HFMA's new chairman, Jerry Fuller: hard-working professional with vision.
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Biomedical subjects
Publications and source records attributed to H Harrison.
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A new device for collecting and administering blood by intraoperative autotransfusion consists of several novel features: a collection bag that is kept expanded by a vacuum and into which the blood is drawn by suction of a lesser degree than the outside vacuum, a crease in the collection bag that decreases turbulence and foaming, and separation of the infusion element from the retrieval system by a valve that allows pressure infusion and suction continously. The apparatus is inexpensive, quickly assembled, operated by wall suction or suction pump. We have had favorable experience with its use in animals.
Use of the membrane oxggenator has been advocated in the management of severe respiratory insufficiency. We have compared this method to conventional therapy in an experimental model in which 23 dogs were subjected to aspiration with 0.1 N HC1 and 18 were supported with a volume respirator and positive end-expiratory pressure or placed on partial bypass using a membrane oxygenator for 12 to 24 hours. Adequate oxygenation (POX greater than 100 mm Hg) was achieved with the membrane oxygenator. The increase in lung weight during conventional therapy was significantly greater than during membrane oxygenator support. Extracorporeal support during recovery from severe pulmonary injury allows pulmonary artery pressure to be controlled and reduces the expected increase in lung water.
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Ten patients received lymphoblastoid alpha-interferon (Wellferon) in a crossover study so that Wellferon and standard microsurgical laryngeal laser therapy could be compared to laser therapy alone. Wellferon was administered initially at an intravenous high dose of 15 megaunits/m2 for 5 days followed by a daily dose of 2 megaunits/m2 subcutaneously for 6 months. Dosage was adjusted according to predefined toxicity. One patient was withdrawn from the study. Of the others, all but one received over 75% of the planned total dose. At follow-up of the nine assessable patients, complete remission was achieved in two of them, partial remission in four, and no response in the remainder. The two complete remissions were sustained for 2 years, but the four partial remissions were not sustained. Thus, a role for alpha-interferon in the kind of regimen used here remains to be established.
During a fifteen month period, 401 two channel (heart rate and respiratory impedance), 12 hour pneumocardiograms on 277 preterm infants were performed. Each pneumocardiogram was evaluated according to the following set of criteria: prolonged apnea (apnea > 19 seconds or shorter if associated with heart rate of < 80bpm for > 2 seconds or observed cyanosis); short apnea (apnea 10-19 seconds); periodic breathing (normal respiratory pattern interrupted by > 2 breathing pauses of > 5 seconds during > 1 minute duration). Apnea density was used as prime measure in determining abnormal pneumocardiograms and was defined by total apnea time (seconds) x 100 divided by recording time while periodic breathing index defined by total periodic breathing time (minutes) x 100 divided by recording time. Sixty infants (24%) had apnea densities > or = 5 which prompted therapy with theophylline. Sixteen of these infants (27%) failed to resolve their apnea within 7 days (apnea density > or = 3) and were placed on caffeine citrate. Caffeine decreased the apnea density of fourteen of these infants (88%) to 0.8 (95% CI; 0-2.3). Efficacy of both methylxanthines to normalize the pneumocardiogram was similar (p = 0.5). Persistent apnea unresponsive to theophylline may respond to orally administered caffeine citrate.
Most extracorporeal continuous renal replacement therapies (CRRT) require inflow pumping of either dialysate, filtrate replacement solution, or both. Outflow of spent dialysate and ultrafiltrate can be accomplished by gravity drainage or pump. Intravenous infusion pumps have been commonly used for these purposes, although little is known about the accuracy of these pumps. To evaluate accuracy of two different types of intravenous infusion pumps used in CRRT, we studied flow rates at nine different pressure variations in three piston type and three linear peristaltic pumps. The results showed that error of either pump was not different for flow rates of 4 and 16 ml/min. Both types of pumps were affected by fluid circuit pressures, although pressure conditions under which error was low were different for each pump type. The linear peristaltic pumps were most accurate under conditions of low pump inlet pressure, whereas piston pumps were most accurate under conditions of low pump pressure gradient (outlet minus inlet) of 0 or -100 mmHg. The magnitude of error outside these conditions was substantial, reaching 12.5% for the linear peristaltic pump when inlet pressure was -100 mmHg and outlet pressure was 100 mmHg. Error may be minimized in the clinical setting by choosing the pump type best suited for the pressure conditions expected for the renal replacement modality in use.
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Improvements in infant mortality (death less than 1 year of age) have been experienced by the United States and Alaska over the past decade. The decline in the Alaska neonatal mortality (death less than 28 days of age) rate has been the major factor in our improved infant mortality rate. Alaska's neonatal mortality rate is one of the lowest in the U.S. However, postneonatal mortality (28 days to 1 year of age) rate has not declined and is one of the highest in the U.S. In this study we used vital statistics records to examine socio-demographic and inter-regional factors that may help to explain Alaska's apparently high postneonatal mortality rate. The study population consisted of all live born infants in Alaska for 1975 to 1985, who died in infancy. The Alaska neonatal mortality rate has been lower, but postneonatal mortality rate has been higher than the U.S. average for the period under consideration (p less than .05). Comparison of alaska postneonatal mortality rate from 1975 to 1985 with the U.S. found Alaska Non-natives have higher postneonatal mortality rates than U.S. White, and Alaska Native have higher postneonatal mortality rates than other U.S. minorities. The rural areas of Alaska have a higher postneonatal mortality rate than urban areas, a phenomenon also observed for the U.S. as a whole.
Several determinants of Alaska postneonatal mortality rate were examined to determine whether very low birth weight (less than 1500 g) and low birth weight (1500-2499 g) surviving neonates contributed to the lack of improvement in postneonatal mortality rate. For an eight year period (1977 through 1984), all infant deaths (n = 1020) of the 82,301 resident births were reviewed through vital statistics data. The infant's place of birth, ethnic group, birth weight and age at death were available. Ethnic and rural-specific postneonatal mortality rate (PNMR) significantly improved, but there was no change in birth weight distribution or birth weight-specific postneonatal mortality rate. However, surviving very low birth weight infant proportion of postneonatal mortality has increased from 5% to 8.2% and low birth weight proportion has remained unchanged (15.6%). These proportions were not offset by the decline in normal birth weight (greater than 2500 g) postneonatal mortality rate. This trend suggests that infants born weighing less than 2500 g have slowed the decline of the postneonatal mortality rate.
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