ABSTRACT
For the first time, we have data that can validly compare the satisfaction level of inpatients in Department of Veterans Affairs (VA) medical centers and private sector hospitals. It shows the satisfaction levels to be very similar. Since the VA will soon be changing its survey, this has been a very short time window. It may never recur. In addition to the general finding, there are some interesting comparisons regarding specific questions. For example, satisfaction with VA physicians, who are salaried and assigned to patients, is just as high as satisfaction with private physicians who are paid by fee and selected by the patient. This would seem to be critical information in the debate over U.S. health care reform.
Subject(s)
Hospitals, Private/standards , Hospitals, Veterans/standards , Patient Satisfaction/statistics & numerical data , Health Services Research , Hospitals, Private/statistics & numerical data , Hospitals, Veterans/statistics & numerical data , Medical Staff, Hospital/standards , Quality of Health Care , Reproducibility of Results , Surveys and Questionnaires , United StatesABSTRACT
Nd-YAG laser resection of a completely obstructing right mainstem tumor in a 36-year-old man was complicated by right lung hyperinflation and left lung collapse and accompanying ventilatory failure. This was attributed to obstruction of the right mainstem bronchus during exhalation, but not inhalation, in a patent but irregularly shaped bronchus postresection. Intubation, positive pressure breathing, bronchodilator therapy, and laser excision of residual right mainstem tumor resolved the ventilatory failure.
Subject(s)
Bronchial Neoplasms/surgery , Laser Therapy/adverse effects , Lung Diseases/etiology , Adult , Bronchial Neoplasms/diagnostic imaging , Humans , Lung Diseases/diagnostic imaging , Lung Diseases/therapy , Male , Metaproterenol/therapeutic use , Positive-Pressure Respiration , RadiographySubject(s)
Carbon Dioxide/blood , Hemofiltration/methods , Positive-Pressure Respiration/methods , Pulmonary Gas Exchange , Respiration, Artificial/methods , Respiratory Distress Syndrome/therapy , Animals , Clinical Protocols , Clinical Trials as Topic , Humans , Random Allocation , Respiratory Distress Syndrome/bloodABSTRACT
Early diagnosis and repair of tracheal rupture are necessary to prevent acute tension pneumothorax, airway obstruction, and chronic tracheal stenosis. Few reliable radiographic signs of tracheal rupture have been proposed. We diagnosed seven cases of tracheal rupture, two related to blunt trauma and five resulting from tracheal intubation. Early radiographic signs included orientation of the distal portion of the endotracheal tube to the right relative to the lumen of the trachea with an overdistended endotracheal balloon cuff, migration of the balloon toward the endotracheal tube tip, and pneumomediastinum and subcutaneous emphysema. In four cases, the overdistended balloon with distal migration preceded the pneumomediastinum by several hours. An overdistended balloon in a patient after tracheal intubation or blunt chest trauma should suggest tracheal rupture.
