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Biomedical subjects

D D Buff

Publications and source records attributed to D D Buff.

At least 19 recordsLinked to original sources
PubMed1997

Circadian patterns in the onset of cardiogenic acute pulmonary edema.

BACKGROUND: Circadian patterns of onset favoring the morning hours have been demonstrated for many cardiovascular disorders. Although much is known about cardiogenic acute pulmonary edema (CAPE), the relationship between time of day and CAPE episode onset has not been previously studied. METHODS: We examined 154 consecutive episodes of CAPE treated at an urban community hospital to determine whether circadian patterns existed in the time these episodes began. RESULTS: For all episodes, a significant circadian pattern existed, with peak onset between 6:00 and 11:59 A.M. (p < 0.01). When CAPE episodes were analyzed by the most probable precipitant of pulmonary edema, only the pattern for patients with progressive symptoms, showing a peak in the 6:00 and 11:59 A.M. interval, was statistically significant (p < 0.01). Although a similar trend existed for CAPE occurring in association with acute myocardial infarction, the pattern fell short of statistical significance (p = 0.09). CONCLUSIONS: These data suggest that circadian patterns favoring the morning hours exist for episodes of CAPE, and that patterns may vary depending on the precipitant of the episode.

Acute Disease↗
PubMed1995

The night float system of resident on call: what do the nurses think?

In 1989, the internal medicine residency training program at St. John's Episcopal Hospital changed from a standard one-in-four on-call system to a night float system of resident on call. Using a confidential questionnaire that assessed the opinions of medical nurses, the nurses were asked which system they preferred, and how the change to a night float system of resident on call affected medical resident performance. A significant majority of the nurses preferred night float over a standard system of resident on call. Most nurses responded that because night float allows residents to get more rest, residents make fewer mistakes and are easier to work with. Residents on night float were not considered to be more knowledgeable. The responders indicated that night float did not create confusion about which resident to call for a patient problem.

Attitude of Health Personnel↗
PubMed1995

Circadian patterns of emergency asthma presentations: implications for staffing and treatment.

UNLABELLED: Are there circadian patterns for time of presentation and clinical status in asthmatic patients admitted to an emergency department for acute exacerbations? DESIGN: Prospective observational study. SETTING: Urban community teaching hospital emergency department. PARTICIPANTS: 279 consecutive patients who presented a total of 310 times with asthma exacerbations between October 19 and December 31, 1993. We grouped patients aged 16 years and above as adults and patients younger than 16 years of age as children. INFORMATION COLLECTED: Time of emergency department presentation, time attack began (for adult patients), peak expiratory flowrate prior to emergency department treatment (for adult patients), need for hospital admission, ventilatory failure during an acute attack, and death during an acute attack. RESULTS: Circadian patterns were demonstrated for time of presentation. For the total study group, the peak time of presentation was 8:00 PM to 11:59 PM (p < 0.05) and the trough time of presentation was 4:00 AM to 7:59 AM (p < 0.01). There were differences in peak time of presentation for patients grouped by age. For adult patients only, the peak time of presentation was 8:00 AM to 11:59 AM (p < 0.01), whereas for children only, the peak time of presentation was 8:00 PM to 11:59 PM (p < 0.001). No statistically significant patterns in time of attack onset, hospital admission rates, or peak flow measurements were observed. CONCLUSIONS: There are circadian patterns for the time at which patients with acute asthmatic exacerbations present to our emergency department. Adult patients have a peak time of presentation between 8:00 AM and 11:59 AM, whereas children have an apparent peak time of presentation between 8:00 PM and 11:59 PM. For all age groups, there is a trough in presentation between 4:00 AM and 7:59 AM.

Adult↗
PubMed1992

Circadian distribution of in-hospital cardiopulmonary arrests on the general medical ward.

BACKGROUND: A circadian pattern has been convincingly demonstrated for the onset of many outpatient ischemic vascular events. A morning peak exists for the onset of acute myocardial infarction, sudden cardiac death, reversible myocardial ischemia, and ischemic stroke. Data regarding circadian patterns of disease in hospitalized patients, however, are lacking. We examined in-hospital cardiopulmonary arrest (CPA) occurring on the general medical ward to determine if a circadian distribution existed in time of onset. METHODS: All CPAs that occurred during a 9-month period and met entry criteria were included for study. The day was divided into 4-hour intervals and analyses were performed for evidence of periodicity in time of onset. The CPAs were then divided into those that were "expected" and those that were "unexpected," and further analyses of periodicity were performed. RESULTS: For the total study population (137 patients), a primary peak frequency of CPA occurred during the interval from 4 to 7:59 AM, and a secondary peak frequency occurred during the 8 to 11:59 PM interval. A minimum frequency occurred during the midnight to 3:59 AM interval. The onset of unexpected CPA peaked during the 4 to 7:59 AM interval, and expected CPA followed no circadian pattern. CONCLUSIONS: Our analysis of CPA occurring in patients hospitalized on the general medical ward demonstrated a circadian pattern of onset that favored the early-morning hours. This pattern is predominantly due to unexpected CPA. If further study confirms our observations, changes in the prophylaxis of in-hospital CPA and adjustments in staff responses to its occurrence may be indicated.

Adult↗
PubMed1991

Dysrhythmia associated with fluoxetine treatment in an elderly patient with cardiac disease.

Although fluoxetine has been shown to be both efficacious and well tolerated, few data are available on the use of this drug in patients with preexisting heart disease and in the elderly. The authors report a case of an elderly patient in whom atrial fibrillation and bradycardia developed shortly after she began treatment with fluoxetine. The dysrhythmias recurred on rechallenge with the drug. A review of the pertinent literature is presented and possible pathophysiologic mechanisms are discussed.

Age Factors↗