The West Virginia medical journal
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Case Reports
Overuse-related vascular injury of the hand--hypothenar hammer syndrome: a case report.
Although rare, vascular insufficiency is a well-recognized cause of hand pain, making a significant impact in the athletic and labor industry. Surgically correctable lesions are important to recognize since definitive treatment may alter the course of the disease and affect outcomes. ⋯ Arteriography is the gold standard of diagnosis and severe symptomatic cases are treated with surgical resection and re-establishment of blood flow. We report such a case of HHS, its clinical course and management.
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Most deaths in West Virginia occur in hospitals and a high proportion take place in intensive care units (ICU). This study was undertaken to determine what West Virginia physicians and nurses treating patients in ICUs perceive to be the barriers to quality end-of-life care. ⋯ In addition, it showed that physicians referred an average of 10 patients to hospice in the preceding year and that they did not refer more patients because the patient or family did not accept that the patient was dying. Futher education of physicians, nurses and especially the public is needed to improve end-of-life care in West Virginia.
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Since the mid-1980s, permanent prostate brachytherapy has been utilized increasingly as a potentially curative treatment for patients of all ages with clinically localized prostate cancer To determine the 8-year biochemical progression-free survival rate for patients who had undergone monotherapeutic brachytherapy for clinically organ-confined prostate cancer, we conducted a study of 202 patients at Schiffler Cancer Center at Wheeling Hospital in Wheeling, W. Va. These patients had undergone brachytherapy without supplemental external beam radiation therapy or androgen deprivation therapy for clinical T1b-T2c NxM0 (2002 AJCC) prostate cancer from April 1995 through May 2001. ⋯ In multivariate analysis, only pretreatment PSA predicted biochemical outcome with a trend for better outcome with younger patient age and lesser percent positive biopsies. The results of our study indicate that permanent interstitial brachytherapy as a monotherapeutic approach for patients with clinically organ-confined disease results in a high probability of 8-year biochemical progression-free survival with a median PSA < 0.1 ng/mL. Generous periprostatic treatment margins with documented high quality day 0 postoperative dosimetry are mandatory for such outcomes.
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Comparative Study
A comparison of neural networks for computing predicted probability of survival for trauma victims.
TRISS is a statistical method for predicting the probability of survival of trauma victims. Analysis of data from the Trauma Registry at Charleston Area Medical Center showed that only 48% of the trauma fatalities in the 5-year period 1992-1996 were correctly predicted by TRISS. Trauma practitioners from other Trauma Centers report similar problems with TRISS. ⋯ The predicted number using TRISS was 86 for a relative error of 27.7%. Since effective quality improvement for trauma care depends on accurately identifying cases that fall outside the expected results, a more accurate predictive tool allows a more focused review of those significant cases, thus conserving resources without compromising quality. Neural Networks appear to be a predictive tool that can provide probability of survival estimates that are more accurate than TRISS.