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At least 1,333 records · Page 74Linked to original sources
PubMed1999

Logistics of parenteral fluids in battlefield resuscitation.

The paper discusses the substantial reduction in weight and volume of the fluids of resuscitation that is possible and desirable on the basis of sound physiology and the vast experience of the U.S. Army in four major wars in this century. We note the major shift in emphasis from massive colloid and whole blood in World War II and Korea to massive crystalloid and packed cells in Vietnam and the serious complications with which this was associated. These complications were edematous in nature and best known as the Da Nang lung, or adult respiratory distress syndrome, multiorgan dysfunction syndrome, and systemic inflammatory response syndrome. The advantage of colloid in reducing the weight and volume of resuscitation fluids in forward areas by 60% to 90%, as well as in avoiding the edematous complications of crystalloid-, are emphasized.

Adult↗
PubMed1999

[Organized screening of colorectal cancer in France. System of care and professional logistics].

The preservation or the amelioration of the health of individuals and populations does not only depend on the activity of the medical profession. It largely depends on public health policies. Screening for cancers illustrates how difficult it is to organise an action of public health within a health care system of liberal tradition in France. Through the example of screening for colorectal cancer, this article proposes to identify the mechanisms by which the system of health care determines the methods of organisation of mass cancer screenings. Through interviews carried out among the organisers of five colorectal cancer screening campaigns, we identified three models on which French screening campaigns are based: an administrative model, a medical model and a mixed model. Each of these models represents a different adaptation of the organisation of mass screening to the health care system in place in France. The interests of the concerned professional groups confront each other and the collective interest. It seems that to integrate such an approach to public health in a system dominated by payment per act is doomed to fail. Today, France can no longer avoid a modification of its health care system and of its nomenclature if it wants to improve the feasibility of cancer screening programmes and increase their chance of success.

Attitude of Health Personnel↗
PubMed1975

Logistic and technical considerations in the treatment of the wounded heart.

As improvements in the prehospital care of traumatically injured patients have paralleled advancements in cardiovascular surgery, changing concepts in the management of the patient with blunt and penetrating injuries of the heart have occurred. More critically injured patients now arrive at a hospital facility still alive than in former years. Between 1951 and 1974, 350 patients with heart injuries were treated at Harris County Hospital District facilities. Gunshot wounds now predominate, compared with stab wounds in former years. Thirteen patients had rupture of the heart secondary to blunt trauma. Patients arriving with cardiac arrest and cerebral signs of preterminal activity had a 67% survival rate when cardiorraphy was performed in the Trauma Center. In the last four years, 50 patients without cardiac arrest, but frequently with pericardiocentesis as a preoperative adjunct, had an 87% survival rate.

Female↗
PubMed2001

[REVEIL Trial: Study validity, information and logistics. Preliminary results. Quality measures].

Self blood pressure measurement (SBPM) is not fully applied because of the cost of devices and the lack of efficient dedicated medical networks. The aim of the REVEIL study was to allow patients to freely rent SBPM devices by their pharmacist after initial medical prescription. Practitioners taught SBPM methods to the patients with a booklet and the pharmacist explained them how to use the device. This preliminary report focuses on the 428 first patients included from September 1999 to June 2000 by their general practitioner (n = 59) or cardiologist (n = 12) in the centre of the city of Reims (France), when he thought there was an indication for a SBPM period. The patient received a medical prescription and took a validated device (Omron 705CP) by one of the 44 pharmacists who accepted to participate. After 7 days the patient consulted his practitioner with the filled booklet. The prescription was for 7 days with 3 measurements each morning (before intake of antihypertensive drugs) and each evening (12 hours later). Patients reported the results on the booklet and enclosed the report printed by the device. From the 428 included patients, 362 (85%) gave analyzable data, the difference being explained by refusals (n = 39) and by the lag between inclusion and completion. Mean age was 55.2 (range 20 to 90). Education levels were: no graduation (n = 71), primary school (n = 172), college (n = 59), university (n = 86) [no answer in n = 40]. Seventy nine percent (n = 286) performed at least 12 measurements on three consecutive days. There is no significant difference between morning and evening completions. According to themselves, 294 patients fully succeeded in SBPM. Eighteen failed (6 reported a failure of the device, 2 had not understood the procedure, 5 had forgotten, 5 reported another cause), 50 did not answer. These results establish the fair applicability of SBPM under the realistic conditions of the REVEIL study (free rent of devices after medical prescription) as 85% of patients gave contributive information with a good quality in 79% of them.

Adult↗