ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A questionnaire investigating the psychologic sequelae of malpractice litigation was administered to sued and nonsued physicians through a major malpractice insurer in a rural southern state. Factor analysis showed clusters of symptoms, including psychologic trauma, job strain, shame/doubt, and active coping. Psychologic stress decreased with time (but did not return to baseline after 2 years), with winning a case, and with increased age. Stress was increased among those with cases pending or multiple suits. Female physicians used more active coping strategies, and being in a high-risk specialty led to greater job strain and active coping, regardless of litigation experience. Malpractice litigation is a major life trauma that should be dealt with as any other trauma, including use of positive coping strategies such as knowledge of the psychologic sequelae, cognitive reframing, and collegial and personal support systems.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The Heart Smart Family Health Promotion Program is a multidisciplinary, school-based program for cardiovascular risk reduction among high-risk children and their families. As a program that includes young adults at high risk, it is adaptable to a clinical practice. Nineteen fourth and fifth graders were selected as probands for elevated risk factors after a general screening to identify families for an intervention program. Twenty-three parents participated in a 12-week program focused on eating, exercise, and smoking behavior changes enhanced by behavicral support strategies. Weekly sessions were held in the auditorium/cafeteria of the elementary school and consisted of orientation and presentations, cardiovascular (GV) screening with medical feedback, activities, self-monitoring, counseling, and contingency contracting. Information gathered before and after the program included medical history, CV health knowledge and relevant behavior, blood pressure, serum lipid and lipoprotein values, anthropometric measurements, and urine electrolyte excretion. Both children and parents showed positive changes in eating habits and physical activity and significant changes in knowledge and blood pressure levels, while the children halted their weight gain. We believe this multidisciplinary, behavior-oriented, school-based program can be an effective cardiovascular risk intervention adaptable for a clinical office practice.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Cellulitis, infected wounds, abscesses, and other bacterial infections of skin and soft tissue are commonly seen in the practice of emergency medicine. Informal observations in a teaching hospital suggest that newer agents having a broader antibiotic spectrum are frequently used for empiric outpatient treatment of mild to moderate soft tissue infections, so information from a prospective study was analyzed to determine whether this practice is appropriate. Healthy adult volunteers were enrolled in a study of the acrobic bacteriology and response to treatment of skin and soft tissue infections. Patients were randomized to receive a 10-day regimen of cephalexin (500 mg bid or qid) or ofloxacin (300 or 400 mg bid). Clinical response was assessed on two follow-up visits. Of 72 patients enrolled, 45 (63%) had cultures positive for pathogens. Cultures in 31 patients (43%) were positive forStaphylococcus aureus, five (7%) grew gram-negative rods, and five (7%) grew streptococcal species. Clinical response rates exceeded 95% in both the cephalexin- and ofloxacin-treated patients. Pathogens isolated from skin and soft tissue infections treated in the emergency department are not exotic or multiply resistant. The bacteriologic profile and clinical course of uncomplicated soft tissue infections indicate that treatment with a “simple” antibiotic, such as cephalexin, will result in resolution of the infection in nearly all cases. Broader spectrum antibiotics are not required for initial treatment of soft tissue infections in the emergency department.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Trauma is the fifth leading cause of death for the elderly. Approximately 7.4 million (3% of the population) are more than 80 years old (the so-called “old” old). More than 40% of Americans will reach the age of 80 years, and those who do can expect to live an average of 8 years more. The advanced elderly burn victim creates special demands because of a greater morbidity and mortality associated with a smaller body surface area burn. From September 1982 through August 1990, there were 29 patients 80 years old or older treated at our burn center. The mean age was 83 years, and 72% of the patients were women. The most common preexisting medical problems were hypertension and diabetes. Seventeen (59%) survived. The mean percentage of body surface area (BSA) burned was 6% among the survivors, with a mean length of hospital stay of 24 days. The mean BSA burned was 32% among those who died, with a mean stay of 17 days. Five of the 12 deaths were due to burns of less than 20% BSA, below the standard commonly used to define a “major” burn. The abbreviated burn severity index (ABSI) was a good indicator of survival. Eleven of 12 with an ABSI of 7 or less survived, and nine of 11 with an ABSI of 9 or more died. Twelve patients had operation; seven survived. Of the 15 survivors living independently before the injury, 11 were discharged home and four were transferred to nursing facilities. In this age group, even small burns can be problems, and indications for hospital admission should be broadened. The advanced elderly also cause financial burdens to burn centers because of inadequate diagnosis-related group (DRG) reimbursement. For those surviving, there is a good chance for maintaining independent function and for being discharged home.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Legislation recently passed by Congress will require health care organizations to maintain specific procedures regarding the right of patients to prepare advance directives. Previous studies have shown that patients may wish to discuss issues regarding future terminal care, but few patients complete living wills or durable powers of attorney. Although physicians often have positive attitudes regarding advance directives, the majority do not initiate discussions regarding these issues. The new regulations may increase the awareness of directives and increase the documentation of patients' desires into the medical record. However, the widespread acceptance of the advance directive and its impact on health care decisions remain to be seen.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Stereotactic biopsies of brain tumors have recently become frequent, but prognosis may be improved by more aggressive surgery for primary and metastatic tumors. This report describes techniques for debulking and removal of deep cerebral tumors that are commonly subjected only to biopsy. With the use of intraoperative ultrasonography and cortical mapping, five gliomas were debulked and three metastatic lesions were grossly totally removed. No complications occurred, and the patients metastatic disease had striking neurologic improvement. Deep cerebral tumors may treated aggressively with appropriate surgical techniques in selected patients.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We describe a system for stereotactic radiosurgery with a linear accelerator. This technique allows treatment of small (<40 mm diameter) intracranial lesions, including vascular malformations, and primary and metastatic tumors that are deep within the brain or in areas not amenable to open surgery. A beam of ionizing radiation (1800 to 2500 cGy) is focused on the center of the lesion, which is determined by stereotactic localization. “Dynamic rotation” of the linac gantry and table continuously about this predetermined point ensures that only the lesion receives the full radiation dose, while the normal structures in the head receive minimal amounts of radiation. The system combines, for the first time in one place, elements of radiosurgical technique developed at various centers. Testing for accuracy compares favorably with results at other centers using linac-based systems as well as comparing favorably with the gamma knife.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Postoperative intussusception in children is a rare but well recognized phenomenon. The diagnosis is often delayed due to the protean manifestations of the disorder (ileus, distention, and nausea and vomiting) which, when encountered shortly after an abdominal operation, usually result in a low index of suspicion because they are common after laparotomy. Experience with two cases of postoperative intussusception within 24 hours heightened our index of suspicion. Review of our records indicated we had diagnosed and treated postoperative intussusception in 14 children during the preceding 4 years. Patient ages ranged from 4 months to 12 years (mean 39 months, median 20 months), and symptoms appeared on postoperative days 3 to 36 (mean 10 days, median 6 days). Initial operations included excision of a retroperitoneal or abdominal tumor (five cases), Nissen fundoplication and gastrostomy (three), ileal resection (two), Ladd procedure (one), Duhamel operation (one), and operative reduction of ileocolic intussusception (the two most recent cases). Eleven patients had appendectomy (five by the inversion technique), and three had placement of a transgastric small bowel feeding tube. Nine children had had either barium enema or upper gastrointestinal studies because of the postoperative suspicion of obstruction; one patient had both. Diagnostic studies were not done in four patients. Operative reduction was successful in all but one child, who required bowel resection.

ISSN:0038-4348    

出版商:OVID    

年代:1991

数据来源: OVID