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Biomedical subjects

W R Smith

Publications and source records attributed to W R Smith.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Paraquat poisoning: an analytical toxicologic study of three cases.

Paraquat concentrations were measured in tissue, serum, urine and hemodialysate obtained from 3 patients who died 16.5 h, 22 days and 23 days after ingestion. In the patient who died 16.5 h post-ingestion, tissue paraquat levels were high. Kidney and liver had paraquat concentrations of 14 micrograms/g and 13.2 micrograms/g respectively, whereas lung tissue had a paraquat level of 3.8 micrograms/g. Low concentrations of paraquat were detectable in the tissues of the patients who died 22 and 23 days post-ingestion. Early in the poisoning, serum paraquat levels were high and large quantities of paraquat could be removed by both hemodialysis and forced diuresis. During an 8-h period, 713 mg of paraquat were removed by hemodialysis and 340 mg by forced diuresis. After the day of ingestion, little paraquat could be removed by hemodialysis or by forced diuresis; however, at all stages of the poisoning studied, hemodialysis was more effective than forced diuresis in removing paraquat from the blood.

Adolescent↗
PubMedDate not supplied

Emergency medical services telephone referral program: an alternative approach to nonurgent 911 calls.

OBJECTIVE: To examine the effects of transferring nonurgent 911 calls to a telephone consulting nurse. It was hypothesized that the telephone referral program would result in fewer basic life support (BLS) responses with no adverse patient outcome or decrease in patient satisfaction. METHODS: A two-phased prospective study was conducted in an urban and rural setting with a population of 650,000. During phase I, a BLS unit was dispatched on all calls and a nurse intervention was simulated. During phase II, no BLS unit was dispatched for calls meeting study criteria. Callers were transferred to the nurse, and consulting nurse protocols were used to direct care. Data were collected from dispatch, BLS, nurse, and hospital records and patient self-assessment. RESULTS: During phase I, 38 callers were transferred to the consulting nurse with no nurse intervention. During phase II, 133 cases were transferred to the nurse line. There were no adverse outcomes detected. The nurse recommended home care for 31%, physician referral for 24%, referral back to 911 for 17%, community resource for 11%, and other referral for 17%. Nurses contacted 85 patients for telephone follow-up. Ninety-four percent of the patients reported feeling better, 6% felt the same, and none felt worse. Patients were satisfied with the outcome in 96% of the cases. CONCLUSION: Transferring 911 calls to a nurse line resulted in fewer BLS responses and no adverse patient outcomes, while maintaining high patient satisfaction. Dispatch criteria correctly identified cases with minimal medical needs. A high percentage of the patients reported feeling better after the intervention. This study has major implications for communities interested in efficient use of emergency medical services resources.

Adolescent↗
PubMedDate not supplied

Renal hemodynamics in drug-overdosed patients.

Effective renal plasms flow (ERPF) and glomerular filtration rate (GFR), as determined by a radioisotopic method, were evaluated in seven heroin-overdosage patients (Group I) and 7 hypnotic-sedative-analgesic overdosage patients (Group II). No patient had evidence of shock. There was no significant intergroup differences in PaO2, PaCO2, pH, blood pressure, pulse rate, respiratory rate, cardiac output, or serum creatinine levels. Group I patients had lower ERPF and GFR compared to Group II (271 +/- 182.8 vs. 580 +/- 62 cc/min and 62.4 +/- 32.6 vs. 102.9 +/- 12.8 cc/min, respectively, p less than 0.005). We conclude that compared to hypnotic-sedative-analagesic overdosed patients heroin overdosed patients heroin overdosed patients have more profoundly altered renal hemodynamics.

Acute Kidney Injury↗
PubMedDate not supplied

Hemoglobinemia in heroin overdose patients.

Four heroin-overdosed patients presented with coma, elevated serum enzymes (creatine phosphokinase (CPK) and serum glutamic oxaloacetic transaminase (SGOT), and increased levels of plasma free hemoglobin. In two patients marked myoglobinuria was also detected. The plasma free hemoglobin returned to normal levels by the 3rd hospital day. Since coma may eventuate in compression of muscles, we suggest that the disruption of erythrocytes occurs as they traverse these ischemic areas.

Adult↗
PubMedDate not supplied

Significant other responses are associated with fatigue and functional status among patients with chronic fatigue syndrome.

OBJECTIVE: The predictive power of partners' responses to illness behavior for illness outcomes was investigated among couples in which one person had chronic fatigue syndrome (CFS). METHODS: One hundred nineteen participants who met case-definition criteria for CFS and were living with a significant other (SO) completed self-report measures of relationship satisfaction, responses of their SO to fatigue symptoms, and outcome measures of fatigue and functional status. RESULTS: The results indicated that more frequent solicitous SO responses to illness behavior were predictive of greater fatigue-related severity and bodily pain. Solicitous SO responses to fatigue behavior were particularly influential in the context of a satisfactory relationship. In highly satisfactory relationships, solicitous SO responses were associated with significantly greater fatigue severity and fatigue-related disability than in relationships characterized by low or average satisfaction. CONCLUSIONS: Solicitous SO responses to CFS-related symptoms are associated with poorer patient outcomes, especially in the context of a satisfactory intimate relationship. Because of the cross-sectional nature of the study, the direction of effects cannot be interpreted unambiguously. SOs may be inadvertently positively reinforcing illness-related behavior: Solicitous partners may help the patient more with tasks of daily living, thereby decreasing the patient's activity level, which may lead to deconditioning and disability. Alternatively, patients with more severe symptoms and disability may present more opportunities for concerned SO responses, which again may be heightened in the context of a caring, satisfactory relationship. In either case, the results suggest that additional research on the role of solicitous SO responses is warranted.

Adult↗
PubMedDate not supplied

An international comparison of physicians' judgments of outcome rates of cardiac procedures and attitudes toward risk, uncertainty, justifiability, and regret.

OBJECTIVE: Compare U.K. and U.S. physicians' judgments of population probabilities of important outcomes of invasive cardiac procedures; and values held by them about risk, uncertainty, regret, and justifiability relevant to utilization of cardiac treatments. DESIGN: Cross-sectional study. SETTING: University hospital and VA medical center in the United States; two teaching hospitals in the United Kingdom. PARTICIPANTS: 171 housestaff and attendings at U.S. teaching hospitals; 51 physician trainees and consultants at U.K. hospitals. MEASURES: Judgments of probabilities of severe complications and deaths due to Swan-Ganz catheterization, cardiac catheterization, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting (CABG); judgments of malpractice risks for case vignettes; Nightingale's risk-aversion instrument; Gerrity's reaction-to-uncertainty instrument; questions about need to justify decisions; responses to case vignettes regarding regret. RESULTS: The U.S. physicians judged rates of two bad outcomes of cardiac procedures (complications due to cardiac catheterization; death due to CABG) to be significantly higher (p < or = 0.01) than did the U.K. physicians (U.S. medians, 5 and 3.5, respectively; U.K. medians 3 and 2). The median ratio of (risk of malpractice suit I error of omission)/(risk of suit I error of commission) judged by U.K. physicians, 3, was significantly (p=0.0006) higher than that judged by U.S. physicians, 1.5. The U.K. physicians were less often risk-seeking in the context of possible losses than the U.S. physicians (odds ratio for practicing in the U.K. as a predictor of risk seeking 0.3, p=0.003). The U.K. physicians had significantly more discomfort with uncertainty than did the U.S. physicians, as reflected by higher scores on the stress scale (U.K. median 48, U.S. 42, p=0.0001) and the reluctance-to-disclose-uncertainty scale (U.K. 40, U.S. 37, p < 0.0001) of the Gerrity instrument. There was no clear international difference in perceived need to justify decisions, or in regret. CONCLUSIONS: The results were not clearly consistent with the uncertainty hypothesis that international practice variation is due to differences in judged rates of outcomes of therapy or with the imperfect-agency hypothesis that practice variation is due to differences in physicians' personal values. The causes and implications of practice variations remain unclear.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Combining state administrative databases and provider records to assess the quality of care for children enrolled in Medicaid.

Our objective was to assess the capability of state administrative health care databases to evaluate the quality of immunization rates for a Medicaid managed care population. Data on 5599 2 year olds were obtained from a Medicaid claims database, a health department database, and the records of the children's assigned providers. The study was conducted on 1 managed care program in 1 state. Test performance ratio analyses were used to assess the relative accuracy and contribution of each source of administrative data. We found that of the 67,188 doses needed, 45,511 (68%) were documented as administered per at least 1 of the data sources. Medicaid claims data alone accounted for 18% of immunized children, while health department data used by itself accounted for 12%. Together, these 2 sources identified 34% of immunized children. Large administrative databases, such as Medicaid claims and data from a health department, while valuable sources of information on quality, may underestimate outcomes such as immunization rates. Assessments of the quality of health care should rely on a combination of administrative data and providers' records as sources of information.

Child Health Services↗
PubMedDate not supplied

Electrocardiographic abnormalities in acute heroin overdosage.

Twenty-one 25 acutely overdosed heroin addicts had abnormalities noted on their admission electrocardiograms. The most common findings were nonspecific ST-T changes in 17 patients, sinus tachycardia in 11, and left or right atrial enlargement in 8. Five patients had more serious arrhythmias (4 atrial fibrillation and 1 ventricular tachycardia). For the entire group the initial PaO2 was 74.8 +/- 48.2 torr. This degree of oxygenation was only achieved with the use of high dose supplemental oxygen. The 5 patients with the more serious arrhythmias had comparable PaO2s but this was only achieved with higher supplemental oxygen concentrations. We conclude that electrocardiographic alterations (other than arrhythmias) are very common in acute heroin overdosage and may be related to hypoxemia. The abnormal cardiac rhythms may be due to the direct effects of heroin or its metabolites. Heroin addiction is associated with a multitude of medical complications which can affect various organ systmes including the heart (1). Within the last six years several reports have appeared documenting electrocardiographic abnormalities in heroin users (2-5). These studies dealt with either a small series of patients or patients who used methadone or heroin in a chronic fashion. No one, to our knowledge, has extensively studied the electrocardiographic changes which occur in patients with acute heroin overdosage. This retrospective analysis of the electrocardiograms (ECG), arterial blood gases and selected electrolytes in 25 consecutively hospitalized patients acutely overdosed on heroin is an attempt to correct this deficiency.

Acute Disease↗