Biomedical subjects
Publications and source records attributed to K A Bryant.
The immunizations recommended in the 2001 Childhood Immunization Schedule are safe and effective. Newly approved vaccines, like the pneumococcal conjugate vaccine, hold the promise of eliminating or dramatically reducing persistent causes of childhood morbidity and mortality in the United States.
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Carbon dioxide medical lasers are being used for various clinical applications with considerable success. Despite the bulk of the generating equipment, the use of light, articulated arms to deliver the power beam to either hand-held or microscope-mounted aiming heads allows accurate power placement. In addition, the beam can be focussed to a small spot size, minimizing damage to adjacent tissue provided that the output power and the precise duration of application are known, and the shielding of deeper tissue has been adequate. In an attempt to assess the reliability of the laser beam as a significant surgical tool (particularly suitable for fine cutting functions in microsurgical procedures), we tested the power output of some of the CO2 surgical lasers now available in Australia. An alarming discrepancy was found between the actual power delivered and the higher power value displayed as being delivered. As these medical lasers were tested and passed as fully functioning by their local agents, it is suggested that purchasers of CO2 lasers should be aware of these possible power inadequacies and subject their equipment to frequent power checks. Otherwise much longer applications of the laser beam will be needed to accomplish the cutting action required, with the consequent infliction of more damage to the surrounding tissues.
OBJECTIVE: To determine the mechanism by which managed care organization (MCO) enrollees enter the emergency medical services (EMS) system. METHODS: All enrollees belonging to the region's largest MCO and transported to emergency departments by a paramedic-level municipal EMS system were identified from billing records. Dispatch logs were examined to determine the time and origin of the call to the 911 communication center. Patient care records were used to obtain age, the level of care delivered (advanced or basic life support), and whether the patient received any medications while out of hospital. Hospital admission was also determined. RESULTS: Over a six-month period, 195 enrollees were transported. Three modes of 911 EMS system entry were identified: group I-enrollees who called 911 directly; group II-enrollees who called the MCO triage center, who then called 911 on behalf of the patient; and group III--enrollees who were sent to the MCO health center for evaluation, and subsequently the MCO called 911 to transfer the patient to the hospital. Of the 195 patients transported to the emergency department, the dispositions of 108 (55%) patients were obtained. Group I (n = 109) patients were more likely to be transported in the evening (3 PM to 11 PM), less likely to require advanced life support therapies, and less likely to be admitted to the hospital when compared with groups II (n = 32) and III (n = 54) patients. Group III patients were the most likely to receive advanced life support care and require admission to the hospital. CONCLUSION: The majority of MCO enrollees called 911 directly, and were most likely to do so during evening hours. Enrollees who called 911 directly (group I) had a trend toward lower acuity, based on the lowest ALS utilization of any group. Those enrollees who most frequently required advanced life support were those who received initial treatment at the MCO center prior to EMS transport. Though EMS system-specific, this type of descriptive analysis is helpful in assisting both EMS systems and MCOs to better assess utilization of 911 EMS resources by MCO enrollees. This study also challenges the prudent layperson paradigm.