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Biomedical subjects

W O Robertson

Publications and source records attributed to W O Robertson.

At least 37 records · Page 2Linked to original sources
PubMed1999

Calls on reproductive and developmental toxicants to a regional poison center.

We sought to characterize calls received by a regional Poison Center concerning reproductive hazards and to assess the quality of the responses. Data was extracted for a 3 mo period from all calls regarding reproductive or in utero developmental effects. The Poison Center responses were evaluated based on completeness of information gathered and final recommendations made. Two hundred seventy-one calls regarding 335 products were received. Ninety-seven percent of the calls concerned exposures during a pregnancy. Fifty-nine percent of the substances of concern were drugs; 32% were other chemicals; 7% were biological agents. Eleven percent of the exposures were occupational; 22% were environmental. Thirty-four percent of the exposures had not yet occurred. Sixty-two percent were characterized as no or minimal risk. For 13% of exposures, callers were advised to avoid initiating or continuing the exposure. Callers were referred to physicians or specialty services for 11% of exposures. The majority of responses were felt to be appropriate. Problematic areas included inconsistent advice and lack of referral. Discussion of exposures in light of other risk factors for and background rates of adverse reproductive outcomes, as well as more frequent referral to a specialist with expertise in reproductive toxicology was recommended.

Adolescent↗
PubMed1998

Misrepresentation of authorship by applicants to pediatrics training programs.

PURPOSE: To determine whether applicants to pediatrics residency and fellowship programs misrepresented authorship of publications. METHOD: The authors sampled 1995 applications to the University of Washington School of Medicine's pediatrics residency program and pediatrics pulmonary fellowship program. They submitted all publications claimed in the submitted applications to extensive efforts to authenticate both their existence and authorship. RESULTS: Among the 404 pediatrics residency program applications studied, 147 claimed authorship of publications; 29 (19.7%) of these contained at least one unverifiable publication. Of the 401 publications claimed in the 147 applications, 41 (10.2%) could not be confirmed. Among 31 fellowship applications, 14 claimed publications. At least one citation was unverifiable for each of the 14 applications. Of the total 77 publications claimed, 31 (40%) could not be confirmed. CONCLUSION: Misrepresentation occurs on graduate medical education applications; solutions are needed to address this problem.

Authorship↗
PubMed1998

Zolpidem-associated hallucinations and serotonin reuptake inhibition: a possible interaction.

BACKGROUND: Zolpidem (Ambien) is a sedative believed to act exclusively at the benzodiazepine omega 1 receptor. Sporadic case reports of zolpidem-associated hallucinations have appeared over the past 5 years, and over the past 2 years, the Washington Poison Center received five reports of prolonged visual hallucinations associated with zolpidem. CASE REPORTS: All five patients reported experiencing visual hallucinations lasting from 1-7 hours soon after taking zolpidem. Most had been taking zolpidem for less than a week and all five were concurrently taking an antidepressant: sertraline, desipramine, fluoxetine, bupropion, or venlafaxine; two sought assistance at a hospital. DISCUSSION: The precise mechanism of zolpidem-associated hallucinations remains unknown. In some previously published cases, the zolpidem-associated hallucinations have been short in duration, lasting at most 30 minutes. In contrast, the five patients in our series and in five previously reported cases, the hallucinations were more persistent, lasting up to 7 hours. Of these ten cases with persistent symptoms, nine were concurrently taking antidepressants that inhibit serotonin-reuptake, despite the fact that zolpidem has no known serotonin-mediated mechanisms. CONCLUSIONS: These cases, plus prior case reports, suggest that a pharmacodynamic interaction between serotonin reuptake inhibition and zolpidem may lead to prolonged zolpidem-associated hallucinations in susceptible individuals.

Adolescent↗
PubMed1998

Sulfhemoglobinemia after dermal application of DMSO.

A 43-y-old Caucasian female applied 4 ounces of dimethyl sulfoxide (DMSO) to her lower abdomen for treatment of interstitial cystitis. Within 24 h she developed fatigue, cyanosis and dyspnea with mild exertion. She sought medical attention 10 d later, at which time initial laboratory tests revealed a methemoglobin level of 47%. Two doses of 1 mg methylene blue/kg i.v. were given without significant improvement in either her cyanosis or methemoglobin level. Repeat analysis the day following admission using an outside lab demonstrated a sulfhemoglobin level of 6.2% and a methemoglobin level of < 0.1%. No prior reports have associated sulfhemoglobin formation with DMSO application. Carbon monoxide-oximetry may falsely identify sulfhemoglobin as methemoglobin; sulfhemoglobinemia should be considered in cases of methemoglobinemia refractory to methylene blue therapy.

Administration, Topical↗
PubMed1997

Hazardous materials exposure information service: development, analysis, and medical implications.

The Hazardous Materials Exposure Information Service (HMEIS) was established at the Washington Poison Center (WPC) to rapidly provide information to medical professionals who treat victims of hazardous-materials exposure. Incident description and exposure information is collected from on-site hazardous-materials teams and immediately analyzed by WPC medical toxicologists. Diagnostic and treatment recommendations are provided to prehospital personnel and receiving physicians. Over the first 22 months of operation, 50 calls were received that met HMEIS criteria. Of the 466 individuals exposed, 256 (55%) were transported to a medical facility for treatment. When the WPC was contacted before the decision to transport a patient to a medical facility, 28 of 185 exposure victims (15%) were transported, compared with a transport rate of 81% of exposure victims (66% change; 95% confidence interval [CI], 60% to 72%) in all other concurrent incidents and a historical transport rate of 63% (25% change; 95% CI, 14% to 36%) before the establishment of the HMEIS. These findings, although preliminary and subject to potential confounding, suggest that the HMEIS reduces health care costs through more efficient use of medical resources.

Costs and Cost Analysis↗
PubMed1997

Dystonic reaction associated with dextromethorphan ingestion in a toddler.

INTRODUCTION: Accidental ingestions of cough and cold preparations containing dextromethorphan (DM) are common in the toddler age group and rarely have serious consequences. Even large intentional overdoses by adults seldom lead to serious morbidity. There have been no previous reports of an extrapyramidal reaction due to a DM ingestion. CASE REPORT: We report a 30-month-old girl who ingested approximately 38 mg/kg dextromethorphan. She presented with opisthotonus, ataxia, and bidirectional nystagmus. There was no change in her status with the administration of naloxone. The child was given diphenhydramine with clearing of her opisthotonus but persistence of her ataxia and nystagmus. DISCUSSION: A moderate ingestion of dextromethorphan in a toddler resulted in extrapyramidal symptoms with opisthotonus that responded to diphenhydramine. Dextromethorphan is known to have complex CNS effects and, in sufficient doses, may have dopamine receptor blocking activity resulting in this dystonic reaction.

Antidotes↗
PubMed1997

Hazardous materials incidents: the Washington Poison Center experience and approach to exposure assessment.

Hazardous materials incidents include gas and vapor releases, spills, explosions, and fires. Incidents involving human exposure are challenging for most health care providers because of the vast number of potential chemicals involved, frequently incomplete incident information, and limited experience in exposure assessment. To facilitate improved evaluation and treatment of patients with chemical exposures, the Washington Poison Center established the Hazardous Materials Exposure Information Service in 1994. During the first 33 months of operation, this service has provided information on 70 incidents, involving a total of 1120 exposed individuals, including 501 patients treated in medical facilities. This paper reviews these incidents, the process used to collect information from the incidental scene, and selected techniques for evaluating the extent of individual chemical exposure.

Data Collection↗
PubMed1997

Hospital preparedness for hazardous materials incidents and treatment of contaminated patients.

Hospital-based facilities providing emergency care in the state of Washington were surveyed to determine their level of preparedness for hazardous materials incidents including the treatment of contaminated patients. Responses to a faxed questionnaire were received from 95 (94%) of the 101 emergency care facilities in Washington State. Only 42 (44%) of the facilities reported the ability to receive any chemically exposed patient. Of the 95 responding emergency care facilities, 39 (41%) had no designated decontamination facilities; 67 (70%) had protocols for handling chemical contamination and possible evacuation from hazardous materials spills, and 52 (55%) had protocols for handling medical facility contamination and possible evacuation from treating chemically contaminated patients. Twelve (13%) facilities had evacuated their emergency department or other part of the hospital for contamination incidents in the past 5 years. Despite the frequent occurrence of hazardous materials incidents, most emergency care facilities in Washington State are not fully prepared to handle contaminated patients and chemical spills. This may have important implications for the care of persons with exposure to hazardous materials and for implementing Joint Commission on Accreditation of Healthcare Organizations standards and federal Occupational Safety and Health Administration regulations.

Accidents, Occupational↗