Failure mode and effect analysis for delivery of lung stereotactic body radiation therapy.

Purpose: To improve the quality and safety of our practice of stereotactic body radiation therapy (SBRT), we analyzed the process following the failure mode and effects analysis (FMEA) method.

Methods: The FMEA was performed by a multidisciplinary team. For each step in the SBRT delivery process, a potential failure occurrence was derived and three factors were assessed: the probability of each occurrence, the severity if the event occurs, and the probability of detection by the treatment team.

Drainage routes of bronchial blood flow in anaesthetized sheep.

The systemic circulation to the lung supplies the trachea and airway walls and may be important in the pathophysiology of asthma and pulmonary oedema. An understanding of the venous drainage pathways of this bronchial blood flow may be therapeutically important. The purpose of this study was to understand the normal drainage pathways in sheep.

Does "mainstreaming" guarantee access to care for medicaid recipients with asthma?

Objective: Recent reforms in the federal Medicaid program have attempted to integrate beneficiaries into the mainstream by providing them with managed care options. However, the effects of mainstreaming have not been systematically evaluated.

Design: Cross-sectional survey.

Development of a telemedicine program: a review of 1,000 videoconferencing consultations.

Objective: To examine the financial and organizational characteristics, demand for services, and satisfaction outcomes of a growing telemedicine program serving both urban or suburban and rural populations.

Design: Retrospective review of 1,000 consecutive telemedicine consultations in the University of California (UC) Davis Telemedicine Program.

Setting: Telemedicine videoconferencing units, used to integrate care in the UC Davis Health System among the UC Davis Medical Center and several urban or suburban primary care clinics, rural hospitals, and clinic affiliates.

The effects of a managed care educational program on faculty and trainee knowledge, attitudes, and behavioral intentions.

Purpose: To assess the state of managed care knowledge and attitudes and to evaluate the effects of a two-day course on participants' knowledge, attitudes, and behavioral intentions.

Method: In 1996, the University of California, Davis, Medical School invited all medical students, residents, faculty, and administrators to participate in one of two sessions of a two-day course on managed care. Participants in the first session were given both pre- and post-course questionnaires.

Attitudes and behavioral intentions regarding managed care: a comparison of academic and community physicians.

Physicians' attitudes toward managed care and the impact of these attitudes on behaviors that affect patient care are important factors in managed care reform. In addition, the attitudes of academic physicians may influence their willingness to reform medical education in an effort to prepare students to practice under managed care. Although it is a conventional opinion that the academic health center and its academic physicians are antagonistic toward managed care, there has not been a direct comparison of the attitudes of these physicians to those of practicing community physicians.

Physicians' attitudes toward managed care: assessment and potential effects on practice behaviors.

This study was designed to identify the key components of physicians' attitudes toward managed care and develop a tool to assess these components. We developed a questionnaire based on physicians' reactions to managed care, as reflected in the published literature. We mailed this questionnaire to a sample of 753 community physicians in the greater Sacramento area.

Optimal pharmacologic treatment of the critically ill patient with obstructive airways disease.

There are few experimental data evaluating the effect of inhaled bronchodilator treatment in the critically ill patient in the intensive care unit. Extrapolating from the data that are available in chronic and acute asthma and chronic obstructive pulmonary disease (COPD) studies, it appears that both agents may be beneficial. Beta-adrenergic receptor agonists are first-line agents in asthma.

Treatment of bronchogenic carcinoma.

Progress in the treatment of bronchogenic carcinoma, the leading cause of cancer death in men and women in the United States, has been slow throughout the past few years, and no major breakthroughs have occurred in the past 12 months. Significant developments in monoclonal antibody techniques and tissue cellular markers offer hope for improved diagnosis and are useful in staging and following disease response to treatment. Advances in patient selection and staging have been primarily responsible for improved surgical outcomes, but some new surgical alternatives like video-assisted thoracoscopy and other tissue-sparing procedures may offer reasonable outcomes with a lower morbidity.

Risk factors for adverse outcome in persons with pneumococcal pneumonia.

Objective: To identify risk factors for death and respiratory failure in persons with penicillin-sensitive pneumococcal bacteremia and pneumonia from data available at initial clinical evaluation.

Design: Retrospective chart review of persons with pneumococcal bacteremia and pneumonia.

Setting: Tertiary care medical center (University of California Davis Medical Center, Sacramento).

Survival of patients undergoing Nd:YAG laser therapy compared with Nd:YAG laser therapy and brachytherapy for malignant airway disease.

Brachytherapy in combination with Nd:YAG laser therapy may add to the duration of survival of the palliative period when compared with laser alone. A retrospective study of patients with inoperable squamous cell carcinoma (SCC) was undertaken to determine if there was a difference in survival between those patients treated with Nd:YAG laser alone and those treated with Nd:YAG laser and brachytherapy. Twenty-two patients were treated with brachytherapy for malignant airway disease at our institution of which 13 had SCC.

Time course of ozone-induced neutrophilia in normal humans.

Five normal human subjects were exposed for 1 h to filtered air (FA) once and to 0.3 ppm O3 on 3 separate days. Bronchoalveolar lavage (BAL) fluid was obtained less than 1 h after FA and either less than 1, 6, or 24 h after O3 exposure.

Closure of a bronchopleural fistula with bronchoscopic instillation of tetracycline.

Persistent bronchopleural fistulas (BPF) due to infection, trauma, or thoracic surgical procedures are often difficult to manage. We report a patient with fulminant Staphylococcus aureus pneumonia complicated by chronic BPF formation which prevented weaning from mechanical ventilation due to severe air leak. Fistula closure was obtained by instillation of tetracycline into the fistula via a fiberoptic bronchoscope using a balloon catheter and blood clot occlusion technique.

Nd:YAG laser bronchoscopy. Rigid or fiberoptic mode?

One hundred twenty four Nd:YAG laser procedures were performed on 79 patients (age range, 25 to 89 years) over a five-year period at our institution. Over 90 percent of patients had malignant tumors. The fiberoptic bronchoscope (FOB group) was used exclusively during the first two years (61 cases, 32 patients).

Using pulmonary function testing in the diagnosis and treatment of asthma.

Asthmatics have remarkable changes in their pulmonary function in response to numerous external stimuli and internal controls. Serial pulmonary function testing in the office, hospital, at home, or the work place allows the objective measurement that is necessary to intelligently diagnose and treat these patients. Once the patient and the physician understand how to use the techniques for monitoring the degree of airways obstruction, they become a key in medical management decisions.

Acute ozone exposure increases plasma prostaglandin F2 alpha in ozone-sensitive human subjects.

Twenty O3-sensitive and 2O O3-nonsensitive subjects participated in a study to investigate the effects of disparate O3 sensitivity on plasma prostaglandin F2 alpha) responses consequent to exposure to ambient O3 concentrations. Subjects were selected from a pool of 75 normal healthy college-aged males who had been previously exposed to 0.35 ppm O3 for 1 h at an exercising VE of 60 L/min.

Indomethacin pretreatment reduces ozone-induced pulmonary function decrements in human subjects.

We studied whether O3-induced pulmonary function decrements could be inhibited by the prostaglandin synthetase inhibitor, indomethacin, in healthy human subjects. Fourteen college-age males completed six 1-h exposure protocols consisting of no drug, placebo, and indomethacin (Indocin SR 75 mg every 12 h for 5 days) pretreatments, with filtered air and O3 (0.35 ppm) exposures within each pretreatment.

Isoniazid overdose: pharmacokinetics and effects of oral charcoal in treatment.

The pharmacokinetics of isoniazid following overdose in two patients is described. One patient was treated with haemodialysis for seizures and persistent coma without obvious immediate clinical improvement. In addition, three volunteer subjects were given isoniazid orally on two separate occasions.

Emergency airway clot removal in acute hemorrhagic respiratory failure.

Three cases of respiratory failure and severe hypoxemia caused by blood clot obscuring the central airway are described. A technique to clear the airway using a no. 6 Fogarty balloon-tip embolectomy catheter inserted through a flexible fiberoptic bronchoscope was used in all three cases.

Pericarditis caused by beta-lactamase-producing Haemophilus influenzae: report of two cases in adults and review of the literature.

Two adult patients with pericarditis caused by beta-lactamase producing Haemophilus influenzae are reported and their management reviewed. Both had pharyngitis, epiglottitis, pneumonia, empyema, or septicemia and were cured with antimicrobics and pericardial drainage (one by catheter and one by surgery). Eleven previously reported cases of pericarditis caused by Haemophilus influenzae are also reviewed.

Noninvasive lung water quantitation by 1H nuclear magnetic resonance spectroscopy.

Three models of volume-dependent pulmonary edema were used in rabbits. Changes in lung water were measured by proton (1H) nuclear magnetic resonance spectroscopy (NMR) using a surface coil system, topical magnetic resonance. The anesthetized rabbits were ventilated with high frequency jet ventilation to minimize lung motion, and the surface coil was placed on the rabbit chest wall over the right lung.

A case of fatal sodium azide ingestion.

A fatal case of sodium azide poisoning in which exchange blood transfusions, charcoal hemoperfusion, hemodialysis and potent vasopressor agents failed to prevent the development of circulatory collapse associated with a wide complex cardiac rhythm is presented. The cellular toxin sodium azide resulted in the development of an altered mental status, profound metabolic acidosis, cardiac arrhythmia (atrial fibrillation and terminal wide complex arrhythmias), a relative decrease in cardiac output, hypotension and non-cardiogenic pulmonary edema. Further animal studies are needed to gain new approaches for the treatment of this rare cause of human poisoning.

Dyspnea in the elderly: cardiac or pulmonary?

Compare the chest film with previous films, if possible. Changes in heart size and interstitial and vascular markings can thus be seen more readily, as can air trapping; this also aids in differentiation of acute from chronic changes. A Holter monitor study should be obtained if dyspnea occurs irregularly, has acute onset and termination, or is associated with dizziness or syncope; or if the resting ECG shows frequent premature atrial contractions, premature ventricular contractions, bradycardia, or periods of advanced heart block.

The value of serial serum angiotensin converting enzyme determinations in hospitalized patients with lung disease.

Abnormal serum angiotensin converting enzyme (ACE) activity has been reported in various human lung disorders and in laboratory animals with acute lung injuries. To test the value of serum ACE activity as an indicator of lung damage and its assistance in diagnosis or prognosis, 328 serum samples were obtained from 108 hospitalized patients with lung disease and 26 normal subjects. When patients were clinically grouped by disease entity, only the sarcoidosis group showed elevated mean serum ACE.