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Biomedical subjects

S Ward

Publications and source records attributed to S Ward.

At least 325 records · Page 18Linked to original sources
PubMed1969

Relation of gastric secretory response in man to dose of insulin.

The relation between dose of insulin and gastric secretion of acid and pepsin was studied in 5 healthy adult men. Doses of insulin ranged from 0.025 to 0.4 unit per kg intravenously. The peak 15-min acid output increased with increasing insulin dose up to a maximum observed response with 0.2 unit per kg; 0.4 unit per kg did not produce a higher peak response. The peak response to 0.2 unit per kg (8.4 mEq per 15 min) was equivalent to 89% of the peak response to a maximal dose of betazole. Peak pepsin output continued to increase up to the highest dose used (0.4 unit per kg). Before a standard dose for clinical testing for incompleteness of vagotomy can be established, further tests must be done to determine whether the dose required for peak response is the same in partially vagotomized as in intact subjects.

Adult↗
PubMedDate not supplied

Transvaginal ultrasound scanning in early pregnancy and correlation with human chorionic gonadotropin levels.

Pregnancy can be detected early using transvaginal ultrasonography and human chorionic gonadotropin (hCG) measurements. The purpose of this study was to correlate serum hCG levels with transvaginal gestational sac measurements. The mean sac diameter (MSD) and gestational sac diameter (GSD) were calculated as the mean and cube root of the product, respectively, of three sac dimensions taken at right angles. A nonlinear relationship between hCG (natural logarithm) and MSD and GSD was observed. The data were best fitted by a second order polynomial regression model (r2 = 0.98), thereby establishing normal hCG levels for various gestational sac dimensions in early pregnancy.

Chorionic Gonadotropin↗
PubMedDate not supplied

Towards optimal regimens of parenteral quinine for young African children with cerebral malaria: the importance of unbound quinine concentration.

Young African children with severe malaria are given quinine using a regimen designed for Thai adults. We measured quinine in the blood, plasma and plasma water of young children in Kenya after rapid intravenous and intramuscular dosing, and calculated the therapeutic range of unbound quinine. The peak plasma quinine concentration after rapid intravenous dosing was 12.3 +/- 3.7 mg/L (mean +/- SD), 43% higher than in adults given the same regimen previously; this was due to a smaller apparent volume of distribution in the children. The therapeutic range of unbound quinine was calculated as 0.2-2.0 mg/L. Simulations of unbound quinine were made for the standard quinine regimen: unbound drug concentrations rose above the therapeutic range after each dose. The possible risks of quinine-induced visual impairment are discussed. Alternative, lower dose regimens for young African children with severe malaria are described.

Child↗
PubMedDate not supplied

Addressing nicotine addiction in women. Role of the midwife.

Smoking is the leading preventable cause of cancer, cardiovascular disease, and other premature deaths among women in the United States. Tobacco use accounts for 10% of perinatal mortality and is 100% preventable. Smoking is now more common among adolescent girls than among boys. Women's health care providers are in an excellent position to intervene in this growing epidemic. This article addresses the health consequences of smoking as well as the social, economic, and emotional toll of cigarette smoking on the woman and her family. The reasons women begin and continue smoking in spite of known risks are examined. The role of the midwife in treating nicotine addiction in women throughout the life span is examined. A theoretical model based on the woman's stage of change is presented as a framework for intervention. Behavioral and pharmacologic treatment recommendations are included. Opportunities for professional activities for community education and advocacy for a tobacco-free society are presented.

Coronary Disease↗
PubMedDate not supplied

The prehospital use of nitroglycerin according to standing medical orders in an urban EMS system.

PURPOSE: The purposes of this study are to quantify the use of nitroglycerin (NTG) in prehospital care, to detect deviations from the Standing Medical Orders (SMO), to determine the effectiveness of its administration, and the incidence of clinically significant adverse reactions (hypotension, bradycardia). METHOD: Retrospective review of 7683 Advanced Life Support (ALS) telemetry, base-station contacts over a three month period (June, July, August 1990) to identify all prehospital patient contacts in which NTG was utilized. SETTING: The Resource Hospital/Telemetry Base-Station and two community hospitals/Telemetry Base-Stations for the Chicago North EMS System. RESULTS: There were 445 runs in which NTG was indicated as per SMO. Two hundred eighty-eight patients (64.7%) received NTG for appropriate indications as per SMO, 203 for ischemic chest pain (45.6%), 79 for pulmonary edema (17.7%), and six for both (1.3%). There were 157 (35.5%) runs in which NTG was indicated, but not administered. There were 22 patients who received NTG for indications that deviated from the SMO. Reassessment data concerning the subjective symptom was completed on 118 patients (40.9%), 92 (45.3%) patients with chest pain and 26 with dyspnea (32.9%). Following the administration of NTG, 21 patients (10.1%) with chest pain were unchanged, while 13 with dyspnea (15.3%) improved, 13 patients (15.3%) were unchanged, and none worsened. In 121 patients, the systolic blood pressure (SBP) decreased, while 24 were unchanged (5.4%), and 28 had an increase (6.3%). The mean initial value SBP was 176 +/- 44 mmHg and the repeat mean SBP was 164 +/- 41 mmHg with a mean decrease of 12 +/- 22 mmHg. The diastolic blood pressure (DBP) decreased in 87 patients, was unchanged in 53 (11.9%), and increased in 33 (7.4%). The initial mean DBP was 97 +/- 24 mmHg, the repeat mean DBP was 92 +/- 23 mmHg, a mean decrease of 5 +/- 15 mmHg. Only one patient became hypotensive with the administration of NTG and was successfully resuscitated with a fluid bolus of 300 ml normal saline. CONCLUSIONS: In this EMS system, NTG is under-utilized based on the indications delineated by this system's SMOs. Reassessment is documented infrequently, but when completed, clinically significant adverse reactions are rare. Since the incidence of hypotension and bradycardia are rare, the inability to establish an IV line should not preclude the administration of NTG.

Aged↗
PubMedDate not supplied

Medical control of mass gatherings: can paramedics perform without physicians on-site?

OBJECTIVE: Evaluate the experience of paramedic personnel at mass gatherings in the absence of on-site physicians. DESIGN: Retrospective review of patients evaluated by paramedics with emergency medical services (EMS) medical control. SETTING: First-aid facility operated by paramedics at an outdoor amphitheater involving 32 (predominantly rock music) concerts in accordance with the Chicago EMS System, June through September 1990. PARTICIPANTS: A total of 438 patients (< or = 0.1% on-site population) were evaluated. INTERVENTIONS: Presentations to the first-aid facility were viewed as if the patient was presenting to an ambulance. Transportation to an emergency department was strongly recommended for all encounters. Time from presentation to the first-aid facility until disposition was limited to 30 minutes in the absence of on-line [direct] medical control. Refusal of care was accepted. On-line [direct] medical control with the EMS resource hospital was initiated as needed. Off-line [indirect] medical control consisted of weekly reviews of all patients records and periodic site visits. RESULTS: Of the 438 patients, 366 (84%) refused further care, including 31 patients (7%) who refused advanced life support (ALS) level care. Seventy-two patients (16%) were transported; 37 by ALS and 35 by basic life support (BLS) units. On-line [direct] medical control was initiated in all ALS patients that were transported as well as for those who refused care. No known deaths or adverse outcomes occurred, based on lack of inquiries or complaints from the local EMS system, emergency departments receiving transported patients, law enforcement agencies, 9-1-1 emergency response providers, venue management, or security. No request for medical records from law firms have occurred. Problems noted initially were poor documentation and a tendency not to document all encounters (e.g., dispensing band-aids, tampons, earplugs, etc.). Concerns noted included: initial and subsequent vital signs, times of arrival, interventions, dispositions, and patient conditions of refusal. Specific problems with documentation of refusals at disposition included: appropriate mental status, speech, and gait; release with an accompanying family member or friend; and parental notification and approval of care for minors. There also was an initial tendency not to establish on-line [direct] medical control for ALS refusal or BLS medicolegal issues. CONCLUSIONS: The medical system configuration modeled after practices of prehospital care, demonstrates physicians did not need to be on-site when adequate EMS medical control existed with less than 30 minutes on-scene time.

Chicago↗
PubMedDate not supplied

A comparison of EMS continuing education for paramedics in the United States.

OBJECTIVE: To determine characteristics of continuing education programs for paramedics in large metropolitan areas, and to make recommendations for changes in the Chicago Emergency Medical Services (EMS) system. DESIGN: A survey of 95 metropolitan areas from each state in the United States. PARTICIPANTS: EMS medical directors, coordinators, and administrators. RESULTS: The survey population included 56 respondents. Within this group, 23% were from areas of 1 million people or more, 61% in areas with populations of 100,000 to 1 million and 16% from areas populated by < 100,000 people. Several system types were represented in the survey. In the systems surveyed, 98% mandate didactic continuing education requirements. Clinical continuing education was required by 34% of the systems. Ten systems (18%) awarded continuing education hours for documented in-field experience. This method did not have a specific structure by the majority of users. Both written and skills testing were used by most EMS systems to evaluate paramedic competency. No statistically significant differences (p > 0.05) could be found among population subgroups or EMS system types when evaluating the use of these various methods. CONCLUSION: EMS systems primarily use didactic sessions to meet their continuing education requirements. Nearly half of the systems requiring clinical continuing education use in-field credit to fulfill these requirements. In-field credit systems are poorly developed to date. This mechanism may be an effective alternative to usual clinical experiences for paramedics and deserves further investigation.

Clinical Competence↗
PubMedDate not supplied

Atrial natriuretic peptide mediated polyuria: pathogenesis of polyhydramnios in the recipient twin of twin-twin transfusion syndrome.

We studied the role of atrial natriuretic peptide (ANP) in the pathophysiology of polyhydramnios in monochorionic (MC) twins with and without twin-twin transfusion syndrome (TTTS). Matched maternal, fetal blood samples and amniotic fluids (AF) were obtained in utero (n=12) and at birth (n=20) from MC twins with TTTS. Blood and amniotic fluid samples were also collected from non-TTTS MC twin pairs in utero (n=6) and at birth (n=20). In both groups cellular localization of ANP in the fetal kidney and heart was performed using anti ANP rabbit polyclonal antibody. Concentrations of ANP in pg/ml were determined by radioimmunoassay.In recipient fetuses, ANP levels were higher than the donors both in utero (P< 0.001) and at birth (P< 0.001). No such differences were found between the non-TTTS twins. In the TTTS group maternal ANP levels were lower than the non-TTTS group (P< 0.05). A linear relationship was found between fetal ANP levels and the AF volumes removed at fetal blood sampling (r(2)=0.68;P< 0.01, n=12). ANP was localized predominantly to the cytoplasm of the distal convoluted tubules of the fetal kidney and heart, and the intensity of immunostaining for ANP in kidney and heart were markedly greater in the recipient than the donor twin. No such differences were found between the twin pairs. These data suggest that polyhdramnios in the recipient twin occurs as a consequence of ANP mediated increase in fetal urine output and raises the possibility of direct fetal therapy with ANP blocking agents.

Amniotic Fluid↗
PubMedDate not supplied

Implementation of an out-of-hospital termination of resuscitation policy.

OBJECTIVE: To evaluate the implementation of an out-of-hospital termination of resuscitation policy in an urban EMS setting. METHODS: A descriptive study characterizing the implementation of an out-of-hospital termination of resuscitation policy in the Chicago EMS system. It includes a retrospective telemetry record review analyzing the utilization and compliance with the policy. The newly implemented policy involved field termination of resuscitation for all nontraumatic, adult cardiac arrest victims presenting in asystole who were not responsive to a standard trial of resuscitation. RESULTS: Over the three-month study period, 228 resuscitations of adult, nontraumatic cardiac arrest victims were identified and submitted for review. The group of 142 cardiac arrest victims who presented in asystole and received resuscitative efforts were categorized into four groups. Group I included 34 cardiac arrests for which resuscitation was terminated in the field following policy criteria. Group II included eight cardiac arrests for which resuscitation was terminated but the patients did not meet criteria for termination of resuscitation. Group III included 84 cardiac arrests for which resuscitation was not terminated because the patients did not meet criteria for out-of-hospital termination. Group IV included 16 cardiac arrests for which resuscitative efforts were continued, although the patients met indications for field termination. CONCLUSIONS: Field termination of resuscitation is practical in the setting of asystole unresponsive to aggressive resuscitative efforts. The implementation of such an out-of-hospital termination of resuscitation policy is complicated by many problems and is best accomplished by a gradual implementation process. Through this process all members of the EMS community can address practical and ethical issues and grow comfortable with the ongoing evolution of out-of-hospital therapy.

Aged↗
PubMedDate not supplied

An investigation into the effectiveness of an early intervention method for delayed language development in young children.

Delayed language development is common and has serious sequelae into adulthood in terms of educational, social and emotional development. The objective of this study was to test the hypothesis that a group of language-delayed infants detected in the first year of life by the screen developed in the author's previous study, and receiving intervention at that stage, would not show language impairment at the age at which children are usually referred for speech and language therapy, whereas an untreated control group would do so. A sample (n = 122), of very young language-delayed children was divided into matched experimental and control groups. The mean (range) age of the sample was 10.6 (8-21) months. The experimental group received intervention, and both groups were followed up until they were 3 years of age to determine whether there were differences in language development at that stage. The results showed that at 3 years, 85% of controls showed language delay while only 5% of the experimental group did so. The differences in mean language quotient in experimental and control groups were statistically significant (t = 2.701, p < 0.01). At this stage, 30% of the controls had been referred for speech and language therapy, while none of the experimental group had so been. The intervention was found to take relatively little resource and the low dropout rate and high take-up indicated that it was popular with carers.

Caregivers↗
PubMedDate not supplied

The ties that bind.

Explore the source record for details and available documents.

Humans↗