Journal of the Association for Academic Minority Physicians : the official publication of the Association for Academic Minority Physicians
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J Assoc Acad Minor Phys · Apr 2002
Is repeat endoscopy necessary after percutaneous endoscopic gastrostomy?
Percutaneous endoscopic gastrostomy (PEG), a safe and effective procedure, is an alternative to open gastrostomy. There are two techniques of placing PEG tubes. One technique consists of a pull-string Ponsky-Gauderer type gastrostomy and the other a push-over-wire Sachs-Vine type gastrostomy. ⋯ Therefore, in 102 of 110 patients (93%), initial placement of the gastrostomy tube bumpers was felt to be adequate, and repeat endoscopy was not necessary. Thus, repeat endoscopy is not routinely required to assess the proper positioning of the internal bumper. Repeat endoscopy should be at the discretion of the endoscopist if there is suspicion of improper positioning of the bumper along the gastric mucosa.
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J Assoc Acad Minor Phys · Mar 2001
Comparative StudyDescribing and predicting frequent users of an emergency department.
The objective of this study was to examine the pattern of emergency department (ED) utilization among a cohort of ED users over a 3-year period and to identify factors predicting use. Billing records were used to track one hospital's cohort of adult frequent ED users (> or = 3 visits/per year) over a 3-year period. Frequent and (< 3 visits/per year) infrequent users were compared by age, gender, marital status, insurance status, and hospitalization rates. ⋯ Other factors (including age, gender, marital status, insurance status, and hospitalization following an ED visit) were not significant independent predictors of frequent ED use. Our data revealed that the past history of frequent ED use is predictive of future frequent ED use. Studies are needed on effective interventions to determine the reasons for continued frequent ED use.
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J Assoc Acad Minor Phys · Mar 2001
Comparative StudyDiversity: the need, the challenge, the promise.
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Post-extubation stridor is a potential complication of endotracheal intubation. The incidence, risk factors, and outcome in adult patient populations are poorly defined. It was our clinical impression that the occurrence of post-extubation stridor in our medical intensive care unit was more frequent than generally reported. ⋯ Medical management was successful in the majority of patients with post-extubation stridor. Routine tracheostomy following a single episode of post-extubation stridor is not indicated. Further investigation regarding risk factors and a placebo-controlled trial evaluating the efficacy of systemic corticosteroids before extubation in individuals at risk for developing post-extubation stridor are needed.
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J Assoc Acad Minor Phys · Jan 1996
Case ReportsNasopancreatic drainage: a novel approach for treating internal pancreatic fistulas and pseudocysts.
Internal pancreatic fistulas are rare but debilitating complications of chronic pancreatitis. Fistulous tracts from the pancreatic duct to the peritoneal or pleural cavities have been treated by medical therapy and surgical management, with success rates of 41% and 89%, respectively. Endoscopic stent placement for internal and external pancreatic fistulas has also been shown effective. ⋯ Following discharge, all three patients were pain free, without evidence of recurrent fistulas or pseudocyst. In conclusion, the use of nasopancreatic/cyst drainage is an effective and convenient way to treat internal, communicating collections and pseudocysts of pancreatic origin. Furthermore, this method provides a simple means of assessing closure of fistulas and pseudocysts.