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Biomedical subjects

K Sherry

Publications and source records attributed to K Sherry.

6 recordsLinked to original sources
PubMed1997

How do palliative physicians manage venous thromboembolism?

This postal survey among 174 UK palliative physicians, aimed to assess current practice and perceived problems within the management of venous thromboembolism (VTE) in patients with advanced cancer. The questionnaire was returned by 131 out of 174 (74%) of the doctors surveyed. The most common estimated incidence of patients with VTE was 1-5%. The diagnosis of VTE is usually confirmed by further investigation and in general, outpatients are more likely to be anticoagulated than inpatients. Problems with anticoagulation include bleeding, international normalized ratio instability, appropriateness of anticoagulation, practical difficulties associated with monitoring, and recurrent VTE. Although probably less effective, 77 out of 128 (60%) of respondents use subtherapeutic regimes in order to minimize the risks. Patients with advanced malignancy and VTE are anticoagulated, if considered appropriate, by the vast majority of palliative physicians in the UK. Warfarin has been abandoned in favour of low-molecular-weight heparin (LMWH) by 26%. LMWH provides anticoagulation with no need for monitoring, has no significant drug interactions and is not affected by liver dysfunction. Theoretically, LMWH is more effective than warfarin in the secondary prevention of VTE with less risk of bleeding.

Anticoagulants↗
PubMed1996

The capacity of children's services in New South Wales to meet their responsibilities under the Public Health (Amendment) Act 1992.

From 1 January 1994 the New South Wales government has required directors of licensed children's services to ask parents for proof of their children's immunisation status, to record and update this information and notify public health units of outbreaks of vaccine-preventable disease. Before introduction of the legislation, we studied the health and safety policies and practices of a random sample of 77 long-day-care centres caring for children under two years of age. All but one recorded immunisation in some way; however, of the 73 centres for which adequate information was available, only 22 per cent (95 per cent confidence interval (CI) 14 to 33) recorded immunisation according to the National Health and Medical Research Council schedule. A review of the records of one in four children enrolled in the centres showed that triple antigen (TA) was recorded in some way on 94 per cent (CI 92 to 95) of records, and measles-mumps-rubella (MMR) on 80 per cent (CI 78 to 83) of records. These entries were independently verified for only 31 per cent of TA and 26 per cent of MMR records, and 38 per cent of TA and 41 per cent of MMR records had not been updated when necessary. Only 53 per cent of directors thought that the school-entry legislation would affect children's services. Directors were generally unaware of the role of the public health units and would have had difficulty in managing an outbreak of a vaccine-preventable disease. Without technical and administrative support, the directors will not be able to meet their responsibilities under the legislation.

Child Day Care Centers↗
PubMed1988

Cerebral blood flow during cardiopulmonary bypass.

In a study of the cerebral consequences of cardiopulmonary bypass (CPB), we have assessed cerebral blood flow (CBF) by intra-arterial Xenon 133 clearance, utilising a Novocerebrograph 10a, before, during and immediately following CPB. All patients (n = 51), under the care of a single surgical team underwent elective coronary revascularisation using a standardised anaesthetic and surgical protocol. CBF, measured as the initial slope index (ISI), fell significantly from before (median 22.5) to on bypass (median 20) (Wilcoxon P less than 0.005) and was significantly increased in the immediate post-bypass period (median 28) compared with pre-bypass (Wilcoxon P less than 0.001). Scattergrams reveal CBF to be independent of arterial pressure (BP) but show an important relationship between arterial PaCO2 and CBF. The correlations between PaCO2 and CBF prior to bypass (r = 0.46 P less than 0.005) and post-bypass (r = 0.46 P less than 0.001) are very similar, whilst on bypass, the correlation, although remaining significant, is reduced (r = 0.31 P less than 0.02). The median values for arterial PaCO2 are low throughout the study (pre-bypass median 33 mmHg, on bypass median 28 mm Hg and post-bypass median 36 mm Hg). The maintenance of PaCO2 within the normal range of 35-45 mm Hg may minimise the risk of low CBF due to hypocarbia which could theoretically be harmful in patients known to be at risk of both short term and long term cerebral dysfunction.

Carbon Dioxide↗
PubMed1988

Sufentanil and nitrous oxide anaesthesia for cardiac surgery.

We have investigated the use of sufentanil 3.75-15 micrograms kg-1 by supplementing anaesthesia with nitrous oxide and midazolam. Thirty patients with ejection fractions exceeding 30% were studied while undergoing scheduled coronary artery vein graft surgery. Even in the lowest dose group (3.75 micrograms kg-1), haemodynamic responses to surgical and anaesthetic stimuli were sufficiently obtunded that no patient exhibited an increase in heart rate or systolic arterial pressure greater than 20% of the control value. Marked hypotension occurred in some patients during unstimulated periods. Such periods of hypotension were associated with equally marked decreases in systemic vascular resistance. The mean recovery times to spontaneous ventilation after the end of surgery ranged from 6 to 12 h. This is longer than would be expected from other studies using a similar dose of sufentanil. This may be related to the use of benzodiazepines during anaesthesia and to their use after surgery in those patients who became restless.

Anesthesia Recovery Period↗