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Biomedical subjects

J Phillips

Publications and source records attributed to J Phillips.

At least 361 records · Page 20Linked to original sources
PubMedDate not supplied

Visits to home environments by emergency medical services: a statewide study.

UNLABELLED: Understanding out-of-hospital transport demographics would clarify the opportunities for injury surveillance and prevention. OBJECTIVE: To test the hypotheses that there are demographic differences in home vs. non-home emergency medical services (EMS) scene transports and that among age groups there are differences in demographics. METHODS: Data were extracted from the EMS State Ambulance Transport database of all reported during 1995. Transports from patient homes were compared with transports from all non-home scenes. Data extracted included age, gender, race, and type of complaint. Subgroup analysis was performed based on age groups in nonvehicular cases, safety problems, and interpersonal violence. Results were compared using a two-tailed chi-square with significance at p<0.05. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for significant differences. RESULTS: The study included 118,131 transported patients: 13% were children, 49% were adult between 18 and 64 years, and 38% were elder; 13% were African American, 82% were white, and 5% were other; 47% were male and 53% were female. Fifty-eight percent of the transports were for safety problems, and 17% were for interpersonal violence. Of the 118,131 transports, 56,812 (48%) were from patients' homes and 61,319 were not. Compared with EMS transports from non-home scenes, fewer home EMS transports were for injury (p<0.01, OR = 0.18, 95% CI = 0.17-0.19) and more home EMS transports were for illness (p<0.01, OR = 5.64, 95% CI = 5.49-5.79). There was no clinically significant difference in age, race, or gender. For all non-vehicular injury transports, the reason was more likely safety problems than interpersonal violence (58% vs. 17%); however, there was no difference in the percentages of type of call between the home and non-home transports. Home EMS transports were more likely interpersonal violence problems among adult patients less than 65 years old; however, among the old and young, the problems were more likely to be safety-related. CONCLUSION: Forty-eight percent of all EMS transports are from the home. Only 18% of these EMS home transports are for injury-related problems. In general, EMS injury transports are more likely related to safety than to interpersonal violence. Among the home EMS transports, more than 50% of transports for young and old patients are safety-related. A large proportion of the home EMS transports for adults less than 65 years of age, however, are for interpersonal violence.

Accidents, Home↗
PubMedDate not supplied

Effect of increased bile flow and bile acid secretion on the hepatic elimination of sodium valproate in the cat.

The effect of increased bile flow and hepatic bile acid flux on the systemic clearance and hepatic elimination of intravenously administered sodium valproate was studied in the bile fistula cat. Taurochenodeoxycholic acid (TCDC), tauro-3 alpha, 7 beta-dihydroxy-12-keto-5 beta-cholanoic acid (T12K), SC-2644, and secretin were infused intravenously to vary bile flow and biliary bile acid secretion. Control animals were infused with 0.15 mol/l NaCl. Less than 1% of the drug administered to controls appeared as unchanged valproate in the bile over 6 h. Although SC-2644, T12K, and secretin significantly increased biliary excretion of valproate, it did not exceed 2% of the intravenous dose. Biliary clearance was directly related to the rate of bile flow, but not to the bile acid flux. By contrast, 18-19% of the dose appeared in bile as metabolite in controls, and none of the choleretic agents significantly increased this percentage. As a result, systemic clearance of valproate was unaltered. We conclude that the movement of unchanged valproate into bile is consistent with a process of simple diffusion. The fact that choleretic agents do not increase metabolite excretion into bile suggests that metabolite formation may be the rate-limiting step in the hepatic elimination of valproate, rather than transport and excretion of metabolites into bile.

Animals↗
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Interictal spike localisation with methohexitone: preoperative activation and surgical follow-up.

Thirty-four patients with intractable temporal lobe epilepsy underwent preoperative and perioperative EEG activation with methohexitone sodium. Subsequently, all patients underwent anterior temporal lobectomy with deep structure preservation. Preoperative spike localisation with methohexitone was concordant with peroperative recording in most cases. Large doses of methohexitone were administered to two patients, rendering the EEG almost isoelectric. Areas of abnormal spiking activity were refractory to the effects of methohexitone, and recovery was marked by an increase in spike frequency. Postoperative clinical evaluation confirmed the specificity of methohexitone for abnormally epileptogenic tissue.

Electroencephalography↗
PubMedDate not supplied

Temporal neocorticectomy in management of intractable epilepsy: long-term outcome and predictive factors.

We report the results of a long-term follow-up study of 50 patients who underwent removal of temporal neocortex with preservation of deeper limbic structures as surgical therapy for intractable temporal lobe epilepsy. The follow-up period ranged from 3 to 15 years. Preoperative EEG investigations were based on interictal discharges alone. Three factors were predictive of a good outcome: (a) A clear unilateral anterior-midtemporal focus (p less than 0.01), (b) stereotypical onset of temporal lobe seizure (p less than 0.005), and (c) greater volume of tissue removed at operation (p less than 0.05). Overall results showed that 62% of patients experienced an outcome of "cure" or "almost cure," as classified according to a modified version of Crandall's criteria (Crandall's I and II). Those who experienced a significant reduction in seizures but who continued to have intractable epilepsy (Crandall's III) were not considered to have had a good result. Overall outcome compares favorably with other that of centers using different surgical approaches and indicates that neocorticectomy is a suitable procedure in a highly selected population even when limited resources are available.

Adaptation, Psychological↗
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Frey's syndrome following submandibular gland excision: an unusual postoperative complication.

Gustatory sweating and flushing, or Frey's syndrome, is a fairly common complication following surgery or injury to the parotid gland and is thought to be caused by aberrant nerve regeneration. A similar condition has been reported in the literature following surgery to the submandibular region. Since this was first described in 1934, only 7 subsequent cases of submandibular sweating and flushing have been reported. We present a case of a 52-year-old female who underwent excision of the left submandibular gland as a result of chronic sialadenitis. Twelve months following surgery, symptoms indicative of Frey's syndrome were experienced in the operative region. A review of the aetiology and treatment of the condition is described.

Female↗
PubMedDate not supplied

Pituitary apoplexy in an ectopic pituitary tumour.

A case report of a patient with unilateral visual loss, due to infarction in an ectopic pituitary tumour, is presented. Good return of vision followed surgical removal of the tumour.

Adenoma↗
PubMedDate not supplied

The aortogram and gastrointestinal bleeding.

Three cases of gastrointestinal hemorrhage are reported which illustrate that the bleeding site may be missed angiographically if the study is limited to celiac and mesenteric angiograms. An abdominal angiogram must be performed as part of the radiological investigation of gastrointestinal bleeding.

Aged↗
PubMedDate not supplied

Caring for patients with enterocutaneous fistulae.

Fistulae are distressing for both patients and staff. The management of fistulae presents a challenge to the nurse in terms of providing care for the psychological and physiological needs of the patient. This article describes the causes of fistulae and examines the nursing priorities and how to achieve them.

Body Image↗
PubMedDate not supplied

Malignant external otitis: now a medical problem.

A 75-yr-old diabetic woman presented with right ear tenderness and neck pain. Pseudomonas aeruginosa was cultured during surgery from an inflammatory area in the region of the cervical vertebrae. A diagnosis of malignant external otitis was made and parenteral antibiotics were given, which produced a cure. This disease has a high mortality rate, which accounts for the use of the word malignant. Our patient also manifested the jugular foramen syndrome involving multiple cranial nerves. If there is cranial nerve involvement, which is seen in at least one-half of cases, the mortality ranges as high as 80%. We describe here the first case with invasion of the cervical vertebrae.

Aged↗
PubMedDate not supplied

Process tracking results from the Treatwell 5-a-Day Worksite Study.

PURPOSE: To report findings from Treatwell 5-a-Day process tracking. DESIGN: Worksites were randomly assigned to a minimal intervention control, worksite-only condition, or worksite-plus-family condition. SETTING: Twenty-two small community health centers in Massachusetts. SUBJECTS: Employees of the community health centers. INTERVENTION: Both intervention conditions included the formation of employee advisory boards; activities such as nutrition discussions and taste tests targeting individual behavior change; and point-of-purchase labeling as an environmental strategy. Worksite-plus-family sites incorporated activities such as family contests, campaigns, and picnics. MEASURES: Documentation of the number and type of activities for extent of implementation; number of participants in activities for reach; program awareness and participation from the follow-up employee survey (n = 1306, representing 76% [range, 56%-100%] of the sample); change in fruit and vegetable consumption from a comparison between the follow-up and baseline surveys (n = 1359, representing 87% [range, 75%-100%] of the sample). RESULTS: A higher number of activities per employee was significantly correlated with greater program awareness (.68; p = .006) and greater change in fruit and vegetable consumption (.55; p = .04). Greater participation in activities was significantly correlated with greater awareness (.67; p = .007), higher participation (.61; p = .02), and increase in fruit and vegetable consumption. (.55; p = .04). CONCLUSIONS: These results provide quantitative indicators of a dose-response relationship between the number of intervention activities per employee and higher percentage of employee participation and observed increases in fruit and vegetable consumption.

Documentation↗
PubMedDate not supplied

A cost-benefit evaluation of helicopter transfers to the Beaumont neurosurgical unit.

A retrospective analysis of all consecutive helicopter transfers to the Beaumont neurosurgical unit was performed over a two year period from January 1994 to December 1996. There were 55 transfers, 55% of which were for trauma patients. Sixty two per cent were intubated prior to transfer. The mean length of stay at the referring hospital prior to transfer was 12.25 hours (range 3-98 hours). Twenty five per cent underwent a neurosurgical operation within 2 hours of arrival at the unit. Seventy eight per cent of patients either made a full recovery or were left with mild to moderate disability. Whilst helicopters do not seem to result in a marked reduction in total transfer time compared with 'blue light' ambulances, they do result in a shorter time being spent in the unstable transfer environment and this, in turn, might be associated with improved patient outcome.

Adolescent↗