Biomedical subjects

A A Cook

Publications and source records attributed to A A Cook.

10 recordsLinked to original sources

PubMed2000

A prospective study of handcuff neuropathies.

Prior reports of handcuff-related neuropathies have been retrospective or small series of cases selected for their unusual electrophysiological or historical features. We conducted a prospective 27-month study at a large, urban, teaching hospital of all patients with a complaint of hand numbness, weakness, or paresthesias attributed to overtightened handcuffs. Forty-one patients were evaluated clinically, and electrodiagnostic testing was performed on 18. In the group with electrodiagnostic testing, neuropathies due to overtightened handcuffs were detected in 22 superficial radial, 12 median, and 9 ulnar nerves. The correlation between clinical and electrodiagnostic findings was best for superficial radial neuropathies, some of which were severe. Median and ulnar nerve injuries were generally mild. Similar clinical findings were obtained in the group without electrodiagnostic testing. Handcuff-related injury to the most commonly affected nerve, the superficial radial, can be severe and permanent.

Adult↗

PubMed1999

Stroke-associated stuttering.

OBJECTIVE: To present patients with stuttering speech in association with stroke. DESIGN: Case series with follow-up for 5 years, or until the stuttering resolved. SETTING: University and community hospital neurology wards, and ambulatory neurology clinics. PATIENTS: Four patients who developed stuttering speech in association with an acute ischemic stroke. A 68-year-old man acutely developed stuttering with a large left middle cerebral artery distribution stroke. A 59-year-old man who had stuttered as a child began to stutter 2 months after a left temporal lobe infarction, as nonfluent aphasia was improving. Another childhood stutterer, a 59-year-old originally left-handed man developed severe but transient stuttering with a right parietal infarction. A 55-year-old man with a left occipital infarction had a right hemianopia and an acquired stutter, for which he was anosognosic. CONCLUSION: The clinical presentation of stroke-associated stuttering is variable, as are the locations of the implicated infarctions.

Aged↗

PubMed1997

Guillain-Barré syndrome in immunocompromised patients: a report of three patients and review of the literature.

Both humoral and cell-mediated autoimmune mechanisms have been implicated in the pathogenesis of Guillain-Barré syndrome (GBS). Therefore, its occurrence in severely immunocompromised patients is not expected. We identified 3 severely immunocompromised patients who developed GBS. Two of the 3 patients had acquired immunodeficiency syndrome with CD4 counts of 5 and 4 cells/mm3, respectively. One post-cardiac transplant patient was taking azathioprine and cyclosporine at the time of onset of GBS. In all 3 patients, immunocompromise was induced by infectious or chemotherapeutic agents which preferentially suppress T-lymphocyte responses. All 3 had severe lymphocytopenia and incomplete recovery. We conclude that GBS can occur in patients with severe t-cell suppression. Although no conclusion regarding prognosis can be drawn from our small group of patients, their incomplete recovery is consistent with the idea that T-cells are important for recovery.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Vertebral fracture after aircraft ejection during Operation Desert Storm.

During Operation Desert Storm, 21 United States and 2 Italian military personnel were held in Iraq as prisoners of war. Of these, 18 had ejected from fixed-wing, ejection seat-equipped, combat aircraft prior to their capture. Of the 18, 6 (33%) had sustained vertebral fractures; 4 of these were compression fractures. This fracture rate is comparable to that of previously studied groups. Fractures were noted to be at several different vertebral sites and after ejecting from a variety of aircraft. Apart from contusions and abrasions, vertebral fractures were the most common injuries discovered in this repatriated population. None of the vertebral fractures produced recognizable neurological disability. The development of vertebral fractures was neither associated with the use of any particular ejection system or aircraft nor did the development of vertebral fractures appear dependent on the age, height or length of service of the affected personnel. Ejected aircrew with low altitude mission profiles seemed more predisposed to vertebral fracture than those at high altitudes, but with a small sample population, this relationship was not statistically significant (p > 0.25). Reliable data were unavailable on aircrew positioning and preparation time for ejection.

Adult↗

PubMed1996

Focal paresthesias with cervical magnetic stimulation.

Subjects undergoing cervical magnetic stimulation with an appropriate coil report focal hand paresthesias in a dermatomal distribution, but the physiologic accuracy of such subjective experiences has been uncertain. In six subjects, we used a butterfly-shaped magnetic coil to stimulate positions on the back of the neck at 1-cm intervals, constant output, and random order, while the subject-estimated location and intensity of paresthesias and sensory nerve action potentials (SNAPs) were recorded from the thumb or index finger. Three subjects each also had recording of finger accelerometry or compound motor action potentials (CMAPs) in the hand and forearm. We found a consistent correlation between subjective paresthesias and SNAPs but an appropriate anatomic divergence between paresthesias and accelerometry or CMAPs. Focal paresthesias from cervical magnetic stimulation are reliable and anatomically accurate, strengthening the hypothesis that other magnetic sensory phenomena are valid as well.

Action Potentials↗

PubMed1994

Illness and injury among U.S. prisoners of war from Operation Desert Storm.

United States prisoners of war had to endure a variety of medical problems during Operations Desert Shield and Desert Storm. All but one of the prisoners suffered some form of injury or illness. Orthopedic injuries were most common. Hematologic, dermatologic, neurologic, and infectious disorders were also noted. Some injuries were combat-related and others were due to mistreatment during incarceration. The prisoners' condition upon repatriation reflected their limited access to appropriate medical care, sanitation, and nutritional support.

Adult↗

PubMed1993

Handcuff neuropathy among U.S. prisoners of war from Operation Desert Storm.

Handcuff neuropathy was the most common neurologic problem acquired by U.S. prisoners of war during Operation Desert Storm. Neurologic deficits were exclusively sensory in all those affected and began to resolve shortly after their release from captivity. Some individuals expressed concern that these injuries could be career-threatening. One of those repeatedly restrained felt that he had discovered measures that could be undertaken to lessen the likelihood of developing neuropathy.

Humans↗

PubMed1992

A multidisciplinary process to determine, communicate, and manage an antibiotic formulary.

This article describes a collaborate process developed by the Pharmacy & Therapeutics Committee to define, determine, communicate, and manage an effective antibiotic formulary. Multiple professional disciplines represented by the antibiotic subcommittee evaluated each classification of antibiotics and recommended a preferred drug(s) for each classification. Decisions were based on relative safety, efficacy, and cost with minimal duplication of therapeutic equivalent antibiotics. A therapeutic interchange policy was unnecessary because extensive communication measures developed by the committee proved effective. The strategy used strengthened pharmacist/physician working relationships. This process permitted rationality and understanding by the medical staff, which resulted in unanimous formulary acceptance.

Anti-Bacterial Agents↗

PubMed1985

An integrated nursing-pharmacy approach to a computerized medication dispensing/administration system.

This paper describes the collaborative efforts of the nursing and pharmacy departments to develop a nurse-generated/pharmacist-verified computerized medication administration record (MAR). The objectives were to improve accuracy in dispensing and administering medications and a avoid duplicate labor efforts created by separate records to dispense and to administer the medications. These efforts provided the nurses with an accurate record to administer the medication and the physicians with an informative record with which to review their patient's drug therapy.

Computers↗

PubMed1983

Operational characteristics of hospital pharmacies in Indiana--1976 vs. 1981.

The operating characteristics and services provided by hospital pharmacies in Indiana were determined. Survey questionnaires were mailed to the pharmacy director for each of the 120 licensed hospitals in Indiana; 62 responded. Pharmacy departments were open an average of 106.3 hours weekly, 51 pharmacies maintained patient profiles, and 29 pharmacies used unit-dose for all beds. Involvement in preparing I.V. solutions was reported by 67.7% of the pharmacies. The mean number of total pharmacy staff (FTEs) reported was 17.1. The ratio of staff FTEs per patient day was larger for pharmacies using a unit-dose distribution system. The most commonly provided clinical services were drug consultation with nursing, drug utilization review, and inservice education. Ratios of average dollar drug inventory and operating expenses per patient day indicated that larger hospitals were more effective with inventory control, but had higher expenses per patient day.

Analysis of Variance↗