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PubMed1999

[Experience with an "isolation unit" for patients infected with multi-resistant bacteria. Retrospective study of 49 patients].

OBJECTIVES: Perform a retrospective analysis of care in a hospital "isolation unit" for patients infected with multirestant bacteria (MRB), i.e. meticillin-resistant staphylococcus aureus (SAMR), broad spectrum beta-lactamase secreting enterobacteria. (BLSE). PATIENTS AND METHODS: Forty-nine patients infected with MRB were cared for in our hospital isolation unit between January 1, 1996 and January 1, 1997. Each patient was in a separate room equipped with a sink and soap distributor, single-use towels, and individual material for patient care (stethoscope, mobile equipment, writing material, etc.). The personnel were given special training in the prevention of nosocomial infections. At admission, and in all patients, bacteriological samples to search for SAMR were acquired from nasal discharge, urine, perineal swabs, wounds and bed sores. Wound, urine and fecal samples were also taken to search for BLSE. Search for other sites of infection depended on the clinical situation. The management protocol in the isolation unit included: isolation, daily antiseptic baths, topical application of antibiotics or antiseptics on all bacteriologically proven sites of SAMR infection, selective decontamination of the digestive tract for patients with BLSE positive stools. Systemic antibiotics were given case by case. RESULTS: Mean duration of stay in the isolation unit was 17 days for SAMR infections and 14 days for BLSE infections. Mean delay to sterilization of the infected sites varied depending on the localization: 2.3 days for blood and 19.4 days for stools. Seven patients died. After leaving the isolation unit, the bacteriological course was followed in 23 patients: there were 7 cases of recurrence at least one site within a mean delay of 34.5 days. CONCLUSION: Use of isolation units provides an interesting solution for health care centers to control spread of multiresistant bacteria. Considering the endemic state of multiresistant bacteria infections in French hospitals, each health care unit should have correctly equipped facilities for isolating infected patients.

Drug Resistance, Microbial↗
PubMed2000

Home visits to the housebound patient in family practice: a multicenter study. Israeli General Practice Research Network.

BACKGROUND: Most countries today are experiencing an accelerated pace of population aging. The management of the elderly housebound patient presents a special challenge to the family physician. OBJECTIVES: To investigate a series of home visits to housebound patients, the therapeutic procedures used, the equipment needed, and the diagnostic conclusions reached. METHODS: The details of 379 consecutive home visits to housebound patients were recorded by 91 family doctors serving 125,000 patients in Israel. RESULTS: The average age of the patients was 76.1 years. The vast majority of the visits were during office hours (94%). In 24.1% it was the doctor who decided to make the home visit on his/her own initiative. The most common initial reason for a home visit was undefined general symptoms, but the doctor was usually able to arrive at a more specific diagnosis after the visit. Medications were prescribed in 59.1% of the visits, and in 23.5% the medication was administered directly by the physician. The commonest drugs used were analgesics and antibiotics. In 19.3% of visits no action at all, other than examination and counseling, was undertaken. The equipment needed included prescription pads (73%), a stethoscope (81%), sphygmomanometer (74.9%), and otoscope/torch (30.6%). Only 15% of visits resulted in referral to hospital. CONCLUSIONS: Home visits to housebound patients serve as a support to caregivers, provide diagnostic information, and help the family with the decision as to when hospitalization is appropriate. The specific medical cause for the patient being housebound had little effect on the process of home visiting.

Aged↗
PubMed1999

Bilateral sound propagation characteristics in electronic TMJ sound recording.

Temporomandibular Joint (TMJ) sounds, clicking and crepitation, are important signs of possible TM disorder or dysfunction (TMD). The sound are usually recorded and observed by stethoscope auscultation or palpation. Sound from one TMJ may propagate through head tissues and be recorded on the contra lateral side misleading the examiner to classify both joints as non-silent. Errors in localization of sound source may lead to an erroneous diagnosis. Widmalm et al. (1997) suggested a mathematical model for estimation of the sound propagation characteristics through the head tissues. A modified model applying the auto-spectral density and cross-spectral density of the signal was used to estimate the bilateral sound propagation characteristics of temporomandibular joint sounds from two subjects. The result indicates that the head tissues act as a bandpass filter causing strong attenuation in some frequency areas with little attenuation in others. The phase response of the transfer function provides a good mean to estimate the latency in time between sounds.

Humans↗
PubMed2001

[The physician's bag and emergency case. What should be in it?].

The contents of the doctor's bag will be determined by the doctor concerned and will depend on his medical training and specialization, on local conditions, the nature of his field of activity, and on the organization of medical emergency services. A selection of commonly employed preparations, classified by indication is proposed and discussed. In addition to the "drug collection", the essential "hardware" (syringes, stethoscope, etc.) and "software" (prescription forms, accounting forms, list of hospital telephone numbers, etc.) are also listed. The specific demands to be met by the contents of an emergency kit are discussed separately.

Emergency Treatment↗
PubMed2001

[Quality of blood pressure measurement in the management of arterial hypertension. Pilot study].

UNLABELLED: In clinical practice, diagnosis and follow-up of hypertension is based on blood pressure (BP) as measured by auscultatory method. BP is usually measured using a stethoscope to auscultate the Korotkoff sounds and mercury or an aneroid sphygmomanometer. However due to the lack of regulatory rules, the devices are rarely checked making the quality of the measures doubtful. OBJECTIVE: To compare BP measured following the WHO recommendations, using 2 different devices: the mercury or aneroid sphygmomanometer used by the physician and a SECURUS manometer that has been calibrated just before the implementation of the study. METHOD: The study was performed with 1694 French general practitioners. Every physician included 2 ambulatory patients: a newly diagnosed non-treated hypertensive patient and a treated hypertensive patient. The physician was asked to include the first patient of each category attending his office. BP was measured sequentially with the 2 devices in a random order. Collected data were socio-demographic parameters, cardiovascular risk factors, hypertension related diseases, drug treatment for hypertension and BP levels. RESULTS: Mean BPs differ by less than 1 mmHg between the 2 devices. However 10% of the treated hypertensive patients are not classified as having normalised BP values (BP < 140/90 mmHg) or high BP values, in the same way by the 2 devices. Mean absolute difference between the 2 devices is > 5 mmHg in 22% and 13% of the physicians for SBP and DBP respectively. CONCLUSION: This pilot study emphasises the need of BP measurements of good quality in clinical practice, because of the possible impact on the care of the patients and the related costs. Regulatory rules on the control of the devices might improve the quality of BP measurements.

Aged↗
PubMed1993

[Wooden chests for the midwife's equipment].

In the museum of medical history in Lund there are several wooden chests containing partly identical instruments apparently belonging to a midwife. The instruments dated from before 1900, e.g. lancets and horn cups for blood-letting, a pewter enema syringe, a wooden stethoscope, a "tobacco pipe" and glass bottles. The use of the tobacco pipe was first puzzling, but it appeared to be a breast reliver. What do we know about the date of the chests? One chest has belonged to Kjersti Nilsdotter, a midwife educated in Lund 1872-1873. Her certificate was in the chest. From Ronnie Hunt, Minnesota we have got information about another chest of the same type. That belonged to Nelly Gustafsson, a midwife educated in Lund probably about 1870. She emigrated to USA and was a practising midwife in Lindstrom, Minnesota from about 1900.

Durable Medical Equipment↗
PubMed2000

The effect of nitrous oxide on laryngeal mask cuff pressure.

During general anesthesia with the laryngeal mask airway (LMA), a significant increase in cuff pressure due to diffusion of nitrous oxide through the cuff wall occurs. This descriptive clinical study was conducted in a university teaching hospital ambulatory surgical center with 100 patients (ASA physical status, I-III; age, 5 months to 76 years; weight, 5.8-146.3 kg) undergoing general anesthesia with an LMA. The airway pressure at which the LMA seal was broken (leak pressure) was determined immediately after the insertion of the LMA. The LMA leak pressure was determined by closing the circuit pop-off valve and recording with a stethoscope at the neck the pressure at which the gas was first heard to escape around the LMA. The LMA cuff pressure was determined by connecting the check valve of the LMA pilot balloon to a sphygmomanometer. The mean LMA cuff pressure increased 16 +/- 8.2 mm Hg (1- to 30-minute group), 38.11 +/- 15.87 mm Hg (31- to 60-minute group), 39.53 +/- 16.9 mm Hg (61- to 90-minute group), 42.63 +/- 20.36 mm Hg (91- to 120-minute group), and 44.25 +/- 14.03 mm Hg (120- to 350-minute group). This study demonstrated that there was a gradual increase in the cuff pressure well over a 3-hour period during nitrous oxide and oxygen anesthesia.

Adolescent↗
PubMed2001

Combined Doppler, blood gas, and Bennet quick test for venous leak practical for prepenile prosthesis testing in solo private offices.

Cavernosal blood gases have been widely reported but have not become routine in private practice. The method reported here employs the aspiration of blood gases 15 minutes after pharmacologic challenge followed by a quick test for venous leak followed by Doppler stethoscope observations. The results in 90 patients suggest its selective use in the subset of nonresponding, nonleakers who have open cavernous arteries by Doppler, typically diabetics.

Blood Gas Analysis↗
PubMed1975

A simple method for obtaining blood pressure in rhesus monkeys (Macaca mulatta).

A relatively simple procedure was devised to obtain blood pressures in rhesus monkeys. This procedure utilized a polygraph, pulse transducer, pressure transducer, blood pressure mixer unit, and pediatric sphygmomanometer cuff. Previous attempts to auscultate the Korotkoff sounds by use of a sphygmomanometer cuff and stethoscope were unsuccessful. Blood pressure can be obtained by cannulation of the femoral artery, but repeated puncture may cause serious trauma to the arterial wall. This procedure was developed and used in our laboratory to obtain repeated blood pressures over a 90-da period. Results from using the cuff and polygraph have been shown to correlate favorably with cannulation of the femoral artery.

Animals↗
PubMed2002

The effect of occlusal relationships on the occurrence of sounds in the temporomandibular joint.

The aim of this investigation was to determine the influence of occlusal relationships on the occurrence of sounds in the temporomandibular joint. A group of 100 male subjects aged 24-52 years (X = 35.03+/-6.92) was examined. Analysis of occlusion included determination of the number of existing teeth, number of teeth in occlusion, overbite and overjet, type of occlusion, mediotrusion interferences, relationship of the retruded contact position (RCP) to intercuspal position (ICP), and the amount and direction of sliding from RCP to ICP. Sound was registered by means of a stethoscope and classified according to its character in click or crepitation. Sound was present in 29% of subjects. In 28% of cases it was registered as click and in 2% of cases as crepitation. One subject had simultaneous click and crepitation. The results of the statistical analysis indicate that overbite, type of occlusion, existence of mediotrusion interferences, the relationship of RCP to ICP, and the amount and direction of sliding from RCP to ICP do not have an influence on the occurrence of sounds. The risk of the occurrence of crepitation is significantly increased in the case of the loss of more than 5 teeth, and in the case of horizontal overbite larger than 7.5 mm (p<0.05).

Adult↗
PubMed2002

[Validation of a French translation of the Edinburgh claudication questionnaire among general practitioners' patients].

OBJECTIVES: Intermittent claudication is one of the clinical symptoms of peripheral arterial disease (PAD). The presence of PAD is a high risk marker of cardiac events and stroke. The PAD screening can be enhanced by the use of questionnaires. The Edinburgh Questionnaire presents in its English version better diagnostic performances compared to the Rose (WHO) Questionnaire. The aim of this study is to precise the performances of the French version of the Edinburgh Questionnaire among a population consulting general practitioners. METHODS: Four centers instructed 10 general practitioners each to the measurement of ankle pressure with a Doppler stethoscope. The physicians administrated the Questionnaire to 10 consecutive consultants in a same day, and measured the pressure on posterior tibial, dorsalis pedis and humeral arteries. With a second questionnaire they collected data concerning age, weight, height, and the presence of major risk factors. The same protocol was repeated a second day on new patients. The diagnosis of PAD was based on an ankle-arm index lower than 0.85 for at least on limb. RESULTS: The population studied consisted of 727 subjects (351 females and 376 males). The mean age was at 58.3 +/- 16.1 years (ranging from 18 to 83.3 years). The sensitivity of the Questionnaire is at 47% (95% CI: 32.3-61.7%), the specificity at 98.8% (95% CI: 97.5-99.4%), the positive and negative predictive values are respectively at 73.3% (95% CI: 54.1-87.7%) and 94.8% (95% CI: 94.7-97.6%). Among this population of general practitioners consultants, the prevalence of a low ankle-arm index under 0.85 is at 6.7%. DISCUSSION: The French version of the Edinburgh Questionnaire maintains the very good specificity of the English version. The lower sensitivity could be explained by the choice of the gold standard, namely the ankle-arm index which includes asymptomatic patients with authentic PAD. The use of this Questionnaire can be recommended for the screening of this disease as well as in epidemiological studies.

Adolescent↗
PubMed2002

[New Hebrew medical terms--what is their fate?].

The process of the Hebrew language revival, which is taking place more than a 100 years, necessitates the invention of new words. The medical field is not an exception. Certain new invented words are accepted and used routinely in hospital corridors while other words are rejected. Recently the Israel Academy for the Hebrew Language suggested new Hebrew words for two medical terms ('stethoscope' and 'stajer'). These new terms allow us to discuss possible reasons that a certain word is accepted and spoken in daily life while another is rejected and forgotten.

Israel↗
PubMed2002

Hand-held computers in healthcare: what software programs are available?

The technology sector of healthcare is entering a new evolutionary phase. The medical community has an obligation to the public to provide the safest, most effective healthcare possible. This is more achievable with the use of computer technology at the point of care, and small, portable devices could fulfil this role. A PriceWaterhouse Coopers 2001 survey on information technology in physician practices found that 60% of respondents say that physicians in their organisation use personal digital assistants (PDAs), compared with 26% in the 2000 technology survey. This trend is expected to continue to the point where these devices will have their position on a physician s desk next to the stethoscope. Once this electronic evolution occurs, doctors will be able to practice medicine with greater ease and safety. In our opinion, the new generation of PDA mobile devices will be the tools to enable a transformation of healthcare to a paperless, wireless world. This article focuses on uses of PDAs in healthcare, whether by the registrar, consultant, nurse, student, teacher, patient, medical or surgical director. Current PDA healthcare software is categorised and discussed in the following five groups: 1) reference/text book; 2) calculator; 3) patient management/logbook; 4) personal clinical/study notebook; 5) utility software.

Computer-Assisted Instruction↗
PubMed2003

The 'swoosh' test--an evaluation of a modified 'whoosh' test in children.

BACKGROUND: Caudal analgesia is widely used in paediatric anaesthetic practice. In adults, the 'whoosh' test has been recommended as a guide to successful needle insertion, but it has not been extensively studied in paediatric patients. We have investigated a modification of the 'whoosh' test, which we have christened the 'swoosh' test. It avoids the injection of air by performing auscultation during injection of the local anaesthetic solution. We have compared it with clinical judgement of correct placement. METHODS: We studied 113 children undergoing elective surgery. During insertion of the caudal block, a stethoscope was placed over the lower lumbar spine and the presence or absence of an audible 'swoosh' noted. The operator's clinical impression of successful insertion was also recorded. RESULTS: The overall success rate of caudal anaesthesia was 95.6%. Of the 108 patients with a successful block, 98 had a positive 'swoosh' test. There were no false positive results. Calculations show the 'swoosh' test to have a sensitivity of 91%, a specificity of 100% and a positive predictive value of 100%. CONCLUSIONS: The 'swoosh' test is a simple and accurate test to confirm successful caudal insertion in children, and is especially useful as a teaching aid for anaesthetists new to the technique.

Adolescent↗
PubMed2002

[The development and clinical application of acoustic diagnostic technique in hip joint].

This study aimed to develop a non-invasive diagnostic technique for the measurement of acoustic transmission in hip joints to reflect the dynamic response of the observed structure. This instrument consists of three sub-systems. An stimulation system applied a vibratory force at the sacrum of the test subject. A transduction system included a pair of identical microphones was installed in the tubes of two stethoscopes, which were placed at the greater trochanters on both sides for picking up the acoustic signals transmitting across the hip joints. The data acquisition and analysis system was a portable frequency analyser with a program of dual channel digital filter for measuring the power of acoustic signals in 1/3-octoscn frequency bands. Twenty-seven normal adults, 20 normal pre-school children and 40 normal neonates were recruited for the testing. Coherence function (CF) of the signal and the discrepancy (D) of bilateral hips were measured during the testing. The results from the three groups showed that there was a high coherence of the signals (CF > 0.9) and a small discrepancy (D < 3 dB) between bilateral hips in the frequency range of 200-315 Hz. For normal neonates, the frequency range (160-315 Hz) was wider in which the acoustic signals maintained a high coherence (CF > 0.94) and a smaller discrepancy (D < 2 dB) were observed between bilateral hips. This study has shown that the development of the acoustical diagnostic technique could provide a practical method with objective parameters. The results obtained in this study can offer a base for further investigation of hip disorders, particularly those related to structural abnormalities of hip joints.

Acoustic Stimulation↗
PubMed2003

Distribution of craniomandibular disorders, occlusal factors and oral parafunctions in a paediatric population.

AIM: The aim of this work was to gather clinical data on craniomandibular (CMD)/temporomandibular joint (TMJ) disorders in a paediatric population. METHODS: The clinical study population comprised patients with TMJ disorders who were being treated in the orthognathic ambulatory clinic of the University of Naples, where an instrumental and clinical study was performed. Data were recorded for extra and intraoral findings, Angles classification and malocclusions. Radiographic examinations were carried out. Study models were fabricated for evaluation. TMJs were assessed by palpation as well as masseter, temporal, suprahyoid, sternocleidomastoid, suboccipital, paravertebral and trapezius muscles to evaluate any possible pain. Auscultation of the TMJ was used to determine presence of articular sounds and their type (cracks, crunches, clicks) by the use of a stethoscope. Pain localisation was evaluated according to these movements taking into account site, intensity, frequency, and duration. Episodes of headache were recorded according to its intensity (mild, moderate, intense), frequency (daily, weekly, monthly), site (top of the head, occiput, temple, frontal, overorbital region, back of the head) and the duration of the episodes (in minutes, hours or whether constant). RESULTS: A substantial number of the 106 patients included in the study showed a malocclusion with prevalence in Angles Class II cases. Bruxism, onychophagy, TMJ pain, headache, mouth opening partial inability, mastication difficulty and articular sound were the most representative symptoms. CONCLUSION: The identification and recognition of factors, such as malocclusions and parafunctions, are considered fundamental to early diagnosis of TMJ problems, which is the most useful way to avoid a dysfunctional state of the stomatognathic system.

Adolescent↗
PubMed2003

[Respiratory syncytial virus infections in children in general practice].

INTRODUCTION: The aim of the study was to describe the course of respiratory syncytial virus (RSV) infections in children under two years of age seen in general practice. MATERIAL AND METHODS: Children under two years of age presenting acute respiratory infection during the registration period on 59 GPs' lists participated in the study. The GPs recorded data on a registration chart and a questionnaire was sent to the parents of the children in question one month after the date of inclusion. The children were tested in general practice for the presence of RSV. The GPs' objective findings and choice of treatment as well as the parents' account of the course of disease were compared in children with and without the presence of RSV. A total of 221 children participated in the study. RESULTS: Fifty-seven children were found RSV positive (25.8%). Among the RSV positive children there were significantly more with wheezing audibly detected with examination by stethoscope than among the RSV negative. The remaining parameters (the GP's objective examination, treatment and course of the disease) were distributed independently of the result of the RSV analysis. DISCUSSION: The results showed that RSV infections in children under two years in general practice are frequent and that the clinical picture most often is uncomplicated.

Family Practice↗
PubMedDate not supplied

The impact of Internet access on nursing practice.

Currently, according to Richards (2001), nurses are unsophisticated in informatics potential. The majority of practicing nurses are limited in their exposure to and competence with computer technology. Richards stated. "Such a deficiency is juxtaposed against the fact that young nurses entering the profession have grown up surrounded by technology, assimilating it as easily as the air they breathe" (p. 6). The new generation of nurses can greatly influence the art and science of nursing during this massive communications revolution. These "Net nurses" will view technology in the same light as contemporary nurses do their stethoscopes, creating a nursing culture that embraces technology and advances the profession in ways that Florence Nightingale could never have imagined.

Computer User Training↗