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Biomedical subjects

S Valentine

Publications and source records attributed to S Valentine.

At least 19 recordsLinked to original sources
PubMed2002

Transdermal fentanyl for the treatment of back pain caused by vertebral osteoporosis.

Pain relief for patients with osteoporosis is important to maintain mobility and facilitate physical therapy. Transdermal fentanyl may be useful but has not been studied systematically. Patients with at least one osteoporotic vertebral fracture requiring strong opioids were enrolled and received transdermal fentanyl. Treatment history, pain, ease of physical therapy, and quality of life were recorded at baseline and after 4 weeks. Of 64 patients enrolled, 49 completed the study; 12 withdrew because of adverse events, most commonly nausea, vomiting, or dizziness. Pain at rest and on movement decreased significantly from baseline to final assessment (mean scores 7.84 and 8.55, respectively, at baseline, falling to 3.56 and 4.50 after 4 weeks). Quality of life improved significantly, and 61% of patients were satisfied with the treatment. Ability to undergo physical therapy improved significantly. Transdermal fentanyl is useful for the treatment of severe back pain caused by osteoporosis.

Administration, Cutaneous↗
PubMed2001

Delayed diagnosis of cardiac tamponade following isolated blunt abdominal trauma.

Traumatic haemopericardium is an uncommon but life threatening condition. It is usually caused by penetrating cardiac injuries or cardiac rupture from blunt chest trauma. We report haemopericardium and cardiac tamponade in a young girl after blunt abdominal trauma. She presented with mild upper abdominal pain, tachycardia and hypotension having been kicked in the abdomen by a horse. No damage was found at laparotomy and she remained haemodynamically unstable. Further investigation found cardiac tamponade and haemopericardium. This was managed by insertion of a pericardial drain using transthoracic echocardiogram guidance, with later drainage in the operating theatre using guidance with a transoesophageal echocardiogram.

Abdominal Injuries↗
PubMed2001

Examining closure rates of rural hospitals: an assessment of a strategic taxonomy.

This article reports a study of rural hospital failure. Testing a model previously suggested by Drain and Godkin (1996), analysis incorporated four financial ratios used to graphically depict the external environment of a hospital or portfolio of hospitals relative to that of an average facility. Applied to a random sample of rural hospitals, the evidence supports the model's ability to exhibit clustering differences on five of seven selected structure-related variables, and trend activity for the group of hospitals that failed during the period under study.

Catchment Area, Health↗
PubMed2000

An integrative contextual developmental model of male stalking.

This article evaluates current research and theory on stalking as a form of male violence against women. The integrative contextual developmental model (White & Kowalski, 1998) suggests that stalking, as legally defined, is best understood as a multiply determined form of violence, with variables identifiable at several levels, the sociocultural, interpersonal, dyadic, situational and intrapersonal. The model also serves as a framework for identifying gaps in current research and suggests directions for further work.

Fear↗
PubMed1999

Pharmacokinetics and pharmacodynamics following intravenous doses of azimilide dihydrochloride.

Azimilide pharmacokinetics and pharmacodynamics were characterized in a safety and tolerance study of intravenously administered azimilide dihydrochloride. This was a parallel-group design (seven treatments), and 68 healthy volunteers received the drug. Single intravenous infusion doses (4.5 to 9 mg/kg) were administered over 60 minutes, and single 4.5 mg/kg intravenous infusion doses were also given over 15 or 30 minutes. Blood and urine specimens were collected and analyzed for azimilide and metabolites. QTc was measured as a marker of class III antiarrhythmic activity. Azimilide pharmacokinetics were dose proportional and did not differ among infusion rates. Azimilide pharmacodynamics did not differ among treatments. Mean Emax ranged from 23 to 28% delta QTc, with mean EC50 of 509 to 566 ng/mL. Peak circadian variation in QTc was equivalent to 14% of Emax. Rapid equilibration occurred between blood and the biophase. Unconfounded pharmacodynamic estimates required inclusion of circadian QTc variation in the pharmacodynamic model.

Adolescent↗
PubMed1999

The effect of different bypass flow rates and low-dose dopamine on gut mucosal perfusion and outcome in cardiac surgical patients.

The aim of this double-blind, randomized, placebo-controlled trial was to investigate the effects of different cardiopulmonary bypass flow rates and low-dose dopamine on gastric mucosal pH (pHi) and outcome. We hypothesized that by minimizing gut mucosal hypoperfusion during and after cardiac surgery endotoxin translocation may be prevented, resulting in an improved clinical outcome. Four groups of 25 patients each receiving high or low flows during bypass and low-dose dopamine or saline for 24 hours after induction of anaesthesia were studied. The pHi was measured at six time intervals over 24 hours. The combination of low-dose dopamine and a low bypass flow rate was associated with a significantly greater frequency and severity of low pHi. This group also demonstrated a significantly lower vascular resistance on admission to the intensive care unit. There may be an association between low pHi and low vascular resistance.

Cardiopulmonary Bypass↗
PubMed1999

Locus of control as a dispositional determinant of men's traditional sex-role attitudes.

The associations among measures of locus of control and attitudes toward women who work were assessed using data from the National Longitudinal Survey of Youth for 1,229 young adult males. Significant positive correlations, ranging from .09 to .14, were found among locus of control and men's negative stereotypes of women who work, which suggests that males who feel a lack of personal control may oppose women working outside of the home. The results also indicate that men with greater personal control may be more accepting of women in nontraditional sex roles than men with an external locus of control. Negative stereotypes of women who work and male self-preservation may explain these relationships.

Adult↗
PubMed1998

Comparison of wound care practices in pediatric and adult lacerations repaired in the emergency department.

OBJECTIVE: We compared emergency physician's wound care practices in young children (< or = 5 years) and adults (> or = 18 years) and the effect of these different practices on infection rate and cosmetic appearance. DESIGN: Cross sectional study. SETTING: University hospital emergency department that rarely uses conscious sedation. PARTICIPANTS: Consecutive patients who presented with lacerations over a four-year period. METHODS: Structured closed question data sheets that assessed 26 separate wound characteristics were prospectively completed at initial presentation and at suture removal. Infection and cosmetic appearance were assessed with previously validated scales. chi(2) tests were used for categorical variables, t tests for continuous variables. RESULTS: We evaluated 3624 patients: 853 children and 2771 adults. Wounds in children were more likely to be on the head (86 vs 38%, P < 0.01); linear (88 vs 77%, P < 0.01); shorter (1.9 vs 3.0 cm, P < 0.01); less often contaminated (4 vs 11%, P < 0.01); and more commonly caused by blunt injury (69 vs 37%, P < 0.01). With respect to treatment, lacerations in children were less likely to receive irrigation (53 vs 77%; P < 0.001) but slightly more likely to be scrubbed (50 vs 45%, P = 0.01). The two groups received similar numbers of sutures per centimeter (2.6 vs 2.3). Using logistic regression, the differences in irrigation were not explained by the differences in laceration characteristics. Despite less frequent irrigation, children had lower wound infection rates (2.1 vs 4.1%; P = 0.004) and better cosmetic appearances (optimal score, 75 vs 64%, P = 0.0003). CONCLUSIONS: Emergency physicians at our institution are less likely to irrigate lacerations in children than adults; however, children had a lower infection rate and more favorable cosmetic outcome.

Adult↗
PubMed1997

An unusual complication following combined spinal-epidural anaesthesia for caesarean section.

The combined spinal-epidural technique is widely used in obstetric anaesthetic practice. Epidural catheter migration through a dural hole is a theoretical but rarely described complication. We report a case of acute and life-threatening respiratory depression following administration of diamorphine through an epidural catheter after a single space combined spinal-epidural technique for caesarean section. We believe this complication occurred as a result of catheter migration through a dural hole into the subdural space and rupture of the thin arachnoid layer causing massive subarachnoid blockade.

Journal Article↗
PubMed1996

Acute renal failure in cardiac surgical patients, potentiated by gentamicin and calcium.

A retrospective study in coronary artery bypass graft patients was undertaken to assess the effect of gentamicin and a bypass prime with a high calcium on the incidence of renal failure. Patients who received both Haemaccel (polygeline, Hoechst Marion Roussel) (calcium concentration 6.25 mmol/l) in the bypass prime and gentamicin perioperatively had a higher incidence of renal failure compared with those who received only Haemaccel (P = 0.005), only gentamicin (P = 0.002) or neither (P = 0.0001). We suggest that the combination be avoided in this group of patients.

Acute Kidney Injury↗
PubMed1995

Wound registry: development and validation.

STUDY OBJECTIVE: More than 11 million patients with traumatic wounds are seen annually in emergency departments. We developed and validated a data registry for traumatic wounds treated in the ED. DESIGN: Prospective, consecutive patient enrollment with a validation cohort of a convenience sample of 100 patients. SETTING: University-affiliated hospital ED. PARTICIPANTS: For all patients with traumatic wounds requiring sutures, wound registry data sheets were completed at the time of initial visit using a closed-question format. Data recorded included demographic characteristics, time from injury to evaluation, pertinent medical history, wound characteristics, type of anesthesia, details of wound-cleansing methods, details of wound closure, and postoperative care. We devised a follow-up tool to evaluate for the presence of infection and short-term cosmetic appearance. Interphysician reliability was assessed for wound description, presence of infection, and cosmetic appearance by use of the kappa statistic. RESULTS: A wound registry data collection instrument that takes less than 1 minute to complete and enables the collection of most wound management techniques used by emergency physicians was found to have substantial interobserver concordance for wound description (kappa range, .55 to .97), wound infection (kappa = 1.0) and overall cosmetic appearance (kappa = .61). CONCLUSION: The wound registry is a reliable data collection instrument that is easy to use. It may be useful as a continuous quality-improvement tool or for standardization of wound surveillance and treatment data to facilitate future prospective studies in wound management.

Adolescent↗
PubMed1995

Effect of inspired oxygen on the cardiovascular effects of protamine after cardiopulmonary bypass.

We have performed a randomized prospective study of the effects of inspired oxygen fraction (FIO2) on the haemodynamic changes after protamine infusion. Thirty-four patients undergoing first time coronary artery bypass surgery were allocated randomly to receive either an FIO2 of 1.0 (group O) or 0.35 (group A) after cardiopulmonary bypass. Before and after infusion of protamine, haemodynamic measurements were obtained, including mean arterial pressure (MAP), mean pulmonary artery pressure, central venous pressure, pulmonary capillary wedge pressure (PCWP), cardiac index (CI), pulmonary vascular resistance index (PVRI) and systemic vascular resistance index (SVRI). In group O, there were increases in mean MAP (8%), PVRI (48%) and SVRI (18%), and decreases in mean CI (10%) and PCWP (15%). Group A showed changes of 0%, -8%, -6%, +3% and +32%, respectively. We found a significant difference between groups in changes in PVRI (P < 0.0001), SVRI (P < 0.01), CI (P < 0.05) and PCWP (P < 0.001). During infusion of protamine, 31% of patients in group O and 6% of patients in group A had a decrease in systolic arterial pressure to less than 80 mm Hg (ns, chi-square test). These observations suggest that FIO2 alters the haemodynamic effects of protamine.

Aged↗
PubMed1995

Poor correlation of short- and long-term cosmetic appearance of repaired lacerations.

OBJECTIVE: To describe the consistency of a cosmetic scale for repaired lacerations and to determine whether the appearance of lacerations at the time of suture removal correlates with the appearance six to nine months later. METHODS: A convenience sample of patients who had lacerations repaired in a university teaching hospital were evaluated at the time of suture removal and six to nine months following repair. All lacerations were assigned 0 or 1 point each for the presence or absence of a step-off borders, contour irregularities, margin separation, edge inversion, excessive distortion, and overall appearance. A total cosmetic score (0-6) was calculated by adding the scores for the categories above. The consistency of the cosmetic scale was assessed by comparison of scores given by two different practitioners evaluating each patient at suture removal and long-term follow-up. The 38 evaluating practitioners were assigned based on availability and did not necessarily perform serial evaluations of the same patient. RESULTS: The 41 participating patients had a median age of 19 years (range, 2-82 years). Wounds were located predominantly on the head (73%) and upper extremity (22%). Long-term follow-up was performed at a median of 219 days (range, 155-280 days) after suture removal. Interpractitioner concordance regarding optimal appearance (score of 6 vs < or = 5) was moderate (kappa = 0.52) at the time of suture removal and substantial at the time of long-term follow-up (kappa = 0.68). However, the correlation of actual scores at the time of suture removal vs at long-term follow-up was poor (r = 0.17, p = 0.29). CONCLUSION: For our clinicians, the six-item categorical scale appears consistent as a tool for the assessment of the cosmetic appearance of wounds. However, correlation between laceration appearance at the time of suture removal and six to nine months later is poor.

Adult↗
PubMed1993

Reduction of acute haemorrhage with aprotinin.

We describe the use of aprotinin in two patients to control life threatening haemorrhage due to coagulopathy when other therapeutic measures had failed. We review the use of aprotinin and give a rationale for its use in acute coagulopathy.

Adolescent↗
PubMed1993

A comparison of effects of fixed and tailored cardiopulmonary bypass flowrates on renal function.

Cardiopulmonary bypass may result in renal impairment but there is little investigative data on the effect of differing flowrates on postoperative renal function. One hundred and twenty-two patients presenting for cardiac surgery were randomly assigned to receive either a fixed CPB flow of 2.4 l.m-2 or a bypass flow tailored to maintain a venous return oxygen saturation of 75-80%. Vasoactive drugs were given to maintain a perfusion pressure of 50 to 80 mmHg. Patients were assessed by serum creatinine, creatinine clearance, arterial blood gases, serum lactates and electrolytes. The results show an overall decline in postoperative renal function compared with preoperative levels, with no significant differences between the two groups.

Aged↗