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Biomedical subjects

R C Fox

Publications and source records attributed to R C Fox.

At least 19 recordsLinked to original sources
PubMed1994

Noninvasive mechanical ventilation via face mask in patients with acute respiratory failure who refused endotracheal intubation.

OBJECTIVE: To evaluate the response to noninvasive ventilation in a group of terminally ill patients with acute respiratory failure who refused endotracheal intubation. DESIGN: Case series. SETTING: Medical intensive care units (ICUs) in a university health science center. PATIENTS: Eleven patients, nine with hypercapnic and two with hypoxemic acute respiratory failure. Mean age of patients was 64 yrs. INTERVENTION: Mechanical ventilation was delivered via a face mask. The initial ventilatory setting was continuous positive airway pressure mode, with pressure-support ventilation of 10 to 20 cm H2O, titrated to achieve a respiratory rate of < 25 breaths/min and a tidal volume of 5 to 7 mL/kg. Ventilatory settings were adjusted based on results of arterial blood gases. Mean duration of mechanical ventilation was 44 hrs. MEASUREMENTS AND MAIN RESULTS: Mechanical ventilation via face mask was effective in correcting gas exchange abnormalities in seven of 11 patients, all of whom survived and were discharged from the ICU. Four patients with hypercapnic acute respiratory failure died. Mechanical ventilation via face mask was effective in improving respiratory acidosis in three patients and had no effect in one patient. Two of the four patients could not be weaned from mechanical ventilation and opted for discontinuation of this method. Removal of the ventilator while retaining the mask for oxygen supplementation was a nontraumatic experience to the patient and family. Even when respiratory failure did not resolve, mechanical ventilation via face mask was effective in lessening dyspnea and allowed the patient to maintain autonomy and continuous verbal communication. CONCLUSIONS: We conclude that mechanical ventilation via face mask offers an effective, comfortable, and dignified method of supporting patients with end-stage disease and acute respiratory failure.

Acute Disease↗
PubMed1992

Post-Jurassic mammal-like reptile from the Palaeocene.

Mammal-like reptiles of the order Therapsida document the emergence of mammals from more primitive synapsids and are of unique zoological and palaeontological interest on that account. Therapsids, first appearing in the Early Permian, were thought to become extinct in the Middle Jurassic, soon after the Late Triassic origin of mammals. Here, however, we report the discovery of a therapsid from the late Palaeocene, 100 million years younger than the youngest previous occurrence of the order. This discovery nearly doubles the stratigraphic range of therapsids and furnishes their first record from the Cenozoic. The documenting fossils, an incomplete dentary containing three teeth, and four isolated teeth from other, conspecific individuals (Fig. 1), are from the Paskapoo Formation, at Cochrane, Alberta, Canada, from beds yielding a diverse mammalian fauna of early Tiffanian age. These specimens are catalogued in the collections of the University of Alberta Laboratory for Vertebrate Paleontology (UALVP) and provide the basis for a new taxon, as named and described below: (see text)

Animals↗
PubMed1991

Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure.

Mechanically assisted intermittent positive-pressure ventilation effectively provides ventilatory support in patients with respiratory failure but it requires placing an artificial airway. We have previously reported our successful experience delivering mechanical ventilation via a face mask (FMMV) rather than with an endotracheal tube in a pilot study of patients with acute respiratory failure. The present investigation evaluated an additional 18 patients with hypercapnic respiratory failure to determine the efficacy of FMMV in a more homogeneous group and to determine factors predicting its success. FMMV was successful in avoiding intubation in 13 of the 18 patients. A significant initial improvement in PCO2 (greater than 16 percent decrease) and in pH (from less than 7.30 to greater than 7.30) predicted success. The five patients who failed on FMMV required endotracheal intubation because of inability to improve gas exchange (three patients), apnea due to sedatives (one patient), and management of secretions (one patient). FMMV was generally well accepted with only two patients withdrawn because of intolerance of the mask. The mean duration of FMMV was 25 h. Complications were seen in only two patients (11 percent): aspiration (one patient) and mild skin necrosis (one patient). Seven patients entered the study by meeting entrance criteria after an unsuccessful extubation attempt and therefore received both forms of mechanical ventilation. All but one patient avoided reintubation, and the face mask proved to be as effective as the endotracheal tube as a conduit for delivering the mechanical tidal volume and improving gas exchange. Our findings indicate that FMMV is a viable option for short-term (one to four days) ventilatory support of patients with hypercapnic respiratory failure and insufficiency.

Acidosis, Respiratory↗
PubMed1990

Medical uncertainty and the autopsy: occult benefits for students.

The autopsy has been of great importance in educating students regarding medical uncertainty. The marked decline in the use of the autopsy in medical education and continuing education has contributed significantly to the current discomfort among physicians regarding medical uncertainty and medical errors, which, in turn, has furthered the decline of the autopsy. Inordinate guilt, denial, and other defensive behaviors that many physicians marshall in response to uncertainty and error prevent these individuals from learning from their mistakes. The autopsy experience during medical school, properly utilized, helps students to confront fallibility and sets the stage for later successful management of uncertainty and error.

Autopsy↗
PubMed1990

The culture of caring: AIDS and the nursing profession.

Caring for persons with AIDS calls upon a range of physical, psychological, social, and spiritual interventions that, in the absence of a cure, can make a palpable difference for patients. The "culture of caring" that nurses bring to bear on the epidemic is shaped by their education and socialization, and by shared background characteristics. The nursing profession has been among the leaders in organizing AIDS care; such care entails stress for individuals at a time when the profession and the health care system are facing a generalized crisis, but nurses have testified to the redeeming significance they find in performing their work. It remains to be seen whether the contribution nurses and their ethos of caring have made will endure to influence the relative status of this profession.

Acquired Immunodeficiency Syndrome↗
PubMed1985

The Daedalus effect: changes in ethical questions relating to hepatitis B virus.

The Daedalus myth is a metaphor for aspects of the scientific process. When a problem is solved it often raises others, and when these in turn are solved they generate additional questions. Although perfect solutions may not be possible, major improvements can be made in many cases. Research on the hepatitis B virus is an example. The ability to detect carriers of hepatitis B virus contributed to the control of post-transfusion hepatitis but raised social and ethical problems inherent to the identification of carriers in the community. Partial solutions to this problem resulted from the ability to distinguish infectious from noninfectious carriers by the use of the hepatitis B antigen (HBeAg) test and the development of an effective vaccine against hepatitis B virus. These solutions will undoubtedly lead to other problems and their solutions, which will in turn lead to other ethical and medical questions.

Bioethics↗
PubMed1983

Personhood, medicine, and American Society.

The problems of personhood with which this conference--and our society--grapples are significantly interwoven with modern medicine, its technology, and its science. More importantly, the conceptual language and recurrect themes of personhood questions are shaped by moral philosophers and jurists: "individualism" and "connectedness" are at the core of debates. Existing institutional arrangements have been inadequate to arrive at an effective societal consensus.

Advisory Committees↗
PubMed1982

Critical care at Tianjin's First Central Hospital and the fourth modernization.

This case study of the Critical Care Unit at Tianjin's First Central Hospital, its physician-director, and one of its patients provides a portrait of how the policy of the four modernizations is being applied to the field of medicine in the People's Republic of China. On this unit of an urban hospital the "fourth modernization," science and technology, is systematically brought to bear on the problems of critically ill patients. The Chinese dualities and dilemmas that this "scaling the heights" policy entails are continually played out on the Critical Care Unit. An intricate balancing is involved between modern Western and traditional Chinese medicine, and between rural public health programs and primary and tertiary care services, within a medical morality framework that combines present-day political ideology with age-old ethical precepts. At this juncture the overall balance seems to be moving in the direction of modern, city-based, curative medicine.

Adolescent↗
PubMed1980

The evolution of medical uncertainty.

Modern developments of scientific medicine have uncovered and created uncertainties and risks that were previously not known or experienced; the stakes have become very much higher. The rise in public expectation, however, is paralleled by a lowered tolerance of uncertainty. Metaphors of "deliverance" and "disaster" abound in discussions of scientific discovery, reflecting differing conceptions and philosophies about errors and mistakes, and the role they play in the physical universe, the biosphere, and human affairs. These concerns highlight the difficulties and dilemmas of finding scientifically adequate, culturally appropriate, and socially effective ways of appraising and controlling risk.

Adult↗