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Biomedical subjects

M Mitchell

Publications and source records attributed to M Mitchell.

At least 271 records · Page 15Linked to original sources
PubMedDate not supplied

Responsibility for controlled drugs in operating departments.

The difficulties experienced with the recruitment and retention of registered nurses has made it necessary for NHS trusts to review the traditional role of nurses and to transfer some of their duties to other groups of staff in order to maintain services. For example, in the operating department, operating department assistants and operating department practitioners (ODAs/ODPs) are undertaking some of the duties that were previously the responsibility of nurses. This article presents the findings of a survey to determine the extent to which ODAs/ODPs have access to controlled drugs in operating theatres. The survey was initially undertaken by the author in Welsh hospitals during 1998. The mixed responses generated discussion in the Duthie Review Committee (Committee Chairman, personal communication, Royal Pharmaceutical Society of Great Britain (RPSGB), 1999) and led to a collaborative exercise based on a random selection of NHS trust hospitals in England, Scotland and Northern Ireland to obtain a broader data across the UK. Despite a clear legal position concerning possession, the survey showed that practice varied widely and that some trusts may be contravening the Misuse of Drugs Regulations 1985 in order to keep the service running when registered nurses are not available.

Drug and Narcotic Control↗
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Insider/outsider partnerships in an ethnographic study of shared governance.

The benefits of research being undertaken by more than one researcher cannot be underestimated. Having one researcher with intimate knowledge of the organisation and another who could provide a dispassionate view, paid dividends in this study into shared governance from an ethnographic perspective.

Anthropology, Cultural↗
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Nursing intervention for pre-operative anxiety.

Surgical nursing is changing as the type of surgical procedures being performed are becoming more complex and the time for delivering nursing care is reducing. This has resulted in condensing the acute physical care required into a few hours, often to the detriment of other aspects of nursing intervention such as pre- and post-operative anxiety management. A pre-operative psychological care plan for use in a modern, dynamic, surgical arena is briefly outlined as no such strategy currently exists.

Adaptation, Psychological↗
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Determination of fluoroquinolone residues in animal tissues using Escherichia coli as indicator organism.

Three strains of Escherichia coli (ATCC 128, 10536, and 25922) and one strain of Bacillus subtilis (ATCC 3491) were compared as indicator microorganisms in microbial inhibition tests for their ability to detect fluoroquinolone residues. E. coli strains 128 and 10536 were most susceptible to fluoroquinolone residues, with detection limits of 35-50 micrograms/kg for enrofloxacin. Of the 2 strains, E. coli 10536 was slightly less susceptible. Ciprofloxacin was detected consistently by E. coli 128 at 30 micrograms/kg. Other fluoroquinolone drugs of veterinary interest detected by E. coli 128 were sarafloxacin and difloxacin at 100-250 micrograms/kg concentration. E. coli 25922 yielded 100% sensitivity in detection of enrofloxacin only at the 250 micrograms/kg concentration, and ciprofloxacin and sarafloxacin at 200 micrograms/kg. B. subtilis detected only enrofloxacin 100% of the time at 250 micrograms/kg. The E. coli strains tested were insensitive to other antibacterials commonly used in animals, with the exception of ceftiofur which was detected by E. coli 128 and 10536 at 500 micrograms/kg. The B. subtilis strain was not effective in detecting the fluoroquinolone drugs, whereas the E. coli strains were selective for the fluoroquinolones. E. coli 128 was 100% effective in detecting enrofloxacin and ciprofloxacin in spiked diaphragm homogenate samples at 50 micrograms/kg. Of the microorganisms tested, E. coli strain ATCC 128 was highly suitable as an indicator microorganism in a microbial inhibition assay for selective detection of fluoroquinolone antibacterial residues in animal tissues.

Animals↗
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Open-access appointment scheduling in family practice: comparison of a demand prediction grid with actual appointments.

BACKGROUND: Inadequate access to their primary care physician remains a major reason for patient dissatisfaction in ambulatory care. The concept of open-access appointment scheduling has been found to accommodate patients' urgent health care needs while providing continuous, routine care. We describe the development of a demand prediction grid for future appointments, compare it with one developed by Kaiser Permanente, and compare the predictions with actual appointments made and held in our clinic. METHODS: Using adjusted 1999 appointments based on historical data for the Scott & White Killeen Clinic (> 75,000 annual appointments; 13 family physicians), we computed appointment predictions for calendar year 2000 by day of the week and by month of the year. We then compared our predictions with those of Kaiser and actual appointments for the first half of 2000. RESULTS: Our data and the Kaiser data agreed on the day of week, but they were different for the summer and winter months. Overall, actual appointments made and held at our clinic for January through June 2000 were within 6% of the predictions. Appointments for January and February were 18% and 4% more than the predictions, respectively, while appointments for March were 3% less than the predictions. Appointments for April through June were 3% to 7% more than the predictions. Few daily variations were observed between actual appointments and predictions. CONCLUSIONS: We conclude that the Kaiser data might be tempered by a different climate, underscoring the need for each practice to develop its own demand prediction grid. That our actual appointments were 6% more than predicted overall but fluctuated month by month reemphasizes the need for continuous monitoring of the adjustment factor for prediction.

Appointments and Schedules↗
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Diagnostic imaging approach to bone tumors of the foot.

The authors review various bone tumors in the foot. They use ten key points with respect to five levels of evaluation, in order to assist the clinician in rapid recognition of these maladies. The classification system relates to plain x-ray films, although the authors also illustrate other sophisticated radiologic techniques for increased accuracy.

Bone Cysts↗
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Relationship of direct nursing care hours to DRG and severity of illness.

Great variation in nursing resource use is documented within DRGs. Much of this variation may be explained by patient severity of illness. Variance in nursing resource use within DRGs can be reduced by using a severity of illness instrument to score patients.

Costs and Cost Analysis↗
PubMedDate not supplied

Management of dizziness in primary care.

BACKGROUND: We sought to determine the types of dizziness problems that are commonly seen in primary care practices, and to bring to light clinical and demographic factors that predict management decisions. METHODS: We undertook a prospective cohort study with a 6-month follow-up using data gathered in nine primary care practices in two North Carolina counties. Subjects were 144 dizziness patients examined by primary care physicians. Data collected included demographic characteristics, a standardized dizziness history, physician estimation of symptom severity and diagnostic certainty, and physician "worry" about arrhythmia, transient ischemic attack, and brain tumor. Physicians reported their management decisions and diagnosis (or differential diagnosis) by responding to a questionnaire after completing the patient encounter. A 6-month follow-up chart review and physician interview were completed on 140 patients (97.2 percent); information obtained included changes in diagnosis and patient mortality. RESULTS: The most common diagnoses were labyrinthitis, otitis media, benign positional vertigo, unspecified presyncope, sinusitis, and transient ischemic attack. The initial diagnosis changed during the 6-month follow-up period in 34 (24.3 percent) of patients. The overall course of these patients was benign, however, with only one death occurring during the 6-month follow-up period. Patients' dizziness tended to be managed using a combination of strategies, including office laboratory testing (33.6 percent), advanced testing (11.4 percent), referral to a specialist (9.3 percent), medication (61.3 percent), observation (71.8 percent), reassurance (41.6 percent), and behavioral recommendations (15.0 percent). Office laboratory testing was associated with younger patient age, a suspected metabolic or endocrine disorder, and physician worry about a cardiac arrhythmia; advanced laboratory testing was associated with suspected cardiovascular or neurologic disorders. Medication tended to be prescribed for vertigo and severe symptoms and avoided when physicians were worried about a cardiac arrhythmia. Referral to a specialist was associated with suspected neurologic disease. Observation, behavior change, and reassurance were avoided in patients with poorly defined dizziness and tended to be used in older patients. The management approaches employed by the 4 physicians who referred the most subjects to the study varied considerably. CONCLUSIONS: Dizziness in primary care represents an extremely broad spectrum of diagnoses. The generally conservative management approach of primary care physicians in this study is consistent with basic clinical and epidemiologic principles, and patient mortality with this approach is low.

Adolescent↗
PubMedDate not supplied

Comparative flow rates of saline in commonly used spinal needles including pencil-tip needles.

BACKGROUND AND OBJECTIVES: Certain characteristics of spinal needles that can influence their clinical usefulness were examined, namely, flow rates, internal diameters, and size of orifices of pencil-type needles. METHODS: Flow rates of 0.9% sodium chloride solution were measured in spinal needles with an infusion pressure of 10 mmHg at isothermic and steady-state conditions. In 15 different types, a new needle was used for each experiment, and 6 experiments were performed with each needle type for a total of 90 experiments. The Hagen-Poisseuille Law for laminar flow was used to calculate the internal diameters. RESULTS: The flow rates of needles of the same gauge varied considerably depending on the manufacturer. Compared with 26-gauge ultrathin-wall spinal needle produced by the same manufacturer (Braun, Bethlehem, Pennsylvania), the flow rate through 29-gauge spinal needle was 18% that of the former needle. The flow rate through 27-gauge Quincke Whitacre needle (Becton Dickinson, Rutherford, New Jersey) was not statistically different from that through 26-gauge needle by the same manufacturer. By arbitrarily choosing < or = 2 seconds to be the in vitro desirable period for saline to traverse the needle from one end to the other, all needles with the exception of 29-gauge and standard 26-gauge Quincke Braun needles met this criterion. The length and size of the orifices of Whitacre needles were found to be significantly smaller than those of Sprotte needles (Havel, Cincinnati, Ohio). The orifice of Sprotte needle was longer than the known thickness of the dura while that of the Whitacre needle was smaller. CONCLUSIONS: Needles of the same gauge do not necessarily have the same flow rate. Flow rate correlates well with internal, not external, diameter. By considering < or = 2 seconds to be the desirable time for saline to traverse a spinal needle, all, except two, meet this criterion. The orifice of Whitacre needle has more desirable features than that of Sprottle needle. Anesthesiologists are encouraged to use 27-gauge needles since their flow rate is not slower than that of 26-gauge needles.

Needles↗
PubMedDate not supplied

Magnetic resonance imaging of the foot and ankle: an updated pictorial review.

The authors describe magnetic resonance imaging (MRI) of the foot and ankle using a variety of cases studied. This modality represents considerable benefit in dealing with the difficult pathologic conditions, as well as clarifying others that may not be evident on plain radiographs. The soft tissue versus osseous abnormalities may be differentiated on the T1 versus T2 images. An excellent pictorial review dealing with the foot and ankle is offered.

Ankle↗
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Sturge-Weber syndrome: cranial MR imaging with Gd-DTPA.

PURPOSE: To study the role of Gd-DTPA in cranial MR of patients with Sturge-Weber syndrome. METHODS AND MATERIALS: Seven patients with Sturge-Weber syndrome, ages 3 months to 36 years, were evaluated with unenhanced and contrast-enhanced (Gd-DTPA) MR imaging. Correlation was made to cranial CT in five patients. RESULTS: MR findings included (in decreasing frequency): pial angiomatosis, cerebral atrophy, decrease in cortical veins, enlargement of deep veins, enlargement of choroid plexus, and parenchymal calcification. Contrast MR imaging was essential in diagnosis in four cases in which cranial CT, unenhanced MR, or angiography was normal or demonstrated nonspecific abnormalities. Pial angiomatosis with adjacent cerebral atrophy were the only consistent radiographic abnormalities. CONCLUSION: In all patients, contrast MR demonstrated the radiographic spectrum of central nervous system abnormalities in Sturge-Weber syndrome to a greater degree than unenhanced MR or CT and may represent the method of diagnosis in these patients. Demonstration of the pial angioma on contrast MR should be considered the most important criterion for the radiographic diagnosis of Sturge-Weber syndrome.

Adolescent↗