Search PubMed⌕ Search

Biomedical subjects

J Weller

Publications and source records attributed to J Weller.

At least 19 recordsLinked to original sources

Anaesthetists' management of oxygen pipeline failure: room for improvement.

Oxygen pipeline failure is a rare but potentially catastrophic event which can affect the care of patients throughout an entire hospital. Anaesthetists play a critical role in maintaining patient safety, and should be prepared to support an institution-wide emergency response if oxygen failure occurs. We tested the preparedness for this through observation of 20 specialist anaesthetists to a standardised simulator scenario of central oxygen supply failure. Responses were documented using multiple approaches to ensure accuracy. All anaesthetists demonstrated safe immediate patient care, but we observed a number of deviations from optimal management, including failure to conserve oxygen supplies and, following restoration of gas supplies, failure to test the composition of the gas supplied from the repaired pipelines. This has implications for patient care at both individual and hospital level. Our results indicate a gap in anaesthesia training which should be addressed, in conjunction with planning for effective hospital-wide responses to the event of critical resource failure.

Anesthesiology↗

Perioperative beta-blockade: guidelines and practice in New Zealand.

The aim of our study was to describe the knowledge and practice of New Zealand anaesthetists in relation to perioperative beta-adrenergic blockade, and to define barriers to implementation of perioperative beta-blockade in surgical patients at risk of myocardial ischaemia. A survey was sent to 400 New Zealand specialist anaesthetists. Information was sought on their knowledge and current practice relating to perioperative beta-blockade, and the barriers encountered to implementing therapy. The response rate was 59%. Perioperative beta-blockade was seen as beneficial in at risk patients by 95% of responding anaesthetists, but practice varied widely. Only 45% of anaesthetists always or usually commenced a beta blocker perioperatively, a department protocol was available to only 20%, and understanding of indications and contraindications to beta-blockade varied. There were logistical difficulties when initiating and monitoring perioperative beta-blocker regimens, and where treatment required multidisciplinary commitment. The lack of clarity of the guidelines was also a barrier to more widespread use. Difficulties were encountered relating general guidelines to individual patients, when co-morbidities, concurrent treatment and the influence of regional or general anaesthesia may influence the risk/benefit ratio. This study has identified variations in practice and reasons why New Zealand anaesthetists use of perioperative beta-blockers is at odds with published guidelines. Deficiencies in the guidelines are part of the problem. However, even with consensus on guidelines, effective multidisciplinary strategies will be required to optimize treatment of patients at risk of perioperative cardiac events.

Adrenergic beta-Antagonists↗

Evidence-based strategies for preventing drug administration errors during anaesthesia.

We developed evidence-based recommendations for the minimisation of errors in intravenous drug administration in anaesthesia from a systematic review of the literature that identified 98 relevant references (14 with experimental designs or incident reports and 19 with reports of cases or case series). We validated the recommendations using reports of drug errors collected in a previous study. One general and five specific strong recommendations were generated: systematic countermeasures should be used to decrease the number of drug administration errors in anaesthesia; the label on any drug ampoule or syringe should be read carefully before a drug is drawn up or injected; the legibility and contents of labels on ampoules and syringes should be optimised according to agreed standards; syringes should (almost) always be labelled; formal organisation of drug drawers and workspaces should be used; labels should be checked with a second person or a device before a drug is drawn up or administered.

Anesthesia, Intravenous↗

Continuing education and New Zealand anaesthetists: an analysis of current practice and future needs.

A survey of Continuing Medical Education (CME) of New Zealand anaesthetists was undertaken to identify current patterns of participation, usefulness of different activities, evidence of effectiveness, motivators and barriers to participation and to define future CME needs. The response rate was 74% and showed high levels of participation in a range of CME activities. Ratings for usefulness differed significantly between these activities. Respondents identified specific changes they had made to their practice as a result of CME, providing strong evidence for its effectiveness. Anaesthetists valued interactive methods of learning that were relevant to clinical practice. The most commonly reported motivators for participation were accreditation requirements and keeping up to date, while other work commitments were the commonest impediment. In this survey, interactive educational interventions were seen as useful, a finding consistent with systematic reviews of the effectiveness of CME in changing physician behaviour. Such reviews conclude that there is no evidence that conferences are effective in changing physician behaviour, yet respondents to this survey attributed many changes in practice to their attendance at a conference. Analysis of the needs of NZ anaesthetists supports increasing the number of workshops and interactive sessions and promoting smaller meetings and practice-based activities. The survey provides a basis for designing a future program of CME for New Zealand.

Anesthesiology↗

Survey of change in practice following simulation-based training in crisis management.

We investigated the long-term effects on clinical practice of a simulation-based course in anaesthesia crisis management. A questionnaire was posted to all anaesthetists who had attended a course in the preceding year. The response rate was 69% (66/96). The crisis management course was valued highly by respondents, who perceive a change in practice as a result of the training. This change in practice was not limited to the specific clinical events simulated in the course, but applied to a wide range of events and to routine practice. The high rate of subsequent critical events reported in the survey supports the need for training in this area. This survey suggests that simulation-based training in crisis management is an effective form of continuing medical education for anaesthetists.

Anesthesiology↗

Evaluation in an anaesthetic simulator of a prototype of a new drug administration system designed to reduce error.

Ten anaesthetists were observed while providing anaesthesia for two simulated surgical procedures, twice using conventional methods and twice using a prototype of a new drug administration system designed to reduce error. Aspects of each method were rated by users on 10-cm visual analogue scales (10 being best) and comments were invited. Median safety scores were 7.7 cm (range 4.3-8.9) for the new system and 4.6 cm (1.3-8.2) for conventional methods (p = 0.009). The new system was compared favourably with conventional methods in respect of safety (p = 0.005), clinical acceptability (p = 0.008), organisation and layout (p = 0.047), and acceptability for use on patients (p = 0.005). The new system saved time in the preparation of drugs both before anaesthesia (105 vs. 346 s; p < 0.001) and during anaesthesia (20 vs. 104 s; p < 0.001). Comments facilitated development of the system and the evaluation endorsed proceeding to a clinical trial.

Anesthesiology↗

Isolation and developmental expression of two nuclear receptors, MHR4 and betaFTZ-F1, in the tobacco hornworm, Manduca sexta.

The cDNAs for two members of the nuclear receptor superfamily were isolated from the tobacco hornworm, Manduca sexta. The deduced amino acid sequence of MHR4 shows 93-95% identity in the DNA-binding domain and the first portion of the hinge (D) region with the germ cell nuclear factor (GCNF)-related factors (GRFs) of the silkworm, Bombyx mori, and the mealworm, Tenebrio molitor, and with a genomic sequence from the fruit fly, Drosophila melanogaster. Northern blot hybridization showed that a 7.5 kb MHR4 mRNA appeared in Manduca abdominal epidermis just as the ecdysteroid titer began to decline during the larval molt, disappeared about 12 h later, then transiently reappeared shortly before larval ecdysis. During the pupal and adult molts, a similar pattern of expression was seen (the very end of the adult molt was not studied). At peak times of expression in the epidermis, MHR4 mRNA was also present in fat body and the central nervous system (CNS). The deduced amino acid sequence of Manduca FTZ-F1 is 100% and 96% identical to that of B. mori and Drosophila betaFTZ-F1, respectively, in the DNA-binding domain and the adjacent hinge region including the FTZ-F1 box. Northern blot analysis showed that the >9.5 kb betaFTZ-F1 mRNA appeared in Manduca epidermis during the decline of the ecdysteroid titer in the larval, pupal and adult molts as the first peak of MHR4 mRNA declined, then it disappeared in the larval and pupal molts before the second peak of MHR4 appeared. betaFTZ-F1 mRNA was also found in fat body and the CNS at the time of peak expression in the epidermis during the larval and pupal molts. Both MHR4 and betaFTZ-F1 mRNAs were found in the testis during the onset of spermatogenesis in the prepupal period.

Amino Acid Sequence↗

Opportunities for future supernova studies of cosmic acceleration.

We investigate the potential of a future supernova data set, as might be obtained by the proposed SNAP satellite, to discriminate among different "dark energy" theories that describe an accelerating Universe. We find that many such models can be distinguished with a fit to the effective pressure-to-density ratio w of this energy. More models can be distinguished when the effective slope dw/dz of a changing w is also fit, but only if our knowledge of the current mass density Omega(m) is improved. We investigate the use of "fitting functions" to interpret luminosity distance data from supernova searches.

Astronomy↗

Gain in strength and muscular balance after balance training.

The isolated effect of balance training on muscle strength of the flexors and extensors of the knee, without accompanying strength training, has not been addressed in the past. Effects of a balance training program alone were compared to a strength training program. Balance and strength training were performed by 15 persons each for 6 weeks including 12 training units of 25 min. Balance training was performed on instability training devices such as rolling board, mini trampoline and large rubber ball. The 15 persons of the strength training group trained on machines for leg curls and on leg presses for 25 min per unit. Measurements for balance were performed with one-leg balance on a narrow edge and a tilting stabilometer for 30 s; maximum isometric strength was measured using an isokinetic device for each leg separately. The muscular balance between dominant and non-dominant leg was calculated. Strength gain was similar for the flexors and extensors in both groups. One-leg balance improved after balance training (P< 0.01) with a 100% increase over the strength training group (P < 0.05) and the stabilometer test for each person in the balance (P < 0.01), but not in the strength training group. In the balance group the initial difference between right and left diminished. The results indicate balance training to be effective for gain in muscular strength, and secondly, in contrast to strength training, equalisation of muscular imbalances may be achieved after balance training.

Adult↗

The frequency and nature of drug administration error during anaesthesia.

We aimed to establish the frequency and nature of drug administration error in anaesthesia (a significant subset of error in medicine) at two hospitals. Anaesthetists were asked to return a study form anonymouslyfor every anaesthetic, indicating whether or not a drug administration error or pre-error (defined as any incident with potential to become an error) had occurred. Further details were sought if the response was affirmative. From 10,806 anaesthetics, 7794 study forms were returned, representing response rates of 80% from Hospital A and 57% from Hospital B (72% overall). The frequency (95% confidence intervals) of drug administration error; of any type, per anaesthetic was 0.0075 (0.006 to 0.009), of i.v. bolus errors was 0.005 (0.0035 to 0.006) and of pre-errors was 0.004 (0.003 to 0.005), with no significant difference between hospitals. Overall, one drug administration error was reported for every 133 anaesthetics. The two largest individual categories of error involved incorrect doses (20%) and substitutions (20%) with i.v. boluses of drug. Of the i.v. bolus substitutions, 69% occurred between different pharmacological classes. One patient was aware while under muscle relaxation, and two required prolonged ventilation. In addition, 47 transient physiological effects were reported, of which five required intervention. We conclude that drug administration error during anaesthesia is considerably more frequent than previously reported.

Anesthesia↗

The genome sequence DataBase.

The Genome Sequence DataBase (GSDB) is a database of publicly available nucleotide sequences and their associated biological and bibliographic information. Several notable changes have occurred in the past year: GSDB stopped accepting data submissions from researchers; ownership of data submitted to GSDB was transferred to GenBank; sequence analysis capabilities were expanded to include Smith-Waterman and Frame Search; and Sequence Viewer became available to Mac users. The content of GSDB remains up-to-date because publicly available data is acquired from the International Nucleotide Sequence Database Collaboration databases (IC) on a nightly basis. This allows GSDB to continue providing researchers with the ability to analyze, query and retrieve nucleotide sequences in the database. GSDB and its related tools are freely accessible from the URL: http://www.ncgr.org

Databases, Factual↗

The phytophthora genome initiative database: informatics and analysis for distributed pathogenomic research.

The Phytophthora Genome Initiative (PGI) is a distributed collaboration to study the genome and evolution of a particularly destructive group of plant pathogenic oomycete, with the goal of understanding the mechanisms of infection and resistance. NCGR provides informatics support for the collaboration as well as a centralized data repository. In the pilot phase of the project, several investigators prepared Phytophthora infestans and Phytophthora sojae EST and Phytophthora sojae BAC libraries and sent them to another laboratory for sequencing. Data from sequencing reactions were transferred to NCGR for analysis and curation. An analysis pipeline transforms raw data by performing simple analyses (i.e., vector removal and similarity searching) that are stored and can be retrieved by investigators using a web browser. Here we describe the database and access tools, provide an overview of the data therein and outline future plans. This resource has provided a unique opportunity for the distributed, collaborative study of a genus from which relatively little sequence data are available. Results may lead to insight into how better to control these pathogens. The homepage of PGI can be accessed at http:www.ncgr.org/pgi, with database access through the database access hyperlink.

Databases, Factual↗

Hours of work and fatigue-related error: a survey of New Zealand anaesthetists.

A nationwide survey (70% response) documented anaesthetists' hours of work, their perceptions about safety limits and their recollection of fatigue-related errors in clinical practice. In the preceding six months, 71% of trainees and 58% of specialists had exceeded their self-defined safety limits for continuous anaesthesia administration. For 50% of trainees and 27% of specialists, their average working week exceeded their own limits for maintaining patient safety, and for 63% of trainees and 40% of specialists, it exceeded their limits for maintaining their personal well-being. Fatigue-related errors were reported by 86% of respondents, with 32% recalling errors in the preceding six months. Specialists were more likely to report a fatigue-related error if they had exceeded their own safety limits for continuous anaesthesia administration, or for weekly work hours. Current measures are not preventing anaesthetists from working hours that they consider to be unsafe for patients or harmful to their own well-being.

Anesthesiology↗

Inhomogeneous Reionization and the Polarization of the Cosmic Microwave Background.

In a universe with inhomogeneous reionization, the ionized patches create a second-order signal in the cosmic microwave background polarization anisotropy. This signal originates in the coupling of the free-electron fluctuation to the quadruple moment of the temperature anisotropy. We examine the contribution from a simple inhomogeneous reionization model and find that the signal from such a process is below the detectable limits of the Planck Surveyor mission. However, the signal is above the fundamental uncertainty limit from cosmic variance, so that a future detection with a high-accuracy experiment on subarcminute scales is possible.

Journal Article↗

Evaluation of AFLP, a high-resolution DNA fingerprinting method, as a tool for molecular subtyping of enterohemorrhagic Escherichia coli O157:H7 isolates.

The amplified fragment-length polymorphism (AFLPTM) technique is based on the selective PCR amplification of restriction fragments. We investigated the utility of AFLP in the molecular subtyping of enterohemorrhagic Escherichia coli serotype O157:H7 isolates. We analyzed a total of 46 isolates of E. coli O157:H7 along with other serotypes, O26:H11, 0114:H19 and 0119:NT. Isolates of E. coli O157:H7 derived from the same outbreak showed an identical AFLP-banding pattern and were subtyped into the same group, giving results almost consistent with those of a pulsed-field gel electrophoresis (PFGE) study, while other serotypes showed clearly different patterns from those of E. coli O157:H7. These results suggest that the AFLP technique has potential as an alternative tool for the molecular epidemiology of E. coli O157:H7.

Bacterial Typing Techniques↗

Helicobacter pylori products upregulate neutrophil superoxide anion production.

Helicobacter pylori-neutrophil interactions may play a pathogenic role in H. pylori-induced gastritis and peptic ulcer disease. To understand these interactions, we explored the effects of H. pylori-derived products on neutrophil chemotaxis and superoxide anion production. H. pylori bacteria were cultured and supernatants fractionated. Neutrophil chemotactic activity was confirmed in the crude supernatants and in one fractionated peak corresponding to a previously described neutrophil chemotactic factor. H. pylori-derived crude supernatant, sonicate and all chromatography-derived peaks failed to directly stimulate neutrophil superoxide anion production. However, after pretreatment with sonicate, neutrophils demonstrated increased superoxide anion production (priming) following subsequent exposure to the secretagogue fmet-leu-phe. These results suggest that H. pylori products may attract neutrophils to the gastric mucosa without initially stimulating superoxide anion production or tissue injury. Oxygen radical-mediated gastric mucosal injury may subsequently result when these primed neutrophils undergo additional stimulation by as yet unidentified factors.

Chemotaxis, Leukocyte↗

History of successful ballot initiatives--Oregon.

In this report, the author traces the background of Ballot Measure 44, which raised taxes on cigarette and other tobacco products in Oregon. He highlights the effect of a positive coalescing of different forces (nonprofit health groups and medical groups) despite initial differences in program strategy.

Humans↗