Biomedical subjects
Publications and source records attributed to C A Sullivan.
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The effects of atropine and glycopyrrolate on anatomical dead space, one and three second forced expiratory volume, maximal expiratory flow rate, and total forced expiratory volume were determined in ten healthy volunteers. Using Fowler's single breath nitrogen analyzing technique, atropine was found to increase dead space by 19.2 per cent at one hour, declining to 11.02 per cent at four hours. Glycopyrrolate increased dead space by 21.57 per cent at one hour, 29.28 per cent at two hours, and 26.65 per cent at four hours. When compared to the effects of saline control injection, the dead space increases are significant. The difference between glycopyrrolate and atropine is significant only at four hours. Increases in maximal expiratory flow rate induced by atropine and glycopyrrolate were significant at one-half hour, while atropine alone induced a significant increase in one second forced expiratory volume. Three second forced expiratory volume and total forced expiratory volume were not significantly altered.
Bilateral superior laryngeal nerve block was combined with topical application of local anaesthetic 140 times in 135 patients to anaesthetize the upper airway and facilitate tracheal intubation, laryngeal instrumentation, or to diminish the response to the endotracheal tube, in a patient already intubated. The technique was successful in 92% of attempts.
In 30 patients undergoing major operations, and anaesthetized with either nitrous oxide, oxygen and enflurane, or nitrous oxide, oxygen and fentanyl, there was no significant alteration in platelet aggregation induced by either adenosine diphosphate or collagen. The absence of any significant effect on platelet function was confirmed by an unchanging thromboelastogram pattern during the study.
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In 109 patients, it was determined that halothane, when used to anesthetize patients for oral surgical procedures, causes an increased risk of serious cardiac arrhythmias when compared to methoxyflurane and fentanyl/droperidol. It is postulated that this is due to halothane's ability to decrease cardiac conduction and to facilitate the development of reentry phenomena. This decreased conduction may be accentuated by vagal efferent reflexes that have the same effect. The decrease in cardiac conduction was manifested by an ECG pattern of aberrant conduction. This phenomenon was not noted with either methoxyflurane or fentanyl/droperidol.
A 22-year-old man suffered a stab wound of the femoral artery and vein. This was followed by disseminated intravascular coagulation. Renal failure then occurred presumably due to fibrin deposition in the small vessels of the kidney. The D.I.C. was successfully treated with heparin and the renal failure with peritoneal dialysis. It is suggested that D.I.C. and consequent alterations in regional blood flow following trauma are not uncommon, and search should be made for these phenomena in every case of major trauma.
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OBJECTIVE: To assess the level of expectation and satisfaction of patients with asthma regarding the counseling provided by community pharmacists, and to identify the counseling information patients consider important in helping them manage their asthma. DESIGN: Mailed survey. PARTICIPANTS: 208 patients seen in the University of Utah Asthma Clinic for at least 3 months, age 18 years or older, and on at least 1 asthma medication. MAIN OUTCOME MEASURES: Frequency of pharmacist-provided asthma medication counseling, patients' perception of the importance of counseling, and their satisfaction with counseling. RESULTS: Response rate was 55% (106 of 194 surveys returned). The majority of patients (> 90%) indicated that their community pharmacist "never" or "sometimes" discussed the management of their asthma with them. Frequency of counseling in three predefined areas of asthma education (role of medications, inhaler technique, and prevention of asthma attacks) was 1.91, 1.72, and 1.31, respectively (1 = never, 4 = always). Most patients (76%) considered these areas of counseling to be important for the management of their asthma. Most patients (62%) were "somewhat" to "pretty" satisfied with the type and amount of asthma counseling provided by their pharmacist. Counseling sessions averaged less than 3 minutes. Only 25% of patients would be willing to pay an additional amount for pharmaceutical care. CONCLUSION: Self-reported rates of patient counseling concerning asthma medications in the community pharmacy setting are low and adequately address neither the educational needs of patients nor the recommendations of the National Asthma Education and Prevention Program.
This article discusses the implications of designing a comprehensive competency assessment program for healthcare providers. Increased liability for providers, institutions, and liability carriers is providing the impetus for change. Current methods to evaluate competency are limited; most methods include requirements that simply validate licensure and credentials. This article discusses the literature that supports methods for evaluating competency by assessing skills and proctoring. The author proposes a three-part model to ensure that competency assessment and performance improvement is the mainstay of an organization's quality management program. The model includes (a) a skills assessment inventory, (b) a standards review to promote compliance, and (c) a peer review program. Included are samples from two comprehensive skills inventories designed for orientations for physicians and nurses.
Perforation of the heart by central venous catheters is an uncommon but life-threatening complication in the neonatal age group. Prevention requires an open insertion technique, the use of soft Silastic catheters, and the maintenance of the catheter tip above the right atrium. Rapid clinical deterioration with signs of tamponade suggests the diagnosis. Catheter withdrawal, early pericardiocentesis, and pericardiotomy with myocardial repair in selected cases contribute to survival.
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The biological basis, rationale, methodology, and results obtained from a laboratory test to identify chromosome aberrations has been described. The limited in vivo use of the method for measuring ionizing radiation exposure to patients, and the results obtained in these studies, have been presented and discussed. A protocol to use the method in an unique and specific application not yet fully explored, namely for the purpose of evaluating the biological effects of occupational radiation exposure of radiologic technologists, is proposed and advocated. The theory is advanced that this method of determining occupational radiation exposure may prove superior to personnel monitoring methods now employed.