Biomedical subjects
Publications and source records attributed to M I Bennett.
Flecainide was used to treat malignant neuropathic pain but despite using therapeutic doses, toxicity occurred resulting in paranoid psychosis. Monitoring of flecainide levels in vulnerable populations is suggested to guide prescribing.
This study investigated the pattern and determinants of hyoscine (scopolamine) use for death rattle by a retrospective analysis of 100 consecutive deaths in a 22-bed hospice. Patient diagnoses, duration of stay, and doses and route of administration of hyoscine used in the final 48 hr before death were recorded. One-half of the patients received hyoscine in some form during the final 24 hr before death. Patients who were in the hospice for longer than 9 days and those with cerebral malignancy were given the highest doses of hyoscine in the final 24 hr (z = -2.558, P = 0.011, and z = -1.968, P = 0.048, respectively). Response to hyoscine appears to be variable, and a distinction is proposed between death while due to salivary secretions (type 1) and that due to bronchial secretions (type 2) to explain the observed patterns of use. It is likely that hyoscine is more efficacious in treating type 1 death rattle than it is in treating type 2 death rattle.
Three contrasting views are presented in three short papers: that a short period of oncology training should be mandatory for trainees in palliative medicine; that many disciplines are important in palliative medicine and training programmes should be tailored to the needs of individuals while recognizing that there will always need to be close cooperation between oncology and palliative medicine; and that a short period of training in palliative medicine should be mandatory for those wishing to pursue a career in oncology.
Ten patients with primary fibromyalgia syndrome were treated with intravenous infusions of lignocaine on a daily basis for six days. This treatment produced a clinically useful improvement in pain relief and mood scores at the time of discharge on day seven and at follow-up on day thirty.
Staphylococcal meningitis associated with implantation of an intrathecal drug pump for spasticity was successfully treated by intrathecal vancomycin delivered by the same pump. This produced high CSF antibiotic levels, and the pump and catheter system did not have to be removed. We are unable to identify a similar case reported in the literature to date.
Five patients with deafferentation pain due to brachial plexus avulsion injuries were treated with cervical dorsal column stimulation (DCS). This has produced a clinically useful improvement in pain relief and mood scores during a mean follow-up period of 13.5 months. No complications have been encountered and the advantages of DCS are discussed.
Vanadate has been previously shown to normalize blood glucose in streptozotocin-induced diabetic (STZ-DM) rats. The effect of a previously studied dose of vanadate (0.8 mg/ml) in drinking water on blood glucose, renal hypertrophy, and whole kidney polyol accumulation was studied in STZ-DM rats. Rats with diabetes of 5 weeks duration had higher blood glucose, greater urinary output, higher kidney weight, lower body weight, and higher kidney to body weight ratios than controls. Whole kidney sorbitol concentrations were significantly increased in diabetes but myo-inositol levels were unchanged vs control animals. After four weeks of oral vanadate treatment, blood glucose, urine volume, and kidney weights were similar to control values. Kidney to body weight ratios fell below that of the STZ-DM animals, but because body weights remained decreased, the kidney to body weight ratios were not normalized. Renal sorbitol levels returned to control values and renal myo-inositol levels remained unchanged in STZ-DM and normal animals treated with vanadate. These results provide evidence that vanadate therapy may result in regression of the hypertrophy and polyol accumulation characteristic of diabetic nephropathy in STZ-DM rats. This effect is most likely due to normalization of blood glucose by the insulin-mimetic activity of vanadate treatment.
Amylase activity and mRNA abundance are reduced to less than 1% of normal levels in diabetic rat pancreas. Administration of vanadate in drinking water restored normal amylase activity and amylase mRNA levels. These results demonstrate an effect of vanadate on pancreatic acinar cells and suggest that vanadate can mimic the effect of insulin on transcription of the pancreatic amylase gene.
The access of the homeless mentally ill to the benefits of psychiatric hospitalization has been excessively limited by deinstitutionalization, the devaluation of the benefits of inpatient evaluation and treatment, a shortage of public-sector psychiatric beds, and a tendency to regard the homeless mentally ill as untreatable. A pilot program was devised to increase the access of the homeless mentally ill to short-term hospital-based treatment within a public mental health system in which beds are in short supply. The program's usefulness demonstrates the value of hospital-based treatment for this population and suggests that hospital-based treatment is currently underutilized.
If most emotional problems, like most medical problems, are caused by bad luck as well as by factors over which man has control, then those who suffer from such problems must accept a burden of helplessness. When patients and their families overuse theories of causality to avoid accepting their helplessness and to create an illusory sense of human control, unjust assignment of responsibility and excessive expectations for change may erode self-esteem and make change more difficult. The authors present examples of interventions that challenge the overuse of theories of causality. Although these interventions aroused hopelessness, they also fostered realistic hope and change.
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OBJECTIVE: Our purpose was to study the ability of personal computer teleradiology (PCT) to improve the quality of communication between physicians during newborn infant transfers and consultations. STUDY DESIGN: In the first part of the study 36 radiographs of neonatal intensive care unit patients were transmitted by PCT. The pediatrician reviewed the original films and three neonatologists reviewed the PCT images. Their interpretations were scored by use of criteria established by a neutral reader. In the second part chest x-ray films (CXR) of 31 newborns weighing > 2000 gm with respiratory distress were transmitted by PCT. A pediatrician and three neonatologists participated in an exercise to simulate a telephone neonatology consultation. Patient severity assessments as measured by assignments to receive intermediate or intensive care were compared before and after neonatologists viewed the PCT image of the CXR. RESULTS: In part 1 of the study neonatologists correctly identified 98%, 91%, and 98% of the x-ray interpretation scoring items, whereas at best the pediatrician identified 82% of the scoring items (p = 0.002). In part 2 neonatologists correctly assigned patient care levels an average of 73% after reviewing a standard clinical profile and a written description of the infant's CXR. After reviewing a PCT image of the infant's CXR, patient care level assignments were correctly assigned an average of 67%. The interpretation of the PCT CXR image was consistent with the radiologic report of record in 90 of 93 interpretations (31 cases read by three neonatologists). CONCLUSIONS: PCT represents an inexpensive means to accurately send a radiographic image over the phone as part of a telephone consultation. Neonatologists were able to interpret teleradiology images more accurately than a pediatrician reviewing the original film. Although this did not result in an improvement in the neonatologists' ability to determine patient severity on the basis of the model used in part 2, their identification of serious radiographic findings missed by the pediatrician can only suggest that teleradiology may be beneficial in certain instances. Although verbal communication can often suffice in a telephone consultation or transfer, there may be specific instances when visualizing a radiographic image such as an x-ray film or computed tomographic scan can provide important information that cannot be optimally described verbally. Rural hospitals can form interhospital image transmission links with tertiary center resources.