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Biomedical subjects

D Parry

Publications and source records attributed to D Parry.

63 records · Page 4Linked to original sources
PubMedDate not supplied

Effect of iron chelation therapy on mortality in Zambian children with cerebral malaria.

To examine the effect of iron chelation on mortality in cerebral malaria, we enrolled 352 children in a trial of deferoxamine in addition to standard quinine therapy at 2 centres in Zambia, one rural and one urban. Entrance criteria included age < 6 years, Plasmodium falciparum parasitaemia, normal cerebral spinal fluid, and unrousable coma. Deferoxamine (100 mg/kg/d infused for a total of 72 h) or placebo was added to a 7 d regimen of quinine that included a loading dose. Mortality overall was 18.3% (32/175) in the deferoxamine group and 10.7% (19/177) in the placebo group (adjusted odds ratio 1.8; 95% confidence interval 0.9-3.6; P = 0.074). At the rural study site, mortality was 15.4% (18/117) with deferoxamine compared to 12.7% (15/118) with placebo (P = 0.78, adjusted for covariates). At the urban site, mortality was 24.1% (14/58) with deferoxamine and 6.8% (4/59) with placebo (P = 0.061, adjusted for covariates). Among survivors, there was a non-significant trend to faster recovery from coma in the deferoxamine group (adjusted odds ratio 1.2; 95% confidence interval 0.97-1.6; P = 0.089). Hepatomegaly was significantly associated with higher mortality, while splenomegaly was associated with lower mortality. This study did not provide evidence for a beneficial effect on mortality in children with cerebral malaria when deferoxamine was added to quinine, given in a regimen that included a loading dose.

Antidotes↗
PubMedDate not supplied

When one is two.

This article is about Karen, who was 20 weeks pregnant when she was involved in a gas explosion. The explosion caused a 35% body surface area deep partial-thickness burn to her legs and arms. This article focuses on the most important concerns and fears Karen expressed while she was in our care. Her statements triggered various clinical memories from several nurses in the burn unit, and thus the stories unfold. These stories reflect nursing practice through the psychological care, clinical signs, and pathophysiology of our patient. The spoken stories, coupled with the reflective stories, provide a total picture of the multidimensional care nurses provide for their patients.

Analgesics↗
PubMedDate not supplied

A comparison of the effect of elemental and immune-enhancing polymeric jejunal feeding on exocrine pancreatic function.

BACKGROUND: There are few studies examining the effect of jejunal feeding on pancreatic exocrine output. The purpose of this study was to compare the effects of jejunal feeding with an elemental formula (EF) and with a polymeric immune-enhancing formula (PIEF) on pancreatic exocrine function. METHODS: Patients undergoing a partial pancreatectomy had a jejunal feeding tube inserted and a pancreatic stent exteriorized, facilitating collection of pancreatic secretions. Postoperatively, patients underwent a secretin-stimulation test to document adequate pancreatic reserve. Patients were then randomized to receive jejunal feeding with EF or with PIEF for a 24-hour period, followed by a washout period of feeding with dextrose, and subsequent jejunal feeding with EF or PIEF. RESULTS: The secretin-stimulation test demonstrated significant pancreatic reserve in all patients. There was a mild increase in pancreatic exocrine secretion with jejunal feeding with EF and PIEF compared with baseline and with dextrose. There was increased bicarbonate secretion with EF compared with PIEF, but there were no other significant differences in pancreatic exocrine function. CONCLUSIONS: In this model of partial pancreatectomy, there was no significant difference in pancreatic exocrine output when use of an EF was compared with use of a PIEF for jejunal feeding. Further clinical studies are needed to determine the potential role of PIEF in pancreatic disease.

Bicarbonates↗
PubMedDate not supplied

Using the Internet to teach health informatics: a case study.

BACKGROUND: It is becoming increasingly important for health professionals to have an understanding of health informatics. Education in this area must support not only undergraduate students but also the many workers who graduated before informatics education was available in the undergraduate program. To be successful, such a program must allow currently-employed students with significant work and family commitments to enroll. OBJECTIVES: The aim was to successfully create and teach a distance program in health informatics for the New Zealand environment. METHODS: Our students are primarily health professionals in full time employment. About 50% are doctors, about 25% nurses, and the rest include dentists, physiotherapists, and medical managers. Course material was delivered via the World Wide Web and CD-ROM. Communication between students and faculty, both synchronous and asynchronous, was carried out via the Internet. RESULTS: We have designed and taught a postgraduate Diploma of Health Informatics program using the Internet as a major communication medium. The course has been running since July 1998 and the first 10 students graduated in July 2000. About 45 students are currently enrolled in the course; we have had a dropout rate of 15% and a failure rate of 5%. Comparable dropout figures are hard to obtain, but a recent review has suggested that failure-to-complete rates of 30% to 33% may be expected. CONCLUSIONS: Internet technology has provided an exciting educational challenge and opportunity. Providing a web-based health informatics course has not been without its frustrations and problems, including software compatibility issues, bandwidth limitations, and the rapid change in software and hardware. Despite these challenges, the use of Internet technology has been interesting for both staff and students, and a worthwhile alternative for delivering educational material and advice to students working from their own homes.

Education, Distance↗
PubMedDate not supplied

Marked variation in peritoneal insulin absorption in peritoneal dialysis.

OBJECTIVE: To assess both peritoneal insulin absorption and adsorption of insulin to the plastic delivery system, and to assess whether variation in peritoneal absorption is related to transport status. DESIGN: Eight insulin-dependent diabetic patients on continuous ambulatory peritoneal dialysis were studied. Insulin was added to the dialysate. The amount adsorbed by the bag tubing was determined; peritoneal absorption was measured by complete spent dialysate collection. RESULTS: Only 14% +/- 5% of added insulin was adsorbed onto the dialysate delivery system. Marked variation in peritoneal absorption occurred (38% +/- 14%, range 17%-66%). Variations in membrane transport status did not account for variation in absorption. CONCLUSION: Marked variation in peritoneal absorption of insulin occurs, accounting for some of the variation in intraperitoneal insulin requirements. This is not related to membrane transport status.

Absorption↗