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Biomedical subjects

S Bolsin

Publications and source records attributed to S Bolsin.

At least 19 recordsLinked to original sources

Successful management of patients with a drug-eluting coronary stent presenting for elective, non-cardiac surgery.

This paper describes the management of three patients for elective surgery with drug-eluting stents in the coronary circulation. The risks posed at the time of surgery by such patients include acute coronary syndromes, as a result of stent thrombosis, after cessation of anti-platelet therapy and excessive bleeding from continued anti-platelet therapy. We describe a regime for the management of such patients that successfully avoided these risks in three patients with paclitaxel drug-eluting stents requiring elective non-cardiac surgery.

Aged↗

Practical virtue ethics: healthcare whistleblowing and portable digital technology.

Medical school curricula and postgraduate education programmes expend considerable resources teaching medical ethics. Simultaneously, whistleblowers' agitation continues, at great personal cost, to prompt major intrainstitutional and public inquiries that reveal problems with the application of medical ethics at particular clinical "coalfaces". Virtue ethics, emphasising techniques promoting an agent's character and instructing their conscience, has become a significant mode of discourse in modern medical ethics. Healthcare whistleblowers, whose complaints are reasonable, made in good faith, in the public interest, and not vexatious, we argue, are practising those obligations of professional conscience foundational to virtue based medical ethics. Yet, little extant virtue ethics scholarship seriously considers the theoretical foundations of healthcare whistleblowing. The authors examine whether healthcare whistleblowing should be considered central to any medical ethics emphasising professional virtues and conscience. They consider possible causes for the paucity of professional or academic interest in this area and examine the counterinfluence of a continuing historical tradition of guild mentality professionalism that routinely places relationships with colleagues ahead of patient safety.Finally, it is proposed that a virtue based ethos of medical professionalism, exhibiting transparency and sincerity with regard to achieving uniform quality and safety of health care, may be facilitated by introducing a technological imperative using portable computing devices. Their use by trainees, focused on ethical competence, provides the practical face of virtue ethics in medical education and practice. Indeed, it assists in transforming the professional conscience of whistleblowing into a practical, virtue based culture of self reporting and personal development.

Attitude of Health Personnel↗

Supporting whistleblowers in academic medicine: training and respecting the courage of professional conscience.

Conflicts between the ethical values of an organisation and the ethical values of the employees of that organisation can often lead to conflict. When the ethical values of the employee are considerably higher than those of the organisation the potential for catastrophic results is enormous. In recent years several high profile cases have exposed organisations with ethical weaknesses. Academic medical institutions have exhibited such weaknesses and when exposed their employees have almost invariably been vindicated by objective inquiry. The mechanisms that work to produce such low ethical standards in what should be exemplary organisations are well documented and have been highlighted recently. The contribution of elements of medical training in eroding ethical standards of medical students have also been emphasised recently and strategies proposed to reduce or reverse this process. The ability to rapidly change the ethical and professional culture of graduate medical trainees may help to deal with some of the perceived problems of declining ethical standards in academic medicine.

Academic Medical Centers↗

The use of the Cusum technique in the assessment of trainee competence in new procedures.

Continuous quality assurance (QA) in health care has necessitated the adoption of statistical methods developed as industrial process monitoring techniques. One such statistical technique is the cumulative summation (Cusum) methodology, which can monitor continuously a production process and detect subtle deviations from a preset defined level of achievement. The method is practical, simple to apply, easy to introduce and has proved popular with trainees in some specialities. This article introduces the concepts of a sequential analysis, deals with the practical steps of setting up a data collection and monitoring performance for procedures in health care.

Clinical Competence↗

Central nervous system toxicity attributable to epidural ropivacaine hydrochloride.

Ropivacaine, a new local anaesthetic agent, has been demonstrated to have less potential than bupivacaine for central nervous system toxicity on the basis of human and animal studies. We report a case of a convulsion secondary to presumed inadvertent intravascular injection of 20 mg of ropivacaine in a 44 kg patient during an epidural for chronic pain. There were minimal signs of cardiovascular toxicity.

Adolescent↗

Effect of metoclopramide on renal vascular resistance index and renal function in patients receiving a low-dose infusion of dopamine.

Metoclopramide is a dopamine receptor antagonist and, in large doses, has been shown to reverse the increase in renal blood flow, the diuresis and the natriuresis produced by a low-dose infusion of dopamine. We gave a single i.v. dose of metoclopramide 10 mg to 21 patients on an intensive care unit who were haemodynamically stable and receiving dopamine 3 micrograms kg-1 min-1. Renal vascular resistance index, measured by duplex Doppler ultrasonography, did not change after metoclopramide. Renal function, measured by creatinine and osmolar clearance, natriuresis, kaliuresis and excretion fractions of sodium and potassium did not change after metoclopramide. We conclude that normal doses of metoclopramide (< 0.2 mg kg-1) do not antagonize the renal effects of a low-dose infusion of dopamine in critically ill patients.

Adult↗

Metoclopramide and renal vascular resistance.

We have studied the effect of i.v. metoclopramide on renal vascular resistance in nine healthy volunteers. Peak systolic and end-diastolic frequencies were measured using duplex Doppler ultrasound of a renal interlobar artery, before and after the administration of i.v. metoclopramide 10 mg, and the resistance index derived. There was no significant change in mean arterial pressure or resistance index following metoclopramide.

Adult↗