Articles: patients.
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The case-notes of 2776 patients diagnosed with oesophageal and OGJ cancer in the 5 years from 1 January 1992 to 31 December 1996 were scrutinized by one experienced surgeon. Tumour types were classified by histology and site, and treatment modalities assessed for 30-day mortality rate together with life-table analyses. ⋯ Squamous carcinomas and adenocarcinomas of the oesophageal body are now equally common; lower-third and OGJ tumours are predominantly adenocarcinomas. This study provides baseline data for critical appraisal of potential changes in the delivery of upper gastrointestinal cancer in the UK.
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To measure airflow resistance in prongs of nasal CPAP, making use of different gas admission flow (GAF) in the ventilation circuit, in different internal diameters of the nasal prongs, besides verifying whether a GAF responding only to the demand of three times the minute-volume(MV) is enough to the circuit not to be cause of CO(2) retention. METHODOLOGY: Nasal prongs, assembled in the original circuits, were used, having their prongs kept open to the atmosphere. Pressure was read at a pressure monitor, in water centimeters, connected to the appropriate entrance of the circuit. A flowmeter balanced to the pressure was used, gauged at 50 psi, installed to the oxygen net of the Hospital, connected to the assessing set of the CPAP circuit. Initially, making use of the 8 l/min flow and keeping the exhaling set of the circuit closed, it was possible to eliminate the nasal prongs larger than two once the measured resistance was equal to zero. Having nasal parts number zero, 1 and 2 selected for this study, the system was then assembled as for the neonate: the inhaling set to the gas source and the exhaling set sunk into different depths in the water seal (2, 4, 6 and 8 centimeters). At the level of patient analysis, in order to assess the CO(2) retention, a mechanical pulmonary ventilation device was used as gas source and a nasal CPAP circuit was assembled to the device in adequate places. GAF values and FiO(2) were determined in the commands of the mechanical ventilation device. The assessment of gas concentration in the ventilation circuit was made while assisting two newborns. Gas samples were obtained within the ventilation circuit in the system assessing set (samples A), and right after the distal prong to the gas entrance (samples B). To determine MV the Tidal Volume (considered 10ml/kg) was multiplied by the respiratory frequency of the patient; GAF was three times MV. ⋯ Taking into account that during ventilation assistance through nasal CPAP there is the possibility of GAF incurring in the increase in resistance, what would involve a greater effort from the newborn to overcome such resistance during exhaling into the system (generating possibly an unexpected CPAP), and minimum GAF determined is that sufficient to meet no more than three times the MV, the conclusion is that prongs with the largest internal diameter possible and GAF only the necessary to meet, at least, the needs of the demand three times the MV should be used during this therapeutic procedure.
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To assess the reliability of an augmented SF-36 instrument, the Treatment Outcomes in Pain Survey ("TOPS"), in patients treated in two pain management programs, and present norms for initial values and treatment-related improvements. ⋯ The accuracy of the TOPS is sufficient to monitor the response of individual patients during multidisciplinary treatment of chronic pain. The TOPS provides needed documentation (e.g., to third-party payors) of the aggregate value of multidisciplinary outpatient treatment of chronic pain as well as its benefit for individual patients.
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The aim of this study was to develop equations by which the costs could be compared of various models of performing diagnostic blocks for spinal pain. ⋯ Best practice, using placebo-controlled diagnostic blocks before neurosurgical therapy of zygapophysial joint pain, is not encouraged and rewarded in the United States. In Australia it is compensated only in the context of lumbar zygapophysial joint pain. In the interests of short-term financial savings, the US fee structure sacrifices the majority of patients to failed treatment because of lack of proper diagnosis. Clinical absurdity, rather than evidence-based, best practice is encouraged.
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The current study investigated marital satisfaction and pain severity as mediators of the relationship between spouse responses to pain and depressive symptoms. The study also investigated possible gender differences in these relationships. ⋯ The current results suggest that marital therapy aimed at improving communication and coping skills may be an appropriate treatment for depression and pain in married chronic pain patients, regardless of sex.