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L Welch

Publications and source records attributed to L Welch.

51 records · Page 3Linked to original sources

Uropharmacology: VIII. Sympathomimetic agents.

Sympathomimetic drugs stimulate the receptors of the sympathetic nervous system. Although the bladder possesses sympathetic receptors, sympathomimetic drugs, in general, have little effect on bladder function. Their most useful clinical applications on the urinary tract are to increase or decrease bladder resistance.

Animals↗

Uropharmacology: IV. Parasympathomimetic drugs.

Parasympathomimetic drugs include (1) acetylcholine and several synthetic choline esters and related derivatives, and (2) naturally occurring cholinomimetic alkaloids and certain related synthetic compounds. Pharmacology of acetylcholine, the prototype parasympathomimetic, is presented, as well as an introduction to other parasympathomimetic drugs and choline esters.

Acetylcholine↗

Global aphasia with seizure onset in the dominant basal temporal region.

A 33-year-old right-handed woman had intractable simple and complex partial seizures (SPS, CPS) that began with global aphasia. EEG closed-circuit TV (EEG-CCTV) monitoring with sphenoidal electrodes showed left inferomesial temporal ictal onset of CPS. Subdural electrodes were implanted over the left frontotemporal convexity, subtemporally and subfrontally. Stimulation of the basotemporal cortex produced global aphasia. A posterolaterotemporal language area was also identified. Spontaneous SPS had focal onset in the basal temporal language area (BTLA). Ictal discharges did not involve the posterotemporal region. This case shows that aphasic speech arrest at seizure onset may be due to seizure discharge in the basotemporal region and that the BTLA is clinically relevant in seizure semiology.

Adult↗

A quality management approach to optimizing delivery and administration of preoperative antibiotics.

OBJECTIVE: To optimize the process for delivering and administering preoperative antibiotics in order to prevent potential adverse patient outcomes. DESIGN: Using a multidisciplinary quality-improvement team, an evaluation of the preoperative medication order and delivery process was conducted. Charts were reviewed by selected time periods, with winter 1994 discharges for orthopedic surgeries (n = 97) and spring 1995 discharges for open heart procedures (n = 50) being used to arrive at baseline data (n = 147). A plan was devised to mainstream the medication-use process so that it would be standardized hospitalwide. A goal of administering preoperative antibiotics within 30 to 60 minutes prior to cut time was established. Following redesign and education, a repeat chart review of orthopedic surgeries (n = 33) and open heart procedures (n = 168) was conducted during April 1997 for discharges from the same diagnosis-related groups to total (n = 201). SETTING: A nearly 1,000-bed tertiary referral center and teaching hospital with three separate campuses. RESULTS: We identified multiple ordering mechanisms, multiple medication sources and delivery sites, multiple administration sites and administering personnel, and other logistical conflicts. Thirty-one percent of cases received antibiotics less than 30 minutes prior to start time, 39% between 30 to 60 minutes, and 30% greater than 60 minutes before start time. Following the multidisciplinary redesign and education, an increase from 39% to 61% receiving preoperative antibiotics between 30 to 60 minutes prior to surgery start time and a decrease from 31% to 18% receiving them in less than 30 minutes was documented. The percentage of patients receiving preoperative antibiotics in 60 minutes or less increased from 70% to 80%. CONCLUSION: A continuous quality-improvement approach that engages all departments involved in patient care is necessary to achieve meaningful change in complicated hospital processes.

Antibiotic Prophylaxis↗

Why construction is different.

Construction differs markedly from many other types of manufacturing in that the nature of the work exacerbates the safety and health risks faced by workers. Even for workers who have health care coverage, the authors point out, the transient nature of the industry makes it difficult to trace an individual's exposure to health hazards.

Accidents, Occupational↗

Medical surveillance programs for construction workers.

In summary, the basic medical examination and carefully documented work and medical history are essential parts of the health examinations of construction workers. To achieve their best potential in preventing occupational and chronic diseases, the examinations should be conducted by professionals who know the working conditions in construction and have a positive attitude toward preventive medicine. One important aspect of these examinations is the opportunity to trigger workplace investigations, followed by exposure reduction. Simultaneously, such examinations provide an opportunity for health education of the worker and an education about work-related health problems for the health care provider.

Environmental Monitoring↗

Perspectives on the future.

There is a growing trend toward new forms of labor-management cooperation, through negotiated agreements involving job-site safety and health, workers' compensation, and preventive medicine (see chapter 14). These developments are likely to change safety and health in the industry. At the same time, they provide opportunities for practitioners and researchers in occupational safety and health. If we can venture to express a professional wish, it would be to find answers to the following: How can we, as the professions concerned with the well being of workers, help preserve the characteristics of construction work that are positive while reducing the aspects of the industry's functioning that are so deleterious to health? How do we preserve the crafts with their fostering of self-esteem: through individual freedom on the job, team work, or empowerment? Meanwhile, how do we reduce the destructive patterns of work, not just on the work site, but also involving the pressures and lifestyle associated with intermittent and uncertain employment? The rewards for safety and health professionals in the construction industry are immediate and striking. Whether through the practice of safety and health or through research, results can be measured in short order. That is a professional benefit afforded by few other industries. To structure occupational safety and health programs for construction workers, the safety and health professions need to engage in the labor-management processes that are changing the industry. In construction, it is not enough to think about what needs to be done in individual workplaces. In construction, we must think industry-wide, because that is how workers are employed.(ABSTRACT TRUNCATED AT 250 WORDS)

Ergonomics↗