ABSTRACT
OBJECTIVE: To investigate the clinical outcome in patients with clinically suspected pulmonary embolism (PE). Design and setting. In a retrospective design we studied 588 consecutive patients with suspected PE and referred for lung scintigraphy from 1995 to 1998. The mean follow-up time was 653 +/- 424 days. RESULTS: The diagnosis of PE was confirmed in 194 and excluded in 394 patients, respectively. The overall prevalence of PE was 33%. Amongst clinical and paraclinical variables, age, chronic obstructive pulmonary disease (COPD), heart rate, pleuritic pain, presence of deep venous thrombosis (DVT), electrocardiographic signs of right ventricular (RV) strain were identified as independent predictors of the diagnosis of PE. Amongst patients with PE anticoagulation was given in 96% for at least 3 months and 13% received thrombolytic therapy. Recurrent PE was seen in 6% of patients with PE whereas none of the patients with no diagnosis of PE suffered PE during follow-up. The 1 year mortality was 18% amongst patients with PE and 15% in patients with excluded PE (P=NS). The cause of death amongst patients with PE was cancer (49%) and PE (28%), whereas patients without PE had an excess mortality because of cancer, COPD, acute myocardial infarction and heart failure. CONCLUSION: Patients admitted to hospital on suspicion of PE have increased risk of adverse clinical outcome whether the diagnosis of PE is confirmed or not. This indicates that the patients where the diagnosis is excluded often suffer from other serious illness that warrants further investigations.
Subject(s)
Pulmonary Embolism/diagnostic imaging , Aged , Cause of Death , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Male , Middle Aged , Predictive Value of Tests , Pulmonary Embolism/etiology , Pulmonary Embolism/mortality , Radionuclide Imaging , Recurrence , Retrospective Studies , Risk FactorsABSTRACT
The aim of the present study was to evaluate the clinical characteristics and mortality in patients with pulmonary embolism during 1995-1998. The diagnosis of pulmonary embolism in 183 patients was confirmed based on the clinical and lung scan findings. Compared to previous studies fewer cases with pulmonary embolism after surgery, immobilisation and history of trauma to lower extremity were noted. Deep vein thrombosis and electrocardiographic signs of acute right ventricular strains were found frequently, and should support the suspicion of pulmonary embolism. A normal plasma fibrin D-dimer was noted in several patients. When using the D-dimer for the diagnosis of pulmonary embolism the result given depends on the assay method used, the assay specific discriminatory level and duration of symptoms. The total one year mortality was 16% whereas the mortality due to pulmonary embolism was 6%.
Subject(s)
Pulmonary Embolism , Adolescent , Adult , Aged , Cause of Death , Denmark/epidemiology , Female , Fibrinolytic Agents/administration & dosage , Humans , Male , Middle Aged , Pulmonary Embolism/diagnosis , Pulmonary Embolism/drug therapy , Pulmonary Embolism/mortality , Thrombolytic TherapySubject(s)
Neoplasms/nursing , Nurse-Patient Relations , Terminal Care , Aged , Female , Humans , Neoplasms/psychologyABSTRACT
OBJECTIVES: To provide an overview of the present use of computer technology in cancer pain management. DATA SOURCES: Review articles, research studies, and books pertaining to the use of computers in cancer pain management. CONCLUSIONS: The availability of computer resources for cancer pain and nursing are limited. However, the application of computer technology to cancer pain management has the potential to improve our delivery of care, educate both health care professionals and consumers, and improve outcome measures. IMPLICATIONS FOR NURSING PRACTICE: Computers can assist our efforts to improve quality of care, teaching, research, and communication with patients. It is essential for nurses to be knowledgeable about available computer resources and the application of new technology.
Subject(s)
Computer Communication Networks , Information Services , Neoplasms/physiopathology , Pain/etiology , Pain/prevention & control , Software , Data Collection , Humans , Nursing Research , Oncology NursingABSTRACT
1. Traditionally, local anesthesia has only been used in patients with coexisting diseases that jeopardize the safety of general anesthesia. Local anesthesia, however, provides a number of advantages that make it suitable for ophthalmic surgery of both the anterior and posterior segment. 2. Preoperative emotional and physical assessment and patient counseling is essential to the successful use of local anesthesia. 3. Anxiety that exists intraoperatively can be relieved by sedentary social diversions such as listening to music, handholding, and other holistic approaches. 4. Discomfort caused by draping can be eliminated by using a drapeholder that lifts the drapes away, providing the patient with a high flow of air.
Subject(s)
Anesthesia/nursing , Ophthalmologic Surgical Procedures , Anesthesia/methods , Humans , Intraoperative Care/nursing , Preoperative Care/nursingSubject(s)
Anesthesia, Local , Eye Diseases/surgery , Adolescent , Adult , Child , Humans , Patient Education as TopicABSTRACT
1. Traditionally, local anesthesia has only been used in patients with coexisting diseases that jeopardize the safety of general anesthesia. Local anesthesia, however, provides a number of advantages which make it suitable for ophthalmic surgery of both the anterior and posterior segment. 2. Preoperative emotional and physical assessment and patient counseling is essential to the successful use of local anesthesia. 3. Anxiety that exists intraoperatively can be relieved by sedentary social diversions such as listening to music, handholding, and other holistic approaches. 4. Discomfort caused by draping can be eliminated by using a drapeholder which lifts the drapes away, providing the patient with a high flow of air.
