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Biomedical subjects

M M Shabot

Publications and source records attributed to M M Shabot.

At least 55 records · Page 3Linked to original sources
PubMed1991

Early absorption of enteral ranitidine after major laparotomy.

Thirty-six patients were studied following abdominal aortic surgery to determine if a commonly used medication could be absorbed from the gastrointestinal (GI) tract in the early postoperative period. Patients were randomized into two groups: Group I received ranitidine elixir 3 mg/kg via nasogastric tube every 12 hours; Group II received intravenous (IV) ranitidine 1 mg/kg every 8 hours. Ranitidine serum levels were measured with high performance liquid chromatography 1 hour after administration of the first three doses. Gastric pH was measured every 4 hours. It was found that serum ranitidine levels generally regarded as clinically effective were achieved in both groups. Although the levels were significantly higher following intravenous (IV) administration (Group II), there were no differences in average gastric pH. The authors conclude that within 24 hours of aortic surgery enterally administered ranitidine is effectively absorbed and provides prophylaxis equivalent to IV administration of the drug at lower cost. Other medications might be deliverable via the GI tract in the early postoperative period.

Administration, Oral↗
PubMed1991

Early diagnosis and treatment of sinusitis in the critically ill trauma patient.

Sinusitis is an important cause of sepsis in the critically ill patient and may be difficult to diagnose. Four patients admitted to the surgical intensive care unit with closed head trauma were found to have sinusitis as the cause of persistent bacteremia. All patients received pharmacologic doses of corticosteroids for treatment of head injury and had prolonged nasotracheal and/or nasogastric intubation. A bedside procedure was used for diagnosis and management. Under local anesthesia, a 16-gauge angiocatheter was inserted under the inferior turbinate and into the maxillary sinus. After purulent fluid was aspirated, the sinuses were irrigated with normal saline. All four patients defervesced within 24 to 48 hours of this procedure, and facial x rays demonstrated clearing of the maxillary sinus. It was concluded that: 1) Sinusitis is a complication of closed head trauma in critically ill patients and should be included in the differential diagnosis when persistent bacteremia occurs; 2) The use of corticosteroids in the treatment of head injury may increase the risk of sinus infection; 3) Facial x rays showing air-fluid levels and/or opacification are a valuable screening test for paranasal sinusitis; and 4) bedside aspiration of the maxillary sinus is an effective diagnostic and therapeutic technique for management of sinusitis in the critically ill.

Adolescent↗
PubMed1991

Impact of ICU nosocomial infections on outcome from surgical care.

The authors studied the impact of intensive care unit (ICU) acquired nosocomial infections on surgical patients stratified by severity of illness before acquisition of the infection. Data were analyzed from 2,122 consecutive patients admitted to a 20 bed surgical intensive care unit (SICU) from January 1, 1988 to December 31, 1988. The simplified acute physiology score (SAPS), a measure of illness severity that correlates with mortality, was calculated for all patients on their first SICU day. Ninety-seven nosocomial infections from various sites were documented in 54 patients. Patients who acquired a nosocomial infection were significantly more ill upon admission to the SICU than patients who did not acquire such an infection (control patients). Stratified by admission severity of illness, patients acquiring one or more nosocomial infections had a significantly longer SICU stay, averaging 25.3 days compared to 2.3 days in control patients (P less than 0.001). Hospital stay was also significantly increased at 59.9 days, compared to 15.0 days in control patients (P less than 0.001). However, the overall mortality rate for patients developing nosocomial infections was significantly higher than control patients only in the middle range of admission SAPS measurements. The authors found that the monthly incidence of isolates of Xanthomatous maltophilia, a multiply-resistant nosocomial organism, reflected the overall incidence of nosocomial infections in the SICU. They observed a decline in the number of new X. maltophilia isolates and nosocomial infections concomitant with the introduction of gown and glove contact isolation procedures. The authors conclude that nosocomial infections in the SICU setting are directly related to increased patient morbidity and mortality depending, in part, on severity of illness upon admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Quality assurance and utilization assessment: the major by-products of an ICU clinical information system.

In 1985 we developed a method of automatically extracting indices of severity of illness and intensity of interventions from CIS charts daily. These indices, when combined with outcome measures such as length of stay and mortality, provide a powerful new tool for quality management in the ICU. In this paper we describe our ICU's severity adjusted survival rates as compared to internationally publish norms. In addition we provide a detailed analysis of glucose levels in our ICU, which suggests that glucose control in surgical ICU patients is more closely related to measured severity of illness than administration of intravenous alimentation per se. CIS extracted indices provide a new basis for continuous quality measurement and improvement in the ICU.

Blood Glucose↗
PubMed1990

Cystadenocarcinoma of the pancreas: neo-adjuvant therapy and CEA monitoring.

Cystadenocarcinoma of the pancreas is generally considered to be unresponsive to chemotherapy and radiation therapy. We present two cases of laparotomy-proven unresectable cystadenocarcinoma which responded to intravenous 5-fluorouracil (1,000 mg/m2/24 hr x 5 days x 2) and 4,000 rads of radiation therapy. Both patients had objective response with marked shrinkage of the tumor as determined by clinical examination and computed tomography. At reexploration both tumors had become completely resectable with histologically clear margins and negative lymph nodes. Carcinoembryonic antigen (CEA) levels were elevated in both patients at initial presentation (86 and 71 ng/ml). The CEA levels declined to 19.9 and 66.0 ng/ml, respectively, after neo-adjuvant therapy, and both fell to normal levels after resection. Although surgical resection has been considered the only curative therapy for patients with pancreatic cystadenocarcinoma, we suggest that preoperative irradiation and chemotherapy may reduce the size of seemingly unresectable tumors. We also recommend serial CEA determinations in patients with levels initially elevated as a marker of the response to neo-adjuvant and operative therapy.

Carcinoembryonic Antigen↗
PubMed1990

The medical device data language for the P1073 medical information bus standard.

A new object-oriented Medical Device Data Language (MDDL) has been developed by the P1073 Medical Information Bus (MIB) Standard Committee, under the auspices of the Engineering in Biology and Medicine Society (EMBS) of the Institute of Electronic and Electrical Engineers (IEEE). The MDDL treats devices, host computers, persons and parameters as objects, and provides methods for describing and passing messages between objects. An elegant method of specifying parameter attributes incorporates the inheritance and encapsulation qualities common to object-oriented languages. Existing standards for device, parameter and attribute nomenclatures are used to represent MDDL components whenever possible. The MDDL provides a rich and extensible method for standardized host-device communications.

California↗
PubMed1990

Decision support alerts for clinical laboratory and blood gas data.

We have designed and implemented a computerized Intensive Care Unit (ICU) decision support alerting system which analyzes all incoming laboratory and blood gas data for critically abnormal values and trends. A computerized patient data management system (HP 78709A PDMS, Hewlett-Packard Co., Waltham, MA) serving 20 Surgical ICU beds is networked to a Clinical Laboratory Information System and a blood gas computer system. The ALERTS subsystem operates on the PDMS as an automatic program triggered by the receipt of fresh laboratory data. Three types of ALERTS are detected: (1) high and low critical values, (2) calculation-adjusted critical values, and (3) critical trends. Once detected, a specific ALERT message is displayed at the bottom of the patient's bedside PDMS terminal and at the central station. Over an eight month period a total of 1,515 ALERTS were detected from amongst approximately 115,000 laboratory data results transmitted to the Surgical Intensive Care Unit (SICU). Slightly over half of all ALERTS were caused by critical blood gas values. ALERTS were found to be a sensitive indicator of severity of illness: patients with one or more ALERTS suffered an ICU mortality of 9.52%, compared to 0% mortality in patients with no ALERTS. We conclude that automated laboratory data ALERTS represent a valuable decision support tool for the management of high risk ICU patients.

Blood Gas Analysis↗
PubMed1989

Standardized acquisition of bedside data: the IEEE P1073 medical information bus.

The absence of standards for medical device communications has stymied the acceptance and success of automated clinical data management systems. Even devices with simple RS-232 data output ports require special interfacing hardware and software. Due to the number and variety of medical devices available, each with their own peculiar data output configuration, it has been impractical to interface with most of them. Limited by manual data entry, most computerized patient data management systems have failed to deliver the productivity gains their users expected. The forthcoming IEEE P1073 Medical Information Bus (MIB) Standard promises to correct this situation with a single powerful bedside device interface method. The MIB will provide specifications for all hardware and software necessary for medical data communications. The MIB handles the need for automatic recognition of new devices placed at a bedside, automatic reconfiguration of the network, binding of a device to a particular patient's bedside and many other issues unique to the medical data communications environment. The MIB is expected to undergo formal IEEE balloting in 1990 and promises to open a new era in data management for clinical patient care.

Computer Systems↗
PubMed1988

Keys to the successful implementation of an ICU patient data management system.

Implementation of an ICU data management system requires consideration of many factors, including site preparation for equipment, system backup, ICU & medical staff training and evaluation. This paper describes the strategy for implementing a patient data management system at Cedars-Sinai Medical Center and details our steps for planning, training, configuration and problem resolution.

California↗
PubMed1988

A 32 key keyboard for the HP PDMS.

The keyboard remains the primary human interface device for existing patient data management systems. The standard bedside keyboard for the Hewlett-Packard PDMS has 16 keys which are used for both numeric data entry and multiple functions, accessed by shift key combinations. We have designed and constructed a 32 key keyboard which speeds single keystroke access to all PDMS functions. The new keyboard is backwards compatible and requires no PDMS software changes. A 32 key keyboard offers many advantages for use with the HP PDMS. The device presented is backwards compatible with the vendor's keyboard and requires no software changes. This keyboard could serve as an updated functional replacement for thousands of keyboards now in use.

Computer Systems↗
PubMed1988

An automatic PDMS interface for the Urotrack Plus 220 urimeter.

Periodic measurements of urine volume and temperature in critically ill patients are time consuming, unclean procedures. These measurements may be automated with an electronic urimeter (Urotrack Plus 220, C.R. Bard Company, Murray Hill, NJ). This device contains an RS-232 output port which transmits a complete device status report once per second. We interfaced 20 Urotrack Plus urimeters to a single I/O port of a computerized patient data management system (Hewlett-Packard 78709A PDMS, Hewlett-Packard Company, Waltham, MA). This interface required daisy chained controllers for port switching and a communications adapter for flow control. The urimeters have proven to be cost-effective, labor-saving devices. The PDMS interface provides a continuous display of measured variables and completely automates data entry for flowsheet documentation. Automatic urimetry data acquisition is estimated to save approximately 27 nursing minutes per patient per day.

Attitude of Health Personnel↗
PubMed1988

The PDMS as a focal point for distributed patient data.

Distributed data links are essential requirements for a successful patient data management system (PDMS). These links funnel clinically needed data into bedside ICU workstations. We have constructed four data links which acquire most of the objective data required for direct patient care. Data from bedside monitors is acquired via a standard HP Signal Distribution Network. Urine volumes and core bladder temperatures are acquired over a link to 20 electronic urimeters. Clinical laboratory data is obtained over an HP General Purpose Data Link (GPDL) to a VAX 11/785 laboratory system. Blood gas data is obtained over a second GPDL link to a DEC 11/23 computer. The ICU staff is notified of incoming lab results with bedside video messages. Combined with automated calculations, these data links eliminate thousands of data entry keystrokes daily and allow the PDMS to serve as the focal point for real-time patient care.

Computer Systems↗
PubMed1987

Automatic extraction of intensity-intervention scores from a computerized surgical intensive care unit flowsheet.

Systems that objectively score severity of illness and intensity of patient care interventions have been used to guide the appropriate use of intensive care facilities, provide information on nurse staffing ratios, validate subjective classifications of patient illness, and normalize scientific and financial studies for severity of illness. Existing scoring systems require a well-trained observer to perform a thorough chart review to complete manual scoring forms. We have designed a new system in which computerized intensity-intervention scores are automatically extracted from electronic intensive care unit flowsheets, eliminating both manual labor and potential observer variation. In prospective studies, these computerized scores correlated well with manual TISS scores, intensive care unit mortality, intensive care unit length of stay, hospital length of stay, and a subjective classification of patients to graded levels of hospital care. Such automated scores may be used for real-time allocation of health care resources and normalization of prospective studies for severity of illness.

California↗
PubMed1986

Graphical reports and displays for complex ICU data: a new, flexible and configurable method.

The use of computers for critical care data management may markedly increase the volume of digital numbers presented to the nurse and clinician. Such digital displays and reports may not be optimum for estimating the graded levels of intervention required for specific physiologic problems. We have devised software subsystems which allow for rapid configuration of medically oriented graphical reports and video images, using an English language syntax rather than specific computer code. These subsystems produce graphical reports which resemble previous hand-written charts, and video displays which are useful for hemodynamic patient management.

Data Display↗