Biomedical subjects
M A Nichter
Publications and source records attributed to M A Nichter.
Childhood near-drowning: is cardiopulmonary resuscitation always indicated?
The case histories of 93 consecutive pediatric near-drowning victims admitted to All Children's Hospital from 1983 to 1987 were retrospectively reviewed for patient status on ED arrival and eventual outcome. Age, sex, length of submersion, core temperature, pHa, absence of spontaneous respiration, lack of response to pain, and pupillary nonreactivity were all found to be unreliable predictors of outcome. Of those who received CPR, 68% went on to intact survival. The use of cardiotonic medicines to establish a perfusing cardiac rhythm in the initial resuscitation was associated with an eventual outcome of severe neurologic damage or death in all instances. The decision to use cardiotonic medicines in the resuscitation of pediatric near-drowning victims should be weighed carefully against their ultimate chances of intact survival.
Profile of drowning victims in a coastal community.
Accidental drowning accounts for 15% of all accidental deaths in Pinellas County, Florida, and this study was conducted to better understand the epidemiologic profile of the victim. The medical examiner's records of 230 drownings in Pinellas County from January 1, 1983, through December 31, 1987, were reviewed for demographic and epidemiologic data. Bodies of salt water were the most common drowning site (47%), followed by swimming pools (22%), lakes (11%), baths (7%), and canals (6%). The drowning incidence for males was more than three times that for females. Drowning was endemic among boys less than five years of age (30/100,000/year). Fifty-nine percent of young adult victims had detectable postmortem blood alcohol levels. Drowning rates were highest among children less than five years and adults more than 80 years. Epidemiologic profiles of populations at risk and contributing factors are described and public safety measures are suggested.
The primary health center as a social system: PHC, social status, and the issue of team-work in South Asia.
Primary health care ideology is considered from the vantage point of health center field staff in South India and Sri Lanka. It is argued that professional and organizational role conflicts are fostered by primary health care inspired programs introduced without regard to the status and motivations of existing cadres of staff. Attention is focused on the health center as a social system and the need for social systems analysis as a preliminary step in planning for team-work at the health center-community level. Inasmuch as team-work is the cornerstone of PHC implementation, more thought need be given to staff response to potential programs.
External cranioplasty: historical perspectives.
Selective external cranial vault remodeling has been practiced since antiquity. The variations, methods, and desired results of external cranioplasty are as pervasive as the practice is old.
The impact of Indian methods for total nasal reconstruction.
The Indian art and science of total nasal reconstruction comprise the first chapter in the history of plastic surgery. Remarkably, centuries after their first use, the original Indian methods utilizing the cheek flap and median forehead flap for total rhinoplasty remain the basis for most reconstructive rhinoplastic procedures.