Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Procedures”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,225 records · Page 68Linked to original sources
PubMed1995

Continuous RT-PCR using AMV-RT and Taq DNA polymerase: characterization and comparison to uncoupled procedures.

A continuous reverse transcription polymerase chain reaction (RT-PCR) procedure was designed with all reaction components included in a single tube prior to thermal cycling. This procedure was compared to uncoupled RT-PCR procedures wherein the addition of reagents was separated. In the latter, in particular, conditions for reverse-primer annealing and cDNA synthesis were investigated. The two RT-PCR approaches were compared in the detection of singly spliced and multiply spliced human immunodeficiency virus type 1 (HIV-1) mRNs. The avian myeloblastosis virus reverse transcriptase and Taq DNA Polymerase were used in the continuous procedure under the compromised condition wherein the two enzymes were active in the same buffer. Reverse transcription was carried out at an elevated temperature of 50 degrees C to overcome problems of mRNA secondary structures that could inhibit the reaction. The continuous procedure was found to be as specific and efficient as the best uncoupled procedure. The procedure was shown to be reliable and to have the sensitivity to detect one HTLV-IIIB-infected H9 cell in a million uninfected H9 cells.

Avian Myeloblastosis Virus↗
PubMed1995

[Comparison of anxiety and pain in two procedures of hematopoietic stem cell collection: cytapheresis and bone marrow collection].

The aim of this study was to compare anxiety, pain and discomfort of cancer patients submitted to two procedures of hematopoietic stem cells collection: peripheral blood stem cells collection (PBSCC) or bone marrow collection (BMC). Patients, randomized (July 1993-February 1994), in view of autograft, to receive the first procedure or the second one, completed self-administered questionnaires before, during and after the procedure. Anxiety was evaluated by State-Trait Anxiety Inventory. Pain was assessed using visual analogical scale (VAS) and McGill Pain questionnaire. Before the procedure, in comparison with PBSCC patients (n = 40), BMC patients (n = 25) experienced more State-anxiety due to the procedure approach (p < 0.01) and more trouble or inconvenience for having to come and stay at the hospital (p < 0.0001). During the procedure, pain related to BMC, as assessed by VAS, is significatively higher than pain induced by PBSCC, whichever the access used (p < 0.001). The McGill total score is twice as high for BMC patients than for patients submitted to PBSCC with femoral catheter (n = 19). The latter patients significatively reported more pain than patients without femoral catheter (n = 21). At the discharge from hospital, 32% of BMC patients judged the procedure quite difficult vs 5% of PBSCC patients (p < 0.05). These results explain a higher acceptability of the peripheral blood stem cells collection.

Adult↗
PubMed1995

Estimation of procedure times in a publicly funded dental programme.

For the purposes of planning and evaluation, knowing the time-costs associated with each dental procedure carried out in a publicly funded dental programme is very helpful. This knowledge, along with the expected or known benefits, also allows researchers to assess the efficacy of a dental procedure. However, only a few estimates of dental procedure times exist in the literature, and most of these focus on restorative treatments. The North York Public Health Department operates a school-based public dental programme, where each dental procedure carried out by a dentist or hygienist is entered into a dental management information system database, along with the date of the procedure and the hours worked by the provider on that date. Using these data and multiple regression analyses it was possible to estimate the average time required to carry out the most common procedures in North York's dental programme. These estimates were found to be similar to estimates published in the dental literature and very similar to estimates of the Ontario Dental Association. Thus, this method of calculating procedure times appears valid and may be very useful to managers of public dental programmes and public dental health researchers.

Costs and Cost Analysis↗
PubMed1995

Procedural distress in critical care settings.

The diagnostic and treatment procedures experienced by critically ill patients are major sources of procedural distress. Procedural distress is defined broadly as unpleasant physical sensations and negative psychological states associated with specific diagnostic or treatment procedures. Although research in this area is limited by small sample sizes, findings suggest that mechanical ventilation is a particularly difficult procedure to experience, especially endotracheal suctioning and the weaning process. Interventions to reduce distress should focus on the preparation of patients for distress, the identification of procedural distress, and appropriate interventions for specific procedures.

Critical Care↗
PubMedDate not supplied

Hospital costs of protective isolation procedures in heart transplant recipients.

BACKGROUND: This study details the hospital costs of strict reverse isolation procedures in heart transplant recipients. METHODS: In a prospective, descriptive design, a research protocol was developed, identifying all of the activities related to strict reverse isolation procedures in heart transplant recipients. For each separate activity, materials used and workload were registered, which allowed the calculation of the material and labor costs for each of the isolation procedures. RESULTS: The cost calculations show that the first day in isolation costs about $160 (for isolation procedures only) and about $65 for each consecutive isolation day. With a mean post-intensive care unit length of stay of 22 days, the mean cost of isolation procedures for heart transplant recipients amounts to $1535. Finally, a modified isolation protocol was developed, incorporating only those procedures with proven effectiveness. It was calculated that a switch to such a modified protocol would allow a savings of over 50% of the hospital resources devoted to isolation measures. CONCLUSIONS: Isolation procedures use a significant portion of hospital resources. Modifying isolation protocols in heart transplant recipients can be a source of considerable savings in a transplant program.

Belgium↗
PubMed1994

An evaluation of a time-saving anaesthetic machine checkout procedure.

Although it is generally acknowledged that a pre-use checkout of the anaesthetic machine significantly improves patient safety, an evaluation of such procedures is uncommon. Previous studies have shown that anaesthetic personnel using different check routines are unable to detect the majority of pre-set technical malfunctions. We have shown that it is possible to develop an effective and time-saving check procedure by integrating seven simple steps into one continuous flow procedure, where the settings and results of one step are used in the following step to optimize step interaction. The method is a 'core' procedure adapted to machines sold after 1980 according to the current ISO standard (presently undergoing revision). A user inquiry demonstrated that this pre-use check has been easily adopted in departments of anaesthesia. Moreover, the inquiry showed that most departments would not accept a checkout procedure which required more than 5-6 min. A study on nurse anaesthetists performing this procedure in the operating suite showed an average checking time of approximately 3 min. A performance test was undertaken by activating four different malfunctions in an anaesthetic machine training simulator. Twelve of 17 nurse anaesthetists rapidly identified all faults, whereas five nurses missed one or two faults. Our study suggests that our check procedure (the seven point check) provides a time-saving method for effective pre-use control of the anaesthetic machine.

Anesthesia Department, Hospital↗
PubMed1994

A new approach to the study of diagnostic procedures in the United States.

Significant changes in the medical environment in the United States pose difficult questions for small medical specialties such as nuclear medicine. How do we get our voice heard in the debates that surround the reform process? What type of information is required to demonstrate the efficacy of nuclear medicine procedures? The older measures of sensitivity and specificity do not carry the same weight in health planning circles as they do in science. Data demonstrating the impact on the outcome for the patient are preferred. American nuclear medicine has started producing outcome data. We have high hopes that we can demonstrate to health planners both the medical and economic benefits of our specialty. Cardiac procedures seem to have an excellent chance of withstanding the challenges of analysis. Some oncologic procedures such as bone imaging are likely to survive unscathed as well. However, where procedure costs are very high, and the gains marginal, such as oncologic antibody imaging, there are serious questions about how these procedures will be reviewed. Likewise, while PET systems still hold great promise, unless data showing a positive impact on medical and economic outcome can be presented, this area is also in jeopardy. Where there is little challenge to the procedure, such as lung scanning, in all likelihood the procedure will retain its current place in the diagnostic algorithm. In closing, clearly as resources become increasingly scarce in medicine, difficult choices must be made. In the past, many of these decisions were made by those with the loudest voices.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗
PubMed1994

Dental procedures in patients receiving oral anticoagulation therapy.

Over a 10-year period a uniform management plan for patients receiving long term oral anticoagulation therapy for prosthetic heart valves and needing dental procedures was instituted. Those undergoing dental extraction or gum hygiene in the presence of gross gum pathology (Group A) had their oral anticoagulation discontinued two days prior to the procedure which was carried out only if the INR was 1.5 or less on the day of the procedure. Patients who needed dental fillings or gum hygiene in the absence of gross gum pathology (Group B) continued their anticoagulation therapy and had these procedures completed provided the INR was 3.0 or less. The main outcome measured were valve thrombosis, thromboembolism and excessive bleeding requiring hospitalization and/or blood transfusion. In Group A, 240 procedures were carried out; 212 dental extractions and 28 dental hygiene in the presence of gross gum pathology. They had a brief period of under-anticoagulation (3-7 days) to an INR of 1.5 or less. In Group B, 156 procedures were performed. No patient developed valve thrombosis or thromboembolism. Two patients, both in Group A needed hospitalization for observation but no blood transfusion. This management plan was easy to implement. Patients needed one extra visit to the anticoagulation clinic within one week of the procedure. It was both safe and effective.

Adolescent↗
PubMed1993

Causes for cancellation of aesthetic and reconstructive procedures.

Cancellation of plastic surgical procedures has several deleterious effects, including emotional distress and economic ramifications. This prospective study, conducted over a 12-month period in a solo practice, reviewed the factors that contributed to surgical cancellations. Cancellations occurred despite many strict measures such as at least two preoperative visits, in-depth counseling and reinforcement by surgeon and staff, laboratory testing done 2 weeks prior to surgery, detailed evaluation of medical background, extensive written and verbal instructions to avoid medications that adversely affect surgery, and thorough discussion of payment plans and insurance coverage, including predetermination of any third-party coverage. Of the 952 patients (667 males, 285 females) scheduled for surgery, 113 experienced cancellation of the operation, either by the surgeon and staff or by the patient. Cancellations were proportionally fewer in male patients (p < 0.025). The total number of scheduled procedures was 1590 (some patients scheduled for more than one procedure); 727 of these were cosmetic (46 percent), and 863 were reconstructive (54 percent). Of the 205 procedures canceled, cosmetic procedures were more likely to be canceled (p < 0.001), since 123 (16.9 percent) cosmetic procedures were canceled in contrast to 82 (9.5 percent) canceled reconstructive procedures. Because of multiple cancellations, there were a total of 119 cancellations for 113 patients. Thirty of the 113 patients were rescheduled at a later date. Of these 30, 24 did undergo surgery, while 6 canceled for a second time. Thirty-two of the 113 canceled patients (28.3 percent) were patients in their fifth decade of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

The contribution of the undergraduate rural attachment to the learning of basic practical and emergency procedural skills.

OBJECTIVE: To assess the effect of a four-week rural attachment on the knowledge and competency of medical students in basic practical and emergency procedures. DESIGN: A before and after comparison of self-reported level of competence in 72 basic, emergency, diagnostic and therapeutic procedural skills. PARTICIPANTS: Eighty-five final year medical students at the University of Western Australia in 1991. OUTCOME MEASURE: A student was considered competent if he or she claimed to be able to do a procedure either alone or with assistance. RESULTS: Over 50% of students were competent in 57 procedures after the attachment compared with 37 procedures before it. There were 26 procedures in which more than 20% of students increased their competence. CONCLUSION: A higher priority needs to be paid to the undergraduate teaching of procedural skills. Rural attachments can play an important part in training medical students in the practical skills required of interns.

Adult↗
PubMed1993

Racial differences in the use of revascularization procedures after coronary angiography.

OBJECTIVE: To assess whether rates of coronary revascularization procedures differ between blacks and whites after coronary angiography is performed and to assess the relationship of these rates to hospital characteristics. DESIGN: A retrospective cohort study using 1987 and 1988 data on hospital claims and characteristics from the Health Care Financing Administration. SETTING: One thousand four hundred twenty-nine acute care hospitals that provide coronary angiography in the United States. PATIENTS: A national sample of 27,485 Medicare Part A enrollees, aged 65 to 74 years, who underwent inpatient angiography for coronary heart disease in 1987. MAIN OUTCOME MEASURE: The adjusted odds of revascularization with either coronary angioplasty or bypass graft surgery within 90 days of angiography for whites relative to blacks, controlling for age, sex, region, Medicaid eligibility, principal diagnosis, comorbid diagnoses, and hospital characteristics of ownership, teaching status, urban/suburban or rural location, and availability of revascularization procedures. RESULTS: White men and women were significantly more likely than black men and women, respectively, to receive a revascularization procedure after coronary angiography (57% and 50% vs 40% and 34%, both P < .001). The adjusted odds of receiving a revascularization procedure after coronary angiography were 78% higher for whites than blacks (95% confidence interval for odds ratio, 1.56 to 2.03). Statistically significant racial differences in the adjusted odds of receiving a revascularization procedure were present in all types of hospitals except rural hospitals, and these differences did not vary significantly by any of the four hospital characteristics (all P > .20 for interaction terms). CONCLUSIONS: Among Medicare enrollees, whites are more likely than blacks to receive revascularization procedures after coronary angiography. Racial differences of similar magnitude occur in all types of hospitals. These differences may reflect overuse in whites or underuse in blacks, but they are unlikely to reflect access to cardiologists or hospitals that perform revascularization procedures. Potential explanations include unmeasured clinical or socioeconomic factors, differing patient preferences, and racial bias at the hospitals performing angiography.

Black or African American↗
PubMed1996

The association between local diagnostic testing intensity and invasive cardiac procedures.

OBJECTIVE: To determine the extent to which geographic variation in invasive cardiac procedures can be explained by the variable use of diagnostic testing. DESIGN: A population-based cohort study using Medicare Part B data (physician services). SETTING AND SUBJECTS: Procedure data for all Medicare beneficiaries in northern New England. MAIN OUTCOME MEASURES: Twelve coronary angiography service areas were constructed for Medicare beneficiaries in northern New England. Age- and sex-adjusted utilization rates were developed for three procedure categories: total stress test, coronary angiography, and revascularization. Total stress tests were further stratified into nonimaging and imaging procedures (eg, thallium). Tests performed in follow-up to invasive procedures were excluded (eg, stress test following revascularizations). Linear regression was used to assess the relationship between procedure categories. RESULTS: A tight positive relationship was found between total stress test rates and the rates of subsequent coronary angiography (R2=0.61, P<.005). Most of the variance was explained by imaging stress tests (R2=0.50, P<.02). A strong relationship was found between coronary angiography and revascularization (R2=0.82, P<.001). Finally, a clear relationship between total stress tests and subsequent revascularizations was also found (R2=0.55, P<.006). CONCLUSION: The population-based rates of diagnostic testing largely explained the variance associated with subsequent therapeutic interventions. Our results suggest that local testing intensity is an important determinant of the variable use of invasive cardiac procedures.

Cardiovascular Diseases↗
PubMed1996

The Malone antegrade colonic enema enhances the quality of life in children undergoing urological incontinence procedures.

PURPOSE: Functional alterations of the gastrointestinal and genitourinary tracts, and physical limitations in children with spina bifida, imperforate anus and spinal cord injury challenge the ability to have independent fecal and urinary continence. Urologists have successfully helped these patients achieve urinary continence. We report our experience with the antegrade colonic enema procedure, which allows select individuals to achieve continence of stool, enhancing quality of life. MATERIALS AND METHODS: Since December 1992, 18 antegrade colonic enema procedures were performed in 12 female and 6 male patients 5 to 31 years old of whom 14 had spina bifida, 2 had imperforate anus and 2 had spinal cord injury. Simultaneous urological continence procedures were performed in 8 patients, including appendicovesicostomy in 4, augmentation cystoplasty in 2 and augmentation cystoplasty plus an ileal Mitrofanoff procedure in 2. Four patients previously underwent urological reconstruction. RESULTS: In 24 months of followup (average 6.6) all patients with a functioning stoma remained continent of stool and 17 were continent of urine. Complications related to the antegrade colonic enema procedure occurred in 4 children (22%) of whom 3 required further surgery. Three patients (17%) had minor stomal stenosis. CONCLUSIONS: The antegrade colonic enema procedure is easily performed and it should be considered for any child with significant physical limitations and/or refractory fecal incontinence before urological continence promoting procedures are done.

Adolescent↗
PubMed1996

Effects of exam procedures on transient evoked otoacoustic emissions (TEOAEs) in neonates.

Debris in the ear canal and ear canal collapse in newborns have been shown to interfere with recording transient evoked otoacoustic emissions (TEOAEs). The purpose of this study was to prospectively evaluate the effects of two simple ear canal cleaning procedures on the TEOAE responses of normal newborns. Three hundred and sixteen ears were studied with an initial TEOAE followed randomly by either an otoscopic exam and refit procedure or a probe refit procedure. At the time of each procedure, any superficial debris attached to the otoscope or probe were removed before the second TEOAE was repeated with identical procedures. The study sample consisted of two equal groups of ears (otoscopic exam and refit). Each group initially had equal proportions of ears with no emission, a weak emission, or a robust emission. In the otoscopic group, 12 of 51 (24%) weak emissions converted to robust emissions, 10 of 53 (19%) no emissions converted to robust emissions, and 15 of 53 (28%) no emissions improved to weak emissions. In the refit group, 20 of 50 (40%) weak emissions converted to robust emissions, 13 of 57 (23%) no emissions converted to weak emissions, and 9 of 57 (16%) no emissions improved to weak emissions. Both the otoscopic viewing procedure and the refit procedure were effective in improving the TEOAE response.

Acoustic Stimulation↗
PubMed1996

Alterations in respiratory mechanics after laparoscopic and open surgical procedures.

OBJECTIVE: To compare the effects of laparoscopic and open surgical procedures on postoperative strength and respiratory mechanics. DESIGN: Prospective cohort study. SETTING: Adult university hospital. PARTICIPANTS: Fifty-one women aged 21 to 62 years scheduled to undergo elective cholecystectomy or hysterectomy (or related procedures), otherwise in good health. INTERVENTIONS: Open or laparoscopic cholecystectomy or hysterectomy (or related procedures). MAIN OUTCOME MEASURES: Maximum voluntary handgrip strength (HGS), forced vital (VC), forced expiratory volume in 1 second (FEV1), and maximal inspiratory pressure (MIP) were each measured preoperatively and on the first postoperative morning. A visual analogue pain scale score was evaluated in relation to performance of the postoperative strength and respiratory measurements. RESULTS: VC, FEV1, and MIP, but not HGS, were decreased after surgery. Postoperative VC, FEV1, and MIP were lower after open procedures than after laparoscopic procedures and after cholecystectomy than after hysterectomy (all p < 0.001). Pain scores were lower after laparoscopic than after open procedures (p < 0.005) and could account in part for differences in postoperative respiratory mechanics. CONCLUSIONS: Cholecystectomy and hysterectomy do not result in generalized muscle weakness, unlike more major abdominal procedures. Postoperative alterations in respiratory mechanics are related to the site of the surgery, the use of an open versus a laparoscopic approach and postoperative pain.

Adult↗
PubMed1996

Comparison of standard and abbreviated distortion product otoacoustic emissions procedures.

Standard and abbreviated distortion product otoacoustic emissions (DPOAEs) procedures derived using the Grason Stadler Model 60 instrument were compared. The standard and abbreviated procedures were compared at frequencies of 1000, 1250, 1593, 2000, 2531, and 3187 Hz for 48 ears from 28 subjects. The subject pool included individuals with normal hearing and those with sensorineural hearing loss. The abbreviated procedure correlated well with the standard procedure for DPOAE amplitude cross all frequencies tested. The two procedures were also highly similar in categorizing the subjects in regard to normal or abnormal hearing sensitivity. It appears that the shorter analysis time for the abbreviated procedure had little effect on its accuracy. Although the abbreviated procedure has an obvious frequency limitation, it may have some clinical advantages for hearing screening.

Acoustic Stimulation↗
PubMed1996

Factors affecting rhythm after the maze procedure for atrial fibrillation.

BACKGROUND: The maze procedure failed to abolish atrial fibrillation (AF) in 14% of patients with underlying organic cardiac lesions. Identification of contributing risk factors will improve results either by treatment of such factors or by avoidance of high-risk patients. METHODS AND RESULTS: We analyzed 192 consecutive patients with AF undergoing three variations of the maze procedure performed simultaneously with correction of valvular diseases (n = 165), congenital anomalies (n = 19), isolated AF (n = 7), and ischemic disease (n = 1). Twenty-six preoperative factors and two postoperative cardiac size parameters were analyzed by multivariate analyses between patients with successfully ablated AF (n = 165) and those who remained in AF (n = 27) after the maze procedure. Among all factors, postoperative left atrial dimension was the most potent in predisposing patients to persistent AF. Duration of AF left atrial dimension, and cardiothoracic ratio were identified as preoperative risk factors, whereas modifications of the maze procedure and pathogenesis and location of underlying disease failed to have a significant prognostic impact on rhythm after surgery. Individual risk analysis using the three preoperative variables revealed that left atrial size reduction to normalize its dimension played a pivotal role in determining rhythm after the maze procedure. CONCLUSIONS: Results favor earlier performance of the procedure before these risk factors develop, after which omission of the procedure or extensive left atrial plication may be appropriate. This requires further study.

Adolescent↗
PubMed1996

[Reconstructive and non-reconstructive procedures in the treatment of the threatened limb].

Limb threatening ischemia is an acute step in the chronic course of peripheral arterial obstructive disease that requires some form of intervention. The objective of this study is to prove that reconstructive surgery as well as non reconstructive approaches are associated with positive results. Ours is a retrospective analysis of a ten year experience in the treatment of limb threatening ischemia. In the period 1983-93, 139 patients under-went 164 procedures. 67% of patients were diabetics. Early in the observation period the therapeutic strategy was non reconstructive, the procedure of choice was sympathectomy. Later vascular reconstructions have been recognized as the procedures of choice. In the cases not amenable to reconstructive procedures according to our group criteria (absence of a tibial vessel in continuity with a patent pedal arch), we have employed procedures such as prostanoid infusion; thrombolysis and epidural spinal cord stimulation. Reconstructive procedures have been associated with a decrease in the number of major amputations. Alternative procedures, employed in patients not amenable to reconstruction have proven worthwhile in terms of limb salvage even if this trend is limited to a short period of observation.

Arterial Occlusive Diseases↗