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Biomedical subjects

Richard Severino

Publications and source records attributed to Richard Severino.

6 recordsLinked to original sources
PubMed2006

Transcutaneous pressure of oxygen: a noninvasive and early detector of peripheral shock and outcome.

A noninvasive tool to recognize early shock would improve outcome by providing prompt recognition of tissue ischemia and precise resuscitation endpoint. The skin is the first tissue bed to vasoconstrict in shock states. Studies have demonstrated that transcutaneous partial pressure of oxygen (PtCO2) increases with higher FiO2 in nonshock states as arterial pressure of oxygen (PaO2) increases, but in shock situations, PtCO2 mirrors changes in cardiac output and oxygen delivery with minimum response to increasing FiO2 and PaO2. This study examined the relationship of hemodynamic variables and the degree of PtCO2 response to FiO2 of 1.0 (identified as the "oxygen challenge test") to mortality and organ failure. This prospective observational study examined 38 patients requiring at least 24 h of cardiac output monitoring for shock resuscitation in the Surgical Intensive Care Unit. Patients were resuscitated to the standard protocol of blood pressure, urine output, oxygen delivery (DO2), and mixed venous O2 (SvO2). Seventy-nine percent of the patients (30/38) with a mean age of 59 +/- 21 years had septic shock or severe sepsis with a 26% mortality (10/38). Measurements included hemodynamic variables, PtCO2, and outcome (mortality and organ failure). In this study, the ability of PtCO2 value to increase by 21 mmHg on a FiO2 of 1.0, at 24 h of resuscitation, divided survivors from nonsurvivors, P <.001. The PtCO2 response to FiO2 may provide an additional noninvasive method of detecting early shock as well as a specific endpoint of resuscitation.

Adult↗
PubMed2005

Hepatitis B and alcohol affect survival of hepatocellular carcinoma patients.

AIM: In the USA, Hawaii has the highest incidence of hepatocellular carcinoma (HCC) and a diverse population. It is an ideal place to characterize HCC in the context of ethnicity/risk factors. METHODS: A total of 262 cases of HCC (1992-2003) were retrospectively reviewed for demographics, ethnicity, birthplace, viral hepatitis, alcohol use, diabetes, smoking and risk factors for viral hepatitis such as intravenous drug abuse (IVDA), transfusions, tattoos and vertical transmission. Tumor stage, Child's class, Cancer of the Liver Italian Program (CLIP) score, alpha-fetoprotein level, treatment and survival were recorded. RESULTS: Gender, age, viral hepatitis, alcohol, IVDA, and diabetes differed significantly in Asians, non-Asians and Pacific Islanders. There were also specific differences within Asian subgroups. Alpha-fetoprotein, smoking, transfusions, stage and resectability did not differ between groups. Asians were more likely to have hepatitis B, while non-Asians were more likely to have hepatitis C. Factors that decreased survival included hepatitis B, alcohol, elevated alpha-fetoprotein, CLIP>2 and increased Child's class. When Asians were combined with Pacific Islanders, median survival (1.52 years vs 3.54 years), 1- and 3-year survival was significantly worse than those for non-Asians. After Cox regression analysis for hepatitis B and alcohol, there was no difference in survival by ethnicity. CONCLUSION: Various ethnicities have different risk factors for HCC. Hepatitis B, alcohol, and alpha-fetoprotein are more important factors for survival than ethnicity.

Alcohol Drinking↗
PubMed2005

Varus derotational osteotomy for spastic hip instability: the roles of femoral shortening and obturator neurectomy.

Varus derotational osteotomy (VDRO) was used to treat 69 unstable hips in 38 patients with spastic quadriplegia. After a mean follow-up of 5.3 years, the total rate of failure as judged by either need for revision or persistent radiographic instability or dislocation was 26%. Overall outcomes were better for hips that had been more congruent (preoperative migration index < 60%) than for hips that had experienced more migration (P = .027), and more-congruent hips were 9 times more likely to be stable radiographically at follow-up (P < .001). The failure rate for VDRO combined with femoral shortening or obturator neurectomy was lower than that for VDRO alone (P = .035). VDRO is an appropriate option for treating less advanced hip subluxation and may be more reliable when combined with femoral shortening and/or obturator neurectomy. VDRO alone, however, may be insufficient for treating more advanced instability.

Adolescent↗
PubMed2003

The International Confederation of Midwives' study of essential competencies of midwifery practice.

OBJECTIVE: To delineate the knowledge, skills, and behaviours that would characterise the domain of competencies of the midwife who is educated according to the international definition of the profession. DESIGN: Phase I: a qualitative Delphi study; Phase II: a descriptive survey research process. PARTICIPANTS: A stratified random sample of member organisations of the International Confederation of Midwives (ICM) and regulatory representatives from these same countries. FINDINGS: A list of basic (essential) and additional competencies for midwives who have been educated in keeping with the ICM/WHO/FIGO international definition of the midwife was developed through an interative Delphi process, and then affirmed, using a survey research method. The final list includes 214 individual task statements within six domains of midwifery practice. IMPLICATIONS FOR PRACTICE: This list of competencies can serve as a basis for educational curriculum design, as a guideline for regulatory policy development, as a reference document for individual practitioners in an assessment of their initial and continued competency and by the ICM and its member associations as a resource for advocating for the role of midwifery within health-care systems world-wide.

Adult↗
PubMed2003

Problem based learning and medical malpractice: does how you've been trained make a difference?

Testing the hypothesis that physicians trained in problem based learning formats versus traditional lecture based formats develop equally strong physician-patient relationships, the rates of malpractice filings against graduates trained in each format at the John A. Burns' School of Medicine were compared. With the graduation of 10 more PBL classes, statistically significant differences between the two groups could be obtained.

Education, Medical↗