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Cain A.M.,York Hospital
Alternative therapies in health and medicine | Year: 2011

Many patients with inflammatory bowel disease (IBD) use probiotics to manage this intestinal condition. Despite widespread use of these natural therapies by patients, health care providers may be unfamiliar with probiotics as a treatment modality. This review describes the rationale for use of probiotics in IBD, the history behind current research directions, and recent controlled clinical studies in which efficacy of probiotics has been explored in patients with IBD. Emphasis is placed upon critical analysis of study designs for investigations that used lactic acid-producing bacteria or Saccharomyces boulardii in management of Crohn's disease or ulcerative colitis. While there is suggestion of benefit when patients with ulcerative colitis use bacterial therapies and when patients with Crohn's disease use S boulardii, small sample sizes and methodological flaws in study designs necessitate that additional investigations be conducted before probiotics can be routinely recommended in clinical practice.

To use the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database to develop an accurate and clinically meaningful preoperative mortality predictor (PMP) for general surgery on the basis of objective information easily obtainable at the patient's bedside and to compare it with the preexisting NSQIP mortality predictor (NMP). Data were obtained from the ACS NSQIP Participant Use Data File (2005 to 2008) for current procedural terminology codes that included open pancreas surgery and open/laparoscopic colorectal, hernia (ventral, umbilical, or inguinal), and gallbladder surgery. Chi-square analysis was conducted to determine which preoperative variables were significantly associated with death. Logistic regression followed by frequency analysis was conducted to assign weight to these variables. PMP score was calculated by adding the scores for contributing variables and was applied to 2009 data for validation. The accuracy of PMP score was tested with correlation, logistic regression, and receiver operating characteristic analysis. PMP score was based on 16 variables that were statistically reliable in distinguishing between surviving and dead patients (p < 0.05). Statistically significant variables predicting death were inpatient status, sepsis, poor functional status, do-not-resuscitate directive, disseminated cancer, age, comorbidities (cardiac, renal, pulmonary, liver, and coagulopathy), steroid use, and weight loss. The model correctly classified 98.6% of patients as surviving or dead (p < 0.05). Spearman correlation of the NMP and PMP was 86.9%. PMP score is an accurate and simple tool for predicting operative survival or death using only preoperative variables that are readily available at the bedside. This can serve as a performance assessment tool between hospitals and individual surgeons.

Bradbury J.A.,Royal Infirmary | Taylor R.H.,York Hospital
Journal of AAPOS | Year: 2013

Purpose: To determine the type, incidence, and clinical outcomes of severe complications from strabismus surgery in the United Kingdom. Methods: Cases were identified prospectively through a national surveillance unit between September 1, 2008, and August 31, 2010. Questionnaire data were requested at the time of the complication recognition and at 6 months' follow-up. Outcome was graded I to V, with a poor or very poor outcome meaning either loss of corrected visual acuity or primary position double vision. Results: A total of 60 completed reports of adverse events and complications were received during the study period. During the same time approximately 24,000 strabismus surgeries were performed in the United Kingdom, yielding an overall incidence of 1 in 400 operations (95% binomial confidence, 1 per 333-500 operations). The most common reported complication was perforation of the globe (19 [0.08%]), followed by a suspected slipped muscle (16 [0.067%]), severe infection (14 [0.06%]), scleritis (6 [0.02%]), and lost muscle (5 [0.02%]). Overall, complications were reported in adults and children in equal numbers; however, scleritis was significantly more common in adults. A poor or very poor clinical outcome was recorded as 1 operation per 2,400. Conclusions: This study provides an assessment of the overall risks associated with strabismus surgery in the United Kingdom. Complications with the potential for a poor outcome are relatively common, but the final clinical outcome is good in the majority of cases. © 2013 by the American Association for Pediatric Ophthalmology and Strabismus.

Houck D.,York Hospital
Clinical Journal of Oncology Nursing | Year: 2014

Oncology nurses may experience intense physical and emotional exhaustion, identified in the literature as symptoms of cumulative grief and compassion fatigue, with significant consequences for both nurses and organizations. The first step in preventing these consequences is recognition. Organizations should provide nurses with resources including education, counseling, and opportunities to grieve. Nurses need to learn the importance of work-life balance, self-care strategies, and communication skills. Using recommendations from the literature, an educational intervention was designed with the purpose of providing nurses with knowledge, skills, and resources to practice effective self-care and recognize when assistance is needed. The program's objective was to help nurses develop the coping skills and inner resources necessary to maintain their emotional and physical health. © Oncology Nursing Society.

Smith R.A.,York Hospital | Wright B.,Adolescent Health and Child Psychiatry | Bennett S.,Adolescent Health and Child Psychiatry
Archives of Disease in Childhood | Year: 2015

Design: A prospective observational study over 1 year. Setting: A District General Hospital, and Child and Adolescent Mental Health Department. Patients: Children aged 8-18 years living in the catchment area of a district hospital service with any type of unexplained hallucinations or illusions associated with or without an established diagnosis of migraine. Results: The study identified nine children with a combination of migraine and a variety of hallucinations and illusions, including illusions of size, time, colour, body shape, movement and visual and auditory hallucination. An average of 10 symptoms (range 7-15) were reported. Interventions: None. Main outcome measure: None. Conclusions: It is important to recognise these symptoms to enable appropriate history taking and diagnosis. These symptoms are common and currently seem to go unrecognised and may pose diagnostic difficulties if onset is before typical migraine headaches occur. © 2015, bmj publishing group. All rights reserved.

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