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Biomedical subjects

C P Murphy

Publications and source records attributed to C P Murphy.

At least 19 recordsLinked to original sources
PubMed1994

Clinical judgment: an integrated model.

Literature on clinical judgment is discussed as a background for proposing an integrated model of diagnostic-therapeutic and ethical reasoning. Information processing and nursing process components related to problem identification and problem solving serve as a framework for the integration of the two domains of clinical reasoning. Discussion focuses on the integration of process components, identification of areas of research, and the use of the model in education and practice.

Clinical Competence↗
PubMed1993

Dose-related cutaneous toxicities with etoposide.

BACKGROUND: Cutaneous toxicities are seen frequently in association with administration of high doses, but not standard doses, of agents. With the increasing use of etoposide in dose-intensive regimens, cutaneous toxicities are appearing with increasing frequency. METHODS: A retrospective analysis of 145 patients treated with various doses of etoposide was conducted. RESULTS: This analysis revealed a statistically significant increase in the frequency of these toxicities at doses of 2400 mg/m2 and 4200 mg/m2, compared with doses of 1800 mg/m2. Intense, painful palmar erythema accompanied by bullae formation and desquamation occurred at the 4200 mg/m2 dose. Symptoms were controlled by a short course of corticosteroids. CONCLUSION: Although they are not dose limiting, substantial dose-related skin toxicities can be an important side effect of high-dose etoposide therapy.

Dose-Response Relationship, Drug↗
PubMed1992

Generalized seizures secondary to high-dose busulfan therapy.

Two patients without prior histories of neurologic disorders experienced generalized seizures while receiving high-dose busulfan (total dose 16 mg/kg) as part of a preparative regimen for allogeneic bone marrow transplantation. A review of the literature revealed 14 similar occurrences. Maintenance of therapeutic blood concentrations of phenytoin in subsequent patients at our institution has resulted in no further patients experiencing generalized seizures. Prophylactic anticonvulsant therapy should be considered in patients receiving high doses of busulfan.

Adolescent↗
PubMed1992

Encephalopathy and seizures induced by intravesical alum irrigations.

Hemorrhagic cystitis is a significant toxic effect of cyclophosphamide therapy. Continuous bladder irrigation of a 1% alum solution is a simple and generally safe method of chemical cautery to treat the bleeding urothelium. We report four cases of encephalopathy coincident with elevated aluminum levels as well as one patient who developed seizures while receiving continuous bladder irrigations with alum. All patients had significant renal insufficiency. We recommend the cautious use of alum irrigation in patients with renal impairment and monitoring of serum aluminum levels to prevent excessive accumulation and toxicity.

Administration, Intravesical↗
PubMed1992

Plate fixation of the humeral shaft for acute fractures, with and without radial nerve injuries.

We report herein the results of operatively treating 44 consecutive acute fractures of the humeral shaft using plates for internal fixation. Ninety-seven percent (43 of 44) of the fractures healed after plate fixation at an average of 12 weeks. One short plate pulled out and required revision with a longer plate and bone grafting; this fracture also healed. Cancellous bone grafting successfully filled in cortical bone gaps. Range of motion of the shoulder and elbow were essentially normal. Plate size varied depending on the location of the fracture and bone size. Eight of nine fractures treated with 3.5-mm compression plates healed uneventfully. All 11 open fractures, eight from bullet wounds, healed uneventfully after early plating. Fifteen radial nerve injuries were associated with the fractures. Twelve anatomically intact radial nerve palsies recovered in 17 weeks on average after plate fixation. One lacerated nerve was sutured and recovered. One nerve with segmental loss associated with an open fracture was left unrepaired, as was an avulsed nerve associated with a closed fracture. The dissection required for plate fixation provides information that may be helpful in determining appropriate treatment of radial nerve injuries and the prognosis for spontaneous return of function.

Adolescent↗
PubMed1991

The small pin circular fixator for proximal tibial fractures with soft tissue compromise.

We used a Monticelli-Spinelli small pin circular external fixator in five cases, in combination with closed reduction or limited open reduction internal fixation, to salvage a satisfactory result in juxtaarticular, intraarticular fractures of the proximal tibia, when associated soft tissue compromise prevented standard fixation with plates and screws. The small pin circular fixator allows juxtaarticular placement of the small pins, enhancing stabilization of the comminuted fractures, allowing early range of motion of the joint and early patient mobilization. The small diameter pins support the soft cancellous bone fragments. This technique attempts to combine the benefits of traction, external fixation, and limited internal fixation. We recommend this method as a salvage procedure when plates and screws are contraindicated because of poor bone and soft tissue conditions.

Adult↗
PubMed1991

The small pin circular fixator for distal tibial pilon fractures with soft tissue compromise.

A Monticelli-Spinelli small pin circular external fixator was used in combination with closed reduction or a limited open reduction internal fixation in five cases in an attempt to salvage a satisfactory result in distal tibia pilon fractures when associated soft tissue compromise prevented standard fixation with plates and screws. The small pin fixator enhances the ability to perform a closed reduction through a technique that uses distraction with pins in the tibia and calcaneus, combined with correction of angulation by tensioning wires with a stop nut. Small pin stabilization of these comminuted fractures allows early patient mobilization. The small diameter pins support the soft cancellous bone fragments. This technique attempts to combine the benefits of traction, external fixation, and limited internal fixation. We recommend this technique as a salvage procedure when plates and screws are contraindicated because of poor bone and soft tissue conditions.

Adult↗
PubMed1989

Stabilization of sacroiliac joint disruption with threaded compression rods.

Eleven cases of sacroiliac dislocation and/or fracture (Malgaigne pattern) were successfully reduced and stabilized using two threaded compression rods. The mean follow-up period was 26.1 months (range, seven to 45 months). None of the implants failed and there was no subsequent displacement. Two patients had mild residual lower back pain, and one was treated with implant removal without subsequent relief of pain. One patient, in whom the operation was done 110 days after dislocation, had extension of an incomplete preoperative peroneal nerve palsy. After anterior pelvic ring stabilization has been performed, two threaded 3/16-inch diameter rods are driven from the normal posterior iliac wing superficial to the sacrum and through the reduced opposite iliac wing. Compression is obtained with washers and nuts. This procedure can be performed safely and effectively, providing stable fixation and allowing early mobilization to help lessen or prevent the complications associated with prolonged bed rest.

Adolescent↗
PubMed1988

Complex femur fractures: treatment with the Wagner external fixation device or the Grosse-Kempf interlocking nail.

One hundred complex femur fractures were treated with the Grosse-Kempf interlocking nail and 35 were treated with the Wagner external fixation device. Retrospectively, we analyzed the results in the two groups to determine specific indications for the future use of these nails. The Grosse-Kempf nail, although a technically demanding procedure, achieved excellent overall end results in comminuted closed fractures, and in Type I, Type II, and some Type III open fractures after appropriate wound care. We found that the Wagner apparatus was a simple, easy device for obtaining initial fracture stabilization in contaminated Type III-B and Type III-C open fractures. It does, however, require substantial postoperative care; four cases required secondary intramedullary fixation. We found a high infection rate with secondary reamed intramedullary nailing after initial stabilization with the external fixator.

Adolescent↗
PubMed1988

Management of the upper extremity in traumatic tetraplegia.

The management of the upper extremity in traumatic tetraplegia is complex and extremely important for the rehabilitation of the patient. The evolution of present management is reviewed. The evaluation and classification of the tetraplegic patient is discussed with general recommendations for treatment.

Arm↗
PubMed1987

Cost of implementing Veterans Administration directives for handling antineoplastic agents.

Directives issued by the Veterans Administration central office for the safe handling of antineoplastic agents are described, and the costs associated with implementing these directives are reported. The directives are similar to other recent guidelines, including those issued by the Occupational Safety and Health Administration. Inventory records for a 12-month period were analyzed to determine the total number of doses of antineoplastic agents prepared and the total number of treatments administered at a 704-bed VA facility with a comprehensive cancer treatment program. For 3112 prepared doses and 2345 treatment regimens, the total cost of implementing the directives was $57,115, including $6,670 for the purchase of a vertical laminar-airflow hood. The VA central office directives represent reasonable guidelines for controlling the potential hazards of handling antineoplastic agents. Considerable expense is associated with implementing the directives; the degree of added expense will vary based on the particular hospital setting, the number of doses of antineoplastic agents administered, and the nature of the oncology services already in place.

Antineoplastic Agents↗
PubMedDate not supplied

An educational intervention for advance directives.

In spite of the passage of the Patient Self-Determination Act in 1991, research indicates that providing information alone has not brought about a significant increase in the completion rates of advance directive (AD) documents. The purpose of this pilot study was to design, implement, and evaluate an interactive multimedia CD-ROM educational program on AD. Study subjects consisted of 31 volunteer elderly men and women in a senior citizens center. An interactive multimedia CD-ROM program was developed in phase I of the study. Subjects were administered on-line pretests and posttests. The effectiveness of the CD-ROM intervention was measured by AD attitude and knowledge changes. A program satisfaction scale was used, and an observer rated the subjects' use of the computer program. Subjects had a statistically significant change in posttest knowledge scores and a high degree of satisfaction and ease in using the computer program. The use of an interactive multimedia CD-ROM program with a touch-sensitive monitor to operate a computer-based AD program for senior citizens shows future promise.

Advance Directives↗
PubMedDate not supplied

Dural puncture using the lateral approach for chemonucleolysis.

The lateral approach for chemonucleolysis was developed to avoid dural puncture, which occurs with midline and posterolateral approaches. It is important to check for dural punctures during the procedure. If the dura is penetrated, a potential pathway is created for chymopapain to enter the subarachnoid space. Large doses of intrathecal chymopapain are highly toxic and small doses show a variable response. Because of the potential disastrous complications associated with intrathecal chymopapain, the chymopapain injection is contraindicated in the presence of a dural leak.

Adult↗