RESUMEN
Beginning in the 1990s, with increased attention focused on the alleged abuses and arbitrary decision making by MCOs, several states began enacting legislation to establish health care ombudsmen. A variety of states, including the District of Columbia, are now considering health care ombudsman legislation. This article focuses on the varying role, functions, and duties of the health care ombudsman in each of these states and their benefit to the health care environment.
Asunto(s)
Atención a la Salud , Defensa del Paciente , Rol Profesional , Toma de Decisiones , Control de Acceso/legislación & jurisprudencia , Programas Controlados de Atención en Salud/legislación & jurisprudencia , Estados UnidosAsunto(s)
Adenoma/diagnóstico por imagen , Bocio Nodular/radioterapia , Radioisótopos de Yodo/uso terapéutico , Neoplasias de las Paratiroides/diagnóstico por imagen , Tirotoxicosis/radioterapia , Adenoma/complicaciones , Anciano , Femenino , Humanos , Neoplasias de las Paratiroides/complicaciones , Cintigrafía , Radiofármacos , Pertecnetato de Sodio Tc 99m , Tecnecio Tc 99m SestamibiRESUMEN
INTRODUCTION: Hydrocoele is a condition frequently encountered in adult urological practice. It is usually of benign aetiology and often diagnosed on clinical grounds. Surgical repair, if indicated, is generally straightforward. CASE PRESENTATION: We report a 53-year-old man with liver cirrhosis and clinical features of a hydrocoele, in whom flow was demonstrated using Doppler ultrasonography in the fluid around the testis, which communicated via varices with the left renal vein. CONCLUSION: In this patient with misleading clinical signs, diagnosis was established radiologically. Had surgery proceeded without this investigation, significant intra-operative bleeding would have been likely.
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OBJECTIVE: Compare airway pressure measurements at the ventilator Y-piece of the breathing circuit (P( Y )) to intratracheal pressure measured at the distal end (P( T )) of the endotracheal tube (ETT) during mechanical ventilation and spontaneous breathing of intubated children. METHODS: Thirty children (age range 29 days to 5 years) receiving general anesthesia were intubated with an ETT incorporating a lumen embedded in its sidewall that opened at the distal end to measure P( T ). Peak inflation pressure (PIP) was measured at P( Y ) and P( T ) during positive pressure ventilation. Just before extubation, all measurements were repeated and imposed resistive work of breathing (WOBi) was calculated at both sites while breathing spontaneously. RESULTS: Average PIP was approximately 25% greater at P( Y ) (19.7 +/- 3.4 cm H(2)O) vs. P( T ) (15.0 +/- 2.9 cm H(2)O), p < 0.01. During spontaneous inhalation P( T ) was 59% lower ({bond}8.5 +/- 4.0 cm H(2)O) vs. P( Y ) ({bond}3.5 +/- 2.0 cm H(2)O), p < 0.01. WOBi measured at P( Y ) (0.10 +/- 0.02 Joule/L) was 86% less than WOBi measured at P( T ) (0.70 +/- 0.40 Joule/L), p < 0.01. CONCLUSIONS: In healthy children P( Y ) significantly overestimates PIP in the trachea during positive pressure ventilation and underestimates the intratracheal airway pressure during spontaneous inhalation. During positive pressure ventilation P( T ) better assesses the pressure generated in the airways and lungs compared to P( Y ) because P( T ) also includes the difference in airway pressure across the ETT tube due to resistance. During spontaneous inhalation, P( T ) reflects the series resistance of the ETT and ventilator circuit, while P( Y ) reflects only the resistance of the ventilator circuit, accounting for the smaller decreases in pressure. Additionally, P( Y ) underestimates the total WOBi load on the respiratory muscles. Thus, P( T ) is a more accurate reflection of pulmonary airway pressures than P( Y ) and suggests that it should be incorporated into ventilator systems to more accurately trigger the ventilator and to reduce work of breathing.