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At least 19 recordsLinked to original sources
PubMed1979

A hospital medication monitoring system.

Hospitals need to process large quantities of scattered information to properly screen medication orders. The data includes complex relationships involving drugs, diseases, and other drugs that determine whether a particular drug is contraindicated for a patient. Hospitals would therefore benefit from a flexible system for storing complex medical data relationships. We have used GPLAN, a CODASYL-like data management system, to construct a functioning model of a hospital pharmacy medication monitoring system. the patients' histories, drug-drug contraindications, disease-drug contraindications, and recommended dosages are stored in the data base in a network structure defined by the Data Description Language. Each drug order is checked for dose, allergies, current diseases, and current medications.

Computers↗
PubMed1991

Knowledge-based approach to the management of serious arrhythmia in the CCU.

An expert system (SETA) for the management of patients in the CCU environment has been developed. SETA suggests therapeutic actions for the treatment of serious arrhythmias that complicate the pathophysiological state of patients recovering from acute and suspected myocardial infarction. The prototype begins by reasoning from the arrhythmia, diagnosed from the ECG signal, and progresses through its inference process by considering ECG changes (i.e. heart rate, QRS width), patient clinical data, patient history and therapeutic drug data, to reach the most appropriate actions for each particular patient. The system was implemented on production rules using M1 as a development tool. SETA uses a multiknowledge base (KB) architecture, one for each particular arrhythmia and relevant complication, and a decision board that controls the firing of the KBs and keeps track of patient status through time. The system takes into consideration aspects that are very important for the human expert, e.g. sequence of arrhythmia appearance, drug contraindications and priority in the case of simultaneous arrhythmia. The development of this system has given insight into the management of critical CCU patients, that should influence the specification and design of intelligent instruments for this clinical environment.

Arrhythmias, Cardiac↗
PubMed1985

Clinical safety of intravenous amrinone--a review.

Clinical trials of intravenous amrinone were performed in 462 patients severely ill with congestive heart failure. All were monitored invasively. Adverse reactions were complicated by underlying disease severity and concomitant drug therapy. No consistent pattern of arrhythmias emerged in relation to intravenous amrinone administration. Thrombocytopenia was noted in 2.4% of patients, but it was asymptomatic with no demonstrable bone marrow depression or antiplatelet antibodies. Gastrointestinal adverse effects, hypotension and fever were rare, each occurring in fewer than 2% of patients. Liver enzyme alterations were seen in 1 patient, but it could not be determined whether these changes were related to intravenous use of the drug. Chest pain and irritation at the site of injection were noted in 1 patient each. Spontaneous anecdotal postapproval reports cited tachycardia, liver enzyme elevation, thrombocytopenia, intravenous site irritation, failure to respond and anaphylactoid response as adverse effects or possible adverse effects; each was mentioned in 3 or fewer reports. Drugs contraindicated for concomitant use with intravenous amrinone are listed, and chemical interactions with glucose solutions and intravenous furosemide are discussed.

Aminopyridines↗
PubMed1990

Use and abuse of drugs in the elderly.

1. Study of 100 patients admitted to the Geriatric Assessment Unit, to evaluate the appropriateness of drug therapy in the elderly. 2. Average patient took 5.15 drugs at admission and 3.67 drugs at discharge. 3. Inaccurate dosages found in 14%, drug-drug interaction in 31%, drug contraindications were evident in 23% and at least one unnecessary drug was prescribed in 39% patients at admission. 4. At discharge, 8% cases had potential drug-drug interaction and 2% received unnecessary drugs.

Aged↗
PubMed1990

Norepinephrine and brain damage: alpha noradrenergic pharmacology alters functional recovery after cortical trauma.

The goal of these experiments was to evaluate the effects of some drugs affecting noradrenergic (NE) synaptic transmission, commonly prescribed following stroke or traumatic brain injury, on functional recovery. Measurement of recovery from a transient hemiplegia produced by a traumatic unilateral focal contusion in sensorimotor cortex (SMCX) of rats was used to assess the effects of chronic haloperidol (HAL) treatment begun early (1 day) or late (18 days to recovered animals) after injury. Additionally, using the same model, the effects of a single administration of drugs with selective action at NE receptors were also evaluated early or late (30 days) after injury. These drugs were: phenoxybenzamine (PBZ), an alpha 1-NE antagonist; prazosin (PRAZ), an alpha 1-NE antagonist; yohimbine (YOH), an alpha 2-NE antagonist; propranolol (PROP), a beta 1- and 2-NE receptor antagonist; methoxymine (METHOX), an alpha 1-NE agonist; and clonidine (CLON), an alpha 2-NE agonist. The data indicate that drugs with antagonistic effects at alpha 1 NE receptors, including HAL and PRAZ but not PROP, administered early after SMCX contusion retard locomotor recovery. Beneficial effects of enhancing NE transmission by METHOX or YOH were not observed. In animals recovered from beam walk (BW) deficits, a single administration of PBZ or PRAZ (alpha 1 NE antagonists) or CLON (alpha 2 NE agonist) transiently reinstated hemiplegic symptoms. The nonspecific beta NE receptor antagonist PROP had no effect in recovered animals. A single dose of HAL had no effect in recovered animals, but a BW deficit transiently developed in some animals following chronic treatment. The data are discussed with reference to drug contraindications noted in clinical studies of recovery from poststroke aphasia and cognition in demented patients with degenerative brain disease.

Animals↗
PubMed1986

Drugs and recurrent ocular herpes.

There are two types of ocular herpes simplex virus (HSV), type 1 and type 2, and infections can be primary or recurrent. This paper reviews characteristics of herpes infections, the prevalence of the disease, virus latency and reactivation, types of ocular involvement, and current concepts for the management of ocular HSV. Various exogenous factors associated with recurrent herpes of the eye are covered with an emphasis placed on corticosteroids, epinephrine, and medroxyprogesterone. Mechanisms of drug action, and reactivation/exacerbation of ocular herpes are discussed. Clinical guidelines for potential drug contraindications are discussed.

Adrenal Cortex Hormones↗
PubMed1980

[Radiofrequency-thermocoagulation in the treatment of trigeminal neuralgia: analysis of 100 cases].

A series of 100 patients suffering from trigeminal neuralgia treated by percutaneous radiofrequency thermocoagulation of the trigeminal ganglion is reported. The authors make some considerations about the basic principles of the thermocoagulation and comment a few important methods of treatment used prior to this new technique. The whole sequency of the surgical procedure is described and its results analysed. The final conclusion is that percutaneous radiofrequency thermocoagulation has become the treatment of choice for trigeminal neuralgia when the clinical treatment is not anymore effective or the side-effects of the drugs contraindicate its use.

Adult↗
PubMed1975

[Glaucoma, tonometry and anaesthesia (author's transl)].

Definition and classification of glaucomas. Indication of drugs contraindicated in glaucomas. Discussion of the problem of tonometry in anaesthesia in congenital glaucoma suspicion with special regard to factors influencing intraocular pressure. Discussion of correlation between intraocular pressure and systemic blood pressure. Report on own experiences with Ketamine and discussion of advantage and disadvantage of the drug for tonometry in anaesthesia in infants. Explanation of the method of impression--and applanation tonometry with regard to Glaucotest, a new borderline--tonometer suitable for the anaesthesiologist.

Anesthesia↗
PubMed1986

[Myasthenia gravis as an anesthesia risk].

Myasthenics must be considered as surgical risk patients. It is imperative to know the exact pathophysiology of the disease pattern with its three types of crisis including their treatment in order to perform safe anaesthesia and to reduce the rate of perioperative complications. In the preoperative phase we must consider a few specific angles besides the routine manipulations: Treatment with cholinesterase inhibitors as practised in myasthenics is continued unchanged or with only slightly reduced dosage up to the day of the operation. If necessary, oral administration may be changed to intramuscular or intravenous application. Premedication is carried out as far as possible without any drugs contraindicated in myasthenics. The patient may get regional or full anaesthesia, the latter always via intubation. We prefer inhalation anaesthetics because they are easily monitored. Neuroleptanalgesia, however, is also possible. One must accept the somewhat higher risk of postoperative respiratory insufficiency since in most cases subsequent artificial respiration must be performed anyway. Relaxation is effected, if at all necessary, via a non-depolarising muscle relaxant in low dosage (one-half to one-tenth of normal dosage). Measurement and monitoring of neuromuscular transmission via the nerve stimulator is mandatory. Succinylcholine is used only in case of vital indication (half of the normal dose). After surgery the patient is transferred to the intensive care ward in intubated position, extubation being performed only after spontaneous breathing has been safely assured. In postoperative analgetic treatment the opiate antagonist pentazocine (Fortral) showed the best results as far as our experience goes. With careful monitoring, however, it is also possible to employ other highly effective analgesics.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1986

Dynamics of infant feeding: mothers, professionals, and the institutional context in a large urban hospital.

A multidimensional approach was taken to understand the constraints to breast-feeding in a large municipal hospital. Data were collected through direct observation, chart review, and questionnaires to patients and staff. Breast-feeding had not yet begun within 24 hours postpartum in 37% of women who wanted to breast-feed. Chart review revealed that at hospital discharge no woman was breast-feeding exclusively: only 16% of infants had ever been breast-fed and all of these also had been formula fed. The most common reason for the use of supplementary formula and early weaning was the mother's perception or anticipation of insufficient milk. The existing procedures communicated the message to patients that the health care providers expected women to bottle-feed. Some practices that prevented successful breast-feeding were prolonged and/or unnecessary separation of mother and infant, routine provision of infant formula, confusion about drug contraindications for breast-feeding, and inconsistent identification of breast-feeding infants. Staff knowledge about breast-feeding management was inadequate, and staff underestimated mothers' interest in breast-feeding. Recommendations to facilitate breast-feeding include a revision of routines and procedures as well as provision of staff education and expansion of patient education.

Adolescent↗
PubMed1983

[Cranio-facial and dental manifestations of erythrocyte abnormalities].

Various types of erythrocyte lesions are observed: hemoglobin anomalies, enzyme disorders, membrane anomalies. This leads to a reduction in the duration of life of the erythrocytes or to abnormal erythropoiesis with, in both cases, reactive development of hematopoietic tissue. This extension of the medullary field in bones results in alterations that are initially visible on radiography, and then, in the severe forms, in the development of mainly craniofacial and dental dysmorphia with, in some cases, additional secondary enamel and dentine anomalies of the hemolytic origin. These anomalies were present to varying degrees in a series of patients in whom cranial radiographies were performed. In two cases there was a fortuitous association of dental anomalies of the melanodontia and opalescent dentine types. These patients may raise particular problems during dental care and treatment: risk of infection, respect of drug contraindications, latent cardiac insufficiency.

Adult↗
PubMed1977

Joint Committee on Aviation Pathology: VIII. Medical investigator preparedness for aircraft accident investigation.

The statutory authority and responsibility of the National Transportation Safety Board in the investigation and determination of the probable cause of aviation accidents is described. The Independent Safety Board Act of 1974 acknowledges the importance of obtaining data regarding trauma sustained in an accident by survivors, as well as those persons injured fatally. Information regarding occupant injuries, coupled with extensive examination of the aircraft wreckage, is necessary in order to identify hazards which inflicted the injuries. The human factors investigator is responsible for reporting the facts, conditions, and circumstances relating to first, the accident causation and, second, the injury causation. These two areas, of necessity, rely quite heavily upon the postmortem examination and laboratory analyses of the cras victims. The Safety Board's investigation must determine if a crewmember suffered from a preexisting disease, whether the crew had ingested drugs contraindicated with their flying duties, as well as a description of all injuries and all toxicological and histological findings for crew and passengers. During Safety Board investigations conducted in densely populated cites, over oceans, and in remote areas, both in the United States and overseas, many situations have developed which have caused musch investigative effort due to less than complete postmortem examinations. These situations, in most instances, could have been averted by advance planning by local authorities.

Accidents, Aviation↗