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101.
102.
Chris J. Eagle J. Roger Maltby Shellie Kryski David Hardy 《Journal canadien d'anesthésie》1994,41(3):248-252
The purpose of this laboratory study was to assess the value of refractometry in identifying the contents of a variety of opioid-containing solutions. A hand-held refractometer was used to document the refraction produced by the undiluted contents of alfentanil, fentanyl, morphine, sufentanil ampoules and by solutions of Ringer’s lactate, 0.9% saline, 3.3% dextrose in 0.3% saline, and distilled water. Each opioid was then serially diluted in serial 1:2, 1:4, and 1:8 dilutions in each of these solutions and the refractions of each determined. Based on this information, blinded identification of various diluted opioid solutions was attempted. Refractometer values for undiluted fentanyl and sufentanil were identical with those for distilled water. Those for undiluted alfentanil and morphine were almost identical with each other and with 1:2 and 1:4 dilutions of either drug in Ringer’s lactate or 0.9% saline. We conclude that refractometry is an unreliable screening method to detect tampering with opioid solutions. 相似文献
103.
The anaesthetic management of the surgical repair of a descending aortic aneurysm in a patient with large, bilateral, pulmonary
bullae is described. Anaesthesia for descending aortic surgery normally involves unilateral, positive-pressure ventilation,
an option which poses some risk of barotrauma in the presence of bilateral bullae. Patients with bullous disease commonly
have severe lung disease and thorough preoperative assessment and preparation are necessary. Intraoperatively, bilateral rupture
of the bullae could be catastrophic and preparations should be made for this possibility. In order to diminish this risk,
a surgical technique including preemptive collapse of the bulla by minithoracotomy and tube drainage, with use of a bronchial
blocker to the affected part of the lung may be used. If rupture occurs, then high frequency jet ventilation may be effective.
Use of a double lumen endobronchial tube may be advantageous for patients with either unilateral and bilateral bullae. Anaesthesia
for patients with bullae should avoid positive-pressure ventilation and nitrous oxide in order to limit the risk of barotrauma
from a ball valve mechanism. In this case, the risk of barotrauma was reduced by performing an inhalational induction of anaesthesia
and limiting peak inflation pressures during thoracotomy. It was elected to use positivepressure ventilation through a double
lumen endobronchial tube following chest incision. A high frequency jet ventilator was available but not employed. Anaesthetic
management was complicated by the presence of pleural adhesions, surgical approach directly through a bulla, and the requirement
for one lung ventilation.
The de i’aone descendante aecouverte cnez un pattent porde grosses bulles bilatérales d’emphysème est discutée, esthésie habituelle
pour une chirurgie de l’aorte descendante site une ventilation mécanique unilatérale et constitue ainsi sque additionnel pour
le porteur de bulles emphysémas bilatérales. Ces patients ont ordinairement des affections onaires graves et l’évaluation
et la préparation préopéraprennent une importance spéciale. Pendant l’intervention, pture de bulles bilatérales peut être
catastrophique et il se préparer à cette éventualité. Pour minimiser ce risque, technique chirurgicale qui inclut le collapsus
préventif de lle par minithoracotomie et drainage, avec installation d’un ieur bronchique sur la partie atteinte du poumon.
Si une re survient, le passage à la ventilation par jet à haute tence peut être salutaire. Le tube endobronchique à double
ère peut présenter des avantages aussi bien dans les cas ulles unilatérales que bilatérales. Chez ces patients, il vaut x
s’abstenir de ventiler avec une pression positive et du xyde d’azote afin de limiter le risque de barotraumisme soupape. Dans
ce cas-ci, on a réussi à limiter le risque arotraumatisme en réalisant une induction par inhalation réduisant la pression
d’inflation de pointe pendant la cotomie. Après l’incision thoracique, on a choisi d’utiliser tilation mécanique avec un tube
endobronchique à double ère. Un ventilateur à jet à haute fréquence était prêt mais as été utilisé. La gestion de l’anesthésie
a été compliquée par dhérences pleurales, par la rencontre d’une bulle d’emphysà l’incision et par l’obligation de ventiler
un seul poumon. 相似文献
104.
Chris Norwood 《Journal of community health》1995,20(2):161-170
In New York City in 1993, there were some 18,000 positive HIV tests but only 350 partner notifications completed by the New York City Health Department. The bleak disparity between these two numbers should haunt us all. We will never know for certain how many lives could have been saved by universally available notification services, but looking at the results of current, obstru tive New York State notification law and policy, we have to know we are facing an enormous public health failure. In states and cities with well-established notification programs, between 50 and 90% of HIV-positive clients cooperate voluntarily with notification and, typically 90% of partners contacted seek HIV-testing and preventive counseling. There are no differences in cooperation based on race, gender or sexual orientation.In New York, urgently required reform means legislation to mandate that notification services are offered to all people who test positive and to require the state to supply enough trained personnel to undertake sensitive notification and counseling. With Black and Latina women — most of whom are mothers — now at the highest risk for sexual HIV infection, New York's refusal to undertake the life-saving policies common elsewhere has not only resulted in a horrible abandonment of a very vulnerable population, but also accelerated the orphaning of children at unprecedented rates.Chris Norwood is Director of Health Force: Women Against AIDS. She is the author ofAdvice for Life: A Woman's Guide to AIDS, Pantheon, 1987.Presented as part of a symposium, Turning Points: Key Policy Debates on HIV in the Inner City, held on April 8, 1994 at the State University of New York, Health Science Center at Brooklyn. 相似文献
105.
Identification of the central vestibular projections in man: a positron emission tomography activation study 总被引:4,自引:0,他引:4
Gabriella Bottini Roberto Sterzi Eraldo Paulesu Giuseppe Vallar Stefano F. Cappa Francesco Erminio Richard E. Passingham Chris D. Frith Richard S. J. Frackowiak 《Experimental brain research. Experimentelle Hirnforschung. Expérimentation cérébrale》1994,99(1):164-169
The cerebral representation of space depends on the integration of many different sensory inputs. The vestibular system provides one such input and its dysfunction can cause profound spatial disorientation. Using positron emission tomography (PET), we measured regional cerebral perfusion with various vestibular stimulations to map central vestibular projections and to investigate the cerebral basis of spatial disorientation. We showed that the temporoparietal cortex, the insula, the putamen, and the anterior cingulate cortex are the cerebral projections of the vestibular system in man and that the spatial disorientation caused by unilateral vestibular stimulation is associated with their asymmetric activation. 相似文献
106.
Tracy Roberts BSc MPhil RGN Stirling Bryan BSc MSc Chris Heginbotham BSc MSc MA & Alison McCallum MB ChB MSc FFPHM 《Health expectations》1999,2(4):235-244
Background Public involvement in health care decision making and priority setting in the UK is being promoted by recent policy initiatives. In 1993, the British Medical Association called for public consultation where rationing of services was to be undertaken. The approach to priority setting advocated by many health economists is the maximization of quality adjusted life years (QALYs). Typically, for a particular health care programme, the QALY calculation takes account of four features: (1) the number of patients receiving the programme, (2) the survival gain, (3) the gain in quality of life and, (4) the probability of treatment success. Only one feature, that relating to quality of life, is based upon public preferences. If the QALY is to be used as a tool for health care resource allocation at a societal level then it should incorporate broader societal preferences.
Methods This study used an interview-based survey of 91 members of the general public to explore whether the traditional QALY maximization model is a good predictor of public responses to health care priority setting choices.
Results and conclusions Many respondents did not choose consistently in line with a QALY maximization objective and were most influenced by quality of life concerns. There was little support for health care programmes that provided a prognostic improvement but left patients in relatively poor states of health. The level of respondent engagement in the survey exercise was not sensitive to the provision of supporting clinical information. 相似文献
Methods This study used an interview-based survey of 91 members of the general public to explore whether the traditional QALY maximization model is a good predictor of public responses to health care priority setting choices.
Results and conclusions Many respondents did not choose consistently in line with a QALY maximization objective and were most influenced by quality of life concerns. There was little support for health care programmes that provided a prognostic improvement but left patients in relatively poor states of health. The level of respondent engagement in the survey exercise was not sensitive to the provision of supporting clinical information. 相似文献
107.
The National Mental Health Policy and National Mental Health Plan published in 1992 provided directions for the reform of mental health services in Australia. They stated that mental health services should be part of the mainstream health system and that integrated mental health programmes should be developed to cover the full range of specialist mental health services, focusing on improved quality of service, the consumers, equity of access, continuity of care and redistribution of resources. The Queensland Mental Health Plan published in 1994 set out specific objectives and strategies for implementing mental health service reform in Queensland. In Queensland there has been a concentration on developing core mental health services involving the reorientation of service delivery from institutions to the community, based on the principles of integration, mainstreaming and regional self-sufficiency. Major restructuring of mental health services is taking place, which has meant changes in service development, organizational structures and work practices. There has been a significant impact on the roles and skills required by the mental health workforce in the context of today's mental health services climate. There is a focus on staff providing individualized assessment and continuing treatment using a case management approach, within a continuum of care. Implications for occupational therapists include developing a generic skill base in preparation for broad-spectrum mental health professional roles while maintaining their professional identity. It is recommended that research be conducted to examine the capacity of occupational therapists to adapt to the changing mental health environment. Copyright © 1999 Whurr Publishers Ltd. 相似文献
108.
109.
Purpose
This case describes the management of a 19-yr-old wheelchair bound primigravida with severe muscular dystrophy who presented for Caesarean section after spontaneous rupture of membranes. Anaesthesia was influenced by several features of her systemic disease which were impediments to both neuraxial and general anaesthesia.Clinical features
Other than for a prenatal record and the history obtainable from the patient, little additional medical information was available. Physical examination showed diffuse muscular weakness and an anatomically abnormal airway. Examination of the spine showed slight 10–15° thoracolumbar scoliosis and > 45° lumbar lordosis. Fetal assessment was normal. Echocardiography revealed mildly decreased left ventricular function and was consistent with pulmonary hypertension. After discussion with the patient and her obstetrician, elective Caesarean delivery was deemed the best management. Neuroaxial anaesthesia was at an increased risk of failure due to the profound lumbar lordosis. A plan for awake intubation and general anaesthesia was described to the patient in case regional anaesthesia could not be initiated. A fibreoptic bronchoscope and difficult intubation kit were made available. General anaesthesia was expected to have increased risk of postoperative pulmonary complications, hence epidural anaesthesia was attempted. After difficult catheter insertion, a sensory block was titrated to a T4 level. This was well tolerated by both mother and fetus. A healthy baby was delivered with Apgar scores of 9 and 9. Postoperatively the mother was transferred to the intensive care unit. After 72 hr, the patients respiratory status allowed transfer to the ward.Conclusion
This case illustrates the use of epidural anaesthesia in the successful management of a severely compromised patient with limb-girdle muscular dystrophy undergoing elective Caesarean section. 相似文献110.
Jeri W. Nieves Felicia Cosman Chris Mars Robert Lindsay 《Calcified tissue international》1992,51(5):352-355
Summary Forearm bone mineral density (BMD) was measured at proximal and distal sites by 125I single photon absorptiometry (SPA) and by dual energy X-ray absorptiometry (DXA) in 67 consecutive subjects, aged 18–75 years. Correlations and regression equations between these two techniques were determined. All forearm measurements were significantly correlated with each other (r=0.599–0.926; P0.0001). Although SPA and DXA correct for fat in different ways, we found similar correlation and regression equations in women with body mass index measurements above and below the mean. In addition, forearm measurements by both techniques were moderately correlated with vertebral spine and hip BMD. We conclude that overall, SPA forearm measurements in a population can be calibrated to DXA measurements if necessary, and that DXA forearm measurements are as predictive of the remainder of the skeleton as SPA measurements. 相似文献