Discordance in the sizing of abdominal aortic aneurysm and its significance

Much of the confusion surrounding the repair of asymptomatic abdominal aortic aneurysms relates to inaccuracies in their measurement, both preoperatively and intraoperatively. Multiple measurements of aneurysms at operation have convinced us that the largest and least variable diameter is the anteroposterior diameter measured from aortic wall anteriorly to vertebral bodies posteriorly. This APto-spine distance is accurately predicted by ultrasonography to within 0.3 cm. Computerized tomography does no better. Plain radiography is accurate but seldom applicable. When properly estimated, aneurysm size can be accurately determined preoperatively by either ultrasonography, computerized tomography, or plain radiography, in that order of preference. Since the decision to operate on asymptomatic aneurysms is based largely on their size, accurate preoperative estimation is essential.     

Developing a sensation information message for femoral arteriography

Sensation information is proposed as a way of decreasing the patient's distress during a threatening health care event. A first step in developing a sensation information message is to determine the content of the message. This study, using a systematic theory-based methodology, was conducted to describe and validate the common physical sensations experienced by patients undergoing the diagnostic procedure of femoral arteriography. (A conceptual framework based on how an individual perceives or senses a situation was used.) A three-stage survey design was used including: (1) tool development following observation of the procedure and pilot-testing of the interview schedule, (2) interview of patients who had undergone femoral arteriography about the sensations experienced during the procedure, and (3) validation of the responses. Twenty-one steps in the femoral arteriography procedure of which patients were aware were identified. Nine 'feeling' sensations commonly experienced during the procedure and the sights and sounds associated with the procedure were determined. The sequencing and duration of procedure steps were observed and the environment in which the procedure was performed was described.     

Long-term outlook in quadriplegic patients with initial ventilator dependency

Traumatic spinal cord injuries frequently result in respiratory insufficiency. With intensive medical support, many of these patients live productive lives in spite of severe neurologic deficit. A ten-year review of ventilator-dependent quadriplegic patients at Craig Rehabilitation Hospital was undertaken to determine the number of patients who could be weaned from mechanical ventilation and their long-term survival rate. Ventilator dependency is defined as requiring continuous mechanical ventilatory support for 30 or more days. Of the 134 patients that were included in the study, 76 were weaned during initial hospitalization. Factors which adversely affected ability to wean include: 1) high level of neurologic injury, 2) age greater than 50 years, and 3) other associated injuries. Of the ventilator-dependent patients surveyed after leaving the hospital, survival rate at one year was 90 percent (37 of 41), 56 percent (14 of 25), at three years and 33 percent (7 of 21) at five years. We conclude that vigorous medical support and maximal efforts to wean these patients from mechanical ventilation should be undertaken to: minimize the financial and emotional burden of long term institutional care, reduce ventilator dependency, and improve overall quality of life.     

Osteochondritis dissecans of the lunate

Osteochondritis dissecans of the lunate appears to be extremely rare. A case is reported with no predisposing abnormality and with no history of previous trauma. The problem was successfully managed by arthroscopic surgery.     

Variability of colonic function in healthy subjects.

Twenty healthy subjects eating normal diets made repeated five-day stool collections, the 10 females making their collections in four to six successive weeks. In most subjects there were striking variations in transit time, measured by Hinton's method. The variability of average faecal wet and dry weight, faecal volume, and the frequency of defaecation was equally great, suggesting that the transit time variations were genuine. The size of individual stools varied even more, often tenfold or more. Faecal water content was relatively constant. There were no significant differences between males and females, and in the females there were no obvious changes related to the phases of the menstrual cycle. The normal variability of colonic function should be taken into account in planning experiments and in interpreting existing data.     

Radio frequency identification applications in hospital environments

Radio frequency identification (RFID) technology has recently begun to receive increased interest from practitioners and academicians. This interest is driven by mandates from major retailers such as Wal-Mart, Target and Metro Group, and the United States Department of Defense, in order to increase the efficiency and visibility of material and information flows in the supply chain. However, supply chain managers do not have a monopoly on the deployment of RFID. In this article, the authors discuss the potential benefits, the areas of applications, the implementation challenges, and the corresponding strategies of RFID in hospital environments.