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At least 487 records · Page 27Linked to original sources
PubMed2004

Volume and outcome of coronary artery bypass graft surgery: are more and less the same?

BACKGROUND: Despite the relatively high degree of regionalization of coronary artery bypass graft surgery in Canada, support is expressed for even further centralization of this procedure. The finding that the risk-adjusted mortality rate is lower at high volume hospitals is the basis for the decision to centralize. The goal of this study was to determine if current evidence supports the extension of such a policy. METHODS: A systematic review of the literature (1980 to 2002) provided mortality and surgical volume studies on 21 patient cohorts. For 16 of these, the published information permitted division of each cohort into those who had surgery at high or low volume hospitals. The target level for division was 200 cases per year; the level achieved was 200+/-44 (mean+/-SD). The odds ratio (OR) was calculated from the observed and expected mortality ratios. In seven studies, volume had been treated as a continuous variable; the effect of volume was expressed as OR per 100 patients in four of these studies. RESULTS: A plot of OR against year of surgery showed a progressive increase from 0.55 (favouring high volume) in 1972 to 0.95+/-0.07 for the past few years. All estimates of OR per 100 patients were very close to 1.0, also indicating little or no effect of volume on mortality. INTERPRETATION: These results are compatible with the concept that with time the lower mortality associated with high volume has been virtually eliminated. It is hypothesized that this development is explained by a multifaceted learning curve, improved surgical training and technical advances. Therefore, the current evidence does not provide a basis for further regionalization of cardiac bypass surgery.

Age Factors↗
PubMed2004

The critical airway, rescue ventilation, and the combitube: Part 1.

Emergency and unexpected difficult airway management can rapidly deteriorate into a critical airway event such as "cannot ventilate, cannot intubate" (CVCI). A critical airway event (i.e., inadequate mask ventilation, failed intubation, and CVCI) can be resolved by rescue ventilation, thus avoiding potential neurological disability or death. Recommended options include use of the larygeal mask airway, the esophageal-tracheal Combitube (ETC; Tyco-Healthcare-Nellcor, Pleasanton, Calif), transtracheal jet ventilation, or a surgical airway. This article reviews proper use of the ETC in combination with the self-inflating bulb (SIB) and/or portable carbon dioxide detector to resolve critical airway situations. The combined use of these 3 devices provides on ideal integrated system for airway control and ventilation. In addition, critical airway events and rescue ventilation options; ETC design, technical aspects, training, insertion, and ventilation; determining ETC location (i.e., esophagus vs trachea); and monitoring ETC lung ventilation are reviewed. The SIB primarily assesses ETC location within the esophagus or the trachea; the carbon dioxide detector also permits monitoring lung ventilation. Use of the ETC in prehospital, emergency medicine, and anesthesia settings, including ETC advantages, contraindications, and reported complications will be reviewed in Part 2. How to safely exchange the ETC for a definitive airway also will be reviewed.

Clinical Competence↗
PubMed2002

Enhancing a medical e-learning environment: the adaptive DI2@DEM approach.

Current medical e-learning tools suffer from a variability of student user. Students are different in terms of motivations, training backgrounds, technical skills and learning objectives. It is obvious that these students do not accede relevant information if their educational resources access is misadapted. Adaptive environments propose to take the user into account in order to provide him or her with the most relevant educational resources. We present the adaptive DI(2)ADEM approach, which enhances the MEDIDACTE e-learning environment of the Faculty of Medicine in Marseille. DI(2)ADEM objective is to select the most relevant information and offer it to the user in an adaptive manner. Adaptability is based on management of knowledge regarding both the user and resources distributed. A match is made between student's profile and knowledge of resources organization and semantics.

Computer Simulation↗
PubMed2006

[Assistive technology devices for the elderly at home].

Using assistive technology (AT) to help the elderly and disabled overcome disabilities and attain their rehabilitation, learning, working and living potentials represents the mainstream trend in well-developed countries. According to data from Taiwan's Ministry of the Interior, Taiwan's senior citizen population exceeds two million. Proper application of AT can help achieve in Taiwan the goal of aging in place. Assistive technology devices can be divided into five categories, including barrier free environment (home modification), daily living aids, mobility aids, seating and positioning devices, and sensory aids. As of 2005, there were 16 senior care centers in Taiwan funded and administered by the Department of Health, all of which maintain interdisciplinary teams--comprising specialists in rehabilitation medicine, occupational therapy, physical therapy, speech therapy, nursing, education, social work and engineering--that provide service directly to persons with special needs and cooperate with manufactures to develop new assistive devices. Services provided by these centers include evaluation, design, customization, adaptation, maintenance, repair, therapy, training and technical assistance related to AT devices. The government has a legal responsibility to provide senior citizens in need with appropriate AT services. Service users, their families and professionals may contact centers directly for consultation.

Accidents, Home↗
PubMed1990

[Aspects of vertical management and "preference" in basic health care].

The author deals with causes of inequalities of health care in different regions. He thinks that it is due to the professional and economic management of the health services. Local decision of the Communist Party and the national committees was frequently at variance with the competence of the state health administration and thus gave preference to some types of health institutions, while others were neglected. To ensure an even development it is important to introduce more consequential vertical management. The author mentions controversies between resolutions of the Communist Party and state organs and reality in conjunction with deceiving the public by maintaining that health care is developing and improving. Actually the health services deteriorated and only narrow specialized branches developed further. The authority of general practitioners declined and so did the satisfaction of patients whose health deteriorated and whose life expectancy declined. At present the objective is to eliminate existing disproportions and restore to the general practitioner his original mission and to enable him to become a family doctor. Subsequently the author deals with the use of the doctor's working hours, inadequate function of the ambulatory services because of technical shortcomings, training of doctors and the reduced ratio of paramedical personnel per doctor.

Czechoslovakia↗
PubMed1987

[Organization of first-aid in street auto-racing].

The author proposes a modus operandi for organizing first-aid services for motor-racing accidents. After reviewing the literature relating to first-aid systems and the provisions of aw applying in this field, attention is drawn to the need to create efficient first-aid systems, particularly in view of the very high number of such events held during the course of the year. In particular, the author examines the problems relating to the study of the territory in which the event is to be held and suggests special training for technical support personnel and for those actually participating in races. He then goes on to assess in detail the positioning of emergency vehicles, the choice of such vehicles and means of liaison with the base of operations. Particular attention is devoted to the role of the doctor in charge of the first-aid service, who should possess the necessary expertise and practical experience.

Accidents, Traffic↗
PubMed1984

Providing primary health care with non-physicians.

The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined.

Allied Health Personnel↗
PubMed1984

Short-term effects of teenage parenting programs on knowledge and attitudes.

The short-term effects of teenage parenting programs upon the knowledge and attitudes of pregnant teenagers were assessed. The programs studied produced a significant change in the teenagers' knowledge of sexuality and child development while having no apparent effect on the teenagers' parenting attitudes. The implications of producing changes in knowledge without accompanying changes in attitudes are discussed.

Adolescent↗
PubMed1983

[The physician's liability and required precaution].

Physicians are worried about increasing malpractice litigation. It is necessary to cope with this situation in a way that damages neither the welfare of the patient nor the rights of the physician. A constitutional state therefore requires legal control of the conduct of physicians by judicial non-medical authorities. In law the physician is only liable for deliberate or negligent malpractice, i.e., for the lack of due diligence. The criterion is the generally accepted practice in his field. To establish this standard, the judge depends on the medical expert. The essential difficult problem is to establish the standard and to determine what constitutes a reproachable deviation. Examples include the adoption of previous diagnosis by another physician, the choice between possible therapies and whether to treat as an out-patient. In regard to damages a reasonable average is required, taking into account a physician's training and technical equipment available to him. If strict liability combined with an insurance scheme were introduced, there would be the same problems, because the judge must distinguish between damages caused by the physician and the natural progress of an illness.

Germany, West↗