLD is an acceptable method of obtaining serial laboratory values in a group of stable, consenting adult ED patients.

Adult↗
PubMed1999

[Evaluation of an educational course for pregnant adolescents].

The pregnancy among adolescent women in Mexico is close than half million by year, this problem could be attended through health education in the Mexican medical care system. Since 1995 the Instituto Nacional de Perinatologia has a free training program only for adolescents designed to improve the health care medical procedures and reduces some perinatals health risks. This paper shows the structural design, functioning strategies and results of its application. Through a pre codificated 48 item list, were analyzed transversally the clinical records of 234 adolescents engraved themselves to the course. Two groups were formed: the "A" group with the patients attended at least to three sessions (106) and the group "B" with the ones who did not (128). The data analysis was made by contrasting each item between the groups using the appropriate statistical tests. The group "A" had greater average in scholarship, the moreover socioeconomic characteristics and gynecoobstetric background did not show significant differences. Group "B" had a higher proportion of adolescent with aggregated pathology to the pregnancy. We too observed significant differences in the proportions of complications during the pregnancy evolution and in the postpartum period. The acceptance on the pregnancy by the adolescent, her family and by her couple also showed significant differences. The average weight of the newborns were greater statistically in the "A" group. The proportions of family planning methods acceptance was higher in the same group, who has too shorter intra-hospitalary stay. This evaluation shows good fitness with the adolescents education expectatives and performance and favorable associations with some perinatals health risks.

Adolescent↗
PubMed2001

A review of therapeutic ultrasound: effectiveness studies.

BACKGROUND AND PURPOSE: Therapeutic ultrasound is one of the most widely and frequently used electrophysical agents. Despite over 60 years of clinical use, the effectiveness of ultrasound for treating people with pain, musculoskeletal injuries, and soft tissue lesions remains questionable. This article presents a systematic review of randomized controlled trials (RCTs) in which ultrasound was used to treat people with those conditions. Each trial was designed to investigate the contributions of active and placebo ultrasound to the patient outcomes measured. Depending on the condition, ultrasound (active and placebo) was used alone or in conjunction with other interventions in a manner designed to identify its contribution and distinguish it from those of other interventions. METHODS: Thirty-five English-language RCTs were published between 1975 and 1999. Each RCT identified was scrutinized for patient outcomes and methodological adequacy. RESULTS: Ten of the 35 RCTs were judged to have acceptable methods using criteria based on those developed by Sackett et al. Of these RCTs, the results of 2 trials suggest that therapeutic ultrasound is more effective in treating some clinical problems (carpal tunnel syndrome and calcific tendinitis of the shoulder) than placebo ultrasound, and the results of 8 trials suggest that it is not. DISCUSSION AND CONCLUSION: There was little evidence that active therapeutic ultrasound is more effective than placebo ultrasound for treating people with pain or a range of musculoskeletal injuries or for promoting soft tissue healing. The few studies deemed to have adequate methods examined a wide range of patient problems. The dosages used in these studies varied considerably, often for no discernable reason.

Humans↗
PubMed1994

PIC lines save money and hasten discharge in the care of children with ruptured appendicitis.

UNLABELLED: With the need for physicians to help control the rising cost of health care, consideration should be made, when appropriate, to shift more expensive inpatient care (IPC) to the less costly home care (HC) setting. The management of ruptured appendicitis (RA) includes appendectomy and intravenous (IV) antibiotics. Although patients' gastrointestinal function often returns by postoperative day 3 to 5, 10 to 12 days of IPC may be required for completion of the IV antibiotics. A new method of IV access, appropriate for pediatric patients and HC, is the PIC line--a peripherally inserted, centrally placed, intermediate-term silastic catheter. The purpose of this study is to compare the use of short plastic cannulas (SPC) and IPC tl PIC lines and HC in the management of patients with RA with respect to cost, length of hospitalization, morbidity, and patient/family acceptance. METHODS: All children under the care of a single surgeon for RA underwent appendectomy and received IV antibiotics. The antibiotics were continued for a minimum of 10 days postoperatively, or until the patient was afebrile and the white blood cell count was less than 10,000/mm3. Group I (n = 8) had IV access via SPC and IPC care. Group II (n = 8) had a PIC line placed and was discharged to HC when intestinal function returned. The two groups were compared for: number of inpatient days (IPD), home care days (HCD), total care days (TCD), inpatient costs (IP$), home care cost (HC$), total care costs (TC$), number of IVs needed (#IV), catheter related complications, patient/family acceptance of the PIC line/HC concept, and overall morbidity. RESULTS: The children with PIC lines (group II) were all discharged to HC by the seventh postoperative day and received an additional 5 days of antibiotics. The children on conventional inpatient therapy (group I) stayed in the hospital an additional 6 days (P = .002). Both groups had equivalent TCD. The children with PIC lines had lower IP$ (P = .002) and significantly lower (40%) TC$ than did IPC patients (P = .004). The children in group I required placement of more than five IV catheters during their hospitalization. In contrast, the PIC lines were successfully placed in group II patients, and no further IV access was necessary (P = .001). There were no complications from the PIC lines. Neither group experienced recurrent infections or required readmission. The patients' and families' acceptance of the PIC line/HC concept was unanimously favorable. CONCLUSION: When compared with SPC/IPC, PIC line/HC is a safe, efficacious, and significantly cost-effective method for the care of the patient with RA. As experience with PIC line/HC grows, it may become the preferred method of treatment for a variety of illnesses that currently require intermediate-length courses of IV therapy and IPC.

Anti-Bacterial Agents↗
PubMedDate not supplied

Methods of cost-effectiveness analysis: areas of consensus and debate.

Methods of evaluating socioeconomic relationships have evolved over many years, and a number of specific approaches have been developed. Among the techniques available, cost-effectiveness analysis (CEA) has emerged as the most widely used and accepted method. Yet, despite considerable effort by the analytical community to refine this technique into one more useful for making health policy decisions, much debate and confusion still persist among analysts, readers, and policy-makers concerning methods standards and the overall usefulness of CEA in resource allocation decision making. Thus the purpose of this paper is to summarize, critically examine, and comment on existing recommended methods for socioeconomic evaluation of health care interventions. In particular, we examine an exhaustive set of component methods within the general area of cost-effectiveness and comment on areas of apparent consensus and debate. Our review reveals many areas of agreement and many yet to be resolved. Analysts generally agree on the components of the overall framework for an analysis; basic methodologic principles; the general treatment of costs; the principle of marginal analysis; the need for and general approach to discounting; the use of sensitivity analysis; the extent to which ethical issues can be incorporated; and the importance of choosing appropriate alternatives for comparison. The principal areas in which disagreement still persists are choice of study design, measurement and valuation of health outcomes including conversion of health outcomes to economic values, transformation of efficacy results into effectiveness outcomes, and the empirical measurement of costs.

Cost-Benefit Analysis↗
PubMed1994

Photography without film: low-cost digital cameras come of age in dermatology.

BACKGROUND: Photography is integral to the practice of dermatology. Digital imaging techniques have only recently been used to assess cutaneous disorders. Previously reported imaging systems have been both expensive and cumbersome. Consequently, they have failed to gain wide-spread acceptance. METHODS: We describe our experience using an inexpensive digital camera. Photographs taken with this portable digital camera (FotoMan) compare favorably to those obtained with conventional 35 mm cameras. RESULTS: This inexpensive digital camera provides photographs of acceptable quality for a variety of dermatologic applications. Images created with this system are available within minutes and are less expensive than traditional photographs. CONCLUSIONS: Digital imaging is a new and exciting development. The digital camera described is simple to operate and provides a useful alternative or adjunct to conventional photography.

Adult↗
PubMed2002

[Early and late complications in patients treated with hysteroscopic surgery].

In the last couple of years operative hysteroscopy has become a very popular surgical method. It provides us with the possibility to visualize the uterine cavity and explore it with absolute accuracy. In the majority of world centers, it is performed in ambulance. This is a very simple and financially acceptable method, for it does not require special pre and post operative treatments. Of course, simplicity of the procedure, the result, as well as the possibility of complications, depends on the surgeon as well as the preceeding diagnostics. In the period from September of 1997, to September of 1998., 320 operative hysteroscopies were performed in the Clinic for Gynaecology and Obstetrics in Sarajevo. All 320 patients were submitted for infertility. Detailed anamnesis was taken for each patient (HSG, diagnostic laparoscopy, operative laparoscopy, IVF). Each patient in our program was also subject to transvaginal Color Doppler diagnostics before the operation. This form of diagnostics turned out to be highly sensitive and highly specific. We used "Stortz" equipment, including an 8 mm resectoscope and OTV endocamera. Uterine distension was achieved through constant flow of "Purisol" solution. Prior to hysteroscope introduction, we dilated the cervical tube using Hegar metal dilatator. All patients were in general ET anesthesia. We divided complications in two groups: early and late complications. Depending on the sort of complication, patients were hospitalized from 1 to 7 days. Early complications occurred in 7 patients: unsuccessful cervical dilatation--2 patients; uterus perforation--1 patient; uterine bleeding--3 patients; intravasation--1 patient. Impossibility to finish the operation was also considered a complication: impossibility of septum incision--1 patient; incomplete myoma enucleation--1 patient; impossibility to reconstruct womb in the whole--1 patient. Late complications are those that appeared 12-24 hours after the operation: post-operative bleeding--2 patients; increased body temperature--2 patients; pain in lower abdomen--4 patients.

Female↗
PubMedDate not supplied

A comparison of two techniques for weighing young children.

PURPOSE: To compare the direct weight of children when weighed on an infant scale to their indirect weight when weighed on an adult scale while being held by a nurse. METHOD: Ninety children who weighed less than 31 pounds were weighed using a set protocol. Analysis used matched t-test and product-moment correlation. The averages of the weights were then plotted against the weight differences to determine the degree of scatter. FINDINGS: There were no significant differences between the means of the two methods of weighing. The correlation coefficient was 0.995 between the two approaches. Four sets of weights fell outside of two standard deviations of difference. The discrepancies appear to be random. CONCLUSIONS: Indirect weight generally is an acceptable method to assess a child's weight unless highly precise or frequent serial weights are needed.

Adult↗
PubMed2005

Sedation as an alternative method to lessen patient discomfort due to transrectal ultrasonography-guided prostate biopsy.

BACKGROUND: Despite being highly efficient for the relief of patient discomfort due to transrectal ultrasound (TRUS) guided prostate biopsy, periprostatic anesthesia is occasionally reported to be of limited use. We aimed to evaluate the efficacy of conscious sedation, an accepted method for lessening patient discomfort due to interventional radiological procedures and compare it with periprostatic anesthesia. METHODS: 93 candidates for biopsy were randomised to three groups: group 1 (n = 31) received intravenous midazolam, group 2 (n = 31) received periprostatic lidocaine injection, whereas group 3 (n = 31) received no anesthetic before the procedure. After the biopsy patients were asked to express discomfort by visual anologue scale (VAS). RESULTS: The mean scores for groups 1 and 2 were significantly lower than that of group 3 (1.4 +/- 1.1 and 2.0 +/- 1.5 versus 4.7 +/- 1.6, respectively; p < 0.05 for both). For patients with VAS scores exceeding 4 (moderate to severe discomfort), a significant difference was calculated between groups 1 and 2 (3% versus 29%, p < 0.05) and between each and group 3 (3% and 29% versus 80%, respectively; p < 0.05 for each). CONCLUSIONS: Sedation is an alternative for increasing patient comfort during TRUS-guided prostate biopsy, especially in clinical situations like patient anxiety, young age, repeat biopsies or inflammatory anal diseases.

Aged↗
PubMed2006

The effect of covariance between the K alpha and the K beta lead peak concentrations on the uncertainty in the result of in vivo (109)Cd KXRF bone lead measurement.

The effect of covariance between the K alpha and K beta lead peak concentrations on the uncertainty in the (109)Cd K x-ray fluorescence measurement of lead in bone is addressed here. It is commonly believed that this covariance arises as a result of the mutual dependence of the ratios of x-ray to coherent amplitudes on the same coherent peak amplitude. Previous work assumes statistical independence between spectral quantities of interest, crudely estimates the uncertainties in the lead peak concentrations, and suggests that the effect of covariance on the measurement uncertainty is small and can be ignored. Consequently, the current method followed by most laboratories reports the measurement uncertainty as if the fluctuations in the measured peak concentrations were independent. The robustness of such assumption, however, is undermined by existing epidemiological data. This paper assesses the magnitude of the covariance effect, using a method based on the observed significant correlations between the ratios of x-ray to coherent peak amplitudes in series of repeat phantom measurements. The revised uncertainties following this approach can exceed the uncertainties estimated by the accepted method by as much as 40%, which suggests a much stronger effect of covariance on the measurement uncertainty than previously reported.

Analysis of Variance↗
PubMed2003

New options in contraception for teenagers.

PURPOSE OF REVIEW: Unintended pregnancy continues to exact a considerable economic, social and personal cost in industrialized nations despite the ready availability of safe, reliable and highly effective methods of contraception. Adolescents still demonstrate some of the highest rates of unintended pregnancy and thus may benefit from considering new contraceptive options that provide unique side effect profiles or delivery systems that could facilitate and improve compliance of contraceptive methods. RECENT FINDINGS: The recent launch of several new combination oral contraceptive pills with novel side effect profiles has expanded the choices for teenagers who choose to use a daily oral contraceptive. Of potentially greater interest is the recent availability of several nondaily contraceptives, as compliance remains a critical issue with successful contraceptive use in adolescents. SUMMARY: New contraceptive methods bring unique side effect profiles and delivery systems that may improve overall contraceptive compliance, especially among teenagers who are more prone to misuse from a wide array of side effect and compliance issues. Even the most accepted method, however, will not provide effective contraception if the process by which contraception is provided fails to address the unique concerns and lifestyle issues of each individual adolescent.

Absorbable Implants↗
PubMedDate not supplied

New treatment methods in verapamil poisoning: experimental studies.

The aim of this study was to evaluate the effectiveness of the treatment with 4-aminopyridine (4-AP, potassium channel inhibitor) and Bay K 8644 (calcium channel activator) in experimentally evoked verapamil poisoning in rats and to compare the results of this treatment with the effectiveness of widely accepted methods (adrenaline, calcium compounds). The experiment was carried out on male and female Wistar rats which were divided into 4 experimental (A, B, C, D) and a control (K) groups. Rats were anesthetized and the abdominal aorta was cannulated for mean arterial pressure and heart rate measurements while caudal vein was cannulated for drug administration. All animals were infused with verapamil (150 mg/kg/h) until 50% reduction of mean arterial pressure and/or heart rate was observed. After verapamil, control animals were given 0.9% NaCl solution and the other groups received 687.5 mg/kg/h of calcium glucolactobionicum (group A), 0.3 mg/kg/h of adrenaline (group B), 2 mg/kg/h of 4-AP (group C) or 2 mg/kg/h of Bay K 8644 (group D). The mean blood pressure and heart rate was checked and ECG was recorded every 10 min. A statistically significant decrease in mortality compared with the control group was observed in animals treated with adrenaline (p < or = 0.05), Bay K 8644 (p < or = 0.01) and 4-AP (p < or = 0.005). The treatment of experimentally evoked poisoning in rats using 4-AP or Bay K 8644 resulted in fast receding of poisoning symptoms: increase in blood pressure and heart rate, receding of bradyarrhythmia and return of sinus rhythm. The results of the study suggest the usefulness of 4-AP and Bay K 8644 in the treatment of verapamil poisoning.

3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethy↗
PubMedDate not supplied

[Breath tests as a noninvasive diagnostic method in Helicobacter pylori infection].

There are several diagnostic methods for Helicobacter pylori infection, some of them need an endoscopic procedure and biopsy to be performed (invasive) like the rapid urease test, culture and histology. Recently non invasive, specific, sensible, easy to perform and patient's well accepted methods had been developed known as breath test, based on the hydrolysis of labelled urea by Helicobacter pylori urease enzyme, to release ammonia and bicarbonate. Labelled CO2 reaches the bloodstream and the lungs, from where can be collected into the breath for quantification. Labelled urea has to options: 13C stable, non-radioactive and 14C unstable, radioactive. Breath test with 13C is based on the atomic mass difference between 12C and 13C and it is necessary a mass spectrometer and 40 minutes to perform it. Breath test with 14C has 1 uCi (one micro-curie) of radioactivity (1/300 of total radiation received in one year from the environment); the test takes 10 minutes and the samples are read in a beta counter. Both non-invasive tests had demonstrated sensitivity and specificity comparable to established "gold standards" for Helicobacter pylori infection diagnosis.

Breath Tests↗
PubMed1994

Construction of an artificial vagina with sigmoid colon in vaginal agenesis.

OBJECTIVES: The study of 15 cases of colonic reconstruction for absent vagina. The outcome in cases of reconstruction of an artificial vagina using the colon is evaluated. METHODS: Fifteen female patients with congenital absence of vagina who were evaluated and treated with sigmoid colonic reconstruction at the Korle-Bu Teaching Hospital in Accra, Ghana were studied. RESULTS: This reconstructive method is successful in patients having a functioning vagina without progressive shrinkage or other symptoms. Disfigurement of the thighs and labia are avoided as is the need for active manipulation. CONCLUSION: Sigmoid colonic reconstruction for vaginal agenesis is an acceptable method especially in the developing world.

Adolescent↗
PubMed2005

Ethical and practical problems in blood sampling for research purposes during pre-hospital emergencies.

BACKGROUND: Research in the pre-hospital phase of emergencies involves certain ethical and practical challenges. Severely ill or injured patients are not able to give informed consent in the immediate stressful situation. The aim of this pilot study was to find an ethically acceptable method to carry out research in acutely ill or injured patients before any treatment was given in order to be able to study the acute and unmodified systemic inflammatory response to trauma. METHODS: Younger physicians were assigned to the mobile emergency care unit (MECU) on a volunteer basis. They drew blood samples 'at the scene' from patients exposed to accidental injury or from patients with acute medical emergencies. The ethical committee accepted that informed consent to blood analyses could be postponed until later or given by relatives. Pro- and anti-inflammatory cytokines, catecholamines and cortisol were measured. RESULTS: During 6 months, the study group accompanied the MECU on approximately 500 call-outs. Blood samples were drawn from 42 patients. Consent to the analysis of blood samples was obtained in 30 cases. In 20 cases, it was not possible to draw the blood sample before medication. CONCLUSION: This pilot study showed that it was possible to conduct blood sampling from acutely ill patients 'at the scene'. However, the present legislation on informed consent makes this type of research very time consuming. When patients die in hospital and no relatives can be found, consent cannot be obtained, and information from these severely affected patients is lost.

Accidents↗
PubMed1999

Determination of inferior vena cava diameter in the angiography suite: comparison of three common methods.

PURPOSE: Significant inferior vena cava (IVC) filter migration has been associated with deployment of some filter types in IVCs measuring more than 28 mm in diameter at inferior vena cavography. The purposes of this study were to (a) determine if significant differences exist between IVC measurements obtained using a gold standard technique and two other widely accepted methods, and (b) if differences exist, how often do these differences cause incorrect IVC sizing around a diameter of 28 mm, with its associated filter migration issues. MATERIALS AND METHODS: One hundred thirteen consecutive inferior vena cavograms were retrospectively reviewed. The transverse diameter of the infrarenal IVC was determined by using a calibrated intravascular catheter (the gold standard), subtraction of 20% from the measured transverse IVC diameter on a cut-film radiograph, and a radiopaque ruler placed immediately posterior to the patient. RESULTS: The concordance correlation of the 20% magnification method versus internal calibration was 0.94. Kappa analysis to determine agreement at a diameter of 28 mm yielded a Kappa coefficient of 0.490. The concordance correlation of an external ruler versus internal calibration was 0.43, with a Kappa coefficient of 0. CONCLUSION: The poor Kappa correlations for both methods demonstrate that they are unreliable in identifying megacava. Inferior vena cavography prior to IVC filter placement should be performed with a calibrated intravascular catheter.

Angiography↗
PubMed2000

The application of standard methods for the determination of toxaphene in environmental media.

In the United States, it is necessary to analyze for toxaphene using approved, validated methods acceptable to the regulatory agencies. As a result of an interlaboratory study and technical exchanges among the US EPA Region IV (EPA), the State of Georgia Environmental Protection Division (EPD), and Hercules Incorporated, guidelines for the application of SW-846 Method 8080 were developed. Results of analyses for sludge, soil, and water samples agreed within a percent relative standard deviation (% RSD) range of 6.9-20%. Through continued technical interchanges, guidance for the application of SW-846 Method 8081 has been developed. The results of analyses of fourteen split samples of soil and sediment produced a percent relative standard deviation that ranged from 1.6% to 127%, with an average of 38%. When two unusually divergent results were removed from consideration, the average % RSD reduced to 26%. The results of analyses of split samples show agreement between the EPA laboratory and a Hercules contract laboratory. Therefore, the guidance has achieved its purpose of producing agreement among data from different laboratories so that data reviewers may have assurance that the analytical method has been applied correctly and consistently for the determination of toxaphene in environmental samples.

Chromatography, Gas↗
PubMed2000

Alloantigen-driven T cell death mediated by Fas ligand and tumor necrosis factor-alpha is not essential for the induction of allograft acceptance.

BACKGROUND: Fas ligand (FasL)-Fas and tumor necrosis factor alpha (TNFalpha)-tumor necrosis factor receptor (TNFR) interactions regulate immune responses and contribute to self-tolerance by mediating antigen-driven T cell apoptosis. It is not known whether FasL and TNFalpha, expressed by the recipient's lymphoid or nonlymphoid cells, are essential for the apoptosis of alloreactive T lymphocytes and the induction of allograft acceptance. METHODS: We compared the survival of fully allogeneic vascularized cardiac allografts between wild-type (wt) and FasL-mutant (gld) recipient mice. In addition, we studied cardiac allograft survival in gld mice injected with TNFalpha-neutralizing antibody. Allograft acceptance (graft survival >100 days) was induced by treating the recipients with CTLA4Ig, a recombinant fusion protein that blocks B7-CD28 T cell costimulation. In vivo alloantigen-driven apoptosis of mature CD4+ and CD8+ T lymphocytes was analyzed in mice repeatedly stimulated with allogeneic splenocytes. RESULTS: We found that CTLA4Ig induces 100% long-term acceptance of cardiac allografts in wt and gld mice. Similarly, CTLA4Ig induced 100% allograft acceptance in gld recipients injected with TNFalpha-neutralizing antibody. In vivo alloantigen-driven apoptosis of mature CD4+ and CD8+ T cells was significantly reduced in gld mice and in wt mice treated with anti-TNFalpha antibody. However, neutralizing TNFalpha activity in gld mice failed to abrogate alloantigen-driven T cell apoptosis. CONCLUSIONS: These data indicate that: (1) FasL and TNFalpha expression are not obligatory for the induction of long-term allograft acceptance by CTLA4Ig and (2) FasL- and TNFalpha-independent death pathways contribute to alloantigen-driven T cell apoptosis.

Acute Disease↗