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At least 19 recordsLinked to original sources
PubMed1985

Mitral valve prolapse and hyperthyroidism: effect of patient selection.

Patients with mitral valve prolapse and hyperthyroidism have common symptoms; the most outstanding symptom is palpitation. To determine whether or not common symptoms contributed to the reported association of these conditions, we evaluated 220 patients with symptomatic mitral valve prolapse and 216 first-degree relatives in 72 families; 65 relatives with mitral valve prolapse and 151 relatives without mitral valve prolapse, all greater than or equal to 16 years of age. Thirty subjects, aged 49 +/- 13 years (p less than 0.025 vs entire study group), had thyroid disease (23 subjects had definite thyroid disease, seven subjects had probable); 27 of 30 subjects with thyroid disease (90%) were female (p less than 0.005). The age- and sex-adjusted prevalence of hyperthyroidism was significantly higher in probands with mitral valve prolapse than in family members without mitral valve prolapse (3.5% vs 0%, p = 0.03), while an intermediate prevalence of hyperthyroidism (2.2%) was observed in family members with mitral valve prolapse. Thus, the prevalence of hyperthyroidism is increased among symptomatic patients with mitral valve prolapse as compared to family members without mitral valve prolapse, but the prevalence of thyroid conditions is similar among family members with or without this condition. These findings are explained by the effect of common symptoms on clinical detection of both mitral valve prolapse and hyperthyroidism.

Adolescent↗
PubMed1992

Patient selection for treatment with conservative surgery and radiation therapy.

There is now general agreement that treatment with conservative surgery and radiation therapy yields survival equal to mastectomy with the advantage of organ preservation for properly selected patients. When competently performed, such treatment gives highly satisfactory cosmetic results and acceptably low rates of local tumor recurrence. However, there remain numerous controversies concerning patient selection for this treatment option. The factors involved in patient selection may be grouped into three categories: patient factors; clinical factors; and pathologic factors. This article reviews their use. Because breast cancer has a long natural history, long follow up of patients is required for ultimate proof of the relative merits of different selection or treatment policies. However, due to the increasing numbers of patients being treated with conservative surgery and radiotherapy, it appears likely that many of these questions will be answered within the next decade.

Breast Neoplasms↗
PubMed1988

Criteria used for patient selection for nursing students' hospital clinical experience.

This study investigated the criteria used by nurse educators when selecting patients for students' hospital clinical experience. Criteria were defined as individual elements or characteristics considered when selecting patients. Factors were defined as broad categories of related criteria. The sample consisted of 54 nurse educators from college and university nursing programs. A researcher-developed questionnaire was used. The three most important criteria for patient selection were: students' individual learning needs, patients' nursing care needs, and matching patients' needs with students' learning needs. One-way ANOVA was performed on the factors by subjects' demographic variables. Teacher-student clinical ratio, program in which teaching, and age most influenced the factors considered (p less than .05).

Clinical Clerkship↗
PubMed1992

Treatment of caliceal diverticular calculi with extracorporeal shock wave lithotripsy: patient selection and extended followup.

We treated 19 selected patients with calculi in 21 caliceal diverticula with extracorporeal shock wave lithotripsy (ESWL). By limiting this treatment to patients with relatively small (less than 1.5 cm.) calculi associated with a radiographically patent diverticular neck, a stone-free state was initially achieved in 11 patients (58%). Of 14 patients with flank pain before ESWL 12 (86%) were rendered symptom-free or markedly improved, often independent of a stone-free state. Extended followup in 13 patients for 12 to 49 months (mean 23.8 months) after ESWL revealed recurrent stones or stone growth in only 1. Although pain relief has remained constant for those initially rendered symptom-free, recurrent infection has been documented in 6 (67%) of 9 patients with infection before ESWL. We conclude that ESWL for selected patients with calculi in caliceal diverticula can achieve a relatively high initial stone-free rate and that recurrent stones may not be inevitable. Treatment in this setting also may provide long-term symptomatic relief that is often independent of a stone-free state. However, recurrent infection is not unusual, especially when associated with residual calculi. Considering the relatively noninvasive nature of this approach, ESWL should be considered an acceptable form of primary management for selected patients with calculi in caliceal diverticula.

Adult↗
PubMed1991

Results of resection and proposed guidelines for patient selection in instances of non-colorectal hepatic metastases.

Resection of hepatic metastases from carcinomas of the colon and rectum appears to extend the survival time in appropriately selected patients. Selection criteria have been widely published. Similar data for patients with hepatic metastases from primary sites other than the colon and rectum are lacking. To determine which, if any, patients in the latter category benefit from resections, we reviewed ten such instances treated at our institution plus 141 instances of resection for noncolorectal hepatic metastases previously reported. The over-all five year survival rate after resection of noncolorectal hepatic metastases is 20 per cent. When Wilms' tumor is excluded, the five year survival rate is 15 per cent. Approximately four of ten patients with metastases to the liver from Wilms' tumor or carcinoid survived five years after resection. Similar benefit is rarely obtained after resection of hepatic metastases of the breast, kidney, adrenal gland and carcinomas of the stomach; malignant melanoma, and leiomyosarcoma. No extension of survival is apparent for resection of hepatic metastases of gynecologic malignancies or carcinoma of the pancreas. Specific guidelines for selection are discussed in view of the limited prognosis when tumors other than carcinomas of the colon and rectum metastasize to the liver. Careful patient selection and minimization of complications are required.

Adult↗
PubMed1990

Patient selection for, results of, and impact on tumor resection of potency-sparing radical prostatectomy.

Our results show that by using the nerve-sparing radical retropubic prostatectomy, potency can be preserved in the majority of appropriately selected patients without compromising the adequacy of tumor excision. However, proper patient selection is important. Patients with focal, well-differentiated tumors, especially young patients with stage A or B1 tumors, are ideal candidates. In patients with more extensive and less well-differentiated tumors, there is a higher risk of incomplete tumor excision. Although we suspect that the adequacy of tumor excision is determined more by the extent of the tumor than by the technique of radical prostatectomy used, we believe that nerve-sparing surgery should be used with great caution, if at all, in patients with extensive or high-grade tumors. In these patients, microscopic extracapsular tumor extension is extremely common, can be impossible to detect at the time of operation, and is less likely to be adequately encompassed by nerve-sparing techniques. On the other hand, our current data provide little evidence that excision of the neurovascular bundles is beneficial. It is possible that more extensive resections will not materially alter the incidence of positive margins or cure rates. Finally, it might be argued that all forms of radical prostatectomy are inappropriate for patients with poorly differentiated clinical stage B2 prostate cancer for whom there are no really effective treatment options. We continue to recommend radical prostatectomy for these patients based on the finding that patients with clinical stage B2 disease who have organ-confined tumors can be expected to have excellent long-term disease-free survival rates similar to those of clinical stage B1 patients. In the remaining patients who are clinically understaged, the prospects for the minimal microscopic tumor remaining being controlled with adjunctive radiation therapy may be better than those of controlling the bulky primary tumor with radiation therapy alone. This hypothesis will need to be tested in a randomized clinical trial.

Erectile Dysfunction↗
PubMed1989

Efficacy of dental radiographic practices: options for image receptors, examination selection, and patient selection.

Many technical factors and treatment philosophies affect the way dental radiology is practiced. Some, like minimum tube filtration, are legislated. Others, like proper darkroom techniques, are universally acknowledged as essential. Still others, like the selection of an image receptor and the selection of the type of examination, are the subject of much discussion and debate. This article addresses some of the more controversial options and choices facing dental practitioners by reviewing the standard assessment techniques available to help make appropriate decisions, by summarizing and analyzing available data, and by offering recommendations for practice.

Efficiency↗
PubMed1992

Applicability of noncardioplegic coronary bypass to high-risk patients. Selection of patients, technique, and clinical experience in 3000 patients.

Although some surgeons still prefer noncardioplegic coronary bypass, most surgeons are skeptical of its suitability for high-risk patients. We analyzed the first 3000 patients who had primary coronary bypass without cardioplegia since our program's inception. Patients with reoperations, valve operations, or carotid endarterectomies were excluded. Multivariate predictors of operative death included age, sex, left ventricular dysfunction, preoperative intraaortic balloon pumping, and urgency of operation. Eight hundred seventy-nine patients (29%) were more than 70 years of age; 795 (27%) were female; 290 (9.7%) had an ejection fraction less than 0.30, and another 77 (2.6%) had left ventricular aneurysms; 196 (6.5%) had an acute myocardial infarction, and another 397 (13%) had a myocardial infarction less than 1 week preoperatively; 917 (31%) had rest pain in the hospital (preinfarction angina). Only 790 (26%) had elective operations. The overall operative mortality rate was 1.47% (44/3000): The mortality rate for elective operations was 0.5% (4/790); urgent 1.7% (28/1687); emergency 2.3% (12/523). In patients with an ejection fraction less than 0.30 the mortality rate was 6.2% (18/290); with age more than 70 years, it was 3.9% (34 of 879); with acute myocardial infarction it was 3.1% (6/196); and with left ventricular aneurysmectomy it was 1.3% (1/77). Inotropic support after leaving the operating room was needed in 6.6% (199 patients), and 1% (30 patients) required new intraaortic balloon pumping postoperatively (two of these 30 patients died). These results provide reassurance that noncardioplegic coronary artery bypass grafting provides excellent myocardial protection and operating conditions for primary coronary bypass and is particularly suitable for high-risk patients.

Adult↗
PubMed1988

Selecting patients when resources are limited: a study of US medical directors of kidney dialysis and transplantation facilities.

This study reports and discusses responses of 453 medical directors of renal dialysis and transplantation facilities to detailed patient selection questionnaires. The questionnaires examine selection criteria being used today as well as those which would be employed were resources to remain or become scarce relative to need. Selection criteria examined (and the number of directors supporting them when resources are limited) are: qualitative prognosis, psychological stability, likelihood of medical benefit, quantitative prognosis, medical benefit (virtually all); willingness, age (very large majority); unique moral duties, disproportionate resources, environment, progress of science, social value (majority); ability to pay, random selection, constituency (very large minority); sex (virtually none). Qualitative prognosis, quantitative prognosis, medical benefit, ability to pay, and especially age are the criteria employed today whose influence would increase if resources are further limited. Some of the ethical implications of various criteria are discussed.

Eligibility Determination↗
PubMed1975

Coronary artery anatomy before and after direct revascularization surgery: clinical and cinearteriographic studies in 67 selected patients.

This report relates the postoperative clinical and cineangiographic status of 67 patients selected from a total of 202 patients who underwent coronary artery surgery at the Peter Bent Brigham Hospital from July, 1970, to July, 1972. The mean interval after operation was 12.6 months. Ninety-one per cent of the 67 patients were improved from their preoperative status. Forty-eight patients (71 per cent) were studied to evaluate recurrence of mild to moderate angina or occurrence of interval myocardial infarction, and 19 patients (29 per cent) were entirely asymptomatic. In the 67 patients studied, 112 coronary arteries received a total of 115 grafts. (There were 89 ungrafted coronary arteries.) Total graft patency rate for the 58 patients in whom angina was totally or significantly relieved was 65 per cent. However, one or more grafts were patent in 52 (90 per cent) of these 58 patients. In grafted arteries, progression was found in segments proximal to the graft in 37 per cent of arteries, at the site of anastomosis in 10 per cent, and distal to the site of anastomosis in 17 per cent. The frequency of obstruction distal to the site of anastomosis was not significantly different from the frequency of progression in nongrafted arteries, in contrast to preliminary data from this laboratory. Overall and regional progression in grafted arteries appeared to occur primarily within the first four months after surgery and was found, thereafter, in a constand percentage of vessels studied. Progression in coronary arteries was independent of patency or occlusion of the graft to the vessel. It is hypothesized that while proximal progression is probably a consequence of altered hydraulic factors, distal lesions seem to represent natural progression of atherosclerotic disease.

Angina Pectoris↗
PubMedDate not supplied

Patient selection for lumbar discectomy. An objective approach.

A reproducible method is presented for selecting patients with low-back pain and sciatica for lumbar discectomy based on specific objective criteria in four categories: neurologic signs, sciatic tension signs, personality factors (MMPI scores), and lumbar myelography. Operative findings for 50 consecutive cases selected using this method revealed complete nucleus pulposus herniation in 43 cases. This contrasts with complete herniation in only 5 of 26 patients undergoing lumbar discectomy before the method was employed. This objective preoperative evaluation method reduced negative disc explorations and improved early surgical results. We recommend its use for patients being considered for elective lumbar discectomy.

Adolescent↗
PubMed1978

Results of the surgical treatment of selected patients with squamous cell cancer of the mouth and throat.

The five year results of excision of cancer of the oral cavity and oropharynx in 172 patients selected for surgical treatment are reported. The overall survival rate was 48.8%, with 39.5% of patients dying with persistent or recurrent disease. An unexpectedly high survival rate of 42.2% was achieved in 45 patients with residual or recurrent tumour resected after failed initial radiation therapy.

Carcinoma, Squamous Cell↗
PubMed1991

Transurethral balloon dilatation of the prostatic urethra: effectiveness in highly selected patients with prostatism.

Transurethral balloon dilatation of the prostate has been shown to be a safe and potentially effective alternative to surgery in the treatment of benign prostatic hyperplasia, with a 66% success rate in relatively unselected patients. This study hypothesized that more careful patient selection might result in a significantly better rate of improvement. Ninety-one subjects with symptoms and signs of prostatism attributable to benign prostatic hyperplasia were studied. Group 1 comprised 42 patients with an initial mean symptom score of 16.8, residual urine of 249 ml, maximal flow rate of 7.9 ml/sec, and nomogram of maximal flow rate of -1.5. Group 2 comprised 49 less symptomatic patients with an initial mean symptom score of 14.5, residual urine of 105 ml, maximal flow rate of 10.7 ml/sec, and nomogram of maximal flow rate of -0.8. The difference in mean age and prostate size between groups was not statistically significant, but differences in baseline symptom score, residual urine, maximal flow rate, and nomogram of maximal flow rate were significant (p less than .04). Transurethral balloon dilatation of the prostate was performed under local anesthesia or IV sedation and analgesia with single-or double-balloon catheters with maximal diameters of 25-30 mm inflated to 2.5-4.0 atmospheres pressure for 10 min. Patients were followed up with repeat symptom scoring, uroflometry, and measurement of residual urine. After a mean follow-up of 22 months (range, 6-48 months), an improvement in symptom score was seen in 80% of group 2 patients compared with 43% in group 1. Improvement in symptom scores was statistically significant in both groups (p less than .04). We conclude that transurethral balloon dilatation of the prostate is more effective in patients with more moderate symptoms and with less marked signs of obstruction than in patients with more marked prostatism.

Aged↗
PubMed1976

Patient selection for anticoagulant therapy in coronary heart disease.

Short-term anticoagulant therapy given after an acute myocardial infarction is directed toward preventing thromboembolism and is fairly safe. Long-term anticoagulant therapy prevents coronary thrombosis in selected patients with coronary heart disease (CHD), but carries an appreciable risk of hemorrhage. A decision for or against short-term therapy should be based on an assessment of the immediate risk of thromboembolism. Similarly, the risk of coronary thrombosis should be the major determinant in a decision for or against long-term anticoagulation. The most important information emerging from the clinical trials of long-term anticoagulant therapy in CHD concerns the significant benefit observed among patients with advanced disease.

Acute Disease↗
PubMedDate not supplied

Patient selection and administration of thrombolytic therapy (continuing education credit).

In selecting patients for thrombolytic therapy, four areas must be closely assessed. The patient's medical history and any family history of cardiovascular disease should be elicited. Once a diagnosis of acute MI is established, the patient must be assessed for any contraindications to thrombolytic therapy, thus avoiding potential complications, and such therapy must be properly administered. In each of these steps, the emergency nurse plays a pivotal role.

Acute Disease↗
PubMed1985

Patient selection for heart transplantation: when is a discriminating choice discrimination?

Section 504 of the Rehabilitation Act of 1973 prohibits discrimination against the handicapped in any program receiving federal funds. With its implementing regulations, Section 504 may well apply to the selection of patients for medical treatments. This article examines patient selection for heart transplantation, in light of the Rehabilitation Act and its previous application in similar (but non-medical) contexts. With the growing need to allocate scarce medical resources comes a need to examine carefully the legal bounds for patient-selection procedures.

Decision Making↗
PubMed1991

Bypass surgery for chronic stable angina: predictors of survival benefit and strategy for patient selection.

The variable mortality risk associated with chronic stable angina calls for careful selection of patients for coronary artery bypass grafting (CABG) if the aim of management is to prolong life. The randomized and observational studies done in the last 20 years have identified the variables relevant to patient selection and thus have provided a rational basis for such clinical decisions. These studies showed that the sicker the patient, as gauged by relevant measures of coronary disease and cardiovascular morbidity, the more likely it is that CABG will prolong life. A CABG-related improvement in survival is therefore more likely to occur the worse the left ventricular function; the greater the number of diseased vessels; the more proximal the location of coronary lesions (more muscle is threatened by such lesions); the greater the severity of the lesions as determined by angiography; the more severe the angina; the more easily provocable the ischemia or the more extreme the measures of ischemia; and, within limits, the older the patient. Greater survival gain after CABG also occurs in patients with peripheral vascular disease, in patients with baseline electrocardiographic ST-segment and T-wave changes, and probably in women. Thus, patients are likely to live longer after CABG if they have left main disease; three-vessel disease with left ventricular dysfunction (ejection fraction less than 50%), class III or IV angina, provocable ischemia, or disease in the proximal left anterior descending coronary artery; two-vessel disease with proximal left anterior descending artery involvement; and two-vessel disease with class III or IV angina as well as either severe left ventricular dysfunction alone or moderate left ventricular dysfunction together with at least one proximal lesion. When the decision of whether to do CABG is less clear-cut, the presence of peripheral vascular disease, female sex, baseline electrocardiographic ST-segment and T-wave changes, or older age (over 60 but under 80 years) should weigh in favor of doing CABG. In general, patients with single-vessel disease do not seem to derive survival benefit from CABG.

Angina Pectoris↗