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Biomedical subjects

J J Murphy

Publications and source records attributed to J J Murphy.

210 records · Page 12Linked to original sources
PubMedDate not supplied

Sepsis associated with transfusion of red cells contaminated with Yersinia enterocolitica.

Between April 1987 and May 1989, the Centers for Disease Control investigated seven cases of transfusion-associated Yersinia enterocolitica sepsis; four were caused by organisms of serotype O:3, and one each was caused by organisms of serotype O:1,2,3; O:5,27; and O:20. All seven recipients developed septic shock after receiving units of red cells (RBCs) contaminated with Y. enterocolitica; five recipients died. The cases occurred in seven states and were unrelated. There was no evidence for contamination of the RBC units during processing. Six of the seven donors had serologic evidence of recent Y. enterocolitica infection, and it is hypothesized that these donors had asymptomatic bacteremia when they donated the implicated blood. Four of the seven donors reported gastrointestinal illness in the 4 weeks before blood donation, and one donor became ill on the day he donated blood. Y. enterocolitica grows well at 4 degrees C and in the presence of dextrose and iron. If blood is contaminated at the time of collection, storage of the RBCs at 4 degrees C provides an ideal environment for bacterial growth and endotoxin production. These cases demonstrate the need for careful evaluation of patients with transfusion reactions for possible sepsis and suggest a need to screen prospective blood donors for mild gastrointestinal illness, including those illnesses not requiring physician evaluation or medication.

Adult↗
PubMedDate not supplied

Beyond cost: 'responsible purchasing' of managed care by employers.

We explore the extent of "responsible purchasing" by employers--the degree to which employers collect and use nonfinancial information in selecting and managing employee health plans. Most firms believe that they have some responsibility for assessing the quality of the health plans they offer. Some pay attention to plan characteristics such as the ability to provide adequate access to providers and services and scores on enrollee satisfaction surveys. A more limited but still notable number of firms take specific actions based on responsible purchasing information. Because of countervailing pressures, however, it is not clear whether or not the firms most involved in responsible purchasing are signaling a developing trend.

Attitude to Health↗
PubMedDate not supplied

Delayed presentation of traumatic splenic arterio-venous fistula.

We report a patient who presented with dyspnoea and was found on examination to have a machinery murmur in the left upper quadrant of the abdomen. The patient had sustained blunt abdominal trauma one year prior to presentation. A diagnosis of splenic arteriovenous fistula was made. The diagnosis and management of delayed presentation of traumatic splenic arteriovenous fistula are discussed.

Abdominal Injuries↗
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Follow-up of patients with suspected venous thrombosis but negative radionuclide venography.

A retrospective review of the outcome of patients presenting to the district general hospital with suspected deep vein thrombosis (DVT) but normal radionuclide venogram. Of 387 scans, 141 (36%) were reported as positive, 81 (21%) as equivocal, and 165 (43%) as negative. The casenotes of 150 (91%) of those with negative scans were reviewed of which 124 were performed as part of the investigation of suspected DVT. During the next 3 months there were 13 DVTs and 7 with pulmonary emboli in this group, 4 of the latter proving fatal (confirmed at postmortem in 3). From a review of the initial clerking, the pre-venogram likelihood of DVT was graded as low in 54 (43%), medium in 23 (18%), and high in 45 (36%). DVT or PE occurred in none of those with a low probability, 9% of those with medium, and 38% of those with high probability. The results suggest that radionuclide venography is insufficient to exclude DVT when suspected clinically.

Adult↗
PubMedDate not supplied

Training and supervision of temporary transvenous pacemaker insertion.

To assess the current training and practice of central venous cannulation and temporary transvenous pacemaker insertion, a telephone survey of senior house officers (n = 60) and registrars (n = 20) was carried out in 80 acute hospitals in England and Wales. A median of one central line and two pacings were performed under supervision before the respondents were left unsupervised. The procedures were almost invariably taught at the bedside and usually by a fellow SHO or registrar. Virtually all the doctors surveyed were familiar with subclavian puncture, but experience with other routes was limited; 39/80 doctors questioned were unhappy about the training they had received, and 47 felt that formal training, such as tutorials or videos, would have helped. Training in central vein cannulation and temporary pacing needs to be more structured. This could be done by the use of videos or mannequins, and should include the use of routes other than the subclavian.

Attitude of Health Personnel↗
PubMedDate not supplied

Increased condom use among teenage males, 1988-1995: the role of attitudes.

CONTEXT: Understanding whether and to what degree changes in young men's attitudes explain increases in condom use over time can be useful in developing more effective disease prevention strategies. METHODS: Data from the 1988 and the 1995 National Survey of Adolescent Males are used to determine changes in attitudes toward condoms, pregnancy prevention and HIV and AIDS. Two-limit tobit models are employed to investigate the association between these attitudes and condom-use behavior and to examine how this relationship may have changed over time. RESULTS: Between 1988 and 1995, young men's attitudes toward partner appreciation of condom use, condom-use embarrassment and pleasure reduction from condom use all changed in a direction suggestive of more consistent condom use. However, attitudes related to pregnancy prevention and AIDS avoidance changed in a direction suggestive of less-consistent condom use. Changes over time in the strength of the relationship between three attitude measures (masculinity, pleasure reduction and partner appreciation) and condom use also were predictive of lower levels of condom-use consistency. Only the strength of the relationship between condom-use embarrassment and consistent condom use changed in a direction corresponding to observed increases in rates of condom use among young men. CONCLUSIONS: Many of the significant changes in young males' attitudes toward condoms do not explain the increase in consistent condom use among adolescent males that occurred between 1988 and 1995. However increasing male contraceptive responsibility and emphasizing the risks and consequences of contracting HIV appear to be viable routes for policymakers to explore. Efforts particularly need to be targeted toward Hispanics.

Acquired Immunodeficiency Syndrome↗