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Biomedical subjects

A Mulhall

Publications and source records attributed to A Mulhall.

At least 19 recordsLinked to original sources
PubMed1992

Improving nursing practice: the provision of equipment.

The quality of nursing care depends not only on the knowledge and skill of practitioners, but also on the equipment provided for their use. The availability and storage of urinary catheters was recorded in two "point prevalence" surveys in one District Health Authority. The numbers of catheters available in different locations were not related to the prevalence or "predicted incidence" of catheterized patients. The second survey documented evidence of improvements in practice, in particular a reduction in excessive and/or out-of-date stocks; a reduction in damaged stock; an increased availability of catheters with small balloons; and a greater awareness of those considerations important to a judicious choice of catheter for each individual patient. Equipment audits improve practice by raising awareness of clinical issues; by providing objective evidence of unnecessary expenditure; and by monitoring indirectly certain aspects of care such as the provision of standards and guidelines.

Catheters, Indwelling↗
PubMed1990

Catheterisation.

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Female↗
PubMed1990

The contribution of the basic sciences to nursing practice research.

The scientific knowledge on which nurses may base their clinical practice is often lacking. Not withstanding this, scientific knowledge in isolation is sterile unless it is invoked to address nursing hypotheses. This paper explores how such nursing questions can be both identified and answered within a scientific framework. Using the example of infection control, the complexity of the problem is examined and the contribution that various research approaches, including in vitro investigations, can offer is evaluated. Nursing practice research has a vital role to play in determining the effective prevention of nosocomial infection. The necessity for a collaborative and flexible approach to such research and the value of multidisciplinary teams of nurses and other scientists is emphasized.

Clinical Nursing Research↗
PubMed1988

Chloramphenicol in paediatrics: current prescribing practice and the need to monitor.

Two hundred and fifty-five neonates, infants and children, from 45 hospitals, who were receiving chloramphenicol therapy for serious infections were the subject of this study. Samples of serum and cerebrospinal fluid (CSF) were assayed for chloramphenicol and the patients' treatment regimens analysed. Less than 50% of neonates and 25% of infants received the "recommended" dose of chloramphenicol. In older children the recommended dose was used. Only 34% babies under 1 year of age and 50% older children had serum concentrations within the therapeutic range (15-25 mg/l). Thirty-one percent of neonates and infants had potentially toxic serum concentrations. Forty-three percent of neonates receiving chloramphenicol every 6 h had subtherapeutic peak serum levels compared to 20% of those receiving the antibiotic every 12 h. Concomitant administration of phenobarbitone or phenytoin had no effect on mean serum chloramphenicol levels. Serum concentrations of chloramphenicol were significantly higher in patients also receiving penicillin. CSF levels in 77 samples (39 patients) ranged from 1-60 mg/l. CSF from 44% patients contained less than 4 mg/l. Twelve neonates and infants (5.5%) suffered toxic side effects, four died. A further eight babies received an accidental 2- to 10-fold overdose and in three others an overdose was assumed following assay. No overdoses or toxic effects were reported in children over 1 year of age. Eight patients with impaired renal function had elevated serum levels and three showed toxic effects. In 22% patients dosage regimens were altered following assay.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Indwelling catheterization and related nursing practice.

A survey of patients with an indwelling urethral catheter was conducted over a 14-day period in five randomly selected district general hospitals in England. The demographic characteristics of the patients and the types of catheter and urinary drainage bags used were recorded. Observational techniques were used to describe nursing care during meatal cleansing and bag emptying Over the 14-day study period 294 patients were catheterized giving an overall daily incidence of catherization of 11.2 per 1000 of the average daily population. Nurses inserted over 50% of catheters and subsequently maintained all closed urinary drainage systems. The closed system was broken for 42% of patients and only 48% of drainage bags were always observed in the correct position. Techniques aimed at preventing infection were observed more frequently when meatal cleansing was performed separately from daily hygiene. The frequency of hand washing, both before and after meatal cleansing and bag emptying, was low. It is concluded that the procedures and practices involved in the care of the urinary drainage system require re-evaluation and re-emphasis.

Adult↗
PubMed1985

Pharmacokinetics and safety of ceftriaxone in the neonate.

The pharmacokinetics and safety of ceftriaxone were examined in 39 neonates who required antibiotics for clinically suspected sepsis. The drug was administered as a once daily dose of 50 mg/kg by the intravenous (IV) or intramuscular (IM) route. Ceftriaxone was assayed in 49 series of blood samples, 3 samples of cerebrospinal fluid (CSF) and 15 samples of urine by a microbiological technique. Blood was collected before, during and after treatment for biochemical analysis. Routine haematological investigations were also monitored. There was no significant difference between the maximum plasma concentrations following IV (153 +/- 39 mg/l) or IM (141 +/- 19 mg/l) administration (first dose). The mean elimination half-life, total body clearance, and volume of distribution following the first dose were 15.4 +/- 5.4 h, 0.28 +/- 0.12 ml/min per kg and 325 +/- 59 ml/kg respectively. Clearance increased with increasing postnatal age and body temperature (P less than 0.0002) and decreasing plasma creatinine concentration (P less than 0.005). Increasing plasma protein concentration was associated with a decrease in volume of distribution (P less than 0.001). There were no drug-associated changes in any of the biochemical or haematological parameters examined. Ceftriaxone is a safe and well tolerated antibiotic for use in the treatment of newborn sepsis and possibly meningitis. A once daily administration of 50 mg/kg by the IV and IM routes provides satisfactory plasma concentrations throughout the dosage interval whilst avoiding accumulation.

Bacterial Infections↗
PubMed1985

Ceftriaxone--clinical experience in the treatment of neonates.

A group of 104 neonates with clinical signs of infection sufficient to justify treatment with penicillin plus gentamicin received instead monotherapy with ceftriaxone (50 mg/kg once daily). Bacteriological cultures from 20 babies before treatment yielded significant isolates (9 had bacteraemia). Following treatment, infecting bacteria were eradicated from 15/20 babies. Ten of the 104 babies died; all were examined post mortem. Only one death was attributed to bacterial infection. The remaining babies responded well to treatment. No adverse alteration in biochemical or haematological values was associated with ceftriaxone therapy. The incidence of diarrhoea, blood in the stools, necrotising enterocolitis or anti-coagulation problems was the same as in the babies not receiving ceftriaxone. Pharmacokinetic values were determined on 40 babies. Elimination half life (T1/2 beta) and minimum serum concentration (Cmin.) decreased and clearance increased with increasing postnatal age. Postnatal age was the single most significant factor affecting pharmacokinetics. Ceftriaxone is a safe and effective alternative to conventional therapy for infected neonates. Prolonged therapy is associated with superficial colonisation with inherently resistant bacteria.

Bacterial Infections↗
PubMed1985

The pharmacokinetics and safety of ceftazidime in the neonate.

The pharmacokinetics and safety of ceftazidime (25 mg/kg twice daily intravenously or intramuscularly) were determined in 41 young, premature neonates who were clinically infected and would otherwise have received gentamicin plus penicillin. Ceftazidime was assayed in 46 series of blood samples by HPLC. Blood was collected before, during and after treatment for analysis of biochemical and haematological factors. Faecal specimens were examined for the presence of Clostridium difficile and its toxin. Although the peak concentration following iv administration was higher (77 +/- 8 mg/l) than that following im injection (56 +/- 7 mg/l), satisfactory serum levels were maintained throughout the dosage interval using either route. Mean pharmacokinetic profiles following both routes are reported. Postnatal age was the most important factor governing total body clearance (P = 0.0001) and serum half life (P = 0.001). The biochemical and haematological status of the majority of babies remained unaffected by therapy and there was no increase in the incidence of Cl. difficile isolation from stools. Ceftazidime is a safe and well tolerated drug for use in the treatment of neonates. 25 mg/kg administered twice daily results in adequate serum levels in babies during the first two weeks of life.

Age Factors↗
PubMed1985

Antibiotic treatment of neonates--does route of administration matter?

The pharmacokinetics of gentamicin (19 babies), benzylpenicillin (7 babies), mecillinam (15 babies), cefuroxime (15 babies), ceftriaxone (37 babies), and latamoxef (27 babies) were compared following intravenous or intramuscular administration in the neonate. The effect of oral or intravenous administration of chloramphenicol was examined in 47 babies. The pharmacokinetics following either intravenous or intramuscular administration were essentially the same. Cmax was equivalent after both routes except for gentamicin (Cmax higher following intravenous administration) and latamoxef (Cmax lower following intravenous administration). Although Tmax ranged between 0.4 and 1.5 h therapeutically effective serum concentrations were attained within 15 min of intramuscular administration of all antibiotics. Clinical rather than pharmacokinetic considerations should therefore dictate which route should be used. Oral administration of chloramphenicol resulted in significantly lower steady-state serum concentrations and therefore this route should be avoided in the young premature neonate.

Administration, Oral↗
PubMed1985

Ceftazidime in the treatment of neonatal infection.

The efficacy of ceftazidime in the treatment of neonatal sepsis was studied in 42 low birthweight premature babies. Forty-nine courses of ceftazidime (25 mg/kg bd, iv or im were administered. In 19 babies, treatment was stopped after 48 h, the remainder were treated for 5 days or more. Six neonates had bacteriological evidence of infection, one other was pyrexial and 29 had radiological evidence compatible with respiratory tract infection. Eight of the study population died. Only one death was attributed to infection which arose 3 days after completion of a 5-day course of ceftazidime. Two babies developed clinical signs of necrotizing enterocolitis (NEC). Clostridium difficile (7) and Cl. perfringens (2) were isolated from 34 post-treatment faecal samples but not from the two babies with NEC. No faecal sample contained Cl. difficile toxin. Post-treatment cultures from 12 neonates yielded ceftazidime-resistant micro-organisms. Ceftazidime therapy was not associated with significant alteration in serum alanine aminotransferase, urea, creatinine, protein or albumin. Four babies had an eosinophilia, three transient and one following two intrauterine transfusions. Coombs' tests were performed on 17 babies. There were no false positives. The abnormal clotting studies observed in one baby were not due to ceftazidime. In a concurrent pharmacokinetic study, the half-life of ceftazidime was 7.4 (SD +/- 4.1) h following iv administration. Other pharmacokinetic values were C max 74 (SD +/- 20) mg l-1 trough concentration 20 (SD +/- 10) mg l-1. Total body clearance ranged from 0.13 to 2.10 ml min-1 per kg and increased with increasing postnatal age.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteria↗
PubMed1979

Biochemical identification of clinically important yeasts.

Four commercially available kits for the speciation of yeasts were tested against 50 clinical isolates that had been identified by conventional methods. On biochemical grounds alone, the four systems varied from 71% to 100% in their efficiency in identifying Candida albicans. Yeasts other than C. albicans were identified with an efficiency varying from 24% to 83%. Conclusions are drawn on the value of these systems to the routine laboratory.

Candida albicans↗