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At least 1,657 records · Page 92Linked to original sources
PubMed1999

Successful outcomes in pheochromocytoma surgery in the modern era.

PURPOSE: We describe our experience with surgical management, complications and treatment outcome of histologically confirmed pheochromocytoma. MATERIALS AND METHODS: The records of 113 patients who underwent surgical excision of pheochromocytoma were reviewed and assessed for preoperative medical treatment, intraoperative findings, postoperative hospitalization and complications. RESULTS: There were no surgical mortalities. Average length of stay in the intensive care unit was 1.2 days. There were only 6 major cardiovascular complications all of which occurred in patients who received preoperative medications, including 5 with alpha blockade. Patients receiving no preoperative alpha blockade required an average of 956 cc less in total intraoperative fluids, which approached statistical significance, and 479 cc less fluids on postoperative day 1, which was statistically significant. CONCLUSIONS: Preoperative alpha-adrenergic blockade is not essential in pheochromocytoma patients. Calcium channel blockers are just as effective and safer when used as the primary mode of antihypertensive therapy. Surgery for pheochromocytoma is safe in the modern era.

Adolescent↗
PubMed1998

FDA Modernization Act: implications for oncology.

The Food and Drug Administration (FDA) Modernization Act, signed into law on November 21, 1997, represents a sweeping review of existing standards for the approval, labeling, and promotion of prescription medicines. Certain sections of the act will influence access that oncologists and their patients have to new treatments and to information about those treatments. Major impacts of the act include: (1) continued funding of drug reviews by the FDA to assure a continuing stream of new drugs to prevent and treat disease; (2) providing greater flexibility in drug approval by permitting approval on the basis of one clinical trial and confirmatory evidence, and by instituting "fast track" designation to certain drugs that will permit approval on the basis of surrogate end points; (3) improving the access of physicians and patients to developing treatments by instituting a clinical trials databank and by authorizing the use of investigational products in emergencies; and (4) loosening restrictions on dissemination by drug companies of health, economic, and off-label use information, while maintaining incentives to investigate new uses for developing products.

Databases, Factual↗
PubMedDate not supplied

[Contribution to studies on the modern health care system in the Republic of Congo: geographical approach].

We carried out a geographic analysis of the modern health care system in the rural areas of Kouilou and Niari (Republic of Congo). Spatial differences in physical (e.g. vegetation, relief) and human (social and demographic profiles) factors must be characterized because they have an effect on the organization and spatial distribution of the health care system. The location of health care structures depended on the structure of the local environment. The health care system seemed primarily to be a component of the economic development determining population distribution in the forest area. In the savannah, it was part of the local administrative framework, the key factor determining the structure of the local space. Health care services were most used in areas with average to large population densities, in which there were the largest number of health care structures. Areas with "marginal" population densities and health care center distributions had the lowest rates of health care use. Health care zones can be defined by considering geographical characteristics and the characteristics of the health care system. This makes health planning (e.g. opening of health centers, improvement of health centers) much easier to undertake.

Congo↗
PubMed1990

The application of modern nurse call systems to flexible nursing.

This paper has shown how modern digital technology is being applied to nurse call systems and how integrated bed head services can be provided using the minimum number of cables and offering the maximum facilities within a very modest cost increase.

Hospital Communication Systems↗
PubMed1996

Modern Healthcare's 1996 physician compensation report.

In response to the confusing wave of physician compensation data released by trade groups, consulting companies and physician search firms, Modern Healthcare, for the third straight year, has combined reports from 10 organizations into an easy-to-read physician compensation compendium.

Data Collection↗
PubMed1997

The modern CIO: forging a new role in the managed care era.

The advent of managed care has helped forge new roles for healthcare professionals. Competitive pressures, the profile of the member community, and provider network design drive healthcare delivery via the managed care model. Careful analysis and design of the managed care model charts the success or failure of the health care delivery system--usually an integrated delivery system (IDS). Therefore, those healthcare organizations that have chosen to get on the managed care bandwagon must re-invent themselves, both culturally and technologically. The chief information officer (CIO) leads this technological revolution. To work effectively, the technological infrastructure of the IDS must be closely in line with enterprise goals and objectives. In the managed care environment the old information system (IS) approach of supporting the operational needs of individual departments simply will not work. The CIO's new role will be to master the concept of managed care to ensure that enterprise-wide needs for operational, clinical, and financial information are met, and that IS and enterprise goals are aligned. CIOs who have an intuitive grasp of the managed care environment--although their numbers are growing as managed care mushrooms--make up a minority group. They are a special breed with clearly definable qualities such as business savvy and an affinity for big-picture thinking. To an IDS, a CIO with these qualities is a rare gem indeed. This article introduces Don Winschel, the associate administrator and CIO of Johnson City Medical Center (Johnson City, TN) as an example of one such modern CIO.

Administrative Personnel↗
PubMed1976

Radiotherapy of skin cancer: modern indications and techniques.

Skin cancer is the most frequent indication for radiation therapy in dermatology. X-ray treatments are particularly valuable in cutaneous neoplasms in special anatomical locations. Advantages and disadvantages of dermatologic radiation therapy are outlined, and modern indications, radiation methods and the selection of physical radiation factors are discussed.

Aged↗
PubMed1998

FDA modernization act of 1997: guidance on medical device tracking; availability--FDA. Notice.

The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled "Guidance on Medical Device Tracking." This guidance is intended to provide guidelines to manufacturers and distributors about their responsibilities for medical device tracking under the Food, Drug and Cosmetic Act (the act), as amended by the Food and Drug Administration Modernization Act (FDAMA). This guidance addresses what statutory and regulatory tracking requirements have changed and what requirements remain the same under the FDAMA amendments. The agency requests comments on this guidance. Elsewhere, in this issue of the Federal Register, FDA is announcing new orders to manufacturers of devices that were subject to tracking.

Device Approval↗
PubMed1998

Medical devices; implementation of third party review under the Food and Drug Administration Modernization Act of 1997; emergency processing request under OMB review--FDA. Notice.

The Food and Drug Administration (FDA) is announcing a program under which persons may be accredited to review premarket notifications and recommend initial classification of certain medical devices. At the same time, FDA is announcing the termination of the Third Party Review Pilot Program. This notice announces the criteria to accredit or deny accreditation to persons (Accredited Persons) who request to conduct premarket notification reviews consistent with provisions of the FDA Modernization Act of 1997 (FDAMA). FDA is also announcing that this proposed collection of information has been submitted to the Office of Management and Budget (OMB) for emergency processing under the Paperwork Reduction Act of 1995 (the PRA). FDA is requesting OMB approval within 45 days of receipt of this submission. FDA is taking this action to implement section 210 of FDAMA. The availability of guidance detailing the review of submissions, training for third party reviewers, and basic document processing by FDA is announced elsewhere in this tissue of the Federal Register.

Accreditation↗
PubMed1981

Modern day fund raising: a whole new ball game.

Modern technology and fierce competition for the philanthropic dollar have revolutionized fund raising. Some special approaches are now required. One approach this author recommends is the development of a symbolic theme appeal.

Financial Management↗
PubMed1984

Modern medical practice: a profession in transition.

Modern medical practice is in a state of transition. The solo practitioner is slowly giving way to the large organized groups of health care providers. Driving this force of change is a change in payment for health care services from cost plus to preestablished pricing. For the first time, medical practice patterns are having a direct impact on the financial viability of the health care institution. To maintain quality of patient care and contain costs, more and more physicians are becoming involved in the administrative side of running a hospital. This article describes the forces of change, the change itself, and the future of medicine.

Humans↗
PubMed1989

Medical facility construction and modernization: requirements for provision of services to persons unable to pay; Office of Management and Budget approval of information collection requirements--HRSA. Final rule; effective date.

The Health Resources and Services Administration (HRSA) announces that the Office of Management and Budget (OMB) has approved the information collection requirements in Sections 124.509(c), 124.514(c), 124.515(b)(2)(ii) and 124.515(b)(3)(ii)(B) of the "Medical Facility Construction and Modernization: Requirements for Provision of Services to Persons Unable to Pay" final rule as published on December 3, 1987 at 52 FR 46022. The Department is amending the regulation to reflect OMB's approval under OMB Control Number 0915-0077. Upon publication Sections 124.509(c), 124.514(c), 124.515(b)(2)(ii) and 124.515(b)(3)(ii)(B) as amended below will become effective.

Data Collection↗
PubMed1999

[Modern diagnostic approaches to investigations of abdominal aorta changes in flying personnel].

Modalities of the modern radiation diagnostics (USI and computer tomography) in expert investigation of the ventral aortas in pilots of different aircraft were demonstrated. The most effective diagnostic algorithm of investigation and determination of hypertrophy of the ventral aorta, and detection of the atherosclerotic plaques calcinosis has been developed and its importance for medical certification demonstrated. Morphostructural changes in the ventral aorta were featured and correlated with the debilitating occupational conditions in different types of aviation.

Adult↗
PubMed1999

[All around the deathbed of Lubbert ten Busch. The Modern Devotion and the plague in Deventer in 1398].

The seriousness of plague epidemics can be expressed in numbers and medical terms, but we get closer to the past, and it becomes our own history more than in any other way, when we can empathise with the story of a single individual. In the summer months of 1398, the plague raged in the city of Deventer, which lies on the river IJssel, in the east of the present-day Netherlands. This plague epidemic also threatened the small community of priests and minor clerics which gave rise to the new spiritual movement of the Modern Devotion. This new community was concerned about its survival. Their vocation required that the brethren should help the citizens who remained behind. However, this could prove to be their undoing, and therefore it would be better to leave the city. They resolved the dilemma by dividing into two groups. Half of the brethren left to ensure the continuity of the community; the other half stayed in Deventer to help the people. The two groups stayed in contact by means of letters, the text of which has survived in several sources. The fears and forebodings became reality. The plague also affected the new community of brethren. The deputy rector, Lubbert ten Busch, also died of the plague. There is a letter from him which he wrote just before he died. This farewell letter was sent together with a letter from one of the brethren, saying that Lubbert had meanwhile died, and describing the scene of his death. Because of the personal tone and the tragic of content, the letters about the death of Lubbert ten Busch are unique medieval documents. They give a good insight into the way in which the plague could personally affect someone and his immediate companions in the late Middle Ages. This paper focuses attention on these letters, and reconstructs the events around this death, so that the letters speak to us once again.

Catholicism↗
PubMed1999

Evaluating marrow margins for resection of osteosarcoma. A modern approach.

Intraoperative evaluation of bone marrow margins by frozen section analysis is a common practice in the surgical treatment of osteogenic sarcoma. The purpose of this study was to assess the clinical use of intraoperative marrow margin evaluation to rule out occult intramedullary tumor extension in osteosarcoma surgery. One hundred twenty-eight consecutive patients with high grade osteosarcoma diagnosed between 1988 and 1996 (Group 1) were reviewed retrospectively and compared with 92 consecutive patients treated from 1979 to 1984 (Group 2). Eighty-five patients in Group 1 met the inclusion criteria of having high grade intramedullary lesions of the long bones observed on preoperative magnetic resonance imaging evaluation of the lesion and intraoperative frozen section analysis of the bone marrow margin. Thirty-three patients in Group 2 met the same inclusion criteria with the exception of having preoperative magnetic resonance imaging. Ninety-two marrow margins in Group 1 and 33 marrow margins in Group 2 were evaluated by frozen section. All 92 marrow margins in patients in Group 1 were negative by frozen section analysis and permanent histologic analysis. Of the 33 marrow margins in patients in Group 2, three (9.1%) were reported positive for tumor. Of these, one was found to be a false positive result on permanent pathologic examination. In addition, one false negative frozen section result was found, which was positive for tumor on permanent pathologic examination. The difference in true positive results of marrow margins between Group 1 and Group 2 was statistically significant. Intraoperative marrow margin evaluation by frozen section is not mandatory with modern imaging techniques. Preoperative evaluation of tumor extent using magnetic resonance imaging and intraoperative evaluation of the specimen by the pathologist (done by bivalving the specimen) are reliable methods to ensure adequate surgical margins in most cases of conventional osteosarcoma of the long bones.

Adolescent↗
PubMed1979

[Modern internal therapy of skin diseases (author's transl)].

Modern internal therapy of skin diseases is based on a knowledge of pharmacology and biochemical pharmacology. The importance of the cytochrome P 450 system and its changes during treatment are referred to. Standard treatment in dermatology is not discussed but the literature is mentioned here. Treatment with glucocorticosteroids and non-steroidal anti-inflammatory substances are discussed in detail. The treatment of porphyria cutanea tarda with chloroquine shows good success. The results of carotinoid therapy of erythropoietic protoporphyria and non-porphyrin induced photodermatoses are debated.

Anti-Inflammatory Agents↗
PubMed1999

[Esophageal carcinoma: accurate staging thanks to modern diagnostic methods open up new therapeutic strategies].

INTRODUCTION: Since the tumour stage has significant prognostic and therapeutic implications, accurate preoperative staging is decisive. ALGORITHM FOR DIAGNOSTIC STUDIES: Flexible endoscopy of the oesophagus with biopsies is the first diagnostic step in patients with signs of oesophageal cancer and allows assessment of (1) tumour localisation, (2) tumour size, (3) grade of stricture, (4) type of histology, and (5) cellular grading. Thereafter, CT scan of the chest and upper abdomen is performed to assess the provisional TNM stage. The local TN stage is verified in operable patients by endosonography and additionally by bronchoscopy if the tumour is located in the upper half of the oesophagus. The M stage can be preoperatively verified by laparoscopy. CONCLUSION: Modern diagnostic methods yield accurate staging, which makes it possible to optimise selection of the most appropriate therapeutic strategy.

Algorithms↗