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PubMed1987

Enteral nutrition practices: similarities and differences between dietitians and physicians in Connecticut.

There has been little evaluation of attitudes, beliefs, and practices of health professionals involved in the provision of enteral nutrition support. A study was undertaken to define and describe enteral feeding practices of registered dietitians (R.D.s) and physicians (M.D.s) in Connecticut. Survey questionnaires were returned by 74.5% of R.D.s and 53.3% of M.D.s. Data were analyzed for 195 respondents. Overall, there were more similarities than differences between R.D.s and M.D.s. Malnutrition was the most frequent indication for tube feedings. Dietitians and physicians selected formulas on the basis of nutrient needs of the patients, but R.D.s gave significantly more weight to formula design and nutrient composition than did M.D.s. Lactose-free low-residue, high-calorie high-nitrogen, and elemental diets were considered to be the most desirable products to include in a hospital formulary. Dietitians more frequently monitored nutrition-related parameters, whereas M.D.s followed metabolic parameters of patients on tube feeding. Physicians relied on R.D.s to recommend formulas and to provide them with enteral nutrition information. The results from this study may be useful in planning nutrition education programs, evaluating standards for enteral nutrition practice, and improving utilization of enteral nutrition therapy.

Attitude of Health Personnel↗
PubMed1986

Equine ehrlichial colitis (Potomac horse fever): recognition of the disease in Pennsylvania, New Jersey, New York, Ohio, Idaho, and Connecticut.

Equine ehrlichial colitis (Potomac horse fever), a newly identified colitis of the horse, was first recognized in Maryland. In this report, we document occurrence of the disease in Pennsylvania, New Jersey, New York, Ohio, Idaho, and Connecticut. Enzootic areas were recognized by a characteristic pattern. Frequently there was a seasonal pattern and high prevalence of sporadic colitis in unstressed horses. The attack rate per farm generally was low. Horses on pasture, as well as those stabled, were affected. Clinical signs varied from fever and depression to severe diarrhea and laminitis. Occasionally horses developed profound ileus and severe colic. Diagnosis was based on detection of an increase or decrease in serum antibody titers to Ehrlichia risticii, using an indirect fluorescent antibody technique.

Animals↗
PubMed1982

Hydatidiform mole and gestational trophoblastic disease in Southern Connecticut.

Of 127 patients with hydatidiform mole in southern Connecticut, 34 (28%) received chemotherapy for persistently elevated human chorionic gonadotropin (hCG) titers. An hCG regression curve was found to be useful if not mandatory for following patients. Excess uterine size, theca lutein cysts, uterine bleeding, and histologic trophoblastic hyperplasia were relative discriminators of the need for chemotherapy. In the absence of metastases, an hCG titer was the only valid discriminator for initiating chemotherapy, provided the patient could be followed consistently and reliably. The indications for initiating chemotherapy are discussed. Early diagnosis and close follow-up were associated with low morbidity. Five of 6 patients with metastatic disease were referred from outside the center.

Female↗
PubMed1997

Minimally invasive coronary artery bypass grafting: initial Connecticut experience.

We report the initial Connecticut experience with minimally invasive coronary artery bypass grafting. This procedure allows bypass grafting to the left anterior descending coronary artery utilizing the internal mammary artery as the conduit. The procedure is minimally invasive because it is performed through a mini-thoracotomy incision in the fourth anterior intercostal space and it is conducted without the use of cardiopulmonary bypass. The procedure has been applied to 13 patients operated between February and October 1996. All but one patient selected were poor candidates for conventional coronary artery bypass surgery because of advanced age (6), chronic renal failure/dialysis/kidney transplant (4), redo status with vulnerable grafts (1), severe peripheral vascular disease (6), severe chronic obstructive pulmonary disease (4). All patients survived operation and were discharged in good condition. Mean postoperative intubation time was seven hours and mean hospital stay was 4.5 days despite the very high pre-existing comorbidity of these patients. All patients are alive at the current follow-up time. Two patients required a conventional bypass procedure for occlusion of the minimally invasive graft, the first because of diffuse disease in the target artery and the second attributable to the technical limitations of minimally invasive coronary artery bypass grafting; both tolerated the subsequent procedure well. All patients are now angina-free. All four grafts studied by routine postoperative angiography were widely patent. Routine post-operative exercise nuclear imaging was normal in an additional patient. This procedure of minimally invasive coronary artery bypass grafting offers significant advantages compared to the conventional bypass procedure (short hospital stay, quick recovery, and, especially, avoidance of cerebrovascular accidents caused by the heart-lung machine). This minimally invasive procedure is expected to apply to a growing percentage of patients. The procedure, especially vis-à-vis angioplasty, may well offer the superior long-term patency of the mammary conduit achieved with a modest initial "investment" in hospital stay, costs of medical care, and discomfort and disability. A prospective, randomized trial comparing angioplasty and minimally invasive coronary artery bypass grafting is warranted.

Aged↗