Narcotic and benzodiazepine use after withdrawal of life support: association with time to death?

Objective: To determine whether the dose of narcotics and benzodiazepines is associated with length of time from mechanical ventilation withdrawal to death in the setting of withdrawal of life-sustaining treatment in the ICU.

Design: Retrospective chart review.

Setting: University-affiliated, level I trauma center.

Evaluation of a standardized order form for the withdrawal of life support in the intensive care unit.

Objective: The intensive care unit remains a setting where death is common, and a large proportion of these deaths are preceded by withdrawal of life support. We describe a quality improvement project implementing and evaluating a "withdrawal of life support order form" to improve quality of end-of-life care in the intensive care unit.

Design: Before-after evaluation.

The immune response of larvae and pupae of Calliphora vicina (Diptera: Calliphoridae), upon administered insult with Escherichia coli.

Adult blowflies, Calliphora vicina Robineau-Desvoidy, are exposed to bacteria-laden decay as adults and larvae. They are protected from infections in such habitats by a family of lytic proteins called Cecropins. In this study, we explore the relationshipbetween the developmental stages of the blowfly and the strength of the immune response when insulted by an endogenous pathogen, Echerichia coli.

A multisite physician's office laboratory evaluation of an immunological method for the measurement of HbA1c.

Objective: To evaluate the clinical performance of a new immunological HbA1c method in physicians' office laboratories.

Research Design And Methods: Three physicians' offices participated in the evaluations. The clinicians routinely use HbA1c test results to monitor their patients' long-term blood glucose control.

Immediate HbA1c results. Performance of new HbA1c system in pediatric outpatient population.

Objective: This study compared the performance of a new device that uses an IA to measure HbA1c in 9 min with a 1-microliter capillary blood sample with AC and CE methods in both nondiabetic and diabetic pediatric patients.

Research Design And Methods: Two hundred seven pediatric subjects (103 nondiabetic, 104 with insulin-dependent diabetes mellitus) had HbA1c measured with the IA method and compared with total GHb values determined by AC and HbA1 by the CE method with the same whole-blood capillary aliquot. Glucose values were also obtained from the same blood samples.

Accuracy and precision of HDL cholesterol measurements using an office chemistry analyzer.

Background: A physician can obtain a patient's complete lipoprotein profile at the time of the office visit including assays of the total serum cholesterol, high-density lipoprotein cholesterol (HDL-C), and fasting triglyceride concentrations, and then calculate the low-density lipoprotein cholesterol (LDL-C). Until recently, this was not possible. Instruments are currently available that provide reliable rapid total serum cholesterol and fasting triglyceride measurements.

Cholesterol assays in the Seralyzer instrument.

We evaluated the Seralyzer instrument for the assay of serum cholesterol and compared it to the Kodak Ektachem method. The Seralyzer showed good accuracy in the analysis of cholesterol in Abell-Kendall-verified serum pools, and the bias from the expected value was small in all cases but one. The Seralyzer exhibited CVs of less than 5% in all cases and good comparison with the Ektachem method.

Chronic parietal cell dysfunction after reversal of gastric bypass.

A middle-aged woman developed a postgastric bypass megaloblastic anemia which responded to treatment. She eventually had the bypass reversed 6 1/2 yr after it had been performed. Gastric parietal cell function has remained abnormal almost 3 yr after reversal of the bypass, as demonstrated by abnormal Schilling tests and high serum gastrin levels.

Late effects of gastric bypass for obesity.

We studied 41 patients who had gastric bypass for obesity from 1974-1979. The procedure was well received by patients and most achieved adequate weight loss, but most subjects consumed inadequate diets and many developed iron and/or vitamin B12 deficiencies. Ten were anemic and 13 had been treated previously for postbypass anemia.

Megaloblastic anemia after gastric bypass for obesity.

A megaloblastic anemia occurred in a middle-aged woman 6 years after a gastric bypass performed for obesity. Marked deficiencies of both vitamin B12 and folic acid were demonstrated. The Schilling test revealed that the vitamin B12 deficiency was due primarily to inadequate intrinsic factor.

Effects of testosterone propionate and environmental temperature on nitrogen balance and wound healing of rats with and without femoral fracture.

Testosterone exerted a sparing effect on nitrogen urinary excretion and balance in pair-fed rats with femoral fracture, dorsal skin incision, and subcutaneously implanted polyvinyl alcohol sponges, whether kept at 22 or 30 degrees C for 1 week postoperatively. No difference in 14-or 21-day wounds was observed among rats with dorsal skin incision and sponge implants, kept at 22 degrees, and starting immediately after operation, given daily IM injections of either 3 mg or 1 mg testosterone propionate in peanut oil, compared with similarly wounded rats given saline or peanut oil injections. Wound healing was impaired in rats kept at 22 degrees for 7 days following a skin incision, sponge implants, and femoral fracture.

Effects of enviromental temperature and femoral fracture on wound healing in rats.

Femoral fracture, unilateral and bilateral, impaired the healing of dorsal skin incisions and formation of reparative granulation tissue in subcutaneously implanted polyvinyl alcohol sponges judged histologically and by breaking strengths and hydroxyproline contents, respectively, 1 week after injury in pair-fed rats kept at 22 degrees C. When rats were transferred to a room at 30 degrees C immediately after skin incision and sponge implants, with or without unilateral fracture, no differences in healing were observed between the two groups. Rats with skin incision, sponge implants, and either femoral fracture or sham-fracture excreted more urinary nitrogen than preoperatively when kept at 22 degrees.

Influence of vitamin A on wound healing in rats with femoral fracture.

Groups of healthy wounded rats with and without comminuted femoral fractures, and maintained on nutritionally complete commercial rat chow with and without supplemental vitamin A, were studied. The test wounds were standard dorsal skin incisions and s.c.

Chemical debridement of burns.

The development of effective, non-toxic (local and systemic) methods for the rapid chemical (enzymatic and non-enzymatic) debridement of third degree burns would dramatically reduce the morbidity and mortality of severely burned patients. Sepsis is still the major cause of death of patients with extensive deep burns. The removal of the devitalized tissue, without damage to unburned skin or skin only partially injured by burning, and in ways which would permit immediate (or very prompt) skin grafting, would lessen substantially the problems of sepsis, speed convalescence and the return of these individuals to society as effective human beings, and would decrease deaths.