Centerpoint Medical Center

Highlights The comorbid course of ischemic cardiovascular diseases with indications for surgical revascularization and untimely surgical correction of blood circulation in chronic ischemic heart disease and lower limb ischemia, asymptomatic stenosis of the common/internal carotid artery ≥ 70% cause high risks of developing adverse cardiovascular outcomes – acute coronary syndrome, acute cerebrovascular accident, critical ischemia of the lower extremities and death. The improvement of the surgical stage of treatment for comorbidity of ischemic cardiovascular diseases based on the tactics of single-stage revascularization of various arterial basins using X-ray endovascular technology contributes to the timely availability of surgical care and the medical and economic efficiency of the healthcare organization. Abstract Aim. To evaluate the medical economic effectiveness of single-stage revascularization of various arterial pools (RVAP) in patients with comorbidity of chronic ischemic cardiovascular diseases (CICVD) and indications for surgical revascularization. Methods. A multicenter research (n = 6) was in 2004–2024. The research subjects were patients (n = 854) with comorbidity of chronic ischemic heart disease (CIHD) and limb ischemia (CLI) 2B-4 st., asymptomatic stenosis ≥ 70% of the common/internal carotid artery (CCA/ICA), with indications for RVAP in accordance with the clinical guidelines of the Russian Federation. The average age of patients was 74.1 ± 7.4 years. Patients of the main group A (n = 106) underwent single-stage RVAP, and patients of the control group B (n = 748) underwent two-stage RVAP, a stage interval – 3.2 ± 8.25 days. Endovascular technology was used for RVAP. To evaluate the safety, clinical, angiographic, social, financial and economic effectiveness of medical care with RVAP. The follow-up period for evaluate of results was 1 and 3 years. The methods of content analysis, statistical, mathematical, comparative analysis were applied. For statistical analysis the program Statistica 6.0 (StatSoft Inc., USA) was applied. Results. Patients in groups A and B were comparable in terms of age and sex, prevalence of CICVD with indications for RVAP and risk factors of cardiovascular complications (CVC). Indications for revascularization in 2 and 3 arterial pools were established in 94.6% (n = 808) and 5.4% (n = 46) of patients, respectively. The structure of 2-pool revascularization: for CLI 3–4 st. and CIHD (n = 539, 63.1%) – single-stage (n = 84, 15.6%) and two-stage (n = 455, 84.4%); for CLI 2B st. and CIHD (16.2%, n = 138) – single-stage (n = 5, 3.6%) and two-stage (n = 133, 96.4%); with CLI 3–4 st. and unilateral stenosis ≥ 70% of CCA/ICA (8.4%, n = 72) – single-stage (n = 8, 11.1%) and two-stage (n = 64, 88.9%); with CIHD and unilateral CCA/ICA stenosis ≥ 70% (4.1%, n = 35) – single-stage (n = 7, 20%) and two-stage (n = 28, 80%); with CLI 2B st. and unilateral stenosis ≥ 70% of CCA/ICA (1.76%, n = 15) – single-stage (n = 2, 13.3%) and two-stage (n = 15, 86.7%); with bilateral stenosis ≥ 70% of CCA/ICA (1.05%, n = 9) a two-stage endovascular procedures was performed. Three-pool revascularization tactic was performed in patients with CLI 3–4 st, CIHD and unilateral stenosis ≥ 70% of CCA/ICA (5.4%, n = 46). One-year results were assessed in all patients in group A and 89.7% (n = 670) in group B. Three-year results were assessed in all patients in group A and 81.3% (n = 608) patients in group B. In all cases, clinical and angiographic effectiveness of RVAP was achieved, there were no complications. The period of hospital treatment in patients of group A was 1.2 ± 2.6 days, group B 2.9 ± 4.15 days. In 1st year of follow-up the indications for repeated revascularization arose due to the progression of CLI in 1 patient of group A and 3 patients of group B and the return of angina pectoris to 2–3 FC in 2 patients of group B. During 3 years of follow-up the remaining patients did not have repeated revascularizations and CVC, which was facilitated by continuous controlled dispensary care according to the developed algorithm. The average bill and direct costs for one-stage RVAP were 487.4 ± 15.1 rubles and 158.6 ± 12.8 rubles, for two-stage – 634.8 ± 18.7 rubles and 196.9 ± 16.2 rubles, for three-stage – 816.8 ± 18.1 rubles and 276.1 ± 24.9 rubles, respectively. Three-year survival in both groups is 98.7%. Conclusion. The scientific practical novelty and theoretical significance of the findings on the safety, medical, social, economic and financial effectiveness of complex medical care in patients with comorbidity of CICVD with indications for surgical care and using single-stage RVAP, can become the basis for improving clinical recommendations in patients with cardiovascular diseases, with the accumulation of analytical data.

The measurement of body temperature is an important aspect of assessment prior to invasive procedures. The purpose of the study was to determine the level of agreement between temporal artery, noncontact infrared, and disposable oral electronic thermometers to a clinical reference device (nondisposable oral electronic thermometer) in outpatients prior to an endoscopic procedure. A descriptive, method-comparison study design was used to compare 3 noninvasive thermometers with a clinical reference device. Four noninvasive temperatures were measured with 3 test devices (temporal artery with ear tap; temporal artery without ear tap; disposable oral electronic; and noncontact infrared), followed by measurement with the clinical reference device (nondisposable, oral electronic). Differences (bias) and limits of agreement (±1.96 SD) were calculated for the test devices and graphed using Bland-Altman method. Clinically acceptable levels of agreement were set at a bias of 0.54 °F or less and precision of 0.90 °F or less. A total of 25 endoscopy patients (N = 14 female; N = 11 male) were studied, with temperatures ranging from 97.5 to 98.9, averaging 98.1 ± 0.3 °F. All thermometers, with the exception of the noncontact infrared (0.66 °F), had acceptable ranges for use in clinical practices. Findings from this study support the use of both temporal artery and disposable oral electronic thermometers in afebrile outpatients but not the noncontact infrared thermometer.

Improving Sibling Relationships Among Young Children: A Social Skills Training Model* Laurie Kramer** and Chad Radey A new approach to improving sibling relationships was evaluated in which social skills training was used to directly coach small groups of children (n = 21) in prosocial sibling behaviors. In comparison to a control condition (n = 21), social skills training was associated with mothers' or fathers' reports of.' (I) increased warmth; (2) decreased rivalry; (3) stable levels of agonism and competition; (4) fewer problematic sibling behaviors; and (5) a reduced status/power differential between siblings. Social skills training may hold promise for setting young children's sibling relationships on a positive trajectory. Disputes among siblings are the most common type of conflict that families face (Straus, Gelles, & Steinmetz, 1980) and may be quite aggressive and even violent (Felson & Russo, 1988; Roscoe, Goodwin, & Kennedy, 1987; Steinmetz, 1978; Straus et al., 1980; Weihe, 1991). Intractable conflictual relations among young siblings have been shown to be predictive of later difficulties, such as antisocial and disturbed behaviors in adolescence (Richman, Stevenson, & Graham, 1982) and adulthood (Patterson, 1982). These factors have led some investigators to refer to sibling relationships as potential training-grounds for violence (Steinmetz, 1978) and for establishing chronic coercive interactions with others (Patterson, 1982). Although resources do exist for assisting families to respond to sibling conflict, they are limited in several ways (Ramsburg & Kramer, 1995). First, most resources are based primarily on clinical or practical experiences and lack both a theoretical foundation and empirical data to support their effectiveness. In addition, resources for younger children focus primarily on promoting their initial adjustment to the birth of a new sibling and generally do not focus on developing competencies for interacting positively and managing conflict once their sibling becomes a more active partner in the interaction. When attention is devoted to sibling interaction (e.g., Leitenberg, Burchard, Burchard, Fuller, & Lysaght, 1977; Levi, Buskila, & Gerzi, 1977; Olson & Roberts, 1987), recommendations are usually reactive (responding in situations where pronounced sibling conflict already exists) rather than proactive and preventive (working to encourage prosocial interaction among siblings before conflictual processes escalate). Finally, most programs are designed to change parents' behavior with the objective of indirectly changing child behavior. Indeed, there is a great deal of evidence to suggest that parents play a substantial role in shaping the quality of children's sibling relationships, particularly as they respond to sibling conflicts (Brody, Stoneman, McCoy, & Forehand, 1992; Ross, Filyer, Lollis, Perlman, & Martin, 1994; Vandell & Bailey, 1992) or work to encourage prosocial sibling behaviors (Kramer & Washo, 1990). For example, Tiedemann and Johnson (1992) found improved sibling behaviors when mothers were taught strategies for promoting child sharing skills. However, even stronger effects may be obtained if we directly support children's acquisition of new sibling interaction patterns. In this research, we evaluate a new approach to improving sibling relationships in which a social skills training model is used to directly coach young children in prosocial sibling behaviors. The approach of developing interpersonal competencies as a way to improve sibling relationships is unique. However, it is supported by previous research on the early development of sibling relationships (Kramer & Gottman, 1992; Stocker & Dunn, 1990). Kramer and Gottman's (1992) longitudinal study demonstrated the importance of peer relationships and social competence in helping children to establish positive relationships with new siblings. …