Recombinant urokinase for restoration of patency in occluded central venous access devices. A double-blind, placebo-controlled trial

The interval occlusion of central venous access devices (CVADs) remains a significant clinical problem, often requiring re-intervention for catheter exchange or replacement. The purpose of this Phase 3, multi-center, double-blinded study was to test the hypothesis that instillation of recombinant urokinase (r-UK) 5000 IU/ml is superior to placebo in restoring total catheter patency to an unselected cohort of occluded CVADs. After obtaining informed consent, adult and pediatric patients with occluded, non-hemodialysis CVADs of any duration or type were randomized (2 : 1) to receive either r-UK 5000 IU/ml or placebo instilled into all occluded lumens of their catheter. Catheter function was assessed at 5, 15 and 30 min after the first instillation. If the catheter remained occluded after 30 min, a second dose was instilled with repeat assessments at 5, 15 and 30 min. The primary efficacy variable was the restoration of catheter function to all treated lumens (i.e., total catheter patency) after one or two instillations. Catheters that were not successfully recanalized after two instillations were allowed to receive up to two instillations of open-label r-UK administered in the same manner. The primary safety variable was the occurrence of hemorrhagic and non-hemorrhagic events within 72 hr after instillation. A total of 180 patients were enrolled at 43 sites in the United States and Canada. Most patients were adults, although 20% were 相似文献   

Comparing aspects of mental health legislation of Israel and Massachusetts

This paper compares the manner in which two sets of mental health laws, that of Massachusetts, U.S.A., and that of the State of Israel, deal with specific areas of civil enforced commitment. The definition of psychiatric disorder that justifies commitment is broader in Massachusetts, in Israel psychosis alone is considered, excluding conditions such as severe non-psychotic depression, obsessive-compulsive disorder and anorexia. In Israel, commitment is possible only when there is a risk of danger that is immediate. In Massachusetts, only a judge can make decisions beyond the first four days, while in Israel they are made by a District Psychiatrist. Unlike Massachusetts, there is no possibility of enforced commitment of alcoholics or drug addicts in Israel, even in the presence of impaired judgement and severe family distress. The changing trends are presented, as Israel seems to be drawing slowly toward the Massachusetts position in some of these issues. The role of consumers in these processes is considered, as is the possibility of enforced commitment of people with severe personality disorders.     

Support Needed to Create Psychiatric Advance Directives

Psychiatric advance directives (PADs) inform treatment during periods of compromised decision-making. We report consumer desire and need for support to create PADs among 106 adult outpatients with severe and persistent mental illness. PADs were completed using computer software and flexible peer support. All participants were able to complete PADs. However, nearly all participants needed support using the software, or clarification of PAD information. Types of support needed may vary depending on PAD creation methods. While one-third of participants wanted support from case managers to complete PADs, the appropriate level of clinician support is not clear-cut, and should be at consumers' discretion.     

Anesthetic management for the placement of a fully implantable artificial replacement heart: a case report

Of the patients with end-stage cardiomyopathy on a heart transplant list, 95% do not receive a donor heart. Due to this severe shortage of donor organs, an artificial replacement heart has been pursued for several decades. To date, 10 patients have received an Abiocor artificial replacement heart (Abiomed, Inc, Danvers, Mass), the latest artificial heart device available. Anesthetic management often is complicated by the preoperative multisystem organ failure arising from the patient's advanced cardiomyopathy. Hemodynamic stabilization before cardiopulmonary bypass is extremely challenging, and the postbypass period creates a unique situation in which the only control the anesthesia provider has on the hemodynamics is management of the systemic vascular resistance. This article describes the anesthetic management of the recipient of the Abiocor artificial heart with the longest survival time.     

Management of a patient admitted with acute non-ST-elevation MI

This case study reviews the history, symptoms, management and rehabilitation of a patient admitted to accident and emergency with severe chest pain. After other conditions had been ruled out he was diagnosed with acute non-ST-elevation myocardial infarction. He later underwent a coronary angioplasty.     

Community dwellers' perspectives on the experience of feeling very tired

Feeling very tired is a phenomenon experienced by all humans at some point in their life. As a means of more fully understanding the human experience of feeling very tired, this concept was explored with a group of 10 community dwelling individuals who had no expressed health concerns. The Parse research method was used to answer the research question, What is the structure of the lived experience of feeling very tired? The central finding of this study is the structure: The lived experience of feeling very tired is dissipated vigor arising with monotonous disquietude amid spirited cherished engagements. The structure was conceptually integrated with the human becoming theory as: feeling very tired is powering the languaging of valuing connecting-separating. The findings are discussed in relation to human becoming and future research.