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Biomedical subjects

R D Kennedy

Publications and source records attributed to R D Kennedy.

14 recordsLinked to original sources

Injuries in the Alaskan Arctic.

In recent years, the State of Alaska has developed a Trauma Registry data collection system on injuries which result in hospitalization or death. All 25 acute care hospitals in Alaska have agreed to participate in this Trauma Registry. Data are presented from this registry on injuries which occurred between March 1988 and December 31, 1990 in the North Slope Borough, the Northwest Arctic Borough, and the Norton Sound Region. Causes of death and serious injury are presented and comparisons made among regions and between Natives (primarily Inupiat Eskimos) and non-Natives. Use of firearms accounted for the majority of fatalities (32%), while falls were the most reported injury (19%). Trauma Registry Data can be used to target high risk groups and activities for the development and evaluation of prevention programs. This database also is used for quality assurance reviews of patient care and outcomes.

Alaska

The NIOSH B reader certification program. An update report.

Physicians trained in the use of the International Labour Office system for classification of radiographs of pneumoconioses who pass a competence test administered by the National Institute for Occupational Safety and Health are designated as B readers. The current certification and recertification examinations for qualification under the NIOSH B reader program are described. Details of the rationale and format of each examination are given, and information on candidates' scores provided for the years 1987-1990.

Certification

Digitalisation and digitalis detoxication in the elderly.

Twenty-three elderly patients with normal renal function were studied during digitalisation for cardiac failure or atrial fibrillation. Mean serum digoxin concentrations were in the therapeutic range from the fourth day in seven patients given digoxin 0.25 mg daily, from the second day in seven patients given 0.5 mg followed by 0.25 mg daily, and from the first day in nine patients given 0.75 mg followed by 0.25 mg daily. Toxic effects were not encountered in any patient. Serial measurement of serum digoxin concentrations in six patients recovering from digitalis intoxication, all of whom had severe renal impairment, allowed calculation of serum half-times (62 to 189 hours), and elimination constants (9 to 27% per day). The apparent volumes of distribution of digoxin were around 300 litres, and the apparent body contents of the drugs around 20-25 mug/kg body weight. Differences between these figures and those determined by others for younger patients seem mainly to reflect the consequences of renal impairment. If reasonable assumptions are made for fractional absorption, volume of distribution, and elimination constant, serum digoxin levels during digitalisation can be predicted, and are found to agree well with those observed.

Aged

Ischaemic heart disease in the elderly.

Studies were made for evidence of heart disease on 501 people aged 65 and more living at home; 22-4 per cent had clinical and/or electrocardiographic evidence of ischaemic heart disease. The prevalence of ischaemic heart disease increased with age, and was slightly greater in men than women. The frequency of ischaemic heart disease increased with increasing current cigarette consumption and with total cigarette consumption. There was no increase in relation to any of the following possible risk factors: systolic and diastolic blood pressure, blood glucose, serum cholesterol, skinfold thickness, percentage of ideal body weight. The survival over a 5-year period of all subjects with ischaemic heart disease did not differ significantly from that of all subjects together, but the mortality of subjects with ischaemic heart disease and an abnormal electrocardiogram was 1-5 to 2 times that of subjects in whom ischaemic heart disease was diagnosed on the basis of angina pectoris or past cardiac infarction, the electrocardiogram being normal.

Aged

Comparative site of action of various anaestetic agents at the mammalian myoneural junction.

Pre- and postjunctional effects of three ethers (enflurane, diethyle ether, and methoxyflurane) and three non-ethers (chloroform, halothane, and trichloroethylene) were studied in the rat phrenic nerve diaphragm preparation using standard microelectrode recording techniques. Depression of postjunctional function included depression of the amplitude of miniature endplate potentials, inhibition of suxamethonium induced depolarization of the muscle endplate, prolongation of duration of the endplate potential, and increase in threshold for generation of the muscle action potential. The last two effects were more marked for the ethers than for the non-ethers. Effects on pre-junctional function included a slight increase in fluctuation of the endplate potential (EPP) amplitude associated with the thers and chloroform, a faster rate of decline of EPP amplitude during a tetanus in presence of the ethers, and prolongation of the normal facilitatory period during paired stimulation in the presence of chloroform. Chloroform had no effect on the rate of decline of EPP amplitude during tetanic stimulation and the ethers had no effect on the facilitatory period during paired stimulation. These results indicate that volatile anaesthetic agents depress synaptic transmission by acting on multiple sites, and that the pattern of this depression is different for each drug or group of similar drugs.

Action Potentials

Drug therapy for cardiovascular disease in the aged.

Cardiovascular diseases and their treatment in the aged are discussed under the headings of ischemic heart disease, hypertension, cardiac failure (with special reference to the use of diuretics and digoxin), infective carditis and thyroid disorders. Advanced age modifies the approach to treatment; the choice of drugs and the dosage must be adjusted accordingly. Possible drug interactions should also be considered. A rehabilitation program is of great benefit for many elderly cardiac patients. It should be planned individually and involve psychologic and environmental factors as well as medical therapy. After successful treatment of the acute episode, even the aged patient can undertake rewarding activities in his remaining lifetime.

Adrenergic beta-Antagonists

Differences between Oklahoma Indian infant mortality and other races.

Indian infant mortality rates (IMR) in the State of Oklahoma follow a downward linear trend from 13 per 1,000 live births in the 1975-76 period to 5.8 in 1987-88. Data from 7,631 death certificates matched to birth certificates, however, reveal much higher Indian IMR across the time interval than is currently documented. Matching (linking) of infant deaths to birth certificates from 1975 to 1988 indicates that infants born Indian had a 28 percent chance of being misclassified as another race (usually white) on the death certificate. Infants born white or black had less than a 1 percent chance of being misclassified. Misclassification of Indian deaths strongly alters the overall IMR for the Oklahoma Indian population from the currently reported 5.8 per 1,000 (1987-88) to an estimated actual rate of 10.4 per 1,000 for the same period.

Black People