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Biomedical subjects

J Raftos

Publications and source records attributed to J Raftos.

At least 19 recordsLinked to original sources
PubMed1997

Emergency management skills of South Australian paediatric trainees.

OBJECTIVE: This article describes a theoretical and practical assessment of the emergency management skills of South Australian paediatric trainees. The aim was to identify strengths and weaknesses so as to optimally orientate future training in this area, and to provide a baseline that could be used to assess effectiveness of future interventions. METHODOLOGY: Thirty-four paediatric trainee medical officers responsible for after hours emergency care in Adelaide were asked to anonymously complete a 24 question theory assessment based on recognized emergency management training programmes, and to perform a mock clinical resuscitation. Response rate was 90% for the theoretical section and 69% for the practical. RESULTS: The average trainee was found to be deficient in one quarter to one third of the theoretical precepts, and required an average of 2 min to establish effective bag-valve-mask ventilation with an infant manikin. CONCLUSIONS: There is a range of theoretical and practical resuscitation deficits that may currently hinder effective emergency management by paediatric trainees.

Child↗
PubMed1996

Topical anaesthesia for minor lacerations: MAC versus TAC.

OBJECTIVE: To determine whether a solution of bupivacaine Marcain [Astra]), adrenaline and cocaine (MAC) is as safe and effective as tetracaine, adrenaline and cocaine (TAC) as topical anaesthesia for wound suturing. DESIGN: Double-blind, randomised, prospective trial. SETTING: Emergency departments of two tertiary referral hospitals (one specialising in paediatric care) in Adelaide, South Australia, between February 1992 and April 1994. PARTICIPANTS: 181 patients, aged six or older, with simple dermal lacerations less than 5mm deep, not involving mucous membranes or areas with end-arterial blood supply. INTERVENTIONS: Patients received a weight-adjusted dose of either MAC or TAC. OUTCOME MEASURES: Needle-prick testing of wound for pain before suturing, pain ratings by patients and physicians during suturing, signs and symptoms of cocaine toxicity, wound complications and patient preference for topical anaesthesia. RESULTS: Topical anaesthesia was adequate for suturing in 73% of patients (83% or those with head wounds and 56% of those with extremity wounds). MAC and TAC did not differ significantly in efficacy overall or by wound location. Pain ratings from patients treated with MAC and TAC were comparable, as was patients acceptance of topical anesthesia (77%, MAC; 81%, TAC) and the incidence of adverse effects (4% infection rate overall). CONCLUSIONS: Topical anesthesia is a safe and effective means of anaesthetising selected lacerations for suturing. As we found no significant differences in either the efficacy or safety of the two solutions, we believe that MAC can be substituted for the less readily available TAC whenever expedient.

Adolescent↗
PubMed1995

Parent satisfaction with services in an emergency department located at a paediatric teaching hospital.

OBJECTIVE: To evaluate parents' satisfaction with the services provided in an emergency department located at a paediatric hospital. METHODOLOGY: A descriptive study in which the parents of children with non-life-threatening illnesses attending an emergency department completed a questionnaire describing their satisfaction with services in the department. RESULTS: The majority of parents were satisfied with the services provided. However, less satisfied parents reported having to wait significantly longer before receiving medical attention than satisfied parents. Consistent with this finding, 77% of less satisfied parents reported that staff did not attend to their children's needs quickly enough and 62% felt that there were insufficient staff available to provide help. Twenty-nine per cent of the less satisfied parents reported that they did not know what was required for the ongoing care of their children after their discharge from the emergency department. CONCLUSIONS: In order to address the concerns of less satisfied parents, emergency departments need to give careful attention to the maintenance of reasonable waiting times, the provision of adequate staffing, and the quality of staff-parent communication. Addressing these issues may improve the ongoing care of children after their discharge from emergency departments.

Adolescent↗
PubMed1991

Head injuries in infants and young children: the value of the Paediatric Coma Scale. Review of literature and report on a study.

The normal verbal and motor responses embodied in the standard Glasgow Coma Scale (GCS) are not achievable during the first few years of life. The recent literature contains numerous reports of attempts to devise scales of responses quantitating the conscious level in infants and young children, both for research purposes and as clinical guides; some of these scales incorporate items, e.g. brainstem reflexes, that are not included in the GCS. We have reported on a simple paediatric version of the GCS, which uses the standard scale with minor modifications in the verbal component, and sets realistic age-related normal responses. This has been tested prospectively in a series of 60 head-injured infants and children (age range 0-72 months). Of 6 cases recorded as comatose 6 h after injury, 4 have confirmed or suspected residual disabilities. Of 35 cases considered to be fully conscious at 6 h, 31 have made good recoveries and only 1 has suspected residual disabilities. The study suggests that the scale accords with the realities of neurological immaturity, and confirms that it can be used in routine paediatric practice. For comparative therapeutic trials, the conscious level in infants has limited value as an index of brain injury, and should be complemented by other indices, such as brainstem reflexes.

Brain↗
PubMed1991

An epidemiological survey of dog bites presenting to the emergency department of a children's hospital.

German shepherds are the most popular registered breed of dog in South Australia, but are also the most hazardous to children, biting more often and more severely. A study of the victims of dog bites presenting to the Emergency Department of the Adelaide Children's Hospital over an 18 month period revealed that, although many breeds were involved, only German shepherds were implicated more frequently than their prevalence in the community. Attacks occurred most often in a domestic setting involving a friendly dog that was known to the victim. Boys were more often bitten than girls and children aged 1-6 years most commonly involved. Injuries to the face and scalp were frequent and the usual ones to require admission for suture under general anaesthetic. Some scarring was a common sequel and resulting fear of dogs remained with some children. Most attacks were reported to be unprovoked and a previous biting history on the part of the dog was uncommon. Parents who are contemplating obtaining a dog for a family pet should be made aware of these facts and advised regarding the biting hazards and possible prevention. The German shepherd situation especially should be brought to their attention.

Animals↗
PubMed1988

Limitation of myocardial infarction by early infusion of recombinant tissue-type plasminogen activator.

In a double-blind randomized trial involving five Sydney hospitals and the city ambulance paramedical service, 145 patients with a first evolving myocardial infarction and with onset of pain less than 2.5 (mean 1.9 +/- 0.5 [SD]) hr previously were allocated to intravenous infusion of 100 mg recombinant tissue-type plasminogen activator (rt-PA) or placebo over 3 hr. The groups at entry were similar. At assessment 21 days later, left ventricular ejection fraction measured both by contrast and radionuclide ventriculography was higher in the rt-PA compared with the placebo group (61 +/- 13%, n = 64, vs 54 +/- 14%, n = 62, contrast, 2p = .006; 52 +/- 13%, n = 66, vs 48 +/- 13%, n = 62 isotope, 2p = .08). This indicates limitation of myocardial infarction by rt-PA.

Adult↗
PubMed1987

Flow properties of modified packed red cells.

We investigated free gravitational blood flow of modified packed red cells. Variables affecting free flow included final haematocrit, duration of blood storage at 4-6 degrees C and the centrifugal force required in preparation of this blood component. Irrespective of the duration of storage, free blood flow of modified packed red cells was not different from whole blood, provided the haematocrit did not exceed 0.63.

Blood Flow Velocity↗
PubMed1985

Thirty-five-day modified red cells and 7-day stored platelet concentrates from triple bags of identical PVC formulation.

There is continuous need for blood components with long shelf life. To this end the 'circle' triple pack has been modified to provide 35-day red cell and 7-day platelet concentrates, in PVC bags of identical formulation and 0.4 mm thick. The plasticizer is a mixture of DEHP and TOTM (CLX Mark II). The primary pack contains 63 ml of CP 277.5 mM glucose. The third pack contains 100 ml of citric acid 2 mM, trisodium citrate 20 mM, NaH2PO4 20 mM, NaCl 123 mM, glucose 40 mM, and adenine 1.26 mM. Plasma is adenine-free. With these modifications both hard- and soft-spun red cells gave satisfactory biochemical and autologous survival indices up to 35 days of storage, the haematocrit not exceeding 60%. Platelet concentrates were acceptable at 7 days of shelf-life.

Adenosine Triphosphate↗
PubMed1982

Combined use of prazosin and beta-blockers in hypertension.

Combined use of prazosin and beta-blockers in a hypertension clinic over a 3-year period was surveyed by means of a computerized record system. Of the 1,250 patients in the clinic, 171 (14%) had been treated with this combination for periods averaging 17 months. Prazosin was administered with a beta 1-selective beta-blocker in 94 cases and with a beta 1 + beta 2-blocker in 100 cases; 23 patients had received treatment with both combinations. Diuretics were given in 86% of cases and other antihypertensive drugs in 19%. The population treated had a high incidence of severe hypertension, with initial diastolic pressure greater than 120 mm Hg in 38% and between 100 and 120 mm Hg in 50%. The percentage of patients with diastolic pressure less than 100 mm Hg was 12% initially and 79% at the end of the treatment period. Side effects necessitated withdrawal of therapy in 35 cases. These were referable in 19 cases to prazosin and in 16 to beta-blockers. Prazosin was found to be more effective in lowering blood pressure in combination with beta 1-blockers than with beta 1 + beta 2-blockers, although there were fewer severe side effects with beta 1-blockers.

Adrenergic beta-Antagonists↗
PubMed1982

Verapamil in the long-term treatment of angina pectoris.

1. A long-term, open clinical trial of verapamil therapy was conducted in ninety-three patients with coronary artery disease, selected on the basis of having stable angina pectoris and of being unsuitable for treatment with beta-adrenoceptor blocking drugs. 2. Two-thirds of the patients (fifty-eight patients) obtained a good relief which was sustained over a period of 1 y. There were few major adverse reactions and the drug was generally well tolerated. The main limiting factor in dosage was hypotension. No adverse effects were observed in patients with obstructive airways disease, controlled cardiac failure and lower limb arteriosclerosis. 3. Verapamil was considered to be a major advance in the chronic therapy of angina pectoris.

Angina Pectoris↗
PubMed1981

Funnel-web spider (Atrax robustus) antivenom. 2. Early clinical experience.

This paper describes the successful use of funnel-web antivenom in two severe cases of envenomation from bites by a male funnel-web spider, Atrax robustus. Rapid resolution of the syndrome occurred in both cases. Although the first patient, a 49-year-old man, may have slowly recovered without antivenom, it is unlikely that the other patient, a three-year-old boy, would have survived without antivenom therapy. In both cases the duration of hospitalisation was dramatically reduced.

Antivenins↗
PubMed1981

A prospective study of serum complement (C3 and C4) levels in normal human pregnancy: effect of the development of pregnancy-associated hypertension.

Serum levels of complement components (C3 and C4) were measured serially in 173 initially normotensive pregnant women and the results compared with those obtained in 32 nonpregnant women of similar ages. There was significant elevation of serum levels of both C3 and C4 during gestation. Pregnancy-associated hypertension developed in the third trimester in 26 pregnant women but they had the-same degree of elevation of serum C3 and C4 levels as did the 147 pregnant women who remained normotensive throughout their pregnancy. Measurements of serum C3 and C4 levels and therefore of no value in predicting the development of pregnancy-associated hypertension.

Adolescent↗
PubMed1980

Verapamil in the long-term treatment of angina pectoris.

A long-term, open clinical trial of verapamil therapy was conducted in 93 patients with coronary artery disease, selected on the basis of having stable angina pectoris and of being unsuitable for treatment with beta-adrenergic blocking drugs. Two-thirds of the patients (58 patients) obtained a good relief which was sustained over a period of one year. There were few major adverse reactions, and the drug was generally well tolerated. The main limiting factor in dosage was hypotension. No adverse effects were observed in patients with obstructive airways disease, controlled cardiac failure, and lower limb arteriosclerosis. Verapamil was considered to be a major advance in the chronic therapy of angina pectoris.

Angina Pectoris↗
PubMed1979

In vivo anti-nuclear antibodies in epithelial biopsies in SLE and other connective tissue diseases.

In vivo anti-nuclear antibody (ANA) was observed by direct immunofluorescence microscopy in epithelial cell nuclei in forty-four biopsies from thirty-three patients. The tissue containing the ANA was macroscopically normal in twenty-seven patients. The thirty-three patients with in vivo biopsy ANA included twenty-three with SLE, three with mixed connective tissue disease, two each with multi-system Sjögren's syndrome, dermatomyositis, and progressive systemic sclerosis, and one with rheumatoid arthritis. Features of sicca syndrome were noted in seventeen patients. The patterns of the in vivo biopsy ANA in the thirty-three patients were speckled (21), homogeneous (6), nodular (2), and both speckled and homogeneous (4). Complement was not detected in the epithelial cell nuclei. Immunoglobulin(s) and/or complement were deposited along the dermoepidermal junction in thirty-two of the forty-four biopsies, and in dermal blood vessels in twenty-two biopsies. Each patient had serum ANA against rat liver substrate; twenty-seven had high titre ANA (1 in 1000 or greater). Elevated levels of DNA-binding were found in twenty patients (61%), but the level of DNA-binding did not correlate with the intensity of in vitro biopsy ANA staining. Serum antibody to ribonucleoprotein (RNP) was present in eight of the twenty-three patients tested (35%), all eight patients having clinical features of sicca syndrome. Hypocomplementaemia was found in thirteen patients (40%), all of whom had active SLE. In vivo biopsy ANA appears to be a real phenomenon of unknown aetiology, and not an artifact, which is found in some patients with active multisystem autoimmune disease, especially SLE.

Adult↗