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PubMed1998

Pulmonary tractotomy as an abbreviated thoracotomy technique.

BACKGROUND: Operative abbreviated thoracotomy techniques in thoracic trauma include emergency center thoracotomy, ligation of major arterial branches, packing the thoracic cavity for diffuse bleeding, towel clip or Bogota bag closure of the chest, and pulmonary tractotomy. Pulmonary tractotomy with selective vascular ligation was originally described for deep through-and-through lung injuries that did not involve hilar vessels or airways. Pulmonary tractotomy has evolved into use as an abbreviated thoracotomy technique in patients with severe thoracic or multivisceral trauma. As with any operative technique in high-risk patients, specific procedure-related complications may occur and are analyzed herein. The objective of this manuscript is to review the indications, techniques, and results for pulmonary tractotomy in trauma patients requiring abbreviated thoracotomy. METHODS: Medical records were retrospectively reviewed for 30 of 32 consecutive tractotomy patients treated at Ben Taub General Hospital, during a 3-year period. By using a model for logistic regression analysis, the characteristics of each patient and their clinical course were tested for impact on mortality. RESULTS: Seventy percent of patients had at least one intraoperative parameter indicative of acidosis (pH < 7.2), coagulopathy (prothrombin time > 13.8 or partial thromboplastin time > 38.0 seconds), or hypothermia (core temperature < 34 degrees C), and 50% of patients manifested two of these three parameters. The mortality rate among the 30 patients was 17%. Three of the five patients who died were noted to be acidotic, coagulopathic, and hypothermic. Twelve of 25 patients who survived more than 1 day had at least one thoracic complication. There were no late deaths. There was one failed tractotomy and one missed injury. A second thoracotomy was not required for control of a lung injury in any patient. Logistic regression analysis showed that intraoperative blood loss was the only predictive factor for mortality. CONCLUSION: Pulmonary tractotomy is a simple and effective technique in injured patients who require an abbreviated thoracotomy and has an acceptable mortality and complication rate. This follow-up report notes that as definitive therapy, tractotomy continues to allow for direct control of bleeding and air leak and obviates the need for formal resection.

Adolescent↗
PubMed1998

An abbreviated area-under-the-curve monitoring for tacrolimus in patients with liver transplants.

This study aims to assess the predictability of individual tacrolimus (FK) concentrations at different time points for the area under the curve (AUC) and to find the best sampling time for the abbreviated AUC to predict the total body exposure of FK. A total of 23 FK blood concentration versus time profiles (11 blood samples per 12 hours) was studied in 12 stable patients with liver transplants at steady state. Each AUC was calculated by the trapezoidal rule, and the relationship between individual concentrations or abbreviated AUC and total AUC was determined by linear regression. The trough concentrations from the morning dose predict AUC better than the trough concentration from the evening dose (r2 = 0.71 for morning dose and r2 = 0.35 for evening dose). In the case of single drug concentration, the 4-hour concentration could predict the total AUC reasonably well (r2 = 0.73). From stepwise multiple regression, the abbreviated AUC at 1, 2.5, 6, and 9 hours could predict the total AUC most accurately (r2 = 0.99). This study shows that the four levels at 1, 2.5, 6, and 9 hours or 1, 4, and 12 hours as an abbreviated AUC is as good as a full pharmacokinetic study. Alternatively, 4-hour concentration is a good predictor of the total body exposure of FK in the stable patients with liver transplants.

Analysis of Variance↗
PubMed1998

[Abbreviations or acronyms in the internal medicine discharge reports. Study Group of the Quality of Information in Internal Medicine (Castilla-La Mancha)].

OBJECTIVES: Quality of discharge reports is very important for an adequate health care activity. Clinical data of these reports must be comprehensible by patients and in the different levels of Health Services. Presence of abbreviations causes severe shortcomings in the clinical data of these records. METHODS: We analyzed the presence of abbreviations in the Internal Medicine discharge reports of 7 hospitals of Castilla-La Mancha in the year 1992. We evaluated 835 discharge reports. RESULTS: Abbreviations were found in personal background 72.4%, present disease 31%, physical examination 87.2%, clinical judgement 39.4%, complementary explorations 95.8%, evolution 61.4% and treatment-follow up after discharge 67.4%. CONCLUSION: These results indicate that abbreviations must be avoided in discharge reports in order to obtain a better communication between patient and doctor and between medical personnel.

Internal Medicine↗
PubMed1991

Codes and abbreviations for approved of effectively published names of genera of bacteria published from January 1980 to December 1990.

Lists of abbreviations for genus names of bacteria are expanded to accommodate 103 new entries which are names that have been validity published since the publication of an updated list by Rogosa et al. in 1986 (Int. J. Syst. Bacteriol. 36:464-472). These abbreviations are provided to serve the need for appropriate codified abbreviations for use in processing or indexing of information on computers.

Abbreviations as Topic↗
PubMedDate not supplied

Abbreviations: the need for legibility and accuracy in documentation.

This article explores the use of abbreviations in health care. It considers the current advice of the Nursing and Midwifery Council against the use of any abbreviations and suggests, in the interests of using time effectively, that it would be wise for directorates within trusts to create a list of approved abbreviations and symbols so that the dangers of misunderstandings are removed. It also considers how the problem of illegibility should be dealt with as a clinical governance issue.

Abbreviations as Topic↗
PubMed2002

[Acronyms and abbreviations in the clinical history].

The authors identify the acronyms, initials and abbreviations which have been produced in the different services at this hospital, establishing unified utilization criteria and creating a valid list for the center's administrative statutes. The authors conclude that there is an excessive utilization of abbreviations in clinical files, more than 30 per file on average, and the professional staff is barely aware that they are abusing these abbreviations. To effect changes in habits regarding their use will require time and perseverance.

Abbreviations as Topic↗
PubMed1976

The identification of brain damage by an abbreviated form of the Halstead-Reitan Neuropsychological Battery.

In recent years there has been an increased interest in the development of neuropsychological tests that can diagnose accurately brain damage. The most successful of these test are represented in the Halstead-Reitan Neuropsychological Battery, which has been shown to be 90% or more effective in the diagnosis of brain damage. However, this battery is not available to many psychologists or clients because of its length, cost, and the considerable background required to use it properly. The present study tested 121 Ss (30 normal, 91 brain-damaged) to develop an abbreviated version of the battery that is relatively brief (1 hour) and inexpensive, but accurate. It was found by discriminant analysis that the abbreviated battery is capable of diagnosing brain damage equally as well as the full battery 93% of the time. The limitations and advantages of the abbreviated battery are discussed.

Adolescent↗
PubMed1977

A comparison of the Stanford-Binet abbreviated and complete forms for developmentally disabled children.

Three abbreviated versions of the Stanford-Binet were reviewed and compared for 50 children with developmental disabilities. The children ranged in age from 6 years - 0 months to 15 years - 11 months. While the IQs obtained from the abbreviated forms correlated highly with the complete Binet IQ, it was felt that the 2-item test yielded too many "misses" both in terms of IQ and classification to be of significant value for use with developmentally disabled children. Although the Terman and Merrill 4-item and Wright versions both yielded considerable "misses" in classification, they were believed to be of definite value to the time-harried examiner. Caution was advised, however, in the use of abbreviated-form IQs as a basis for important diagnostic decisions.

Adolescent↗
PubMed1985

A change of mind: the Conners abbreviated rating scales reconsidered.

A cutoff score of 15 on the Conners 10-item Abbreviated Teacher Rating Scale (ATRS), based on a study from this laboratory, has been widely used by investigators for diagnosis of the syndrome known now as Attention Deficit Disorder with or without Hyperactivity. A replication of the original research employing a larger norm sample indicates that the suggested score of 15 is too low. Comparing the norm sample with hyperactive subjects selected by cutoff of 15 on the ATRS showed that the groups differed greatly on hyperactivity but not on inattention. The abbreviated form of the Conners scale does not effectively select children with attention deficits. Numerous problems with both the 39-item teacher scale and the abbreviated form suggest strongly that they be abandoned as research tools.

Attention↗
PubMed1984

The relationship between heat abbreviation and neural progestin receptors in female rats.

The purpose of this study was to determine whether changes in the levels of neural progestin receptors are associated with mating-induced heat abbreviation in the rat. Mating caused a decrease, 8-10 hr after stimulation, in the duration of sexual receptivity. No difference in the concentration of cytosol progestin receptors was found between mated and nonmated animals 8-10 hr after treatment. Mating caused a statistically significant decrease in the concentration of nuclear progestin receptors at that time. However, this difference was probably not related to heat abbreviation, because no difference in nuclear progestin receptor levels was found between animals mated with vaginal masks and animals mated without masks, while mated-masked animals were found to exhibit significantly higher levels of sexual receptivity than mated-nonmasked animals after treatment. In addition, mating either with or without masks caused a statistically significant increase in serum progesterone levels relative to that measured in nonmated animals. Therefore, it is suggested that mating, even in the absence of cervical-vaginal stimulation, may cause the release of adrenal progestins which, in turn, may influence the rate at which neural progestin receptors accumulate and are processed within cell nuclei. The results of the present study suggest that mating-induced heat abbreviation in the rat is not associated with decreased levels of neural cytosol or nuclear progestin receptors.

Animals↗
PubMed1994

Randomized prospective evaluation of prolonged versus abbreviated intravenous heparin therapy after coronary angioplasty.

OBJECTIVES: This study was designed to prospectively evaluate the routine use of continuous heparin therapy after successful uncomplicated coronary angioplasty. BACKGROUND: The use of such therapy varies among institutions and may increase the incidence of complications. Evaluation of the risks and benefits of abbreviated heparin therapy combined with early sheath removal after coronary angioplasty is necessary to determine optimal postprocedure care. METHODS: We prospectively studied 284 patients who were scheduled for elective coronary angioplasty. Historical, clinical, physiologic and angiographic data were gathered. All patients received an initial bolus of heparin and then were randomized during the procedure to receive either no additional heparin therapy or an adjusted 24-h infusion. On the basis of specific criteria, additional heparin was not withheld if procedural results suggested an increased risk for complications. RESULTS: Two hundred thirty-eight patients completed the study; 46 others were excluded in the catheterization laboratory because of unfavorable procedural results. The patients with abbreviated (n = 118) and 24-h (n = 120) therapy did not differ with respect to demographic and angiographic findings. However, the former had fewer bleeding complications (0% vs. 7%, p < 0.001) and were discharged earlier (mean +/- SD 23 +/- 11 h vs. 42 +/- 24 h, p < 0.001). One patient in this group had a major complication shortly after angioplasty. The mean savings in hospital charges in the abbreviated therapy group was $1,370 ($6,093 +/- $1,772 vs. $7,463 +/- $1,782, p < 0.001). CONCLUSIONS: Omission of routine heparin therapy after successful coronary angioplasty reduces bleeding complications without increasing patient risk. Earlier discharge and significant cost savings are possible under proper conditions.

Algorithms↗
PubMed2006

Concurrent validity of abbreviated WAIS-III index scores in geriatric outpatients with suspected dementia.

Assessments of older adults with suspected dementia can be time limited and clinicians might consider using abbreviated versions of measures. The present study examined the concurrent validity of abbreviated WAIS-III index scores in a sample of geriatric patients referred for assessment of suspected dementia (N=43; mean age=63.8 years). All 2-subtest estimates of the Verbal Comprehension, Perceptual Organization, and Working Memory index scores accurately estimated more than 80% of cases within +/-2 standard errors of measurement (S.E.M.), and in most cases, more than 90% of cases were accurate at this level. While none of the 1-subtest estimates of these index scores were as accurate, both of the 1-subtest estimates of the Processing Speed index had high clinical accuracy. Abbreviated versions of the four index scores can be substituted in situations with this clinical population where testing time is limited or a patient fatigues easily.

Aged↗
PubMed2006

A comparison of measured trough levels and abbreviated AUC estimation by limited sampling strategies for monitoring mycophenolic acid exposure in stable heart transplant patients receiving cyclosporin A-containing and cyclosporin A-free immunosuppressive regimens.

BACKGROUND: Mycophenolate mofetil (NIMF) pharmacokinetics vary widely, and enterohepatic recirculation of the drug and its metabolites may be altered by concurrently administered immunosuppressants, including the widely used agent cyclosporin A (CsA). A reliable method of achieving effective and well-tolerated levels of NIMF-based immunosuppression would be of eminent interest. OBJECTIVE: This study compared the use of measured mycophenolic acid (MPA) trough levels (C0) and abbreviated AUC estimation by limited-sampling strategies for monitoring MPA exposure in stable heart transplant recipients (>1 year after transplantation) receiving a CsA-containing or CsA-free immunosuppressive regimen. METHODS: The treatment groups were receiving chronic maintenance immunosuppressive regimens consisting of either CsA/MMF or rapamycin (RAPA)/MMF. An additional subgroup of patients was switched from the CsA-containing regimen to the RAPA-containing regimen. Fasting venous blood samples were obtained before dosing and at 40, 75, 120, and 240 minutes after administration of the morning dose of MME The validated Emit assay was used to measure MPA plasma concentrations. Dose adjustment of AUCs was performed by dividing the AUC by the morning NIMF dose in grams. Cmax after administration of the morning dose was determined from available MPA data points using curve-fitting analysis. The increase to Cmax (Cmax-C0) was calculated, and dose adjustment was performed as before. Abbreviated 12-hour MPA AUCs were estimated using a limited-sampling strategy (before dosing and 30 and 120 minutes after dosing) based on high-performance liquid chromatography data. Adverse events were monitored during routine follow-up visits. RESULTS: The study included 47 patients receiving CsA/MMF, 15 receiving RAPA/MMF, and 9 who were switched from CsA/MMF to RAPA/MME The population included 55 men and 7 women, with a mean age of 58.94 years and a mean weight of 81.85 kg. The only significant differences in baseline clinical characteristics between groups were the mean number of years since heart transplantation (3.62 CsA/MMF vs 8.53 RAPA/MMF; P<0.01) and the proportions of patients still receiving corticosteroids (44.7% vs 13.3%, respectively; P<0.01). Reported adverse events were generally mild, including leukopenia (8.1%), diarrhea (6.5%), and abdominal pain (4.8%), and did not require drug discontinuation. In patients receiving CsA/MMF, MPA AUCs ranged from 19.67 to 81.80 mg/h.L (mean [SD], 41.92 [14.14] mg/h.L). MPA Co levels were poorly correlated with total AUC (r2=0.36). MPA Co levels of 0.5 and 1.6 mg/L were correlated with AUCs of <30 and <40 mg/h.L, respectively. In patients receiving RAPA/MMF, MPA AUCs ranged from 34.40 to 87.60 mg/h.L (mean, 51.07 [15.80] mg/h.L). The correlation between Co and total AUC was better than in the CsA/MMF group (r2=0.61). MPA C0 levels of 1.0 and 2.3 mg/L were correlated with AUCs of 30 and 40 mg/h.L, respectively. Statistically significant differences between RAPA/MMF and CsA/MMF were noted in the mean MMF dosage (1.90 [0.71] vs 2.87 [0.78] g/d, respectively; P<0.001), the mean dose-adjusted MPA AUC (60.95 [27.42] vs 31.92 [16.12] mg/h.L.g MMF; P<0.001), and mean dose-adjusted MPA C0 levels (5.10 [3.41] vs 1.41 [0.95] mg/L.g; P<0.001). The dose-adjusted increase to Cmax after morning dosing was comparable between groups, and there was no difference in the frequency distribution of Cmax. In the group switched from the CsA-containing regimen to the RAPA-containing regimen, the changes in MMF dose, dose-adjusted AUC, and MPA C0 levels were similar to those in the CsA/MMF and RAPA/MMF groups. CONCLUSIONS: In this comparison of measured MPA C0 levels and 12-hour MPA AUCs estimated by a limited-sampling strategy in stable heart transplant patients receiving chronic maintenance immunosuppressive therapy with CsA/MMF or RAPA/MMF, abbreviated AUC estimation predicted drug exposure more accurately than did measured C0 levels. Thus, MPA AUCs obtained by limited sampling may be useful in guiding clinical management and dosing. However, further study is required, including validation of these findings in clinical outcome studies.

Area Under Curve↗
PubMed1992

Abbreviated esophageal pH monitoring as an indication for fundoplication in children.

Intraesophageal pH recordings from 40 patients with abnormal studies who underwent fundoplication during a 1-year period were evaluated. Scores were recalculated for the first 12, 16, and 20 hours, respectively. Five of the recordings were for less than 24 hours, but were grossly abnormal and mathematically could not have normalized at 24 hours. The percentage of studies which were normal at 12, 16, and 20 hours were 20%, 15%, and 0%, respectively. One fifth of the patients would have been denied a fundoplication based on 12-hour results. In addition, 75 consecutive pH recordings were evaluated prospectively. Total scores were determined for the first 12, 16, and 20 hours with accuracies of 85%, 93%, and 92%, respectively. The sensitivity of 12-hour monitoring was only 78%. All abbreviated studies had a low rate of false positives; however, any false positives may be significant when used to determine the need for an operation. Abbreviated studies were associated with high false-negative rates (up to 52% for the 12-hour studies) for the calculated mean duration of sleep reflux, a parameter that has been found to be useful in identifying patients with respiratory symptoms secondary to gastroesophageal reflux. The use of abbreviated pH monitoring is discouraged.

Child↗
PubMed1984

The accuracy of abbreviated esophageal pH monitoring in children.

Extended (18 to 24 hour) esophageal pH monitoring establishes the diagnosis of gastroesophageal reflux (GER) utilizing a pH score, and relates respiratory symptoms to GER when the mean duration of sleep reflux (ZMD) is prolonged. A disadvantage of this method is the expense of overnight hospitalization. We performed extended esophageal pH recordings in 66 consecutive children (1 week to 15 years old) being evaluated for GER. Six portions of the 18- to 24-hour esophageal pH recording were compared to the complete record in an attempt to define the relative accuracy of abbreviated monitoring periods. The abbreviated monitoring periods included the 30 minutes after apple juice feedings (30 minutes AJ), the 2 hours after apple juice feedings (2 hours PC AJ), the 2 hours after milk-formula feedings (2 hours PC MF), the 8 hours with two feedings of apple juice (8 hours AJ), the 8 hours with two feedings of milk formula (8 hours MF), and the first 12 hours of recording (1st 12 hours). The accuracy relative to the 18- to 24-hour recording was poor for 30 minutes AJ, 2 hours PC AJ, and 2 hours PC MF periods (30% to 58%). An improved accuracy occurred during 8-hour AJ periods (29/31, 94%) in children without respiratory symptoms. Although the accuracy in patients with respiratory symptoms was best during 8-hour MF (31/35, 89%) and 1st 12-hour (33/35, 94%) periods, a high false-negative rate for the ZMD (31% to 41%) during abbreviated pH monitoring indicates that many patients with reflux-induced respiratory symptoms will be unrecognized.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1976

Immune response of guinea-pigs to chemically abbreviated prepatent Metastrongylus apri infection.

The effect of chemical abbreviation of the primary infection dose (PID) of 160 infective larvae of Metastrongylus apri on the immune status of the guinea-pig host was studied. The criteria used for assessing the status of immunity consisted of clinical manifestations following administration of a challenge infection dose (CID) of 800 infective larvae of M. apri, the rate of worm recovery 15 days post-CID and the rate of mortality following administration of CID. Among the guinea-pigs of the main experimental group, where 15-day-old PID was abbreviated by two parenteral doses of levamisole, a strong immunity to CID given 35 days post-PID was built-up. Against this, all the guinea-pigs of a control group, which did not receive PID, died between 16 and 22 days post-CID. The increase in serum gamma-globulin level of the guinea-pigs, where the PID was abbreviated chemically, suggested that the rise of this globulin fraction in the serum could be in some way related to the resistant state of guinea-pigs.

Animals↗
PubMed2000

Solution 1H NMR study of the heme cavity and folding topology of the abbreviated chain 118-residue globin from the cyanobacterium Nostoc commune.

The globin from the cyanobacterium Nostoc commune, abbreviated GlbN, which appears to serve as a part of a terminal oxidase rather than as a respiratory pigment, displays relatively normal O2 binding properties, despite the highly abbreviated polypeptide chain, (118 residues) relative to more conventional globins [Thorsteinsson, M. V. , Bevan, D. R., Potts, M., Dou, Y., Eich, R. F., Hargrove, M. S., Gibson, Q. H., and Olson, J. S. (1999) Biochemistry 38, 2117-2126]. The nature of the heme cavity and the general folding topology of this cyanoglobin were investigated by solution 1H NMR to establish the extent to which, and the manner in which, this compact globin adheres to the standard globin fold. This represents by far the smallest globin subjected to structural analysis. The paramagnetic cyanomet derivative was selected because its characteristically large magnetic anisotropy imparts significant dipolar shifts which both improve resolution to greatly facilitate assignments and serve as indicators of the folding topology of the globin. Identification of the axial His 70 and highly conserved Phe 35 (CD1) determined the absolute orientation of the heme and proximal His. Sequential assignments of four helical and one loop segments, which exhibit dipolar contacts to the heme and among each other, confirm the presence of well-conserved F, G, and H helices and the FG corner. The majority of the abbreviation of the chain relative to the more conventional length globins is accommodated in the A-D helices, of which the last is completely missing. The distal residue which provides a H-bond to bound ligand is identified as Gln 43, but the expected helical position E7 could not be confirmed. His 46, placed at position E10, is found to adopt alternate orientations into, and out of, the heme cavity depending on protonation state, suggesting the presence of a Bohr effect at low pH. It is shown that the dipolar shifts exhibited by backbone protons for the assigned residues conform well to those observed for other cyanomet globins and further support a conserved Mb fold. Perturbed medium-range dipolar contacts and the pH-independent backbone proton lability of the F helix are interpreted in terms of a holoprotein which is less stable than a conventional length globin.

Amino Acid Sequence↗
PubMed1998

Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus.

BACKGROUND: The Pediatric AIDS Clinical Trials Group Protocol 076 reported a reduction in the rate of perinatal transmission of the human immunodeficiency virus (HIV) from 25.5 percent to 8.3 percent with a three-part regimen of zidovudine given ante partum, intra partum, and to the newborn. We examined the effects of abbreviated zidovudine regimens on perinatal HIV transmission using data from the HIV polymerase-chain-reaction (PCR) testing service of the New York State Department of Health. Pregnant women who received abbreviated regimens rather than the recommended regimens did so because of limited prenatal care or by choice. METHODS: The requisition form used by the PCR testing service included information on the demographic characteristics of the infants and the timing of any perinatal treatment with zidovudine. We also analyzed data on the timing of zidovudine prophylaxis collected by chart review in a subgroup of 454 infants as a means of validating the results in the entire cohort. RESULTS: From August 1, 1995, through January 31, 1997, specimens from 939 HIV-exposed infants who were 180 days of age or younger were submitted for PCR testing. The rates of perinatal HIV transmission varied depending on when zidovudine prophylaxis was begun. When treatment was begun in the prenatal period, the rate of HIV transmission was 6.1 percent (95 percent confidence interval, 4.1 to 8.9 percent); when begun intra partum, the rate was 10.0 percent (3.3 to 21.8 percent); when begun within the first 48 hours of life, the rate was 9.3 percent (4.1 to 17.5 percent); and when begun on day 3 of life or later, the rate was 18.4 percent (7.7 to 34.3 percent). In the absence of zidovudine prophylaxis, the rate of HIV transmission was 26.6 percent (21.1 to 32.7 percent). CONCLUSIONS: These results confirm the efficacy of zidovudine prophylaxis and suggest that there are reductions in the rates of perinatal transmission of HIV even with the use of abbreviated regimens that are begun intra partum or in the first 48 hours of life.

Anti-HIV Agents↗