Biomedical subjects

William B Long

Publications and source records attributed to William B Long.

46 records · Page 3Linked to original sources

PubMed2004

Use of UV-protective windows and window films to aid in the prevention of skin cancer.

People are exposed to ambient solar ultraviolet (UV) radiation throughout their daily routine, intentionally and unintentionally. Cumulative and excessive exposure to UV radiation is the behavioral cause to skin cancers, skin damage, premature skin aging, and sun-related eye disorders. More than one million new cases of skin cancer were diagnosed in the United States this year. UV radiates directly and diffusely scattered by the various environmental and atmospheric conditions and has access to the skin from all directions. Because of this diffuse UV radiation, a person situated under a covering, such as the roof of a car or house, is not completely protected from the sun's rays. Because shade structures do not protect effectively against UV radiation, there have been major advances in photoprotection of glass by the development of specially designed photoprotective windows and films. It is the purpose of this collective review to highlight the photoprotective windows and films that should be incorporated into residential, commercial, and school glass windows to reduce sun exposure. Low-emittence (low-E) coatings are microscopically thin, virtually invisible, metal or metallic oxide layers deposited on a window or skylight glazing surface to reduce the U-factor by suppressing radiative heat flow as well as to limit UV radiation. The exclusive Thermaflect coating uses the most advanced, double-layer soft coat technology to continue to deliver top performance for UV protection as well as prevent heat loss in the home. This product blocks 87% of UV radiation and has an Energy Star certification in all climate zones. Tints and films have been another important advance in glass photoprotection, especially in automobiles. Quality widow film products are high-tech laminates of polyester and metallized coatings bonded by distortion-free adhesives. The International Window Film Association provides members with accreditation in solar control films, safety films, and automotive films in an effort to increase consumer awareness and demand for all professionally installed film window products. The Skin Cancer Foundation has also played a leadership role in certifying window films that limit UV transmission. The Panorama Designer and Safety Films are currently recommended for UV photoprotection by The Skin Cancer Foundation. On the basis of these innovative scientific and industrial advances in window and film photoprotective products, we recommend that they be used in all residential, commercial, and school facilities to provide photoprotection in an effort to reduce skin cancer.

Glass↗

PubMed2004

Strategies to reduce hyperthermia in ambulatory multiple sclerosis patients.

Approximately 400,000 Americans have multiple sclerosis. Worldwide, multiple sclerosis affects 2.5 million individuals. Multiple sclerosis affects two to three times as many women as men. The adverse effects of hyperthermia in patients with multiple sclerosis have been known since 1890. While most patients with multiple sclerosis experience reversible worsening of their neurologic deficits, some patients experience irreversible neurologic deficits. In fact, heat-induced fatalities have been encountered in multiple sclerosis patients subjected to hyperthermia. Hyperthermia can be caused through sun exposure, exercise, and infection. During the last 50 years, numerous strategies have evolved to reduce hyperthermia in individuals with multiple sclerosis, such as photoprotective clothing, sunglasses, sunscreens, hydrotherapy, and prevention of urinary tract infections. Hydrotherapy has become an essential component of rehabilitation for multiple sclerosis patients in hospitals throughout the world. On the basis of this positive hospital experience, hydrotherapy has been expanded through the use of compact aquatic exercise pools at home along with personal cooling devices that promote local and systemic hypothermia in multiple sclerosis patients. The Multiple Sclerosis Association of America and NASA have played leadership roles in developing and recommending technology that will prevent hyperthermia in multiple sclerosis patients and should be consulted for new technological advances that will benefit the multiple sclerosis patient. In addition, products recommended for photoprotection by The Skin Cancer Foundation may also be helpful to the multiple sclerosis patient's defense against hyperthermia. Infections in the urinary tract, especially detrusor-external sphincter dyssynergia, are initially managed conservatively with intermittent self-catheterization and pharmacologic therapy. In those cases, refractory to conservative therapy, transurethral external sphincterotomy followed by condom catheter drainage is recommended. However, if external urethral sphincterotomy fails to reduce residual urine and detrusor pressure, urinary diversion or bladder reconstruction may be necessary.

Body Temperature↗

PubMed2004

An organized approach to trauma care: legacy of R Adams Cowley.

The organized approach to caring for trauma patients was introduced into the civilian setting by the innovative pioneer, R Adams Cowley. His system in Maryland has the following 11 components: (1) a State Police Aviation Division that transports patients throughout the State; (2) trained paramedics at the scene of the accident as well as on the helicopter, who will stabilize the patients en route to the Shock Trauma Center; (3) one central dispatch communication center in Baltimore that coordinates information between paramedics and the Trauma Center; (4) a Shock Trauma Center with a helicopter landing zone near the building; (5) trained trauma nurses and trauma technicians to transfer the patient from the helicopter by stretcher to the resuscitation area; if there is a special complication, such as an airway problem, the anesthesiologist and or trauma surgeon may meet the helicopter on the roof as well; (6) trauma surgeons, board-certified in surgery, with a certificate of added qualification in surgical critical care, to treat the critically ill trauma patients in the resuscitation area; (7) a CT scan and portable X-ray units in the admission area that aid in the diagnosis of the injury; (8) operating rooms adjacent to the admission area for repair of trauma injuries; (9) a surgical intensive unit to care for the trauma patient; (10) a team of specialty physicians trained in a wide variety of specialties who work as a multidisciplinary unit caring for the hospitalized patient; and (11) an ambulatory outpatient unit that allows the patient to be followed in the center after discharge. Dr. R Adams Cowley incorporated each of these 11 components for an organized trauma center into Maryland. In recognition of his landmark contributions to trauma, the eight-story Shock Trauma Center was named the R Adams Cowley Shock Trauma Center. There is growing evidence that this organized system in trauma care seen in Maryland must be replicated in every state in our nation. The results of the Health Resources and Services Administration Report in 2002 show serious limitations in our nation's organized approach to emergency and trauma care. This report indicates that many Americans do not have access to well-trained pre-hospital emergency personnel. Between 10 and 15% of the US population does not have access to basic emergency medical and communication services. Moreover, the presence of key trauma system components continues to vary throughout the country, most likely because of growing economic constraints. Emergency communication systems remain fragmented, and adequate training programs and protective equipment for health personnel remains notably absent. The threat of inadequate funding for the state manifests itself in the consistent uneasiness regarding the recruitment and continued retention of trauma care providers. Federal authorities must devise national emergency medical and organized trauma programs to save the lives of injured Americans.

Disaster Planning↗

PubMed2004

Special considerations in the selection of the certified rehabilitation supplier.

During the last four decades, there have been revolutionary advances in the design of wheelchairs, complimented by special seating systems. Some of these advances include battery-operated power mobility, ergonomic steering devices, and a wide variety of innovative devices that allow the user to achieve a unique array of positions. These positions include tilting of the seat, reclining the back of the sear, achieving a passive standing position, and, finally, the unique ability of the wheelchair to climb over steep curbs cuts and even up staircases. Because of the availability of such a wide variety of wheelchairs, the medical profession requires the development of many new, unique partnerships. First, the user of a wheelchair must purchase the wheelchair from a certified rehabilitation supplier (CRTS). Realizing the importance of purchasing a wheelchair from a CRTS, there are other special considerations that the purchaser must make in the selection of a CRTS. First, the CRTS must have a coordinated team of healthcare personnel, including physicians, occupational therapists, physiatrists, and other seating specialists who are able to complete a pre-authorization form that will be approved by the private insurance company as well as Medicare and Medicaid. The CRTS must have a president as well as a successor who is familiar with the powered wheelchair products, especially the powered wheelchair that can allow the user to achieve a passive standing position. In this comprehensive report, we will illustrate how an inexperienced CRTS who is not familiar with powered wheelchairs that can achieve a passive standing position can design and construct a wheelchair product that can seriously injure the user when they achieve a passive standing position. In Portland, Oregon, Tri-Care Wheelchair Service, Inc., is an experienced supplier of pow notered wheelchairs that achieve a passive standing position. Its two CRTS carefully assist the purchaser in selecting and then registering the powered wheelchair. Working with a team of seating specialists, they prepare preauthorization forms that will be approved by the private insurance company as well as Medicare and Medicaid. They carefully make adjustments in the design of the wheelchair seating system so that the user is comfortable as well as safe in a passive standing position.

Activities of Daily Living↗

PubMed2004

Prevention of disabling back injuries in nurses by the use of mechanical patient lift systems.

Occupational back pain in nurses (OBPN) constitutes a major source of morbidity in the health care environment. According to the National Institute for Occupational Safety and Health (NIOSH), occupational back injury is the second leading occupational injury in the United States. Among health care personnel, nurses have the highest rate of back pain, with an annual prevalence of 40-50% and a lifetime prevalence of 35-80%. The American Nursing Association believes that manual patient handling is unsafe and is directly responsible for musculoskeletal disorders encountered in nurses. It has been well documented that patient handling can be done safely with the use of assistive equipment and devices that eliminate these hazards to nurses that invite serious back injuries. The benefit of assistive patient handling equipment is characterized by the simultaneous reduction of the risk of musculoskeletal injury to the nursing staff and improvement in the quality of care for patient populations. To understand the cause of disabling injuries in health care workers, several factors must be considered, including the following: (1) anatomy/physiology of the back, (2) risk factors, (3) medical legal implications, and (4) prevention. Among nurses, back, neck, and shoulder injuries are commonly noted as the most prevalent and debilitating. While mostly associated with dependant patient care, the risk for musculoskeletal injury secondary to manual patient handling crosses all specialty areas of nursing. The skeletal defects of an abnormal back make the back more susceptible to occupational injury, even under normal stress conditions. Workers compensation guidelines for occupational back injury differ in public and private health care sectors from state to state. Nursing personnel should be reminded that the development of back pain following occupational activities in the hospital should be reported immediately to the Occupational Health Department. A nurse's failure to report OBPN immediately has resulted in numerous denials of claims for rehabilitation and compensation that nurses deserve. Experts believe that training in proper body mechanics does not prevent back injury. Consequently, focus has been placed on other innovative injury prevention programs, including the use of engineering controls as well as the "lift team" method. Ergonomics involves the use of mechanical devices (e.g., walking belt and mechanical hoist) to aid in patient lifting and transferring tasks. Guldmann Inc. has devised ceiling lift systems and slings during the past 20 years. They have successfully completed thousands of installations worldwide, covering a wide range of challenging conditions and complex environments. The Guldmann ceiling-mounted hoist system consists of a wide range of lifting units, rail components, and a complete assortment of lifting slings and accessories. Its sling is made of polyester, which is characterized by its strength and elasticity. It retains its shape and is dirt repellent and easy to maintain. The Guldmann network has one of the largest and indisputably most experienced group of certified installers in the United States. The "lift team" method was devised to remove nursing personnel from the everyday task of moving patients. This type of intervention assumes that lifting is a specialized skill to be performed only by expert professional patient movers who have been thoroughly trained in the latest lifting device techniques.

Back Injuries↗

PubMed2003

Biliary casts after orthotopic liver transplantation: clinical factors, treatment, biochemical analysis.

OBJECTIVES: Biliary casts develop in up to 18% of liver transplant recipients. Casts are associated with morbidity, graft failure, need for retransplantation, and mortality. Proposed etiological mechanisms include acute cellular rejection, ischemia, infection, and biliary obstruction. We aimed to identify clinical features associated with biliary cast formation, review treatments, and analyze the biochemical composition of casts at a single, large, liver transplant center. METHODS: Patient records were reviewed retrospectively to identify patients who developed casts. Data were collected with attention to ischemia, rejection, obstruction, infection, immunosuppression, postoperative biliary drain use, and cast-directed management, and were compared with data from controls. Cast specimens, retrieved at cholangiography, were analyzed with chromatography techniques. RESULTS: Ischemic factors were noted in 70% (7/10) of cast patients versus 15% (6/40) of controls (OR = 13.2; 95% CI = 2.7-66.0; p = 0.001). Biliary strictures were present in 50% of cast patients versus 10% of controls (OR = 9.0; 95% CI = 1.8-45.2; p = 0.01). Differences in cold ischemia time, acute cellular rejection, cyclosporin use, infection, and postoperative biliary drain use were not significant. Casts were successfully treated by endoscopic and percutaneous methods in 60% of patients. One patient died of cast-related complications (mortality 10%). Four casts were in satisfactory condition for biochemical analysis. Bilirubin was the main component ( approximately 10-50%). Bile acid synthesis products and cholesterol comprised smaller percentages, and protein comprised only 5-10%. CONCLUSIONS: Biliary casts are more likely to develop in the setting of hepatic ischemia and biliary strictures. Endoscopic and percutaneous cast extraction might achieve favorable results and should be attempted before surgical therapy.

Adult↗

PubMed2002

Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases.

BACKGROUND: Endoscopic mucosal resection (EMR) is an alternative to surgery for removal of superficial neoplastic lesions of the GI tract. The aim of this study was to assess the safety, efficacy, and clinical outcomes of EMR. METHODS: Data from consecutive EMR procedures performed by using suction cap-assisted and/or saline solution-assisted snare resection techniques over a 45-month period were reviewed retrospectively. EUS was performed before EMR in the majority of cases. Immediate and delayed complications were recorded. Survival was assessed in patients with carcinoma or high-grade dysplasia on final histopathology in whom EMR achieved complete resection. RESULTS: One hundred one lesions were removed by EMR in 92 patients. Indications were adenoma (67%), high-grade dysplasia (13%), intramucosal carcinoma (11%), and lesions of uncertain histopathology (10%). Locations were esophagus 19%, stomach 14%, duodenum 27%, rectum 12%, and colon 29%. Suction cap-assisted technique was used in 26% and saline solution-assisted polypectomy in 74% of cases. Complete resection was achieved in 89%. For complete resection, 17% required more than 1 session. Post-EMR histopathology was adenoma 47%, high-grade dysplasia 13%, carcinoma 16%, carcinoid 3%, benign 19%, and low-grade dysplasia 3%. EMR resulted in upgrading of histopathologic staging to carcinoma or high-grade dysplasia in 44%. Bleeding was the only complication (early 16, delayed 6). The median cancer-free survival in patients with adenocarcinoma who underwent complete resection by EMR was 27 months (interquartile range: 17-28 months). CONCLUSION: EMR achieves complete resection in a majority of patients but is associated with a higher risk of bleeding compared with standard polypectomy. EMR changes pathologic stage in a significant number of patients. Survival data are encouraging, but long-term follow-up studies are needed.

Adult↗

PubMed2002

Noninvasive reduction of open-book pelvic fractures by circumferential compression.

OBJECTIVES: To determine the efficacy and optimal application parameters of circumferential compression to reduce external rotation-type pelvic fractures. DESIGN: Biomechanical investigation on human cadaveric specimens. SETTING: Biomechanics laboratory. INTERVENTION: Partially stable and unstable external rotation injuries of the pelvic ring (OTA classification 61-B1 and 61-C1) were created in seven human cadaveric specimens. A prototype pelvic strap was applied subsequently at three distinct transverse levels around the pelvis. Circumferential pelvic compression was induced by gradual tensioning of the strap to attempt complete reduction of the symphysis diastasis. MAIN OUTCOME MEASUREMENTS: Pelvic reduction was evaluated with respect to strap tension and the strap application site. The effect of circumferential compression on intraperitoneal pressure and skin-strap interface pressure was measured. RESULTS: A successive increase in circumferential compression consistently induced a gradual decrease in symphysis diastasis. An optimal strap application site was determined, at which circumferential compression most effectively yielded pelvic reduction. The minimum strap tension required to achieve complete reduction of symphysis diastasis was determined to be 177 +/- 44 Newtons and 180 +/- 50 Newtons in the partially stable and unstable pelvis, respectively. CONCLUSIONS: Application of circumferential compression to the pelvic soft tissue envelope with a pelvic strap was an efficient means to achieve controlled reduction of external rotation-type pelvic fractures. This study derived application parameters with direct clinical implication for noninvasive emergent management of traumatic pelvic ring disruptions.

Aged↗

PubMed2002

A protocolized approach to pulmonary failure and the role of intermittent prone positioning.

INTRODUCTION: We present a series of adult patients treated under a protocol for severe lung failure (acute respiratory distress syndrome [ARDS]) that uses positive end-expiratory pressure (PEEP) optimization and intermittent prone positioning (IPP) to reduce shunt, improve oxygen (O(2)) delivery, and reduce FiO(2). METHODS: Trauma, emergency vascular, and general surgical patients with PaO(2)/FiO)(2) (PF) ratio < 200 were entered into a protocol designed to maintain mixed venous saturation (SVO(2)) > 70% with FiO(2) < 0.50. Therapy involved a sequential algorithmic approach that included pulmonary artery oximetry, "best-PEEP" determination, optimization of cardiac function, limitation of VO(2), transfusion to hematocrit of 35%, frequent bronchoscopy, rational diuresis and, if the FiO(2) was > 0.50, a trial of IPP with every-6-hour rotations. Unstable spine fractures and pelvic external fixators were the only contraindications to IPP. We collected data prospectively and from the charts and trauma registry. RESULTS: Forty adults were treated by protocol, 29 were injured and 11 had vascular or general surgical primary problems. The patients were 46.3 +/- 3.1 years old (the trauma patients were 42.9 +/- 3.2, and the vascular/general patients were 62 +/- 7.5 years old). Average Injury Severity Score was 25.9 +/- 3.7 and the Murray lung injury score was 2.65 +/- 0.9. IPP was used in all patients including those with recent tracheostomy, open abdomens, laparotomy, thoracotomy, leg external fixators, central nervous system injury, continuous venovenous hemofiltration and extracorporeal membrane oxygenation cannulae, vasopressor therapy, recent chest wall open reduction and internal fixation, and facial fractures. With the initiation of IPP therapy, the PF ratio increased from 132.1 +/- 8.5 to 231.6 +/- 14.2 (p < 0.001), the FiO(2) was decreased from 65.9 +/- 4.0% to 47.0 +/- 1.1% (p < 0.001), and the SVO(2) increased from 75.3 +/- 1.8% to 78.6 +/- 1.6% (p = 0.023). PEEP and static compliance were unchanged. The duration of IPP was 85.6 +/- 14.9 hours (median, 55 hours; range, 12 to 490 hours). Within 48 hours, all patients were on FiO(2) < or = 50. Mortality was 20% (14% for trauma) and none died of ARDS. The only complications of IPP were one case of partial-thickness skin loss from a malpositioned nasogastric tube and a case of transient lingual edema. CONCLUSION: IPP was independently responsible for an increase in PF ratio and SVO(2). We effectively and safely used IPP in our patients with ARDS, including many with issues generally considered to be contraindications. IPP and best-PEEP therapy enabled us to wean all of our patients' Fio2 to < or = 0.50 within 48 hours of ARDS onset.

Adolescent↗

PubMed2002

Diagnostic yield of barium enema examination after incomplete colonoscopy.

PURPOSE: To determine the diagnostic yield of barium enema examination for neoplastic lesions larger than 1 cm in diameter in the nonvisualized portion of the colon after incomplete colonoscopy. MATERIALS AND METHODS: A review of computerized gastroenterology and radiology databases identified 355 patients who underwent incomplete colonoscopy; 158 (44.5%) underwent subsequent barium enema examination (125 double-contrast and 33 single-contrast barium enema examinations). The radiographic reports were reviewed and compared with the endoscopic reports by one author to identify neoplastic lesions larger than 1 cm in the nonvisualized colon after incomplete colonoscopy. Six such lesions were found. In all six cases, the images from the barium enema examinations were reviewed together by two authors to determine the size, location, and morphologic features (polypoid, ulcerated, or annular) of the lesions. Medical, endoscopic, and surgical records were subsequently reviewed by one author to determine whether these represented true- or false-positive radiographic findings. RESULTS: Barium enema examination depicted six possible lesions in the nonvisualized colon after incomplete colonoscopy; five were found to be true-positive radiographic findings, and one was found to be a false-positive finding. The five true-positive findings included two annular lesions (both adenocarcinomas) and three polypoid lesions (all tubulovillous adenomas, with high-grade dysplasia in one). Thus, neoplastic lesions larger than 1 cm were found on barium enema images in the nonvisualized colon in five (3.2%) of 158 patients after incomplete colonoscopy. CONCLUSION: Barium enema examination had a diagnostic yield of 3.2% for neoplastic lesions larger than 1 cm in the nonvisualized colon after incomplete colonoscopy.

Adult↗