Biomedical subjects

John Murdoch

Publications and source records attributed to John Murdoch.

5 recordsLinked to original sources

PubMed2006

Contamination: a comparison of 2 personal protective systems.

BACKGROUND: The purpose of this study was to examine the difference in self-contamination rates and levels of contact and droplet protection associated with enhanced respiratory and contact precautions (E-RCP) and a personal protective system that included a full body suit, personal protective equipment and a powered air-purifying respirator (PAPR). METHODS: In this prospective, randomized, controlled crossover study, 50 participants donned and removed E-RCP and PAPR in random order. Surrogate contamination consisted of fluorescein solution and ultraviolet (UV) light- detectable paste, which was applied after each ensemble was donned. A blinded evaluator inspected participants for contamination using a UV lamp after removal of each ensemble. Areas of contamination were counted and measured in square centimetres. Donning and removal violations were recorded. The primary end point was the presence of any contamination on the skin or base clothing layer. RESULTS: Participants wearing E-RCP were more likely to experience skin and base-clothing contamination; their contamination episodes measuring > or = 1 cm2 were more frequent, and they had larger total areas of contamination (all p < 0.0001). The anterior neck, forearms, wrists and hands were the likeliest zones for contamination. Participants donning PAPR committed more donning procedure violations (p = 0.0034). Donning and removing the PAPR system took longer than donning and removing E-RCP garments (p < 0.0001). INTERPRETATION: Participants wearing E-RCP were more likely to experience contamination of their skin and base clothing layer. Those wearing PAPR required significantly more time to don and remove the ensemble and violated donning procedures more frequently.

Cross-Over Studies↗

PubMed2006

Pain, health-related quality of life and health care utilization after inpatient surgery: a pilot study.

BACKGROUND: Little is known about pain-related outcomes in surgical inpatients after discharge from the hospital. An ongoing risk and outcomes monitoring system would provide valuable feedback to improve the quality of patient care. OBJECTIVES: The purpose of the present pilot study was to describe postoperative pain, medication use, health care utilization and health-related quality of life (HRQOL) immediately and four weeks after surgery; merge clinically captured data with Web-based follow-up data; and examine patients' willingness to complete Web-based health questionnaires. METHODS: One hundred two consecutive surgical inpatients were approached for participation. Perioperative data were abstracted from the acute pain management service clinical database and linked to follow-up data captured four weeks postoperatively. RESULTS: Follow-up questionnaires were completed by 88 participants. Clinical assessment data were successfully linked to Web-based follow-up data. Average pain intensity (3.7) four weeks following discharge fell just short of the acute pain management service active pain score of 3.9. At four weeks, all 88 participants reported significantly impaired HRQOL, 36 were still taking pain medications and 15 had visited an emergency room. Two-thirds of the participants had access to the Internet at home and approximately one-half were willing to complete on-line health questionnaires. DISCUSSION: The study indicates that it is feasible to link clinical and research data, and shows a significant burden of pain and reduced HRQOL in the weeks following discharge. This approach to converting clinically captured data into meaningful information about surgical outcomes is valuable in the development of an ongoing risk and outcomes monitoring system.

Adolescent↗

PubMed2005

The effect of clonidine on cell survival, glutamate, and aspartate release in normo- and hyperglycemic rats after near complete forebrain ischemia.

The present study was undertaken to investigate the effects of the alpha2 adrenergic agonist, clonidine, on the near complete cerebral ischemia (NCFI) evoked release of glutamate and aspartate from normo- and hyperglycemic rodent brain tissue using microdialysis tissue techniques. Hemodynamic variables, blood lactate, and glucose levels were monitored throughout the 40 min NCFI occlusion period. After 48 h, rats were killed and the extent of neuronal injury was determined in the cortex, striatum, and hippocampus. Hemodynamic variables recorded during ischemia improved with clonidine treatment in both normo- and hyperglycemic groups. Glutamate and aspartate levels were greatly increased over control values during normo- and hyperglycemic NCFI treatment. Clonidine pretreatment suppressed the release of both glutamate and aspartate during NCFI in normo- and hyperglycemic rodents when compared with NCFI-treated normo- and hyperglycemic rats without the drug. Significant neuroprotection of cells in the cortex, striatum, and hippocampus was also observed in drug-treated animals 48 h postischemia. The combined effects of diminished glutamate release after NCFI and reduced neuronal injury in both normo- and hyperglycemic states suggests that clonidine treatment during NCFI is neuroprotective. The neuroprotective effect of clonidine during ischemia may be ascribed to both a sensitization of central sympathetic activity and a reduced release of glutamate thereby reducing NMDA receptor activation and neuronal damage.

Adrenergic alpha-Agonists↗

PubMed2002

Perioperative management of complex skull base surgery: the anesthesiologist's point of view.

The anesthetic management of complex skull base surgical procedures provides unique problems and concerns for the neuroanesthesiologist. Positioning to access the skull base could put the patient at risk for peripheral nerve injury and some of the positions may increase the risk for air emboli. In addition, tumor pathology and involvement with vital structures could increase the chances for substantive blood loss, destruction of associated nerves or vessels, and may require temporary occlusion of the carotid artery necessitating intraoperative neuroprotection. Neurophysiological monitors may also be used to safeguard nerve function and anesthetic techniques must be adjusted to accommodate their use. Finally, postoperative morbidity may be affected by surgical approach to the skull base and the anesthesiologist should be aware of which approach may produce a greater incidence of pain, nausea, and vomiting in the postoperative period. The authors discuss the anesthetic concerns and management for complex cranial base surgery. Different approaches will be discussed and comparisons of perioperative parameters between these approaches will be made with data provided by retrospective chart review of more than 600 skull base procedures performed at the authors' institution over the last 10 years. This information should help guide decision making concerning anesthetic management for these skull base procedures.

Anesthesia, General↗

PubMedDate not supplied

How do patients perceive electronic documentation at the bedside?

Electronic patient records provide an opportunity for real-time access to patient information at the bedside, which has the potential to improve healthcare quality because it would increase efficiency and facilitate best practice. Patients in this study reported that portable computers used at the bedside did not affect the clinician-patient relationship. Many patients thought that the technology was a valuable tool and that it could foster an efficient hospital atmosphere and promote reliable and accurate medical documentation.

Hospital Information Systems↗