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Biomedical subjects

R Milton

Publications and source records attributed to R Milton.

10 recordsLinked to original sources
PubMed2003

Effect of extended perioperative antibiotic prophylaxis on intravascular catheter colonization and infection in cardiothoracic surgery patients.

Intravascular catheter-related infections (CRI) account for one third of nosocomial bloodstream infections in England. UK Department of Health guidelines state that antibiotic prophylaxis is not required during placement, or use of, central venous catheters, to prevent CRI. However, some clinicians continue to use antibiotics in an attempt to prevent CRI. We investigated the effect of extended routine perioperative antibiotic prophylaxis in cardiothoracic patients on rates of intravascular catheter (IVC) colonization and infection. Investigations were undertaken in patients undergoing uncomplicated cardiothoracic surgery during July 2001-February 2002. Patients who received three doses of cefuroxime as perioperative prophylaxis were compared with those who received extended cefuroxime prophylaxis until the IVC was removed. Patients were not randomized into groups, but received the different prophylaxis regimens according to the usual practice of the consultant cardiothoracic surgeon. A roll tip method was used to determine IVC colonization. Of 191 patients who fulfilled the inclusion criteria, 12 were excluded because data were incomplete. One hundred and forty-six patients received routine prophylaxis, and 33 prophylaxis until the IVC was removed. Twenty-three out of 146 (16%) IVCs in the 'routine' group and four out of 33 (12%) in the 'extended' group became colonized; no IVC-related bloodstream infections occurred during the survey. The duration of IVC placement and the types of operation performed in the two groups were not significantly different (P > 0.05). In routine cardiothoracic surgery patients, extending routine perioperative antibiotic prophylaxis until all IVCs have been removed does not influence rates of IVC colonization.

Anti-Bacterial Agents↗
PubMed1992

Are you seeing a mass killer?

Whatever the underlying reasons, we have to be prepared for more episodes of this nature, and as medical practitioners do what we can to prevent them. With the wisdom of hindsight it is possible to suggest that the Knight and Vitkovic killings could have been avoided. Knight had a history of violence causing him to leave Duntroon Military College. Despite this, he was not prevented from holding a shooter's licence in his own State, and in particular nothing was done to stop him having a collection of weapons. Vitkovic sought help from a university psychology clinic and from the Church of Scientology. Coroner Hal Hallenstein criticised the Church of Scientology for failing to help Vitkovic after he failed their personality test on 8 October 1987, and also suggested that a general obligation be placed on psychologists to refer to a psychiatrist if they think that is required. Practitioners' concern for their own safety must be considered. It would have been an extraordinarily difficult and possibly risky task to try to deter Julian Knight from persisting in his adoration of aggression and love of weapons, or to talk Frank Vitkovic out of watching violent films and videos and later purchasing a semi-automatic weapon. Nevertheless, the practitioner's responsibility remains, and as a last resort notification to police of the risk posed by the person might have to be considered. Unfortunately the anonymity of a practitioner making such a notification might not be able to be guaranteed, given current freedom of information legislation.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMedDate not supplied

Development of an ex vivo model to investigate the effects of altered haemodynamics on human bypass grafts.

The insertion of vein grafts into the arterial circulation may contribute to vessel wall thickening and accelerated atherosclerosis, a common feature of late vein graft failure. We aimed to develop a model suitable for investigation of the effects of altered haemodynamics on human saphenous vein following its implantation into the arterial circulation. Segments of human saphenous vein obtained from patients undergoing coronary artery bypass surgery were sutured at each end to PTFE and placed into a flow system. Pressure and flow rates to stimulate the arterial and venous systems were achieved. A theoretical model of the flow chamber was created and computational fluid dynamics software (FLOTRAN, Swanson Analysis Systems) was used to determine the flow profile within the model. In summary, a flow model has been developed to investigate the effect of altered haemodynamics on the molecular and pathological changes that occur in vein grafts incorporated into the arterial circulation.

Blood Flow Velocity↗