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At least 811 records · Page 45Linked to original sources
PubMed2006

Cardiomyopathy in pregnancy and caesarean section: four case reports.

We present the clinical details of four women with cardiomyopathy who required caesarean section. Two women had peripartum cardiomyopathy and two had hypertrophic obstructive cardiomyopathy, one of whom has had two caesarean sections. Those with peripartum cardiomyopathy were more compromised than those with hypertrophic obstructive cardiomyopathy. Co-operation between obstetric and cardiac anaesthetists ensured optimum experience was available. An incremental combined spinal-epidural technique with invasive monitoring was used for three women and one received general anaesthesia. The risks and benefits of different anaesthetic techniques are discussed.

Adult↗
PubMed2005

Saliva control issues in the neurologically challenged. A 30 year experience in team management.

OBJECTIVE: The objective of this paper is to report the experience of a multidisciplinary team (otolaryngologist, speech-language pathologists, pediatric dentist, and social worker) functioning at a pediatric rehabilitation center have had in the management of 1487 neurologically challenged individuals with saliva control issues assessed from 1976 to the end of 2004. METHOD: The role of each team member is outlined. Management decisions have consisted of no treatment, utilization of oral-motor training program, elimination of contributing situational factors, utilization of medication, surgery and Botox injections of the major salivary glands. RESULTS: Oral-motor programs to improve oral-motor function is essential initially if there is patient compliance. Surgery was recommended in the majority of patients. Submandibular duct relocation with simultaneous sublingual gland excision remains the procedure of first choice for persistent significant drooling. Aspiration is much less common than drooling and is more problematic to treat. Simultaneous ligation of the submandibular and parotid ducts (aka 4-duct ligation) is promising. A recent initiative to inject the major salivary glands with Botox is being evaluated. CONCLUSIONS: Team evaluation with consensus decision making has worked well in this patient population with complex medical conditions.

Adolescent↗
PubMed2005

Physicians ask for more problem-solving information to promote and support breastfeeding.

Physicians (n=262) were surveyed about their breastfeeding promotion practices, knowledge, and areas in which they need more information in order to be more influential with patients in the initiation and duration of the process. Over half (51%) reported no or limited education in breastfeeding, whereas only 9% reported adequate education. A knowledge assessment indicated almost half (42%) did not know certain viruses can be transmitted through breast milk. There were also mixed responses to the need for vitamin D supplementation. Promotion practices included most (82%) thinking the physician has a primary role in the feeding decision, and most did discuss the benefits with patients; however, only 54% would recommend breastfeeding to a patient who had decided to bottle-feed. Problem-solving was the main area physicians reported needing more education. Partnerships with dietetics professionals may fill the gaps in the support needed to increase rates of breastfeeding.

Adult↗
PubMed2006

Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders.

It is the position of the American Dietetic Association that nutrition intervention, including nutritional counseling, by a registered dietitian (RD) is an essential component of the team treatment of patients with anorexia nervosa, bulimia nervosa, and other eating disorders during assessment and treatment across the continuum of care. Diagnostic criteria for eating disorders provide important guidelines for identification and treatment. However, it is thought that a continuum of disordered eating may exist that ranges from persistent dieting to subthreshold conditions and then to defined eating disorders, which include anorexia nervosa, bulimia nervosa, and binge eating disorder. Understanding the complexities of eating disorders, such as influencing factors, comorbid illness, medical and psychological complications, and boundary issues, is critical in the effective treatment of eating disorders. The nature of eating disorders requires a collaborative approach by an interdisciplinary team of psychological, nutritional, and medical specialists. The RD is an integral member of the treatment team and is uniquely qualified to provide medical nutrition therapy for the normalization of eating patterns and nutritional status. RDs provide nutritional counseling, recognize clinical signs related to eating disorders, and assist with medical monitoring while cognizant of psychotherapy and pharmacotherapy that are cornerstones of eating disorder treatment. Specialized resources are available for RDs to advance their level of expertise in the field of eating disorders. Further efforts with evidenced-based research must continue for improved treatment outcomes related to eating disorders along with identification of effective primary and secondary interventions.

Anorexia Nervosa↗
PubMedDate not supplied

Information exchange between general practitioner and nursing home physician in The Netherlands.

BACKGROUND: In response to the specific characteristics of nursing home residents, the Netherlands has become the only country to develop the specialty of nursing home medicine. The "nursing home physician" has attained independent status. This development has, however, created a division between medical care in the community and medical care in nursing homes, which challenges the quality of the transitional processes taking place when a patient is admitted to or discharged from nursing home care. OBJECTIVES: To give insight into the type of medical information exchanged between general practitioners (GPs) and nursing home physicians (NHPs) at the time of admission, while a patient is under care of the NHP, and at the time of discharge. METHODS: Questionnaires were sent to a sample of 780 GPs, who were selected using a 2-phase sample strategy. Three hypothetical patient vignettes, involving the admission of a patient to a nursing home, to day care, and to an outreaching nursing home care project, were constructed and presented in the questionnaire. GPs were asked to answer questions about the information exchanged during the care of a patient illustrated in each vignette only if they were really familiar with a patient such as presented. The advantage of hypothetical patient vignettes is that each physician reacts to a standardized situation. RESULTS: In the case of admitting a patient to or discharging a patient from the nursing home, results indicate that the continuity of care at those moments will be better ensured if GPs have more frequent personal contacts with NHPs. In the case of day care patients, the study also reveals that GPs who have frequent personal contact with NHPs will share relevant patient information significantly more often at the start of the day care program, both during day care and also when intercurrent medical problems occur. Similar findings can be expected in patients receiving outreaching nursing home care. CONCLUSIONS: The findings indicate the advantages of personal contacts between different medical professionals in exchanging specific patient information. It can be expected that this will lead to more tailor-made medical care for the patient. Adequate exchange of relevant information is an important aspect of mutual collaboration between professionals. Recommendations as to how to achieve more personal contact and a better collaboration among medical professionals are proposed.

Aged↗
PubMed2005

Canadian nurses' and respiratory therapists' perspectives on withdrawal of life support in the intensive care unit.

PURPOSE: To describe perspectives of nurses (RNs) and respiratory therapists (RTs) related to end-of-life care for critically ill patients. METHODS: For patients who had life support withdrawn in 4 Canadian university-affiliated ICUs, RNs and RTs reported their comfort level with decision making and process for 14 aspects of end-of-life care. RESULTS: Ninety-eight patients had life support withdrawn. Responses were received from 96 (98.0%) bedside RNs and 73 (74.5%) RTs. Most RNs (85/94, 90.4%) and RTs (50/73, 68.5%) were very comfortable with decisions to withhold cardiopulmonary resuscitation or to withdraw life support (83/94, 88.3% of RNs and 56/73, 76.7% of RTs). Most RNs (range 71.3%-80.65%) and RTs (60.0%-70.8%) were very comfortable with ventilation/oxygen withdrawal and sedation. Among paired responses for 72 (73.5%) of 98 patients, RTs rated less favorably than RNs ( P < .05): the quality of the physician explanation of the life support withdrawal process, the availability of the physician, the peacefulness of the dying process, and the amount of privacy for families. Suggested improvements included earlier and more inclusive discussions, clearer plans, and better preparation of families and the ICU team for patients' deaths. CONCLUSIONS: Most RNs and RTs were comfortable with decision making and the process of life support withdrawal, but they suggested several ways to improve end-of-life care.

Aged↗
PubMed2006

Ethnobotany and ethnopharmacology--interdisciplinary links with the historical sciences.

In this paper we use three disparate examples to highlight the relevance of historical methods in the context of ethnobotany and ethnopharmacology. Unfortunately, in ethnopharmacology we have only very few examples where such historical depth is possible. On the other hand the first hand data available through ethnopharmacological research, may be of relevance for interpreting historical information. Three distinct methods were used successfully in the retrospective exploration of diachronic data. In order to gain an insight into historical developments in the use of plant species and evolution of pharmacopoeias we used a botanico-historical approach (Rosmarinus officinalis), one that combines linguistic and statistical methods (Popoluca/Mixe), and one that uses historical documentary evidence (Ch'orti). We hope that this methodological discussion encourages a wider use of such historical methods in ethnopharmacology and related areas of research.

Ethnobotany↗
PubMedDate not supplied

Medical students' knowledge of midwifery practice after didactic and clinical exposure.

Information concerning the student outcomes of interdisciplinary education is limited. The purpose of this study was to identify the knowledge of third-year medical students regarding the practice of certified nurse-midwives (CNMs). A 1-page survey instrument was developed and pretested. The instrument was administered as a pre- and posttest at the beginning and end of 7 Obstetrics and Gynecology rotations at 2 medical school clinical campuses of a large Midwestern medical school. Direct interaction with CNMs improved knowledge of collaborative practice arrangements and roles. This was particularly evident in knowledge areas related to CNM prescriptive authority. The medical students who had direct experience with CNMs expressed more interest in working with them in the future than those who lacked the exposure. Collaborative, interdisciplinary education of medical students appeared to promote improved understanding of roles and capabilities.

Case-Control Studies↗
PubMed2005

Teaching behavioral pain management to healthcare professionals: a systematic review of research in training programs.

UNLABELLED: Pain is a common and potentially debilitating condition. Whereas there is vast literature on developmentally appropriate behavioral techniques for pain management, results of curriculum evaluations and knowledge surveys reveal a dearth of awareness of these strategies in healthcare professionals. As a result, the development and evaluation of pain management training programs are important endeavors. Results of studies evaluating such programs are promising and suggest that training might be an effective means of impacting healthcare professionals' knowledge, attitudes, and even patient care. These results must be interpreted with caution, however, because the literature contains several conceptual and methodologic limitations. These limitations, in combination with the wide diversity in program components, format of delivery, and research methods, preclude definitive conclusions on the most practical and effective means to provide training. To address this question, further systematic work on the development and evaluation of pain management training programs is warranted. PERSPECTIVE: To address the problems of dissemination of behavioral pain management techniques, the development and evaluation of pain management training programs are important endeavors. The current article presents a systematic review of studies evaluating such programs and provides recommendations for future systematic work in this area.

Behavioral Medicine↗
PubMed2005

Relationship between surgical volume and clinical outcome: should pediatric surgeons be doing pancreaticoduodenectomies?

BACKGROUND: The relationship between surgical volume and clinical outcome is well established in adult pancreatic surgery. We examined whether this relationship is applicable in pediatric surgery, given that very few cases are done regularly by pediatric surgeons even at tertiary centers. METHODS: A retrospective analysis of all patients who underwent pancreaticoduodenectomies between 1993 and 2003 was done. Comparisons were made to the largest recent series of pancreaticoduodenectomies in the adult literature. RESULTS: With the age at presentation from 9 to 17 years, 5 patients were identified. Mean operative time was 451 minutes with a median of 363 minutes compared with the mean and median in the adult literature of 420 minutes. Clean margins were obtained in all patients compared with 71% in adults. Mean follow-up was 35 months. All patients are alive, with 1 patient who has underwent subsequent resections for local recurrence. CONCLUSION: Although 5 consecutive cases of pancreaticoduodenectomies represent very low volume compared with high-volume adult centers, minimal difference in operative time, length of stay, and mortality (none) were observed in this series. Therefore, unlike adults, particular case volume in the pediatric population may not be a significant factor because of the nature of pancreatic pathology, patient characteristics, and hospital and surgical environment.

Adolescent↗