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At least 379 records · Page 21Linked to original sources
PubMed2000

Piezoelectric pulse sensor device (Pulse Chek)-monitoring after the treatment of lower leg ischemia.

BACKGROUND: The aim of this study was to evaluate the usefulness of the piezoelectric pulse sensor device (Pulse Chek) as a continuous monitoring method in early surveillance after the treatment of lower leg ischemia with either surgical or interventional procedures. METHODS EXPERIMENTAL DESIGN: prospective study. SETTING: institutional practice. PATIENTS AND INTERVENTIONS: two patient groups with peripheral arterial occlusive disease were included; a surgical group undergoing femoropopliteal bypass grafting (22 patients) and a group undergoing PTA of the femoral or popliteal arteries (18 patients). MEASURES: the piezoelectric pulse sensor was applied on the skin over the dorsalis pedis artery. A baseline waveform was recorded preoperatively and continuous monitoring begun immediately after the surgical or interventional procedure. Hard copy recordings of the pulse wave were done in the immediate postoperative period, the postoperative evening, the following morning or at any time the alarm was triggered. A late follow-up waveform was recorded after an average of 34 days. Simultaneous ABI measurements were recorded. RESULTS: Preoperatively or pre-intervention, the pulse waveform was accurately recorded in 15/22 (68%) patients in the surgical group and 14/18 (78%) patients of the PTA group. In 20 (91%) surgical group patients and in 14 (78%) PTA group patients, postoperative monitoring was reliable, the pulse waveform confirmed patency of the vessel. Piezoelectric pulse sensor device monitoring did not detect graft occlusion in only one patient in the surgical group where interpretation of the pulse wave was complicated by a slow atrial fibrillation. There were 19 alarms in the pulse waveform during monitoring for 11 (55%) surgical group patients and 18 alarms for 9 (64%) PTA group patients. None of the alarms resulted from graft occlusion. Reliable pulse waveform recordings were obtained in 16/21 (76%) surgical group patients of the original 22 (one graft occluded) and for 15/18 (83%) PTA group patients in the follow-up assessment after the mean 34 days. One surgical patient was lost to follow-up. CONCLUSIONS: The piezoelectric pulse sensor device can be recommended as a method of continuous monitoring immediately after the revascularization procedure in those patients who have a pedal artery where a reliable pulse waveform can be recorded.

Aged↗
PubMed2001

Femoral vein valve repair with angioscopy-assisted anterior valve sinus plication. Early results.

BACKGROUND: The efficiency of angioscopy-assisted anterior valve sinus plication for primary deep venous insufficiency was evaluated. METHODS EXPERIMENTAL DESIGN: retrospective, clinical study with short follow-up. SETTING: institutional practice. PATIENTS: 15 limbs in 12 patients had class 4 or higher disease (SVS/ISCVS classification). Descending venography showed class 3 or 4 reflux in all patients. Venous refilling time (VRT) was abnormal (<15 sec) in all of the nine limbs in which photoplethysmography was conducted. The limbs were treated with angioscopy-assisted anterior valve sinus plication of the superficial femoral vein. Postoperative descending venography was performed between the first and third day after operation. Clinical evaluation and VRT measurement were repeated when the patients were discharged and checked at the outpatient office. RESULTS: Mean follow-up was 22 weeks with a range of 1 to 70 weeks. At postoperative descending venography, the reflux of the superficial femoral vein was significantly improved. At final follow-up, all patients reported greater or lesser relief of subjective symptoms. In four limbs with class 6 disease, ulcers healed and did not recur. In one limb with class 5 disease, ulcers did not recur. In the other 10 limbs with class 4 disease, a distinct clinical improvement occurred with resolution of skin changes. VRT was normal in 11 of the 12 limbs examined. CONCLUSIONS: Our preliminary experience demonstrates that angioscopy-assisted anterior valve sinus plication gives early good clinical and hemodynamic improvement in patients with primary deep venous insufficiency.

Adult↗
PubMed1994

[A comparative analysis of two historical approaches to the formation of the modern clinical medicine].

From the perspective of research methodology, it may be said to exist two kinds of different historical approaches with regards to the formation of modern clinical medicine at the turn of the nineteenth century. One is to explain this in terms of the agency or structure that is associated with research topic. This historical view assumes that the Western scientific rationalism is characterized by the unity of Western tradition and its evolution as continuity. Its main focus is given either on how French revolution and war affected the growth of clinical medicine and the hospital reform movement or on how Paris Clinical School contributed to the birth of modern clinical medicine. The other is, according to Michel Foucault, to analyze how medical discourses are related to social (institutional) practices. Following Canguilhem's history of concepts, Foucault traces the historical development of the concept of disease. Elizabeth A Williams, another proponent of this method, conceptualizes the eighteenth-century medicine as three different medical discourses--anthropology, physiology and philosophical medicine, and analyzes how their structural fragmentation were transformed into the modern establishment of clinical medicine in the nineteenth century. ...

Clinical Medicine↗
PubMed1975

Economics of institutional pharmacy services under national health insurance in Australia.

The development and effect of the National Health Scheme on institutional Health Scheme on institutional pharmaceutical services in Australia are discussed. Government control over drug costs and the provision of pharmacy services, with its effect on both community and institutional practice, is assessed. Methods of improving the present system of health insurance under the Pharmaceutical Benefits Scheme in Australia are suggested, including their relevance to health care in the United States.

Australia↗
PubMed2003

Urban slum-specific issues in neonatal survival.

Urbanization is rapidly spreading throughout the developing world. An urban slum poses special health problems due to poverty, overcrowding, unhygienic surroundings and lack of an organized health Infrastructure. The primary causes of neonatal mortality are sepsis, perinatal asphyxia and prematurity. Home deliveries, late recognition of neonatal illness, delay in seeking medical help and inappropriate treatment contribute to neonatal mortality. Measures to reduce neonatal mortality in urban slums should focus on health education, improvement of antenatal practices, institutional deliveries, and ensuring quality perinatal care. Success of a comprehensive health strategy would require planned health infrastructure, strengthening and unification of existing health care program and facilities; forming a system of referral and developing a program with active participation of the community.

Adolescent↗
PubMed2004

Reproducibility of proximal and distal transcutaneous oxygen pressure measurements during exercise in stage 2 arterial claudication.

AIM: Although transcutaneous oxygen pressure measurements (tcpO2) are largely used in the investigation of vascular patients, its reproducibility is still debated. Indeed an unpredictable gradient exists between arterial and transcutaneous oxygen pressure. We hypothesised that indices taking into account changes over time and independent of absolute starting values would be more reproducible than other indices. METHODS EXPERIMENTAL DESIGN: comparative test-retest procedure (1 to 13 days between tests). SETTINGS: institutional practice, ambulatory care. PATIENTS AND PARTICIPANTS: 15 subjects with stage 2 claudication. INTERVENTIONS: tcpO2 recordings at rest and at exercise during the 2 treadmill tests. MEASURES: calculation of the Delta-from-rest of oxygen pressure index (limb tcpO2 changes minus chest tcpO2 changes), of the resting - or minimal values attained during exercise - of absolute tcpO2 and of the regional perfusion index (regional perfusion index: ration of limb to chest). RESULTS: Both absolute tcpO2 and regional perfusion index at rest showed low reproducibility. During exercise the best reproducibility was attained through Delta-from-rest of oxygen pressure index calculation. Equations from the linear regression analysis (test 2 versus test 1) were 0.88 x -4.2 (r(2)=0.82) at the buttock level and 0.82 x -3.8 (r(2)=0.80) at the calf level. CONCLUSION: TcpO2 measurement on the calf or buttock during exercise, is a reproducible measurement in patients with vascular claudication, specifically when corrected for exercise-induced systemic pO2 changes trough Delta-from-rest of oxygen pressure calculation.

Aged↗
PubMed2004

Sudden death secondary to fulminant intracranial aspegillosis in a healthy teenager after posterior fossa surgery: the role of corticosteroids and prophylactic recommendations.

Postoperative complications from corticosteroids in neurosurgical patients are not uncommon. Too often the deleterious immunosuppressive effects of corticosteroids are overlooked in neurosurgery patients and can lead to serious and lethal infections. EXPERIMENTAL DESIGN: case report of a 16-year-old healthy male who presented for elective resection of a recurrent juvile pilocytic astrocytoma of the posterior fossa 4 years after initial resection. SETTING: major University institutional practice. INTERVENTION/RESULTS: a standard suboccipital craniotomy with gross total resection. Postoperatively, the patient suffered from posterior fossa syndrome and diminished gag reflex requiring nasogastric feeds with progressive improvement. While awaiting transfer to a rehabilitation center on postoperative day 12 he suffered a sudden temperature spike followed by neurological decline. A stat computed tomography scan of the brain revealed a diffuse miliary process with severe cerebral edema. Sputum and cerebrospinal fluid cultures identified Aspergillus. Despite immediate therapy to combat the malignant cerebral edema, the patient died within 24 hours of onset of the symptoms. Corticosteroids are used routinely in neurosurgery to combat cerebral edema without much consideration for the immunosuppressive effects. This case demonstrates how the immunosuppressive effects of corticosteroids can lead to a fulminant lethal fungal infection. Neurosurgeons should be aware of the anticatabolic medications now available to combat the deleterious side effects of corticosteroids.

Adolescent↗
PubMed2005

[Present-day hygienic aspects of dealing with industrial and consumption waste].

The article covers scientific hygienic positions in forming and solving the acute scientific and technical problem of dealing with waste. The given problem is topical due to growing amount and diversity of waste and relatively small knowledge of ecological, medical and biological aspects of the problem. The paper covers the entire "life cycle" of waste, chiefly industrial and communal, as the most diverse and potentially dangerous to the environment. Special attention is paid to neutralization and recycling of waste for its application as secondary material in various branches of national economy. Having critically analized the results of complex studies, the authors conclude the article with outlining the prospective tasks of research for scientific and practical institutions of sanitary surveillance of Russian Federation Ministry of Health.

Humans↗
PubMed2005

Transcutaneous oxygen pressure measurements (tcpO2) at ankle during exercise in arterial claudication.

AIM: Although a time consuming technique, tcpO2 provides complementary information as compared to other tests. Simultaneous recording of systemic and peripheral oxygen pressure changes with exercise could be interesting to confirm that local hypoxemia is of arterial origin, but accuracy versus gold standard arteriography and objectively determined cut-off points to be used in arterial claudication at the ankle are not reported. METHODS EXPERIMENTAL DESIGN: retrospective plus prospective study. SETTING: institutional practice, ambulatory care. PATIENTS: 100 patients suffering stage 2 claudication (group A) were retrospectively studied to objectively define cut-off points derived from tcpO2 recordings to be used in exercise testing. Then, applicability and reproducibility of these cut-off points were analysed prospectively in another 50 patients (group B). INTERVENTION: tcpO2 was measured on both calves and with a chest reference electrode. Arteriography on each side was quoted positive for a diameter stenosis superior to 75% or occlusion on the aorto-popliteal axis or of all-3-calf arteries. RESULTS: The best performance was obtained with tcpO2 changes from rest at the calf normalised to eventual chest changes (DROP) during or following the treadmill test. Optimal cut-off point determined through ROC curve analysis for DROP was -15 mmHg in group A. Applying this cut-off point in group B provided a 86/84% sensitivity/specificity and showed excellent reproducibility. CONCLUSIONS: TcpO2 measurement on the calf during exercise could be useful in a selected population of patients with claudication of questionable vascular origin and/or when other non-invasive investigations cannot be performed.

Aged↗
PubMed1992

Low-dose amiodarone for maintenance of sinus rhythm after cardioversion of atrial fibrillation or flutter.

OBJECTIVE: To study efficacy and safety of low-dose amiodarone for maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation or flutter. DESIGN: Nonrandomized trial; mean duration of follow-up, 20.7 months. SETTING: Referral center; institutional practice; both hospitalized and ambulatory care. PATIENTS: Eighty-nine consecutive patients having chronic atrial fibrillation or flutter and eligible for cardioversion. Patients had failed previous treatment aimed at maintaining sinus rhythm. During follow-up one patient was withdrawn because of side effects; all patients were available for follow-up. INTERVENTION: Before cardioversion, patients received 600 mg of amiodarone daily during a 4-week loading period. After conversion, the daily maintenance dose was 204 +/- 66 mg (mean +/- SD). MAIN OUTCOME MEASURES: Arrhythmia recurrence and adverse effects causing drug discontinuation. RESULTS: During loading, 15 patients (16%) converted, and after electrical cardioconversion, 90% of all patients had sinus rhythm. Actuarially, 53% of these patients were still in sinus rhythm after 3 years. In patients with compromised left ventricular function, 93% maintained sinus rhythm after 6 months. One patient died due to congestive heart failure. Intolerable side effects occurred in one patient. No proarrhythmia was observed. Logistic regression analysis revealed that amiodarone was ineffective in patients with mitral stenosis or chronic arrhythmia. CONCLUSIONS: Low-dose amiodarone is effective for maintaining sinus rhythm in patients with difficult to treat chronic atrial fibrillation or flutter and is associated with a low incidence of serious side effects.

Amiodarone↗
PubMed1992

Strategic planning for the colony-stimulating factors.

The rapid development and emergence into the marketplace of therapeutic and diagnostic biotechnology products pose a considerable challenge to pharmacists, particularly in light of economic strictures wrought by changes in the health care field. At the same time, the pharmacy profession is moving to a position of greater involvement and responsibility in the clinical management of drug therapy. These changes mandate that pharmacists become strategic thinkers, capable of designing and implementing plans that can integrate biotechnology products into their institutions' practices in a way that both enhances patient care and maintains or promotes financial stability. A strategic plan model incorporating the components of environmental scanning and strategy formulation, implementation, and analysis can be applied to the recombinant colony-stimulating factors.

Colony-Stimulating Factors↗
PubMed1990

Jones v. Gerhardstein: the involuntarily committed mental patient's right to refuse treatment with psychotropic drugs.

The question of whether an involuntary committed mental patient has a fundamental right to refuse treatment with psychotropic drugs continues to be a subject of much debate. Over the past twenty-five years, psychotropic drugs have become the most common form of treatment for the mentally ill. For many patients, these drugs provide substantial benefits; for others, however, they produce severe, sometimes debilitating, side effects. Because of the possibility of serious harm to the patient and because of the potential for abuse of drug treatment by psychiatric staffs, the mental health bar generally has argued for increased procedural protection for mental patients. In Jones v. Gerhardstein, the Wisconsin Supreme Court responded to these concerns by requiring that a judicial hearing be held on the issue of a patient's competency to refuse treatment before the attending physician may administer medication without the patient's consent. This Note discusses the controversy between the legal and medical communities over treatment refusal by mentally ill patients in light of the impact of the Jones decision on institutional practice and on refusing patients. The author argues that the strictly rights-based analysis used by the Jones court has done little to benefit involuntarily committed mental patients. The author suggests alternative ways of approaching treatment refusal that might be more responsive to the distinctive needs of the mentally ill.

Commitment of Persons with Psychiatric Disorders↗
PubMed2005

Post-affirmative action Supreme Court decision: new challenges for academic institutions.

This article describes several aspects of the University of Michigan Supreme Court cases regarding diversity in higher education. It provides a number of resources that are useful in shaping the rationale and institutional practices and policies for admissions and the recruitment and retention of diverse classes of students for the health professions.

Civil Rights↗
PubMed2006

Effectiveness of oxygenation under the drape in phacoemulsification with intraocular lens implantation: a randomized clinical trial.

OBJECTIVE: To compare the oxygen saturation and comfort of the patients undergoing phacoemulsification with intraocular lens implantation (PE/IOL) between the patients with and without oxygenation under the linen drape. SETTING: Institutional practice. MATERIAL AND METHOD: A randomized, triple-blind, clinical equivalence trial was conducted. Eighty consecutive patients, scheduled for PE/IOL under topical or subconjunctival anesthesia, were randomized The patients in group 1 received 5 liters/minute flow of 100% oxygen via tubes attached to the upper chest walls. Sham oxygenation was given to the patients in group 2. Patients, surgeons and investigators were masked. The oxygen saturation was recorded every 10 minutes. The patients rated the comfort score within 15 minutes after operation. RESULTS: In group 1 (n = 37), mean age was 68.2 +/- 10.5 years and mean operative time was 29.4 +/- 7.2 minutes. In group 2 (n = 43), mean age was 66.9 +/- 10.6 years and mean operative time was 27.2 +/- 6.3 minutes. In both groups, the oxygen saturation ranged from the mean of 97.3 to 100% throughout the present study. The 99% confidence intervals of the mean differences of the oxygen saturation at 10, 20, and 30 minutes after draping were -1.60 to 0. 17%, -1.63 to 0.05%, and -2.37 to 0.74%, respectively. The comfort score was 84.9% in group 1 and 89.8% in group 2 (p = 0.61). CONCLUSION: With or without oxygen flow under the drape with the tip of the oxygen tube 1.5 cm away from the chin during PE/IOL, the patients' oxygen saturation is equivalent. The patients' comfort is not statistically different. Oxygenation under the linen drape seems to be unnecessary in uncomplicated cases.

Aged↗
PubMed1987

[Seeking refuge in the community.].

One of the many objectives of psychiatrie deinstitutionaliza-tion is to try to ensure that individuals who receive treatment reintegrate their community. The author points out that, for a certain category of young people undergoing treatment, such an objective requires a much broader approach involving more than psychiatric intervention alone; an increasing proportion of young people are left without community support and using prison as their drop-in centre. The situation is examined from the points of view of institutional practice and the life experience of subjects. The author sheds light on another step of psychiatric deinstitutionalization, namely social deinstitutionalization of a community's acceptance, support and accompaniment of the new generation of so-called mental patients.

English Abstract↗
PubMedDate not supplied

[Adolescent social integration through the "Cuidar cuidando" program].

The "Care Caring program" is a device of social reinsertion, carried out by a multidisciplinary and a multi-institutional practice of more than fifteen years. Those who sustain it, have always presented the necessity of articulating the cure with social reinsertion, therefore the purpose of the Program itself is not only to favour a clinical psychiatric recovery, but also to prompt changes in the manner of social liaison of the children and youngsters taking part. Animal contact in many way produce therapeutic effects. We describe here those we have seen and discuss the "popular" term zootherapy. After 16 years of non stop activity, more than 500 children and adolescents benefited from this innovative experience. We learned also that without broad social integration policies, the devices of reinsertion are limited in their long term effects. Breaking the differentiation circuit is impossible only with these resources. Working out these difficulties will allow us to answer if it is possible to think of strategies of rehabilitation in psychology and psychiatry for infancy and adolescence using communal resources.

Adolescent↗
PubMed1991

[Appraisal of outcomes of the treatment of equinus-cavus-varus deformities of the foot in adults].

There is presented the experience of treatment of 81 patients with equinus-cavus-varus deformation of 102 feet of different etiology by means of closed application of Volkov-Oganesyan-Povarov's hinged-distraction apparatus to restore the form and function of foot and talocrural articulation. For impartial assessment of the outcomes of treatment there has been developed and applied the scheme of multimark grading system of clinico-functional state of feet. The grade of the foot form and function restoration is appraised by 15 indices in comparison with the same in normal state. The sum of marks equals to 100 in case of optimum outcome. In accordance with the developed scheme there have been appraised 54 feet with the sum of marks obtained from 45 to 91 and their statistic reliability. The proposed scheme allows to make an impartial assessment of the outcomes of treatment of the equinus-cavus-varus deformation of feet and can be applied in practical institutions.

Adult↗
PubMed1991

Chromosome anomalies in human oocytes in vitro.

OBJECTIVE: To determine possible effects on chromosomal status of human oocytes in vitro. DESIGN: A prospective cytogenetic study of human oocytes fixed at 4, 20 (noninseminated oocytes), or approximately 52 hours after pick-up (inseminated-unfertilized oocytes). SETTING: Primary treatment of infertility in an institutional practice. PATIENTS, PARTICIPANTS: Eighty-eight consecutive in vitro fertilization (IVF) patients (262 inseminated-unfertilized oocytes) and 47 IVF patients with greater than 8 oocytes retrieved (95 noninseminated oocytes). INTERVENTIONS: Ultrasound-guided transvaginal follicular aspiration. MAIN OUTCOME MEASURE(S): Planned before data collection began. RESULTS: The incidence of chromosome anomalies did not differ between groups. However, a negative correlation between oocytes apparently without chromosomes and oocytes with fragmented chromosomes was found. CONCLUSIONS: Incubation of oocyte in vitro does not affect the chromosome complement. The mechanisms leading to oocytes apparently without chromosomes and with fragmented chromosomes are self-excluding.

Chromosome Aberrations↗