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At least 1,099 records · Page 61Linked to original sources
PubMed1981

The pain cocktail as an adjunctive agent in the treatment of spine pain patients.

A retrospective review of 20 spine pain patients hospitalized between May 1977 and May 1979, who received pain cocktails was performed to determine the effectiveness of this manner of decreasing pain medication requirements. The primary objective of the pain cocktail is to reduce or eliminate addiction, habituation, and pain medication consumption. The pharmacist is responsible for regulating dosages, performing the compounding, and writing the orders for the pain cocktails. Gradual medication adjustments, based on the patient's need and tolerance, are made. Medication was reduced in 19 of the 20 patients. Twelve patients who started on narcotic analgesics and six who started on pentazocine had a final medication reduction of 71 percent and 51 percent respectively. Five of the 12 patients receiving narcotic analgesics in their initial cocktail were tapered to acetaminophen at time of discharge. Results were favorable and indicate the pain cocktail as a beneficial treatment modality for selected spine pain patients.

Analgesics↗
PubMed2006

Navigating Medicare drug coverage: Part B vs. Part D.

One of the gray areas of Medicare Part D coverage is determining when a prescription falls under Part D and when it falls under Part B. Most Part B drug spending is for drugs billed by a physician and provided incident to the physician's services for a Medicare patient. Medicare Part D medications are dispensed via a prescription and are usually self-administered. Here are examples of situational rules that determine whether a patient is covered under Part B or Part D. Many situations exist where a particular drug for a specific patient is covered under both Part B and Part D, albeit with different delivery and cost-sharing aspects. Understanding which applies when is important to gaining access to medically necessary prescriptions for patients. Giving this information to the prescription plan when writing a prescription order will assure that the medication is provided efficiently, rather than having to deal with denials and an appeal process.

Insurance, Pharmaceutical Services↗
PubMedDate not supplied

The National EMS Research strategic plan.

One of the eight major recommendations put forth by the National EMS Research Agenda Implementation Project in 2002 was the development of an emergency medical services (EMS) research strategic plan. Using a modified Delphi technique along with a consensus conference approach, a strategic plan for EMS research was created. The plan includes recommendations for concentrating efforts by EMS researchers, policy makers, and funding resources with the ultimate goal of improving clinical outcomes. Clinical issues targeted for additional research efforts include evaluation and treatment of patients with asthma, acute cardiac ischemia, circulatory shock, major injury, pain, acute stroke, and traumatic brain injury. The plan calls for developing, evaluating, and validating improved measurement tools and techniques. Additional research to improve the education of EMS personnel as well as system design and operation is also suggested. Implementation of the EMS research strategic plan will improve both the delivery of services and the care of individuals who access the emergency medical system.

Emergency Medical Services↗
PubMedDate not supplied

Medical student attention to preventive medicine: change with time and reinforcement.

We followed medical students' attention to documentation in their write-ups of appropriate preventive medicine information, based upon a patient's age, sex, and existing medical conditions, as well as the translation of critical findings to the problem list, for three years. The proportion of relevant items documented was .50 in year one, .80 in year two, and .69 in year three. Significant differences (p less than .001) were found between all three years. Similarly, the proportion of important items translated to the problem list was .04 in year one, .22 in year two, and .18 in year three. There was significant improvement in years two and three as compared to year one (p less than .001). The impact of interventions designed to reinforce the medical student's attention to preventive medicine was also studied. Cued forms on which to record the patient's history were compared to written feedback regarding the student's write-ups. Both significantly improved student performance. The effect of the written feedback also persisted in the follow-up period.

Adult↗
PubMedDate not supplied

Mechanism for national distribution of delta 9-tetrahydrocannabinol (NSC-134454).

The National Cancer Institute (NCI) is initiating a national THC distribution program by applying to the FDA for its classification as a Group C investigational agent. Since THC is also a Schedule I drug, the distribution system requires strict adherence to Drug Enforcement Agency (DEA) security and safety regulations. Contrary to the usual distribution of Group C drugs, THC will not be available directly to physicians. THC will be made available to hospital pharmacies which are: (1) an NCI recognized Cancer Center (P-30 grant supported), (2) an NCI designated New Drug Study Group, (3) a member of the Council of Teaching Hospitals. Hospital pharmacies that are located in inadequately represented geographic areas when certain criteria are met by them will also be considered. Physicians desiring to prescribe THC need not have Schedule I registration, but should (1) have experience in cancer chemotherapy, (2) have a current DEA registration number, (3) agree to abide by the Guidelines for Use of THC, and (4) be registered with a participating pharmacy. A registered physician may prescribe THC by writing a Research Order for Medication on a usual prescription blank, including, in addition to normal required information, confirmation that patient consent has been obtained and the name of the hospital at which the physician is registered to prescribe THC.

Antineoplastic Agents↗
PubMed2004

Primary non-Hodgkin's lymphoma of the common bile duct presenting as obstructive jaundice.

Primary non-Hodgkin's lymphoma of the extrahepatic bile duct presenting as obstructive jaundice is an extremely rare disease. At this writing, a review of the medical literature disclosed 17 reported cases of primary non-Hodgkin's lymphoma arising from the extrahepatic bile duct. We, herein, report an additional case of obstructive jaundice caused by primary non-Hodgkin's lymphoma of the common bile duct, in a 21-year-old woman. Our patient showed clinical evidence of obstructive jaundice, and endoscopic retrograde cholangiopancreatography and abdominal magnetic resonance imaging demonstrated a long strictured segment of the common bile duct with proximal bile duct dilatation. These clinical and radiological findings resembled those of cholangiocarcinoma. Resection of the common bile duct tumor, cholecystectomy, lymph node dissection, and Roux-en-Y hepaticojejunostomy were carried out. Histology and immunohistochemistry of the resected specimen confirmed a diffuse large B-cell-type malignant lymphoma involving the common bile duct. She received four courses of combination chemotherapy, including cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), and 3060 cGy external irradiation. She has been well, without evidence of tumor recurrence, 17 months after the surgery. In summary, first, primary non-Hodgkin's lymphoma of the extrahepatic bile duct, despite its rarity, should be considered in the differential diagnosis of causes of obstructive jaundice. Second, an accurate histopathologic diagnosis and surgical resection, if feasible, combined with chemotherapy with or without radiotherapy may be the approach to offer a chance for cure.

Adult↗
PubMed1998

Experiences of administering and receiving therapeutic touch in intensive care.

This article describes the experiences of a practitioner who administered therapeutic touch (TT) to two patients in an intensive care unit and the experiences of the two patients who received TT. The experiences are presented as two case studies. Each of the patients presented in the case studies received either five or ten treatments of TT lasting five minutes each. Following each administration of TT the practitioner described what she sensed verbally and in writing. However, owing to the medical conditions of the patients, only brief interviews were conducted in which the patients were asked to describe their experiences of receiving TT. The experiences, which have been reflected in the case studies, indicate TT assists patients to relax, brings comfort and a sense of peace. Much like meditation, TT helps patients become more in touch with themselves. They come to understand more about themselves and reality. TT is recommended as a practice which could contribute to the psychological well-being of patients in intensive care as it promotes relaxation, comfort and a sense of peace.

Adult↗
PubMed2000

Towards a minimum dataset in urology.

OBJECTIVE: To establish and prospectively collect data for a minimum dataset in urology by agreeing a dataset amongst a group of urologists, designing structured forms around the data items and implementing them in clinical practice. METHODS: Consultant urologists decided the initial dataset. Structured forms, which incorporated the dataset items, were designed. These forms were piloted before implementation in two urology departments. They were used to document clinical information instead of writing this in the traditional medical record. After use forms were 'scanned' before being filed in the medical record, thus storing the data in an electronic format. RESULTS: Nine forms were designed; inpatient and outpatient activity was captured separately. There were six outpatient forms; a generic new patient form and five specific follow-up forms (lower urinary tract symptoms, oncology, erectile dysfunction, female urology and stones). Three generic inpatient forms were designed. The forms were used by nine registrars, five senior house officers and six clinical nurse practitioners, who required minimal training. CONCLUSION: It is possible to agree a minimum dataset amongst a relatively small group of urologists. The information can be acquired prospectively using structured forms instead of the traditional medical record. This locally agreed dataset could form the basis for a national consensus on a minimum dataset in urology.

Data Collection↗
PubMed1996

Attitudes of Oregon psychiatrists toward physician-assisted suicide.

OBJECTIVE: After passage, in November 1994, of Oregon's ballot measure legalizing physician-assisted suicide for terminally ill persons, the authors surveyed psychiatrists in Oregon to determine their attitudes toward assisted suicide, the factors influencing these attitudes, and how they might both respond to and follow up a request by a primary care physician to evaluate a terminally ill patient desiring assisted suicide. METHOD: An anonymous questionnaire was sent to all 418 Oregon psychiatrists. RESULTS: Seventy-seven percent of psychiatrists (N = 321) returned the questionnaire. Two-thirds endorsed the view that a physician should be permitted, under some circumstances, to write a prescription for a medication whose sole purpose would be to allow a patient to end his or her life. One-third endorsed the view that this practice should never be permitted. Over half favored Oregon's assisted suicide initiative becoming law. Psychiatrists' position on legalization of assisted suicide influenced the likelihood that they would agree to evaluate patients requesting assisted suicide and how they would follow up an evaluation of a competent patient desiring assisted suicide. Only 6% of psychiatrists were very confident that in a single evaluation they could adequately assess whether a psychiatric disorder was impairing the judgment of a patient requesting assisted suicide. CONCLUSIONS: Psychiatrists in Oregon are divided in their belief about the ethical permissibility of assisted suicide, and their moral beliefs influence how they might evaluate a patient requesting assisted suicide, should this practice be legalized. Psychiatrists' confidence in their ability to determine whether a psychiatric disorder such as depression was impairing the judgment of a patient requesting assisted suicide was low.

Attitude of Health Personnel↗
PubMed2003

Who was Akilaos? A problem in medical historiography.

In the years before the conquest of Alexandria by the Arabs in 642, Alexandrian scholars produced compendia, summaries, and commentaries on Galen's writings and other works in the Hippocratic medical tradition. This paper concerns the identities of those Alexandrian commentators-two in particular, whose names are reported in Arabic texts, but about whom little else is known-and the routes by which Galenic medicine was transmitted to other parts of the Mediterranean world after Alexandria's fall. We review debates over the identity of "Akilaos" and "Anqilaos," and argue that "Akilaos" is not merely a scribal duplication, as some have supposed. Instead, we suggest a connection with the city of Aquileia in northern Italy, as a source for the name "Akilaos" and as a route by which Alexandrian medical texts reached northern Italy (where their Latin versions subsequently were associated with a "Ravenna school" of medicine).

Egypt, Ancient↗
PubMed2000

Readability of published dental educational materials.

BACKGROUND: A growing number of adult Americans are functionally illiterate. These people often do not understand educational documents written by health care professionals, especially if English is the reader's second language. This problem has received little attention in dentistry. METHODS: In this study, the author selected a sampling of 24 patient educational documents from several dental resources and reviewed them for readability, using a computer-based program that assigns a reading level of understanding on the basis of a standard formula known as the Flesch-Kincaid Formula. The author also conducted a subjective review of each document to identify seemingly unnecessary professional jargon and words that were unlikely to be understood by many readers. RESULTS: Reading levels varied from third to 23rd grade (according to the Flesch-Kincaid Formula), and 41.7 percent of the materials were written at greater than the recommended level for understanding by most patients (mean level: seventh to ninth grade). Many dental specialty publications were written at or near college levels. Many documents had multiple grammatical errors. Seventy-nine words in the reviewed documents were considered to be jargon or potentially obscure to many lay readers. CONCLUSIONS: More attention needs to be focused on the preparation of written educational materials for dental patients, to make the documents more understandable to the average patient. Guidelines for acceptable writing are available in the medical, nursing and pharmaceutical literature.

Adult↗
PubMed1980

Family practitioners: justice for GPs and patients.

The Family Practitioner Committee has a broad ombudsman function, writes Judy Allsop, a former medical service committee lay member and senior lecturer in social policy, Polytechnic of the South Bank. She discusses the way PFCs deal with complaints against GPs and highlights some of the problems faced by complainants and the medical service committees.

Contract Services↗
PubMed2000

Roundway, Wiltshire County Asylum attendants and nurses, 1881-1905: a window onto Victorian sobriety.

The only detailed surving Male and Female Registers of Roundway provide a rich documentary glimpse of nineteenth century mental health care staff. An analysis is made of what constituted desirable behavior and problems occurring in the workplace. More primary source material has been gathered from visitors books, medical superintendents' reports, patient case records, admission/discharge registers and account books. An attempt will be made to show how the dominant characteristics of Victorianism shaped the lives of the staff. Religion, morality and personal qualities appear more influential than scientific inquiry in determining the pattern of events. The 'Asylum for the Pauper Insane of the County of Wiltshire' later came to be called 'Roundway Hospital'. It is commonly remembered as 'Roundway' and that is how it is referred to here. The nursing staff changed their titles in minor ways during the period considered, but for convenience the dominant titles - 'attendants' for men and 'nurses' for women - are used. The period chosen, 1881-1905, begins from when Dr John Bowes was appointed Medical Superintendent and started to write in the new Staff Registers. The period finishes when he ceased to make entries. There are no detailed registers for any other nineteenth century period.

England↗
PubMed2005

Medical miracles and the longue durée.

The hematologist-historian author became interested in the nature 'medical miracles', following a request to write a report on a set of bone marrows that was sent to the Vatican as a possible miracle cure in a cause for canonization. She questioned the prevalence of medical miracles, their structure, and relationship to other 'official' miracles that are recognized by the Church. Evidence was drawn from a variety of sources: oral testimony of pilgrims at feast day celebrations, ex voto paintings, and 160 miracle files in 67 canonization records of the Vatican Archives. Some changes can be detected through time, but the results also testify to remarkable longue durée in the healing experience: the patterns of suffering and despair, the gestures of pleading, the presence of beds and dreams, the astonishment of the caregivers, and above all the simultaneous recourse to medicine and religion both.

Catholicism↗
PubMed2006

[A peculiar speech disorder due to bomb injury of the brain].

Oslo was bombed by British bombers 6 September 1941, and a 28-year-old woman was hit on the head by a bomb fragment. She was seriously wounded with a large defect in the cranium frontally on the left side, and it was believed that she was not going to survive. She was unconscious for 3-4 days, and when she woke up she had right-sided hemiplegia and complete aphasia. She gradually recovered, and two months later she was discharged from hospital. Remarkably, the brain damage had altered her melody of language, and she spoke with a German-like accent. This led to problems for her during the war: she was for example not served in shops. The case story was published after the war by the Norwegian neurologist Georg Herman Monrad-Krohn (1884-1964), and it is the best known case of the so-called foreign accent syndrome. In this paper, this rare syndrome is presented, emphasising Monrad-Krohn's patient and based on his writings and the patient's medical record.

Adult↗
PubMed1991

Handling the pressure on an offshore rig.

The chief instigator of offshore stress is time which in oil parlance is money, writes Patrick Whyte, an offshore medical officer. He explains that medical personnel by showing that they practice a healthy lifestyle on the offshore oil rigs can set a practical example of coping with the stressful conditions.

Adaptation, Psychological↗
PubMed1995

BibleCard: network-based virtual database for laboratory information.

The clinical laboratory's use of computers has evolved beyond the single minicomputer stand-alone system. Our laboratory information system is now part of an institutional network. The laboratory also uses smaller systems and workstations for a wide variety of functions, often with much data duplication among systems. We have been developing a network-based virtual database for laboratory test information. This system uses World Wide Web standards for hypertext and multimedia displays, which allows for the display of information retrieved from various department computer sources without the necessity of data duplication, modification of existing systems, or centralization of data. The medical technologists can continue to write testing procedures on their word processors. Maintenance of reference values, specimen requirements, etc., can continue as a laboratory information system function. Yet information from all of these disparate sources can be viewed in a consolidated format that has platform independence.

Chemistry, Clinical↗