Characteristics of intradialytic hypotension: experience of Agadir Center-Morocco.
(73/125)
We report in this retrospective study the experience of our hemodialysis (HD) center in the incidence of intradialytic hypotension (IDH) over 18 months. We first studied the demographic, clinical, biological and morphological data of our 52 HD patients and compared the characteristics of patients with frequent IDH and those without. We found that factors significantly associated with IDH include diabetes, left ventricular hypertrophy, impaired diastolic function, weight gain and high ultrafiltration rates. Despite these results, further larger studies are required to confirm them. (+info)
Correlates of posttraumatic epilepsy 35 years following combat brain injury.
(74/125)
Lessons learned from implementation of voice recognition for documentation in the military electronic health record system.
(75/125)
This study evaluated the implementation of voice recognition (VR) for documenting outpatient encounters in the electronic health record (EHR) system at a military hospital and its 12 outlying clinics. Seventy-five clinicians volunteered to use VR, and 64 (85 percent) responded to an online questionnaire post implementation to identify variables related to VR continuance or discontinuance. The variables investigated were user characteristics, training experience, logistics, and VR utility. Forty-four respondents (69 percent) continued to use VR and overall felt that the software was accurate, was faster than typing, improved note quality, and permitted closing a patient encounter the same day. The discontinuation rate of 31 percent was related to location at an outlying clinic and perceptions of inadequacy of training, decreased productivity due to VR inaccuracies, and no improvement in note quality. Lessons learned can impact future deployment of VR in other military and civilian healthcare facilities. (+info)
Pattern of prescription drug use in Nigerian army hospitals.
(76/125)
Methods used to reduce the prevalence of hepatitis C in a dialysis unit.
(77/125)
In the present study, we report on the follow-up of the epidemiology of hepatitis C viremia in our dialysis unit after our previous report, over the period from July 1, 2003 to December 31, 2005. The methods to reduce the prevalence of hepatitis C viremia in our center included: strict adherence to universal infection control precautions, separation of hepatitis C virus (HCV) positive patients from the negative patients and using specially designated machines for them, and from July 2003, periodic testing of all patients for HCV-RNA. Following the application of the above mentioned methods, we have not had, since 31 December 2005, any case of sero-conversion from HCV-negative to HCV-positive in our dialysis unit and the only HCV-positive patients present were those who were already positive at entry. The overall prevalence of HCV-RNA positive patients in our unit has presently come down to 6.5%. Although isolation and use of designated machines for HCV-RNA positive patients is not recommended following the latest guidelines of "Kidney Disease: Improving Global Outcomes" (KDIGO, 2008), the present study supports previous reports that these measures might be beneficial, when there is a high prevalence of HCV-RNA positive patients, and in units where due to understaffing or other causes, break in infection control procedures is likely to occur. (+info)
Cardiac surgery in patients on hemodialysis: eight years experience of the Tunisian military hospital.
(78/125)
End-stage renal disease (ESRD) is known to be an important risk factor for cardiac operations performed with cardiopulmonary bypass. We investigated the influence of preoperative status on perioperative mortality and morbidity. We retrospectively analyzed data from 26 patients with ESRD, who were on maintenance dialysis and underwent a cardiac surgical procedure bet-ween 2000 and 2007. Of them, 61.5% of the patients had isolated coronary artery bypass grafting (CABG) and 38.5% had replacement or reconstruction of one or two valves. The perioperative mortality rate was 26% with five deaths occurring in patients undergoing CABG procedure. We found CABG procedure, being female and left ventricular (LV) function < 30% to be associated with a higher relative risk for perioperative death. In conclusion, our data suggest that both indi-cations and referral for surgical intervention for coronary artery disease may be delayed in pa-tients who have ESRD, contributing to the relatively high perioperative mortality. (+info)
Group B streptococcus serotype prevalence in reproductive-age women at a tertiary care military medical center relative to global serotype distribution.
(79/125)
Immunization outreach using individual need assessments of adults at an army hospital.
(80/125)
A comprehensive assessment of the immunization status of 2,451 adults was carried out at Walter Reed Army Medical Center's Allergy-Clinical Immunology Service, Washington, DC, during an influenza immunization program from October 1985 through February 1986. More than 66 percent of those screened needed either immunization other than for influenza, or an immunologic test, a decline from 72 percent noted during a 1984-85 influenza immunization program. The mean number of interventions was 2.00 per patient in the 1985-86 program and 2.26 during the previous program. Of patients screened in the period 1985-86, 20.5 percent received diphtheria-tetanus toxoids, 15.7 percent received pneumococcal vaccine, and 23.1 percent received a tuberculin skin test. Vaccination or titers for measles were ordered for 10.4 percent, for rubella for 10.9 percent, and for hepatitis B for 20.3 percent. Assessment of those who came to the clinic for influenza vaccination in the second program demonstrated that the needs of some patients had been met in the first program. However, a general lack of immune protection existed in the majority of patients screened in the second program. In both programs, those older than 59 years needed pneumococcal vaccine and diphtheria-tetanus toxoids more frequently than the general population. The means of the numbers of interventions and the percentages of patients needing intervention other than influenza vaccine declined from the first program to the second, suggesting progress in meeting some individual immunization needs in a large and changing ambulatory population. (+info)