Biomedical subjects

K Burchett

Publications and source records attributed to K Burchett.

6 recordsLinked to original sources

PubMed2002

Assessing critical care unit performance: a global measure using graphical analysis.

Outcome measurement in critical care is difficult because of the wide variety of patients treated and the diverse therapeutic options and pathways available. Individual outcome measures for critical care are available but are naturally limited to only a single aspect of performance. Most importantly, better performance in one aspect of care may compromise the standard of care in another. A global measure of performance would be helpful. For the year 1999-2000, the five hospitals in the East Anglian Critical Care Network provided data on capacity, workload and performance. The data was transformed and displayed graphically on a radar chart so that the area of the polygon within the radar chart was proportional to each unit's overall performance. The results from the five hospitals suggest that there is little overall difference in the units' global performance but the graphical representation highlighted some individual deficiencies. Graphical analysis of complex processes such as critical care delivery may facilitate performance assessment, providing that the measures chosen, weightings assigned and scales used are standardised with care.

Bed Occupancy↗

PubMed2000

The prevention of pulmonary aspiration with control of tracheal wall pressure using a silicone cuff.

A prospective open randomized controlled study was performed to assess the ability of Euromedical ILM endotracheal tube cuff (silicone cuff) to prevent pulmonary aspiration. The inflation characteristics of this silicone cuff enables the control of tracheal wall pressure. The silicone cuffed tube was shortened and an adjustable flange was used to convert it to a cuffed tracheostomy tube. Twelve patients requiring a tracheostomy on a four-bed intensive care unit (ICU) in a district general hospital received either a silicone or a Shiley cuffed tracheostomy tube. Tracheal wall pressures of both cuffs were maintained at 30 cm H2O with a constant pressure inflation device. Blue food dye was instilled once daily into the subglottic space through a fine catheter above the cuff. There were six patients in the Shiley group and six patients in the silicone cuff group. Dye leaked to the trachea in six (100%) of the Shiley group compared with none (0%) of the silicone cuff group (P = 0.001). This study confirms the effectiveness of this silicone cuff at preventing aspiration and the high incidence of leakage with the conventional high-volume low-pressure tracheostomy tube cuff.

Aged↗

PubMed1999

A comparison of hospital and critical-care activity.

When compared with changes in hospital activity, corresponding fluctuations in critical-care activity are not clear. Therefore, trends in hospital activity were compared with those of the critical-care services and simple patient demographic details. The results suggest that while the size of hospitals remained static, hospital admissions and outpatient attendances increased by 5% each year. During the same period, the number of critical-care beds increased by 21.4%. Despite this increase in capacity, the activity of the critical-care services continued to increase by a similar 5% per annum, indicating a huge surge in critical-care workload. The results indicate that the increase in the rate of activity in hospitals and critical-care services is similar but the workload of the critical-care services is increasing much faster. This suggests that the demand for critical care may be generated from within hospitals.

Age Factors↗

PubMed1997

Heterogeneity in intensive care units: fact or fiction?

Reports and guidelines concerning intensive care practice have been issued recently. However, the introduction of such centrally issued recommendations may be difficult because of marked heterogeneity between intensive care units. This study examined the facilities (number of beds, consultant sessions, nursing establishment), annual workload (number and types of patients admitted) and outcome (intensive care unit mortality) in the (old) Anglia Region. There were significant differences in the distribution of patients' ages, severities of illness, diagnoses, durations of admission and outcomes. Such heterogeneity may make multicentre trials more difficult to conduct and create problems when uniform measures designed to improve intensive care services are being planned.

APACHE↗

PubMed1995

Stereo-specific analysis of a novel protein kinase C inhibitor.

SPC-100270 drug substance ((2S,3S)-2-aminooctadecane-1,3-diol) is a synthetic sphingosine analogue possessing limited ultraviolet absorbance (UV) and two chiral centres. Analytical methodology employing derivatization of SPC-100270 with o-phthaldialdehyde (OPA) and a chiral thiol, N-acetyl-D-penicillamine, was developed to assess the isomeric purity of SPC-100270 in the presence of two of its three stereoisomers. Separation of the isoindole derivatives was achieved with isocratic reversed-phase column chromatography with detection at 330 nm. Under the conditions studied, the derivatization was complete within 3 h at 50 degrees C. The standard and derivatized solutions were stable for 7 days under refrigerated conditions. The limit of detection was 0.036 micrograms SPC-100270 per ml and the limit of quantitation was 0.237 micrograms SPC-100270 per ml. The assay response was linear over a concentration range of 4.7-376 micrograms SPC-100270 per ml with a coefficient of determination of greater than 0.9999. The precision, ruggedness and specificity of the assay were acceptable for determination of SPC-100270 in the presence of its stereoisomers and under forced degradation conditions. The method has been applied successfully in two independent laboratories for quality control release and stability assessment of SPC-100270 drug substance for early clinical studies.

Chromatography, High Pressure Liquid↗

PubMed1993

Serotonin involvement in the discriminative stimulus effects of kappa opioids in pigeons.

The purpose of the present study was to examine the role of serotonin (5HT) in the discriminative stimulus effects of kappa opioids. Pigeons were trained to discriminate 5.6 mg/kg of the kappa opioid, U50,488, from water. During substitution tests, both U50,488 and another kappa opioid, spiradoline, produced > 80% responding on the U50,488-appropriate key. In contrast, the non-opioid compound, phencyclidine and several serotonergic compounds failed to substitute for the U50,488 discriminative stimulus across a wide range of doses. During combination tests, the selective 5HT1A agonist, 8-OH-DPAT (0.001-3.2 mg/kg), dose-dependently attenuated the discriminative stimulus effects of 5.6 mg/kg U50,488 and 3.2 mg/kg spiradoline. This effect was reversed by the 5HT1A antagonist, NAN-190 (0.01-1 mg/kg), in a dose-dependent manner. Buspirone (0.01-10 mg/kg), a 5HT1A partial agonist, also attenuated the discriminative stimulus effects of the training dose of U50,488 but ipsapirone, another 5HT1A partial agonist, did not. Ketanserin, a 5HT2 antagonist, and MDL72222, a 5HT3 antagonist, attenuated the effects of U50,488, whereas the 5HT1B,1C agonist, mCPP, and the 5HT2 agonist, DOI, did not. Depletion of 5HT with p-CPA also attenuated U50,488's discriminative stimulus effects. Taken together, the results suggest that serotonin release is an important component in the discriminative stimulus effects produced by kappa opioids; however, the effects of DOI and mCPP alone suggest that activation of post-synaptic 5HT receptors is not sufficient to produce the full spectrum of kappa opioid discriminative stimulus effects.

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗