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William E Hurford

Publications and source records attributed to William E Hurford.

12 recordsLinked to original sources
PubMed2006

A randomized controlled trial of simulation-based teaching versus traditional instruction in medicine: a pilot study among clinical medical students.

OBJECTIVE: To compare simulator-based teaching with traditional instruction among clinical medical students. METHODS: Randomized controlled trial with written pre-post testing. Third-year medical students (n = 38) received either a myocardial infarction (MI) simulation followed by a reactive airways disease (RAD) lecture, or a RAD simulation followed by an MI lecture. RESULTS: Mean pre-post test score improvement was seen across teaching modalities (overall change score [simulation] = 8.8 [95% CI = 2.3-15.3], pretest [62.7]; change score [lecture] = 11.3 [95% CI = 5.7-16.9], pretest [59.7]). However, no significant differences were observed between simulator-based teaching and lecture, in either subject domain. CONCLUSIONS: After a single instructional session for clinical medical students, differences between simulator-based teaching and lecture could not be established by the written test protocols used in this pilot. Future studies should consider the effects of iterative exposure assessed by clinical performance measures across multiple centers.

Clinical Clerkship↗
PubMed2006

Outcome of postoperative critically ill patients with heparin-induced thrombocytopenia: an observational retrospective case-control study.

INTRODUCTION: Heparin-induced thrombocytopenia (HIT) is described as a decrease in platelet count associated with heparin administration and is an immune-mediated adverse drug reaction that can cause both arterial and venous thromboses. It can be a life-threatening complication of heparin exposure. Little data concerning incidence, predisposing factors, or outcome in critically ill surgical patients are available. METHODS: All critically ill, postoperative patients admitted between January 1, 2000, and December 31, 2001, to a surgical intensive care unit (SICU) who tested positive by an enzyme-linked immunosorbent assay for the HIT antibody (HPIA; Diagnostica Stago, Inc., Parsippany, NJ, USA) were identified. Patient risk factors and outcomes were abstracted retrospectively from the medical record and compared with those from control patients matched for age, gender, diagnosis, severity of illness, and date of SICU admission. RESULTS: Two hundred and ten patients out of 2,046 patients (10%) admitted to the SICU had HIT assays performed. Nineteen patients (0.9% of admissions; 9% of tested individuals) had positive tests. HIT-antibody-positive patients, compared with 19 matched controls, had an increased risk of death or major thrombotic complications (37% versus 10%; P < 0.05) and prolonged length of intensive care unit (ICU) stay (20 days versus 10 days; P < 0.05). Exposure to heparin via intravascular flushes alone was sufficient to generate HIT antibodies in 12 of 19 (63%) patients. Five patients received platelet transfusions after the diagnosis of HIT was known; four of these patients died. CONCLUSION: Heparin flushes were the most common cause of HIT in this study. HIT-antibody-positive patients had an increased risk of death or major complications and a prolonged length of ICU stay. Platelet transfusions often were administered despite a positive HIT test result and were associated with a high mortality rate. Treatment algorithms that minimize exposure to heparin and contraindicate platelet transfusions merit further study.

Adult↗
PubMed2004

Cellular phone interference with the operation of mechanical ventilators.

OBJECTIVE: To determine whether a cellular phone would interfere with the operation of mechanical ventilators. DESIGN: Laboratory study. SETTING: University medical center. SUBJECTS: Fourteen mechanical ventilators. INTERVENTIONS: We evaluated change in operation and malfunction of the mechanical ventilators. MEASUREMENTS AND MAIN RESULTS: The cellular phone (Nokia 6120i) was computer controlled, operating at 828.750 MHz analog modulation. It was operated at 16, 40, 100, 250, and 600 mW, 30 cm from the floor and 30, 15, and <3 cm from all sides of each ventilator. Six of the 14 ventilators tested malfunctioned when a cellular phone at maximum power output was placed < or =15 cm from the device. None of these responses were considered immediately life threatening except for the response of the Puritan Bennett 840, which stopped ventilating when the cellular phone at maximum power output was placed < or =30 cm from the ventilator. One ventilator doubled the ventilatory rate and another increased the displayed tidal volume from 350 to 1033 mL. In one of the infant ventilators, displayed tidal volume increased from 21 to 100 mL. In another ventilator, the high respiratory rate alarm sounded but the rate had not changed. CONCLUSIONS: In a controlled laboratory setting, cellular phones placed in close proximity to some commercially available intensive care ventilators can cause malfunctions, including irrecoverable cessation of ventilation. This is most likely to occur if the cellular phone is <30 cm from the device and ringing. Based on our data and the available literature, we believe it is reasonably safe to permit the use of cellular phones in the intensive care unit, as long as they are kept > or =3 feet from all medical devices. The current electromagnetic compatibility standards for mechanical ventilators are inadequate to prevent malfunction. Manufacturers should ensure that their products are not affected by wireless technology even when placed immediately next to the device.

Boston↗
PubMed2004

Critical rebound methemoglobinemia after methylene blue treatment: case report.

A 39-year-old man developed significant methemoglobinemia after receiving benzocaine spray; he was treated appropriately with intravenous methylene blue. The patient's methemoglobin levels decreased, but this was followed by a critical rebound phenomenon to levels frequently considered near fatal. After further treatment with methylene blue, the patient's methemoglobin levels returned to normal. Clinicians need to be aware that a decreasing level of methemoglobin does not necessarily indicate that a crisis has passed and that further monitoring and treatment may be indicated.

Adult↗
PubMed2002

Inhaled nitric oxide.

Inhaled NO offers a novel therapy for the treatment of pulmonary hypertensive diseases and the symptomatic relief of hypoxemia. The use of iNO reduces the necessity for ECMO in newborns and infants with acute hypoxemic respiratory failure. Proper indications, contraindications, dosing criteria, and implications of the toxic actions of NO must be delineated fully. Randomized clinical trials of patients with carefully defined, specific acute disease states that are characterized by pulmonary hypertension or hypoxemia have not been completed.

Administration, Inhalation↗
PubMed2002

NO-body's perfect.

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Administration, Inhalation↗
PubMed2002

Sedation and paralysis during mechanical ventilation.

Treatment of anxiety and delirium, provision of adequate analgesia, and, when necessary, amnesia in critically ill patients is humane and may reduce the incidence of post-traumatic stress disorders. Injudicious use of sedatives and paralytics to produce a passive and motionless patient, however, may prolong weaning and length of stay in the intensive care unit. This report reviews indications and choices for pharmacologic treatment of anxiety, delirium, agitation, and provision of anesthesia in critically ill patients. The choice of pharmacologic agents is made difficult by complex or poorly understood pharmacokinetics, drug actions, and adverse effects in critically ill patients. Advantages, adverse effects, and limitations of drug treatment, including use of neuromuscular blocking drugs and use of sedatives and analgesia during the withdrawal of life-sustaining measures are reviewed.

Analgesia↗