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Full-Text Articles in Medicine and Health Sciences
Video-Recorded Usability Testing Of A Web-Based Self-Administered Dietary Assessment, Yasmine Probst, David Steel, Linda Tapsell
Video-Recorded Usability Testing Of A Web-Based Self-Administered Dietary Assessment, Yasmine Probst, David Steel, Linda Tapsell
Professor David Steel
No abstract provided.
Developing A Process Of Continuous Quality Improvement In Medical School Assessment Processes: Lessons From One School, Alison Jones, Ian Wilson, Dorothy Keefe
Developing A Process Of Continuous Quality Improvement In Medical School Assessment Processes: Lessons From One School, Alison Jones, Ian Wilson, Dorothy Keefe
Alison L Jones
Introduction: Setting high quality assessments for medical students can be a resource intensive exercise. This study explored the feasibility of coordinating and rationalising the use of expertise to set assessments and to raise the standard of those assessments. Method: A literature review on staff development for assessment was undertaken and the governance structure for assessment design and monitoring in our institution was explored. A manual was developed to outline issues around assessment and processes for improving assessments and this was distributed to key personnel involved in the assessment setting process. A two-day examination setting workshop was organised and evaluated. A …
Relative Safety Of Hyperinsulinaemia/Euglycaemia Therapy In The Management Of Calcium Channel Blocker Overdose: A Prospective Observational Study, S Greene, I Gawarammana, David Wood, Alison Jones, Paul Dargan
Relative Safety Of Hyperinsulinaemia/Euglycaemia Therapy In The Management Of Calcium Channel Blocker Overdose: A Prospective Observational Study, S Greene, I Gawarammana, David Wood, Alison Jones, Paul Dargan
Alison L Jones
Objective: To examine the clinical safety of hyperinsulinaemia/ euglycaemia therapy (HIET) in calcium channel blocker (CCB) poisoning. Design: A prospective observational study examining biochemical and clinical outcomes of a HIET protocol administered under local poisons centre guidance. Setting: Critical care settings. Patients: Seven patients with significant CCB toxicity [systolic blood pressure (BP) < 90 mmHg] treated with HIET. Interventions: HIET was commenced after correction of any pre-existing hypoglycaemia ([blood glucose]< 65 mg/dl) or hypokalaemia ([K+] < 3.5 mmol/l). A quantity of 50 ml of 50% intravenous dextrose was followed by a loading dose (1 unit/kg) of intravenous short-acting insulin and an insulin maintenance infusion (0.5–2.0 units/kg/h). Euglycaemia was maintained using 5–10% dextrose infusions. Potassium was maintained within low normal range (3.8–4.0 mmol/l). Measurements and results: Six patients survived. All patients received fluids, calcium, and conventional inotropes. Three patients (who all ingested diltiazem) received an insulin-loading dose; all experienced a significant sustained rise in systolic BP (> 10 mmHg) during the first hour of HIET. Systolic BP did not increase significantly in four patients who did not receive insulin loading. Single episodes of non-clinically significant biochemical hypoglycaemia and hypokalaemia were recorded in one and two patients respectively. Hypoglycaemia was not recorded in any patient administered …
Acceptance Of Pandemic (H1n1) 2009 Influenza Vaccination By The Australian Public, K Eastwood, D Durrheim, Alison Jones, Michelle Butler
Acceptance Of Pandemic (H1n1) 2009 Influenza Vaccination By The Australian Public, K Eastwood, D Durrheim, Alison Jones, Michelle Butler
Alison L Jones
To investigate the Australian public’s expectations, concerns and willingness to accept vaccination with the pandemic (H1N1) 2009 influenza vaccine. Design, setting and participants: A computer-assisted telephone interview survey was conducted between 20 August and 11 September 2009 by trained professional interviewers to study issues relating to vaccine uptake and perceived safety. The sample comprised 1155 randomly selected representative adults who had participated in a 2007 national study exploring knowledge and perceptions of pandemic influenza. Main outcome measures: Likely acceptance of pandemic (H1N1) 2009 vaccination, factors associated with acceptance, and respondents’ willingness to share Australian vaccine with neighbouring developing countries. Results: …
Is Cocaine Use Recognised As A Risk Factor For Acute Coronary Syndrome By Doctors In The Uk?, David Wood, Duncan Hill, Awini Gunasekera, S Greene, Alison Jones, Paul Dargan
Is Cocaine Use Recognised As A Risk Factor For Acute Coronary Syndrome By Doctors In The Uk?, David Wood, Duncan Hill, Awini Gunasekera, S Greene, Alison Jones, Paul Dargan
Alison L Jones
Background: Cocaine is a sympathomimetic agent that can cause coronary artery vasospasm leading to myocardial ischaemia, acute coronary syndrome and acute myocardial infarction (ACS/AMI). The management of cocaine-induced ACS/AMI is different to classical atheromatous ACS/MI, because the mechanisms are different. Methods: Knowledge study—Junior medical staff were given a scenario of a patient with ACS and asked to identify potential risk factors for ACS and which ones they routinely asked about in clinical practice. Retrospective study—Retrospective notes reviews of patients with suspected and proven (elevated troponin T concentration) ACS were undertaken to determine the recording of cocaine use/non-use in clinical notes. …
Mercury Contamination Incident, R Maclehose, G Pitt, S Will, Alison Jones, L Duane, S Flaherty, D Hannant, B Stuttard, A Silverwood, K Snee, V Murray, Q Syed, Ivan House, M Bellis
Mercury Contamination Incident, R Maclehose, G Pitt, S Will, Alison Jones, L Duane, S Flaherty, D Hannant, B Stuttard, A Silverwood, K Snee, V Murray, Q Syed, Ivan House, M Bellis
Alison L Jones
No abstract provided.
Haemodynamic Parameters Predicting Variceal Haemorrhage And Survival In Alcoholic Cirrhosis, A Stanley, I Robinson, E Forrest, Alison Jones, P Hayes
Haemodynamic Parameters Predicting Variceal Haemorrhage And Survival In Alcoholic Cirrhosis, A Stanley, I Robinson, E Forrest, Alison Jones, P Hayes
Alison L Jones
No abstract provided.
Selective Iga Deficiency, Hypothyroidism And Congenital Lymphoedema, Alison Jones, D Webb
Selective Iga Deficiency, Hypothyroidism And Congenital Lymphoedema, Alison Jones, D Webb
Alison L Jones
The occurrence of selective IgA deficiency and hypothyroidism with congenital lymphoedema has never previously been documented, although the association of hypogammaglobulinaemia with congenital lymphoedema has previously been reported and can result in recurrent respiratory infections. We report a 34 year old woman with congenital lymphoedema who was found to have symptomatic autoimmune hypothyroidism and asymptomatic selective IgA deficiency.
Adverse Drug Reactions To Poison Antidotes: Part 1, Alison Jones
Adverse Drug Reactions To Poison Antidotes: Part 1, Alison Jones
Alison L Jones
Summary: The probability of benefit generally outweighs the risk of adverse reactions for antidotes such as N-acetylcysteine used for treatment of paracetamol (acetaminophen) poisoning, and naloxone used in opioid poisoning. For some antidotes, such as dicobalt edetate in cyanide poisoning, administration carries high risk, and the clinical decision to use the antidote is only taken in severe poisoning. Use of an antidote rarely replaces the need for supportive measures. Except for N-acetylcysteine in paracetamol poisoning, the clinical state and not plasma concentration dictates whether an antidote is used. In pregnancy, it is usually reasoned that treatment of the mother takes …
Severity Scores For Poisoned Patients: Reasons And Rationale, A Proudfoot, Alison Jones
Severity Scores For Poisoned Patients: Reasons And Rationale, A Proudfoot, Alison Jones
Alison L Jones
No abstract provided.
Australian Clinical Toxicology Investigators Collaboration Randomized Trial Of Different Loading Infusion Rates Of N-Acetylcysteine [6], I Gawarammana, S Greene, Paul Dargan, Alison Jones
Australian Clinical Toxicology Investigators Collaboration Randomized Trial Of Different Loading Infusion Rates Of N-Acetylcysteine [6], I Gawarammana, S Greene, Paul Dargan, Alison Jones
Alison L Jones
Adverse reactions to N-acetylcysteine are reported in 6% to 23% of patients who are administered the antidote for treatment of paracetamol poisoning.1 Because paracetamol is the most common pharmaceutical product taken in overdose in many countries, it is essential that attempts be made to prevent or minimize adverse effects caused by N-acetylcysteine. We congratulate Kerr et al2 on their attempt to address this important issue.
Antidotes 5. Antidotes To Organophosphorus And Carbamate Anticholinesterases, Robert Flanagan, Alison Jones
Antidotes 5. Antidotes To Organophosphorus And Carbamate Anticholinesterases, Robert Flanagan, Alison Jones
Alison L Jones
No abstract provided.
Immediate Gp Strategies In Cases Of Poisoning, Alison Jones
Immediate Gp Strategies In Cases Of Poisoning, Alison Jones
Alison L Jones
Poisoning is a common problem for GPs. The challenge is to identify 1-2 per cent of patients who have taken enough toxin to be at serious risk and to start appropriate management as early as possible, especially if there is going to be a significant delay in getting them to hospital.
Antidotes 2. Sulphydryl Donors (N-Acetylcysteine, Methionine), Robert Flanagan, Alison Jones
Antidotes 2. Sulphydryl Donors (N-Acetylcysteine, Methionine), Robert Flanagan, Alison Jones
Alison L Jones
No abstract provided.
A Pandora's Box: Sustainable Pharmaceutical Supply, Alison Jones, Rosemary James, Lisa Harris, Forbes Mcgain, Simon Quilty, Robert Pearce, Jacquellne Kewley
A Pandora's Box: Sustainable Pharmaceutical Supply, Alison Jones, Rosemary James, Lisa Harris, Forbes Mcgain, Simon Quilty, Robert Pearce, Jacquellne Kewley
Alison L Jones
No abstract provided.
Digoxin Immune Fab, Alison Jones, Robert Flanagan
Digoxin Immune Fab, Alison Jones, Robert Flanagan
Alison L Jones
No abstract provided.
Paracetamol (Acetaminophen) Overdose, Alison Jones
Paracetamol (Acetaminophen) Overdose, Alison Jones
Alison L Jones
A 23-year-old woman. who is 34 weeks pregnant with her first child, is seen In the Emergency Department after taking 28 paratetamol (500 mg) tablets 2 h ago. She is 62 kg in weight. She did not co-ingest any other drug or alcohol. She complains of nausea and intermittent vomiting. but this has been consistent throughout her pregnancy.
Measuring Plasma Salicylate Concentrations In All Patients With Drug Overdose Or Altered Consciousness: Is It Necessary?, David Wood, Paul Dargan, Alison Jones
Measuring Plasma Salicylate Concentrations In All Patients With Drug Overdose Or Altered Consciousness: Is It Necessary?, David Wood, Paul Dargan, Alison Jones
Alison L Jones
Background: Salicylate self poisoning is potentially fatal. Plasma salicylate concentrations can be used to guide management when taken in the context of clinical features of toxicity and acid base status. Previous studies in the USA and Hong Kong have shown that routine measurement of plasma salicylate concentrations in all overdose patients is inappropriate, but there have been no previous studies in the UK. Methods: A retrospective case note study from 1 February 2001 to 31 January 2002 was undertaken at the emergency department of St. Thomas’ Hospital, London. Records were reviewed and information on demographic data, history, details of salicylate …
A Young Woman Who Has Taken An Overdose Of Paracetamol (Acetaminophen), Alison Jones
A Young Woman Who Has Taken An Overdose Of Paracetamol (Acetaminophen), Alison Jones
Alison L Jones
No abstract provided.
Adverse Drug Reactions To Poison Antidotes: Part 2, Alison Jones
Adverse Drug Reactions To Poison Antidotes: Part 2, Alison Jones
Alison L Jones
Administration of antidotes such as dicobalt edetate in cyanide poisoning or dimercaprol in arsenic poisoning carries a high risk of adverse reactions, and the clinical decision to use the antidote is only taken in severe poisoning. Supportive measures such as ventilation may be required in addition to the antidote. In pregnancy, it is usually reasoned that treatment of the mother takes precedence and provides the best chance for fetal survival, notwithstanding worries about teratogenicity.
Drug Interactions With Paracetamol, M Toes, Alison Jones, L Prescott
Drug Interactions With Paracetamol, M Toes, Alison Jones, L Prescott
Alison L Jones
Paracetamol (acetaminophen) is one of the most commonly used analgesic antipyretic drugs worldwide, and it is widely available by prescription and over the counter (OTC). Fortunately, few clinically significant drug interactions have been documented. There is probable potentiation of hepatotoxicity following an overdose from the paracetamol metabolite NAPQI by enzyme-inducing drugs. There is considerable controversy regarding the possible interaction with warfarin in its potential to increase its anticoagulant effects because of discrepancies between observational studies and those in healthy volunteers. Otherwise, no serious adverse drug interactions with therapeutic doses of paracetamol have been confirmed in humans. Because the absorption of …
Plasma Salicylate Concentrations Following Overdose; Are They Worth It ?, David Muir Wood, Alison Jones, Paul Dargan
Plasma Salicylate Concentrations Following Overdose; Are They Worth It ?, David Muir Wood, Alison Jones, Paul Dargan
Alison L Jones
Treatment following salicylate ingestion is determined by clinical evidence of toxicity. Previous studies have shown that routine measurement of plasma salicylate concentrations in all overdose patients is unnecessary except in those with clinical features suggestive of salicylate poisoning or in those who are unable to give an accurate history [1]. This retrospective study evaluates whether plasma salicylate concentrations are appropriately measured. A retrospective study of all plasma salicylate concentrations measured in St Thomas’ Hospital Accident and Emergency department from 1 February 2001 to 31 January 2002 was conducted. Admission record cards were surveyed for history of salicylate ingestion, clinical features …
Hepatocellular Damage Following Therapeutic Intravenous Iron Sucrose Infusion In A Child, David Wood, Alison Thomson, Matthew Lawes, Alison Jones, Paul Dargan
Hepatocellular Damage Following Therapeutic Intravenous Iron Sucrose Infusion In A Child, David Wood, Alison Thomson, Matthew Lawes, Alison Jones, Paul Dargan
Alison L Jones
The maximum tolerated single dose of intravenous iron infusion and iron pharmacokinetics are not known in children and not clear in adults. The case reported here is of a child given a large dose of intravenous iron sucrose (16 mg/kg) over 3 hours, who subsequently developed features of systemic iron toxicity. A TDM consultant discusses the case in the context of toxicokinetic analysis. Because the maximum tolerated dose and pharmacokinetics of intravenous iron preparations are not known, their use in both adults and children should still be undertaken with caution.
Determinants Of Paramedic Response Readiness For Cbrne Threats, Garry Stevens, Alison Jones, George Smith, Jenny Nelson, Kingsley Agho, Melanie Taylor, Beverley Raphael
Determinants Of Paramedic Response Readiness For Cbrne Threats, Garry Stevens, Alison Jones, George Smith, Jenny Nelson, Kingsley Agho, Melanie Taylor, Beverley Raphael
Alison L Jones
Paramedics play a pivotal role in the response to major emergencies. Recent evidence indicates that their confidence and willingness to respond to chemical, biological, radiological, nuclear, and explosives-related (CBRNE) incidents differs from that relating to their "routine" emergency work. To further investigate the factors underpinning their readiness to respond to CBRNE incidents, paramedics in New South Wales (NSW), Australia, were asked to complete a validated online survey instrument. Univariate and multivariate analyses were performed to examine associated factors determining readiness. The sample of 663 respondents was weighted to reflect the NSW paramedic population as a whole. The univariate analysis indicated …
Multiple Toxicity From 3,4-Methylenedioxymethamphetamine ("Ecstasy"), S Greene, Paul Dargan, Niall O'Connor, Alison Jones, Mary Kerins
Multiple Toxicity From 3,4-Methylenedioxymethamphetamine ("Ecstasy"), S Greene, Paul Dargan, Niall O'Connor, Alison Jones, Mary Kerins
Alison L Jones
There have been no published case series illustrating “ecstasy” (3,4-methylenedioxymethamphetamine [MDMA]) toxicity in a group of patients who have ingested ecstasy in the same environment. We report a series of 7 patients who ingested ecstasy in a nightclub and presented with varying degrees of MDMA toxicity. Three patients presented with features of severe MDMA toxicity. One died within an hour of hospital admission, another died 4 days later, after developing fulminant hepatic failure, and the third recovered after 12 days in intensive care. MDMA was identified in the serum of all 7 patients. High serum MDMA concentrations correlated with severe …
A Patient With Neurosyphilis Presenting As Chorea, Alison Jones, I.A.D Bouchier
A Patient With Neurosyphilis Presenting As Chorea, Alison Jones, I.A.D Bouchier
Alison L Jones
Despite the marked decline infrequency of neurosyphilis over the past three decades in the United Kingdom, new cases continue to appear both sporadically and as a complication of HIV infection. There is clinical evidence that neurosyphilis is becoming less typical. We describe a case of neurosyphilis presenting predominantly with choreoathetosis and associated hemiparesis in an otherwise healthy, immunocompetent patient. Only six cases of neurosyphilis presenting with features of basal ganglia damage have been reported in the recent literature, five of whom had HIV infection.
Fulminant Hepatic Failure Due To Diclofenac Treated Successfully By Orthotopic Liver Transplantation, Alison Jones, T Latham, T Shallcross, K Simpson
Fulminant Hepatic Failure Due To Diclofenac Treated Successfully By Orthotopic Liver Transplantation, Alison Jones, T Latham, T Shallcross, K Simpson
Alison L Jones
A 62-year-old woman had received Arthrotec® (containing diclofenac and misoprostol) 50 mg three times per day for two months for treatment of a painful left heel. She subsequently developed fulminant hepatic failure for which viral and auto-immune etiologies were excluded. Other drugs or chemical exposures were also excluded. She developed five out of five poor prognostic criteria for nonparacetamol drug-induced fulminant hepatic failure and underwent successful orthotopic liver transplantation from which she made an excellent recovery. This is the first report of successful treatment of diclofenac-induced fulminant hepatic failure. Four similar cases reported previously in the literature have died without …
Fellows And Members Survey Of The Royal College Of Physicians Of Edinburgh, Alison Jones, S Lewis, D Doyle, R Agius, D Lawson
Fellows And Members Survey Of The Royal College Of Physicians Of Edinburgh, Alison Jones, S Lewis, D Doyle, R Agius, D Lawson
Alison L Jones
No abstract provided.
Collapse, Reported Seizure-And An Unexpected Pill, David Wood, Paul Dargan, Jennifer Button, David Holt, Hanna Ovaska, John Ramsey, Alison Jones
Collapse, Reported Seizure-And An Unexpected Pill, David Wood, Paul Dargan, Jennifer Button, David Holt, Hanna Ovaska, John Ramsey, Alison Jones
Alison L Jones
In May, 2006, on a Bank Holiday weekend, an 18-year-old woman presented to an inner-city London emergency department. She had been at a nightclub with friends and purchased tablets, which she understood to be Ecstasy or amfetamines, from a dealer. After ingesting fi ve tablets, she collapsed in the nightclub and appeared to have a seizure lasting 10 min. On arrival in the emergency department, she was agitated and had dilated pupils (8 mm), sinus tachycardia (156 bpm), and a blood pressure of 150/51 mm Hg. Her score on the Glasgow coma scale was 15 and she was apyrexial (35·9°C). …
Severe Hypokalaemic Metabolic Alkalosis Following Ingestion Of Gaviscon, I Gawarammana, J Coburn, S Greene, Paul Dargan, Alison Jones
Severe Hypokalaemic Metabolic Alkalosis Following Ingestion Of Gaviscon, I Gawarammana, J Coburn, S Greene, Paul Dargan, Alison Jones
Alison L Jones
Uncommon metabolic abnormalities in the emergency department could be a result of drug overdose due to uncommon agents. Case report. A 35-year-old male presented to the emergency department with a Glasgow Coma Scale (GCS) of 3/15 and a normal pulse rate and blood pressure. Subsequent questioning after recovery revealed he had ingested 2 L of Gaviscon® over the preceding 48 hours. He had normal haematology, liver, and renal function during admission. The electrocardiogram showed T wave inversion in the inferior leads on admission. Arterial blood gas on air was: pH 7.54, HCO3 50 mmol/L (50 meq/L), Chloride 66 mmol/L, anion …