Biomedical subjects
Publications and source records attributed to S Metcalf.
An algorithm for the emergency treatment of anaphylaxis is presented. The need for early hands-on involvement of senior personnel is stressed. Continuous assessment, monitoring of response to treatment, and a low threshold for hospital admission for observation and further treatment if necessary are required.
Residents living near a polyurethane foam manufacturing facility expressed concern to health officials over chemical emissions from the plant. Environmental monitoring of ambient air near the plant indicated the presence of toluene diisocyanate (TDI), which was used in foam production. Health officials collected blood samples from 113 residents and analyzed the blood sera for antibodies to TDI and related diisocyanates. Ten of the 113 residents (9%) had elevated levels of IgG or IgE antibodies specific for one or more diisocyanates. Exposure histories were taken from antibody-positive individuals to identify possible occupational exposure to TDI or the use of diisocyanate-containing consumer products. Exposure to TDI in ambient air may be responsible for the positive antibody responses detected in some residents of the community.
We implemented a computerized decision support tool to standardize the administration of supplemental oxygen (O2) therapy in the acute care (non-ICU) hospital setting. Caregiver acceptance of the computerizeds oxygen therapy protocol (COTP) instructions was measured to determine the clinical performance of the computerized decision support tool. 49.6% of instructions generated were followed by the clinical caregiver, and 16.8% of instructions generated were explicitly acknowledged by the user through the COTP computer interface. Despite this low caregiver response rate, significant favorable changes in the administration of oxygen were observed. This paper is focused on the issues of general importance the caregiver response rate raises for the implementation and clinical use of computerized decision support tools, including: (1) limitations of the user interface and (2) inherent difficulty in changing long-standing practice patterns.
The inadvertent administration of a concentrated vancomycin solution to a 47 day-old premature male twin resulted in extremely high vancomycin levels and altered renal function. A 1.5 volume exchange transfusion did not change the measured vancomycin level. Multiple doses of oral activated charcoal, 1 g/kg, were administered beginning 5 h after the exchange transfusion. A calculated half-life of vancomycin before the exchange transfusion was 35 h. The half-life after the exchange transfusion and during charcoal administration was calculated to be 12 h. The only apparent adverse effect of this vancomycin overdose was reversible nephrotoxicity. The infant's hearing, tested by brainstem auditory responses, was normal. The higher volume of distribution of vancomycin in infants may preclude removing significant amounts of this drug by exchange transfusion. Gastrointestinal dialysis with activated charcoal warrants consideration in cases of vancomycin overdose in neonates.
Adolescence is a normal developmental phase that can be experienced with confidence and optimism if it is anticipated as a time of challenge and of growth. The characteristics of adolescent thinking and affect are considered and the challenges that the fit adolescent must overcome are reviewed. Factors that protect against things going wrong are discussed.
The time spent dealing with unknown patient factors can have a dramatic effect on the radiographer's productivity. This article identifies a mechanism for enhancing the department's level of information about those permanent patient factors that can affect the outcome of radiologic examinations.
The syndrome of male childhood transsexualism is described and the case history of a six year old boy is reported. Treatment strategies are explained in detail and the results of ongoing therapy over an 18 month period are presented.
Povidone-iodine solution (Betadine) at concentrations of 0.167% (v/v) reduced the end-point titers of Strain E.M. herpesvirus, type 2, by more than 99.99%. Even at concentrations of 0.0167% (v/v), povidone-iodine solution reduced the titers by 92%. The iodine solution, per se, had no effect on cultured human fibroblasts in concentrations of 1.67% (v/v).
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This article looks at the implementation of shared governance at directorate level and its role in improving vascular access catheter care.