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PubMedDate not supplied

Hemostasis in aortic and cardiothoracic surgery.

Hemostasis abnormalities in cardiovascular and aortic surgery remain a major source of morbidity and mortality in patients undergoing such complex procedures. The need for frequent transfusions of red cell and other blood products increases risks and costs to patients and institutions providing patient care. Specifically in cardiovascular and aortic surgery, the nature of the surgery is, at best, semi-elective, and careful preparation to preserve the hemostatic mechanisms of the body is essential. Contact of blood with the extracorporeal circuit induces a hemorrhagic diathesis through a variety of different mechanisms. Dilution of the patient's blood volume by the extracorporeal circuit prime causes depletion of platelets and coagulation factor levels. Aorto intimal disease initiates fibrinolysis by the release of tissue plasminogen activator. Due to the numerous etiologies of bleeding, a combination of blood conservation strategies is suggested. The ideal combination of interventions has yet to be determined and is currently dependent on patient variables, physician and institutional practices, and economic pressures.

Aminocaproic Acid↗
PubMedDate not supplied

[Illness rate with viral infections in the Russian Federation].

Presents data on the incidence of infections controllable by vaccine prevention, hepatitides, arbovirus infections, and hemorrhagic fevers, as well as on the share of virus infections in nosocomial morbidity. Defines the tasks of research and practical institutions in liquidation of poliomyelitis and decrease of the incidence of measles. Formulates the problems in epidemiology, prevention, and diagnosis of virus infections to be solved by the year 2000.

Humans↗
PubMed1998

Culture, gender, and suicidal behavior in Sri Lanka.

In less than 50 years, the rate of suicide among Sri Lankans has risen from a modest level to one of the highest in the world. This article describes the current pattern of suicides, including sex differences and similarities, and reviews some of the institutional practices, material conditions, and social norms that may figure in the increases. A study is reported, which asked how ordinary Sri Lankans account for suicidal behavior and what practices they recommend for assisting suicidal individuals. Gender inflected these accounts, with essentialist accounts associated with women's suicides and contextual accounts associated with men's suicides.

Adult↗
PubMed1998

Saphenous vein sparing surgery: principles, techniques and results.

OBJECTIVE: Evaluation of saphenous vein sparing surgical procedures alternative to high ligation and distal stab avulsion, in terms of effectiveness and suitability for eventual bypass surgery. EXPERIMENTAL DESIGN: Prospective evaluation of 421 operations for primary varicose veins, 64 external valve-plasties of the sapheno-femoral junction (EV-SFJ), (42 performed using the hand sewing technique and 22 using the Veno-cuff device), mean follow-up 52 months, and 357 hemodynamic correction of varicose veins (French acronymis CHIVA), mean follow-up 49 months. Moreover, a subgroup of 27 patients was operated on using the CHIVA technique in two steps, mean follow-up 18 months. SETTING: Institute of General Surgery, University of Ferrara. Institutional practice, one-day surgery. PATIENTS: Patients were selected using clinical and duplex scanning evaluations, and classified according to CEAP criteria. Patients with varicose veins due to sapheno-femoral reflux with duplex scanning evidence of mobile valve leaflets underwent EV-SFJ. The other patients were operated on using the hemodynamic correction technique. INTERVENTIONS: EV-SFJ restores valve function correcting vein wall dilatation by applying an external prosthesis. CHIVA consists of selected ligatures of the superficial veins that allow superficial blood aspiration in the deep veins through the perforators as well as the preservation of saphenous drainage. MEASURES: The outcome was evaluated with independent clinical and ultrasonographic examinations; pre and postoperative AVP and LRR-RT measurements were assessed in 125 cases. Data from self-assessment of the functional and cosmetic result of the patients of the CHIVA group were also obtained using a scoring system. Moreover, scanning the preserved long saphenous vein the rate of long saphenous vein suitable as arterial conduit following sparing surgery was also evaluated. RESULTS: Overall long saphenous vein patency registered after EV-SFJ and CHIVA was 94%. Varicose veins recurrence rate was 12% and 11%, respectively. Postoperative AVP and LRR-RT improvement was statistically significant (p<0.001). CONCLUSIONS: These two alternative procedures seem to be effective in varices treatment following the proposed indications and techniques. In addition, they appear able to preserve a more significant rate of saphenous veins suitable for eventual bypass surgery than high ligation and multiple cosmetic avulsion.

Adult↗
PubMed1998

Right thoracotomy as an alternative for redo mitral valve replacement and concomitant repair of the tricuspid valve.

BACKGROUND: We report the results of a right thoracotomy for reoperation on the mitral plus concomitant procedures. Access to aorta or repair of other lesions by this approach is controversial. EXPERIMENTAL DESIGN AND SETTING: Retrospective study. Institutional practice (University of Tsukuba Hospital, Tsukuba Japan). METHODS: Until 1995, 9 patients underwent right thoracotomy for mitral reoperation. The indication for this approach was no retrosternal space with the pericardium left open. Seven patients had deteriorated bioprosthesis, 1 periprosthetic valve leakage, and 1 re-stenosis. Four were associated with moderate tricuspid regurgitation. Operations were performed under fibrillation. Cardioplegia was used in 1. RESULTS: Through thoracotomy, 4 underwent mitral valve re-replacement, and 4 mitral valve re-replacement plus tricuspid annuloplasty. One was abandoned because of severe pleural adhesion. No neurological injury, or perioperative myocardial infarction occurred. CONCLUSIONS: The right thoracotomy was an effective alternative to repeat sternotomy for redo mitral valve operation. Also, concomitant repair of the tricuspid valve could be safely done by this approach.

Aged↗
PubMed1998

A comparison of the recovery times of desflurane and isoflurane in outpatient anesthesia.

The low solubility of desflurane has been shown to contribute to faster awakening from anesthesia when compared with other anesthetics in common use. However, research has failed to consistently demonstrate faster discharge times from the postanesthesia care unit following the use of desflurane. This study was undertaken to compare the recovery and discharge times of outpatients undergoing procedures greater than 2 hours in length. Thirty-three patients aged 18 to 70 years were randomized to receive either desflurane or isoflurane following a standard intravenous induction with propofol. Patients received premedication and opioids consistent with institutional practice, and inhalation agents were titrated to effect during anesthetic maintenance. Following surgery, patients were evaluated for time to emergence and time to meeting discharge criteria. The results demonstrated no differences between the emergence or discharge times following desflurane or isoflurane. In addition, measured parameters, such as intraoperative vital signs and postoperative emesis and opioid requirements, were not different between the groups. The use of desflurane as part of a balanced anesthetic technique did not speed the emergence or discharge time when compared with isoflurane.

Adult↗
PubMed1985

Indoor climate problems in day institutions for children. Practical, Administrative and policy perspectives.

Based on case material from the late 1970s and early 1980s from the Institution of Medical Officers of Health covering a Danish county some examples of practical indoor climate problems in day institutions for children are given. Insufficient ventilation of premises is probably the single most important factor in the development of indoor climate problems. An effective cleaning generally improves the indoor air. The study particularly illustrates the administrative and policy perspectives of the decision making process. Those that make decisions on indoor climate problems unfortunately seem to favour a narrow definition of health, i.e. the absence of overt disease; and they are not always aware that the relationship between indoor climate factors and health effects cannot be proven in an absolute sense. Experts on the scientific aspects are needed but their statements are influenced by personal values and their perception of the reasonable balance between health protection and social costs. One of the main factors influencing the indoor climate situation in Danish day institutions for children has been the lack of an adequate regulatory framework; and the central administration and responsible ministers have failed to use the already existing legislative powers to prevent problems. Decision making in cases on the indoor climate of institutions should be accelerated; we cannot wait for proof before taking preventive measures. The indoor air of institutions is a "public good" to the same extent as the ambient air and the responsible authorities have an obligation to regulate accordingly. When building regulations prove insufficient other central authorities must support local decision makers with more specific directions. Testing of building materials, hazard rating and an approval system is needed. Guidelines on indoor climate requirements for public institutions should be developed. In countries with a built-up system of child institutions and a decreasing birth rate it is especially important to improve the already existing institutions. In our regulatory and administrative practice we must restore the balance between the present concern for the health of the adult working population and the insufficient protection of children. We obviously need more research but increased attention should be paid to the administrative and political barriers that prevent improvements of the indoor air.

Air Pollutants↗
PubMed2003

Institutioning a clinical practice guideline to decrease the rate of normal appendectomies.

With the advent of laparoscopic appendectomy, the rate of normal appendectomies increased at our institution. To decrease our rate of normal appendectomies, we instituted a clinical practice guideline in January 1999 for the preoperative evaluation and treatment of patients with possible acute appendicitis. The medical records of 464 consecutive patients who underwent either open or laparoscopic appendectomy with a preoperative diagnosis of acute appendicitis between January 1, 1997, and December 31, 2000, were reviewed. The decision of open versus laparoscopic appendectomy was made at the time of surgery by the attending surgeon. Two hundred twelve patients (116 females, 96 males) underwent an appendectomy for acute appendicitis (142 open, 70 laparoscopic) from January 1, 1997 through December 31, 1998, prior to the institution of the guideline. Two hundred fifty-two patients (117 females, 135 males) underwent an appendectomy for acute appendicitis (193 open, 59 laparoscopic) from January 1, 1999, through December 31, 2000 (after the guideline was instituted). Prior to the guideline, the normal appendectomy rate was 21.7 per cent (18.3% open, 28.6% laparoscopic). After the guideline was instituted, the normal appendectomy rate was 16.7 per cent (14.5% open, 23.7% laparoscopic). In females, the normal appendectomy rate prior to the guideline was 31.0 per cent (26.6% open, 36.5% laparoscopic) while the normal appendectomy rate after the guideline was 23.1 per cent (19.0% open, 31.6% laparoscopic), P = 0.172. In males, the normal appendectomy rate prior to the guideline was 10.4 per cent (11.5% open, 5.6% laparoscopic) while the normal appendectomy rate after the guideline was 11.1 per cent (11.4% open, 9.5% laparoscopic), P = 0.861. By instituting a guideline for the diagnosis and treatment of possible acute appendicitis, we were able to decrease our rate of normal appendectomies. Although statistical significance was not reached, there is a trend toward decreasing the rate of normal appendectomies in females after the guideline was instituted.

Acute Disease↗
PubMed2004

Institutional review board practices regarding assent in pediatric research.

OBJECTIVE: To assess how Institutional Review Boards (IRBs) implement the assent requirement for research with children. METHODS: Telephone interviews were conducted with 188 chairpersons of IRBs from a range of institutions nationwide. Respondents were queried on 4 topics: 1) which children are considered capable of assent, 2) which information investigators must provide pediatric research subjects, 3) whether IRBs favor the enrollment of children who are capable of assent, and 4) how chairpersons view payment for children's research participation. RESULTS: Half of IRBs have a method that they require investigators to follow when determining which children are capable of assent, most commonly an age cutoff. Half of IRBs do not have a method, and the majority rely on investigators' clinical judgment. IRBs largely follow the adult research regulations when determining which information should be provided to an assenting child. A total of 58% of IRBs would enroll a child who is incapable of assent in a nonbeneficial study, even if children who are capable of assent could be enrolled instead. Almost half (46%) of chairpersons believe that it sometimes or always acceptable to offer incentive payments to children, and more than one third (35%) thought it acceptable to offer payment to the parents. CONCLUSION: When possible, IRBs follow the federal regulations for research with adults when implementing the assent requirement. For considerations that do not have analogs in the adult regulations, IRB practices vary widely. These data suggest that IRBs need guidance on how to implement the assent requirement in a way that provides appropriate protections for pediatric research subjects.

Biomedical Research↗
PubMed1984

Current and future pharmacy initiatives in institutional and corporate practice.

The future of pharmacy in organized health-care settings is discussed in light of changes in the health-care industry. The shift of health-care financing from cost-based reimbursement to prospective pricing provides pharmacists with the challenge of providing high-quality, cost-effective pharmaceutical services. Implementation of clinical pharmacy services will be a key factor in containing costs and improving patient care. The consolidation and corporate restructuring of hospitals will permit diversified services to develop in a highly competitive market. The formulary system, within which the medical staff may authorize and place conditions on the use of therapeutic equivalent drug products, will continue to play an important role in hospitals. Changes in the health-care industry will offer institutional pharmacists opportunities to enhance their roles as health professionals and as providers of economical quality care.

Formularies, Hospital as Topic↗
PubMed1988

Comprehensive family practice clerkship in a minority institution.

A comprehensive family practice clerkship program at Howard University College of Medicine has been conducted since 1970. This institution is one of three predominantly black institutions offering a family practice program. The senior clerkship is mandatory and at least 20 to 25 percent of each class elect to participate in a four-to six- week family practice preceptorship. As a result of the clerkship's success, over 50 percent of the program's graduates actively practice in primary medical manpower shortage or medically underserved areas.

Black or African American↗
PubMed1996

[Nutritional practices in type II diabetic patients in primary care. Mexican Social Security Institute]

Nutritional practices of diabetics reflect both human behavior and the health culture of such patients. They also represent how the diabetic deals with the health/illness issue. The purpose of this survey was to identify and relate nutritional practices with metabolic control, age, sex, years of schooling, and time since diagnosis of illness. The sample was taken from 114 cases selected through systematic random sampling in five family practice units in Guadalajara. Using thirteen structured, coded, and quantified questions of the Likert type, the study evaluated nutritional practice with a range of 0-65. Results showed that 21% of the diabetics had appropriate nutritional practices (>31 points), and when related with years of schooling and time since diagnosis of illness, they showed statistically significant differences (p=0.05). Simple regression showed that 9% of metabolic control can be explained by nutritional practices.

Journal Article↗
PubMed1993

A challenge to the rhetoric of emancipation: recreating a professional culture.

This paper explores the notion that nursing education is a political process which reproduces traditional practices. There is evidence to suggest that dominant ideologies, embedded in the social processes of education and health care, shape the consciousness of nurse teachers and students towards conformity and compliance with established practices in hegemonic institutions. Traditional practices or 'common sense' reinforces the structural arrangements which contribute to the contradictions that students experience between knowledge they are 'given' in the classroom and knowledge they derive from their clinical learning experiences. It is clinical placements which bring students face to face with their position in the established hierarchy of knowledge, professional relationships and routinized practices. In this sense students may experience their classroom education as a denial of their lived experience in clinical settings. They may learn to negotiate among the different meanings and explanations they encounter and learn to act in ways that are personally and professionally 'safe', thereby reproducing traditional nursing culture. Project 2000 in Great Britain and the calls for a 'curriculum revolution' from North America promise transformation of traditional practice. But it is the political processes of teaching and learning and their practical effects which must be revealed for critique and transformation if professional ideals of reflective practice, emancipatory knowledge and professional autonomy are to play an integral part in transforming professional nursing practice within hegemonic institutions.

Attitude↗