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Biomedical subjects

J Havill

Publications and source records attributed to J Havill.

9 recordsLinked to original sources
PubMed2003

Intermittent enteral nutrition--a comparative study examining the effect on gastric pH and microbial colonization rates.

In a prospective randomized study we aimed to examine the effect on gastric pH and microbial colonization of enteral nutrition (EN) delivered both by intermittent and continual infusion. Forty-three mechanically ventilated patients were randomized to receive EN by one of three methods, intermittent or continual gastric or continual jejunal. We sampled gastric aspirate for pH and culture in all patients at 0600 hours and pH in gastric intermittent feeders at 2200 hours daily. Patients were studied for 12 days or until extubated. Data was obtained on 41 patients, of whom 73% had a diagnosis of trauma. Median APACHE II score was 17 and ventilation time 11 days. Twelve patients received gastric continuous, 15 gastric intermittent and 14 jejunal nutrition. No significant difference was observed between the three groups with regard to median 0600 pH (P = 0.16). This was lowest in the jejunal group (3.2) followed by the gastric intermittent group (4.0) and then gastric continuous group (5.0). With overnight cessation of EN in the gastric intermittent group, the median pH fell from 5.2 at 2200 to 4.0 at 0600 (P = 0.01) with no effect on gastric colonization. The probability of gastric colonization over time however was significantly lower in the jejunal group compared with the two gastric groups (Log rank test, P = 0.02). These results demonstrate that in a patient population consisting predominantly of trauma, overnight cessation of EN made no overall difference to 0600 gastric pH or colonization rates. The preservation of pH and lowered colonization in those given jejunal feeding may have implications in the pathogenesis of ventilator-associated infection and may warrant further study using larger patient numbers.

APACHE↗
PubMed2001

Complete practice operating systems: the long-term solution to practice management.

A carefully structured, well thought-out CPOS based on a successful prototype(s) that has proven itself over time is probably the fastest and most reliable way to get your practice on the road to profitability that can be sustained and built upon over the life of the practice. If you rely on "bits and pieces" of practice management ideas and extraneous methods that of themselves may be effective, they may, when integrated into your existing operating structure or system, actually have a negative impact. When addressing something as important as your practice operations, and hence, your livelihood, carefully determine if the changes advocated will be effective, and how these changes will interface with your existing systems. If your existing systems are faulty, building on them may be futile. Look closely and carefully examine the knowledge, credibility, and expertise of anyone who is suggesting and implementing change in your practice. Further, and equally important, ask these two questions: (1) Is the operating system you are considering designed and built from a successful prototype? (2) Can the system's success be documented in terms of sustained increase in production, collections, and net income over time? If the answer is "no" to either or both of the above, tread lightly. You may actually be making things worse. Look for an operating system that has made other dental practices successful, and you can have the great practice you've always wanted!

Appointments and Schedules↗
PubMed1981

Ruptured abdominal aortic aneurysm: an 11 year review.

This paper reviews experience over 11 years at Waikato Hospital of an aggressive approach to ruptured abdominal aortic aneurysms. The total hospital mortality was 51 percent. Of those reaching operation 34 percent died in hospital. This was reduced to 28 percent over the last five years of the survey. Features relating to the presentation, operative and postoperative management, and subsequent progress of patients are discussed.

Acute Kidney Injury↗