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Biomedical subjects

D Daley

Publications and source records attributed to D Daley.

35 records · Page 2Linked to original sources
PubMed1994

Nitrous oxide in early labor. Safety and analgesic efficacy assessed by a double-blind, placebo-controlled study.

BACKGROUND: Intermittent self-administered nitrous oxide has long had widespread use as an analgesic in labor, but its efficacy has not been adequately established. Questions about its effect on maternal oxygenation between labor contractions also have been raised. METHODS: Twenty-six women were recruited to participate in a randomized, double-blind, cross-over, placebo-controlled study to assess the effect of intermittent nitrous oxide inhalation on labor pain and maternal hemoglobin oxygen saturation (SPO2) during the first stage of labor. Visual analog scale pain scores for each of five consecutive labor contractions were measured after administration of either nitrous oxide or compressed air. RESULTS: Mean visual analog scale pain scores for five contractions were 5.1, 5.2, 5.7, 5.2, and 5.6 (nitrous oxide) and 4.9, 5.2, 6.1, 5.6, and 5.7 (compressed air). There were no statistically significant differences in pain when nitrous oxide as compared with compressed air was administered. Pain scores did not differ significantly over time as a function of inhaled substance (F = 0.41, P = 0.53). The mean lowest SPO2 observed between these contractions after self-administration of nitrous oxide and air were 97, 97, 97, 97, and 97% (nitrous oxide) and 97, 96, 96, 96, and 96% (compressed air). SPO2 was significantly higher after nitrous oxide administration (F = 8.8, P = 0.007). CONCLUSION: While intermittent self-administered 50% nitrous oxide in oxygen does not appear to predispose parturient women to hemoglobin oxygen desaturation, its analgesic effect has yet to be clearly demonstrated.

Adult↗
PubMed1993

M-6 endocarditis: report of an Australian case.

Neisseria elongata subsp. nitroreducens (formerly CDC group M-6) is a newly-recognized cause of particularly destructive endocarditis, frequently requiring valve replacement. We describe an Australian case of endocarditis caused by this organism, summarizing the clinical and microbiological features of this rarely isolated subspecies.

Adult↗
PubMed1989

Relationship between the pharmacokinetics and the analgesic and respiratory pharmacodynamics of epidural sufentanil.

To establish the relationships between epidural sufentanil analgesia and respiratory effects and to determine the pharmacokinetics of the drug, 22 adult patients undergoing thoracotomy were put into a randomized, double-blind study and received either 30, 50, or 75 micrograms per dose in 20 ml normal saline solution. Repeated doses were given on request for the 24-hour study period. There was a weak but significant nonlinear correlation between length of effective analgesia and the cumulative dose of the drug (r = 0.26, p less than 0.001). In 12 of 22 patients, the maximal length of effective analgesia was reached before the last dose and the effect tended to taper off thereafter. The mean maximal length of effective analgesia was 4.69 +/- 0.32 hours (mean +/- SEM), whereas the length of effective analgesia with the last dose was only 3.34 +/- 0.46 hours (p less than 0.0005). There was a significant correlation between the peak serum concentrations of sufentanil during the dose interval and the length of effective analgesia (r = 0.44, p less than 0.0001). Area under the concentration-time curve was proportional to the size of the epidural dose, and with all three doses tested there was a gradual accumulation of sufentanil in the serum. Mean time-to-peak concentration (tmax) increased with repeated doses (p less than 0.05). Mean serum concentration of sufentanil during periods of slow respiratory rate (0.47 +/- 0.05 ng/ml) was significantly higher than during episodes without adverse respiratory effects (0.37 +/- 0.05 ng/ml, p less than 0.05). The above data suggest that an important part of the analgesic and adverse effects of sufentanil are mediated centrally, after this opioid is absorbed systemically.

Analgesics↗
PubMed1988

Meningococcal serogroups in New South Wales, 1977-1987.

Data are presented on serogroups of meningococci (Neisseria meningitidis) that were submitted to Westmead Hospital and The Children's Hospital, Camperdown, from patients in Sydney and in rural areas of New South Wales, from January 1, 1977 to December 31, 1987. One hundred and ten organisms that were isolated from cerebrospinal fluid or from blood were examined. All organisms were isolated from sporadic cases of meningococcal disease. Patients in the zero-to-two-years' age-group were affected most commonly, but 36.3% of isolates were from older children and adults. The distribution of serogroups was as follows: serogroup B, 43.6; serogroup A, 28.2%; serogroup C, 10.0%; serogroup W135, 8.2%; serogroup Y, 4.5%; and serogroup Z, 0.9%. The isolates that were serogrouped by us represented approximately half the cases of meningococcal meningitis that were notified in New South Wales during this period. Serogrouping of meningococcal isolates is very important in order to follow epidemiological trends in the disease and to monitor the serogroups that cause outbreaks, where vaccination of contacts may be indicated. Our laboratories are prepared to receive isolates for serogrouping and antibiotic sensitivity testing from across New South Wales.

Adolescent↗
PubMed1988

A practical approach to needs assessment for chemical dependency programs.

The authors discuss the concept of Needs Assessment within the context of the planning process for chemical dependency treatment programs. The five basic Needs Assessment approaches are critically reviewed, and their application in specific forecasting models is addressed. Practical guidelines for the clinical planner using Needs Assessment techniques are discussed, and recommendations made for the type, timing, and frequency of assessment. The authors note the problems inherent in the multiplicity of methods used by various states, and call for a uniform approach to Needs Assessment.

Health Planning↗
PubMed1988

Analgesic and respiratory effects of epidural sufentanil in patients following thoracotomy.

Immediately following thoracotomy, 22 patients were entered into a randomized, double blind study comparing the effects of three lumbar epidural doses of sufentanil on postoperative pain and respiratory pattern. Patients were given either 30 micrograms (group I), 50 micrograms (group II), or 75 micrograms (group III) of epidural sufentanil in 20 ml N saline. Repeat doses were given on request for the 24-h study period. Linear analogue pain score (PS), heart rate (HR), and mean arterial pressure (MAP) were measured at 15-min intervals after each dose. Respiratory depression was assessed by the presence of: 1) slow respiratory rate (SRR--less than 10 breaths per minute for greater than 5 min), 2) apnea (AP--cessation of tidal ventilation for greater than 15 s), and 3) increased PaCO2 in arterial blood gases (ABG) drawn at regular intervals. SRR and AP were measured using respiratory inductive plethysmography (RIP). A further group of ten patients (group IV) underwent preoperative RIP monitoring during sleep and in the absence of any drug. Maximum analgesia was achieved within 15 min after a dose of sufentanil for all groups. Analgesia was not significantly prolonged by increasing the dose of sufentanil. SRR occurred in all four groups (group I: 2/9; group II: 2/6; group III: 7/7; group IV: 2/10 P less than 0.05 I, IV:II, I, IV:III, II:III). The number of episodes of SRR/hr was highest in group II (group I: 0.6 +/- 0.8, group II: 4.12 +/- 0.6, group III: 1.8 +/- 2.0, group IV: 0.5 +/- 0.2) (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

In vitro antibacterial activity of enoxacin (CI-919).

Antibacterial activity of enoxacin was evaluated against more than 3,700 clinical isolates using the agar-dilution method and an inoculum of 10(4)-10(5) cells per site. For comparison other antibiotics appropriate for each species were also included. For most enterobacteria and for Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa, the MIC90 of enoxacin was below 2 mg/l. Serratia marcescens was more resistant; the MIC90 being 4 mg/ml. Enoxacin also showed high activity against Campylobacter jejuni and Neisseria gonorrhoeae. Streptococci were comparatively resistant, 32 mg/l to 64 mg/l of the compound being required to inhibit 90% of strains.

Anti-Bacterial Agents↗
PubMedDate not supplied

Clinical profile of comorbid major depression and alcohol use disorders in an initial psychiatric evaluation.

This study evaluated the clinical profile of patients who presented with both DSM-III major depression (MD) and alcohol use disorder (AUD) as compared with that of patients with either diagnosis alone. Comparison of these three groups (MD without AUD, AUD without MD, and comorbid AUD-MD) selected from a large sample (8,139) of general adult psychiatric patients showed that the historical, cross-sectional, and dispositional profile of AUD-MD patients occupied an intermediate position between that of the other two groups. The symptomatology of AUD-MD patients was somewhat closer to that of MD patients, whereas the premorbid personal and social history and dispositional status were more similar to those of AUD patients. AUD-MD patients had a strikingly higher rate of suicidal indicators as compared with AUD or MD patients.

Adult↗
PubMedDate not supplied

Public funding of contraceptive, sterilization and abortion services, fiscal year 1990.

In FY 1990, the federal and state governments spent $504 million to provide contraceptive services and supplies, according to results of a survey of state health, social services and Medicaid agencies conducted by The Alan Guttmacher Institute. Medicaid accounted for 38 percent of all public funds spent on contraceptive services, Title X provided 22 percent, and two federal block-grant programs--Social Services and Maternal and Child Health--together were responsible for 12 percent of public expenditures. State governments accounted for the remaining 28 percent of public funding. Although public expenditures for contraceptive services have risen by $154 million over the past decade, when inflation is taken into account, expenditures have actually fallen by one-third. Since 1980, the proportion of public contraceptive expenditures contributed by Title X has been cut virtually in half, while the proportion contributed by state governments has nearly doubled. When inflation is taken into account, Title X expenditures for contraceptive services have fallen by almost two-thirds since 1980. The federal and state governments together spent $95 million to subsidize sterilization services in 1990, and $65 million to provide abortion services. The federal government was the major source of funding for sterilization services but provided less than one percent of the cost of abortion services. Because of changes over time in survey methodology and the difficulties some states had in separating out expenditures by type of care, these data are approximations.

Abortion, Legal↗
PubMedDate not supplied

Reproductive health and AIDS-related services for women: how well are they integrated?

To explore the relationship between human immunodeficiency virus (HIV) and AIDS services and reproductive health services, a survey was undertaken in 1994 of 30 health care facilities that are grantees under Title IIIb of the Ryan White Comprehensive AIDS Resource Emergency Act, 19 family planning clinics that offer at least some HIV services, and two family planning agencies that are also grantees under Title IIIb. The Title IIIb providers and the family planning agencies offer similar sets of services, but they tend to view reproductive health and HIV and STD services as distinctly different categories. Eliminating the perceptual distinctions between these services and viewing reproductive health services as key components of HIV and AIDS prevention could result in a more integrated system of helping women with HIV infection or AIDS as well as those at risk of HIV infection.

Comprehensive Health Care↗
PubMedDate not supplied

Public funding for contraceptive, sterilization and abortion services, fiscal year 1992.

In 1992, the federal and state governments spent $645 million to provide contraceptive services. According to the results of a survey of health, social service and Medicaid agencies conducted by The Alan Guttmacher Institute, Medicaid accounted for 50% of all public spending on family planning services. State governments, which spent a total of $155 million of their own revenues for contraceptives services, accounted for 24% of public funding, Title X for 17%, and the social services and maternal and child health block-grant programs for nearly 10%. Medicaid expenditures for contraceptive services increased dramatically between 1990 and 1992, and were responsible for a 28% rise in total expenditures for contraceptive services during that period. However, when inflation is taken into account, total public expenditures for contraceptive services have decreased by 27% since 1980, and Medicaid has replaced Title X as the primary source of funding for such services. The federal and state governments together spent $138 million to subsidize sterilization services in 1992, an increase of 46% from 1990. The federal and state governments also spent $80 million to provide 202,622 abortions to poor women; less than 1% was contributed by the federal government. These estimates of expenditures are approximations that, because of methodologic problems and changes over time, may overstate public expenditures for contraceptive services.

Abortion, Legal↗