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PubMed1979

Charles Dickens and the ear, nose, and throat.

Charles Dickens is known as a novelist, humorist, humanist, and a social reformist. One of his many abilities was an astute power of observation, and some of his writings included descriptions considered as original medical knowledge. Among the hundreds of characters portrayed by Dickens, many had depictions or diseases of interest to the otolaryngologist. Dickens described deaf children and was interested in the methods used in their teaching. He had a keen interest in children and their welfare and described his visits to the Childrens Hospital in London and to Parkins Institute at Boston. He described both temporary and permanent deafness following exposure to loud noise. Dickens was a medical critic and most of his writings on the subject were humorous, though mixed at times with a spicy element of satire.

Adolescent↗
PubMed1988

Leeches. Objective monitoring of altered perfusion in congested flaps.

In plastic and reconstructive surgery, there has been new interest in the use of the medicinal leech (Hirudo medicinalis) for the treatment of venous congestion. To the best of our knowledge, no study has been performed to objectively demonstrate the benefits of leeching a congested flap. Doppler laser perfusion monitoring (DLPM) was used to record blood flow changes in pig rump flaps compromised by venous occlusion. With the application of leeches to nine congested pig rump flaps, significant increases in blood flow were demonstrated both clinically and by DLPM. It is concluded from this study that DLPM can demonstrate objective improvement in microcirculatory perfusion with leeching.

Animals↗
PubMed1994

Diagnostic blood loss in the patient undergoing head and neck surgery.

OBJECTIVE: To examine retrospectively the amount of blood lost solely for diagnostic purposes in a defined group of patients. DESIGN: Retrospective medical chart review of a case series. SETTING: Operating theater and surgical intensive care unit in a major tertiary care center. PATIENTS: Thirty-nine consecutive patients with head and neck cancer undergoing major surgical procedures and requiring overnight intensive care unit monitoring. MAIN OUTCOME MEASURES: Patient medical records were analyzed for procedure, starting hematocrit reading, intraoperative estimated blood loss and intravenous fluids, operative time, history of blood product transfusion, blood lost for each phlebotomy encounter, and the immediate cost therefrom. RESULTS: The mean diagnostic blood loss was 181 mL, which was 36% of estimated blood loss. In the group of 23 nontransfused patients, the average drop in hematocrit was 9.7%. This change in hematocrit correlated most strongly with operating time (P < .02) and the amount of intraoperative intravenous fluid administration (P < .05). The average cost to the patient directly from phlebotomy-associated charges was $542. CONCLUSION: Diagnostic blood loss contributes significantly to the overall blood loss in the patient undergoing head and neck surgery.

Blood Loss, Surgical↗
PubMed1992

Effect of educational program on compliance with glove use in a pediatric emergency department.

OBJECTIVE: To investigate the effect of an educational program on compliance with glove use in a pediatric emergency department. DESIGN: Without their knowledge, participants were observed for routine use of gloves during vascular access procedures before and after an educational program. Participants with up to 3 years' vascular access experience were defined as less experienced and those with 4 or more years' experience were defined as more experienced. Their success rates performing vascular access procedures with and without wearing gloves were also monitored. SETTING: Inner-city pediatric hospital emergency department. PARTICIPANTS: Twenty-three emergency department registered nurses. INTERVENTIONS: A 30-minute lecture with slides, written materials, and posters addressing the reasons and need for universal precautions, and recommended methods of barrier precautions to prevent skin and mucous membrane exposure when handling sharp instruments. MEASUREMENTS/MAIN RESULTS: For the less experienced registered nurses, the compliance rate before the educational program was 70% and remained at about 93% afterward. For the more experienced registered nurses, the compliance rate before the program was only 15%. After the program, this compliance rate rose to 93%, but declined to only 50% by the fifth month. The registered nurses' success rate on the first attempt at vascular access while wearing gloves was 75% compared with 70% without gloves. CONCLUSION: Educational programs can result in a clinically significant increase in glove use by pediatric emergency department registered nurses. Long-term improvement was less pronounced for the group of more experienced registered nurses. We also observed that glove use does not appear to interfere with the proficient performance of vascular access procedures.

Bloodletting↗
PubMed1989

Limitations to donating adequate autologous blood prior to elective orthopedic surgery.

We reviewed 175 patients who predeposited autologous blood prior to elective orthopedic surgery to define potential limitations of procuring adequate autologous blood. These potential limitations include physician underordering, storage interval, and erythropoietic response. We found that a continuing medical education intervention increased the amount of autologous blood requested by physicians for storage: from 121 U for 50 patients (mean = 2.4) before CME to 195 U for 65 patients (mean = 3.0) afterward; eight (16%) of 50 patients had 4 U or more requested before CME vs 25 (38%) of 65 patients afterward. Continuing medical education had no impact on mean (+/- SD) effective storage interval, 22.6 +/- 9.0 vs 21.6 +/- 9.4 days. Thirty (17%) of 175 patients were deferred (hematocrit less than or equal to 0.34) and were unable to donate units of blood requested; of these, 13 (43%) received homologous blood compared with 19 (13%) of 145 not deferred. We conclude that a significant percentage of patients are deferred from autologous donation because of hematocrit limitations and receive homologous blood. This problem is not related to physician underordering or inappropriate physician transfusion behavior, but rather to the erythropoietic response to serial phlebotomy over a limited storage interval. Future studies should focus on mechanisms to maximize autologous blood procurement.

Blood Banks↗