Unprepared Patients Research Articles

Effects of a Fast-Track Closing on a Nursing Facility Population

Sixty-nine patients in a nursing facility were subjected to sudden, forced relocation to other nursing facilities when the facility they were in failed to meet conditions for participation in the Medicaid program. A retrospective study was conducted to examine the effects one year after transfer. Comparisons between those returned following recertification of the facility and those not returned demonstrated dramatic differences; 65 percent of the first group suffered deterioration or death, compared with 19 percent of the second group. Other factors found to be associated with high death rates or worsening of condition one year later were being male, severe physical or mental impairment, and lack of social support. Findings verify that serious adverse effects occur when unprepared patients are suddenly relocated and suggest that return to the facility of origin can mitigate those effects. Implications for policy and practice are discussed.

Radiographer-performed abdominal and pelvic ultrasound: its value in a urology out-patient clinic.

To assess the efficacy of radiographer-performed ultrasound examination as a routine investigative procedure in a urological out-patient clinic. A total of 151 patients attending a District General Hospital Urological Out-patient Department underwent an ultrasound examination in the clinic. Diagnosis by ultrasound was achieved in 93% of patients. The remaining patients underwent further investigations. Two (1%) patients with normal scans had small bladder tumours. Subsequent intravenous urography in these individuals showed normal upper tracts. Abdominal and pelvic ultrasound examination performed in the urological out-patient clinic on unprepared patients was the only investigation necessary for evaluation of common problems such as non-specific urinary symptoms, recurrent urinary tract infections and bladder outlet obstruction.

A trial to assess the effectiveness of bowel preparation prior to intravenous urography

A randomized prospective trial was undertaken to compare the relative effectiveness of two commonly used bowel preparations (senna tablets and sodium picosulphate powder) administered to patients before they underwent out-patient intravenous urography. Their 'control' films were compared with plain 'kidneys, ureters, and bladder' (KUB) radiographs of patients who had had no bowel preparation. The results show no significant difference in the degree of faecal shadowing between those receiving a bowel preparation and the unprepared patients. Nor is there any difference between the two laxatives. We conclude that the routine administration of a bowel preparation is unlikely to improve the diagnostic quality of out-patient intravenous urograms. In addition, 40% of the urogram patients found the effects of the laxatives to be unpleasant or very unpleasant.

Comparison of Whole-gut Irrigation with Golytely (GOL) and with a Balanced Electrolyte Solution (BES) as Preparation for Colonoscopy

The cleansing results of whole-gut irrigation with golytely (GOL) or with a balanced electrolyte solution (BES) were compared in otherwise unprepared patients. In one study 30 patients were randomly prepared either with 4 l GOL or with BES till a clear rectal effluent was obtained. Only 4/15 patients prepared with GOL, as compared with all 15 prepared with BES, had good or excellent cleansing results. In a second study, both solutions were infused in a double blind manner in 40 patients till rectal effluent was clear. No significant differences in the amount of fluid needed, the duration of lavage or degree of cleansing was found. However, significantly less fluid retention occurred with GOL.

Bowel preparation and the safety of colonoscopic polypectomy

A fatal colonic explosion has been recorded during colonoscopic polypectomy after oral mannitol bowel preparation. It has been suggested that bacterial degradation of oral mannitol allows the production of hydrogen and methane which are potentially explosive. We have analyzed the gas composition of colonic aspirates in unprepared patients (n = 11), after orthograde saline lavage (n = 11), after oral mannitol alone (n = 11), and when oral mannitol was given with oral antibiotics (n = 11). After oral mannitol bowel preparation 7 patients had potentially explosive gas mixtures compared with 4 in the unprepared group, 1 after orthograde saline lavage, and none when oral antibiotics were used before mannitol. We believe, therefore, that if oral mannitol is used for bowel preparation before colonoscopic polypectomy oral antibiotics should also be administered or insufflation should be with carbon dioxide.

Colorectal cancer and hemoccult.

Hemoccult slides have been used in an attempt to determine their usefulness as a screening method for the detection of colorectal neoplasia. Two methods have been used. In the first, 300 unprepared patients had an immediate single-stool specimen tested with Hemoccult. Only nine patients were referred for investigation after this single test, and no case of colorectal neoplasia was discovered. In the second method over 2,500 three-stool test kits were distributed to the public, of which 1,160 (46%) have been returned and tested. Positive tests were obtained in 68 patients. Follow-up of 58 of these patients has led to the detection of three cases of carcinoma of the colon and nine cases of benign polyps greater than one centimetre in diameter. The cost of screening patients with a three-stool test has been calculated to be $2.50 per patient.

Ultrasound evaluation of the gallbladder wall.

In a series of 526 consecutive, unprepared patients examined by ultrasound, the gallbladder was visualized in 507 (96%). The average wall thickness was 2 mm or less in 97% of asymptomatic subjects without cholelithiasis and 3 mm or greater in 45% of those with choletithiasis. Pathologic correlation of increased thickness and chronic cholecystitis was made in a subgroup of 47 surgical patients. Local tenderness and mucosal thickening were found in 8 patients with acute cholecystitis. Use of electronic sector scanning is emphasized.

Primary hemicolectomy for perforated lesions of the right colon.

Not all patients with right-sided abdominal pain and associated inflammatory signs have acute appendicitis. When the usual surgeon finds unusual pathology coupled with evidences of peritonitis, he naturally inclines toward conservative action. The old adage, "The surgeon should run when the pus runs," is not sound surgical judgment in all cases. When one unexpectedly encounters a perforated lesion of the right colon in a completely unprepared patient, he must consider the possibilities of the pathology involved and the consequences of an inadequate procedure. Inflammatory lesions of the colon cannot always be distinguished from neoplastic ones. This lack of certainty is admitted by our most experienced surgeons. One must therefore at times base his judgment on probabilities. From a statistical viewpoint one must assume that a perforated right colon lesion is a carcinoma. Although the frequency of cancer of the left colon is emphasized, cancer of the right colon is not

A RENAL CONCENTRATION TEST EMPLOYING POSTERIOR PITUITARY INJECTION

We have previously reported a renal concentration test employing posterior pituitary injection. 1 This procedure consists in the subcutaneous injection into an unprepared patient of 10 units of posterior pituitary injection (1 cc. obstetric or 0.5 cc. surgical). Specimens of urine are collected at half hourly intervals for two hours and their specific gravities determined. The small volumes of urine resulting from this procedure require a Saxe urinopyknometer, or weighing bottle, for the estimation of the specific gravity. Such a procedure does not lend itself well to clinical practice. We have therefore modified the technic by lengthening the intervals between collections to one hour. This modification is just as satisfactory and requires only the usual small size urinometer. Cheap accurate urinometers requiring only 4 to 6 cc. of urine are available. The procedure is as follows: The unprepared subject empties the bladder, and the specimen is saved. Immediately