PubMed Health⌕ Search

Biomedical subjects

I Y Pearson

Publications and source records attributed to I Y Pearson.

16 recordsLinked to original sources
PubMed1995

A survey of personal and professional attitudes of intensivists to organ donation and transplantation.

A questionnaire survey was carried out to examine the attitudes and practices of Australian and New Zealand intensivists with regard to brain death and organ donation. A return rate of 82.5% was achieved. Fifty-eight per cent had written evidence of their own wishes to donate organs and 94% would agree to donation from a dependent. At least one intensivist is involved in certifying brain death on 95% of occasions. Intensivists are involved in the request for organ donation over 90% of the time although one-third do not believe that it is their role to request organ donation. Although two-thirds believe that the family should always be approached for organ donation, another 52 out of 254 indicated that it was their (the intensivist's) role to decide if families should be asked for organ donation. Possible reasons for not requesting are language or other communication problems, perceptions of cultural differences and degrees of family distress. Twenty per cent of respondents do not provide haemodynamic support before brain death confirmation. Australian and New Zealand intensivists overwhelmingly support the concept of brain death, current methods of confirmation of brain death, organ donation and transplantation. Possible reasons behind loss of potential donors include decisions not to resuscitate both before and after brain death is confirmed. Perceptions of family grief and cultural differences clearly inhibit requests for organ donation. A very few units have an effective policy on approaching families about organ donation. Intensivists have almost exclusive control over requests for organ donation and thus bear a full professional responsibility for this element of hospital practice.

Adult↗
PubMed1995

A survey of families of brain dead patients: their experiences, attitudes to organ donation and transplantation.

A questionnaire survey of 69 families of brain dead patients is reported. The study population included those who had been asked about organ donation as well as those who had not, those who had agreed to organ donation and those who had declined. Their experiences and their perceptions of treatment and explanations of underlying disease, brain death and organ donation were examined. Their own knowledge of and attitudes towards organ donation as well as the prior knowledge and wishes of their deceased relative were also explored. Statistical analysis did not show any differences between the three groups of families with regard to their experiences, their perceptions of the treatment they received, or in the resolution of their grief. Family members who had agreed to organ donation were significantly more likely to donate their own organs and to be more resolved in their grief. There was a strong correspondence between the attitudes of respondents and their agreement or otherwise to donate their relatives' organs. One quarter, however, made the opposite choice for their relative, where their relative's wishes were known. There was a highly significant relationship between those who had previously discussed organ donation to have expected to be asked or to raise the subject themselves. Hospital treatment in general did not appear to have any effect on the decision to donate. Involvement in organ donation was felt by most of the donor families to have been helpful to the grieving process.

Adult↗
PubMed1993

The potential organ donor.

The source of most organs for transplantation is the brain-dead cadaveric donor. The realistic potential donor is one for whom mechanical ventilation and other support, to the point of brain death, is provided in the best interests of that patient, and not solely for the purpose of organ donation. Brain death secondary to spontaneous intracranial haemorrhage now exceeds traumatic head injury as a source of organ donors in Australia. There are now few medical exclusions to organ donation. Age limits rise constantly. No patient should be excluded without referral to the transplant coordinator. Adequate medical support of the potential donor is no more than should be provided to the severely brain-injured patient. Haemodynamic and other organ support are as logically appropriate as ventilation and must be continued until confirmation of brain death. Support should cease only if organ donation will not occur. Australian State laws define brain death as irreversible cessation of all function of the brain of the person, but do not dictate the methods of confirmation. The prospect of organ donation should not be raised until brain death is confirmed. The over-riding principle is that the family always has the right to be asked. There is no other way for the family's and patient's wishes about organ donation to be known and respected. It is vital that the person who will ask be experienced, competent and committed. A dedicated medical, nursing and allied health team providing care of the family throughout the period is essential.

Australia↗
PubMed1992

Potential for cadaveric organ retrieval in New South Wales.

OBJECTIVES: To measure the potential for cadaver organ retrieval in New South Wales and to determine the reasons for potential donors failing to become actual donors. DESIGN: Prospective audit of all patients dying in five hospitals in New South Wales between 1 December 1989 and 30 November 1990; quality assurance of the data by independent medical specialist and if disagreement by study committee. PATIENTS: 2879 patients (100% of all deaths) yielding 364 patients with coma and 181 potential donors. OUTCOME MEASURES: Realistic medically suitable potential donor rate, missed potential donor rate, rate of potential donors with permission refused, donor rate, reasons for realistic medically suitable potential donors failing to become actual donors. RESULTS: 2879 deaths yielded 73 medically suitable potential donors, resulting in 19 actual donors, 30 missed potential donors, 19 potential donors with permission refused, and five in whom adequate resuscitation failed. The most common reason for a potential donor failing to become an actual donor was a decision by the senior medical practitioner to withdraw or not to institute ventilatory or haemodynamic support (26/73). The second major obstacle was refusal of permission by the next of kin (17/73). Assuming that the potential donor rate was that implied by the observed donor rate (13/million population/year) the projected missed potential donor rate was 9/million population/year (95% confidence interval 4 to 15) and the projected rate of potential donors with permission refused was 13/million population/year (95% confidence interval 5 to 22). Assuming that the rate of potential donors in the study hospitals was the same as in the other New South Wales hospitals, the projected donor rate for New South Wales was 18/million population/year (10 to 26); the projected missed potential donor rate was 15/million population/year (7 to 23); and the projected rate of potential donors with permission refused was 18/million population/year (10 to 27). CONCLUSIONS: The donor rate could be increased 70%-80% by overcoming the reluctance of medical practitioners to resuscitate missed potential donors and increased further by gaining permission for organ retrieval from the next of kin.

Cadaver↗
PubMed1986

Is semiquantitative culture of central vein catheter tips useful in the diagnosis of catheter-associated bacteremia?

Semiquantitative culturing of catheter tips has been used as an index of catheter-related bacteremia. As the sensitivity and predictive values of this test have not been determined, we studied 780 tips from central vein catheters inserted into 440 critically ill patients in an intensive care unit. The results were correlated with clinical data for 30 bacteremic episodes which occurred in these patients, 14 of which were catheter related. When five or more colonies per plate were taken as a positive result, the sensitivity of the method was 92%, and the specificity was 83%. Although the predictive value of a negative result was excellent (99.8%), the predictive value of a positive result was low (8.8%) in our patient population, which had a relatively low incidence of catheter-related bacteremia (2%). We conclude that a semiquantitative culture technique is useful in the diagnosis of bacteremia associated with central vein catheters.

Bacteria↗
PubMed1986

Arteriovenous fistula following lumbar disc surgery--the use of total cardiopulmonary bypass during repair.

Arteriovenous fistula is a rare complication of lumbar disc surgery and there is often a delay in diagnosis. A patient who developed multi-system failure associated with an aortocaval fistula, which occurred following a lumbar disc operation, is presented in this study. Surgical repair was facilitated by the use of total cardiopulmonary bypass which enabled a degree of safety and control that would have been difficult to obtain with standard methods.

Adult↗
PubMed1982

A technique for insertion of two intravascular catheters via a single skin puncture.

Modern intensive care often requires multiple intravascular catheters, and sites of access may be limited. Therefore, a technique for insertion of two vascular catheters via a single skin puncture has been developed. No increased incidence of bleeding, sepsis, or other complications has been observed, the hazards of multiple procedures are avoided, and alternative sites for vascular access are preserved.

Catheterization↗
PubMedDate not supplied

Cardiovascular collapse and propranolol overdose.

We report three cases of propranolol overdose in two patients, both of whom suffered cardiovascular collapse after receiving an emetic compound in a hospital's casualty department. Such a collapse may be caused by vagal activity in the presence of sympathetic beta-blockade. We recommend the administration of atropine, which may increase vagal tone, before a patient receives an emetic compound, or undergoes gastric lavage or endotracheal intubation.

Adolescent↗