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At least 1,117 records · Page 62Linked to original sources
PubMed2005

Pain and anxiety during interventional radiologic procedures: effect of patients' state anxiety at baseline and modulation by nonpharmacologic analgesia adjuncts.

PURPOSE: To assess how patients' underlying anxiety affects their experience of distress, use of resources, and responsiveness toward nonpharmacologic analgesia adjunct therapies during invasive procedures. MATERIALS AND METHODS: Two hundred thirty-six patients undergoing vascular and renal interventions, who had been randomized to receive during standard care treatment, structured empathic attention, or self-hypnotic relaxation, were divided into two groups: those with low state anxiety scores on the State-Trait Anxiety Inventory (STAI, scores < 43; n = 116) and those with high state anxiety scores (> or = 43; n = 120). All had access to patient-controlled analgesia with fentanyl and midazolam. Every 15 minutes during the procedure, patients rated their anxiety and pain on a scale of 0-10 (0, no pain/anxiety at all; 10, worst possible pain/anxiety). Effects were assessed by analysis of variance and repeated-measures analysis. RESULTS: Patients with high state anxiety levels required significantly greater procedure time and medication. Empathic attention as well as hypnosis treatment reduced procedure time and medication use for all patients. These nonpharmacologic analgesia adjunct treatments also provided significantly better pain control than standard care for patients with low anxiety levels. Anxiety decreased over the time of the procedure; patients with high state anxiety levels experienced the most significant decreases in anxiety with nonpharmacologic adjuncts whereas patients with low state anxiety levels coped relatively well under all conditions. CONCLUSION: Patients' state anxiety level is a predictor of trends in procedural pain and anxiety, need for medication, and procedure duration. Low and high state anxiety groups profit from the use of nonpharmacologic analgesia adjuncts but those with high state anxiety levels have the most to gain.

Adaptation, Psychological↗
PubMed2006

Pulmonary artery pressure changes during ethanol embolization procedures to treat vascular malformations: can cardiovascular collapse be predicted?

PURPOSE: Ethanol has been used for embolization of vascular malformations. Cardiovascular collapse, although rare, has been reported, occurring immediately to a few hours after ethanol embolization. The pathophysiology has been theoretically attributed to direct toxicity to the cardiac conduction system or pulmonary artery (PA) vasospasm leading to cardiovascular collapse. Because of cardiovascular collapse in one patient at the authors' institution, it was standard of care at the time of this study to monitor the pulmonary artery pressures during ethanol embolization. This study was conducted to clarify the effect of ethanol on the PA pressure during these procedures. METHODS: Data from 92 ethanol embolization procedures performed on 56 patients with vascular malformations between May 2001 and May 2003 are reported. PA and noninvasive cuff systemic pressures were recorded before and after each injection and also before and after the entire procedure. Upper limit for volume of ethanol used during these procedures was drawn at 1 mL/kg. Simple and multiple linear regression analyses were done to study factors affecting changes in PA and systemic blood pressure. RESULTS: For each injection, ethanol volume averaged 3.1 mL per injection. The systolic systemic and PA systolic pressures increased by 2.3 and 1.0 mm Hg, respectively. Amount of ethanol injected and systemic blood pressure changes were predictive of change in PA blood pressure. During the entire procedure, systemic systolic blood pressure increased by an average of 11.6 mm Hg, and PA systolic blood pressure by 5 mm Hg. Change in systemic blood pressure was a strong predictor of, and volume of ethanol was a weak predictor of, change in PA blood pressure. CONCLUSION: The mild rise in PA blood pressure in the patients during ethanol embolization correlated strongly with minor elevation in systemic blood pressure throughout the procedure, which the authors believe is related to pain from the ethanol injection causing sympathetic stimulation, even when patients are under general anesthesia. The minimal rise in PA blood pressure during these procedures does not elucidate the cause of the rare complication of cardiovascular collapse during ethanol embolization.

Adolescent↗
PubMed2006

Occupational radiation exposure from fluoroscopically guided percutaneous transhepatic biliary procedures.

PURPOSE: The aim of this study was to determine occupational dose levels for projections commonly used in fluoroscopically guided percutaneous transhepatic biliary (PTB) drainage and stent placement procedures. METHODS: Exposure data from 71 consecutive PTB examinations were analyzed to determine average examination parameters for biliary drainage and stent placement procedures. An anthropomorphic phantom was exposed at three projections common in PTB interventions according to the actual geometric parameters recorded in the patient study. Scattered air-kerma dose rates were measured for neck, waist, and gonad levels at various sites in the interventional radiology laboratory. To produce technique- and instrumentation-independent data, dose rate values were converted to dose-area product (DAP)-normalized air-kerma values. In addition, sets of thermoluminescent dosimetry crystals were placed in both hands of the interventional radiologist to monitor doses during all PTB procedures. RESULTS: Isodose maps of DAP-normalized air-kerma doses in the interventional laboratory for projections commonly used in PTB procedures are presented. To facilitate effective dose estimation, normalized dosimetric data at the interventional radiologist's position are presented for left and right access drainage procedures, metallic stent placement only, and drainage and metallic stent placement in one-session procedures with and without under-couch shielding. Doses to the hands of interventional radiologists are presented for left and right transhepatic biliary access and metallic stent placement. CONCLUSIONS: Body level-specific normalized air-kerma distributions from commonly used projections in PTB procedures may be useful to accurately quantify dose, maximum workloads, and possible radiogenic risks delivered to medical personnel working in the interventional radiology laboratory. Normalized dose data presented will enable occupational exposure estimation from other institutions.

Aged↗
PubMed1998

Multiple comparison procedures updated.

1. A common statistical flaw in articles submitted to or published in biomedical research journals is to test multiple null hypotheses that originate from the results of a single experiment without correcting for the inflated risk of type 1 error (false positive statistical inference) that results from this. Multiple comparison procedures (MCP) are designed to minimize this risk. The present review focuses on pairwise contrasts, the most common sort of multiple comparisons made by biomedical investigators. 2. In an earlier review a variety of MCP were described and evaluated. It was concluded that an effective MCP should control the risk of family-wise type 1 error, so as to ensure that not more than one hypothesis within a single family is falsely rejected. One-step procedures based on the Bonferroni or Sidák inequalities do this. For continuous data and under normal distribution theory, so does the Tukey-Kramer procedure for all possible pairwise contrasts of means and the Dunnett procedure for all possible pairwise contrasts of means with a control mean. 3. There is now a new class of MCP, based on the Bonferroni or Sidák inequalities but performed in a step-wise fashion. The members of this class have certain desirable properties. They: (i) control the family-wise type 1 error rate as effectively as the one-step procedures; (ii) are more powerful than the one-step Bonferroni or Sidák procedures, especially when hypotheses are logically related; and (iii) can be applied not only to continuous data but also to ordinal or categorical data. 4. Of the new step-wise MCP, Holm's step-down procedures are commended for their combination of accuracy, power and versatility. They also have the virtue of simplicity. Given the raw P values that result from conventional tests of significance, the adjustments for multiple comparisons can be made by hand or hand-held calculator. 5. Despite the corrective abilities of the new step-wise MCP, investigators should try to design their experiments and analyses to test a single, global hypothesis rather than multiple ones.

Analysis of Variance↗
PubMed2004

Efficiency of obliteration procedures in the surgical treatment of hydatid cyst of the liver.

BACKGROUND: Hydatid cyst of the liver (HCL) is a parasitic infestation caused by several species of Echinococcus and is endemic in many sheep-raising areas. The aim of the present study is to evaluate the value of clinical, physical and laboratory findings and to discuss the diagnostic and therapeutic options in 250 patients with HCL. METHODS: Between January 1980 and December 1989, 148 patients with HCL were treated surgically, and surgical procedures performed were evaluated retrospectively. On the basis of these findings, a prospective study of 102 patients was initiated between January 1990 and December 1999. RESULTS: External drainage was performed in retrospective and prospective groups, respectively, in 110 and five patients, obliteration procedures in 31 and 82 and resectional procedures in seven and 15. While mean hospitalization time morbidity, mortality and recurrence rates were 16.2 +/- 6.9 days, 37.8%, 2.0% and 6.7% in the retrospective group, these rates were decreased to 7.8 +/- 3.5 days, 10.7%, 0.9% and 1.9%, respectively, in the prospective group. Overall morbidity, mortality and recurrence rates and median hospitalization time were 49.5%, 2.6%, 9.5% and 18.0 +/- 7.4 days in external drainage group, 7.0%, 0% 0.8% and 8.5 +/- 4.5 in obliteration procedures and 9.0%, 4.5%, 0% and 7.3 +/- 1.9 resectional procedures, respectively. CONCLUSIONS: External drainage should be performed only in infected HCL. Resection procedures are too radical and extensive for benign lesions. Obliteration procedures are simple and safe methods for the treatment of HCL, and they have low morbidity, mortality and recurrence rates.

Adult↗
PubMedDate not supplied

Bacterial isolates from plaque and from blood during and after routine dental procedures in dogs.

OBJECTIVE: This study evaluates the association between dental procedures and bacteremia in dogs, including a comparison of bacteria isolated from plaque and blood, severity of the bacteremia versus the severity of dental disease, and the longevity of bacteremia. STUDY DESIGN: Bacteria cultured from the blood over time were compared with those isolated from the plaque and crevicular fluid and in relation to severity of dental disease. ANIMALS OR SAMPLE POPULATION: Twenty adult greyhounds. METHODS: Blood samples were collected for culture before induction of general anesthesia, immediately after intubation, 20 minutes after initiation of the dental procedure, and at 10-minute intervals until 10 minutes after the dental procedure was completed. Samples of plaque were taken for microbiological culture. RESULTS: Sixty to ninety percent of the bacterial genera isolated from the plaque were present in the blood. Dogs classified according to severity of dental disease showed no difference in the total number of different species or number of different Gram-negative, Gram-positive, or anaerobic bacteria isolated from plaque or blood (P < .05). Bacteremia was present in all of the dogs studied, within 40 minutes from the initiation of the dental procedure, regardless of the severity of oral disease. CONCLUSIONS: Gram-negative, Gram-positive, and anaerobic bacteria are present in blood during dental procedures; the bacteremia can persist beyond the dental procedure, and is not associated with the severity of dental disease. CLINICAL RELEVANCE: The nature and extent of bacteremia occurring during routine dental procedures is important in understanding a potential risk to dogs.

Animals↗
PubMed2004

Electroanatomic versus fluoroscopic mapping for catheter ablation procedures: a prospective randomized study.

INTRODUCTION: The aim of this prospective randomized study was to compare the routine use of electroanatomic imaging (CARTO) with that of conventional fluoroscopically guided activation mapping (conventional) in an unselected population referred for catheter ablation. We sought to compare the two approaches with respect to procedure outcome and duration, radiation exposure, and cost. METHODS AND RESULTS: All patients undergoing catheter ablation (with the exception of complete AV nodal ablation) were prospectively randomized to either a CARTO or conventional procedure for mapping and ablation. One hundred two patients were randomized. Acute procedural success was similar with either strategy (CARTO vs conventional 43/47 vs 51/55, P > 0.5), as was procedure duration (144 [58] vs 125 [48] min, P = 0.07 (mean [SD]). CARTO was associated with a substantial reduction in fluoroscopy time (9.3 [7.6] vs 28.8 [19.5] min, P < 0.001) and radiation dose (6.2 [6.1] vs 20.8 [32.7] Gray, P = 0.003). CARTO cases used fewer catheters (2.5 [0.7] vs 4.4 [1.1], P < 0.001), but catheter costs were higher (13.8 vs 9.3 units, P < 0.001, where one unit is equivalent to the cost of a nonsteerable quadripolar catheter). CONCLUSION: For all catheter ablation procedures, even when a center's "learning curve" for CARTO is included, procedure duration and outcome are similar for CARTO and conventional procedures. CARTO is associated with drastically reduced fluoroscopy time and radiation dose. Although fewer catheters are used with CARTO, catheter costs remain higher.

Adolescent↗
PubMed2002

The performance of procedures on the recently deceased.

OBJECTIVE: To determine the prevalence of performing procedures on the recently deceased for training purposes in emergency departments (EDs) with emergency medicine (EM) training programs. METHODS: Surveys were mailed to program directors of Accreditation Council for Graduate Medical Education (ACGME)-approved residency programs in EM. A check-off system was used to identify which procedures were performed and who performed the procedure. The survey also documented whether consent was obtained and whether written policies exist that address this issue. A Likert scale was used to evaluate respondents' attitudes toward this practice. RESULTS: Ninety-six (83%) of 116 surveys were returned. Forty-seven percent of the respondents indicated procedures were performed on the recently deceased for teaching purposes in their EDs. Emergency medicine residents perform the procedures in all departments where this practice occurs, with off-service residents and medical students using this technique in half of those departments. Paramedics, flight nurses, and attending physicians occasionally use this resource. Endotracheal intubation was the most commonly performed procedure. Seventy-six percent stated they "almost never" obtain consent from family members. Only four of 96 respondents have written policies concerning this practice. The majority of program directors (69%) would favor a position statement from a national EM organization concerning this issue, while 11% were opposed. CONCLUSIONS: The performance of procedures on the recently deceased is a common and important practice in EM training programs. Consent is infrequently obtained and policies concerning this practice are rare and restrictive when present.

Attitude of Health Personnel↗
PubMed2004

Evaluation of polyp detection in relation to procedure time of screening or surveillance colonoscopy.

BACKGROUND AND OBJECTIVES: Multiple factors influence the yield of colonoscopy for the detection of neoplasia. Few studies have addressed the impact of colonoscopy duration on procedure yield. The aim of our study was to determine whether endoscopist-specific procedure times correlate with the number and clinical significance of polyps detected at screening or surveillance colonoscopy. METHODS: Procedural data from screening or surveillance colonoscopies performed at Mayo Clinic, Rochester MN, between January 1, 1996 and June 30, 2000, were reviewed. Individual endoscopists were characterized by their personal endoscopist procedure mean time (EPMT) to perform a negative colonoscopy. Procedure time included patient's consent and sedation. EPMT was then correlated with individual polyp detection rates. RESULTS: Overall, 10,159 colonoscopies were reviewed of which 4,312 (42.4%) yielded polyps. Polyp detection varied among endoscopists between 19.0% and 62.3%. There was a close correlation between EPMT and polyp yield (all sizes), r = 0.64, although correlation was weaker for polyps >10 mm (r = 0.42) and polyps >20 mm (r = 0.20). On multivariate analysis, longer mean endoscopist time was associated with colonic lesion detection, OR = 1.54 (95% CI 1.37-1.62). Longer mean procedure duration demonstrated a looser association with identification of polyps >10 mm, OR = 1.40 (1.19-1.64) and polyps >20 mm, OR = 1.03 (0.74-1.43). CONCLUSIONS: There is a direct correlation between colonoscopy procedure time and yield, with a three-fold variation of polyp detection rates. These results should prompt future prospective studies assessing the impact of colonoscopic withdrawal time on lesion detection.

Colonoscopy↗
PubMed2004

Is routine ileoscopy useful? An observational study of procedure times, diagnostic yield, and learning curve.

BACKGROUND: IIeoscopy is not routinely attempted because of its perceived technical difficulty, time constraints, and the expectation of a low diagnostic yield. AIMS: To investigate the value of routine ileoscopy as an integral part of colonoscopy in terms of additional diagnostic information, extra time spent, and the relationship between ileoscopy rate and accumulation of colonoscopic experience. METHODS: We examined colonoscopy data from September 1995 to April 2004 of a gastroenterological firm. Crude and adjusted total colonoscopy rates (CTCR, ATCR) and ileoscopy rate (IR) were calculated. For calculation of ATCR and IR, 108 procedures in patients with previous colonic resection and 91 with unavoidable reasons for failure to reach cecum were excluded. Time trend in ileoscopy rate was analyzed with IR as a function of cumulative colonoscopy experience. Data on procedure times were collected for 1,222 consecutive colonoscopies between November 2000 and April 2004. Sixty-three procedures in patients with previous colonic resection, and 47 unavoidable and 14 avoidable failures to reach cecum were excluded from analysis of procedure times. RESULTS: Of 2,537 colonoscopies, 1,902 were performed by a single consultant and 635 by eight trainees with or without assistance from the consultant. The CTCR, ATCR, and IR were 94%, 97.5%, and 71.5% respectively. IR and ATCR rose progressively to plateau at 85% and 99% after 600 and 750 procedures respectively. The diagnostic yield from ileoscopy and ileal histology was 16.7% and 19% in patients with colonic inflammatory bowel disease, and 2.69% and 7.4% in other patients. Twenty six ileoscopies in 24 patients showed Crohn's ileitis with normal colon. The other diagnoses were NSAID related or nonspecific ileitis, ileal lipoma, ileal villous atrophy, and amyloidosis. The median anus to cecum and cecum to ileum times were 8.5 and 2 minutes (interquartile ranges=5.5 to 14 and 1 to 4 minutes) respectively. Procedure times for colonoscopies involving trainees were significantly longer compared with those by the consultant alone (median anus to cecum and cecum to ileum times=16.5 v 7 and 2.5 v 1.5 minutes; p<0.0001 and 95% CI for difference=7.5 to 9 and 0.5 to 1 minutes respectively). The median length of ileum examined was 15 cms (IR=10-20 cms). CONCLUSIONS: IIeoscopy is the gold standard in the documentation of completeness of colonoscopy. With practice, it can be achieved routinely in at least 85% of colonoscopies. In skilled hands, it adds only 3 minutes to the procedure time, and contributes significantly to quality assurance and diagnostic yield.

Adolescent↗
PubMed2005

Witnessing invasive paediatric procedures, including resuscitation, in the emergency department: a parental perspective.

OBJECTIVE: To determine whether parents prefer to be present during invasive procedures performed on their children in the ED. METHODS: A prospective study using a written survey was carried out in the ED of a secondary level regional hospital in south-east Queensland. The survey conducted between August 2003 and November 2003 consisted of parental demographics, seven theoretical paediatric procedural scenarios with increasing level of procedural invasiveness (including resuscitation) and reasons for the decisions of parents to either stay with the child or leave the room. Parents of children with Australasian Triage Scale (ATS) triage category 3, 4 and 5 were surveyed. RESULTS: Of 573 surveys collected, 553 (96.5%) were completed correctly. The number of parents expressing a desire to be present during a procedure performed on their child was 519 (93.9%) for phlebotomy or i.v. cannulation of an extremity, 485 (87.7%) for nasogastric tube insertion, 461 (83.4%) for lumbar puncture, 464 (83.9%) for urinary catheter insertion, 430 (77.8%) for suprapubic bladder aspiration, 519 (93.4%) during procedural sedation and 470 (85%) during a resuscitation where the possibility existed that their child may die. The most common reason for wanting to be present was to provide comfort to their child (542/98%). The most common reason for not wanting to be present was a parental concern of getting in the way (181/33%). CONCLUSION: Most parents surveyed would want to be present when invasive procedures are performed on their children in the ED. With increasing invasiveness, parental desire to be present decreased. However, the overwhelming majority of parents would want to be in attendance during procedural sedation or resuscitation.

Adolescent↗
PubMedDate not supplied

Evaluation of four warming procedures to minimise heat loss induced by anaesthesia and surgery in dogs.

OBJECTIVE: To evaluate the efficiency of four warming procedures, introduced after anaesthetic induction and continued during surgery, in minimising heat loss in anaesthetised dogs. DESIGN: Dogs were paired. One of each pair was a control; the other was subjected to one of four warming procedures. METHODS: Ninety-six dogs were involved in total. Pairs of dogs were matched for breed, hair length, and type of surgical procedure and placed adjacent to each other in a large temperature-controlled surgical theatre. One dog within each pair was assigned to one of four warming procedures that commenced immediately after anaesthetic induction. Group 1 (11 pairs) were placed on a purpose-designed prewarmed (41 degrees C) electrically heated pad. Group 2 (18 pairs) were placed on a prewarmed electric heat pad (41 degrees C), cocooned by four wrapped water bottles (initially 41 degrees C) and subjected to radiant heat (150 watt lamp placed 50 cm away from the head of the dog). Group 3 (11 pairs) were surrounded by a forced air warming mattress (set at 43 degrees C). Group 4 (8 pairs) were connected via the anaesthetic breathing circuit to a heater/humidifier (set at 41 degrees C). Rectal temperature measurements were recorded every 15 min for the first 3 h of anaesthesia. The fall in rectal temperature of the control dog was subtracted from the fall in temperature of the treatment dog and this measurement was used to assess the efficacy of the various warming procedures. RESULTS: The mean rectal temperature of unheated 'control' dogs decreased 1.9 +/- 0.6, 1.4 +/- 0.4 and 1.1 +/- 0.4 degrees C over the first, second and third hour respectively. After 3 h the temperature fall differential for all groups were 0.7 +/- 0.7 (Group 1), 3.1 +/- 1.1 (Group 2), 2.4 +/- 1.1 (Group 3) and 1.0 +/- 1.1 degrees C (Group 4). Thus the group 2 procedure was the most successful in preventing a drop of temperature followed by groups 3, 4 and 1. CONCLUSION: Large dogs undergo significant reduction in core body temperature especially during the first 2 h of anaesthesia and surgery. Supplementary warming substantially reduces this fall in body temperature, although certain warming procedures were found to be more effective than others.

Anesthesia, General↗
PubMed1999

The potential for radiation-induced skin damage in interventional neuroradiological procedures: a review of 522 cases using automated dosimetry.

The Food and Drug Administration (FDA) has recommended the monitoring of radiation skin dose to patients during procedures having the potential for radiation damage. Radiologists need information about typical radiation doses during interventional procedures. The skin doses to patients during 522 interventional neuroradiological procedures have been monitored using an automated dosimetry system. Estimated entrance skin doses (ESD) were binned into 0.5 Gy increments and compared to FDA recommended thresholds for inclusion in the patient record. Percentages of procedures exceeding the above mentioned thresholds are presented. In addition, the percentage of dose in each view and the percentage of dose in fluoroscopic and digital angiographic modes are shown. Six percent of embolization procedures and one percent of cerebral angiograms are estimated to have potential for main erythema (ESD>6 Gy). All types of procedures have potential for temporary erythema and exceed the threshold for inclusion in the patient record (ESD> 1 Gy) at the 95% percentile. The types of procedures with most potential for skin damage also have significant percentages of dose in the digital angiographic mode. Thus, monitoring fluoroscopic time alone underestimates the potential for skin injury. On the other hand, combining the doses in the posterior-anterior and lateral views, tends to overestimate the potential for radiation injury.

Biophysical Phenomena↗
PubMed1981

Modified enrichment-serology procedure for detection of salmonellae in soy products.

A modified enrichment-serology (MES) procedure was used to reduce the time necessary for salmonella analysis. Naturally contaminated samples of soy products were preenriched in 1% proteose peptone for 6 h at 37 degrees C followed by inoculation into tetrathionate broth for 18 h at 37 degrees C. Two drops of the tetrathionate sample were inoculated into M broth. After incubation at 37 degrees C for 6 h, 0.85 ml of the mixture was formolized, and 0.1 ml of polyvalent H antiserum was added. After incubation in water bath at 50 degrees C for 1 h, the appearance of a typical floccular flagellar precipitate was observed in tubes positive for salmonellae. Over 3,000 samples were subjected to standard biochemical and serological procedures, and the results were compared with those of the MES method with a 96.7% correlation. Eleven of the samples (0.3%) were false-negative with the MES procedure, and 3% were false-negative with the U.S. Food and Drug Administration Bacteriological Analytical Manual procedure. The 3% negative samples by this latter procedure were subsequently found to be positive by the MES procedure. The MES procedure reduced the time required for salmonella analysis from 4 days to 32 h.

Culture Media↗
PubMed1989

Development and evaluation of an in vitro virus isolation procedure as a replacement for the mouse inoculation test in rabies diagnosis.

A tissue culture virus isolation procedure for rabies street strain virus on mouse neuroblastoma cells is described. Parameters for the optimum sensitivity of the procedure were determined to include a minimum 4-day incubation of virus in tissue culture and the use of diethylaminoethyl-dextran for increased cell susceptibility. The in vitro procedure performed well in a comparison with the fluorescent-antibody test and the mouse inoculation test (MIT) on weakly positive brain tissue. Decomposed specimens and virus inhibitors present in brain suspensions were found to interfere with the in vitro procedure. A Formalin-methanol fixative was found to be superior on plastic 96-well plates to previously used fixatives. A 2-year clinical trial of the procedure in parallel with the MIT demonstrated the practicality of the procedure. Accordingly, the New York State rabies diagnostic laboratory has replaced the MIT with the in vitro procedure as a backup for the fluorescent-antibody test in the routine diagnosis of rabies.

Animals↗
PubMed1978

Comparison of a radiometric procedure with conventional methods for identification of Neisseria.

A radiometric procedure was compared with the conventional cystine tryptic agar (CTA) sugar fermentation method for identification of Neisseria species. Four different ATCC cultures of Neisseria were identified by both procedures with identical results. The only difference noted was that the radiometric procedure required 3 h for completion, whereas the conventional CTA sugar method required overnight incubation. The radiometric procedure was also compared with the fluorescent antibody (FA) and CTA methods for identification of Neisseria gonorrhoeae. The organisms examined were gram-negative, oxidase-positive diplococci isolated from 49 clinical specimens sent to the laboratory for bacteriological analysis. Results obtained by both CTA and FA procedures were comparable. However, the radioisotope method appeared to be superior to the other two methods in that only one isolate identified as positive by both the CTA and FA methods was not identified radiometrically, whereas four isolates positive by the radiometric method were not identified by the other two procedures. Thus, a total of seven more positive identifications were made radiometrically than by either of the two other methods. All positive identifications were confirmed by a reference laboratory. These results indicate that the radiometric procedure is more rapid and reliable as compared with both the CTA and direct FA methods and, thus, may serve as a valuable addition to the methodology available for diagnostic microbiology.

Bacteriological Techniques↗
PubMed1983

Effects of routine care procedures on transcutaneous oxygen in neonates: a quantitative approach.

The changes in transcutaneous oxygen tension (TcPO2) during 123 observations of 10 care procedures were compared with the intrinsic variability of the TcPO2 at the time of the procedures. Standard deviations of the TcPO2 were measured by planimetry from continuous recording in undisturbed infants during a 10-minute control period immediately before each procedure. The decrement of TcPO2 during the procedure and the change in TcPO2 5 minutes after the procedure had ended were measured. A chest x-ray film had the most striking early hypoxic effect, but all the procedures produced early hypoxia in at least one-quarter of the infants. The significant decreases in oxygenation with particular procedures indicate areas in which changes in techniques might be applied to the benefit of the neonate.

Humans↗
PubMed1989

Cardiac catheterisation by the Judkins technique as an outpatient procedure.

OBJECTIVE: To assess the safety and cost benefit of left heart catheterisation by a modified Judkins technique performed as a day patient procedure. DESIGN: Review study of case notes of consecutive patients examined by the procedure over three years (January 1984 to December 1986). SETTING: Outpatient referrals in a regional cardiac centre within a district general hospital. PATIENTS: Nine hundred patients aged 18-76 (mean 54) selected at a previous clinic as suitable for the procedure. MAIN RESULTS: Eight hundred and fifty patients (94.4%) were discharged home on the day of the procedure. Forty others (4.4%) could not be discharged owing to complications during or just after the procedure. Of these patients, two died (0.2%), six suffered a myocardial infarction (0.7%), and two had major vascular complications. The remaining 30 patients were admitted because of chest pain without infarction (10 cases), minor vascular incidents (six), haemorrhage at the puncture site (five), arrhythmia (four), pulmonary oedema (three), and contrast reaction (two). Ten patients were admitted for either urgent coronary artery bypass grafting or social reasons. CONCLUSIONS: Cardiac catheterisation is safe as an outpatient procedure in most cases. Beds are spared and roughly 35,000 pounds is saved for every 500 procedures performed.

Adolescent↗