Showing papers by "British Hospital published in 2004"

Atrioventricular block during upright tilt table test.

Abstract: Patients with a cardioinhibitory response (asystole or atrioventricular block [AVB]) during upright tilt table test (UTT) constitute a therapeutic challenge. Our present knowledge is partial and in those who experience AVB is absent. Furthermore, we ignore if there is any difference between both groups, particularly pacemaker indication. We aimed to study patients with a cardioinhibitory response during UTT and incidence of AVB during UTT, compared to asystole; plus the outcome during prolonged follow-up. Of 867 patients who underwent UTT, 172 were positive for a neurally mediated response, all with normal neurocardiovascular evaluation. Of the 172 patients, 6 (3.4%) developed AV block (group A), and 26 (15.1%) experienced asystole (group B). Group A included 6 women (100%), mean age 21 ± 12 years. All patients in group A had sinus rate deceleration during AVB. Group B included 10 women (38%), mean age 28 ± 17 years, and a mean pause of 15 ± 9 seconds. We contacted 30 of 32 patients, mean follow-up of 45 ± 38 months. Seven patients in group B had syncopal recurrences; five had 2 or more episodes. One patient from group B received a DDD pacemaker. In group A, one had one recurrence. No deaths were observed. AVB during UTT is rare, occurs in young women, and is always associated with sinus rate deceleration. Medium- to long-term prognosis is good, and equivalent to patients with asystole. There is no evidence that patients with AVB during UTT require a pacemaker implant. (PACE 2004; 27:632–638)

Hemorrhagic adrenal pseudocyst: laparoscopic treatment.

Abstract: The incidence of adrenal hemorrhagic pseudocyst is very low. A total of 613 adrenal cysts and 85 hemorrhagic pseudocysts have been reported. A laparoscopically diagnosed and resolved case is presented here, together with the current diagnostic and therapeutic procedures. A 40-year-old woman was admitted because of an asymptomatic nonfunctional right adrenal tumor. Right laparoscopic adrenalectomy was performed, 8-cm cyst which found an with thick walls and organized hematic content. The postoperative course was uneventful. Follow-up was 14 months. The pathology was an adrenal hemorrhagic pseudocyst. A total of 56% of adrenal cysts are pseudocysts. One third of them have hematic content. They may present as an asymptomatic finding with nonspecific symptoms or as a hormone secreting or complicated tumor. Their vascular etiology is not yet totally accepted. There is a tendency for intracystic bleeding. it is advisable to evaluate the hormonal profile and morphologic characteristics in all cases. Treatment options include needle aspiration, percutaneous drainage, and cyst or gland resection. Laparoscopic excision should be evaluated.

Documentation forms for patients with asthma: an evaluation

Abstract: TO THE EDITOR: The focus of pharmacy practice is moving from being centered on dispensing to being focused on the patient. Professional organizations are promoting patient-centered care as routine, for which systematic and consistent documentation is essential. We report on an evaluation of the use of various documentation methods by community pharmacists managing patients with asthma, with a view to developing documentation in Portuguese pharmacy practice. Methods. The study was based in 5 community pharmacies during February and March 2002. Patients using the pharmacy who were prescribed asthma medication were invited to participate in the study. Patients agreed to participate following receipt of a leaflet explaining the study and signed a consent form. The pharmacists’ interventions in managing these patients were documented using various data collection forms. These included a questionnaire to predict respiratory conditions in adults (IUALTD)1; a form to document patient data, the drugs prescribed, and drug-related problem (DRP) classification2; the Mini-Asthma Quality of Life Questionnaire3; a checklist to assess patients’ inhaler techniques4; a questionnaire to assess the patients’ knowledge of their drugs and condition5; and a patient information leaflet developed by the research team. Before the study, pharmacists attended a training session to familiarize themselves with the documentation. The pharmacists’ opinions of the use and utility of the documentation were evaluated using a 5-point scale. Descriptive and inferential statistics (SPSS for Windows, release 10) were used to analyze the collected data. Results. The participating pharmacists developed opinions about the documentation tools after using them over the 2-month study period on 24 patients. Every tool was considered generally useful (Table 1). However, the DRP classification was useful but not very simple to use and generated considerable workload. The lowest scores were obtained for the diagnostic tool and the knowledge and quality of life questionnaire (x– = 3.0), both of which are often used in research studies and therefore may need to be reviewed if research is to be fully implemented in practice. While the inhaler technique checklist was considered useful and simple, it created extra workload. Three of the piloted tools were regarded as able to be incorporated in daily practice. Pharmacists ranked the patient information leaflets highest (4.9), considering them to be very useful and simple while generating no extra workload. The use of peak flow meters was also ranked very positively (4.3), viewed as very useful and quite simple to use, even though they generated some extra workload. The patient profile forms were ranked quite positively (3.9); they were useful and simple, while creating some workload. The limitations of this study include the small sample and the convenience sampling process used. The study may not be widely generalizable; however, it is important to report on such feasibility studies to help with understanding how best to target such implementation strategies. It seems that most of the methods of documentation are considered usable in daily practice and could be made part of the documentation processes being implemented in professional activities in Portugal.