Why should I?--Acceptance of Health Information Technology Among health professionals.

Applying the Technology Acceptance Model, the end user intentions to use technology applications is studied. The study finds the end users negative perception of the usefulness of the application as a major factor in its suboptimal utilisation.

Tracheostomy in the critically ill: the myth of dead space.

Benefits and advantages of tracheostomy have been vigorously debated. There is a lack of consensus as to whether perceived clinical improvement is attributable to fundamental changes in respiratory dynamics. We compare the effect of tracheostomy versus endotracheal tube on dead space, airway resistance and other lung parameters in critically ill ventilated patients. Data collected included patients who were admitted to surgical, burn and neurosurgical intensive care units at the University of North Carolina. Twenty-four intubated patients were included in our analysis with various aetiologies of respiratory failure. Tracheostomy was deemed necessary either for severe neurological devastation or failure to wean from the ventilator. The diameter of the endotracheal tubes ranged from 6-8 mm and the tracheostomy tube diameters were from 6.4-8.9 mm. Internal diameters between endotracheal tube and tracheostomy tubes, ventilator settings and sedation were kept consistent throughout the study. Respiratory parameters were measured using the Respironics' non-invasive cardiac output 2 device (Phillips, Andover, MA) immediately prior to tracheostomy and repeated within 24 hours of tracheostomy. Only two (8%) of the patients had slight improvement (>6% decrease in dead space). The average dead space of endotracheal versus tracheostomy tubes was 41±12.6% and 40±14.6%, respectively (P=0.75). The remaining 22 patients (92%) had no significant change in dead space, compliance or other respiratory parameters. This study shows that there is no significant difference in respiratory mechanics and dead space with a tracheostomy versus endotracheal tube.

Design of a Community Ownership and Preparedness Index: using data to inform the capacity development of community-based groups.

BACKGROUND: Community mobilisation is an important component of a participatory approach to health and development interventions. However, it is challenging to define, measure and assess community participation and ownership of a programme, especially at scale. METHODS: An iterative cross-sectional survey was designed for implementation across a representative sample of community-based groups, using a weighted index that captured both qualitative and quantitative data in a standardised form. These data were aggregated at the level of individual groups, as well as state-wide or across the whole programme. Community participation in the survey is a primary feature of the methodology and was integral to the process of designing the index and administering the survey. RESULTS: The survey provided programme management and communities with objective tools for monitoring community mobilisation across a large-scale and complex intervention covering 32 districts in India. The implementation of the survey engaged communities in an open discussion of their goals and capabilities and helped them to challenge the power dynamics between themselves and other stakeholders. CONCLUSIONS: It is possible to translate the theoretical premises of participatory development into a tool that both measures and fosters meaningful participation. The active participation of community members in the collection and analysis of data on their mobilisation suggests that monitoring of participation can be undertaken to inform a scaled-up programme and can be a useful intervention in its own right.

Pyogenic brain abscess managed by repeated elective aspiration.

37 cases of capsular stage of brain abscess based upon CT scan staging were treated by repeated elective aspiration through a burr hole and intracavitary application of antibiotics on alternate days, till two consecutive negative aspirations were obtained. A combination of furosemide and antibiotics in multiple doses were also given. The mortality rate was 2.7% and the morbidity rate 8.3%. Corticosteroids were not used in the management of brain abscess. Thus, repeated elective aspiration was found to be an effective mode of surgical management of brain abscess.

Enzymatically amplified voltammetric sensor for microliter sample volumes of salicylate.

A new voltammetric sensing strategy for salicylate employing two enzymes and applicable to microliter sample volumes is demonstrated. The method involves the use of the enzyme salicylate hydroxylase to convert salicylate to catechol, which is oxidized at a carbon electrode. The product of this oxidation reaction, o-quinone, is then reduced by a second enzyme, glucose oxidase, to regenerate catechol. Reoxidation of catechol results in a signal that is amplified due to repeated cycling of catechol molecules between the oxidized and reduced states. This chemistry is implemented in two configurations. (i) A paper disk into which both enzymes have been absorbed is mounted on a coplanar three-electrode assembly for aqueous experiments. Determination of salicylate in a nonprescription dermatological product is demonstrated. (ii) A small solution volume confined directly on the coplanar electrodes is used for determination of salicylate in whole blood. The advantages of the use of two enzymes and of monitoring steady-state catalytic currents are discussed.

Non-cardiogenic pulmonary oedema: a complication of larynagospasm - abstract

Four cases are presented in which pulmonary oedema followed general anaesthesia in fit, male patients. All patients developed laryngospasm on extubation, which promptly resolved on treatment but which was followed by acute pulmonary oedema. Oxygenation defects and X-ray changes diagnostic of pulmonary oedema were documented in all cases. Management consisted of endotracheal intubation with intermittent positive ventilation and the administration of furosemide. Independent cardiology evaluation, including a 12-lead electrocardiogram, was done post-operatively and was completely normal in each case. All patients recovered completely. The risk of laryngospasm is reduced if extubation is done at a deep plane of anaesthesia. In emergencies when this is not possible, extubation is best delayed until the protective reflexes have returned. If pulmonary oedema occurs, it should be treated with intermittent positive pressure ventilation and diuretics (AU)

Pulmonary oedema after anaesthesia in fit adult patients - abstract

Three cases are presented in which pulmonary oedema followed general anaesthesia in fit, young, male patients. The surgical procedures were appendicectomy in two of the cases, and exploration of the scrotum in the other. Anaesthesia was monitored with the electrocardioscope and Dinamap in all cases and was uneventful. All three patients developed laryngospasm on extubation, which quickly resolved on treatment. Acute pulmonary oedema occurred forty-five, thirty-five and forty-five minutes after the respective episodes of laryngospasm. Oxygenation defects and X-ray changes of pulmonary oedema were documented. Management consisted of tracheal intubation and intermittment positive pressure ventilation. The respiratory distress resolved in 24, 4 and 19 hours, respectively. Independent cardiology evaluation, including twelve-lead electrocardiogram and echocardiogram, was completely normal in each case. The literature suggests that when laryngospasm occurs in this setting, immediate prophylaxis for acute pulmonary oedema, and close observation of the patient for respiratory distress in the early post-operative period are indicated (AU)

Cancer in pregnancy - a report on a ten-year study (1980-1989) - abstract

A review of cancer in pregnancy at the University Hospital of the West Indies over the ten-year period 1980 to 1989 is presented. The incidence of malignant disease in pregnancy and the outcome of affected pregnancies are studied. Over the period of study, 27, 871 live births were conducted. Data were analysed on all patients who became pregnant in the period of study. In those 10 years, 21 patients with cancer in pregnancy were treated. The incidence of cancer in pregnancy was found to be 0.08 percent. This compared favourably with the internationally quoted incidence of 0.07 percent to 0.1 percent. The types of malignant disease discovered were Non-Hodgkin's lymphoma - 29 percent, cancer of the cervix uteri - 23 percent, malignant trophoblastic disease coexisting with live foetus - 23 percent, breast cancer and Hodgkin's disease ecah 10 percent, and leukaemia - 5 percent. This differs from the international figures in that Hodgkin's disease has been found in other series to predominate over Non Hodgkin's lymphoma in pregnancy. The derived maternal mortality due to cancer in that period was 21.52 per 100,000 live births. This conforms with the internationally stated conclusion that cancer is the leading cause of maternal mortality. The experience gained in the review suggests that there is a define indication for separate coding of this entity in the medical records of this institution and for the establishment of a Registry for the care and follow-up of all patients with this entity (AU)