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Biomedical subjects

R W Koster

Publications and source records attributed to R W Koster.

60 records · Page 4Linked to original sources
PubMed1981

Biochemical and circulatory parameters during purely mental stress.

In order to evaluate biochemical and circulatory parameters during purely mental stress, 20 healthy medical students were studied before, during and at the end of an important written medical examination. Plasma catecholamines and diastolic blood pressure rose significantly during the examination, whereas systolic blood pressure did not change and heart rate declined. Continuous ECG recording in 12 of the subjects showed a high peak in heart rate at the start of the examination, quickly followed by a rapid decline to values seen on the previous day. It is suggested that in mental stress without physical effort, the enhanced sympathetic activity triggers an increase in parasympathetic activity which overrides the circulatory effects of the former.

Adult↗
PubMed1976

Quinidine-induced ventricular flutter and fibrillation without digitalis therapy.

Three cases are described with documented ventricular flutter and fibrillation during quinidine medication without concomitant digitalis therapy. In all three patients the arrhythmia developed while they were receiving moderate doses of quinidine. Although no changes in QRS width were observed after administration of quinidine, there was marked prolongation of the Q-T interval. The mechanism of development of ventricular flutter and fibrillation in patients taking quinidine may be similar to that in patients with the Q-T prolongation syndrome.

Adult↗
PubMedDate not supplied

Impact of survival probability, life expectancy, quality of life and patient preferences on do-not-attempt-resuscitation orders in a hospital. Resuscitation Committee.

Consensus exists that a do-not-attempt-resuscitation order (DNAR) is appropriate if a resuscitation attempt is futile. Less agreement exists when this point is reached. We investigated the influence of three major considerations for in-hospital DNAR orders: expected survival probability after resuscitation, prospects of the patients' current condition without a cardiac arrest and the patients' autonomous decision not to want resuscitation. We calculated an expected survival probability according to two multi-morbidity prediction scores for each patient, assuming the event of cardiac arrest. The prospects of the current condition without a cardiac arrest was estimated by the patients' physician, in terms of life expectancy and quality of life (level of dependency after discharge and pain). The patients' preference was documented from the medical records. A total of 470 patients were included in the study. Fifty-eight patients (12%) had a DNAR-order, 11 of these patients (19%) wanted no resuscitation. The patients' prospects (life expectancy, dependency after discharge), and age proved to be independently associated with the presence of a DNAR order. The odds ratio (OR) for the presence of a DNAR order was 37 (CL 14-107) for an estimated life expectancy less than 3 months, 13 (CL 4-41) for a life in a nursing home and four (CL 2-12) for an age of 80 years and older. Expected survival probability after resuscitation and pain were not independently associated with a DNAR order. We conclude that resuscitation is considered futile on the basis of the patients' age and prospects without cardiac arrest and that the impact of expected survival probability on these decisions is small.

Aged↗
PubMedDate not supplied

Decisions to terminate resuscitation. Resuscitation Committee.

To gain more insight into decision making around the termination of resuscitation (CPR), we studied factors which influenced the time before discontinuing resuscitation, and the criteria on which those decisions were based. These criteria were compared with those of the European Resuscitation Council (ERC) and the American Heart Association (AHA). For this study, we reviewed the audiotapes of resuscitation attempts in a hospital. A total of 36 attempts were studied, involving 27 men and nine women, mean (S.D.) age 64 (18) years. A total of 19 patients received resuscitation on general wards, and 17 in the emergency room after an out-of-hospital circulatory arrest. The median interval time (range) from start to termination was 33 min (8-81 min). Results from multiple linear regression showed that a delay greater than 5 min in first advanced life support measures, drawing a sample for biochemical analysis, and the patient's response shown by return of spontaneous circulation were independently associated with the time of terminating resuscitation. The team used a number of criteria which can be found in the guidelines of the ERC and the AHA, but also used additional criteria. The ERC and the AHA criteria were not sufficient to cover all termination decisions. We conclude that the point in time to terminate resuscitation is not always rationally chosen. Updating of the current guidelines for terminating resuscitation and training resuscitation teams to use these guidelines is recommended.

Blood Circulation↗