Blood leak alarm interference by hydoxocobalamin is hemodialysis machine dependent.

CONTEXT: Hydroxocobalamin has been reported to interfere with the blood leak alarm on hemodialysis machines making it difficult to use this treatment modality after hydroxocobalamin infusion. OBJECTIVE: The objective was to determine if this interference with hydroxocobalamin occurs across hemodialysis machines by different manufacturers. Additionally, we aimed to see if this represented a colorimetric interference alone or if it is the optical properties of hydroxocobalamin. MATERIALS AND METHODS: Hydroxocobalamin was reconstituted per package insert. Food coloring was added to 0.9% saline to create the colors of the visual spectrum. Optical properties of absorbance and transmittance were measured. Hydroxocobalamin and the saline solutions were infused into the Fresenius 2008K™ and the Gambro Phoenix X36™ machines. Times were recorded from the start of the machine until the solution finished or the alarm triggered. RESULTS: When evaluating the Gambro Phoenix X36™ machine and dialysis circuit; the alarm did not trigger. In contrast, the blood leak alarm on the Fresenius 2008K™ machine was tripped by both the red solution and hydoxocobalamin infused per the package insert. The alarm stopped the machine between 128 and 132 seconds for the red solution and between 30 and 35 seconds with the hydroxocobalamin. Membranes of the circuits where the alarm tripped were examined and remained intact without blood. Results were validated on different machines with new circuits. DISCUSSION: Hydroxocobalamin infusion per package insert and the red saline solution prepared with Red Dye 40 both triggered the blood leak alarm and stopped the Fresenius 2008K™ machine. However, this was not true for the Gambro Phoenix X36™ machine as the alarm never triggered. The interference with the Fresenius 2008K™ appears colorimetric due to normal saline with Red Dye 40 triggering the alarm. CONCLUSION: We alert physicians to become familiar with the properties of individual dialysis machines prior to use of hydroxocobalamin. When facing difficulties with hemodialysis after the administration of hydroxocobalamin, consider attempting with a different manufactures machine or model if available or contact the manufacturer directly.

Management of elder abuse in the emergency department.

Emergency physicians are in an ideal position to diagnose and intervene in suspected cases of elder abuse. This article reviews domestic violence against the elderly, highlighting the risk factors for elder abuse, its prevalence, and related medicolegal issues. A special section on mistreatment of the elderly in long-term care facilities is included. In addition to the management of elderly abuse in the emergency department, possible future directions for improved detection of elder abuse or neglect are reviewed.

Emergency medicine in the new South Africa.

A description of recent developments in emergency medicine and prehospital care in the new South Africa is detailed. As South Africa creates a new integrated health care system with equal access for all citizens, expansion of emergency care services to previously disadvantaged populations is occurring. To illustrate current disparities, a comparison of 2 regional systems of emergency medicine is included. The challenges involved and possible future directions in this effort are discussed.

Computer simulation of cerebral blood flow in moyamoya and the results of surgical therapies.

Moyamoya is the disease which involves the terminal portions of the internal carotid or origins of the middle or anterior cerebral arteries. The posterior communicating arteries are also involved, but not the vertebrals or the basilar artery. The disease occurs more commonly in females than males and it has two age peaks at less than 10 and 40 years. Over the years many treatment options or procedures have been advocated for this disease either with direct bypasses or indirect revascularization procedures or both in combination. Whether one procedure is better than another is a matter of question and still to be determined. Along with it, there are various diagnostic and research work have been done for the etiology and the management of this disease. We have tried to implement a computer model of cerebral blood flow in order to assess and predict the flow in this disease process. At this time to know and predict the effectivity of certain types of offered treatment of Moyamoya disease is only to evaluate patients clinically with long term follow ups and at some interval after surgery with angiography or blood flow determinations. This study tries to focus on the use of computerized model of predicting cerebral blood flow which tries to assess the cerebral flow and decide which treatment option would be the best for a particular patient. After various computer simulations the blood flow following each treatment option is detected and the situation which offers the best treatment in a particular case is offered to the patient. To confirm the use of utility of this computer model a larger population of patients with Moyamoya disease need to be evaluated.

Characteristics of attenders to community based alcohol treatment centre with special reference to sex difference.

Alcohol misusers attending a London community day treatment centre were interviewed about their drinking habits and the expectations they had of the treatment they were receiving. The results show that the women experienced twice as many alcohol related problems as the men and were significantly more dependent upon alcohol. The men reported that they hoped to improve their health and confidence by coming for treatment.

AIDS: legal issues in a growing epidemic.

The article reviews selected legal issues regarding AIDS and HIV infection. Following an overview of the legislative and regulatory structure of public health laws in the United States, the article describes legal issues relating to the development of an AIDS vaccine, determination of appropriate professional liability standards in diagnosing and treating persons with AIDS or HIV infection, availability of tort law damages for persons negligently or intentionally exposed to infection, use of criminal laws against individuals who engage in conduct likely to transmit the virus, and protections against discrimination available to individuals with AIDS or HIV infection.

Comparison of the physiological effects of enflurane and isoflurane for outpatient general anesthesia.

The effects of enflurane and isoflurane were compared in fifty consecutive adults who had their third molars removed under outpatient general anesthesia. The results indicate that there is no significant difference in the transcutaneous partial pressure of oxygen or carbon dioxide; additionally, there was no siginificant difference in the mean arterial pressure of patients treated with either enflurane or isoflurane.

A cost/effectiveness evaluation of lay therapy treatment for child abusing and high risk parents.

This longitudinal investigation tested the effectiveness and cost-efficiency of a lay therapy treatment program in comparison with a standard social work treatment approach. A pretest-extended posttest research design was used to follow a group of child abusing and high risk mothers who received lay therapy (N = 27) and a randomized control group of similar clients (N = 28) over a 12-month period. Outcome data were obtained through interview and direct observation of the parents and children at six-month intervals. A variety of standardized instruments were used including Cattell's 16 Personality Factor Test, Coopersmith's Self-Opinion Form, and the Nurturance and Parent Observation Scales, adapted from Baumrind. Treatment success was defined as progression toward the mean scores of a matched comparison group (N = 21) obtained from the general population of the community during the pretest. The results indicated a trend toward improvement on the outcome measures for both treatment groups. The group receiving lay therapy treatment improved only slightly more than the group receiving standard treatment; however, there was also significantly less attrition with the lay therapy group. Analysis of time budget study data indicated that the lay therapists spent an average of 17.46 hours per month with each of their clients thus permitting the social workers to spend considerably less time with lay therapy clients. Analysis of the direct costs of the programs, based on time budget information, indicated that the lay therapy treatment involved more direct client contact than the standard treatment approach and was also substantially more costly. The high cost of the program was attributed to low caseloads and redundancy in supervision. This study presents several practical program and research recommendations.