James R. Hall

Hemodynamic Consequences of Severe Pancreatitis

Fifteen patients with severe pancreatitis underwent cardiovascular monitoring in an intensive care unit. The principal findings were a high cardiac index and a decrease in systemic vascular resistance. A significant negative correlation was found to exist between these two parameters (p > 0.001). Severe pancreatitis apparently results in hemodynamic changes similar to those observed in sepsis. The mechanisms responsible for these observations are not known, although circulating vasoactive compounds resulting from pancreatic necrosis remain a strong possibility. Despite demonstrating a significant decrease in left ventricular stroke work index and an abnormal elevation in pulmonary capillary wedge pressure, the existence of a myocardial depressant factor could not be conclusively proved from these data.

Blood contamination of anesthesia equipment and monitoring equipment

This study was conducted to determine the extent of blood contamination of anesthesia equipment and monitoring equipment in clinical use in operating rooms. The study employed a catalytic-test method, which is used in forensic medicine, to detect blood contamination of anesthesia equipment and monitoring equipment. Nineteen definable surfaces were sampled in 22 operating rooms. Thirty-three percent of surfaces were contaminated with blood. Contaminated equipment included surfaces that are in continuous contact with patients, e.g., blood pressure cuffs and pulse oximeter probes. Visual inspection was not a reliable means of detecting blood contamination. Whether this blood contamination represents an infection risk was not determined. Nevertheless, improved cleaning and disinfection procedures are probably needed. Equipment design needs to focus on reducing the potential for blood contamination and enhancing capability for cleaning and disinfection.

Work hours of residents in seven anesthesiology training programs

Medical educators and credentialing organizations recently have called attention to the long hours that some house staff are required to spend in the hospital during training. To determine the average duration of in-hospital work hours of anesthesiology residents, 148 residents at seven, university-affiliated training programs kept daily logs of their activities for one week. Residents in clinical anesthesia years 1, 2, and 3 spent an average of 66, 65, and 64 hours per week, respectively, in the hospital with a range of 43 to 104 hours per week. Although there was not a difference in in-hospital work time among years of training, there was a statistical difference between two of the seven programs studied. The largest portion of the in-hospital time was devoted to patient care activities in the operating room. Residents had time for educational activities, conferences, and reading while in the hospital. The overall work hours of the residents in the anesthesiology training programs included in this survey appeared to be within current guidelines.

Question database management and program for generation of examinations in national board of medical examiner format

A microcomputer-based program has been developed to maintain a database of exam questions from which examinations can be administered in a standard format - based upon the question types of the National Board of Medical Examiners. This program maintains databases on each exam given and also on the use of questions from the master question files. Selection of microcomputers and peripherals and of operating systems and languages was done to provide economy and enhance portability.