Search PubMed⌕ Search

Biomedical subjects

Joseph Varon

Publications and source records attributed to Joseph Varon.

At least 19 recordsLinked to original sources
PubMed2006

Sleepiness in medical residents: impact of mandated reduction in work hours.

OBJECTIVES: To assess the sleepiness among Family Practice residents using subjective data, the Epworth sleepiness scale (ESS), as well as objective assessment, the multiple sleep latency test (MSLT). METHOD: We conducted the study on Family Practice residents at Texas A&M University, Corpus Christi. Sixteen residents, aged 21-40 yrs, were recruited and divided into two groups. The study group was comprised of residents who were on night-float rotation for at least three days and underwent MSLT post-call, and the control group was comprised of residents who were not on night-float and were not post-call. Daytime sleepiness was evaluated using both the ESS and MSLT. Respondents also completed a questionnaire assessing their beliefs regarding effects of sleep loss. RESULTS: Sleep latencies <10 min were observed in 6 out of the 8 day shift-work interns, while only 1 out of 8 night-float residents had an average sleep latency <10 min (p=0.0195). Following night-float, despite less sleep, residents had sleep latencies which were higher [14.2 (+/-5.0) min] than those in the control group [8.4 (+/-5.4) min, (p=0.043)]. Despite the difference in objective sleepiness, subjective sleepiness (Epworth scores) did not differ. Over 80% of interns reported having driven while sleepy. CONCLUSION: Sleepiness continues to be a significant issue among medical residents despite recently mandated reductions in resident work hours. MSLT values in the pathologic range are seen in the majority of residents studied, but in those who were post-night call there seemed to be a paradoxical improvement.

Adult↗
PubMed2006

Therapeutic hypothermia.

Therapeutic hypothermia has been used for millennia, but in recent years was not in much clinical use due to an apparent high risk of complications. More recently, the benefits of induced therapeutic hypothermia have been rediscovered, mainly with the improvement in neurological outcome in out-of-hospital cardiac arrest victims. In addition, therapeutic hypothermia has been suggested to improve outcome in other neurological conditions such as traumatic brain injury, neonatal asphyxia, cerebrovascular accidents and intracranial hypertension. This article reviews the history of the discovery of therapeutic hypothermia, as well as the current therapeutic applications and ways to deliver this treatment. Cooling techniques and recovery processes, as well as potential complications are also reviewed. Clinicians caring for a wide variety of critically ill patients should be familiar with the use of therapeutic hypothermia.

Heart Arrest↗
PubMed2006

Complete neurological recovery following delayed initiation of hypothermia in a victim of warm water near-drowning.

Induced hypothermia has been demonstrated to improve outcome following cardiac arrest and is now widely endorsed. However, the optimal method of cooling and the identification of patients most likely to benefit from this therapy remains to be determined. We report a patient in whom there was a long delay in return of spontaneous circulation (at least 45 min) and the initiation of induced hypothermia (12 h) who made an almost complete neurological recovery following cardiac arrest from warm-water near-drowning.

Electroencephalography↗
PubMed2005

Purple urine bag syndrome.

The purple urine bag syndrome (PUBS) is a rare condition associated with chronic urinary catheterization. It is characterized by the purple discoloration of the urine, collecting bag, and tubing. A number of factors are involved, but not always present, in its development including female sex, urinary tract infection, constipation, indicanuria, and alkaline urine. Despite multiple theories that involve the complex tryptophan metabolism to the tubing dye, the cause remains elusive. The syndrome resolves usually after treatment of urinary tract infection or changing of the collecting bag. We present a case of a patient with purple urine bag syndrome and a pertinent literature review.

Aged↗
PubMed2005

A clinician's guide to the appropriate and accurate use of antibiotics: the Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria.

In response to the overuse and misuse of antibiotics, leading to increasing bacterial resistance and decreasing development of new antibiotics, the Council for Appropriate and Rational Antibiotic Therapy (CARAT) has developed criteria to guide appropriate and accurate antibiotic selection. The criteria, which are aimed at optimizing antibiotic therapy, include evidence-based results, therapeutic benefits, safety, optimal drug for the optimal duration, and cost-effectiveness.

Anti-Bacterial Agents↗
PubMed2005

The discovery and rediscovery of oxygen.

The therapeutic use of oxygen was pioneered in the early 20(th) century by the respiratory physiologist John Scott Haldane. His work followed Claude Bernard's description of the toxic effects of carbon monoxide. Haldane, having also observed the effects of carbon monoxide poisoning, became aware of the therapeutic benefits of oxygen in this condition. He was also an advocate of oxygen as a therapeutic agent in other respiratory illness, and made efforts to define how the gas could best be administered. The history of identification of oxygen as a chemical element is convoluted. In the 17(th) century, the controversial John Mayow suggested that only a portion of air was necessary for sustaining life. Mayow's work was largely overlooked during his lifetime, and his insight was subsequently eclipsed by the phlogiston theory, an erroneous concept widely believed for nearly a century after his death. This theory was ultimately disproved by Joseph Priestley in 1774. Although the point of primacy is somewhat contentious, Priestley shares the distinction of discovering elemental oxygen with Antoine-Laurent Lavoisier, the French chemist, and Carl Wilhelm Scheele, the Swedish apothecary.

Europe↗
PubMed2005

Open-chest cardiopulmonary resuscitation: past, present and future.

Out-of-hospital cardiac arrests account for approximately 1000 sudden cardiac deaths per day in the United States. Since its introduction in 1960 closed-chest cardiac massage (CCCM) often takes place as an attempt at resuscitation, although its survival rates are low. Other resuscitation techniques are available to physicians such as open-chest cardiopulmonary resuscitation (OCCPR). OCCPR has been shown by several scientists to be hemodynamically superior to CCCM as it increases arterial pressures, cardiac output, coronary perfusion pressures, return of spontaneous circulation and cerebral blood flow. Improved neurological and cardiovascular outcome and an increase in survival rate compared to CCCM have been described. Timing is one of the key variables in determining patient outcome when performing OCCPR. The American Heart Association in association with the International Liaison Committee (ILCOR) has specific indications for the use of OCCPR. Some investigators recommend starting OCCPR in out-of-hospital cardiac arrests on arrival at the scene instead of CCCM. Surprisingly, the incidence of infectious complications after thoracotomy in an unprepared chest is low. The vast majority of the patients' families accept OCCPR as a therapeutic choice for cardiac arrests and it has been showed to be economically viable. This paper reviews some of the basic and advanced concepts of this evolving technique.

Acidosis↗
PubMed2004

Bench-to-bedside review: Rhabdomyolysis -- an overview for clinicians.

Rhabdomyolysis ranges from an asymptomatic illness with elevation in the creatine kinase level to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure and disseminated intravascular coagulation. Muscular trauma is the most common cause of rhabdomyolysis. Less common causes include muscle enzyme deficiencies, electrolyte abnormalities, infectious causes, drugs, toxins and endocrinopathies. Weakness, myalgia and tea-colored urine are the main clinical manifestations. The most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration.

Acute Kidney Injury↗
PubMed2004

Clinician discomfort with life support plans for mechanically ventilated patients.

OBJECTIVE: To examine the incidence and predictors of clinician discomfort with life support plans for ICU patients. DESIGN AND SETTING: Prospective cohort in 13 medical-surgical ICUs in four countries. PATIENTS: 657 mechanically ventilated adults expected to stay in ICU at least 72 h. MEASUREMENTS AND RESULTS: Daily we documented the life support plan for mechanical ventilation, inotropes and dialysis, and clinician comfort with these plans. If uncomfortable, clinicians stated whether the plan was too technologically intense (the provision of too many life support modalities or the provision of any modality for too long) or not intense enough, and why. At least one clinician was uncomfortable at least once for 283 (43.1%) patients, primarily because plans were too technologically intense rather than not intense enough (93.9% vs. 6.1%). Predictors of discomfort because plans were too intense were: patient age, medical admission, APACHE II score, poor prior functional status, organ dysfunction, dialysis in ICU, plan to withhold dialysis, plan to withhold mechanical ventilation, first week in the ICU, clinician, and city. CONCLUSIONS: Clinician discomfort with life support perceived as too technologically intense is common, experienced mostly by nurses, variable across centers, and is more likely for older, severely ill medical patients, those with acute renal failure, and patients lacking plans to forgo reintubation and ventilation. Acknowledging the sources of discomfort could improve communication and decision making.

APACHE↗
PubMed2004

To plug or not to plug?

Coronary artery disease remains a common problem in industrialized countries. Percutaneous coronary interventions are usually performed utilizing the femoral approach. Arterial puncture-closing devices have been developed in hope to avoid manual compression and shortening the period of rest. In a recent meta-analysis in the Journal of the American Medical Association these devices have shown only marginal benefits over manual compression. Further, well designed studies are necessary to document the comparative effects of these devices versus manual compression.

Angioplasty, Balloon, Coronary↗