Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Concurrent Review”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 757 records · Page 42Linked to original sources
PubMed1997

Laparoscopic splenectomy. The emerging standard.

BACKGROUND: The purpose of this study was to evaluate the outcome of patients undergoing laparoscopic splenectomy (LS) at the University of California, San Francisco. METHODS: The medical records of the initial 52 unselected patients undergoing LS were reviewed and compared to 28 concurrently treated open splenectomy patients (OS). RESULTS: Patients did not differ with regard to age, gender, body, or splenic weights. The operative time was longer in the LS patients (mean 196 vs 156 min), but the length of stay and duration of ileus were shorter in the LS group. For adult patients admitted exclusively for splenectomy, operative times did not differ between LS and OS and total hospital cost was less in the LS group (mean $8, 939 vs $14,022). Six patients required conversion to OS, four occurring in the first 11 patients treated (overall conversion rate of 11%). Three patients died from complications related to their underlying disease. Two other major complications occurred. Complication rates and transfusion requirements did not differ between OS and LS patients. CONCLUSIONS: Laparoscopic splenectomy is a safe and effective alternative to open splenectomy for treatment of hematologic diseases in patients of all ages.

Adolescent↗
PubMed1980

Consultation psychiatry in an Italian general hospital: a report on 500 referrals.

Five-hundred consecutive referrals to the psychiatric consultation service at the University of Padua School of Medicine have been reviewed. In 69% of cases concurrent physical and psychiatric disorders were reported. There was a prevalence of females, working class patients, and individuals with limited schooling. Depression was the most common psychiatric disorder in all classes of organic disease and accounted for 37% of all psychiatric diagnoses, followed by anxiety neurosis (18.6%) and drug dependence (13.8%). In 10.8% of cases no psychiatric diagnosis was made.

Adolescent↗
PubMed1994

Misdiagnosis of acute appendicitis: common features discovered in cases after litigation.

To identify differences between correctly diagnosed appendicitis and misdiagnosed cases that resulted in litigation between 1982 and 1989 retrospective review of malpractice claims was conducted. A total of emergency department (ED) charts at the time of the initial ED visit were reviewed and compared with 66 concurrent controls. Missed cases appeared less acutely ill, had fewer complaints of right lower quadrant pain, received fewer rectal examinations, received intramuscular (IM) narcotic pain medication for undiagnosed abdominal pain or symptoms, and more often received an ED discharge diagnosis of gastroenteritis. Misdiagnosed patients had a 91% incidence of ruptured appendix, more extensive surgical procedures, and more postoperative complications. Data were analyzed using the Pearson's chi 2 Test, Mann-Whitney U Test, and stepwise discriminant analysis. Significance was defined as P < or = .05. Misdiagnosis of acute appendicitis is more likely to occur with patients who present atypically, are not thoroughly examined (as indexed by documentation of a rectal examination), are given IM narcotic pain medication and then discharged from the ED, are diagnosed as having gastroenteritis (despite the absence of the typical diagnostic criteria), and with patients who do not receive appropriate discharge or follow-up instructions.

Acute Disease↗
PubMed1998

Transposed basilic vein versus polytetrafluorethylene for brachial-axillary arteriovenous fistulas.

BACKGROUND: Both transposed basilic vein (BV) and polytetrafluorethylene (PTFE) upper arm arteriovenous fistulas (AVF) are common angioaccess operations. To evaluate the patency and complication rates after AVF, a concurrent series of patients was reviewed. METHODS: Ninety-eight patients underwent brachial artery to axillary vein AVF: 30 BV and 68 PTFE. The PTFE grafts were performed in the standard fashion, whereas the basilic veins were translocated subcutaneously to the brachial artery. RESULTS: Risk factors were similar between the two groups. Basilic vein AVF had better patency at 24 months (70% BV versus 46% PTFE, P = 0.023). The dialysis access complications were higher in the BV group (20%) versus PTFE (5%), but the PTFE group had a higher infection rate (10%) than BV (0%). CONCLUSIONS: The primary and secondary patency rates were superior in the BV AVFs. The BV AVF preserves the venous outflow tract after AVF thrombosis for a future PTFE AVF operation.

Arteriovenous Shunt, Surgical↗
PubMed1987

Changes in payment policies: impact on physicians' office testing.

Recent changes in payment policies include powerful pecuniary incentives to move care from expensive hospital settings to cheaper outpatient sites. Physicians face competition from a growing number of alternative providers in the diagnostic testing marketplace. Given that a concurrent trend involves aggressive utilization review with stiff penalties for noncompliance, physicians are challenged to practice appropriate restraint in ordering and performing tests.

Clinical Laboratory Techniques↗
PubMed1995

Carotid artery shortening: a safe adjunct to carotid endarterectomy.

PURPOSE: Kinks and coils of the extracranial carotid artery system have been described in conjunction with atherosclerotic disease of the internal carotid artery. The purpose of this study was to determine whether adding a carotid artery shortening procedure to carotid endarterectomy affected perioperative mortality and stroke-morbidity rates or late restenosis. METHODS: A retrospective chart review of all patients who concurrently underwent carotid endarterectomy and ipsilateral carotid artery shortening between 1983 and 1992 was performed. Long-term follow-up was obtained by contacting the primary physician or patient, and carotid artery duplex scans were obtained. RESULTS: One hundred seven patients were found to have undergone concurrent carotid endarterectomy and carotid artery shortening. The age range was 47 to 89 years, with 53 female and 54 male patients. Indications for surgery in this group were transient ischemic attacks in 28%, stroke in 18%, amaurosis fugax in 7%, and high-grade asymptomatic stenosis in 47%. Shortening procedures were performed by use of a variety of techniques at the completion of endarterectomy. The combined 30-day mortality and stroke morbidity rate was 2.7%, with two postoperative deaths and one stroke. In this same period, a total of 1072 carotid endarterectomies were performed, and the combined 30-day mortality and stroke morbidity rate was 4.0%. During late follow-up there were no ipsilateral strokes, recurrent symptoms, or significant restenoses. CONCLUSIONS: This experience suggests that the addition of a shortening procedure to carotid endarterectomy can be performed without increased morbidity and mortality rates and, when deemed appropriate, is a procedure with which the vascular surgeon should be familiar.

Aged↗
PubMed1998

Combined aortorenal reconstruction: is there an optimum method of exposure?

OBJECTIVE: To determine the advantages and disadvantages of two different transabdominal approaches to expose the pararenal aorta; infacolic (IC) and medical visceral rotation (MVR). DESIGN: Retrospective study. METHODS: We reviewed a consecutive series of concurrently treated patients undergoing combined aortorenal reconstruction using one of these two approaches (IC n = 45; MVR n = 30). RESULTS: The two groups were identical with respect to demographics, risk factors and associated illnesses. Aortic aneurysmal disease predominated among MVR patients, and occlusive disease among IC patients (p = 0.001). The most common aortic reconstruction was aortofemoral bypass grafting. Renal revascularisation was most often performed for symptoms; only in the MVR group it was the result of involvement by aortic aneurysmal disease (p = 0.000). Thromboendarterectomy was the most common renal reconstruction, though performed only 10 times in the MVR group (p = 0.01). Except for supraceliac aortic cross-clamping, which was required more often in the MVR group (p = 0.004), operative details did not differ between the groups. Although the overall perioperative mortality and complication rate were equal, intraoperative splenic injury occurred solely in the MVR group (p = 0.001), and these patients experienced more pulmonary complications (p = 0.004) and they were hospitalised longer than the IC group (29.7 +/- 35.8 vs. 17.2 +/- 15.4 days; p = 0.04). CONCLUSIONS: MVR has increased morbidity, but its unrestricted continuous exposure is optimum for combined aortorenal reconstruction involving pararenal aneurysmal disease. Pararenal occlusive disease is adequately exposed in most cases by the IC approach.

Aged↗
PubMed2002

Epidemiology of chronic hepatitis C virus infection in sub-Saharan Africa.

Hepatitis C virus (HCV) is a major cause of chronic liver disease in the world. The WHO estimates that 3% (170 million) of the world's population are chronically infected with HCV. Sub-Saharan Africa is of great interest because it is reported to have the highest HCV prevalence rate (5.3%), and a concurrent HIV epidemic. In our review of the published literature we found consistent evidence of high HCV prevalence in many countries of Africa. We estimate the overall prevalence of HCV in Sub-Saharan Africa is 3.0%. The central African region has the highest estimated prevalence of 6%, west Africa has an estimated prevalence of 2.4%, and southern and east Africa with the lowest estimated prevalence of 1.6%. Given low sexual transmission of HCV and infrequency of intravenous drug use in Sub-Saharan Africa, iatrogenic causes of HCV transmission need to be further evaluated.

Adult↗
PubMed2001

Expanding conceptualizations of culturally competent care.

AIM: The aim of the study was to gain an understanding of cultural competence from the perspectives of non-mainstream nurse educators, specifically those of Latin heritage. BACKGROUND/RATIONALE: Although the theoretical concepts of 'cultural diversity' and 'culturally competent care' have been supported and promoted by the largest professional nursing organizations, the practical application of these concepts has often created difficulties for nurse researchers, educators, and clinicians. The lack of progress in teaching and evaluating cultural competence suggested the need to 'center the margins' and explore cultural competence from the margins of one particular non-mainstream nursing group, Latina nurse educators. DESIGN/METHODS: A grounded theory research design was employed. A group of 10 doctoral, prepared, self-identified, Latina nurse educators participated in face- to-face audiotaped interviews. Data collection, analysis, and theoretical sampling decisions occurred concurrently, strengthening theory generation. Institutional review board approval was received for all steps of the study. The major limitation of the study was the omission of student voices. RESULTS/FINDINGS: The analysis suggests that the Latina participants shared the common purpose of teaching students how to think about difference. The teaching practices of this group of Latina educators was based on a belief that 'difference' is not solely about specific cultural groups. For example, content about 'Hmongs' or 'Latinos'. Rather, Latina faculty focused on teaching students how to directly connect with anyone perceived as different from oneself. CONCLUSION: Latina faculty did not distinguish between competent care and culturally competent care; for them, competence necessarily includes cultural competence. They conceptualize the provision of competent care to all persons who are perceived as different, rather than focusing only on those who are perceived as 'culturally' different. These conceptualizations have the potential to shed new light on how nurses and nurse educators think about, develop, and integrate cultural competence into nursing education, practice, and research.

Cultural Diversity↗
PubMed2002

Prosthetic rehabilitation of amputees aged over 90 is usually successful.

Prosthetic rehabilitation and prosthetic limb use in patients over 90 years of age have not been studied in detail. This study reports two concurrent successful cases and a review of registered patients aged over 90. Satisfactory outcomes often occur in this population and such patients should be referred for prosthetic rehabilitation, regardless of advanced age.

Aged↗
PubMed1992

Influence of political power, medical provincialism, and economic incentives on the rationing of surgical intensive care unit beds.

OBJECTIVE: To determine factors influencing rationing decisions in a surgical ICU during a temporary nursing shortage when two to six of the unit's 16 beds were closed. DESIGN: Blinded, concurrent data collection, retrospective chart review. SETTING: Surgical ICU. PATIENTS: All patients (n = 308) for whom a surgical ICU bed was requested were studied during a 3-month period. MEASUREMENTS AND MAIN RESULTS: Admitting patterns did not change and no attempts were made to limit admissions to more severely ill patients during times of the greatest shortage of surgical ICU beds. Contrary to findings in previous reports, the severity of illness of patients admitted to the surgical ICU decreased as bed availability and bed census decreased. Bed allocation across surgical services was influenced by factors other than medical suitability. Of major users, cardiothoracic surgery experienced the highest percentage (59%) of all patient admissions and lowest percentage (1.6%) of all denied admissions. General surgery experienced the lowest percentage (15%) of all admissions and highest percentage (10.4%) of all denied admissions, although these patients had the highest average Acute Physiology and Chronic Health Evaluation (APACHE II) scores for all patients admitted (17.7) and for patients denied admission (15.8). CONCLUSIONS: Surgical attending physicians rarely used other open inhouse ICU beds when surgical ICU beds were unavailable. Political power, medical provincialism, and income maximization overrode medical suitability in the provision of critical care services.

Adult↗
PubMed1998

Base deficit is superior to pH in evaluating clearance of acidosis after traumatic shock.

OBJECTIVE: This study was done to evaluate the differences in base deficit (BD) clearance, pH normalization, and the occurrence of complications between survivors and nonsurvivors after trauma. DESIGN: Concurrent data entry with retrospective review. METHODS: Trauma patients meeting registry criteria from July 1990 through August 1995 with arterial blood gases performed within 1 hour of admission and admission BD < or = -6 were included. Data was grouped by BD category (moderate, -6 to -9; severe, < or = -10). Group means +/- SEM were compared with a two-tailed t test. MEASUREMENTS AND MAIN RESULTS: Six hundred seventy-four patients met entry criteria. Survivors in both the moderate and severe BD groups had improved their BD within 4 hours and normalized their BD by 16 hours. Nonsurvivors did not improve their BD category until 8 hours (for the severe group) and 16 hours (for the moderate group) and did not normalize BD before 24 hours. The BD differences between survivors and nonsurvivors were significant at each time interval, whereas pH differences were significant at 2 hours in the moderate group and at 2, 16, and 24 hours in the severe group. Patients who failed to improve their BD > -6 had an increased frequency of adult respiratory distress syndrome, multiple organ failure, and mortality. CONCLUSION: Base deficit reveals differences in metabolic acidosis between survivors and nonsurvivors not shown by pH determinations and is clearly a better marker of acidosis clearance after shock.

Acidosis↗
PubMed2001

Empiric use of cefepime in the treatment of serious urinary tract infections in children.

BACKGROUND: Urinary tract infections (UTIs) are common in childhood. They represent a significant proportion (10%) of hospital-acquired infections in children. Bacteria causing UTIs in children vary, depending on the setting (community-acquired vs. nosocomial), underlying anatomic anomalies and concurrent medical conditions. OBJECTIVE: To review published and unpublished clinical studies that have used cefepime for the treatment of UTIs in children. METHODS AND RESULTS: In two recent multicenter, randomized trials, cefepime (50 mg/kg/dose every 8 h and every 12 h) was compared with ceftazidime (50 mg/kg/dose every 8 h) for the treatment of serious urinary tract infections including pyelonephritis in children less than 12 years of age. In these studies a favorable clinical and microbiologic response was observed in >95% of cefepime-treated and ceftazidime-treated children assessed at the end of treatment. CONCLUSIONS: These results indicate that cefepime represents an important therapeutic option for the treatment of serious UTIs in children.

Adolescent↗
PubMed2005

The pathobiology of amyotrophic lateral sclerosis: a proteinopathy?

Amyotrophic lateral sclerosis (ALS) is increasingly considered to be a disorder of multiple etiologies that have in common progressive degeneration of both upper and lower motor neurons, ultimately giving rise to a relentless loss of muscle function. This progressive degeneration is associated with heightened levels of oxidative injury, excitotoxicity, and mitochondrial dysfunction--all occurring concurrently. In this article, we review the evidence that suggests, in common with other age-dependent neurodegenerative disorders, that ALS can be considered a disorder of protein aggregation. Morphologically, this is evident as Bunina bodies, ubiquitin-immunoreactive fibrils or aggregates, neurofilamentous aggregates, mutant copper/zinc superoxide dismutase (SOD1) aggregates in familial ALS variants harboring mutations in SOD1, peripherin-immunoreactive aggregates within spinal motor neurons and as neuroaxonal spheroids, and in an increasingly greater population of patients with ALS with cognitive impairment, both intra- and extraneuronal tau aggregates. We review the evidence that somatotopically specific patterns of altered kinase and phosphatase activity are associated with alterations in the phosphorylation state of these proteins, altering either solubility or assembly characteristics. The role of nonneuronal cells in mediating motor neuronal injury is discussed in the context of alterations in tyrosine kinase activity and enhanced protein phosphorylation.

Amyotrophic Lateral Sclerosis↗
PubMed1993

The interrelationship of eclampsia, HELLP syndrome, and prematurity: cofactors for significant maternal and perinatal risk.

OBJECTIVE: To determine if there are differences between mothers and fetuses in eclamptic pregnancies with or without concurrent HELLP syndrome. DESIGN: Retrospective review. SETTING: A single tertiary perinatal centre, the University of Mississippi Medical Center. SUBJECTS: All eclamptic pregnancies treated during a 141 month period from 1980 until the end of 1991. METHODS: Pregnancies were grouped according to the presence or absence of HELLP syndrome subclassified as class 1 = platelet nadir < or = 50,000/microliters, class 2 = platelet nadir > 50,000 to < or = 100,000/microliters, and class 3 = platelet nadir > 100,000 to < or = 150,000/microliters. RESULTS: Among 49,782 live births, there were 117 women with eclampsia prior to delivery (incidence 1:425), 62 of which had HELLP syndrome. The group with HELLP syndrome were delivered significantly earlier (32.1 vs 36.4 weeks), and had lower birthweights (1821 vs 2550 grams) and higher perinatal mortality (113 vs 18:100). They were also transfused more frequently (65% vs 35%), and suffered greater overall serious maternal morbidity and mortality. CONCLUSION: Eclampsia is more likely to be associated with the HELLP syndrome at early gestations. Although eclamptic patients are already at risk, the presence of HELLP syndrome accentuates the risk for adverse maternal-perinatal outcome.

Adolescent↗
PubMedDate not supplied

Improving the quality of inter-hospital transfers.

This study is unique in that it involved the efforts of several professional groups at eight medical centers to solve a common quality assurance problem. The study used a systematic approach to evaluate and improve the quality of care provided to veterans transferred from one facility to another. The initial survey of personnel identified perceived problems with the transfer process. Both the concurrent and the retrospective focused reviews substantiated these problems. As a result of the study, an inter-hospital transfer form was developed and implemented at eight VA medical centers with plans to expand its use to other facilities. An important benefit of the inter-hospital transfer form is the ability to use it to continuously monitor and improve the quality of inter-hospital transfers. The study was conducted by Medical District No. 1 MEDIPRO. The Medical District Initiated Peer Review Organization is a physician directed system of quality assurance within the Department of Veterans Affairs. In each geographic District, VA medical centers provide physician representatives to a medical peer review board. The MEDIPRO board, with staff support, identifies potential quality issues, designs studies, establishes standards and thresholds, and analyzes and reports study results to the medical centers. The goal of MEDIPRO is to assure and continuously improve the quality of medical care provided in VA medical centers.

Age Factors↗
PubMedDate not supplied

Decision analysis for lower-third-molar surgery.

The objective of the study was to identify those factors that should affect treatment planning for patients who have lower third molars, using decision-analytic techniques. Utility values based on data from 104 patients indicated that the respondents considered that postoperative complications (except mild pain and temporary paresthesia) reduced health to a greater degree than did complications following non-intervention. A decision analysis indicated that the maximum expected utility of prophylactic third-molar surgery (60.25) was lower than that for non-intervention (76.96). The decision was sensitive to changes in the probabilities of occurrence of recurrent pericoronitis (threshold = 0.52), resorption of an adjacent tooth (threshold = 0.29), loss of an adjacent tooth (threshold = 0.32), and cystic change (threshold = 0.34). These thresholds are much higher than the incidence of problems affecting the lower third molar shown by a concurrent clinical audit and literature review. This study therefore suggests that lower third molars should not be removed prophylactically.

Decision Trees↗
PubMedDate not supplied

Serious renal impairment occurs rarely with use of tenofovir DF.

PURPOSE: The purpose of this study was to evaluate the short-term effects (up to 6 months) of tenofovir disoproxil fumarate (DF) use on renal function in patients being treated for HIV-1 infection. METHOD: The charts of 447 HIV-1-infected patients who received at least three months of tenofovir DF treatment were reviewed. Data collected included demographics, concurrent antiretrovirals, other concurrent medications, CD4 counts and HIV-1 viral loads, and serum creatinine values while on tenofovir DF. Data collection was truncated at 6 months. RESULTS: Baseline serum creatinine (SCr) was 1.0 mg/dL, with a calculated creatinine clearance (CLCr) of 95.2 mL/min (using the Cockroft-Gault equation). There was no significant change in SCr or CLCr at 12 weeks (1.1 mg/dL and 92.7 mL/min, respectively) or 24 weeks (1.1 mg/dL and 92.9 mL/min, respectively). All three patients with grade 2 increases in SCr had other medical reasons for an increased SCr (one patient each had indinavir-associated nephrolithiasis, lactic acidosis, and pancreatitis). No patients experienced any complications from these increases in SCr. CONCLUSION: Increases in SCr and CLCr within the first 6 months of tenofovir DF therapy were rare. Although no clinical nephrotoxicity was observed, continued observation of renal function is warranted in patients predisposed to renal impairment.

Adenine↗