Biomedical subjects
Publications and source records attributed to A Allen.
Successful risk management is a proactive process designed to prevent litigation and possible loss of assets. Some examples of standards of care and legal implications for nurses in ambulatory and PACU units are discussed. Suggestions are made regarding specific risk management issues.
Numerous proposals have been made for health care reform during the last decade. Still, the richest health care system in the world offers little or nothing to millions of Americans. The quality of nursing practice is threatened by calls for rationing of health care resources and cost control. The Canadian system for national health care is frequently cited as a model for health care reform in the United States. Physicians for a National Health Program have designed a plan similar to that of Canada. This article presents an overview of the physicians' proposal and suggests its comparison with that of the Pepper Commission.
The scope of services and responsibilities of the nursing staff in the PACU are expanding. The flexibility of the PACU and the diversity of the usual postanesthesia population, along with the availability of monitoring technology and nursing expertise, make the unit vulnerable to expansion of its mission. Even with all of its advantages, the PACU is not the ideal environment for many patients. The implications of extended use of the PACU are discussed in the following article.
Hospitals faced with additional reductions in Medicare and Medicaid reimbursements are discontinuing unprofitable services and programs. Nurses and physicians are finding that the patient's care plan is often dictated by economic considerations rather than what they believe to be beneficial. This article provides an overview of the problems and considerations involved in the rationing of health care resources.
Nurses face many moral, ethical, and legal issues in an environment where biologic life can be maintained long after cognitive function has ceased. Highly publicized cases involving the right to die and assisted suicide have brought attention to the right of self-determination regarding medical treatment. A brief discussion of these issues is offered and some questions posed.
Integrity of central cholinergic neurotransmission is essential for adequate cognitive functioning. Many psychotherapeutic medications have anticholinergic side-effects. In order to determine the impact of circulating anticholinergic activity on cognitive performance, 28 geropsychiatric inpatients underwent cognitive testing at different levels of anticholinergic serum activity. In 10 subjects with a diagnosis of probable Alzheimer's disease, significant deterioration of selected cognitive functions was observed at anticholinergic serum levels that caused no dysfunction in the 18 non-demented subjects. The data suggest that non-demented elderly patients with psychiatric problems tolerate psychotropic pharmacotherapy without significant negative impact on their cognitive competency. By contrast, patients with Alzheimer's disease are at risk of additional impairment. The introduction of anticholinergic serum activity as a monitoring technique for safe psychopharmacotherapy in geriatric patients is discussed.
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1. Mucolytic (mucus solubilizing) activity in human faeces has been characterized with both purified human and pig colonic mucin and shown to be mediated by proteolysis. 2. Mucolytic activity was demonstrated by: (i) a drop in mucin viscosity; (ii) a substantial reduction in mucin size, from polymer to degraded subunit, as assessed by Sepharose CL-2B gel filtration; (iii) formation of new N-terminal peptides. 3. Mucolytic activity was also followed in faecal extracts by its proteolytic activity using standard succinyl albumin substrate. Proteolysis extended over the pH range 4.5-11.0. Proteolysis was inhibited at pH 7.5 by soybean trypsin inhibitor and phenylmethanesulphonyl fluoride, suggesting the presence of serine proteinases. 4. The polyacrylate carbomer (934P) inhibited both mucolysis of pig colonic mucin and proteolysis of succinyl albumin. 5. Interaction between the polyacrylate (carbomer 934P) and purified human and pig colonic mucin was demonstrated by a marked synergistic increase in solution viscosity (360% above control). 6. The results demonstrate the presence of a mucolytic activity in the human colonic lumen that has the potential to degrade the mucus barrier, and that polyacrylates inhibit this mucolysis and interact to strengthen the colonic mucus barrier. Polyacrylates may therefore have therapeutic potential in inflammatory bowel disease where luminal proteolytic activity can be raised.
It has been alleged that the exposure of a transdermal delivery system to leakage of microwave radiation from a domestic microwave oven can result in the user receiving a second-degree burn in the area of the patch. Several transdermal delivery systems were exposed to microwave radiation from an Electro Medical Supplies Microtron 200 microwave diathermy unit. Temperature rises of up to 2.2 degrees C were recorded at a maximum power density of 800 W/m2. These temperature rises were considered insignificant compared to that required to produce a burn. The exposure of transdermal delivery systems to a microwave diathermy field or lower level leakage radiation from a microwave oven is unlikely to cause direct thermal injury to the wearer.
The mucus barrier is a layer of water-insoluble gel adherent to the gastroduodenal epithelium. In man most previous studies have focused on luminal mucus or histological assessment of presecreted, intracellular mucus--neither of which can be directly correlated with the protective capacity of the adherent mucus barrier. We here describe direct observation of adherent mucus thickness in man, and changes in peptic ulceration. Adherent mucus gel on human antral mucosa is a continuous homogeneous layer of variable thickness, in the range 50-450 microns (median 180 microns), comprising 67% polymeric mucin. In gastric ulcer patients, adherent antral mucus is significantly increased in thickness (median 240 microns), but is very heterogeneous and structurally a substantially weaker gel, comprising only 35% polymeric mucin. Adherent antral mucus from duodenal ulcer patients is homogeneous, significantly thinner (median 110 microns), and structurally a weaker gel, comprising 50% polymeric mucin. The adherent mucus layer from patients with gastric carcinoma resembled that from subjects with gastric ulcer in that it was very heterogeneous, of significantly increased thickness (median 240 microns) and structurally a very weak gel (23% polymeric mucin). These results are discussed in the context of gastroduodenal mucosal protection against acid and pepsin in the gastric juice.
The educational achievement of 37 long-term survivors of childhood cancer were matched with the sibling closest in age. Analysis of the sibling pairs revealed no significant difference in educational achievement between the study group and controls. A subset, who were treated with cranial prophylaxis, also showed no difference, but their numbers were small.
This study evaluated the putative impact of circulating anticholinergic equivalents on cognitive functional performance in non-demented geropsychiatric inpatients. Standard rating instruments were administered to measure memory functions, concentration and overall functional competency. Anticholinergic plasma activity was assayed, using a radioreceptor technique with tritiated quinuclidinyl benzilate as the active reagent. None of the cognitive tests employed indicated a statistically significant change in the subjects' quantifiable level of cognitive performance. All changes in anticholinergic activities were related to adjustments in psychotherapeutic medications. The possible role of reversal of pseudodementing features is discussed as well as the potential for monitoring anticholinergic activity when treating elderly individuals with more than one centrally active medication having anticholinergic properties.
Musculoskeletal injuries, including back disorders, rank second among work-related injuries in the United States. Back pain is an expensive problem that is difficult to treat. Studies show that workers with the greatest prevalence of back, shoulder, and knee injuries are employed in the health care industry. The PACU is an area where staff members are especially vulnerable to musculoskeletal injuries. Expenses related to on-the-job injury add significantly to the cost of health care. This article focuses on the problem and offers some suggestions for reducing the incidence of work-related injuries.
Granisetron is a novel specific 5-HT3 receptor antagonist whose effects have been evaluated in an extensive programme of volunteer studies. Single intravenous doses of 2.5-300 micrograms/kg of granisetron over 30 min, and of 40-160 micrograms/kg, administered over 3 min, were very well tolerated. There were no serious adverse events. There were no consistent or clinically important effects on cardiovascular parameters (pulse rate, blood pressure, ECG). Single doses of 40-200 micrograms/kg (30 min infusion) or 160 micrograms/kg (3 min infusion) did not influence subjective state, psychomotor performance or EEG. The only adverse event reported consistently more frequently with granisetron than placebo was constipation; this generally subsided spontaneously after 24-72 h. In volunteers, granisetron was widely distributed and also rapidly eliminated, largely through non-renal mechanisms. Granisetron exhibited essentially linear kinetics over the dose range studied (30-300 micrograms/kg). There was considerable inter-subject variability in terminal phase half-life and total plasma clearance. Biological activity of granisetron, as evidenced by significant inhibition of cutaneous 5-HT-induced, axon-reflex flare, was still apparent 24 h after a single dose of 40 micrograms/kg. Repeated intravenous doses of granisetron (up to 160 micrograms/kg b.d. for 7 days) were also well tolerated. As in the single dose studies, constipation was the only adverse event reported consistently more with active treatment than with placebo, but in no case did this necessitate withdrawal from the study or administration of a laxative.(ABSTRACT TRUNCATED AT 250 WORDS)
Many Americans are without adequate health care as costs continue to rise. Health care insurance is unaffordable or unavailable to over half the working poor, but hospitals can no longer bear the expense of uncompensated care. The United States Bipartisan Commission on Comprehensive Health Care has issued recommendations to Congress entitled "Health Care and Long Term Care for All Americans." The Commission plan proposes a system that would be phased in over several years. This article discusses phases of the system from the first through the fifth year.
The case of the Mo cell line was the first to address the issue of ownership of human tissues removed during the course of surgery. It is also about the disclosure of sufficient information to enable "informed" consent for surgical or diagnostic procedures. Can patients have confidence when informed consent fails and conflict of interest may exist? In dealing with conflicting values, health care professionals must recognize that what may be immoral or unethical is not necessarily illegal.