Biomedical subjects

T Dorman

Publications and source records attributed to T Dorman.

58 records · Page 4Linked to original sources

PubMedDate not supplied

Prevalence and predictors of recurrent IgA nephropathy following renal transplantation.

BACKGROUND: IgA nephropathy is a common glomerulonephritis for which there is no effective cure. It may recur after renal transplantation and cause graft loss. AIMS: To determine the prevalence and predict recurrence of IgA disease in transplant recipients. METHODS: A retrospective analysis was performed of all renal allografts in patients with IgA disease attending a National Renal Unit between 1984 and 1995. An immunopathological grading system was devised to assess the severity of disease at initial presentation and each patient was assigned a simple severity index. RESULTS: A total of 42 patients with IgA disease received 44 renal allografts. Biopsies were performed in 21 of the 44 transplants. Recurrence was diagnosed in five grafts (24%) and recurred only in the 'moderate' and 'severe' IgA groups. Recurrence was associated with younger age, glomerular crescents on the original renal biopsy, better donor/recipient HLA matching and greater number of rejections. CONCLUSION: The prevalence of recurrent IgA disease following transplantation in an Irish population is less than that reported at other centres (24% versus 60%). The severity of the original disease and transplant factors may predict recurrence post-transplantation.

Adult↗

PubMedDate not supplied

The difficult airway: mechanisms for effective dissemination of critical information.

The perioperative management and dissemination of critical information regarding a patient with an unexpected difficult intubation, including successful application of a difficult airway algorithm (Figure 1), are described. Documentation and dissemination of critical information include entry of patient data into an in-hospital computerized Difficult Airway/Intubation Registry, simultaneous application of a highly visible Difficult Airway/Intubation Patient Wrist Band (coded for access to computer registry), summary reports distributed to health care providers, and enrollment of the patient in the Medic Alert Foundation International's newly established category difficult airway/intubation for 24-hour access. We postulate that the widespread use of the procedures described in this report may reduce the contribution of unexpected difficult airway/intubation to anesthetic morbidity and mortality.

Algorithms↗

PubMedDate not supplied

Use of and satisfaction with a browser-based nurse teaching tool in a surgical intensive care unit.

Our goal was to determine if a computerized teaching tool is an effective teaching method for nurses in a high-stress fast-paced intensive care unit. We also measured the level of satisfaction with this method of instruction. Thirty-six surgical intensive care nurses used a Web-based Microsoft PowerPoint presentation located on the intranet at nursing stations located on the surgical intensive care unit (SICU). The presentation was designed to provide instruction regarding the methodology and use of APACHE III prior to its implementation. Paired t-tests were performed to compare the results of a pretest and posttest. The questions were divided into two types: methodology and use. After the nurses completed their training sessions, they were asked to complete a questionnaire. The questionnaire questions were rated one a 1 to 5 scale. The average scores were higher on the posttest compared to the pretest (63.2% vs. 69.1%, p = 0.03). The methodology scores were higher on the posttest (74.3% vs. 88.2%, p = 0.001), while the use scores remained the same at 78.1% vs. 75.0%. Our Web-based teaching tool is an effective way to train nurses to understand the APACHE III medical system. The tool was effective at conveying the APACHE III medical systems methodology but was not effective in explaining the usefulness of the system. Most important, the nurses thought the browser-based teaching tool was easily accessible and an effective way to communicate new material to the medical staff.

APACHE↗

PubMedDate not supplied

Intensive care unit nurse staffing and the risk for complications after abdominal aortic surgery.

CONTEXT: We previously found that length of stay in the intensive care unit (ICU) after abdominal aortic surgery increased when fewer ICU nurses were available per patient. We hypothesized that having fewer nurses increases the risk for medical complications. OBJECTIVE: To evaluate the association between nurse-to-patient ratio in the ICU and risk for medical and surgical complications after abdominal aortic surgery. DESIGN: Observational study. SETTING: All nonfederal acute care hospitals in Maryland. DATA SOURCES: Information about patients came from hospital discharge data on all patients in Maryland with a principal procedure code for abdominal aortic surgery from 1994 through 1996 (n = 2606). The organizational characteristics of ICUs were obtained by surveying ICU medical and nursing directors in 1996 at the 46 Maryland hospitals that performed abdominal aortic surgery. Thirty-nine of the ICU directors (85%) completed the survey. EXPOSURE: Surgery in hospitals with fewer ICU nurses (in which each nurse cared for three or four patients) compared with hospitals with more ICU nurses (in which each nurse cared for one or two patients). OUTCOME: Proportion of patients who developed postoperative complications. RESULTS: Seven hospitals with 478 patients had fewer ICU nurses, and 31 hospitals with 2128 patients had more ICU nurses. Patients in hospitals with fewer nurses were more likely than patients in hospitals with more nurses to have complications: 47% vs. 34% had any complication, 43% vs. 28% had any medical complication, 24% vs. 9% had pulmonary insufficiency after a procedure, and 21% vs. 13% were reintubated (P < 0.001 for all comparisons). After adjustment for patient, hospital, and surgeon characteristics, having fewer versus more ICU nurses was associated with an increased risk for any complication (relative risk, 1.7 [95% CI, 1.3 to 2.4]), any medical complication (relative risk, 2.1 [CI, 1.5 to 2.9]), pulmonary insufficiency after procedure (relative risk, 4.5 [CI, 2.9 to 6.9]) and reintubation (relative risk, 1.6 [CI, 1.1 to 2.5]). CONCLUSION: Having fewer ICU nurses per patient is associated with increased risk for respiratory-related complications after abdominal aortic surgery.

Aged↗