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J A Haines

Publications and source records attributed to J A Haines.

9 recordsLinked to original sources
PubMed1998

Poisoning severity score. Grading of acute poisoning.

BACKGROUND: A standardized and generally applicable scheme for grading the severity of poisoning allows a qualitative evaluation of morbidity and facilitates comparability of data. Working from a simple grading scale proposed by the European Association of Poisons Centres and Clinical Toxicologists, a Poisoning Severity Score has been developed jointly with the International Programme on Chemical Safety and the European Commission. METHODS: The Poisoning Severity Score has been elaborated, tested, and gradually revised during a project running 1991-1994. Fourteen poisons centers from various countries have participated. Each center independently graded 371 cases of acute poisoning by ten different toxic agents. The data were then analyzed and compared. RESULTS: The concordance in grading the severity increased during the study period, and in the last phase there was an acceptable concordance among centers in 80% or more of the cases. Given the condition and quality of the original case records, this result was considered satisfactory and agreement was reached on the scoring scheme presented here. The Poisoning Severity Score grades severity as (0) none, (1) minor, (2) moderate, (3) severe, and (4) fatal poisoning. It is intended to be an overall evaluation of the case, taking into account the most severe clinical features. Use of the Poisoning Severity Score normally requires a follow-up of all cases, but may be used on admission or other times during the course of poisoning if this is clearly stated when data are presented. CONCLUSIONS: A Poisoning Severity Score has been developed and found applicable for grading the severity of poisoning. It is foreseen that the Poisoning Severity Score will meet the expectations and be used in practice, but its future use and evaluation may result in some further revision and refinement.

Acute Disease↗
PubMed1997

The relative efficacy of antidotes: the IPCS evaluation series. International Programme on Chemical Safety.

Antidotes may play an important role in the treatment of poisoning. For many physicians and toxicologists an antidote is an antidote. According to the IPCS definition, an antidote is a therapeutic substance used to counteract the toxic action(s) of a specified xenobiotic. Given this wide definition, the efficacy of an antidote may vary considerably depending on which toxic action(s) is/are being counteracted and on the level of counteracting power: An almost 100% efficacy is seen using specific antagonists, such as naloxone in opiate poisoning or flumazenil in benzodiazepine poisoning, e.g. resulting in complete reversal of opiate toxicity unless complications, such as anoxic brain damage, have developed. At the other end of the efficacy scale, we may place chelating agents for heavy metal poisoning and diazepam for organophosphorus insecticide poisoning. Therefore, in the IPCS/EC evaluation series of antidotes, some chelating agents are considered only to be an adjunct to supportive care which is the cornerstone of treatment. When teaching clinical toxicology or recommending the use of antidotes in poisoned patients, the expected efficacy level of the antidote in question should be stressed. This may be particularly important in severe poisonings when the antidote may only be considered as an adjunct to supportive care, e.g. deferoxamine in acute iron poisoning. Unless this is stressed, the unexperienced physician may rely too much on the antidote and may not pay sufficient attention to the supportive care. In this presentation, the varying efficacy levels of antidotes are discussed as based on the presently ongoing IPCS/EC evaluation programme on antidotes.

Antidotes↗
PubMed1997

Evaluation of antidotes: activities of the International Programme on Chemical Safety.

Important developments concerning the role of antidotes in managing poisoning cases have taken place in recent decades due to new toxicodynamic and toxicokinetic studies and to growing international concern regarding the effectiveness of antidotes. A number of activities are carried out by the International Programme on Chemical Safety which aim to: (1) evaluate their effectiveness in clinical practice, (2) disseminate evaluated information, and (3) promote the availability of useful antidotes. The International Programme on Chemical Safety has undertaken the preparation of Antidote Monographs that summarize and assess the clinical use, mode of action, effectiveness, and other evaluated information, and a consolidated International Programme on Chemical Safety List of Antidotes that classifies antidotes and related drugs by their clinical effectiveness and urgency of need. A chart of Antidote Dosages, with information concerning the recommended antidotes and their indications, is being prepared, and the Availability of Antidotes in different countries is being surveyed. Further International Programme on Chemical Safety initiatives are also being undertaken in the area of antidotes and clinical toxicology in order to examine particular issues. The International Programme on Chemical Safety INTOX Project and related activities provide powerful tools for multicenter studies, but such research faces continuing financial and regulatory difficulties. Twinning arrangements between scientists from different parts of the world are being promoted to enhance the capabilities of evaluating treatment procedures and to compare clinical data. International organizations have important aims: to promote adequate and appropriate regulations and increase antidote availability, to establish international consensus and to increase interest in co-operative research. Cooperation with scientific bodies is essential in supporting these aims.

Animals↗