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Biomedical subjects

A J Macnab

Publications and source records attributed to A J Macnab.

At least 55 records · Page 3Linked to original sources
PubMed1987

Expo '86, Vancouver: impact on British Columbia's Children's Hospital.

Over 22 million visitors attended the 1986 world exposition in Vancouver, and this had a significant impact on the local pediatric facility. A total of 559 children visited the emergency department of British Columbia's Children's Hospital with injuries or illnesses resulting from the fair. Of these, 193 (34%) had come directly from the site. The children's ages ranged from 1 1/2 months to 18 years, 4 months (mean 6.99 years). Of the 559 children 31% were not covered by medical insurance. Twenty-four of the children were admitted to the hospital, and one died at the Expo site. Most of the illnesses were upper respiratory tract infections and gastroenteritis. The proportion of visits for trauma was 50%, compared with the yearly average of 25%. There was a 6% increase in the workload in the emergency department during the fair; the percentage was even higher during July and August, particularly after 1800 hours. Recommendations are made to aid with the planning of medical care for similar events.

Adolescent↗
PubMed1987

Proptosis and diplopia following traumatic asphyxia.

We describe a previously unreported complication of traumatic asphyxia. An 11-year-old boy developed proptosis and diplopia following a crush injury in an automatic garage door. Computed tomography scan confirmed displacement of the eye. There was no retrobulbar hemorrhage or skull fracture, and the proptosis appeared secondary to traumatic displacement of orbital fat. Proptosis and diplopia resolved completely over six weeks. Visual disorders may be overlooked as a complication of trauma.

Accidents, Home↗
PubMed1985

Group support for parents of high risk neonates: an interdisciplinary approach.

Many parents are unable to develop a satisfying relationship with their sick newborn. Although data are divided over the critical nature of the attachment process, measures to assist parents and reduce socio-environmental stresses are considered desirable. Group support is one such measure which can provide parents with a commonly needed component of neonatal intensive care. In the group described, weekly sessions are informal, encouraging discussion, an understanding of neonatal care and recognition that some emotional and coping disturbance is normal. Staff involved are an interdisciplinary team (social worker, doctor and nurse). The group requires no special funding and time commitment is low considering the support provided. We have met weekly for five years with sustained attendance. No control group exists but parents appear increasingly comfortable in the nursery and able to achieve more meaningful and ongoing interaction with their infant and the staff.

Humans↗
PubMed1976

A portable infusion system for the ambulant child.

A portable infusion system has been developed that can maintain a continuous intravenous or nasogastric infusion in a child for prolonged periods of time. Three children have received infusions of several months' duration over a period of two years. They were able to remain ambulant and the system has been maintained by parents at home. A minature peristaltic rotary pump is carried on the back, which infused fluid from an IV solution pack via an indwelling silicone rubber catheter. During IV infusion two bacterial filters are used in series. The first removes the particles normally present in commercial IV solutions, enabling the second to reduce the risk of infection and air embolism. Nasogastric infusion is simpler to maintain and the silicone rubber tubes are well tolerated for long periods. The pump unit is small, inexpensive, and requires minimal maintenance; the pump chambers and catheters are readily sterilized. Modified systems are in use, (e.g. for nasojejunal feeding of preterm infants) and the unit could provide compact alimentation for the ambulant patient after massive gut resection.

Ambulatory Care↗
PubMed1976

Defect of platelet function associated with chronic hypoglycaemia.

Two patients are described with chronic hypoglycaemia; the first having glucose-6-phosphatase deficiency (type I glycogen storage disease), and the second fructose 1:6-diphosphatase deficiency. Both cases were associated with a bleeding diathesis, a defect of platelet aggregation, and a deficiency of platelet adenine nucleotides. The effect on the platelet abnormalities of a period of normoglycaemia was studied in both patients. Correction of the platelet abnormalities occurred rapidly after stabilization of the blood glucose within the normal range. Normal function persisted for the duration of the normoglycaemia, facilitating diagnostic liver biopsy and surgical procedures. A biochemical explanation for the nucleotide deficiency is suggested.

Adenine Nucleotides↗
PubMed1976

Neonatal pyridoxine responsive convulsions due to isoniazid therapy.

A 17-day-old infant on isoniazid therapy 13 mg/kg daily from birth because of maternal tuberculosis was admitted after 4 days of clonic fits. No underlying infective or biochemical cause could be found. The fits ceased within 4 hours of administering intramuscular pyridoxine, suggesting an aetiology of pyridoxine deficiency secondary to isoniazid medication.

Female↗
PubMedDate not supplied

Clinical and echocardiographic evidence suggesting afterload reduction as a mechanism of action of tolazoline in neonatal hypoxemia.

The effect of tolazoline was assessed in 29 hypoxic neonates. Tolazoline was given in a bolus starting at 1 mg/kg and repeated or infused for 5-134 hours. A "good clinical response," defined as a rise in PaO2 of more than 20 mm Hg, was obtained in 23 (79%), 20 of this group were weaned from the respirator, and three died. Six infants did not respond initially and four died. Failure to respond to tolazoline or to be weaned from the ventilator was usually associated with severe additional pathology. Urine output (greater than 1 ml/kg/h) was adequate in most neonates during therapy. In those with preexisting oliguria (less than 1 ml/kg/h), output improved during therapy. Blood pressure monitoring showed a fall in blood pressure in 19 patients during tolazoline administration, but true hypotension only occurred in four; in seven there was no fall and in three there was a rise in blood pressure. Echocardiography was performed prior to therapy in 19 patients and repeated in 12 patients after 24 h. Additional "tracking" was performed at 10 min, 1 h, and 4 h in seven patients. Prior to therapy, right ventricular dysfunction was demonstrated by abnormal right ventricular systolic time intervals (RVSTIs) in 17 of the patients tested. A rapid improvement was evident during therapy especially with "tracking." Left ventricular dysfunction, assessed by left ventricular systolic time intervals (LVSTIs), ejection fraction (EF), shortening fraction (SF), and velocity of circumferential fiber shortening (VCF), was also evident prior to therapy and improved, though more gradually than the RVSTIs.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMedDate not supplied

Purpose of family photographs displayed in the pediatric intensive care unit.

OBJECTIVE: To investigate why parents frequently display family photographs on their children's beds in the intensive care unit (ICU). DESIGN: Questionnaire. SETTING: Tertiary-care pediatric ICU. SUBJECTS: Twenty-three parents who displayed pictures, 25 parents who did not, and 50 ICU nurses. OUTCOME MEASURE: Content analysis. RESULTS: Parents' stated primary reasons for displaying pictures were (1) to motivate the staff and (2) to comfort themselves. Parents not displaying photographs had not thought of displaying them, and the idea had not been suggested to them. Sixty-eight percent of the nurses surveyed reported that they invite parents to display photographs. CONCLUSIONS: We recommend that ICU staff consider discussing with parents the potential benefit of displaying photographs of their children. Pictures may open an avenue for communication, allow parents to express unspoken concerns, and give parents comfort or a goal to strive for and thus alleviate some of the stress associated with having a child in the ICU.

Adaptation, Psychological↗
PubMedDate not supplied

Improved transport incubator temperature control with insulating thermal cover.

INTRODUCTION: Cold stress, secondary to heat loss, can compromise infants in transport incubators during interfacility transfer. With current incubator designs, considerable radiant heat loss occurs. The use of additional external thermal insulation to reduce heat loss has been recommended for infant transports in cold environments. METHOD: A laboratory experiment was done to compare the rate of heat loss from a transport incubator with and without a commercially available, thermal insulating cover in place. The environment was a commercial freezer simulating subzero environmental temperatures. Measurements included air temperatures. inside the incubator and freezer, patterns of heater action and duration of battery power output. The significance of the different rates of cooling was compared using Pearson's r. Suboptimal battery performance was excluded by repeating one arm of the study with an external battery in place of the internal unit. RESULTS: The rate of heat loss from the incubator was: 1) significantly slower when the covered and uncovered incubators were compared (r2 = 0.52), and 2) essentially identical for the uncovered incubator with either the internal or the external battery (r2 = 0.96). CONCLUSION: In the laboratory setting, external thermal insulation slows transport incubator radiant heat loss. Clinically, this effect likely would benefit infants at risk of cold stress during interfacility transports.

British Columbia↗
PubMedDate not supplied

Cost-benefit of trained transport teams: estimates for head-injured children.

INTRODUCTION: Care during transport influences the outcome of head-injured children. Secondary adverse events, e.g., hypotension and hypoxia, worsen morbidity and mortality. Trained transport teams lower the incidence of such secondary "insults." OBJECTIVE: To estimate the cost-benefit of improved care from trained escorts. METHODS: The setting was a provincial air ambulance service during transition to trained pediatric escort paramedics. A retrospective review of transport and hospital records for a 12-month period was conducted. All children with head injuries (n = 43) transported to tertiary care [11 by untrained escorts (UE), 32 by trained escorts (TE)] were enrolled. Severity of injury was classified by Glasgow Coma Score (GCS); incidence of adverse events was counted and cost of change of severity resulting from preventable insults was estimated using published care costs. RESULTS: There were 13 preventable insults in six patients (55%) in the UE group and five preventable insults in four patients (12%) in the TE group (p<0.05). Among those in the UE group, two changed in severity from moderate to severe, one moderate worsened (decrease in GCS of 2 or more), and two severe worsened. In the TE group, there were no changes >1. Cost-benefit estimates based on change in severity were $136,000 (median) to $238,000 (mean). CONCLUSION: Significant cost-benefit likely accrues from training escorts who transport children with significant head injuries to tertiary care.

Canada↗