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Biomedical subjects

D M Forrest

Publications and source records attributed to D M Forrest.

At least 19 recordsLinked to original sources
PubMed2001

Introduction of a practice guideline for penicillin skin testing improves the appropriateness of antibiotic therapy.

We hypothesized that the introduction of a practice guideline for penicillin skin testing would increase the appropriateness of skin testing and reduce antibiotic costs for patients with a history of penicillin allergy who have infections caused by penicillin-susceptible pathogens. We measured the appropriateness of skin testing and daily antibiotic costs before and after the introduction of a guideline for penicillin skin testing. For patients who had negative results of skin testing and were subsequently treated with a penicillin instead of an alternative antibiotic, we calculated the difference between the actual costs and the projected costs of continuing alternative antibiotics without skin testing. After the guideline was introduced, appropriateness of skin testing increased from 17% to 64%, but daily antibiotic costs did not change. For patients who had negative results of skin testing and who were subsequently treated with a penicillin, there was no difference between actual costs and the projected costs if they had not been skin tested. We conclude that introduction of a guideline for penicillin skin testing increases the percentage of eligible patients who have a skin test, and it does so without increasing costs.

Cost Savings↗
PubMed2000

Practical points in spinal endoscopy.

This article presents an overview of spinal endoscopy, including history, indications, and contraindications, along with the anatomy and physiology of the spine. A description of the procedure is provided, complications are identified, and nursing considerations are highlighted.

Endoscopy↗
PubMed2000

Volume expansion using pentastarch does not change gastric-arterial CO2 gradient or gastric intramucosal pH in patients who have sepsis syndrome.

OBJECTIVE: In hypovolemic patients with sepsis syndrome, to determine the effects of colloid volume infusion using 10% pentastarch on abnormal gastric tonometer measurements (gastric intramucosal CO2 tension, gastric intramucosal-arterial PCO2 gradient, and gastric intramucosal pH [pHi]) and on cardiac index, global oxygen delivery, and hemoglobin. DESIGN: Prospective prepost intervention study. SETTING: Tertiary care, university-affiliated 15-bed general systems intensive care unit. PATIENTS: Patients were studied who had sepsis syndrome, who had pulmonary arterial catheters in place, who were hypovolemic (pulmonary arterial occlusion pressure [PAOP] <15 mm Hg), and who had a gastric arterial PCO2 gradient >10 mm Hg. INTERVENTIONS: Baseline measurements of gastric intramucosal CO2 tension, gastric intramucosal-arterial PCO2 gradient, and pHi, as well as arterial lactate, pulmonary arterial occlusion, central venous and systemic arterial pressures, thermodilution cardiac output, and temperature. Boluses of 500 mL pentastarch were administered to a total of 1,000 mL or until PAOP was >18 mm Hg. Measurements were repeated at 30 mins and 120 mins postinfusion of pentastarch. MAIN RESULTS: Volume infusion using pentastarch did not change gastric PCO2, gastric-arterial PCO2 gradient, or pHi. Volume expansion with pentastarch significantly increased cardiac index, global oxygen delivery, and PAOP. Administration of pentastarch decreased hemoglobin and arterial lactate at 30 mins but not at 120 mins. CONCLUSIONS: Volume expansion using a colloidal solution of 10% pentastarch does not change abnormal intramucosal CO2 tension, gastric-arterial PCO2 gradient, or pHi in critically ill hypovolemic patients who have sepsis syndrome despite increasing cardiac index, oxygen delivery, and pulmonary artery occlusion pressure.

APACHE↗
PubMed1999

Determinants of short- and long-term outcome in patients with respiratory failure caused by AIDS-related Pneumocystis carinii pneumonia.

OBJECTIVES: To determine (1) predictors of in-hospital mortality and long-term survival in patients with acute respiratory failure (ARF) caused by acquired immunodeficiency syndrome-related Pneumocystis carinii pneumonia (PCP) and (2) long-term survival for patients with ARF relative to those without ARF. METHODS: A retrospective medical chart review was conducted of all cases of PCP-related ARF for which the patient was admitted to the intensive care unit of a single tertiary care institution between 1991 and 1996. Data were extracted regarding physiologic scores, relevant laboratory values, and duration of previous maximal therapy with combined anti-PCP agents and corticosteroids at entry to the intensive care unit. Duration of survival was determined by Kaplan-Meier methods from date of first hospital admission and compared for patients with and without ARF. RESULTS: There were 41 admissions to the intensive care unit among 39 patients, with 56.4% in-hospital mortality. Higher physiologic scores (Acute Physiology and Chronic Health Evaluation II [APACHE II], Acute Lung Injury, and modified Multisystem Organ Failure scores) were predictive of in-hospital mortality. Duration of previous maximal therapy also predicted in-hospital mortality (45% for patients with <5 days of previous maximal therapy vs 88% for those with > or =5 days of previous maximal therapy; P = .03). Combining physiologic scores and duration of previous maximal therapy enhanced prediction of in-hospital mortality. There was no difference in long-term survival between patients with PCP with ARF and those without ARF (P = .80), and baseline characteristics did not predict long-term survival. CONCLUSIONS: In-hospital mortality of patients with acquired immunodeficiency syndrome-related PCP and ARF is predicted by duration of previous maximal therapy and physiologic scores, and their combination enhances predictive accuracy. Long-term survival of patients with ARF caused by PCP is comparable to that of patients with PCP who do not develop ARF, and determinants of in-hospital mortality do not predict long-term survival.

AIDS-Related Opportunistic Infections↗
PubMed1998

The incidence and spectrum of AIDS-defining illnesses in persons treated with antiretroviral drugs.

The incidence and spectrum of primary AIDS-defining illnesses in human immunodeficiency virus-positive patients receiving antiretroviral drugs may have changed since the introduction of newer antiretroviral agents. We performed a retrospective analysis of patients enrolled in the British Columbia Drug Treatment Program who were ever prescribed antiretroviral drugs between 1 January 1994 and 31 December 1996. Rates were calculated on a 6-month basis. There were 344 AIDS cases diagnosed among 2,533 participants between 1994 and 1996. The incidence of primary AIDS diseases decreased from 1994 to 1996, with a sharp decline in 1995 and 1996. There was no statistically significant change in the incidence of primary AIDS diagnoses relative to one another, and Pneumocystis carinii pneumonia and Kaposi's sarcoma remain the most common AIDS index diagnoses. In patients receiving antiretroviral therapy in the modern era, the incidence of AIDS-defining illnesses has decreased substantially, but the spectrum of AIDS-defining illnesses remains unchanged.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Validation of the modified multisystem organ failure score as a predictor of mortality in patients with AIDS-related Pneumocystis carinii pneumonia and respiratory failure.

STUDY OBJECTIVES: To validate a previously developed multisystem organ failure (MSOF) score with and without the addition of the lactate dehydrogenase (LDH) level as a predictor of survival to hospital discharge in patients with AIDS-related Pneumocystis carinii pneumonia (PCP) and acute respiratory failure (ARF). DESIGN: Retrospective chart review between April 1, 1991, and September 30, 1996. SETTING: University-affiliated tertiary care center in downtown Vancouver, British Columbia, Canada. PATIENTS: All patients with PCP-related ARF admitted to the ICU of St. Paul's Hospital during the study period. INTERVENTIONS: As putative prognostic instruments, data were extracted regarding the APACHE II (acute physiology and chronic health evaluation II), acute lung injury (ALI), AIDS, and modified MSOF scores, as well as LDH levels, at entry to the ICU. Patients were stratified based on an LDH level of < or > or = 2,000 U/L and this threshold was assessed in its predictability of outcome when added to each of the above scores. For APACHE II, the score was categorized in six groups and evaluated with and without inclusion of the LDH. Receiver operating characteristic curves were constructed for LDH and for each score with and without the LDH level to assess accuracy of prediction. The area under each curve was calculated and compared to estimate the statistical significance of observed differences. MEASUREMENTS AND RESULTS: There were 40 admissions to the ICU of 38 patients with 52.5% mortality. The ALI and AIDS scores were not predictive of outcome. The modified MSOF and APACHE II scores were significant predictors of survival and the performance of both was enhanced by the addition of LDH. CONCLUSIONS: Both the APACHE II and the modified MSOF scores were significant predictors of outcome in the patient population studied. These results validate the modified MSOF score as an effective predictor of survival to hospital discharge among patients with AIDS-related PCP who develop ARF and the performance of the score is enhanced by the addition of the LDH level.

AIDS-Related Opportunistic Infections↗
PubMed1996

Spinal cord stimulator therapy.

Presented in this article is an overview of chronic pain and types of spinal cord stimulators, how they work, effects of their therapy, and indications for their use. Highlights of patient selection criteria, surgical procedures, complications, and nursing considerations are discussed.

Chronic Disease↗
PubMed1987

Management of the colonised shunt.

A system of management is described for colonised hydrocephalus shunts. If organisms have reached the lateral ventricles as well as the valve chamber, the shunt must be removed and the ventricles drained externally with instillation of a suitable antibiotic until the fluid is sterile. If the ventricular fluid is not infected the shunt can safely be replaced at the same operation, using a site on the opposite side of the head. The operation has been performed 12 times without reinfection.

Bacterial Infections↗
PubMed1986

The silastic urethral ligature: an aid to catheter management.

A technique is described for improving catheter control in patients with neuropathic bladder who have inadequate sphincter tone to retain an indwelling catheter without leaking or to remain dry with a regime of intermittent catheterisation. The urethra or bladder neck is narrowed by one or more ligatures of silastic tubing. 24 patients were operated upon. Results were excellent in 6, satisfactory in 5 and a failure in 13. Successful results are easier to achieve in males than females. In the latter, an alternative method of narrowing the bladder outlet would be preferable. The operation does not spoil the operative field for a possible future artificial sphincter insertion.

Adolescent↗
PubMed1981

Appendicectomy in children: a plea for the use of the transverse pararectal approach.

A retrospective study of 100 consecutive emergency appendicectomies in children is presented. All were performed through the transverse pararectal incision, the details of which are briefly outlined. A low rate of wound infection was present. It is suggested that this was mainly due to the approach, which combines atraumatic access with safety. The aim of the study is to dispel the reluctance of surgeons to adopt this incision in children.

Adolescent↗