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PubMed1983

Diagnostic imaging procedure volume in the United States.

Comprehensive data on 1979 and 1980 diagnostic imaging procedure volume were collected from a stratified random sample of U.S. short-term general-care hospitals and private practices of radiologists, cardiologists, obstetricians/gynecologists, orthopedic surgeons, and neurologists/neurosurgeons. Approximately 181 million imaging procedures (within the study scope) were performed in 1980. Despite the rapidly increasing use of newer imaging methods, plain film radiography (140.3 million procedures) and contrast studies (22.9 million procedures) continue to comprise the vast majority of diagnostic imaging volume. Ultrasound, computed tomography, nuclear medicine, and special procedures make up less than 10% of total diagnostic imaging procedures. Comparison of the data from this study with data from an earlier study indicates that imaging procedure volume in hospitals expanded at an annual growth rate of almost 8% from 1973 to 1980.

Humans↗
PubMed1987

Percutaneous diagnostic and therapeutic interventional radiologic procedures in children: experience in 100 patients.

Diagnostic and therapeutic interventional radiologic procedures that provide many treatment options in adults are gaining acceptance in pediatric medicine. Diagnostic (69 patients) and therapeutic (31 patients) interventional experiences in 100 children are summarized, and the procedures of choice for various clinical problems are outlined. Procedures include percutaneous biopsy for benign and malignant diseases, transhepatic cholangiography and biliary drainage, genitourinary procedures (nephrostomy, stent placement, balloon dilation), aspiration of fluid for laboratory analysis, therapeutic drainage of abscesses and noninfected fluid collections, and percutaneous gastrostomy and gastroenterostomy. Diagnoses were accurate in 96% of cases, and therapeutic procedures were successful in 84% of patients, usually obviating operation. Complications occurred in six patients (6%); the most severe was hemoptysis causing respiratory distress. There was no procedure-related mortality. Interventional procedures have wide applications in pediatric patients.

Adolescent↗
PubMed1994

Bloodstream infections after interventional procedures in the biliary tract.

PURPOSE: To assess the adequacy of prophylaxis for interventional radiologic biliary procedures and the etiologic organisms of subsequent bloodstream infections. MATERIALS AND METHODS: Data from 148 patients who underwent 480 interventional radiologic biliary procedures were evaluated for evidence of bloodstream infection. Data analyzed included type of procedure performed, whether an antibiotic was used, and evidence of infectious complications occurring during and within 72 hours after the procedure. All culture data obtained before and after the procedure were recorded. RESULTS: Seven cases of new bloodstream infection were identified, five of which were caused by Enterococcus species. No substantial risk factors for bloodstream infection were identified, although it occurred only in patients who had recently undergone biliary surgery or underwent manipulations other than simple cholangiography. Microbial colonization of the bile was associated with older age. Evidence of possible or proved infection after the first interventional procedure was more common in patients with positive bile cultures. CONCLUSION: Although the importance of enterococcal bacteremia is uncertain, current recommendations for cephalosporin prophylaxis for interventional radiologic biliary procedures should be reevaluated.

Bacteremia↗
PubMed2006

Reversal of Hartmann's procedure after surgery for complications of diverticular disease of the sigmoid colon is safe and possible in most patients.

BACKGROUND: Although evidence is growing that most patients who need an operation for diverticular disease of the sigmoid colon can be treated by a single-stage procedure, a two-stage procedure will still be necessary in some patients because of significant sepsis or technical difficulties. The outcomes of 65 patients who underwent secondary restoration after a Hartmann procedure for complicated diverticulitis were studied and the factors leading to complications and mortality were identified. PATIENTS AND METHODS: Of 91 patients, in a consecutive 12-year period, whose primary operation was a Hartmann procedure, 72 survived longer than 3 months after discharge. Sixty-five underwent an attempted reversal of the Hartmann procedure. The POSSUM scores were calculated in all patients as well as the morbidity and mortality rates. RESULTS: In 63 (96.9%) patients the bowel continuity could be restored with a morbidity of 38.5% and a mortality of 3.1%. The POSSUM and p-POSSUM scores adequately predicted the mortality in this series. CONCLUSION: This series shows that when surgical treatment for complicated diverticular disease of the sigmoid colon is necessary, the Hartmann procedure is still a valid indication. In a high percentage of patients the Hartmann procedure could be restored with a low mortality.

Adult↗
PubMedDate not supplied

Percutaneous umbilical blood sampling: indication changes and procedure loss rate in a nine years' experience.

A 9 years' experience with percutaneous umbilical blood sampling (PUBS) has been appraised. A total number of 1,272 procedures have been performed in our institution between 1986 and 1994; 861 before the 24th week of gestation and 411 after 24 weeks. The indications for PUBS changed throughout these years because of the rapid evolution of molecular biology and because of the fact that certain conditions can now be diagnosed at earlier stages of gestation by chorionic villi sampling and amniocentesis. Sampling at a later gestational age reflected changes in indications. PUBS loss rate has been calculated for 482 fetuses less than 24 weeks, retrospectively found to be negative for the suspected condition and has been related to gestational age, duration of the procedure and number of needle insertions. Total procedure-related loss rate was 2.3%: 1.6% intrauterine fetal deaths within 48 h of the procedure and 0.7% spontaneous abortions in the 2 weeks following the procedure. Gestational age at the time of the procedure and duration of the procedure were significantly related to fetal losses within 48 h.

Abortion, Spontaneous↗
PubMed1996

Health-care technology assessment of surgical procedures: the case of reduction pneumoplasty for emphysema.

End-stage chronic obstructive pulmonary disease (COPD) is frequent in the practice of pulmonology. The recent report that reduction pneumoplasty results in lung function improvement in a high proportion of patients with emphysema has raised the question of how effectively the medical profession assesses the efficacy of new surgical procedures. Unlike drugs and devices, the introduction of new surgical procedures is not regulated. Technique changes rapidly for a period of time after new procedures are introduced. Peer review is done mainly by quality-improvement activities in the surgeon's hospital and by publication in peer-reviewed journals. Randomized clinical trials (RCT) are procedurally and ethically difficult to do and few have been done for new surgical procedures. Some trials have been problematic. For example, a controlled cooperative trial of radial keratotomy resulted in unsuccessful antitrust suits brought by physicians and patients alleging that third-party payers would not reimburse them for surgery. RCTs that have been done have tended to be reported long after the procedure has been incorporated into surgical practice. A RCT of reduction pneumoplasty would be impossible at this time because of rapid flux in surgical techniques. There might also be ethical problems because of the substantial improvement in lung function of many patients in the existing case series, a level of improvement seen with no other treatment than lung transplantation. It is proposed that a prospective, cooperative, consecutive-case, observational study (registry) of reduction pneumoplasty for emphysema could greatly speed the acquisition of information about the efficacy of this new procedure.

Humans↗
PubMed1997

A comparison of three procedures for the detection of Bence-Jones proteinuria.

A traditional electrophoretic procedure for detection of Bence-Jones proteinuria, employing Amido black stain on 200-fold concentrated urine, has been compared to two procedures employing highly sensitive protein stains not requiring prior urine concentration. All three procedures were carried out on 80 random urine samples screened for Bence-Jones proteinuria and 10 samples were provided by patients attending a myeloma clinic. A new procedure employing modified Coomassie brilliant blue stain on unconcentrated urine showed comparable sensitivity to the established procedure (82% versus 88%, respectively) and specificity (77% versus 74%, respectively), when assessed against immunofixation as a reference method. However, the new method is considerably quicker and cheaper. A second method, employing Gold stain, showed enhanced sensitivity (94% versus 88% for Amido black) but lower specificity (62% versus 74% for Amido black). However, this method is labour intensive and relatively expensive. Our data suggest that the procedure employing modified Coomassie brilliant blue may be a suitable alternative to the traditional procedure commonly used in many clinical laboratories.

Amido Black↗
PubMed1991

Overcorrection as an academic remediation procedure. A review and reappraisal.

Overcorrection procedures traditionally were designed to reduce the behavioral excesses of persons with mental retardation. However, beginning with a study of Foxx and Jones (1978), it became clear that variations of the procedure could be used to enhance academic proficiency in students with average intelligence, borderline intelligence, learning disabilities, and various levels of mental retardation. Studies were reviewed in this article that have used overcorrection procedures to enhance academic proficiency, and it was concluded (a) that overcorrection, alone or combined with positive reinforcement, significantly increased the academic proficiency of the students, and (b) that the label "overcorrection" is inappropriate, given that the procedures described in these studies did not meet the criteria for overcorrection procedures. It was suggested that overcorrection procedures used for academic remediation be called directed rehearsal in the future to reflect more accurately the procedures actually used.

Achievement↗
PubMed2002

Keller procedure and chevron osteotomy in hallux valgus: five-year results of different surgical philosophies in comparable collectives.

We evaluated 97 Keller procedures and 64 chevron osteotomies, both combined with the "Cerclage fibreux" distal soft-tissue procedure, with a minimum follow-up period of five years to assess the limits of indications of these two different operations. We then formed two subgroups providing a statistical midrange of the metatarsophalangeal angle, intermetatarsal angle I-II and degree of arthrosis of the first metatarsophalangeal joint to obtain comparable collectives of 40 Keller and 36 chevron procedures. The postoperative AOFAS score averaged 85.4 for the Keller procedure and 83.0 for chevron patients. The metatarsophalangeal angle was improved to an average of 11.0 degress and 13.9 degrees, the intermetatarsal angle to values of 8.8 degrees and 9.4 degrees, respectively. The patient's overall satisfaction rated "very satisfied" and "satisfied" in 92.5% and 94.4%, respectively. The main reason for dissatisfaction was pain. Compared to the literature, the good long-term results in this series following resection arthroplasty are attributed to the routine use of the "Cerclage fibreux" technique. This contemporary type of the Keller procedure is still a valuable surgical procedure for older patients with minor functional expectations. Excellent outcome after chevron osteotomy was not only seen in younger patients with minor deformities, but also in an older population. The chevron osteotomy should not be restricted to younger patients. The combination of the chevron distal metatarsal osteotomy with a distal soft-tissue procedure does not increase the risk of clinically manifest avascular necrosis of the metatarsal head and helps to correct higher metatarsophalangeal and intermetatarsal angles.

Adult↗
PubMed2005

Removal of power-line interference from the ECG: a review of the subtraction procedure.

BACKGROUND: Modern biomedical amplifiers have a very high common mode rejection ratio. Nevertheless, recordings are often contaminated by residual power-line interference. Traditional analogue and digital filters are known to suppress ECG components near to the power-line frequency. Different types of digital notch filters are widely used despite their inherent contradiction: tolerable signal distortion needs a narrow frequency band, which leads to ineffective filtering in cases of larger frequency deviation of the interference. Adaptive filtering introduces unacceptable transient response time, especially after steep and large QRS complexes. Other available techniques such as Fourier transform do not work in real time. The subtraction procedure is found to cope better with this problem. METHOD: The subtraction procedure was developed some two decades ago, and almost totally eliminates power-line interference from the ECG signal. This procedure does not affect the signal frequency components around the interfering frequency. Digital filtering is applied on linear segments of the signal to remove the interference components. These interference components are stored and further subtracted from the signal wherever non-linear segments are encountered. RESULTS: Modifications of the subtraction procedure have been used in thousands of ECG instruments and computer-aided systems. Other work has extended this procedure to almost all possible cases of sampling rate and interference frequency variation. Improved structure of the on-line procedure has worked successfully regardless of the multiplicity between the sampling rate and the interference frequency. Such flexibility is due to the use of specific filter modules. CONCLUSION: The subtraction procedure has largely proved advantageous over other methods for power-line interference cancellation in ECG signals.

Journal Article↗
PubMed2005

A comprehensive, unembalmed cadaver-based course in advanced emergency procedures for medical students.

BACKGROUND: Preparing medical students for residency in emergency medicine involves education in many areas of knowledge and skill, including instruction in advanced emergency procedures. OBJECTIVES: To outline the logistics involved in running a training course in advanced emergency procedures for fourth-year medical students and to report students' perceptions of the impact of the course. METHODS: The course is a cadaver-based training laboratory that utilizes several teaching modalities, including a Web-based syllabus and online streaming video, didactic lecture, hands-on practice with models and ultrasound, and hands-on practice with unembalmed (fresh) cadavers. The course focuses on seven emergent procedural skills, including deep venous access via the subclavian, internal jugular, and femoral veins; tube thoracostomy; saphenous vein cutdown; intraosseous line placement; and emergency cricothyrotomy. The course is taught by attending emergency physicians and anatomy department faculty. After completion of the course, students reported their self-assessments on a five-point Likert scale. Data were evaluated using a paired t-test (two-tailed). RESULTS: Thirty-three students completed the evaluation. The students reported a mean (+/- standard deviation [SD]) increase in their understanding of the indications for all procedures from 3.3 (+/- 1.1) before to 4.8 (+/- 0.4) after the course (p = 0.004, 95% CI = 0.7 to 2.0). The students reported a mean increase in their understanding of how to perform all procedures from 2.1 (+/- 0.9) before to 4.6 (+/- 0.6) after the course (p = 0.003, 95% CI = 1.9 to 3.0). The students reported a mean increase in their comfort level performing all procedures from 1.6 (+/- 0.8) before to 4.2 (+/- 0.7) after the course (p < 0.001, 95% CI = 2.0 to 2.9). CONCLUSIONS: These findings support the value of an advanced emergency procedural training course using an unembalmed cadaver-based laboratory and incorporating several teaching modalities.

Cadaver↗
PubMed1997

Ketamine-midazolam versus meperidine-midazolam for painful procedures in pediatric oncology patients.

PURPOSE: To compare the efficacy, characteristics of onset/recovery, and safety of ketamine/atropine/midazolam with meperidine/midazolam used as premedication for painful procedures in children with cancer. METHODS: A randomized, double-blind crossover trial for two successive painful procedures (bone marrow aspiration or biopsy, lumbar puncture, or combined procedures) was performed at a referral-based pediatric hematology-oncology clinic and associated inpatient service of a university teaching hospital. Twenty-two children, aged 24 to 178 months, were enrolled and 18 (81.8%) completed the double-blind, crossover trial. Each child received intravenous premedication with either meperidine 2 mg/kg and midazolam 0.1 mg/kg (MM) or atropine 0.01 mg/kg, midazolam 0.05 mg/kg, and ketamine 1.5 mg/kg (KM) on one occasion followed by the alternative regimen on a second occasion. The initial premedication regimen was chosen by random assignment. RESULTS: Efficacy was assessed by a trained observer using the Observational Scale of Behavioral Distress-Revised (OSBD-R). Operator, nurse, parent, and patient opinions of efficacy were recorded on a visual analog scale (VAS). Side effects were monitored by pulse oximetry, nasal end-tidal capnography, and serial blood pressure measurements. Use of KM resulted in significantly less procedural distress than MM (1.37 +/- 2.20 v 7.04 +/- 8.06 OSBD-R units; P < .05). Both operators and nurses rated KM more effective than MM. KM use was associated with earlier readiness for the procedure (19.2 v 24.0 minutes) and more rapid recovery (39.3 v 74.6 minutes for removal of monitoring devices and 58.5 v 87.1 minutes for discharge). Procedures undertaken after ketamine sedation were associated with fewer side effects than observed with MM sedation (hypoxia, 17.7% v 82.4%; hypotension, 16.6% v 55.6%; reduced respiratory rate, 0% v 38.9%). The incidence of emergence reactions or behavioral abnormalities within 24 hours postprocedure was similar in both treatment groups. At 7 days postprocedure, no child had persistent behavioral abnormalities and all children had amnesia for the procedure. Parents and children expressed a preference for KM over MM in 12 of 18 cases (P < .05). CONCLUSION: A premedication regimen of KM produced superior sedation with a faster onset and recovery and fewer side effects than a MM combination.

Anesthetics↗
PubMed2003

A multidimensional workshop using human cadavers to teach bedside procedures.

BACKGROUND: Internal medicine residents should be able to perform bedside procedures safely and efficiently. DESCRIPTION: We developed a human cadaver workshop for teaching internal medicine residents bedside procedures. The workshop consisted of lectures and hands-on experiences with cadavers covering thoracentesis, paracentesis, lumbar puncture, arthrocentesis, and bone marrow biopsy. A Web site was developed to provide technical support to residents on the medical wards after completion of the workshop. EVALUATION: We successfully developed and implemented a procedure workshop for residents using human cadavers. The workshop improved mean scores on knowledge and procedure comfort level assessments. Residents demonstrated the skills required to safely complete each procedure. CONCLUSIONS: Our multidimensional educational intervention may be an effective tool for improving the knowledge, skills, and attitudes required for performing bedside procedures. More research needs to be done to determine if this workshop increases the number and proficiency of bedside diagnostic procedures performed by residents.

Attitude of Health Personnel↗
PubMed2004

The place of Riedel's procedure in contemporary sinus surgery.

Many operative procedures have been described to treat frontal sinus disease with varying results. Obliteration of the frontal sinus is attempted when drainage procedures fail. Most large series of patients undergoing sinus obliteration have reported recurrent disease yet the management of these patients is rarely discussed. We believe Riedel's procedure has an important role in the management of these patients. Riedel's procedure can help eradicate frontal sinus disease and symptoms when drainage and obliteration have failed and where there is persistent disease involving the anterior wall of the frontal sinus or the sinus itself. Whilst cranialization has a role in the removal of the mucosa or contents of the frontal sinus in craniofacial resection, the morbidity associated with it make Riedel's procedure preferable for dealing with chronic infection or locally invasive disease. Riedel's procedure also maintains a barrier in the form of the posterior wall of the frontal sinus and the intracranial contents. Post-operative disfigurement, the main criticism of this procedure, can be reduced to some extent by chamfering the margins of the frontal sinus along with the supraorbital rims and reconstructing the anterior wall at a later date if necessary. The authors are aware that any report about frontal sinus surgery should be judged after several years follow-up, and whilst not all these cases have been asymptomatic for a decade, several have been reviewed for many years.

Adult↗
PubMed2005

Skin dose alarm levels in cardiac angiography procedures: is a single DAP value sufficient?

Maximum estimated skin doses to patients undergoing coronary angiography procedures were obtained using radiographic slow film and diode dosemeters. Conversion factors of maximum entrance skin dose versus dose-area product (MESD/DAP) for diagnostic (coronary angiography (CA); 20 patients; 2 operators) and interventional procedures (percutaneous transluminal coronary angiography (PTCA); 10 patients; 1 operator) were 4.3 (mean value of 10 CA; operator A), 3.5 (mean value of 10 CA; operator B) and 9.7 (mean value of 10 PTCA; operator B) mGy(Gycm2)(-1), respectively. The results emphasise a need for both operator- and procedure-specific conversion factors. Compared with a single, global factor for all cardiac procedures and/or operators that is commonly applied today, such a refinement is expected to improve the accuracy in skin dose estimations from these procedures. Consequently, reference DAP values used in the clinic to define patients who could suffer from a radiation induced skin injury following a cardiac procedure, should be defined for each operator/procedure. The film technique was found to be superior to the diode in defining conversion factors in this study, and allowed for a rapid and accurate estimation of MESD for each patient. With appropriate positioning of the diode, a combined film/diode technique has a potential use in the training of new angiography operators. The patient body mass index (BMI) value was a good indicator of the variation in average lung dose (critical organ) between patients. The highest lung dose/DAP value was obtained for normal sized patients (BMI: 19-26), and was close to 1.5 mGy(Gycm2)(-1) with both CA and PTCA procedures.

Angioplasty, Balloon, Coronary↗
PubMed2003

Radiation doses to the legs of radiologists performing interventional procedures: are they a cause for concern?

The purpose of this study was to ascertain the magnitude and distribution of doses to the legs of radiologists when performing interventional procedures. LiF:Mg,Ti TLD100 chips were used to measure simultaneously doses to the lower limbs and, for comparison, the hands during 100 interventional procedures. Results show leg dose was dependent upon type and complexity of procedure, equipment used and whether lead protection was available. Where no lead protection was used, the doses to the lower limbs were frequently similar to or higher than those received by the hands. The mean dose to the legs ranged from 0.19 mSv to 2.61 mSv per procedure, compared with 0.04 mSv to 1.25 mSv to the hands. During transjugular intrahepatic portosystemic shunt and embolisation procedures the leg dose could be as much as 2-3 times greater than that to the hands. When lead protection was used, the dose to the legs was reduced significantly to 0.02 mSv to 0.5 mSv per procedure. A clear linear relationship was shown between the dose-area product (DAP) reading and the dose to the feet of the radiologist. As a "rule of thumb", a DAP reading of 100 Gy cm(2) will give a dose of 1 mSv to the legs, if no lead protection was used, dropping to approximately 0.02 mSv if lead protection was present. This study demonstrates that the dose to the legs of radiologists can be higher than that to the hands when no lead protection is used. The inclusion of a lead screen to protect the legs is an effective method of dose reduction when performing interventional procedures.

Embolization, Therapeutic↗
PubMed2004

Etomidate for procedural sedation in the emergency department.

OBJECTIVE: To review the current efficacy and safety evidence for the use of etomidate for procedural sedation in the emergency department (ED). DATA SOURCES: MEDLINE (1966-December 2003), EMBASE (1980-December 2003), PubMED (1966-December 2003), and Cochrane Database of Systemic Reviews (up to December 2003) were searched for full-text reports published in English on the use of etomidate in humans. Search terms included etomidate, procedural sedation, conscious sedation, relocation, dislocation, abscess incision, abscess drainage, and cardioversion. STUDY SELECTION AND DATA EXTRACTION: Prospective and retrospective studies evaluating efficacy or safety endpoints using etomidate for procedural sedation in the ED were included. All studies were evaluated independently by both authors. For clinical outcomes (efficacy, safety), the definitions specified by each study were used. DATA SYNTHESIS: Three observational studies and 5 prospective, randomized controlled trials were included in this review. Onset of action and time to recovery following etomidate were rapid and found to be comparable to that of propofol and thiopental but significantly faster than that of midazolam. The dose of etomidate for procedural sedation ranged from 0.15 to 0.22 mg/kg. No significant hemodynamic effects were observed; however, respiratory depression resulting in oxygen desaturation to <90% or apnea appears to occur in approximately 10% of patients undergoing procedural sedation with etomidate with or without analgesia. The most prominent adverse effect reported with etomidate was myoclonus, occurring in 20-45% of patients. CONCLUSIONS: Etomidate is an appropriate and valuable agent for performing procedural sedation in the ED. The rapid onset and recovery time and relative lack of significant hemodynamic and respiratory effects may facilitate optimal and safe conditions for procedural sedation in the ED.

Emergency Service, Hospital↗
PubMed2006

Core verbal autopsy procedures with comparative validation results from two countries.

BACKGROUND: Cause-specific mortality statistics remain scarce for the majority of low-income countries, where the highest disease burdens are experienced. Neither facility-based information systems nor vital registration provide adequate or representative data. The expansion of sample vital registration with verbal autopsy procedures represents the most promising interim solution for this problem. The development and validation of core verbal autopsy forms and suitable coding and tabulation procedures are an essential first step to extending the benefits of this method. METHODS AND FINDINGS: Core forms for peri- and neonatal, child, and adult deaths were developed and revised over 12 y through a project of the Tanzanian Ministry of Health and were applied to over 50,000 deaths. The contents of the core forms draw upon and are generally comparable with previously proposed verbal autopsy procedures. The core forms and coding procedures based on the International Statistical Classification of Diseases (ICD) were further adapted for use in China. These forms, the ICD tabulation list, the summary validation protocol, and the summary validation results from Tanzania and China are presented here. CONCLUSIONS: The procedures are capable of providing reasonable mortality estimates as adjudged against stated performance criteria for several common causes of death in two countries with radically different cause structures of mortality. However, the specific causes for which the procedures perform well varied between the two settings because of differences in the underlying prevalence of the main causes of death. These differences serve to emphasize the need to undertake validation studies of verbal autopsy procedures when they are applied in new epidemiological settings.

Adult↗