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139341. A pilot randomised controlled trial of medical versus nurse clerking for minor surgery. Full Text available with Trip Pro

A pilot randomised controlled trial of medical versus nurse clerking for minor surgery. Nurse led clerking is currently practiced in a growing number of UK centres, but there is a paucity of evidence to underpin the safety of this innovation.To assess the safety of nurse led clerking in paediatric day case and minor surgery.Children aged 3 months to 15 years were randomly assigned to clerking by either a nurse or a senior house officer (SHO) (resident). All children were then independently (...) reassessed by a specialist registrar anaesthetist to provide a "gold standard" against which practitioner performance could be judged.In 60 children studied, nurses identified a significantly greater proportion of the detectable abnormalities present in the sample (p = 0.16). This difference is attributable to nurses' greater accuracy in history taking (p = 0.04); no conclusions regarding the comparability of nurses' and SHOs' skills in physical examination can be derived from the current study.Evidence

2000 Archives of disease in childhood Controlled trial quality: uncertain

139342. Quality of life after coronary angioplasty or continued medical treatment for angina: three-year follow-up in the RITA-2 trial. Randomized Intervention Treatment of Angina. (Abstract)

with angina, allowing assessment of long-term health consequences.A total of 1,018 patients were randomly assigned (504 to PTCA and 514 to medical treatment). The short form 36 (SF-36) self-administered quality-of-life questionnaire was completed at randomization and three months, one year and three years later. To date, 98% of patients reached one year and 67% reached three years.The PTCA group had significantly greater improvements in physical functioning, vitality and general health at both three (...) groups, there were also improvements in ratings of physical role functioning, emotional role functioning, social functioning, pain and mental health, but for these the superiority of PTCA over medical treatment was less pronounced. After one year, 33% and 22% of the PTCA and medical groups, respectively, rated their health much better.Coronary angioplasty substantially improves patient-perceived quality of life, especially physical functioning and vitality, as compared with continued medical

2000 Journal of the American College of Cardiology Controlled trial quality: uncertain

139343. Methylcobalamin as an adjuvant medication in conservative treatment of lumbar spinal stenosis. (Abstract)

, and the methylcobalamin group, 70 patients. All had classical history, and physical and radiographic findings which confirmed the diagnosis of spinal stenosis. Conventional management, including patient education, physical therapy and medication, were carried out in every patient and in addition methylcobalamin 0.5 mg was given orally three times a day in the methylcobalamin group for 6 months. All patients were followed up periodically for 2 years. Most of the patients in both groups showed improvement (...) Methylcobalamin as an adjuvant medication in conservative treatment of lumbar spinal stenosis. To find out the clinical effects of methylcobalamin on the conservative treatment of degenerative lumbar spinal stenosis, the study was carried out as a control single blind trial with 2 year follow-up in 152 patients, 68 males and 84 females, whose ages ranged from 55 to 85 years, average 67 +/- 18.1 years. They were randomly allocated into 2 groups, the control group, 82 patients

2000 Journal of the Medical Association of Thailand = Chotmaihet thangphaet Controlled trial quality: uncertain

139344. Effects of cost sharing on care seeking and health status: results from the Medical Outcomes Study. Full Text available with Trip Pro

Effects of cost sharing on care seeking and health status: results from the Medical Outcomes Study. This study sought to determine the effect of cost sharing on medical care use for acute symptoms and on health status among chronically ill adults.Data from the Medical Outcomes Study were used to compare (1) rates of physician care use for minor and serious symptoms and (2) 6- and 12-month follow-up physical and mental health status among individuals at different levels of cost sharing.In (...) comparison with a no-copay group, the low- and high-copay groups were less likely to have sought care for minor symptoms, but only the high-copay group had a lower rate of seeking care for serious symptoms. Follow-up physical and mental health status scores were similar among the 3 copay groups.In a chronically ill population, cost sharing reduced the use of care for both minor and serious symptoms. Although no differences in self-reported health status were observed, health plans featuring cost sharing

2001 American Journal of Public Health Controlled trial quality: uncertain

139345. Are routine preoperative medical tests needed with cataract surgery? (Abstract)

groups.The results of this study suggest that routine medical testing before cataract surgery does not reduce the rate of complications during the perioperative period. The results also suggest it would be more efficient not to request routine preoperative tests unless indicated by patient history or physical examination. (...) Are routine preoperative medical tests needed with cataract surgery? The objective of this study was to investigate whether routine medical testing before cataract surgery reduces the rate of complications during the perioperative period in adults.The study was carried out in an academic medical center in Brazil, between 10 February 2000 and 10 January 2001. The scheduled cataract operations were randomly assigned to one of two groups: 1) to be preceded by routine testing (the "routine-testing

2001 Revista panamericana de salud pública = Pan American journal of public health Controlled trial quality: uncertain

139346. Clinafloxacin versus piperacillin/tazobactam in the treatment of severe skin and soft-tissue infections in adults at a Veterans Affairs medical center. (Abstract)

Clinafloxacin versus piperacillin/tazobactam in the treatment of severe skin and soft-tissue infections in adults at a Veterans Affairs medical center. Severe skin and soft-tissue infections (SSTIs), particularly diabetic foot infections, are a source of considerable morbidity and mortality. Inappropriate antimicrobial therapy may contribute to the increasing emergence of bacterial resistance, as well as to increased health care costs. Thus, there is a continuing search for reasonably safe (...) , well-tolerated, and effective antimicrobial agents that are less susceptible to the development of resistance than older agents.The Department of Veterans Affairs (VA) Medical Center in Nashville, Tennessee, was I site in a multicenter, Phase III, randomized, investigator-blinded clinical trial comparing the safety and efficacy of clinafloxacin with those of piperacillin/tazobactam in the treatment of adult patients with SSTI.Over an 18-month period, patients aged > or = 18 years with physical

2002 Clinical therapeutics Controlled trial quality: uncertain

139347. Multicenter randomized controlled trial of the management of unresectable malignant mesothelioma proposed by the British Thoracic Society and the British Medical Research Council. (Abstract)

Multicenter randomized controlled trial of the management of unresectable malignant mesothelioma proposed by the British Thoracic Society and the British Medical Research Council. Malignant mesothelioma is almost invariably fatal. The incidence of the disease is rising rapidly in many countries, and there is no generally accepted standard treatment for patients with unresectable disease. According to current British Thoracic Society (BTS) guidelines, patients should be treated with active (...) symptom control (ASC), involving (1) regular follow-up in a specialist clinic; (2) structured assessments of physical, psychological and social problems with appropriate action; (3) rapid involvement of additional specialists; and (4) parallel nursing support. Although many nonrandomized studies have reported tumor responses to anticancer chemotherapy, few have studied palliation and it is not known whether chemotherapy prolongs survival or provides clinically worthwhile palliation with acceptable

2002 Seminars in oncology Controlled trial quality: uncertain

139348. Does the outpatient setting provide the best environment for medical student learning of urology? (Abstract)

Does the outpatient setting provide the best environment for medical student learning of urology? To determine in which environment medical students learn clinical urology most effectively, we retrospectively reviewed a natural experiment in which medical students were randomly assigned to complete the 1-week rotation in clinical urology in an outpatient/clinic based or inpatient/operative setting.Exit surveys were completed by 25 of the 39 medical students (64%) who had just completed (...) the mandatory 1-week rotation in urology. Students were asked to record on a 5-point scale the amount learned in regard to 13 urological topics and skills, and to document the number of patient encounters experienced per topic and skill.Students randomized to the outpatient/clinic based setting tended to be 1) more likely to have exposure to a greater number and breadth of patients with common urological problems, 2) more likely to perform pertinent physical examination skills and 3) more likely to perceive

2002 The Journal of urology Controlled trial quality: uncertain

139349. Depression, health-related quality of life, and medical cost outcomes of receiving recommended levels of antidepressant treatment. (Abstract)

with Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) criteria for major depression who were starting antidepressant treatment. The primary outcomes measures used were the 17-item Hamilton Depression Rating Scale (HDRS), Hopkins Symptom Checklist depression scores, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) mental and physical component summary scores, and the total outpatient and inpatient medical costs.Of 358 patients starting antidepressant (...) treatment, 195 (54.5%) received doses recommended by the Agency for Health Care Policy and Research for 90 days or more. Mean HDRS score decreased from 14.1 to 8.8 in patients receiving less-than-recommended treatment and decreased from 13.8 to 8.9 in patients with minimum recommended treatment (P = .761). No significant differences in improvement of HRQL outcomes during 6 months were observed between patients receiving recommended or less-than-recommended antidepressant therapy. Mean total medical

1998 Journal of Family Practice Controlled trial quality: uncertain

139350. Predictors and mediators of successful long-term withdrawal from antihypertensive medications. TONE Cooperative Research Group. Trial of Nonpharmacologic Interventions in the Elderly. (Abstract)

(BP) after withdrawal of antihypertensive medication.The Trial of Nonpharmacologic Interventions in the Elderly tested whether lifestyle interventions designed to promote weight loss or a reduced intake of sodium, alone or in combination, provided satisfactory BP control among elderly patients (aged 60-80 years) with hypertension after withdrawal from antihypertensive drug therapy. Participants were observed for 15 to 36 months after attempted drug withdrawal.Trial end points were defined by (1 (...) BP (P < .001), fewer years since diagnosis of hypertension (P < .001), fewer years of antihypertensive treatment (P < .001), and no history of cardiovascular disease (P = .01) were important predictors of maintaining successful nonpharmacological BP control throughout follow-up, based on logistic regression analysis. Age, ethnicity, baseline level of physical activity baseline weight, medication class, smoking status, and alcohol intake were not statistically significant predictors. During follow

1999 Archives of family medicine

139351. Comparison of subacute rehabilitative care with outpatient primary medical care. (Abstract)

Comparison of subacute rehabilitative care with outpatient primary medical care. Prior rehabilitation outcome studies have had many weaknesses. but they gradually observe a lack of long-term benefits from inpatient care alone. The goal of this study was to measure the additive effect of outpatient, subacute rehabilitation (compared with usual outpatient primary medical care) for adults diagnosed with a disabling disorder in four major diagnostic groups (nervous, circulatory, musculoskeletal (...) and injury).A randomized clinical trial was conducted to determine the effects of outpatient, subacute rehabilitative care on: (1) physical function; (2) health; (3) well being; (4) family function; and (5) social support. Patients hospitalized for the first time with a disabling condition (n = 180) were provided inpatient rehabilitation and then were randomly assigned to either outpatient, subacute rehabilitation at home (n = 90) or to usual outpatient follow-up (n = 90) in which only primary care

2001 Disability and rehabilitation Controlled trial quality: uncertain

139352. A randomized controlled trial of low-dose recombinant human growth hormone in the treatment of malnourished elderly medical patients. Full Text available with Trip Pro

A randomized controlled trial of low-dose recombinant human growth hormone in the treatment of malnourished elderly medical patients. High-dose recombinant human GH (rhGH) has been shown to improve the nutritional status of malnourished older adults. It is uncertain whether low-dose rhGH is effective and whether its effect on nutritional status will lead to any improvement in physical function. There is also no data on the outcome after a short course of rhGH treatment. The objectives (...) of this study were to determine the efficacy of low-dose rhGH treatment for 4 weeks in malnourished elderly patients, its effect on physical functions, and the intermediate term outcome after a 4-week rhGH treatment. The study design was a randomized, placebo-controlled, double-blind trial conducted in a university teaching hospital. The patients were 19 medically stable malnourished elderly subjects. Intervention in the rhGH group was as follows: rhGH (Saizen, Serono, Switzerland) 0.09 IU/kg body weight

2001 The Journal of clinical endocrinology and metabolism Controlled trial quality: predicted high

139353. Quality of life indices may be predictive of placebo and medication response to treatment for allergic rhinitis. (Abstract)

to placebo, compared with placebo nonresponders. In addition, the overall physical health and 36-item short-form health survey averages were significantly lower. Differences between responders and nonresponders to budesonide did not reach statistical significance.Lower baseline QOL scores were associated with a clinically significant response to placebo in a trial of treatment for allergic rhinitis. QOL may be a factor in participant response to medication in clinical studies and, hence, a predictor (...) Quality of life indices may be predictive of placebo and medication response to treatment for allergic rhinitis. Quality of life (QOL) is known to be an important clinical endpoint in determining medication efficacy; however, the predictive value of QOL indices for response to medication or placebo has not been tested.To determine whether a correlation between measures of QOL and response to medication/placebo exists in an evaluation of budesonide for allergic rhinitis.Two hundred nine

2001 Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Controlled trial quality: predicted high

139354. Integrated medical care for patients with serious psychiatric illness: a randomized trial. (Abstract)

Integrated medical care for patients with serious psychiatric illness: a randomized trial. This randomized trial evaluated an integrated model of primary medical care for a cohort of patients with serious mental disorders.A total of 120 individuals enrolled in a Veterans Affairs (VA) mental health clinic were randomized to receive primary medical care through an integrated care initiative located in the mental health clinic (n = 59) or through the VA general medicine clinic (n = 61). Veterans (...) medicine clinic (4.7 points vs -0.3 points, P<.001). There were no significant differences between the 2 groups in any of the measures of mental health symptoms or in total health care costs.On-site, integrated primary care was associated with improved quality and outcomes of medical care.

2001 Archives of general psychiatry Controlled trial quality: uncertain

139355. Are components of a comprehensive medical assessment predictive of work disability after an episode of occupational low back trouble? (Abstract)

disability prediction literature of low back trouble prognosis revealed that no high-quality studies included a full medical history and physical examination in the design. The results of studies included in the systematic review were equivocal with respect to predictive usefulness of medical variables.Participants completed medical history questionnaires and then were clinically examined by one of six experienced examiners (three physicians and three physiotherapists). Return-to-work status was measured (...) 3 months later, and predictive validity was evaluated using logistic regression modeling.Medical variables (, medical history subscales, physical examination subscales, and lumbar range-of-motion tests) showed modest correct classification rates varying between 61.6% and 69.1% for participants.Comprehensive medical assessments play a crucial role in the early identification of serious pathology after low back trouble. We were unable to identify, however, any medical evaluation variables

2002 Spine

139356. Radiation dose reduction to medical staff during vertebroplasty: a review of techniques and methods to mitigate occupational dose. (Abstract)

Radiation dose reduction to medical staff during vertebroplasty: a review of techniques and methods to mitigate occupational dose. Case crossover design was conducted.The purpose of the current study was to determine the radiation exposure level of operators performing fluoroscopically assisted vertebroplasty and to determine optimal techniques to reduce this exposure.The use of ionizing radiation to provide quality imaging during minimally invasive orthopedic procedures has dramatically (...) a significant reduction in whole-body and hand doses. For the fluoroscopic modes investigated, the shielding used resulted in reductions ranging from 42.9% to 86.1%.It is critical that operators performing vertebroplasty procedures have a fundamental understanding of radiation physics and radiation protection to minimize radiation exposure.

2003 Spine

139357. Quality of life following early medical or surgical abortion. (Abstract)

Quality of life following early medical or surgical abortion. Short-term quality of life following abortion is poorly characterized. We conducted a prospective cohort study to evaluate 97 U.S. women who selected either medical abortion with mifepristone and misoprostol or surgical abortion up to 9 weeks gestation in a private-practice setting. Women choosing medical abortion and those choosing surgical abortion with local anesthesia were similar on most baseline characteristics. Eighty-five (...) participants completed a standardized quality of life assessments three times over 1 month. The 30-item questionnaire yielded scores for global health, emotional, social, cognitive and physical functioning and for specific symptom scales. At baseline, participants reported many symptoms and functional limitations during the previous week. Subjects in both treatment groups experienced clinically and statistically significant improvements on all scales at follow-up. Surgical abortion patients had worse

2003 Contraception

139358. Medical futility: predicting outcome of intensive care unit patients by nurses and doctors--a prospective comparative study. Full Text available with Trip Pro

Medical futility: predicting outcome of intensive care unit patients by nurses and doctors--a prospective comparative study. First, to assess the pattern of the prediction of intensive care unit patients' outcome with regard to survival and quality of life by nurses and doctors and, second, to compare these predictions with the quality of life reported by the surviving patients.Prospective opinion survey of critical care providers; comparison with follow-up for survival, functional status (...) , and quality of life.Six-bed medical intensive care unit subunit of a 1,000-bed tertiary care, university hospital.All patients older than 18 yrs, admitted to the medical intensive care unit for >24 hrs over a 1-yr period (December 1997 to November 1998).Daily judgment of eventual futility of medical interventions by nurses and doctors with respect to survival and future quality of life. Telephone interviews with discharged patients for quality of life and functional status 6 months after intensive care

2003 Critical Care Medicine

139359. Health-related quality of life before, 1 month after, and 9 months after intensive care in medical cardiovascular and pulmonary patients. (Abstract)

Health-related quality of life before, 1 month after, and 9 months after intensive care in medical cardiovascular and pulmonary patients. Assessment of health-related quality of life before, 1 month after, and 9 months after an intensive care unit stay using an established generic instrument, the Medical Outcome Survey Short Form-36 (SF-36).Prospective, observational study.University hospital medical intensive care unit.Two hundred forty-five patients with predominantly cardiovascular (...) impaired functioning after 9 months compared with baseline values. Physical and emotional role deteriorated after 1 month but returned to baseline thereafter. Notably, the mental health summary scale did not change during the course of the study, whereas the physical health summary scale consistently improved over time. Patients older than the median of 66 yrs rated their physical functioning lower. No association with SAPS II or SOFA and SF-36 was found.Quality of life after intensive care unit

2003 Critical Care Medicine

139360. Medical outcomes study short form-36: a consistent and powerful predictor of morbidity and mortality in dialysis patients. (Abstract)

. Although this recommendation stresses the importance of assessing and monitoring physical and mental health functioning, the Medical Outcomes Study Short Form-36 (MOS SF-36) might also be useful for predicting crucial longer-term patient outcomes. This cross-sectional study tested the hypothesis that the Physical Component Summary (PCS) and Mental Component Summary (MCS) scales of the MOS SF-36 predict morbidity (measured as hospitalization) and mortality rates among dialysis patients.Data were (...) Medical outcomes study short form-36: a consistent and powerful predictor of morbidity and mortality in dialysis patients. One of the guidelines released by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) recommends that patients with glomerular filtration rate (GFR) less than 60 mL/min/1.73 m2 undergo regular assessment of functioning and well-being (FWB) to establish baselines, monitor changes in FWB over time, and assess the effect of interventions on FWB

2003 American Journal of Kidney Diseases

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