Biomedical subjects
D Bell
Publications and source records attributed to D Bell.
Effective use of magnesium for acquired torsade de pointes in a 4-month-old infant.
We report a 4-month-old infant with torsade de pointes secondary to procainamide treatment. The infant presented with atrial flutter and converted to normal sinus rhythm with intravenous procainamide. Oral procainamide therapy was initiated as the infusion was tapered, and the patient subsequently developed incessant torsade de pointes. Once the proarrhythmia was recognized, procainamide was withheld, and intravenous magnesium was administered. The torsade de pointes resolved after one bolus of magnesium sulfate. An infusion regimen of magnesium was given until the procainamide and N-acetylprocainamide concentrations became undetectable. Intravenous magnesium should be administered to newborns with acquired torsade de pointes; dosing guidelines for its use are suggested.
Host-dependent Anopheles flavirostris larval distribution reinforces the risk of malaria near water.
Malaria control strategies are more likely to be successful if groups at high risk can be accurately predicted. Given that mosquitoes have an obligate aquatic phase we were interested in determining how vector larval abundance relates to the spatial distribution of human malaria infection. We examined the relationship between malaria parasite prevalence and distance from vector larval habitat, and vector larval abundance and distance from human habitation, in separate studies in rural, low-endemic areas of the Philippines. Parasite prevalence among symptomatic patients was significantly higher among those living in proximity (< or = 50 m) to potential larval habitats of the major vector, Anopheles flavirostris (adjusted odds ratio [AOR] = 2.64, P = 0.02 and AOR = 3.43, P = 0.04). A larval survey of A. flavirostris revealed a higher density of early and late instars near human habitation (adjusted P < 0.05). The results suggest that larvae are associated with human habitation, thereby reinforcing malaria risk in people living close to larval habitats. This has implications for understanding the interaction between vectors, hosts, and parasites, and the potential for success of localized malaria control measures.
A stereotaxic principle using a nonmathematical three-dimensional approach.
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Focus on: Thomas Jefferson University Hospital, Department of Biomedical Instrumentation.
Technology management services at Thomas Jefferson University Hospital are provided by two distinct cost centers: The Department of Biomedical Instrumentation and Jefferson Biomedical Shared Services. The in-house division of the Department of Biomedical Instrumentation (BMI) provides clinical engineering services to the hospital, a 717-bed, tertiary care facility. BMI supports traditional patient care instrumentation, as well as dialysis machines, anesthesia machines, lasers, and the neonatal extracorporeal membrane oxygenation (ECMO) systems. In addition, the department supports over 3,000 personal computers and associated peripherals, and provides research, design, database support, device evaluation, incident investigation, and product problem investigation services. Jefferson Biomedical Shared Services, an integral component of the Department of Biomedical Instrumentation, offers a shared services program to local area hospitals. It has a current client list of 11 major healthcare institutions with annual revenues approaching $3,000,000 per year.
Lumbosacral joint angles in children.
We wished to determine values for the lumbosacral angles in children without spondylolisthesis. Eleven angles were measured on 112 consecutive standing lateral radiographs of children ranging in age from 3 to 18 years. Gender and scoliosis affected only sacral roll and the lumbosacral angle, respectively. Lumbar lordosis, lumbar index, and sacral roll all increased with age. Sagittal rotation and slip angle were negative in children without spondylolisthesis. We recommend that sagittal rotation be used to measure rotation at the lumbosacral joint and that lumbar lordosis be measured using the top of the first and the fifth lumbar vertebra.
Reduced venous compliance and increased transcapillary escape of protein in insulin-dependent diabetic patients.
Lower limb venous compliance and transcapillary escape rate of transferrin were measured in eight normotensive, insulin-dependent male diabetic patients and eight control subjects using a dual isotope technique. Technetium-99m labelled autologous erythrocytes were used to measure venous compliance and to correct for local changes in blood volume, whilst Indium-113m labelled transferrin was used to measure transcapillary escape of protein. The diabetic patients were found to have reduced venous compliance 1.5 (0.7 to 3.4) x 10(-2) mmHg-1 compared with controls 3.2 (2.4 to 4.1) x 10(-2) mmHg-1 (p less than 0.01). The diabetic patients were also found to have greater transcapillary escape of transferrin -2.7 (-1.5 to -5.3) x 10(-3), compared with control subjects -5.2 (-4.1 to -8.1) x 10(-3) (p less than 0.02) in response to increasing hydrostatic pressure. These results show reduced venous compliance in patients with a mean duration of diabetes of 15 years and with only at most, early complications of diabetes, and confirm previous observations showing increased transcapillary escape of protein.
Experience of HIV disease in a London District General Hospital.
The aim of this paper is to describe and discuss the experience of HIV disease in Central Middlesex Hospital, London up to June 1993. A retrospective study of the total number of HIV-positive patients cared for was performed. In addition, prospectively collected data as part of local epidemiological surveillance from January 1987 to June 1993 on all HIV test requests was analysed. Between January 1987 and June 1993 3695 individuals were tested for HIV-1 antibody at Central Middlesex Hospital. Of these, 101 HIV-1 seropositive individuals were identified and have attended this District General Hospital. Seven HIV-1 seropositive individuals were identified from before December 1986. Sixty (56%) had acquired their infection heterosexually. Thirty-eight (35%) originated from the UK and 47 (44%) from sub-Saharan Africa; the remaining 23 (21%) originated from the rest of Europe, South America and the Caribbean. Thirty-four (31%) of the patient group developed AIDS during follow-up at the hospital and in 26 individuals AIDs developed within 2 months of their first positive HIV result. The mean survival of 20 patients after AIDS-defining diagnoses was 7 months 18 days. This unselected group of HIV-1 seropositive patients present late in the course of their HIV disease and survival following AIDS is poor.
Conformation of the cytoplasmic domain of phospholamban by NMR and CD.
Nuclear magnetic resonance (NMR) and circular dichroism (CD) spectroscopy have been used to characterize the conformation of the putative cytoplasmic domain of phospholamban (PLB), an oligomeric membrane-bound protein which regulates the activity of the cardiac sarcoplasmic reticulum Ca(2+)-dependent ATPase. In aqueous solution the 25-residue peptide adopts a number of rapidly interconverting conformers with no secondary structural type obviously predominating. However, in trifluoroethanol (TFE) the conformation, while still highly dynamic, is characterized by a high proportion of helical structures. Evidence for this is provided by alpha CH chemical shifts and low NH chemical shift temperature coefficients, small NH-alpha CH intraresidue scalar coupling constants, a substantial number of distinctive interresidue nuclear Overhauser effects (NOEs) [dNN(i, i + 1), d alpha N(i, i + 3), d alpha beta(i, i + 3) and d alpha N(i, i + 4)] and characteristic CD bands at 190 (positive), 206 (negative) and 222 nm (negative). The helicity is interrupted around Pro-21. The activity of PLB is regulated by phosphorylation at either Ser-16 or Thr-17. CD shows that phosphorylation at Ser-16 by the cAMP-activated protein kinase causes about an 11% decrease in alpha-helical content in TFE.
Controversies in the prevention and control of antimicrobial drug resistance.
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Planning a clinical workshop.
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The impact of weekends on outcome for emergency patients.
Levels of staffing and access to diagnostics at weekends are recognised to be significantly lower than on weekdays. It is unclear if subsequent inpatient mortality and readmission rates for acute medical admissions are increased for weekend admissions compared to those on a weekday. A large Canadian study demonstrated increased weekend mortality but does the Edinburgh healthcare model support these findings? This study analysed all hospital admissions in 2001 to the Royal Infirmary of Edinburgh for six predetermined diagnoses (total 3,244): chronic obstructive pulmonary disease, cerebrovascular accidents, pulmonary embolism, pneumonia, collapse and upper gastrointestinal bleed. We compared hospital mortality rates, readmission rates and hospital length of stay for weekend admissions as compared to those on a weekday. Weekend admission was not associated with significantly higher in-hospital mortality, readmission rates or increased length of stay compared to the weekday equivalent for any of the six conditions. The implementation of an acute medical admissions unit in the Royal Infirmary of Edinburgh, with consistent staffing levels and 24-hour access to diagnostics for the early phase of critical illness, may have helped address the discrepancy in care suggested by previous studies.
Prediction of in-hospital mortality and length of stay using an early warning scoring system: clinical audit.
This aim of this study was to assess the impact of the introduction of a standardised early warning scoring system (SEWS) on physiological observations and patient outcomes in unselected acute admissions at point of entry to care. A sequential clinical audit was performed on 848 patients admitted to a combined medical and surgical assessment unit during two separate 11-day periods. Physiological parameters (respiratory rate, oxygen saturation, temperature, blood pressure, heart rate, and conscious level), in-hospital mortality, length of stay, transfer to critical care and staff satisfaction were documented. Documentation of these physiological parameters improved (P<0.001-0.005) with the exception of oxygen saturation (P=0.069). The admission early warning score correlated both with in-hospital mortality (P<0.001) and length of stay (P=0.001). Following the introduction of the scoring system, inpatient mortality decreased (P=0.046). Staff responding to a questionnaire indicated that the scoring system increased awareness of illness severity (80%) and prompted earlier interventions (60%). A standardised early warning scoring system improves documentation of physiological parameters, correlates with in-hospital mortality, and helps predict length of stay.
Salinity tolerance of Anopheles farauti Laveran sensu stricto.
To assess the salt tolerance of the malaria vector Anopheles farauti sensu stricto, larvae were collected from a freshwater environment on the outskirts of Honiara, Solomon Islands and placed in trays containing water with salinity varying from freshwater to seawater. Dead larvae and pupae and emerged adults were recorded and preserved. Most adults and nearly half of the larvae and pupae were then subjected to DNA analysis for species identification. No adult An. farauti emerged after prolonged immersion of larvae in undiluted seawater (3.5% salinity), although temporary immersion before pupation was compatible with survival. Salinities of up to 2.2% to 2.5% were compatible with good survival and adult emergence, at least from fourth instars. The results suggest that higher salinities may slow larval development and show that mortality at a given salinity is not uniform.
Prostate screening health beliefs and practices of African American men.
The purpose of this study was to investigate the health beliefs and practices of African American men regarding prostate cancer screening. A descriptive non-experimental design was used with a self-administered questionnaire to identify participants' knowledge level, health beliefs and practices related to the screening and early detection of prostate cancer in African American men. Results indicate that most participants had a high level of prostate cancer knowledge, early detection and had prostate screening done on a regular basis. They believed prostate cancer was not preventable but if contracted treatment would be painful and impair sexual function. Other significant beliefs included: good health habits were important, most rated their health as good or excellent, and they rely on their faith to stay healthy. Findings of this study provide culturally appropriate information which may contribute to developing prostate cancer prevention programs in African American communities.
Pathophysiology of type 2 diabetes and its relationship to new therapeutic approaches.
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Pulmonary tuberculosis and HIV infection.
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Computerizing records for continuing education.
The system was devised as a joint project by members of the Nursing Education Department, secretarial staff, and Information Services. The nursing education department members identified needed outcomes. The secretaries described what was necessary to simplify data entry. The information services personnel had the technical expertise to interpret the input from the others and put the system together. All members of this project were essential to its development. The reports provide information about classes, attendees, and educational budgets. The reports also meet requirements of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Occupational Safety and Health Administration (OSHA), and state continuing education regulations.