Preceptorship: creating clinical and educational partnerships.
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Communication↗
Biomedical subjects
P M King
Publications and source records attributed to P M King.
Fundamentals of drug design from a biophysical viewpoint.
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Animals↗
Health promotion: the emerging frontier in nursing.
Health promotion is gaining recognition as a health care strategy. The major premise of this paper is that the nature of health promotion is emerging. Rising into view, health promotion offers many challenges and opportunities to all health care professionals. Many of the influences that health promotion will have on nursing have not yet been fully explored. What is health promotion? What concepts are inherent in health promotion? Are there models of health promotion that are specific to nursing? What will be nursing's role in health promotion? What changes are required by the nursing profession to enable nurses to emerge within this new frontier? These are central questions for nurses as health promotion professionals to ponder, and attempts are made in this paper to answer these questions.
Canada↗
Correlation of trauma scoring and outcome in a Canadian trauma centre.
OBJECTIVE: To study the effectiveness of treatment and the outcome in trauma patients, and to correlate these with trauma scoring systems. DESIGN: A prospective study over 1 year of the probability of survival after trauma, based on TRISS methodology. A computerized database provided outcome statistics. SETTING: A regional trauma centre in a Canadian university teaching hospital serving regional and referral patients. PATIENTS: Three hundred consecutive patients treated at a single trauma unit. Two patients were excluded because of lack of physiologic data. Blunt injuries (94%) were most frequently from motor vehicle accidents (46%). INTERVENTIONS: Those appropriate to multidisciplinary trauma management in a level 1 trauma centre. MAIN OUTCOME MEASURES: Survival (Z values) and injury severity (M values) for the total group and subsets were calculated for comparison of outcomes with the Multiple Trauma Outcome Study baseline and other Canadian centres for multisystem and single-system injuries. RESULTS: The mean Injury Severity Score was 21.16 and the mean Revised Trauma Score was 6.75. There were 51 (17%) deaths--a Z value for the study group of 2.26. The M value was 0.78. Forty of the 51 single-system injuries were head injuries and accounted for 15 deaths. The Z value for multisystem injuries only was 0.54, and the M value was 0.77. CONCLUSIONS: The TRISS method for analysing blunt trauma is comparable to other trauma scoring systems. The correlation of outcome analysis with other scoring systems is affected by exclusion rates, pre-referral resuscitation and single- versus multiple-injury mix of cases.
Abdominal Injuries↗
Use of Autosuture Surgiport for pleural drain insertion.
The insertion of pleural drains (tube thoracostomy) is associated with serious complications in up to 10 per cent of cases. A safe and efficient technique of tube thoracostomy using the Autosuture Surgiport is described.
Chest Tubes↗
Outcome analysis of work-hardening programs.
The competitive marketplace and the demand for accountability by health care payers are strongly influencing the need for work hardening programs to participate in program evaluation and produce outcome data. This study compiled program performance data on 22 work programs in Wisconsin over an 11-month period. Client data related to demographics of gender, age, occupation, insurance coverage, diagnosis, services clients received, patterns of attendance, and outcomes upon discharge were collected. Results described the majority of the clients treated in the work hardening programs to be men, aged 26 to 46 years, with occupations classified in the miscellaneous category according to the Dictionary of Occupational Titles. The reimbursement source for the majority of work program clients was worker's compensation. The most frequent condition treated was injury to the lumbar spine. Most clients were treated and discharged within a 3-week period. More than half of the clients served returned to their usual and customary jobs.
Accidents, Occupational↗
Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis.
OBJECTIVE: To evaluate the feasibility and safety of laparoscopic cholecystectomy in severe acute cholecystitis. DESIGN: Analysis of data collected prospectively from a consecutive series of 350 laparoscopic operations. SETTING: Two general surgical units in a teaching hospital. SUBJECTS: 31 patients with a diagnosis of severe acute cholecystitis based on clinical examination, investigation results, and operative findings. INTERVENTIONS: Initial intravenous fluids and broad spectrum antibiotics followed by laparoscopic cholecystectomy within 72 hours of presentation. MAIN OUTCOME MEASURES: Failure to complete the operation laparoscopically, length of postoperative stay in hospital, early postoperative morbidity, interval from operation to full activity, and return to work. RESULTS: Laparoscopic cholecystectomy was attempted in 19 patients with empyema of the gall bladder and 12 who had severe cholecystitis which failed to settle on medical management. A total of 29 operations were successfully completed with two conversions to open surgery. Two minor postoperative complications occurred, and one case of retained common bile duct stones with jaundice was treated by endoscopic retrograde cholangiopancreatography and papillotomy. Median postoperative hospital stay was two days, with return to normal activity in seven days and to work in two weeks. There were no deaths related to the operation. CONCLUSIONS: In the presence of severe acute cholecystitis laparoscopic cholecystectomy is feasible in most patients, with minimal risk of injury to surrounding structures and considerable benefits. It is recommended that laparoscopic cholecystectomy should be attempted in these patients when appropriate surgical skill is available.
Acute Disease↗
Profiling the work-hardening therapist: education and experience.
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Education, Continuing↗
Passive tube and suction drainage after elective cholecystectomy--a comparison using ultrasonography.
Daily ultrasonography of the gallbladder bed was performed in patients with suction or passive tube drains after elective cholecystectomy. A total of 19 patients was randomized to suction drainage and 17 to passive tube drainage. A policy of early drain removal was followed. No significant difference was found between the volume drained and the size of collection detected in either group. Significant bile leaks were detected and were adequately drained by suction and passive tube drains. There were no complications from drains. In view of these findings, we advocate short-term drainage of the gallbladder bed after both open and laparoscopic cholecystectomy using the drain of the surgeon's choice.
Abdomen↗
Place of death in South Australia. Patterns from 1910 to 1987.
OBJECTIVES: To portray the changes in the place of death of South Australians during the 20th century and to examine the effects of sociodemographic and cause of death variables. DESIGN: Data relating to 2566 deaths from 1910 to 1987 were extracted from the records of funeral directors. A comparison of our sample of deaths with State mortality statistics, in terms of age, sex and diagnosis, was made to assure the representativeness of the sample. RESULTS: The proportion of deaths which occurred at home decreased from 55.6% in 1910 to 26.2% in 1970, and thereafter about a quarter of all deaths occurred at home. Most of the "institutionalisation of death" was due to increasing proportions of deaths in public hospitals; by 1970 over two-thirds of all deaths occurred in hospitals. After 1970 death has been transferred from hospitals to nursing homes and inpatient hospices. Multivariate analyses indicated that the institutionalisation trend was present after taking account of confounders (age, sex, marital status, occupation, number of children, and cause of death). CONCLUSIONS: Mortality patterns are determined by social and demographic characteristics of those who die, the availability of hospital and nursing home beds, changes to health insurance schemes, and the emergence of hospice care and related services. Further study is required to determine whether patterns of terminal care are cost-effective and medically appropriate.
Cause of Death↗
Efficiency of blood use and prospects for autologous transfusion in general surgery.
A 6-month retrospective audit of crossmatch and transfusion practice in a general surgical unit has been performed. Inefficiencies in blood ordering practices have been demonstrated and the value of performing a local audit to allow estimation of blood needs has been proven. Using criteria based on the suggested tariff for operations derived from this audit, only a small number of general surgical patients would be considered as potential autologous blood donors.
Blood Donors↗
Practical surgical audit: a morbidity profile.
A prospective study of 248 patients admitted consecutively under the care of a single surgeon was performed and data on a variety of patient details were collected daily during the period of their hospitalization. Analysis of the data identified four quantifiable indices of morbidity, namely duration of hospitalization, duration of intravenous infusion, analgesic requirement and antibiotic administration, which can be combined arithmetically and used to produce a morbidity profile. The use of such a profile may allow comparisons to be made between different units if applied to specific conditions and permit a more accurate assessment of overall patient morbidity than can be presently done using mortality rates.
Adult↗
Histamine tautomerism and its mode of action.
An established combination of quantum mechanical calculations and molecular dynamics simulations (Worth, C.A., King, P.M. and Richards, W.G. (1989) Biochim. Biophys. Acta 993, 134-136; Cieplak, P., Singh, U.C. and Kollman, P.A. (1987) Int. J. Quant. Chem. QBS14, 65-74; Reynolds, C.A., King, P.M. and Richards, W.G. (1988) Nature 334, 80-82) has been used to calculate the tautomer ratios of histamine species in aqueous solution. The results are in good agreement with experiment and provide a bridge between experimental data and earlier theoretical calculations.
Calorimetry↗
Bacterial colonization of the skin after chemical depilation.
A study of the effects of preoperative skin depilation on skin microflora has been performed. Areas of skin were prepared with a chemical depilatory agent and compared with areas of unprepared skin. Preparation of skin with a chemical depilatory agent causes no increase in skin microflora, in contrast to the effects of shaving as demonstrated by earlier studies.
Bacteria↗
Theoretical calculation of tautomer equilibria in solution: 4-(5-)methylimidazole.
A combination of quantum mechanical calculations and molecular dynamics simulations has been used to calculate the tautomer ratio of 4-(5-)methyl imidazole in solution, and the results are in good agreement with experiment.
Female↗
Skin stapling of wounds in the accident department.
In a randomized prospective study of 100 consecutive patients presenting to the accident and emergency department with superficial lacerations, staples and sutures were compared for skin closure. Acceptability of the methods by staff and patients, and end results were similar. Staples were more expensive than sutures, but were significantly quicker, simpler to use and safer. They are, therefore, particularly suitable for use in a busy accident and emergency department.
Attitude of Health Personnel↗
Solvation effects.
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Computer Simulation↗
Acute abdominal pain: the value of liver function tests in suspected cholelithiasis.
Over a 4-year period, prospective data were collected on 311 patients with suspected acute cholecystitis. By identifying the diversity of conditions which can masquerade as acute cholecystitis, we have examined the role of biochemical liver function tests in the diagnosis and management of these patients. The initial clinical diagnosis of acute cholecystitis was confirmed in 229 patients (73.6%). Of those patients on whom liver function tests were performed, 76.3% (206/270) were confirmed to have cholecystitis and 69.9% (144/206) of these had some evidence of liver dysfunction. In the group of patients (64/270) with other diagnoses on whom liver function tests were performed, significantly fewer (57.8%, 37/64) had abnormal liver function tests (P less than 0.05). This is of little clinical value since normal liver function does not exclude cholecystitis (predictive value of negative test = 30.3%). In proven cases of cholecystitis, there was a significantly increased incidence of liver dysfunction when ductal calculi were present. Using the information obtained from this study, an investigative protocol is proposed which may substantially reduce the rate of misdiagnosis of patients with abdominal pain suggestive of cholelithiasis.
Abdomen, Acute↗