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Biomedical subjects

R Stewart

Publications and source records attributed to R Stewart.

At least 199 records · Page 11Linked to original sources
PubMed1982

Impact of attending level supervision of the emergency department experience.

Medical experiences encountered in the activities of an emergency department are important for the development of a well-trained internist. Therefore, a rotation in the emergency department must remain an integral part of any program in internal medicine. At the University of Pittsburgh, faculty members from both the internal medicine and emergency medicine departments worked together in order to develop the emergency department to its fullest capacity as part of a broad educational program. The faculty attendings provide supervision, immediately available consultation, and an on-going curriculum, including daily lectures and chart review. The results of their programmatic change have been the following: 1) enthusiasm and satisfaction on the part of the housestaff; 2) a 20+ increase in admissions to the hospital from the emergency department; 3) decreased utilization of the observation unit; and 4) fewer patients leaving without being examined.

Ambulatory Care↗
PubMed1982

Presence of dihydrostreptomycin and penicillin in cows' milk following intrauterine administration.

Cows were given liquid intrauterine infusions of dihydrostreptomycin and penicillin or dihydrostreptomycin alone approximately 24 hours after the onset of oestrus to determine the necessary withholding period for milk intended for human consumption. When dihydrostreptomycin and procaine penicillin were administered together, a withholding period of 72 hours provided an adequate safety margin. Thirty-six hours was an adequate withholding period when dihydrostreptomycin was administered.

Animals↗
PubMed1980

A comparison of standard, "MAST"-augmented, and open-chest CPR in dogs. A preliminary investigation.

Hemodynamic, respiratory, and cerebral variables during 2 h of standard external CPR were studied in 5 dogs. In an additional 12 dogs, possible augmentation of these variables by Military Anti-Shock Trousers (MAST) was evaluated. In 9 dogs, external and internal cardiac massage were compared. During ventricular fibrillation (VF) and after 2 min of circulatory arrest, standard CPR basic life support (without drug support) could sustain only borderline values: systolic arterial pressure (SAP) remained at 70--80 mm Hg and mean arterial pressure (MAP) at 35--45 mm Hg. Sternal compressions increased central venous pressure (CVP) to near SAP, and also increased intracranial pressure (ICP), but less than CVP. Thus, systemic perfusion pressures (SPP, i.e., MAP-mean CVP) control value 130 mm Hg) were only 11--15 mm Hg; and cerebral perfusion pressures (CPP, i.e., MAP-ICP) were 20--32 mm Hg during CPR. Common carotid arterial blood flow (CCABF) remained at an average of 8--20% of control values. Normalization of aerobic metabolism proved impossible (final pHa of 7.1). During external CPR, MAST inflation moderately increased MAP, SAP, SPP, and CPP; and significantly increased CCABF from 6.8 to 13.2% of prearrest control. The MAST failed to improve cerebral venous PO2, pupil signs, and EEG activity. With fixed pressure IPPV/100% O2, the MAST decreased tidal volumes and PaO2 (increased shunting); and increased PaCO2 and acidemia. Epinephrine 1 mg iv improved arterial pressures but not flows. A switch to open-chest (internal) cardiac massage (OCCM) after 2 h of external CPR significantly increased arterial and perfusion pressures (decreased venous pressures) and more than doubled CCABF; and resulted in a return of EEG activity and pupillary constriction. Prolonged standard CPR, and to a lesser extent MAST-augmented CPR, seem unlikely to maintain adequate oxygen transport for vital organ systems viability, particularly the brain. OCCM might better sustain viability.

Animals↗
PubMed1980

Experimental infections with group A streptococci in humans.

Experimental inoculation of 7 strains of Group A streptococci failed to result in either colonization or infection of normal intact skin of human volunteers. All strains rapidly died on normal skin; suppression of the resident microflora did not affect survival and no difference in survival was seen between inoculation on lipid-rich and lipid-poor body areas. Inoculation on skin damaged by superficial scarification resulted in localized infections when 1 x 10(4) or more organisms were inoculated into the wound by rubbing and covered with an impermeable plastic film. Intradermal inoculation resulted in localized cellulitis, regional lymphadenopathy, and fever. All strains were equally effective in producing localized infections in scarified skin.

Humans↗
PubMed1979

The nature of needs assessment in community mental health.

Confusion in defining needs assessment is discussed. A tripartite model of needs assessment is proposed: an identification of a problem; a statement about priorities; and a chosen solution. The parts can be used independently or linked together to plan new or altered services. Various needs assessment techniques are examined for their usefulness in each area. Two examples of needs assessment processes are given.

Community Mental Health Services↗
PubMed1979

Updated in vivo methods for evaluating topical antimicrobial agents on human skin.

Updated and expanded in vivo quantitative testing procedures to determine the efficacy of topical antimicrobial agents are presented. The occlusion test measures the ability of an agent to prevent the expansion of the resident microflora which occurs when an impermeable dressing is applied to the forearm. Measurements are made at 24 and 48 hr. The expanded flora test measures the ability of an agent to suppress a dense population of micro-organisms produced by expansion of the resident flora of the forearm by prior application of an impermeable occlusive dressing. Measurements are made at 6, 24 and 48 hr or after 10 min in the case for agents designed for immediate degerming. The persistence test measures the ability of an agent to establish a reservoir in skin and exert an antimicrobial effect up to 3 days after the last application of the test material. The ecological shift test determines any major alteration in cutaneous microbial ecology following several applications of the material under occlusive dressings. The serum inactivation test determines whether the presence of serum proteins interferes with antimicrobial activity.

Adult↗
PubMed1979

Neighborhood health center patients who use minor tranquilizers.

Thirty-four ambulatory medical patients who had used minor tranquilizers for varying lengths of time were interviewed to determine their medical and psychiatric statuses, and to learn their own perspective of their medical care. The population was elderly of lower socioeconomic status, and chronically ill (a significant minority with serious and disabling illness). Depressive equivalents, depression, and anxiety were prominent, but clinical states requiring psychiatric care were not. Slightly less than one-half were alcoholic. Forty-one percent took the medications for target symptoms other than anxiety, and 76% believed these agents were efficacious. Chronic users had significantly more chronic medical illness, and significantly more somatization, anxiety, and fatigue.

Acute Disease↗