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101.
Luis I. Ruffolo Marsha Pulhamus Theresa Foito Elizabeth Levatino Heather Martin Julie Michels Jan Schriefer Kori Wolcott Derek Wakeman 《Journal of pediatric surgery》2021,56(1):30-36
PurposePediatric gastrostomy tubes (G-tubes) are associated with considerable utilization of healthcare resources. G-tube dislodgement can result in tract disruption and abdominal sepsis. We aimed to reduce early G-tube dislodgement by 25%.MethodsAn interdisciplinary team convened to identify key drivers of G-tube dislodgement and implement initiatives to reduce this complication. A G-tube care bundle was implemented in 2018. Rates of early G-tube dislodgement (within 90 days of insertion) were tracked. 15 months of cases after bundle implementation were compared to 20 months of cases before implementation. Length of stay (LOS, balancing measure) and bundle compliance (process measure) were tracked.ResultsG-tube dislodgements decreased 47% after bundle implementation. Overall, dislodgements after G-tube insertion decreased from 43% to 19% dislodgements per tube inserted, p = 0.004. Reductions were observed for dislodgements occurring in both the inpatient (14% vs. 1.5%) and outpatient (29% vs. 18%) settings. Median LOS was reduced from 15.3 to 7.1 days following implementation, p = 0.004. Process measures demonstrated 75% or greater compliance one year after implementation.ConclusionAn interdisciplinary team using quality improvement science methodology can significantly reduce G-tube dislodgement and improve value after pediatric gastrostomy tube insertion.Type of studyLongitudinal cohort study.Level of evidenceIII. 相似文献
102.
Annals of Surgical Oncology - 相似文献
103.
Olasveengen Theresa M. Semeraro Federico Ristagno Giuseppe Castren Maaret Handley Anthony Kuzovlev Artem Monsieurs Koenraad G. Raffay Violetta Smyth Michael Soar Jasmeet Svavarsdóttir Hildigunnur Perkins Gavin D. 《Notfall & Rettungsmedizin》2021,24(4):386-405
Notfall + Rettungsmedizin - Der Europäische Rat für Wiederbelebung hat diese Leitlinie – Basismaßnahmen zur Wiederbelebung – auf Grundlage des... 相似文献
104.
John W. Bracey Mark A. Tait Sophie B. Hollenberg Theresa O. Wyrick 《Hand (New York, N.Y.)》2021,16(2):253
Background: Telemedicine is an evolving tool to increase patients’ access to subspecialty care. Since 2014, Arkansas has been utilizing telemedicine in the evaluation of patients with hand injuries. The purpose of this study is to assess the effect of this novel telemedicine system for the management of hand trauma on patient transfer. Methods: We reviewed data from the first year of the telemedicine program (2014) and compared it to data from the year prior (2013). Data collection from both years included number of hand consults and need for transfer. From the 2014 data, we also recorded the use of telemedicine, type of transfer, distance of transfer, and time to disposition. Results: During 2013 (pre-telemedicine), there were 263 hand traumas identified. In all, 191 (73%) injuries required transfer to a higher level of care, while 72 (23%) were managed locally. In the first year of the telemedicine program (2014), a total of 331 hand injuries were identified. A total of 298 (90%) resulted in telemedicine consultation with 65% (195) utilizing video encounters. After telemedicine consultation, local management was recommended for 164 injuries (55%) while transfer was recommended for 134 (45%). Using telemedicine, there was a significant decrease in the percentage of transfer for hand injuries (P < .001). Conclusions: The telemedicine program was well utilized and provided patients throughout the state with continuous access to fellowship trained hand surgeons including regions where hand subspecialty care is not available. The program resulted in a significant decrease in the number of hospital transfers for the management of acute hand trauma. 相似文献
105.
Charlotte V. Hobbs Jan Drobeniuc Theresa Kittle John Williams Paul Byers Panayampalli S. Satheshkumar Kengo Inagaki Meagan Stephenson Sara S. Kim Manish M. Patel Brendan Flannery CDC COVID- Response Team CDC COVID- Response Team Bailey Alston Shanna J. Bolcen Darbi Boulay Peter Browning Li Cronin Ebenezer David Tonya Hayden Han Li Travis Lim Panagiotis Maniatis Palak Patel Mathew Pauly Amanda Poe Lili Punkova Vera Semenova Evelene P. Steward-Clark Alexandra Tejada Briana Zellner 《MMWR. Morbidity and mortality weekly report》2021,70(9):312
106.
Nika Adham Laurence A. Borden Lee E. Schechter Eric L. Gustafson Tamara L. Cochran Pierrre J.-J. Vaysse Richard L. Weinshank Theresa A. Branchek 《Naunyn-Schmiedeberg's archives of pharmacology》1993,348(6):566-575
We recently described the cloning of a fifth member of the 5-hydroxytryptamine (5-HT)1 (serotonin1) receptor class that inhibits adenylyl cyclase, namely the human 5-HT1F receptor (Adham et al. 1993 a). In the present study we have examined in greater detail the functional coupling of the 5-HT1F receptor in two different cell lines, NIH-3T3 and LM(tk–) fibroblasts (receptor densities of 1.7 and 4.4 pmol/mg protein, respectively). The maximal inhibitory response elicited by 5-HT was significantly greater in NIH-3T3 as compared to LM(tk–) cells, whereas the EC50 values were comparable.To investigate the relationship between receptor occupancy and inhibition of cAMP accumulation mediated by 5-HT1F receptors in NIH-3T3 cells (and hence the degree of receptor reserve), we used the irreversible receptor antagonist N-ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline (EEDQ). The half-maximal response required only about 10% receptor occupancy, consistent with a receptor reserve of 90% (88±2.1%, n = 4) for 5-HT-induced inhibition of FSCA. Despite the presence of such a high degree of receptor reserve, a range of intrinsic activities was displayed by structurally diverse classes of compounds. For example, sumatriptan and lysergol were as efficacious as 5-HT itself and thus acted as full agonists, whereas metergoline and 1-NP behaved as partial agonists and as shown previously (Adham et al. 1993a), methiothepin was a silent antagonist (Kb = 438 nM).We have also investigated activation of additional signal transduction pathways by the 5-HT1F receptor and found that the responses differ in the two cell lines with respect to stimulation of phospholipase C. For example, in NIH-3T3 cells no elevation of inositol phosphates (IP) of [Ca2+]i was observed even at very high agonist concentrations (100 M). In contrast, in LM(tk–) cells concentrations of 5-HT as low as 10 nM induced stimulation of IP and a rapid increase of [Ca2+]i. The 5-HT1F receptor failed to alter arachidonic acid release in either cell line.The maximal increase in IP accumulation in LM(tk–) cells was modest, averaging about 100% above basal. The increases of IP and [Ca2+]i required 5-HT concentrations less than one order of magnitude greater than those inhibiting FSCA (EC50 = 17, 55 and 8 nM, respectively), and both responses were blocked by 100 M methiothepin. All three responses (cAMP, IP, and [Ca2+]i) were sensitive to pertussis toxin pre-treatment, suggesting the involvement of Gi/Go protein(s) in these signal transduction pathways. [Ca2+]i was also elevated by sumatriptan, which may provide a mechanism by which this drug causes constriction of the vasculature. In conclusion, these data indicate that the human 5-HT1F receptor can couple to multiple effectors, and that this coupling is cell-type dependent.Abbreviations FSCA
forskolin-stimulated cAMP accumulation
- [Ca2+]
intracellular free calcium concentration
- AA
arachidonic acid
- EEDQ
N-ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline
- CHO
chinese hamster ovary cell
- LM(tk–)
mouse fibroblast cell
- Bmax
maximal binding site density
- Ki
apparent dissociation constant obtained from competition binding studies
- G protein
guanine nucleotide-binding protein
- HBS
HEPES-buffered saline
- IP
inositol phosphates
- IP3
inositol 1,4,5 trisphosphate
- PLC
phospholipase C
- Kb
antagonist dissociation constant
- Kd
equilibrium dissociation constant
- N-1F-6
stable NIH-3T3 cells expressing the cloned 5-HT1F receptor
- L-1F-3
stable LM(tk–) cells expressing the cloned 5-HT1F receptor
- PTX
pertussis toxin
- BSA
bovine serum albumin
- METH
methiothepin
- SUMA
sumatriptan
- 5-MeO-DMT
5-methoxy-N,N-dimethyltryptamine
- 1-NP
1-(1-napthyl)piperazine
- 5-CT
5-carboxyamidotryptamine
Correspondence to: N. Adham at the above address 相似文献
107.
Battista P Palmirotta R Vitullo P Veri M Colalongo C Rigoli L Fedele F Caruso R Inferrera C Romano F Marianicostantini R Frati L Cama A 《International journal of oncology》1997,10(1):65-70
Microsatellite replication errors (RERs), consisting in random tumour-associated allele contractions or expansions, represent a frequent genetic alteration in gastric cancer and appear to be associated with important clinicopathologic parameters. To verify the role of microsatellite instability in the initial phases of gastric carcinogenesis, we analysed the status of II microsatellites in paired microdissected samples of tumour and unaffected mucosa from 30 cases of early gastric carcinoma. Fifteen tumours (50%) demonstrated RERs: these included 7 cases with RERs at one locus and 8 cases with RERs at 2 or more loci. Cases with 2 or more RERs were more frequent among intramucosal tumours, compared to tumours with submucosal spread (43% vs. 12%) and among tumours staged T1NOMx, compared to tumours staged T1N1Mx (35% vs. 0%). RER-positive microsatellite typings were statistically more frequent among tumours with intramucosal extension, lower stage (T1NOMx) and excavated growth pattern (macroscopic type III), compared to tumours with submucosal extension, higher stage (T1N1Mx) and elevated, flat or depressed growth patterns (macroscopic types IIa-IIb-IIc respectively). The above findings indicate that microsatellite instability occurs early in the progression of sporadic gastric cancer and tends to be associated with good prognostic indicators. 相似文献
108.
109.
110.
Preliminary results of a multicentre trial of the electrically stimulated gracilis neoanal sphincter 总被引:5,自引:0,他引:5
Mander BJ Wexner SD Williams NS Bartolo DC Lubowski DZ Oresland T Romano G Keighley MR 《The British journal of surgery》1999,86(12):1543-1548
BACKGROUND: The electrically stimulated gracilis neoanal sphincter was initially developed to treat refractory incontinence. Good early results were reported from the two centres that pioneered the technique. The aim of this study was to assess the operation in a prospective multicentre setting. METHODS: The procedure was performed on 64 patients from seven centres worldwide and was performed in stages. All patients were evaluated clinically and manometrically before and after operation. RESULTS: There was a high incidence of infective and hardware-related complications. At a median of 10 months following closure of the defunctioning stoma 56 per cent had experienced a good functional result. The major functional problems comprised evacuatory difficulties experienced by 25 per cent. CONCLUSION: The technique is effective in treating otherwise refractory incontinence. It is, however, a complex procedure and the morbidity rate may be high, particularly during the learning curve, factors that necessitate careful patient selection. Presented to the Association of Surgeons of Great Britain and Ireland in Bournemouth, UK, April 1997 and the European Council of Coloproctology in Edinburgh, UK, June 1997; and published in abstract form as Br J Surg 1997; 88(Suppl): 39 and Int J Colorectal Dis 1997; 12: 144 相似文献