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Biomedical subjects

P Curry

Publications and source records attributed to P Curry.

At least 19 recordsLinked to original sources
PubMed2002

Treatment of superior vena cava obstruction secondary to pacemaker wires with balloon venoplasty and insertion of metallic stents.

AIMS: Pacemaker wires can result in stenosis of the superior vena cava and other central veins. The aim of this study is to demonstrate the safety and effectiveness of treating stenoses of the superior vena cava (SVC) and central veins with balloon venoplasty and metallic stent insertion in the presence of cardiac pacemaker wires. METHODS AND RESULTS: Three patients were referred to the department after developing symptomatic SVC obstruction following implantation of a cardiac pacemaker several years earlier. They were examined with duplex ultrasound and venography, which revealed significant stenoses of the central veins. These patients subsequently underwent endovascular treatment which involved balloon dilation and stent insertion. The treatment was successful in all three patients, without any complications. Long-term patency of up to 4 years is recorded. No pacemaker function dysfunction was encountered. CONCLUSION: SVC stenting is safe and effective in patients who develop the SVC obstruction after cardiac pacemaker insertion.

Adult↗
PubMed2001

The Payment Error Prevention Program (PEPP): reducing Medicare payment errors in prospective payment system hospitals.

Peer Review Organizations (PROs) are charged by the Health Care Financing Administration (HCFA) to assist in protecting the integrity and solvency of the Medicare program. Recent audits of the Medicare program from the Office of Inspector General (OIG) revealed that more than $12 billion Medicare dollars in 1998 were spent in improper payments, with more than 25% attributed to prospective payment system (PPS) hospitals. The Payment Error Prevention Program (PEPP) is an initiative designed by HCFA in 1999 to assist PROs in meeting the goal of reducing payment errors in PPS hospitals. PEPP is implemented through the development of quality improvement (QI) methodologies. These projects are designed to achieve measurable improvements in processes and outcomes of payment errors. PEPP works to reduce payment errors at PPS hospitals through cooperative efforts with Ohio agencies and licensing boards, federal law enforcement organizations, HCFA contractors, hospital medical staffs, and medical and osteopathic associations.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

Airway management training using the laryngeal mask airway: a comparison of two different training programmes.

Nurses without prior experience in the use of the laryngeal mask airway (LMA) were randomly allocated to one of two groups to be trained in the emergency technique of insertion of an LMA. Group A (32 nurses) were trained only on a manikin and group B (20 nurses) were trained on a manikin and with live anaesthetised patient practice in theatre (five successful insertions). Without further practice, both groups were asked to insert an LMA in a live patient in theatre 3 months after initial training. Three attempts per nurse were allowed. In group A, 75% passed the LMA successfully at the first attempt, 22% at the second attempt and 3% (one nurse) at the third attempt. In group B, 80% were successful at first attempt and 20% at the second attempt. Skill performance and retention were shown to be high following either training method, with no significant difference between the performance of either group (chi 2). We have shown that manikin-only training in the emergency technique for LMA insertion is as effective as live patient training. It is proposed that manikin training alone may be adopted as a future training modality if, as is expected, the use of the LMA in resuscitation becomes more commonplace.

Cardiopulmonary Resuscitation↗
PubMed1997

Nisoldipine CC: clinical experience in ischaemic heart disease.

Nisoldipine coat core (CC) is a long-acting calcium channel blocker (CCB) with a slow and smooth onset of action. It is effective in the treatment of angina pectoris, increasing exercise duration, time to ST segment depression and time to onset of angina. The results of two studies reviewed here, in which patients received concomitant treatment with a beta-blocker, showed that the anti-anginal efficacy of nisoldipine CC, 40 mg once daily, measured at trough was comparable with amlodipine, 10 mg once daily, and with diltiazem retard, 120 mg twice daily, and that efficacy was maintained over a 24-hour period. The third trial reviewed here showed that nisoldipine CC was at least as effective as three-times-daily treatment with diltiazem (total dose 240 mg). To date, the effects of nisoldipine CC have been investigated in over 4,000 patients with hypertension and angina pectoris. Clinical experience suggests that once-daily nisoldipine CC is at least as well tolerated as other CCBs, provides consistent efficacy and is a useful treatment in the management of patients with angina pectoris. The CCBs show promising beneficial effects in experimental atherosclerosis and a small number of clinical trials show some effect on the progression of atherosclerosis in coronary artery disease and restenosis following coronary angioplasty. An ongoing long-term trial with nisoldipine CC after coronary angioplasty is discussed.

Amlodipine↗
PubMed1994

Training for the use of the laryngeal mask in emergency and resuscitation situations.

It has been suggested that the laryngeal mask has a role to play in the management of the airway during resuscitation both from cardiac arrest and possibly major trauma. Should it be introduced for this purpose, there will be a need to provide training for a very large number of paramedical staff. Currently training in advanced airway management techniques involves live patient practice in theatres; clearly this system is already reaching a limit as paramedics in training often have some difficulty in reaching the prescribed number of procedures. This paper describes experience with a possible alternative utilising only classroom teaching.

Allied Health Personnel↗
PubMed1992

Comparison of exposure assessment guidelines for pesticides.

The field of exposure assessment of pesticides has become well established in the past decade. Consequently, government agencies and industry groups have identified the need for guidelines for conducting studies that assess mixer/loader/applicator exposure to pesticides, as well as the exposure of individuals to residues. This paper reviews guidelines on mixer/loader/applicator exposure studies issued by the International Group of National Associations of Manufacturers of Agrochemical Products, the National Agricultural Chemicals Association, the U.S. EPA, and the World Health Organization. Mention is also made of Canadian exposure guidelines in preparation. Also reviewed are two guidelines for conducting indoor occupant exposure studies, one by the National Agricultural Chemicals Association and one by Health and Welfare Canada. The only available guideline (EPA) on assessing pesticide exposure to workers upon reentry into treated fields is also reviewed. These guidelines are reviewed and compared as to criteria for requirements of exposure studies, methodologies recommended for dermal, inhalation, and biological monitoring, quality assurance and quality control, the use of surrogate data, data reporting, and exposure calculations. From this comparison, it is evident that there has been little significant progress in the area of methodologies used for dermal exposure monitoring. The use of patches as suggested by Durham and Wolfe (1962) is still accepted and widely used, despite its limitations. However, relatively recent research in this area has shown that the fluorescent tracer technique (Fenske et al. 1986a,b) and use of full-body dosimeters may help in overcoming some of these limitations. The tracer technique is mentioned in the EPA guidelines and full-body dosimeters are addressed by EPA, WHO, and NACA. Biological monitoring can also overcome many of the limitations of passive dosimetry, but all guidelines stress the need for extensive knowledge of the pharmacokinetics and metabolism of the pesticide before this approach can be used. Rapid advancement has been made in quality assurance/quality control and analytical techniques. This has increased the level of confidence placed in exposure estimates and is evidenced by the detailed requirements of quality assurance and quality control in most of the guidelines reviewed. Guidelines on conducting indoor occupant exposure studies deal extensively with methodologies for collecting residue samples, but do not make concrete recommendations for estimating human exposure based on these residues. More research is required before the subject can be adequately dealt with in guidelines. It is encouraging that this research is being coordinated among industry, academia, and government. Further research is also needed in determining exposure to pesticides during reentry into treated areas in order to develop further guidelines.(ABSTRACT TRUNCATED AT 400 WORDS)

Air Pollution, Indoor↗
PubMed1988

Information systems planning at the University Medical Center of Southern Nevada.

In summary, UMC benefitted from the planning process and resulting information systems plan because the Medical Center was better able perform the following tasks: Understand organizational interrelationships; Identify organizational and user needs; Set enterprise-wide priorities; Document information systems needs, priorities, and relationships; Ensure management and user agreement on system direction and sequence prior to system implementation; Maximize opportunities for cost effectiveness and operational efficiency; and Define functional requirements of systems. Essential to the above tasks and resulting benefits were an executive management team at UMC which worked together to plan, and departmental managers who assessed their individual needs in the light of UMC's overall strategy.

Computer Systems↗
PubMed1985

Intravenous amiodarone in the acute termination of supraventricular arrhythmias.

This study was performed to ascertain whether intravenous amiodarone would revert supraventricular tachycardias to sinus rhythm, and if so, whether this effect depended upon the underlying mechanism of the arrhythmia. Fourteen patients were studied. Seven had Wolff-Parkinson-White (WPW) syndrome, 1 had dual atrioventricular nodal pathways and 1 an ectopic atrial tachycardia. Five patients had atrial fibrillation without accessory pathways. An atrial electrode was inserted to initiate tachycardias and record the electrogram. If tachycardias were stable for more than 5 min, amiodarone (5 mg/kg) diluted with dextrose saline was infused intravenously over 5 min. Two electrocardiographic leads and the right atrial electrogram were monitored. In 7 patients with atrial fibrillation (2 with accessory pathways), 6 did not revert to sinus rhythm, 1 reverted only after 1 hr. In 5 cases without accessory pathways the ventricular rate fell 5-10 min after commencing amiodarone. Four of the 5 patients with WPW syndrome and re-entrant tachycardias returned to sinus rhythm within 6 min of commencing the infusion (atrioventricular and ventriculoatrial times increased by 0-38% and 0-14% respectively). (Tachycardias terminated in the anterograde limb.) Three patients underwent intermittent right atrial stimulation for 1 hr. No tachycardias could be initiated for 30 min post amiodarone. The ectopic atrial tachycardia and that due to dual atrioventricular nodal pathways terminated within 7 and 2 min, respectively, of commencing intravenous amiodarone. Thus the use of intravenous amiodarone would be appropriate in the acute management of sustained supraventricular tachycardias.

Adolescent↗
PubMed1985

Autopsy calibration of carotid artery B-mode ultrasound imaging: effects of pressure on residual lumen size.

The accuracy of B-mode ultrasound (9 MHz) vascular imaging was studied on seven carotid arteries obtained at autopsy. Parallel cross-sectional images on five serial planes of each artery were compared with readings on corresponding sections of silicone rubber replicas of the vessel lumens and with histologic sections. A close correlation between ultrasound and cast measurements was observed (r = 0.88, p less than 0.01), and both corresponded well with histologic measurements. Longitudinal ultrasound views of the arteries were employed to determine changes of normal vessel diameter (maximum lumen diameter) and residual lumen diameter with increasing arterial pressure. In the specimens studied, compression of lesions occurred in addition to circumferential vessel enlargement, and the rate of compression of lesions exceeded that of circumferential vessel diameter enlargement.

Arteriosclerosis↗
PubMed1981

Relation between atrioventricular pathways and ventricular response during atrial fibrillation and flutter.

We have analysed the ventricular response as seen on the surface electrocardiogram in patients with paroxysmal atrial fibrillation and flutter in relation to the electrophysiological properties of the corresponding atrioventricular pathways. In 15 patients who had atrial fibrillation with conduction solely through the atrioventricular node, there was a significant correlation between th shortest and mean RR intervals during atrial fibrillation and the functional refractory period, "pre-Wenckebach cycle length", and the shortest ventricular cycle length that resulted from 1:1 atrioventricular conduction. In 18 patients with conduction through an accessory atrioventricular pathway the only good correlation was between the shortest and mean ventricular rate during atrial fibrillation and the "pre-Wenckebach cycle length" and shortest ventricular cycle length during 1:1 atrioventricular conduction. In 12 patients with an atriofascicular bypass tract or rapidly conducting atrioventricular node there was no significant correlation between the RR intervals during atrial fibrillation and the electrophysiological indices; the same lack of correlation was evident in all 11 patients with atrial flutter, all of whom had atrioventricular nodal conduction. The response of atrioventricular pathways to electrophysiological testing, particularly the use of incremental atrial pacing, provides useful guidance in the further management of these atrial arrhythmias.

Adult↗
PubMed1980

New intervention in mitral valve prolapse. Use of cold pressor test during echocardiography.

A study was performed in 13 patients with idiopathic mitral valve prolapse and in 21 control subjects to assess the effect of the cold pressor test on systolic motion of the mitral valve. A significant increase in blood pressure occurred in 10 patients with mitral valve prolapse and in 19 controls after immersion of one hand in ice-cold water. M-mode echocardiographic recordings from the mitral valve were obtained in all patients before, during, and after the cold pressor test, together with simultaneous phonocardiograms in selected patients. Nine out of 10 patients with mitral valve prolapse and a hypertensive response to the cold stimulus showed a significant increase in the depth of mitral valve prolapse during the cold pressor test whereas in three patients with mitral valve prolapse and no hypertensive response the depth of mitral valve prolapse did not change during cold stimulation. Three patients with previously demonstrated mitral valve prolapse had equivocal resting echocardiograms but developed diagnostic evidence of mitral valve prolapse during the cold pressor test. No evidence of mitral valve prolapse was seen in any of the control subjects before, during or after the cold pressor test. In four patients with mitral valve prolapse and a hypertensive response to cold stimulation the systolic click was delayed by the cold pressor test, whereas the time of the systolic click remained constant in the three patients whose blood pressure did not increase. It is concluded that the cold pressor test provides a stimulus sufficient to delay the onset and increase the depth of mitral valve prolapse, thereby enhancing the diagnostic sensitivity of echocardiography in this condition.

Adult↗
PubMed1980

Assessment of chest pain in hypertrophic cardiomyopathy using exercise thallium-201 myocardial scintigraphy.

Exercise thallium-201 myocardial scintigraphy was performed in 23 patients with hypertrophic cardiomyopathy. Eighteen patients presented with chest pain which was a persistent symptom in 11. Selective coronary arteriography was performed in 16 patients and showed normal coronary arteries in 15 and insignificant luminal irregularities in one patient. Eighteen patients had abnormal scintigrams. Three had an abnormal distribution of tracer entirely attributable to asymmetric septal hypertrophy, whereas 15 had discrete tracer uptake defects which could not be explained solely by myocardial hypertrophy. In this latter group of patients three scintigraphic patterns were identified: (1) in 10 patients defects were seen in scintigrams immediately after exercise but not in delayed images obtained four to six hours later. Eight of these patients had chest pain. (2) Four patients had uptake defects seen in both initial and delayed images. One patient had chest pain. (3) In three patients, one of whom had chest pain, tracer defects were seen only in delayed images and were not apparent in the initial scintigrams. Chest pain occurred in eight out of 10 patients with scintigraphic evidence of myocardial ischaemia but was present in only three out of 13 patients with non-ischaemic scintigrams. The value of exercise thallium-201 myocardial imaging as a diagnostic technique in hypertrophic cardiomyopathy appears limited. Scintigraphic evidence of regional myocardial ischaemia in the absence of significant coronary artery disease, however, contributes to an understanding of the mechanism of angina production in patients with hypertrophic cardiomyopathy.

Adult↗