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Biomedical subjects

J A Moylan

Publications and source records attributed to J A Moylan.

At least 19 recordsLinked to original sources
PubMed1992

Automated acuity scoring within a computer based medical record.

This paper describes the initial development of a completely automated acuity scoring system that resides within the TMR bedside computing system at the Duke University Medical Center, Surgical Intensive Unit. The scoring system is based upon the APACHE II acuity scoring system and provides for the recalculation of acuity scoring at 12 hour intervals through the patient's ICU course. When comparing hand calculated versus computer generated acuity scores for 19 patients, discrepancies fell into three broad categories: 1) data available to the application differed from that available to the human scorer. 2) apparent transcription errors 3) data items lost or absent from the paper record. It remains to be determined if computer generated acuity scoring provides for a more accurate representation of the patient's acuity.

Creatinine↗
PubMed1991

Transmural surgical gown pressure measurements in the operating theater.

Transmural gown pressures encountered when the surgeon comes into contact with a patient were measured in the operating theater. The surgical gown industry has assumed these pressures to be less than 5 psi in testing the efficacy of the gown and drape barrier material to impede bacterial transmission through its pores. In this study, pressure-sensitive contact film and resistive strain gauge recordings made from the surgeon's abdominal region and forearms indicated peak contact pressures in excess of 60 psi. This report indicates a need to reassess the basis of test utilization in evaluating barrier materials used in gowns and drapes.

Humans↗
PubMed1988

Toothbrush swallowing.

We encountered four cases of toothbrush swallowing and reviewed the literature on this subject. A total of 31 toothbrushes within the gastrointestinal tract have been reported. None have passed spontaneously. Several have caused significant complications related to pressure necrosis, including gastritis, mucosal tears, and perforation. The recommended treatment is endoscopic retrieval and postoperative monitoring for 24 hours in case of esophageal or gastric injury.

Adult↗
PubMed1988

Factors improving survival in multisystem trauma patients.

This report analyzes the effect of air versus ground interhospital transport on survival following multisystem injury. There were 136 air-transported patients versus 194 ground-transported patients. The groups were similar in trauma scores, ages, mechanism of injury, and organ systems injured. There was a statistically significant survival advantage for air-transported patients with trauma scores between 10 and 5 (82.8% survival vs. 53.5%, p = less than 0.001). The time interval between accident and admission to the authors' institution was similar for both groups. Important therapeutic interventions contributing to better survival by the air-transported group included higher incidences of endotracheal intubation (50% vs. 25%), blood transfusions (32% vs. 10%), larger volumes of electrolyte fluid (3.3 L per patient vs. 2.1 L per patient) as well as the use of MAST trousers (60.3% vs. 34.9%). Transport charges for both ground and air services were similar. However, helicopter charges met only 15% of the operational budget of the aeromedical service. The remainder of the costs were generated from hospital patient revenues. Overall, total hospital charges were similar for both groups and were influenced by the variability of length of stay, particularly for orthopedic patients.

Aircraft↗
PubMed1988

Impact of helicopters on trauma care and clinical results.

This report reviews the history of the development of civilian helicopter ambulance program as a component of a total emergency medical services (EMS) system. Current literature demonstrates significant reduction in trauma mortality for those patients transported by air either from the scene of the accident or from an outlying hospital to a trauma center. The primary factor is not the speed of the transport but administration of life-saving care by the helicopter medical crew at the scene of the accident or at the outlying hospital. Regulations have been developed to assure proper patient selection, quality care, safety, and minimization of misuse of this expensive resource.

Aircraft↗
PubMed1987

Reducing wound infections. Improved gown and drape barrier performance.

A 21-month study involving 2181 clean and clean-contaminated general surgical procedures was performed to evaluate the effectiveness of a commercially available disposable gown and drape system vs a cotton system in reducing wound infection. The series in which the disposable spun-laced fiber system was used had a significantly lower overall infection rate (2.83% vs 6.5%) as well as better rates in clean (1.8% vs 3.8%) and clean-contaminated (4.8% vs 11.4%) procedures. This effect was independent of all other factors. The odds of developing a wound infection was 2 1/2 times higher with a cotton system than with a disposable system. Actual cost analysis from three types of hospitals showed lower costs with utilization of disposable gown and drape systems. Hospital charges were significantly higher for those patients developing wound infections. The results of the study demonstrated not only significant reduction in wound infection rates but also major cost savings when a disposable gown and drape system was used in the operating room.

Clothing↗
PubMed1985

Trauma injuries. Triage and stabilization for safe transfer.

Categorization of trauma injuries and identification of special resources and facilities for treatment of major injuries have markedly affected morbidity and mortality. Reduction in trauma morbidity and mortality depends on early identification of severely injured patients, proper initial stabilization, and safe interhospital transfer. The trauma score and the American College of Surgeons anatomical injury categorization are valuable triage tools. Protocols for initial stabilization and for safe transfer have been described to assist the primary referring physician in providing optimal early care.

Abdominal Injuries↗
PubMed1985

Emergency care of chemical burns.

Because of the large number of potentially injurious chemicals present in the home and workplace, chemical burns pose a unique challenge to the health care professional. For the majority of injuries, prompt and prolonged hydrotherapy is the cornerstone of therapy. The clinician needs to remember that the extent and depth of chemical injuries are difficult to assess in the acute phase; therefore, careful monitoring of blood values, urine output, and other parameters is necessary to gauge the volume of fluid required with major injury.

Alkylmercury Compounds↗
PubMed1983

Perforation of the jejunum from blunt abdominal trauma.

Thirteen cases of jejunal perforation from blunt trauma are presented. There are no reliable signs or symptoms, and a normal physical examination may be seen. Free intraperitoneal air on plain radiograms is characteristically absent. Simple debridement and closure is adequate. Mortality is usually associated with other serious concomitant injuries, and complications are associated with diagnostic delays. Diagnostic peritoneal lavage is a safe and reliable procedure for establishing an early diagnosis of serious intraperitoneal injury. Its routine use in all cases of serious blunt abdominal trauma is advocated.

Abdominal Injuries↗
PubMed1980

Apocrine differentiation in human mammary carcinoma.

Six invasive carcinomas that contained apocrine differentiation as the primary morphologic pattern were selected from a series of 1500 prospectively examined breast carcinomas (0.4%). While apocrine features were seen in many breast tumors, these six cases were identified by uniformly fine granular, pale, eosinophilic cytoplasm with apical cytoplasmic projections similar to that seen in apocrine metaplasia. In each example, ultrastructural analysis revealed the presence of numerous 400-600 nm membrane bound vesicles with dense homogeneous osmophilic cores. These granules clustered toward the apex of the cytoplasm in the majority of the epithelial cells. All six tumors were deficient in high-affinity, low-capacity 8S estrogen and progesterone proteins, while a high-capacity, low-affinity, nonsaturable 4S progesterone-estrogen binding protein was observed. Cortisol did not bind to this protein. These observations characterize the ultrastructure of apocrine carcinoma as a variant of human mammary carcinoma.

Apocrine Glands↗
PubMed1979

Hypercalciuresis in trauma patients on high-nitrogen enteral and parenteral diets.

Calcium balances in ten enterally or parenterally hyperalimented trauma victims were compared as protein intake was manipulated from 50.5 +/- 12.8 to 128.0 +/- 17.4 gm/day during an isocaloric metabolic balance study. Calciuresis increased as protein intake increased in all subjects, resulting in an average reduction in daily calcium balance of 195 +/- 65 mg/day (p less than 0.001). There was no difference in fecal calcium in the enterally fed subgroup. Total and "corrected" total serum calcium were lowered, and indirect evidence suggests that ionized calcium was lowered as well. The mechanism of the increase in urinary calcium is not fully elucidated, although it appears to be a direct effect on the kidney rather than an indirect influence of calcium homeostasis. It is suggested that a calorie/nitrogen ratio of about 360 be maintained in enteral and parenteral alimentation of trauma victims. Thus nitrogen balance can be maintained by the increased nonprotein calorie availability, and possible complications of increased calcium mobilization and excretion can be avoided.

Adolescent↗