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Biomedical subjects

D R Walker

Publications and source records attributed to D R Walker.

82 records · Page 5Linked to original sources
PubMedDate not supplied

Problems in the development of a computerized ward monitoring system for a paediatric intensive care unit.

A computerised ward monitoring system based on Archimedes PC's at each bedside is under development for the PICU at Killingbeck Hospital in Leeds. This work was initiated with a view to reducing the amount of paperwork in the unit. The present paper charts have been broken down into sections for the purpose of entry into the computer. The completed charts may be viewed in tabular form. There are several alternative displays. The default display mode illustrates the patients principal cardiovascular variables over the previous six hours. Alternative graphical displays include 12 hour trend curves for the cardiovascular variables, a screen with one hour trend graphs and panels illustrating the latest values of other patient variables, and graphical 12 hour reviews for clear fluid balance, blood volume balance and respiratory variables. The program also serves as a vehicle for testing an alarm generating system and a cardiovascular status index in the paediatric environment. A separate program has been developed which allows the retrospective construction of data bases by using some or all of the data from one or more of the charts for a series of patients. Finally the difficulties encountered in preliminary trials of the system are discussed. At the present time the program is being run at a central station while attempts are being made to surmount these difficulties.

Algorithms↗
PubMedDate not supplied

Evaluation of myocardial damage in patients undergoing coronary-artery bypass procedures with halothane-N2O anesthesia and ajuvants.

During a 6-month period in 1975, 102 patients undergoing scheduled coronary-artery bypass grafting were studied by both conventional ECG and heart-specific enzymatic methods to evaluate the incidence and estimate the extent of myocardial damage associated with an anesthetic management protocol using halothane as a primary agent with adjuvant agents. Anesthetic interventions were made to maintain heart rate and systolic pressure at resting levels or below the heart rate systolic pressure product documented during exercise-induced angina. These interventions included adjustment of halothane concentration in all patients, the use of adjuvant agents in 88.2 percent, vasodilators in 26.5 percent, and the precardiopulmonary bypass use of vasoconstrictor or cardiostimulants in 9.8 percent. There were 2 early postoperative deaths. ECG evidence of infarction was observed in 4 surviving patients. Sustained release of heart-specific CPK-MB isoenzyme occurred in 78 percent of surviving patients. Isoenzyme activity was detected in only 1 patients prior to cardiopulmonary bypass (CPB), in 1 patient during CPB, and in all others after termination of CPB. The extent of myocardial damage as estimated by integrating CPK-MB values over time was directly related to number of vessels grafted and to aortic cross-clamp and CPB times. The ECG and enzymatic data both document a low level of myocardial damage associated with this anesthetic management protocol.

Adjuvants, Anesthesia↗
PubMedDate not supplied

Surgical ligation of the patent ductus arteriosus in low birth weight pre-term infants. A review of 67 consecutive cases.

Between March 1978 and October 1983, sixty-seven low birth weight infants (600-1500 gm) with gestational age of 26-33 weeks had surgical ligation of PDA in our unit. Thirty-six (54%) had previous failed indomethacin therapy. Congestive cardiac failure (61), respiratory distress syndrome (48) and failure to thrive (34) were the presenting features. Nine patients had severe acidosis (pH 6.8-7.18) on admission. A trans-pleural approach was used in all. Ventilation was required for 1-13 days. There were no intra-operative deaths. Sixteen (24%) died of the problems of prematurity. The others have continued to thrive. We believe that ligation of PDA is a safe and effective procedure in the low birth weight premature infant, but should only be undertaken in a well set up paediatric cardiac surgical unit.

Ductus Arteriosus, Patent↗
PubMedDate not supplied

Total anomalous pulmonary venous drainage into the right superior vena cava.

An unusual case of total anomalous pulmonary venous drainage (TAPVD) is described with four anomalous veins draining separately into the posterolateral wall of the right superior vena cava (SVC). The defect was successfully reconstructed with a pericardial patch, sutured to the posterior wall of the right SVC, right atrium and the margins of an artificially enlarged inter-atrial communication, thereby directing the pulmonary venous return into the left atrium. The right SVC was reconstructed with a further pericardial patch. Initially autologous pericardium was used, but due to contraction this had to be replaced at a further procedure with heterologous pericardium.

Humans↗
PubMedDate not supplied

Disinfection/sterilization in U.S. dental practices--practice behavior and attitudes.

In an era when we are experiencing an increased awareness of communicable infectious diseases such as tuberculosis and hepatitis B, and in which stories regarding the fear of the spread of the HIV virus receive almost nightly news coverage, all health care professionals are taking extra precautions when providing care to patients. The concern of occupational transmission of infectious diseases from the perspective of patient to health care worker is not new. However, the sensationalized singular instance of a dentist in Florida who reportedly transmitted the HIV virus to five of his patients raises questions about the possibility of health care worker to patient transmission and puts the spotlight on the dental community.

Attitude of Health Personnel↗