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Biomedical subjects

J L Fletcher

Publications and source records attributed to J L Fletcher.

At least 19 recordsLinked to original sources
PubMed1998

AANA Journal course: update for nurse anesthetists--ERR WATCH: anesthesia crisis resource management from the nurse anesthetist's perspective.

Anesthesia crisis resource management (ACRM) was developed by David Gaba, MD, and colleagues at Stanford University in the early 1990s. Derived from cockpit resource management of the aviation industry, ACRM addresses the issues of human performance and patient safety in anesthesia. Due to the inherent complexity of our dynamic work environment, we are frequently faced with situations that could escalate into critical incidents. ACRM explains the role of personal and environmental factors that can contribute to the evolution of critical incidents and provides the practitioner with some behavioral and intellectual guidelines to manage the risks more effectively. ERR WATCH is an acronym I developed to interpret the principles of ACRM from the nurse anesthetist's perspective. It provides a quick review of the major principles of ACRM, which are Environment, Resources, Reevaluation, Workload, Attention, Teamwork, Communication, and Help. Used together with good clinical management, these principles may provide an edge in solving complex problems and improving performance.

Crisis Intervention↗
PubMed1997

Abortion procedure.

Explore the source record for details and available documents.

Abortion, Induced↗
PubMed1995

AANA journal course: update for nurse anesthetists--anesthesia simulation: a tool for learning and research.

High fidelity simulators are a new technology for training and research in anesthesiology. The simulators accurately replicate the anesthetist's entire work environment, including the patient, anesthesia machine, monitors, and drugs. The trainee is allowed to develop and refine his skills in anesthesia management in a safe and realistic environment. By tailoring the scenario, both basic and advanced management skills can be taught. Learners can be exposed to serious or uncommon anesthetic events which they may not otherwise see during their training. Videotaping and case logs provide unbiased recording of the session. Simulators also allow the use of new instructional techniques that are untenable in a real operating room, such as allowing critical incidents to develop fully to teach management skills or redoing cases that were poorly handled. Allowing the student to make critical errors, pausing the simulation to discuss management, or replaying the case with different management techniques are valuable teaching tools. Research studies in human performance, learning and cognition, and anesthesia crisis management training are currently underway and may produce improved training methods for novice and expert anesthesia practitioners alike.

Education, Nursing↗
PubMed1994

Continuation of warfarin-nafcillin interaction during dicloxacillin therapy.

Interactions between warfarin and penicillins have been infrequently reported. A case report of a single patient who experienced the effects of a warfarin-nafcillin interaction as well as a warfarin-dicloxacillin interaction is presented. Clinical effects of this interaction were documented primarily through changes in prothrombin time (PT) and the need for higher warfarin dosing. While the patient received nafcillin, warfarin doses were increased to as much as 4.5 times the previous amounts needed to provide adequate anticoagulation. During dicloxacillin therapy, warfarin doses were gradually decreased, but stabilized to a maintenance dose higher than the patient's pre-nafcillin dose. The dicloxacillin-warfarin interaction appears similar to that noted during nafcillin-warfarin combination.

Adult↗
PubMed1991

Successful use of subcutaneous recombinant human erythropoietin before cholecystectomy in an anemic patient with religious objections to transfusion therapy.

Use of recombinant human erythropoietin has been advocated for therapy in anemic patients with end-stage renal disease and to enhance the harvesting of autologous red blood cells from healthy patients scheduled for elective orthopedic surgery. The authors report the case of a diabetic patient with moderate chronic renal failure and cholelithiasis but whose religious beliefs forbade the use of transfusion therapy. She underwent successful cholecystectomy only after treatment with recombinant human erythropoietin.

Anemia↗
PubMed1991

Perinatal transmission of human papillomavirus.

Human papillomavirus infection is probably the most prevalent sexually transmitted disease in the United States. In adults, it is associated with condylomata acuminata and with neoplastic changes ranging from dysplasia to carcinoma. Infected mothers may transmit human papillomavirus during the perinatal period; affected children face prolonged, difficult treatment for respiratory papillomatosis. Prevention of infection remains the best approach, since diagnostic and therapeutic methods are suboptimal.

Adult↗
PubMed1990

Geographical and social variations in mortality due to childhood accidents in England and Wales 1975-1984.

An analysis was made of the death rates from accidents in children aged 0-14 by health districts in England and Wales during the five year periods 1974-79 and 1980-84. Death rates were generally higher in the north and west of England and lower in the south and east. Rates were higher in urban areas than in rural areas. There was a more than five-fold difference between the highest and lowest rates by districts during both periods. There was a very strong correlation with social deprivation. Greater efforts are required to reduce unnecessary deaths and disability from childhood accidents. The lessons already learned in many parts of the world must now be put into much wider use and practice in the United Kingdom.

Accident Prevention↗
PubMed1990

Perinatal transmission of bacterial sexually transmitted diseases. Part I: Syphilis and gonorrhea.

Sexually transmitted diseases (STDs) have reached epidemic proportions in the United States and have captured the attention of both laypersons and health professionals. Of special concern is that most STDs can be transmitted vertically to the offspring of infected mothers. Since the advent of acquired immunodeficiency syndrome, other STDs have been at risk of being relatively disregarded. This paper, the first of two parts, reviews issues of prevalence, morbidity, mortality, prevention and treatment of syphilis and gonorrhea as they affect the maternal-fetal dyad.

Anti-Bacterial Agents↗
PubMed1990

Perinatal transmission of bacterial sexually transmitted diseases. Part II: Group B streptococcus and Chlamydia trachomatis.

Sexually transmitted diseases (STDs) have reached epidemic proportion in the United States and have captured the attention of both laypersons and health care professionals. Of special concern is that most STDs can be transmitted vertically to the offspring of infected mothers. Since the advent of acquired immunodeficiency syndrome, other STDs have been at risk of being relatively disregarded. This paper, the second of two parts, reviews issues of prevalence, morbidity, mortality, diagnosis, prevention, and treatment of group B streptococcal and chlamydial infections as they affect the maternal-fetal dyad.

Chlamydia Infections↗