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Denise M Connor Shawn Binkley Neil O Fishman Leanne B Gasink Darren Linkin Ebbing Lautenbach 《Infection control and hospital epidemiology》2007,28(12):1408-1410
We examined the possible unintended consequences of a 72-hour automatic order to discontinue vancomycin therapy in an antimicrobial stewardship program (ASP). Of 120 patients, 11 had vancomycin therapy discontinued at 72 hours without a call to the ASP, and 7 experienced a treatment interruption of 6-36 hours. All discontinuation of therapy was considered appropriate, and the 7 treatment interruptions did not have clear clinical consequences. Only one-third of patients had ASP stickers that warned of impending discontinuation of vancomycin therapy placed appropriately in the medical record. 相似文献
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Darren S Parsons David A Reaveley Darrell V Pavitt Madhukar Misra Edwina A Brown 《Nephrology, dialysis, transplantation》2003,18(9):1848-1853
BACKGROUND: Studies have reported an increase in median Lipoprotein (Lp) (a) in patients with high molecular weight (HMW) apolipoprotein (apo) (a) isoforms and renal impairment. Some studies identify Lp (a) levels as a risk factor for vascular disease in renal failure whilst others have demonstrated an association with apo (a) isoform type and vascular disease. METHODS: A total of 239 patients at end-stage renal failure (ESRF) were studied prior to the initiation of dialysis. Blood was taken for Lp (a) levels and apo (a) isoforms. Clinical vascular disease (CVD) was assessed on the basis of clinical history and Rose questionnaire. The control group for Lp (a) levels consisted of 228 healthy volunteers. RESULTS: Despite a higher median Lp (a) level in those with HMW isoforms, 30% of patients had Lp (a) levels <10 mg/dl. Overall, 49% patients were identified as having CVD. Diabetes, smoking history and Lp (a) levels were significantly associated with CVD in logistic regression analysis, although when patients with low molecular weight (LMW) and HMW isoforms were analysed separately, Lp (a) levels were not significantly associated with CVD in those with LMW isoforms. The rates of CVD in those with HMW isoform and low Lp (a) levels were significantly lower than those with HMW isoforms and elevated Lp (a) levels, 34 vs 57% (P < 0.01). CONCLUSIONS: Although median Lp (a) levels in those patients at ESRF with HMW isoforms are higher than controls, in a third of such patients Lp (a) levels remain relatively low. These patients have lower rates of CVD than those with high levels of Lp (a). 相似文献
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Recently, anatomic or double-bundle reconstruction of the anterior cruciate ligament (ACL) has been presented in an effort to more accurately restore the native anatomy. These techniques create 2 tunnels in both the femur and tibia to reproduce the bundles of the ACL. However, the increased number of tunnels, particularly on the femoral side, has raised some concerns among authors and surgeons. We describe a technique to reconstruct the 2 distinct bundles of the ACL by using a single femoral tunnel and 2 tibial tunnels, the “hybrid” ACL reconstruction. The femoral tunnel is drilled through an anteromedial arthroscopy portal, which allows placement in a more anatomic position. Fixation in the femur is achieved with a novel device that separates a soft-tissue graft into 2 independently functioning bundles. Once fixed in the femur, the anteromedial and posterolateral bundles of the graft are passed through respective tunnels at the anatomic footprint on the tibia. These bundles are independently tensioned, which creates a reconconstruction that is similar to the native ACL. The technique presented provides surgeons with an alternative to other double-bundle techniques involving 4 tunnels. 相似文献
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J H Calhoun F Li B R Ledbetter C A Gill 《Clinical orthopaedics and related research》1992,(280):15-22
Compression, distraction, and torsion stiffness of the Ilizarov external fixator was measured in two fracture models in autopsy specimens of tibia and fibula. A transverse model was tested in six frame constructions with the osteotomy site preloaded in four different positions. An oblique model was tested in four frame constructions also with four preloaded positions. Stiffness was more dependent on bone preload than wire number, wire type, or frame design. High stiffness was achieved by bone preloading, by compressing the rings together, by increasing the number of wires, and by using olive wires. The stiffness can be decreased (dynamization) by separating the rings and by removing wires. This data is helpful for frame design of the Ilizarov fixator. 相似文献
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K H Calhoun B R Peters C M Stiernberg F B Quinn 《Otolaryngology--head and neck surgery》1988,99(1):76-78
We report a metallic foreign body that entered through the anterior table of the frontal sinus, and rolled down to lodge in the nasofrontal duct. An electromagnet was used to remove the foreign body through a trephination. 相似文献
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Peter A. Schneider Peter W. Abcarian Darren Y. Ogawa Jean R. Leduc Philip W. Wright 《Annals of vascular surgery》1997,11(6):574-580
p < 0.01). Cumulative combined primary patency at 1 year by life-table methods was 82 ± 10% in the staged group and 83 ± 9%
in the simultaneous group (p= 0.79). Mean follow-up was 13 ± 6 months. There is a role for balloon angioplasty and stent placement in operative revascularization
of ischemic limbs in selected patients: patency was similar to that produced with the staged approach while the length of
stay was shorter. Intraoperative balloon angioplasty is safe and effective and stents permit a measure of control in assuring
an optimal intraoperative postangioplasty result. 相似文献