Large volume injection and infiltration system

Summary A system which can be used for injection or infiltration of large volumes of fluid is described. This consists of a syringe which fills automatically from a reservoir through an inlet/outlet valve.     

Decisions near the end of life.

Designing behavior change programs and evaluating their effects on patient care has been a persistent challenge in research on continuing medical education. The challenge becomes even more complex when we aim to change behaviors that are interactive and highly influenced by the formal and informal institutional context. The authors describe an interdisciplinary continuing education program in bioethics that is designed to effect just such behaviors. The program aims to help hospital and long-term care facilities improve their ability to resolve the ethical dilemmas inherent in terminal care decisions. Targeted to interdisciplinary groups of physicians, nurses, social workers, pastoral counselors, and administrators, Decisions Near the End of Life will provide strategies and tools for examining institutional policies and team practices as well as more traditional information, education, and skill building. The authors describe the program's rationale and design, and raise questions about the potential for developing interdisciplinary, action-oriented CME on other topics.     

EXTERNAL CEPHALIC VERSION

External cephalic version has been used periodically for centuries to manage breech presentations. As cesarean section rates have escalated in the last two decades, ways to curb this rise have been evaluated. By reducing the number of infants that arrive in labor in a representation, it is possible to impact the overall cesarean section rate. External cephalic version is a safe, effective method when used in appropriate cases of breech presentation. A forward or backward roll can be accomplished in women at term with singleton gestations, adequate amniotic fluid, and reactive nonstress tests. Parity, fetal and placental position, and descent of the presenting part may all influence the success rate of the version.     

Shoot First,Draw Later Peroneal Nerve Palsy: A Sonographic Study

A 32–year–old man had an unusual gunshot wound to the leg, causing a peroneal nerve palsy. Sonography provided useful complementary findings to the electrodiagnostic localization of the injury.     

Insertion of Hickman central venous catheters by using angiographic techniques in patients with hematologic disorders.

During a 9-month period, 69 Hickman catheters were successfully inserted by using angiographic techniques in 59 patients with hematologic disorders. A pneumothorax, which did not require drainage, developed in one patient. No other significant complications occurred at the time of insertion. Eighteen catheters were removed electively, 15 are still in situ, six were removed for thrombosis, and five were accidentally removed. Infection precipitated removal in six subjects. Ten patients died with the catheter in place. Five catheters were removed in patients with refractory septicemia of unknown origin. One catheter burst during an injection and had to be removed. Three patients were lost to follow-up. There were 3.24 infectious episodes per 1000 days of catheterization, more than twice the rate found in some other series. The results of this study are compatible with the growing body of evidence in favor of the angiographic insertion of Hickman catheters. The apparently high rate of infection is ascribed to factors other than insertion in the angiography suite, including the high proportion of bone marrow transplantation patients.     

Addiction.: By David Marteau. Quay Books Division, Mark Allen Publishing, Ltd, London. 2001, 168pp., {pound}14.99. ISBN: 1-85642-189-9.

Addiction was written by David Marteau, a nurse and former headof treatment at Clouds House. It is a short book offering comprehensivecoverage of the causes, nature and treatment of