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At least 1,261 records · Page 70Linked to original sources
PubMed2006

What are the professional and logistic demands to appropriately follow patients with an implantable cardioverter-defibrillator?

OBJECTIVES: To determine events during follow-up of patients with implantable cardioverter-defibrillators (ICD) and the specific experience cardiologists need for trouble-shooting. DESIGN: Prospective evaluation of all patient visits in an outpatient clinic. SETTING: University hospital, single centre performing ICD controls in a region of 1.5 Mio inhabitants. SUBJECTS: A total of 351 patients with 1118 consecutive visits during 14 months. INTERVENTIONS: Classification of events according to predefined training levels. MAIN OUTCOME MEASUREMENTS: Skill levels A: simple visit, e.g. for switching the device 'off'. B: normal visit, no further measures taken (no device reprogramming), even though the patient might have experienced ICD interventions. C: complex visit, electrophysiologist actively involved. Correlation of these levels with timing (routine, emergency on/off office hours) and reason of visits. RESULTS: Seventy-six per cent of visits were scheduled routine visits, 5% performed within 24 h because of shocks, 19% performed for other reasons (shock tests; switching the device 'off/on'; reported dizziness, syncope, palpitations without ICD interventions). Required skill levels were A in 44 (4%), B in 796 (71%) and C in 278 (25%) visits. Emergency visits were more often classified as level C (60%) than regular visits (20%), Skill level C was more often encountered during emergency (30%) than during regular visits (6%) (both P = 0.001). CONCLUSIONS: Our study suggests that for standard follow-up in patients without obvious problems, a cardiologist might be sufficient, whereas presentations due to/with clinical problems most likely will need the expertise of an electrophysiologist.

After-Hours Care↗
PubMed1989

Impact, logistics and prospects of traditional prenatal diagnosis.

Traditional second trimester prenatal diagnosis (PD) by amniocentesis was introduced about 20 years ago. It is still the most frequently used procedure for this purpose. About 85% of all requests for PD are based on maternal age alone. The commonest indication is a maternal age of 35 or higher at delivery. Attempts are being made to improve utilization of the limited laboratory capacity by evaluating the indication for PD by combining age and other indicators, ie. maternal-serum-alpha-fetoprotein and unconjugated estriol. Chorionic villus sampling so far has appealed to an additional group of pregnant women rather than being a replacement for the older procedure. While the impact of PD on the individual woman and her family is great, it has limited impact on the prevalence of Down syndrome patients in the society. Of major concern is the impact of PD on the attitude to a pregnancy with a possibly affected child, on the attitude to induced abortion in general and on the acceptance of disabled individuals. The importance of proper genetic counseling including ethical issues is stressed.

Amniocentesis↗
PubMed1992

Ethics, logistics and a trial of transurethral versus open prostatectomy.

An increased long-term morbidity rate after transurethral compared with open prostatectomy has recently been claimed on the basis of retrospective studies of operations done up to 20 years ago. These studies have led to a demand for a prospective trial. Most reports show that peri-operative mortality following prostatectomy is virtually confined to unfit men over 80 years old. Before agreeing to participate in a trial we examined our operative mortality in this group of patients. Between 1981 and 1987, 123 octogenarians underwent transurethral prostatectomy: 64 operations were elective and 59 were performed for retention. There were 2 operative deaths (1.6%), both from gram-negative septicaemia despite prophylactic antibiotics. There were no additional deaths in the first 12 months following surgery. Few of these patients would have been considered fit to undergo an open prostatectomy. Any proposed randomised trial would have to exclude such high risk patients until it can be shown that open prostatectomy is equally safe.

Aged↗
PubMed1991

Variation in torus mandibularis prevalence in Norway. A statistical analysis using logistic regression.

The prevalence of torus mandibularis was assessed in two groups of dental patients, altogether 2010 individuals over 10 yr of age: 1181 individuals native to the Lofoten Islands in North Norway, situated at 68 degrees latitude; and 829 patients indigenous to Gudbrandsdal, an inland district in the southeastern part of the country at 61 degrees latitude. Both groups were supposed to be of the same Caucasian stock and, therefore, to have similar genetic predisposition to torus on the average. The following observations were found: 1) the prevalence of torus mandibularis was much greater in Gudbrandsdal than in Lofoten (P much less than 0.001); 2) the prevalence decreased among persons above 50 yr of age as compared with those of the age classes 10-49 yr (P less than 0.01); and 3) it was smaller among women than men (P less than 0.05), mainly due to such a decrease in Lofoten. In a recent investigation of people living in Gudbrandsdal the fraction of the variation of torus that was attributable to genetic differences was estimated as about 30%, whereas approximately 70% of the causes seemed to be ascribable to environmental influences in terms of occlusal stress. It is suggested that dietary habits and number of existing teeth seemed to be environmental variables with an influence on the observed variation of torus prevalence between geographical regions, age classes, and sexes. The question about a possible sexual difference as to the genetic component of liability to torus mandibularis was outside the scope of the present study.

Adolescent↗
PubMed1970

Use of a logistic function in expressing kinetic hemolysis data.

A method of rectifying sigmoidal kinetic hemolysis curves is described. The curves are described, within limits, by the equation t = K(l/1 - l)(1/n) where t is time, K is a constant, l expresses the degree of lysis, and l/1 - l is the ratio of lysed to unlysed cells. This description holds over a wide range of red cell and lysin concentrations, provided the conditions are not substrate limited and the lysin preparation is reasonably stable. Graphical solution of the logarithmic transformation of the equation yields straight lines, and the intercepts of these lines with time ordinates may be used to define a time of initial lysis or, under suitable conditions, a time of 50% lysis. The time of initial lysis is inversely related to the lysin concentration, and thus its reciprocal may be used to precisely define units of lytic activity.

Journal Article↗
PubMed1992

The ethics of cardiopulmonary resuscitation. II. Medical logistics and the potential for good response.

Mismatches between provision of paediatric cardiopulmonary resuscitation (CPR) and potential to benefit are examined. Deficiencies are most likely to occur in peripheral maternity units but futile CPR is more common in emergency departments where the child is unknown. Decision making in individual cases is best retained by the medical profession for the sake of the child and family. American style intervention by the legislature is likely to dissipate scarce resources and perhaps harm infants not capable of benefiting.

Cardiopulmonary Resuscitation↗
PubMed2000

Scientific, ethical, and logistical considerations in introducing a new operation: a retrospective cohort study from paediatric cardiac surgery.

OBJECTIVE: To review the initial impact on mortality of infants with congenital heart disease of a new surgical technique that is now taken for granted. DESIGN: Retrospective cohort study. SETTING: A tertiary paediatric cardiology centre. SUBJECTS: 325 consecutive neonates with simple transposition of the great arteries admitted before, during, and after the preferred management changed from the Senning operation to the arterial switch (1978-98); and 100 consecutive neonates requiring a different neonatal open heart operation that did not change in that period. MAIN OUTCOME MEASURES: Mortality before and early after operation reconstructed sequentially as the series evolved and retrospectively once the series was complete; actuarial survival associated with the different treatment strategies. RESULTS: For both the transposition and the comparison group, early mortality in 1998 was lower than in 1978. During that period, however, there was a phase temporally related to the adoption of the switch operation in which early mortality for transposition increased. Actuarial survival of recent patients with "intention to treat" with arterial switch is superior to those with intention to treat with the Senning operation, as predicted when the switch operation was first adopted. CONCLUSIONS: A period of increased hazard for individual patients may occur when a specialist community, a particular unit, and an individual surgeon are all learning a new technique concurrently. Obtaining informed consent during this time of uncertainty is helped by clarity about the objectives of treatment and availability of relevant local and international data.

Child↗
PubMed1976

Introduction of a Vickers M300 analyser into the routine service of a hospital laboratory. 1. Installation, staffing, logistics.

A Vickers M300 analyser has been successfully installed in a busy hospital laboratory. A permanent team of operators is used, but this introduces problems for staff rotation, particularly for educational purposes. The vials used for the collection of samples are an essential feature of the system, but they present many difficulties and are no longer used for collecting samples from outpatients, or at remote sites. Direct costs during 1974, excluding staff and depreciation, amounted to approximately pounds 0-45 per patient sample: this is assessed on the rising workload during implementation. An increased workload could still be handled with existing staff. The siting of such high-capacity analysers constitutes an important policy decision.

Autoanalysis↗
PubMed1978

Pattern discrimination in matching chest radiographs. Including a role for logistic distribution of observer responses.

Tests were designed to determine how well individuals can differentiate similar chest radiographs. These tests were given to 17 persons (radiologists, x-ray technologists, medical students, and secretaries). Each test contained a number of paired, dissimilar, and/or unique radiographs which were to be distinguished from one another or matched. The results suggest, that a radiologist does not have an innate advantage over untrained observers in pattern recognition. It is not known whether pattern-recognition tests are valuable in evaluating potential radiologists. A receiver operating characteristic curve is also described.

Diagnostic Errors↗