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Biomedical subjects

R J Geller

Publications and source records attributed to R J Geller.

At least 19 recordsLinked to original sources
PubMed2001

Nosocomial poisoning associated with emergency department treatment of organophosphate toxicity--Georgia, 2000.

Emergency department (ED) staff caring for patients contaminated with toxic chemicals are at risk for developing toxicity from secondary contamination. This report describes three cases of occupational illnesses associated with organophosphate toxicity caused by exposure to a contaminated patient and underscores the importance of using personal protection equipment (PPE) and establishing and following decontamination procedures in EDs and other areas of acute care hospitals.

Adult↗
PubMed2001

The first year of Health Improvement Programmes; views from Directors of Public Health.

BACKGROUND: The White Paper The new NHS, modern, dependable gave the strategic lead at the local level in the new National Health Service to Health Authorities (Boards in Scotland and Northern Ireland). They are expected to lead the development of strategies that will identify the health needs of local people and what has to be done to meet them. These Health Improvement Programmes (HImPs) will be the local strategy for improving health and health care and the means to achieve national targets for each Health Authority or Board area. METHOD: To assess the strengths and weaknesses of HImP production for 1999, a questionnaire survey was carried out of Health Authorities or Boards throughout the United Kingdom. Participants were all district Directors of Public Health (DsPH) or Chief Administrative Medical Officers (CAMOs). The main outcome measures were the opinions of DsPH or CAMOs on the successes and failures of their local HlmP process. RESULTS: Ninety-three (83.8 per cent) DsPH responded. In just over half of all Health Authorities or Boards (56 per cent) the DsPH had taken the lead in producing the HlmP. Many aspects of the HlmP process went well, including multiagency 'stakeholder' involvement and partnership working, good project management, and agreeing a limited set of priorities for action. Key problems included: the short timescale and late Departments of Health guidance; difficulty in obtaining commitment from some local 'stakeholders'; linking HlmP aspirations with service and financial planning and securing funding for HlmP priority developments. Action plans to improve health and health care services were well developed in 40.5 per cent of HlmPs. This was less so for social services (8.3 per cent). It was too soon to assess the impact of HlmPs on the public's health. CONCLUSIONS: DsPH or CAMOs and local 'stakeholders' have been on a learning curve for HlmP production during 1999. Lessons learnt will translate into better HlmPs for next year. DsPH urged the Departments of Health to fully support HlmPs through resources and management processes so that HlmPs can realize their potential benefits for local populations.

Administrative Personnel↗
PubMed2001

Beta-adrenergic antagonist exposures in children.

Since limited toxicological data exists for beta-adrenergic antagonist (BA) exposures in children, a survey to describe triage practices by regional poison centers nationwide and to characterize clinical manifestations of unintentional pediatric BA exposures was sent to 49 poison centers. A 7-y retrospective review of acute BA exposures in children aged < 7years from 1 regional poison center was also undertaken. Thirty-three centers (67%) responded: 19/33 (58%) had no established BA triage guideline for young children. The 14/33 remaining centers (42%) most often referred these children to a hospital if any BA was ingested. In the 1-center review, metoprolol (28%) and atenolol (27%) exposures were most common, but = 1 tablet of BA was involved in 83% of the exposures. Symptoms occurred in 8 children; 2/378 had lethargy and 6/378 had bradycardia and/or hypotension. Immediate-release preparations were ingested by 7/8 symptomatic patients (median time to onset of symptoms = 3.0 h, range 45 min to 3.5 h). Of 280 children with definitive follow-up, 272 had no clinical effects, 4 had minor effects, and 4 had moderate effects. Regional poison centers commonly refer children exposed to any amount of BA to the hospital. The majority of BA exposures involved a small amount and significant clinical effects were rare. The range of toxicity for BA in children needs to be established.

Adrenergic beta-Antagonists↗
PubMed2000

Calcium channel blocker ingestions in children.

UNLABELLED: Limited data exists regarding toxicity of calcium channel blockers (CCBs) in children. The purpose of this study was to determine the frequency, the range of toxicity, the appropriate observation time, and to assess effective interventions for CCB ingestions in children. A 6-year retrospective review of CCB ingestions in children younger than 7 years of age reported to one regional poison center was undertaken. Patients with coingestants with recognized cardiovascular or central nervous system (CNS) effects were excluded. Two hundred eighty-three patients met criteria for review. The mean age was 27 months with 52% of all patients being boys. Nifedipine (38%), verapamil (34%), and amlodipine (14%) were most commonly ingested. Seventy-five percent of ingestions reportedly involved < or =1 pill. Symptoms occurred in 16/283 (6%): 4 had vomiting, and 12 had CNS or cardiovascular effects. The mean time to onset of symptoms for regular-release and for sustained-release (SR) CCB preparations were 1.5 hours (range 0.5 to 3 hr) and 4.5 hours (range 1 to 14 hr) respectively. OUTCOME: 74% of patients had no clinical effects, 4% minor effects, 2% moderate effects, and 20% other. No deaths or major effects were reported. TREATMENT: 88% of patients evaluated in an emergency department received gastric decontamination, usually one dose of charcoal. Calcium chloride was given in three verapamil SR cases. Five of six patients had reversal of hypotension with IV fluids and decontamination alone. Most pediatric CCB ingestions involve ingestions of small amounts of drug with no effects. Asymptomatic children in this study group who were known to have ingested <12 mg/kg of verapamil SR or <2.7 mg/kg of nifedipine SR could have been monitored at home. Of the children requiring evaluation and monitoring in a health care facility, an observation period for regular-release and SR-CCBs for 3 and 14 hours respectively would have been appropriate. There were insufficient cases with symptoms to draw conclusions for optimal therapeutic interventions.

Biotransformation↗
PubMed1999

Poison center planning for mass gatherings: the Georgia Poison Center experience with the 1996 Centennial Olympic Games.

BACKGROUND: The host city for the Olympic Games needs to prepare for "the world" to visit. This article is the first published report describing the impact of an event such as the Olympics on poison center services. PLANNING AND ACTIONS: We evaluated our operations and identified potential new demands. Operational aspects reviewed included: staffing; communication with foreign language callers; knowledge of international drug products; telephone access; procedures for disaster response and recovery; poison treatment protocols; and handling of hazardous material releases. We collaborated with local, state, and federal planners to delineate the poison center role and to develop protocols for use in a poisoning, including a hazardous material's release at a densely populated site. We enhanced our capability to respond to unusual incidents by forming new alliances. Fortunately, no such events occurred; these plans were therefore not tested. CONCLUSIONS: The Georgia Poison Center developed and implemented new capabilities for the Centennial Olympic Games. Immediate access to poison center resources would have facilitated the care of poisoned patients at multiple hospitals if this had become necessary. Communities preparing for mass gatherings should capitalize on the common interests of poison centers, hazardous materials specialists, and public safety agencies. Preparations should emphasize the most likely events, while recognizing the possibility of the unexpected. Planning an integrated response allows the talents and resources of participating agencies to be maximally utilized.

Anniversaries and Special Events↗
PubMed1999

The utility of toxicologic analysis in children with suspected ingestions.

OBJECTIVE: To evaluate the usefulness of toxicologic studies on the management of children with suspected ingestions. DESIGN: Prospective, consecutive case series. SETTING: Two tertiary care children's hospital emergency departments. PATIENTS: All children < or =18 years of age presenting with a suspected ingestion. STUDY DESIGN: Pediatric emergency physicians completed a 14-point questionnaire on each identified patient that included demographics, signs, and symptoms, and if applicable, the extent of drug analysis performed. Pre-test and post-test utility values were determined by the ordering physician using an 11-point scale (0 = least valuable, 10 = most valuable). Physicians also assessed how positive or negative drug analyses affected patient management. RESULTS: Two hundred twenty patients met study criteria. Median age was 5 years, with males making up 53% of patients. Drug analysis was ordered in 72% (158/220) of cases, with 59% of these tests obtained for a history of ingestion and 27% obtained for altered mental status (AMS). The most common suspected ingestions were acetaminophen and cold preparations. Seventy-eight of 158 (49%) patients had positive toxicology tests, with 17 unsuspected findings. Patient management was affected in 53/158 (34%; 95% CI, 27-41%) cases. Unsuspected findings affecting management were found in only 4/158 (3%; 95% CI, 1-6%) cases. Significant differences in pre-test and post-test utility values occurred for serum assays (mean difference +0.4, P = 0.008), patients presenting with AMS (mean difference -0.8, P = 0.005), and patients having a negative drug test (mean difference -0.5, P = 0.003). Although negative drug analysis gave the physician reassurance in 39/80 (49%; 95% CI, 38-60%) cases, patient management was altered in only 8/80 (10%; 95% CI, 5-18%) cases. CONCLUSIONS: Seventy-two percent of children presenting with suspected drug ingestions had toxicologic analysis performed as part of their evaluation. Analysis was most valuable to physicians when evaluation of overdoses required serum drug levels. Qualitative urine drug screens provided minimal useful information. Unexpected findings on urine drug screening leading to changes in management were uncommon.

Adolescent↗
PubMed1998

Treatment adherence among low-income children with asthma.

OBJECTIVE: To investigate the adherence behaviors (MDI use, MDI/spacer technique, appointment attendance, smoking in the home) of low-income, urban, primarily African American children with asthma. METHOD: Participants were 55 children ages 6 to 17 with moderate to severe asthma. Adherence to MDI anti-inflammatory agents was estimated primarily from canister weight at the follow-up appointment. RESULTS: The mean use of MDI medication was 44% of prescribed use, with 27% of subjects demonstrating MDI/spacer technique likely to prevent drug delivery. Almost half reported that household members smoked cigarettes, and 21% missed scheduled follow-up appointments. CONCLUSIONS: These findings have implications for how clinicians should assess and improve adherence.

Adolescent↗
PubMed1996

Development of a scale to measure children's metered-dose inhaler and spacer technique.

BACKGROUND: A measure of metered dose inhaler (MDI) and spacer technique would help health care providers to estimate the degree to which technique may confound clinical efficacy of inhaled medications. OBJECTIVE: Our purpose was to extend earlier efforts to develop a rating scale to assess the accuracy of children's technique in using an MDI with three of the newer spacer devices. METHODS: Subjects were children, 7 to 17 years old, with moderate to severe asthma attending a follow-up appointment in an outpatient specialty clinic for asthma. Nurse practitioners and/or physicians completed a rating scale (MDI Check-list) for 50 children using an Optihaler spacer, 29 using Azmacort, and 21 using InspirEase. RESULTS: Depending on the spacer used, 14% to 26% of the children failed to demonstrate the critical skills for delivering medicine to the conducting airways, with the InspirEase group showing the best results. Items vary in difficulty (percent correct). The scale has excellent internal consistency reliability for Optihaler. CONCLUSIONS: The scale can be used (1) by health care providers to instruct patients or colleagues, (2) by parents to monitor and correct their children's MDI/spacer technique, and (3) by researchers to estimate drug delivery in studies of clinical outcome or adherence.

Adolescent↗
PubMed1994

Venomous snake bite: current concepts of treatment.

The optimal treatment of venomous snake-bites remains controversial. Because of the variables involved in treatment, an ideal, prospective clinical trial likely will never be done. The purpose of this article is to review the available treatment methods and outline the treatment methods preferred in our institution for crotalidae envenomation.

Animals↗
PubMed1993

Learning, school performance, and children with asthma: how much at risk?

Children with asthma may be at risk for decreased school functioning due to acute exacerbations, increased absenteeism, iatrogenic effects of their asthma medication, and the stress associated with a chronic illness. The purpose of this article is to critically review extant research pertaining to the school functioning of children with asthma, including studies of school attendance, school performance, the effects of asthma medications on learning and behavior, and the role of psychological variables in the development of functional impairments. There is not sufficient evidence to suggest that children with asthma are at significantly higher risk for poor school performance than children without asthma. Factors that may contribute to poor school performance among children with asthma include iatrogenic effects of oral steroids, poor medical management of the disease, and psychological problems. Recommendations for improving the school functioning of children with asthma are discussed.

Absenteeism↗
PubMed1992

Orthostatic hypotension in ciguatera fish poisoning.

PURPOSE: The purpose of this study was to investigate the pathophysiology of persistent orthostatic hypotension in a patient with ciguatera fish poisoning. METHODS: A patient who became ill and who developed prolonged and symptomatic orthostatic hypotension with ciguatera fish poisoning after eating barracuda is described. Studies of autonomic function included measurements of plasma catecholamine levels in the supine and standing positions, and pressor responses to infusions of norepinephrine, atropine, and propranolol. RESULTS: Volume depletion was excluded as a cause for hypotension. Our patient showed low plasma catecholamine levels and marked pressor hypersensitivity to norepinephrine infusion. Hypotension and bradycardia were reversed by atropine infusion. The heart rate freed from autonomic influences, ie, after atropine plus propranolol infusion, was normal. CONCLUSIONS: In ciguatera fish poisoning, orthostatic hypotension appears to be a result of both parasympathetic excess and sympathetic failure.

Animals↗
PubMed1991

Cyanide toxicity from acetonitrile-containing false nail remover.

A patient presented without symptoms 30 minutes after ingesting acetonitrile, also known as methylacyanide. He had prompt gastric lavage and activated charcoal administration. Hours later, the onset of clinical toxicity was heralded by mental status abnormalities and vomiting prior to a generalized seizure. Following administration of sodium thiosulfate, the patient made an uneventful recovery. A blood cyanide level drawn shortly after presentation, but reported after the patient had been discharged, documented significant exposure. During hospitalization, cyanide toxicity was inferred from the history of ingestion of acetonitrile, plus a significant absence of venous blood hemoglobin desaturation. Because even small amounts can be harmful and toxicity is delayed, all acetonitrile ingestions should be presumed dangerous. Patients should be observed and repeatedly evaluated for at least 24 hours. In the absence of cyanide level determinations, lethargy, vomiting, seizures, and the lack of normal venous blood hemoglobin desaturation are clues to cyanide toxicity.

Acetonitriles↗