Health Care Blog (Part 2)

Canadian Neighbor Pharmacy: Results of Procedures Requiring Signed Consent

hospitalsPolicies were received from 65 (49 percent) of the 132 Indiana hospitals, 21 (44 percent) of the hospitals of greater than 500 beds, and 19 (34 percent) of those facilities with less than 275 beds. Thirty-seven (57 percent) of the responding Indiana hospitals use a general consent form, while 28 (43 percent) itemize specific procedures that require signed patient consent. Among the 21 responding large hospitals from outside Indiana, 11 (52 percent) use a general format while ten (48 percent) specify procedures. Data for the 19 smaller hospitals are similar with 11 (58 percent) incorporating a general guideline and eight (42 percent) itemizing procedures (Table 1).

Therefore, of the 105 hospitals answering the survey, 59 (56 percent) use a general statement as the hospital policy directing when a formal signed approval from the patient is necessary. The remaining 46 (44 percent) itemize one or more specific diagnostic or therapeutic procedures requiring signed consent. These latter hospitals may or may not also have a more general policy statement as part of their precise list to provide general coverage for other nonspecified procedures. The largest number of specified procedures by a single hospital was 55. The list of clinical procedures itemized by more than 10 percent of the 46 hospitals using a specific policy format is given in Table 2. Adjacent to each item is the number of hospitals specifying that procedure.

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Tags: Hospitals, local anesthesia, therapeutic procedures

Canadian Neighbor Pharmacy: Pathogenic Determinants of Ischemic Heart Disease

Ischemic heart diseaseIschemic heart disease is manifested as angina, myocardial infarction, arrhythmia and sudden death. However, asymptomatic ischemic heart disease is quite common, as evidenced by recent data from the cardiac care unit, exercise laboratory, and ambulatory ECG recordings. Furthermore, epidemiological studies reveal that painless myocardial infarction is a frequent occurrence.

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Tags: ischemic heart disease

Canadian Neighbor Pharmacy: Pulmonary Vasoconstriction Play an Important Role in Patients with Primary Pulmonary Hypertension

vasodilator drugsBecause vasodilator drugs have proved to be a useful approach to the management of patients with systemic hypertension and left ventricular failure, there has been great interest in their application in the treatment of patients with primary pulmonary hypertension. This therapeutic approach makes a number of assumptions that need to be critically evaluated: (1) pulmonary vasoconstriction plays an important role in a significant number of patients with primary pulmonary hypertension; (2) pulmonary vasoconstriction is pharmacologically responsive to drug therapy; (3) drugs can be developed that selectively antagonize this vasoconstrictor response; and (4) the benefits of drug therapy can be sustained for long periods with few adverse reactions.

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Tags: benefit, improvement, primary pulmonary hypertension, Pulmonary Vasoconstriction, vasodilator drugs

Canadian Health and Care Mall: Results of Electrocardiographic and Vectorcardiographic Diagnosis of Posterior Wall Myocardial Infarction

patientsTable 1 displays the individual angiographic characteristics of the 27 patients. Twenty-two had total and five had subtotal occlusion of the circumflex or obtuse example of an ECG and vectorcardiogram is shown in Figures 1 and 2.

The electrocardiographic analysis is shown in Table 2. The total QRS duration was within normal limits. Pathologic Q waves of 35 msec or more in lead aVF were present in six patients (22 percent). The R wave in lead Vj was equal to or greater than 40 msec in seven patients (26 percent) and in lead V2 was equal to or greater than 50 msec in five patients (19 percent). The amplitude of the R wave in lead Vx was equal to or greater than 0.5 mV in six patients (22 percent), and the mean R/S ratio in leads Vx and V2 was 0.66 and 1.45, respectively. In lead Vx the ratio was greater than 1 in only six patients, and in lead V2, it was greater than 1.5 also in six patients (22 percent). With the exception of the QRS duration, all of these variables are significantly different from controls.

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Tags: cardiac catheterization, circumflex coronary artery, ventriculography, Wall Myocardial Infarction

Canadian HealthCare Mall: Results of Pulmonary Cell Populations from Patients with Carcinoma of the Lung

alveolar macrophagesAs shown in Table 1, interstitial cell populations obtained using the method described herein were predominantly composed of alveolar macrophages, with substantial percentages of both lymphocytes and neutrophils. No increase in the percentage of lymphocytes was seen in the interstitial cell populations contiguous to tumor. Cytotoxity was 1.3 percent or less at all ET ratios for interstitial cell populations from all patients with cancer. To confirm previous reports that the cell separation procedures used do not hinder the detection of natural killer activity, evaluation of apparently normal lung was also performed. Cytotoxic cell responses of 9.3±1.6 and 14.8±0.3 were demonstrated in interstitial cell preparations from the two control cell populations at the lowest ET ratio (50:1). At the ET ratio of 50:1, cytotoxicity of peripheral blood mononuclear cells from 15 nonsmoking normal control subjects studied in our laboratory was 28 ± 35 percent.

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Tags: alveolar macrophages, Carcinoma, pulmonary tissue

Canadian Health and Care Mall: Results of Cardiogenic and Noncardiogenic Pulmonary Edema

The chest x-ray film of patient 10 who had ARDS following a prolonged surgical procedure is shown in Figure 1 with a subsequent film obtained a week later after he had recovered. The scintillation camera studies obtained at the time of these x-ray films are shown in Figure 2. The images represent the scintiscans obtained at the end of the loading period and seven minutes thereafter. The decline in radioactivity observed over six regions of interest for these two studies are shown in Figure 3. Note that the activity decreases more rapidly during the acute phase of the illness thanduring the recovery period.

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Tags: fluid, lungs, Pulmonary edema, respiratory distress syndrome, Solute Clearance

Canadian Neighbor Pharmacy: Clinical Pulmonary Hypertension

pulmonary circulationVASODILAIAnON: ROLE OF ArACHIDONATE

Metabolites

There is accumulating evidence that products of the arachidonic acid cascade are involved in the control of the pulmonary circulation. Moncada and Vane suggested that the balance between thromboxane A (TXAJ, a potent vasoconstrictor, and prostacyclin (PGIJ, a potent vasodilator, may be more important than their absolute concentrations in regulating vascular tone. Recent studies emphasize the importance of the products of the lipoxygenase pathway of arachidonic acid, eg, leukotrienes, in modulating pulmonary vascular tone and in interacting with the cyclooxygenase pathway, ie, by inducing TXA release. Thus, it is possible that leukotrienes, to some extent, exert their actions via release of TXA.

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Tags: Clinical Pulmonary Hypertension, mechanical barrier, potent vasoconstrictor, pulmonary vascular tone, thromboxane