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Biomedical subjects

C Smith

Publications and source records attributed to C Smith.

At least 1,261 records · Page 70Linked to original sources
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Leveling when monitoring central blood pressures: an alternative method.

Monitoring central hemodynamic pressures is an important part of total assessment by those who assume responsibility for total care of those critically ill patients in need of invasive monitoring. In such patients frequent measurements are required during the course of the several days, on a 24 hour basis. If the data are to be highly reliable and valid, particular attention must be given to the important aspects of leveling the two reference points by the several nurses who assume such responsibility. The two methods of leveling now in use, sighting and use of the spirit level, leave the question of such consistent accuracy in doubt. This alternative method of using water in a closed loop of tubing for leveling, with its definite and necessary steps, may seem to be time consuming to the already busy critical care nurse. The ability to master the necessary technique after a few practices and to gain speed and confidence in performing the steps has been demonstrated clearly by those nurses who have received instruction and supervision in this approach to leveling and monitoring central blood pressures. The loop of tubing used for this alternative method is easily made from materials readily available in each critical care unit. Its looped construction allows it to be placed for convenience and accessibility to the patient undergoing frequent hemodynamic monitoring, and can be used for a number of similarily placed patients.

Blood Pressure Determination↗
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Use of right atrial catheter for prolonged iv support in cancer patients.

A right atrial catheter has proven to be a well-tolerated technical advance for patients requiring prolonged vascular access. It is easily inserted and suited for ambulatory maintenance by the patient. Catheters are utilized for a wide spectrum of iv medications with an acceptably low complication rate. Most significantly, the infection rate is negligible, despite severely compromised hosts. Their use should be considered for any patient in whom problems with vascular access are anticipated. This report comprises our experience with the first 70 catheters in 66 patients in the Hematology/Oncology service.

Ambulatory Care↗
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Drug delivery in asthma.

Explore the source record for details and available documents.

Administration, Inhalation↗
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Pharmacology of local anaesthetic agents.

Local anaesthetic agents are widely used throughout medicine and dentistry. The profiles of the different members of this group of drugs vary considerably, so that an understanding of the pharmacology of these agents is essential if they are to be used safely.

Absorption↗
PubMedDate not supplied

A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts. International Society for Heart and Lung Transplantation.

A clinically applicable, standardized method for assessing functional results after lung transplantation is required to evaluate factors that may affect long-term outcome, to permit comparison of results from different centers, and to evaluate results of clinical trials. An ad hoc working group was established under the auspices of the International Society for Heart and Lung Transplantation for the purpose of developing such a clinically applicable system. Chronic allograft dysfunction is often associated with pathologic findings of obliterative bronchiolitis, the cause of which has not been defined. Physiologically, such dysfunction is associated with obstructive airways disease. The group concluded that the forced expiratory volume in 1 second was the most reliable and consistent indicator of graft dysfunction, excluding other identifiable causes. The term bronchiolitis obliterans syndrome was adopted to describe such dysfunction, recognizing that there may or may not be pathologic evidence of bronchiolitis obliterans present. Four stages of bronchiolitis obliterans syndrome were defined, each with two subcategories to indicate whether pathologic evidence of obliterative bronchiolitis had been identified. This working formulation will require reappraisal in the future to reassess its practical application and to make such adjustments as may seem appropriate.

Bronchiolitis Obliterans↗
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Interface pressure measurements of support surfaces with subjects in the supine and 45-degree Fowler positions.

In the past 20 years there has been a dramatic increase in different types of support surfaces to reduce the incidence of pressure ulcers. The purpose of this study was to determine the effect of static air overlays (Sof-Care and Tendercloud), replacement mattresses (Dermarest and Therarest), and a standard hospital mattress on tissue interface pressures in healthy subjects. A convenience sample of 25 subjects had tissue interface measurements obtained under the sacrum and heel bony prominences on the five support surfaces in the supine and 45-degree Fowler's positions. A repeated measures analysis of variance (p < 0.05) indicated that the Dermarest, Therarest, Sof-Care, and Tendercloud support surfaces reduced pressure significantly under the sacral bony prominence compared with the standard hospital mattress. Heel interface pressure measurements were significantly higher than sacral interface pressure measurements. There was no significant difference between supine and 45-degree Fowler's positions with respect to tissue interface pressures.

Adult↗
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Care of the older hypothermic patient using a self-care model.

This paper focuses on the problem of hypothermia and provides an overview of its causes, signs and symptoms. A case study of a patient who was admitted to an acute assessment of the elderly ward with hypothermia is described and the use of Orem's self-care model of nursing is explained.

Age Factors↗
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Techniques for bronchial anastomosis.

BACKGROUND: Many techniques have been described to optimize the construction of the bronchial anastomosis in lung transplantation. Over the past 60 months we have performed 86 bronchial anastomoses in 70 patients receiving single lung or bilateral single lung transplants. METHODS: No anastomosis was wrapped and no attempt was made at revascularization of bronchial arteries. A continuous nonabsorbable suturing technique was used in all cases. Standard triple-drug immunotherapy with cyclosporine, azathioprine, and prednisone (starting at day 7) was used for each patient. RESULTS: There were no anastomotic leaks, and seven stenoses were identified in five patients (7%). All complications were managed conservatively with stenting, and there were no related deaths. Mean time to stent placement was 109 days. One patient had bilateral stents placed prophylactically during an episode of severe infection for questionable anastomotic viability but without evidence of airway necrosis or obstruction. This patient died of infection at 16 days. Another patient died with stents in place at 71 days. In the four remaining patients, all stents have been removed after a mean of 310 days. These patients were followed up with serial bronchoscopy and were without evidence of recurrent obstruction at 2, 34, 35, and 36 months. Six of seven stenoses occurred in patients with cystic fibrosis. In each patient where stenosis developed the anastomosis was telescoped. Since abandoning the telescoping technique in the remaining 50 anastomoses (14 in patients with cystic fibrosis), no dehiscence or stenosis was encountered. CONCLUSIONS: These data suggest that elaborate techniques aimed at construction of the bronchial anastomosis are not necessary. Moreover, attempts at telescoping may be detrimental. Patients with cystic fibrosis may be a population at higher risk for anastomotic complications. Airway complications can be managed conservatively with good results and little risk to the patient.

Adult↗
PubMedDate not supplied

A technique for investigating the antigenicity of cultured rheumatoid synovial cells.

Antisera to rheumatoid and nonrheumatoid synovial cells were prepared by: intraarticular injection of rabbits with these cells, subsequent synovectomy, and autologous immunization of each animal with the cultured rabbit synovial cells, or homogenized whole rabbit synovial membrane. Resultant antisera were studied by immunofluorescence and 51chromium cytotoxicity tests against other cultured rheumatoid and nonrheumatoid cells. Activity of positive sera could be removed by absorption with nonrheumatoid cells, except for one antiserum which appeared to produce immunofluorescent staining specific for rheumatoid cells.

Animals↗