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PubMed2002

Interhospital transport: transport of critically ill patients.

Primary emergency medicine systems in developed countries are well organized. Besides this primary system a secondary interhospital transport system has been developed in the past decade. The need for this system is expected to increase in the future following dramatic changes in the organization of the medical health system. This article outlines the current status of these secondary interhospital transfer systems, their components, possibilities, advantages or disadvantages, and the actual literature. Surprisingly, the available scientific data on these cost-intensive and highly developed systems are quite insufficient.

Journal Article↗

PubMed2002

Current nutrition in liver disease.

Malnutrition is common in severe liver disease. Assessment of malnutrition usually requires a subjective global assessment of the patient with a few additional tests that often include handgrip strength and arm-muscle circumference. The severity of liver disease correlates well with the severity of malnutrition, which has prognostic value. Malnutrition is multifactorial, is difficult to correct, and occurs in liver disease independently of the etiology of hepatic injury. Patients who have severe protein-calorie malnutrition require diets with high calorie and protein intake, even in the presence of hepatic encephalopathy. Some forms of complementary and alternative medicine are frequently used in patients with advanced liver disease, but supporting scientific data is needed. Obesity is detrimental to patients with advanced liver disease and is of greater concern in liver transplant candidates because it increases transplant-related morbidity. Data detailing the effects of aggressive nutritional support before transplantation are scarce, and more studies are needed.

Journal Article↗

PubMed1998

Colorectal cancer screening.

Comprehensive evidence-based guidelines for screening and surveillance for colorectal cancer were published in 1997. Backed by compelling scientific data from recently completed controlled trials and case-control studies, these guidelines recommend annual fecal occult blood test screening plus periodic flexible sigmoidoscopy about every 5 years for asymptomatic, average-risk individuals over 50 years of age. Other screening studies published during the past year refine knowledge about how these screening tests detect early cancer and polyps and assess factors that influence compliance with screening recommendations. Preliminary reports suggest revolutionary new methods of screening that may become clinically feasible in the next millennium.

Colorectal Neoplasms↗

PubMed1997

Dimensions and indicators of patients' perceived nursing care quality in the hospital setting.

Nursing professionals have noted the impact of cost-containment strategies on nursing care quality in the hospital setting. However, there is a lack of scientific data to demonstrate the impact. The author reviewed 53 published data-based primary studies of patient satisfaction with nursing care (PSNC) from 1982 to the present and identified 13 published PSNC instruments. The author performed content analysis of the published instruments and identified the dimensions and indicators of patients' perceived structure, process, and outcomes attributed to nursing care. The needs for further development of instruments to assess patients' perceived nursing care quality are identified.

Attitude of Health Personnel↗

PubMed1999

The physician's role in a world of technology.

Technology has come to dominate the medical world over the past 100 years. Some of this technology has come from science and some has been imported from the world of business. Some technology exists in the form of physical objects; other technology takes the form of systems and organization. Technology to manage information has played a particularly critical role in changing how medicine is practiced. Those who choose to apply the latest technologies to patient care do so in ways that are not merely a reflection of some "objective" set of scientific data. Rather, the use of technology transforms both the clinical encounter and the technology itself, and in so doing reflects the values of those who created and those who use the technology. Despite the many ways that technology has come to be used for medical care over the course of the past century, the role of the physician has remained central.

Forecasting↗

PubMed1999

Long term global evaluation of a national AIDS prevention strategy: the case of Switzerland.

OBJECTIVES: The Swiss Aids prevention strategy has been subject to a continuous process of evaluation for the past 12 years. This paper describes the conceptual approach, methodology, results obtained and contribution to policy-making of that evaluation. DESIGN: The evaluation is on-going, global with respect to all components of the strategy, and utilization-focused. Each successive phase of the evaluation has included 10-20 studies centred either on aspects of process, of outcome or of environmental context. Findings are synthesized at the end of each phase. METHODS: Both quantitative and qualitative methods are used. Studies generally have one of three functions within the overall evaluation: assessment of trends through surveys or other types of repeated studies; evaluation of specific areas through a series of studies from different viewpoints; in-depth investigation or rapid assessment through one-off studies. Various methods of triangulation are used to validate findings. RESULTS: The evaluation has allowed for: the observation of behavioural change in different populations; the availability of scientific data in controversial fields such as drug-use policy; an understanding of the diversity of public appropriation of prevention messages. Recommendations are regularly formulated and have been used by policy-makers and field workers for strategy development. CONCLUSIONS: The global approach adopted corresponds well to the evaluation requirements of an integrated long-term prevention strategy. Cost is low relative to the extent of information provided. Such an evaluation cannot however address the question of causal relationship between the strategy and observed changes. The evaluation has contributed to the development of a culture of evaluation in Swiss AIDS prevention more generally.

Acquired Immunodeficiency Syndrome↗

PubMed2000

The treatment of neuropathic pain: antidepressants and opioids.

OBJECTIVE: The objective of this article was to review the positive scientific data on antidepressants and opioids, which are largely confined to randomized controlled trials in two neuropathic pain conditions that have proved to be good models for clinical investigation. These two disorders are postherpetic neuralgia and painful diabetic neuropathy. DESIGN: This is a review of the literature using MEDLINE, CINAHL, and the Cochrane Database. RESULTS: There is extensive literature supporting the use of the older antidepressants such as amitriptyline in neuropathic pain. Newer randomized controlled trials support the use of opioids. CONCLUSIONS: First-line therapy for neuropathic pain may be either an older generation antidepressant such as amitriptyline or nortriptyline or the anticonvulsant gabapentin. For refractory cases, chronic opioid therapy may be the only avenue of relief, and evidence is accumulating that this approach is safe if proper guidelines are observed.

Analgesics, Opioid↗

PubMedDate not supplied

A review of chronic pain after inguinal herniorrhaphy.

BACKGROUND: Chronic pain was believed to be a recognized but infrequent complication after inguinal hernia repair. Evidence suggests that patients with chronic pain place a considerable burden on health services. However, few scientific data on chronic pain after this common elective operation are available. OBJECTIVES: To review the frequency of chronic pain and to discuss etiological theories and current treatment options for patients with chronic post herniorrhaphy pain. MATERIALS AND METHODS: All studies of postoperative pain after inguinal hernia repair with a minimum follow-up period of 3 months, published between 1987 and 2000, were critically reviewed. RESULTS AND DISCUSSION: The frequency of chronic pain after inguinal hernia repair was found to be as high as 54%, much more than previously reported. Quality of life of these patients is affected. Chronic pain is reported less often after laparoscopic and mesh repairs. Recurrent hernia repair, preoperative pain, day case surgery, delayed onset of symptoms, and high pain scores in the first week after surgery, however, were identified to be risk factors for the development of chronic pain. Definition of chronic pain was not explicit in the majority of the reviewed studies. Accurate evaluation of the frequency of chronic pain will require standardization of definition and methods of assessment. Prospective studies are required to define the role of risk factors identified in this review.

Chronic Disease↗

PubMedDate not supplied

Nutritional concerns related to Roux-en-Y gastric bypass: what every clinician needs to know.

Weight loss surgery, particularly the Roux-en-Y gastric bypass (REYGB), has become a popular treatment strategy for obesity. Often the only measure of success is the amount of weight lost following surgery. Unfortunately the nutritional adequacy of the postoperative diet has frequently been overlooked, and in the months to years that follow, nutritional deficiencies have become apparent, including protein-calorie malnutrition and various vitamin and mineral deficiencies contributing to medical illnesses and limiting optimal health. Therefore, patients require close monitoring following REYGB, with special regard to the rapidity of weight loss and vigilant screening for signs and symptoms of subclinical and clinical nutritional deficiencies. Several specific nutrients require close surveillance postoperatively to prevent life-threatening complications related to deficient states. This article addresses nutritional concerns associated with REYGB with fastidious focus on recognition and treatment of the nutritional deficiencies and promotion of nutritional health following REYGB. Recommendations regarding nutritional intake following REYGB are based on available scientific data, albeit limited. In cases where data do not exist, expert or consensus opinion is provided and recommendations for future research are given. Ultimately, clinical application of this information will contribute to the prevention of nutrition-related illness associated with REYGB.

Deficiency Diseases↗

PubMed2006

Laparoscopic management of the adnexal mass.

Ovarian neoplasms are common in women of all ages. As many as 10% of women in the United States will undergo surgical removal of an adnexal mass sometime in their lifetime. Gynecologic surgeons have pioneered laparoscopic surgery, developing what was originally a diagnostic tool into a safe and effective approach to management of adnexal masses. Accumulating scientific data support the laparoscopic approach to the adnexal mass as the preferred treatment.

CA-125 Antigen↗

PubMed1996

Geometric mismatch of the Gamma nail to the Chinese femur.

The geometric mismatch of the femoral component of the Gamma nail to the Chinese femora resulted in intraoperative complications. To provide scientific data for modification of the implant, 28 pairs of normal Chinese femora were studied with the 3-dimensional reconstruction from the computed tomography scan data. Measurements were taken from the reconstituted drawings, and the anthropometric data were applied in the modification of the implant. This study is the first report on the application of Chinese anthropometric data on the design of a trauma implant. It is hoped that a larger scale of the study will provide a more comprehensive data base for wider application to orthopaedic implant design in the future.

Aged↗

PubMed1985

Criteria for the administration of KI for thyroid blocking of radioiodine.

Scientific data are reviewed to evaluate the risks of radioiodine uptake and to compare those risks with the benefits and risks of low milligram doses of stable potassium iodide (KI). The limit of 25 rad to the thyroid due to radioiodine uptake is adopted as the "break-even" point above which 130-mg KI doses should be administered. The biological and radiological kinetics of radioiodine for protracted uptakes were derived from the Medical Internal Radiation Dose Committee (MIRD) model (MIRD75). Resulting calculations yielded estimates of dose commitment rates to the thyroid as a function of thyroidal uptake. The extrapolated value of the 1-hr inhalation curve for 131I with 30% uptake compares well with the established MPCa value and intercepts the origin. The calculated KI-blocking efficiency as a function of time after radioiodine uptake agrees well with previously reported experimental data. The prevention or "blocking" of 25 rad to the thyroid was the criterion used to define critical values of radioiodine in the thyroid. Critical values are functions of isotope, the duration of uptake and the elapsed time between inhalation and assay of thyroid content. The presence of radioiodine in the thyroid in amounts greater than the critical value indicates that more than 25 rad to the thyroid can be averted, and KI should be administered in the absence of contraindications. Critical average concentrations are implicitly defined by the method of calculation used in the derivation. Critical average concentrations are presented as criteria for KI administration when assays of the radioiodine content of the thyroid are unavailable. Illustrative applications of critical values and critical average concentrations are presented in the Appendix.

Accidents↗

PubMed2003

Developing a scientific basis for radiation risk estimates: goal of the DOE Low Dose Research Program.

The U.S. Department of Energy's Low Dose Radiation Research Program is a 10 y activity currently funded at $21 million per year. It focuses on biological responses to low doses (<0.1 Gy) of low-LET ionizing radiation. The overall goal of this program is to provide a sound scientific basis for the radiation protection standards. The program supports basic research that combines modern genomic, molecular, and cellular techniques with recent advances in scientific instrumentation. These combinations make it possible to detect responses and test paradigms associated with the mechanisms of low dose radiation action not previously measurable or testable. Research to date is briefly reviewed and suggests the need for some major paradigm shifts. Exposure of the extracellular matrix can modify both the pattern of gene expression and the phenotype of the cells which result in cell transformation without direct mutation. Low dose radiation exposure results in a range of dose-response relationships for changes in the number, types, and patterns of gene expression. Such studies suggest an increased role for gene expression relative to single mutations for radiation induced cancer. Low dose research using microbeams demonstrated that cells do not require a direct "hit" to result in significant biological alterations. These "bystander effects" demonstrate that "non-hit" cells respond with changes in gene expression, DNA repair, chromosome aberrations, mutations, and cell killing. Research to link genomic instability with cancer is also being conducted and will be discussed. Detection of radiosensitivity genes as markers of genetic susceptibility in individuals and populations can be used in epidemiological studies to determine how molecular changes may impact risk. It is not possible to determine how this research will influence current radiation standards. However, the Low Dose Research Program will help ensure that radiation standards are set using the best scientific data available, and that they are adequate and appropriate for the protection of workers and the public.

DNA↗

PubMed2004

The bell tolls for LNT.

The linear no-threshold (LNT) model has been a convenient tool in the practice of radiation protection, but it is not supported by scientific data at doses less than about 100 millisievert or at chronic dose rates up to at least 200 millisievert per year. Radiation protection practices based on the LNT model yield no demonstrable benefits to health when applied at lower annual doses. The assumption that such exposures are harmful may not even be conservative and has helped to foster an unwarranted fear of low-level radiation. For its new recommendations, to be issued probably in 2005, the International Commission on Radiological Protection (ICRP) has said that it expects to continue the application of the LNT model "above a few millisievert per year." National societies for radiation protection may wish to consider the need to lobby the ICRP, through the auspices of International Radiation Protection Association, to further relax adherence to the LNT assumption--up to "a few tens of millisievert per year."

Body Burden↗

PubMed1996

Children's response to parental separation during operation desert storm.

OBJECTIVE: Commonly held attitudes concerning the effects of parental wartime deployment on children have usually been guided by stereotype, rather than scientific data. To determine the effects of Operation Desert Storm on military children and their parents, the authors compared children and families with and without a deployed soldier-parent prior to and during Operation Desert Storm. METHOD: Three hundred eighty-three children and the remaining caretaking parent completed self- and parent-report instruments concerning child and family functioning and life stressors. Children of deployed and nondeployed personnel were compared cross-sectionally, as well as longitudinally, using data collected prior to any knowledge of Operation Desert Storm. RESULTS: Children of deployed personnel experienced elevated self-reported symptom levels of depression, as did their parents. Likewise, families of deployed personnel reported significantly more intervening stressors, compared with children and families of nondeployed personnel. However, deployment per se rarely provoked pathological levels of symptoms in otherwise healthy children. CONCLUSIONS: Generally, the factors shaping differential outcomes among children of deployed personnel do not differ from the variables affecting outcomes of children of nondeployed parents. However, boys and younger children appear to be especially vulnerable to deployment effects, and increased monitoring of these children is warranted. Adequate treatment of children requires treatment of the effects of the deployment on other family members. For children showing more persistent or pervasive psychopathology, factors other than simple deployment should be considered.

Adjustment Disorders↗

PubMed1990

Visual information processing of computed topographic electrical activity brain maps.

Effective display of computer-generated biomedical images draws on computer graphics and image processing, display technology and human factors, visual psychophysics and perception, cognitive psychology, and the new field of scientific data visualization. In converting from raw, acquired data to a visual display, developers need to know the limitations of the data and of the display technology. To obtain reliable inferences about the clinical or physiological state of the patient requires that the computer display be matched to the visual information-processing competence and limitations of human observers. The issues that should be considered by both developers and users of computer-based display technologies to enhance clinical performance in observation and diagnosis are surveyed with reference to electrical activity brain maps.

Brain↗

PubMed1998

Neuroprotective agents in acute ischemic stroke.

Recent scientific data suggest that there is a "window of opportunity" between the onset of brain ischemia and irreversible neuronal death. Although neurons can withstand complete absence of blood flow for only minutes, collateral circulation typically surrounds the "core" of the stroke. In these brain regions known as the ischemic penumbra, brain tissue can survive for several hours following stroke onset. Recent studies suggest that neuroprotective agents would give these viable neurons the chance for recovery. This article reviews the mechanisms of ischemic neuronal injury, mechanism of action of neuroprotective agents, current neuroprotective clinical trials, and guidelines for patient care management.

Acute Disease↗

PubMedDate not supplied

Cardiovascular disease prevention and lifestyle interventions: effectiveness and efficacy.

Over the past half century scientific data support the strong relationship between the way a person or population lives and their risk for developing or dying from cardiovascular disease (CVD). While heredity can be a major factor for some people, their personal health habits and environmental/cultural exposure are more important factors. CVD is a multifactor process that is contributed to by a variety of biological and behavioral characteristics of the person including a number of well-established and emerging risk factors. Not smoking, being physically active, eating a heart healthy diet, staying reasonably lean, and avoiding major stress and depression are the major components of an effective CVD prevention program. For people at high risk of CVD, medications frequently need to be added to a healthy lifestyle to minimize their risk of a heart attack or stroke, particularly in persons with conditions such as hypertension, hypercholesterolemia, or hyperglycemia. Maintaining an effective CVD prevention program in technologically advanced societies cannot be achieved by many high-risk persons without effective and sustained support from a well-organized health care system. Nurse-provided or nurse-coordinated care management programs using an integrated or multifactor approach have been highly effective in reducing CVD morbidity and mortality of high-risk persons.

Cardiovascular Diseases↗