John S Fountain

Publications of John S Fountain

• Guidelines for the management of paracetamol poisoning in Australia and New Zealand--explanation and elaboration. A consensus statement from clinical toxicologists consulting to the Australasian poisons information centres.

  Authors: Frank F S Daly, John S Fountain, Lindsay Murray, Andis Graudins, Nicholas A Buckley

  The Medical journal of Australia. 04/2008; 188(5):296-301.

  Paracetamol is involved in a large proportion of accidental paediatric exposures and deliberate self-poisoning cases, although subsequent hepatic failure and death are both uncommon outcomes. TheParacetamol is involved in a large proportion of accidental paediatric exposures and deliberate self-poisoning cases, although subsequent hepatic failure and death are both uncommon outcomes. The optimal management of most patients with paracetamol overdose is usually straightforward. However, several differing nomograms and varying recommendations regarding potential risk factors for hepatic injury introduce complexity. In order to reconcile management advice with current Australasian clinical toxicology practice, revised guidelines have been developed by a panel of clinical toxicologists consulting to the poisons information centres in Australia and New Zealand using a workshop and consultative process. This article summarises the rationale for the recommendations made in these new guidelines.

• Lead shot in the appendix.

  Authors: Leo J Schep, John S Fountain, William M Cox, Gene R Pesola

  The New England journal of medicine. 05/2006; 354(16):1757; author reply 1757.

• Veratrum poisoning.

  Authors: Leo J Schep, David M Schmierer, John S Fountain

  Toxicological reviews. 02/2006; 25(2):73-8.

  Several species of the Veratrum genus are associated with toxicity in humans and animals. The principal toxins are steroid alkaloids; some have a modified steroid template, whereas others differ inSeveral species of the Veratrum genus are associated with toxicity in humans and animals. The principal toxins are steroid alkaloids; some have a modified steroid template, whereas others differ in their esterified acid moieties. These alkaloids act by increasing the permeability of the sodium channels of nerve cells, causing them to fire continuously. Increased stimulation, associated with the vagal nerve results in a reflex that causes the triad of responses known as the Bezold-Jarisch reflex: hypotension, bradycardia and apnoea. Clinically, various Veratrum extracts were marketed for clinical use as antihypertensive drugs, but because of their narrow therapeutic index were withdrawn from the market. Following the ingestion of Veratrum alkaloids, expected signs and symptoms include vomiting and abdominal pain, followed by cardiovascular effects such as bradycardia, hypotension and cardiac conduction abnormalities and death. Similar symptoms arise in other mammalian species ingesting these alkaloids; teratogenic effects may occur to the fetuses of animals that have grazed on Veratrum californicum. Treatment consists of supportive care, with an emphasis on haemodynamic stability with fluid replacement, atropine and vasopressors. The onset of symptoms occurs between 30 minutes and 4 hours, and the duration of the illness can range from 1 to 10 days; however, with prompt supportive care, patients typically make a full recovery within 24 hours.

• Comparison of CD-Rom and Internet access to clinical information.

  Authors: John S Fountain, David M Reith, Martin Watts

  International journal of medical informatics. 09/2005; 74(9):769-77.

  INTRODUCTION: The New Zealand National Poisons Centre has developed an extensive clinical poisons information database, TOXINZ. This resource was originally provided on a CD-Rom, and in 2002 madeINTRODUCTION: The New Zealand National Poisons Centre has developed an extensive clinical poisons information database, TOXINZ. This resource was originally provided on a CD-Rom, and in 2002 made accessible solely via the Internet (www.toxinz.com). It was unknown whether users would prefer the CD-Rom or Internet version to access the same information. METHODS: In September 2003 a total of 100 questionnaires were mailed to the emergency departments of 15 hospitals to be answered by medical and nursing staff utilizing the Internet version of TOXINZ. The results were then compared with a nearly identical questionnaire conducted in the same way in the same hospitals when only the CD-Rom database version was available. RESULTS: There was a 79% response rate with both medical and nursing staff rating the poisons management recommendations highly when accessed both on CD-Rom and Internet. Statistically significant differences (p<0.05, Mann-Whitney U-test) identified the Internet accessed database as: supplying better visual aids, being more repetitive, harder to search, and more difficult to print. CONCLUSION: Those developing Internet accessible databases for a healthcare environment are encouraged to incorporate robust search functionality, mobility solutions, and an ability to integrate with other healthcare applications.

• 'Opioid poisoning deaths in New Zealand (2001-2002)' and the UK's recent decision to withdraw the pain killer coproxamol.

  Authors: David M Reith, John S Fountain, Murray Tilyard

  The New Zealand medical journal. 03/2005; 118(1209):U1294.

• Compliance with poisons center referral advice and implications for toxicovigilance.

  Authors: Martin Watts, John S Fountain, David Reith, Leo Schep

  Journal of toxicology. Clinical toxicology. 02/2004; 42(5):603-10.

  BACKGROUND: When Poisons Information, or Poisons Control Centers (PCC) give directive advice in response to general public calls it is usually assumed that the advice will be followed, but it isBACKGROUND: When Poisons Information, or Poisons Control Centers (PCC) give directive advice in response to general public calls it is usually assumed that the advice will be followed, but it is difficult to measure the actual compliance of callers to a PCC. Epidemiological data regarding the incidence of poisoning incidents (Toxicovigilance) often utilizes reports of calls to a PCC. METHODS: Retrospective review of advice given to all callers to the New Zealand National Poisons Centre (NZNPC) from a defined area for the calendar year 2001. Callers to the NZNPC telephone hotlines who were advised to attend or not to attend the hospital Emergency Department (ED) were subsequently matched with actual ED visits. RESULTS: The compliance rate for those advised to attend the ED was 76.1%, whereas those advised not to attend had a compliance rate of 98.7%. The overall compliance rate was 94.1%. Of the patients presenting to the ED with a potential poisoning, only 10.2% were referred by the PCC. The callers referred by PCC and direct ED visitors appeared to differ in some respects. CONCLUSIONS: Compliance with PCC telephone advice is similar to the compliance rates in many other health interventions. Comparisons between populations calling a PCC and those self-presenting to an ED show that PCC data may not reflect the true burden of poisoning to health care systems.