Articles: adult.
-
Comparative Study
Anterolateral minithoracotomies for the radical correction of congenital heart diseases.
During the past 10 years, minimally invasive surgical techniques have been applied more and more widely in both adult and pediatric populations, especially in female patients. Right anterolateral minithoracotomy is an alternative to median sternotomy that yields a better cosmetic outcome. From May 1997 through September 2008, 132 patients (107 females, 25 males) underwent open-heart surgery through right anterolateral minithoracotomy. ⋯ All patients had gratifying cosmetic results at longer follow-up. Indeed the mortality and morbidity rates obtained through our approach were almost the same as those obtained through median sternotomy, and there were no significant differences in cardiopulmonary bypass time, aortic cross-clamp time, ventilation time, or postoperative hospital stay. We conclude that the right anterolateral minithoracotomy for correction of congenital heart defects offers superior cosmetic results without increasing morbidity or mortality rates and confers upon patients psychological and social satisfaction.
-
J Egypt Public Health Assoc · Jan 2009
Risk factors of oral health problems among adults in marion county, indiana, USA.
This study aimed to identify the risk factors associated with orodontal diseases (ODD), including periodontal diseases (PDD) with or without dental caries (DC), in Marion County, Indianapolis, Indiana, USA. ⋯ With such rates and in the presence of the available oral health programs, it is concluded that oral health problems pose a threat to the public health in Marion County's health resources. The rising demand for dental services depletes resources and exaggerates the likelihood of health disparity. An overall evaluation of the dental care system in Marion County, focusing on prevention is stressing.
-
Does the instillation of normal saline before suctioning reduce the incidence of ventilator-associated pneumonia in intubated and ventilated adults? ⋯ Instillation of normal saline before tracheal suctioning decreases the incidence of VAP in mechanically ventilated adults.
-
Ont Health Technol Assess Ser · Jan 2009
Oral appliances for obstructive sleep apnea: an evidence-based analysis.
The objective of this review was to determine the clinical effectiveness of oral appliances compared to 'no treatment', continuous positive airway pressure (CPAP), or surgery for the management of obstructive sleep apnea (OSA). ⋯ Obstructive sleep apnea, oral appliances, mandibular advancement splints, tongue repositioning devices.
-
Ont Health Technol Assess Ser · Jan 2009
Bariatric surgery for people with diabetes and morbid obesity: an evidence-based analysis.
In June 2008, the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project, an evidence-based review of the literature surrounding strategies for successful management and treatment of diabetes. This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry's newly released Diabetes Strategy.After an initial review of the strategy and consultation with experts, the secretariat identified five key areas in which evidence was needed. Evidence-based analyses have been prepared for each of these five areas: insulin pumps, behavioural interventions, bariatric surgery, home telemonitoring, and community based care. For each area, an economic analysis was completed where appropriate and is described in a separate report.To review these titles within the Diabetes Strategy Evidence series, please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/masabout.html,DIABETES STRATEGY EVIDENCE PLATFORM: Summary of Evidence-Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics: An Evidence-Based AnalysisBehavioural Interventions for Type 2 Diabetes: An Evidence-Based AnalysisBARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY: An Evidence-Based SummaryCommunity-Based Care for the Management of Type 2 Diabetes: An Evidence-Based AnalysisHome Telemonitoring for Type 2 Diabetes: An Evidence-Based AnalysisApplication of the Ontario Diabetes Economic Model (ODEM) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario ⋯ Bariatric surgery, morbid obesity, comorbidity, diabetes ES Table 1:GRADE Quality of Evidence for Bariatric Surgery for the Resolution or Improvement of DiabetesOutcomeQuality AssessmentSummary of FindingsDesignQualityConsistencyDirectnessOtherNo. of PatientsEffectQualityImprovement in HbA1c indiabetic and glucoseintolerant patientsMeta-analysisModerate*ConsistentDirectNonen=171-2.70% (-5.0% to -0.70%)weighted mean change(range)ModerateResolution or improvement of diabetes(Studies reporting combinationas well as studies that only usedthe term "improved", but not thestudies reporting only resolution)Meta-analysisModerate*ConsistentDirectNone414/485(n resolved orimproved/nevaluated)86.0% (78.4% to 93.7%)mean% (95% CI)ModerateResolution of diabetes(diabetes disappeared or nolonger required therapy)Meta-analysisModerate*ConsistentDirectNone1417/1846(n resolved/nevaluated)76.8% (70.7% to 82.9%)mean% (95% CI)ModerateRecovery of diabetes(fasting plasma glucose level ofless than 126 mg per decilitre[7.0 mmol per litre])Observationalprospectivecontrolled studyModerate*ConsistentSomeuncertainty(†)Someuncertainty(‡)control n=84intervention n=1183.45 (1.64 to 7.28)OR (95% CI) at 10 yrsModerate*Downgraded due to study design (not randomized controlled trial)†Unlikely to be an important uncertainty. Inclusion criteria for the SOS study not specific to conventional definition of "morbidly obese" patients (BMI ≥ 40 or ≥ 35 kg/m(2) with comorbid conditions)‡Unlikely to be an important uncertainty. Control group not standardized, however, this lends to the pragmatic nature of the study.