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Biomedical subjects

A Smyth

Publications and source records attributed to A Smyth.

At least 19 recordsLinked to original sources
PubMed2002

Chronic respiratory failure: an unusual cause and treatment.

Hypoventilation secondary to brainstem stroke resulting in chronic respiratory failure is extremely uncommon. This case documents the treatment of chronic type II respiratory failure secondary to central hypoventilation with medroxyprogesterone, a new treatment option.

Administration, Oral↗
PubMed2001

Trends in passive smoking in cystic fibrosis, 1993-1998.

We set out to study trends in exposure to passive smoking in children with cystic fibrosis over a 5-year period. We also evaluated the effects of this exposure on lung function. Cross-sectional data were collected on 52 children in 1998 and compared with similar data collected on 56 children in 1993. Within these two groups, there were 34 children who were studied on both occasions. Data collected included: questionnaire information about family smoking habits; forced expiratory volume in 1 sec (FEV1); forced vital capacity (FVC); and measurements of urinary and salivary cotinine levels. Salivary cotinine was more closely related to family smoking behavior than urinary cotinine concentrations (r for salivary cotinine = 0.54, P < 0.001; r for urinary cotinine = 0.37, P = 0.008). In 1993, 26/56 (46%) households contained at least one smoker (smoking households) compared with 23/52 (44%) in 1998. In 1993, a median of 15 cigarettes was smoked/day in smoking households compared to 20 cigarettes/day in 1998. In the longitudinal group, there was a small, nonsignificant reduction in mean urinary cotinine levels (geometric mean, 1993 = 5.03 ng/mL; 1998 = 4.76 ng/mL; P = 0.4). There was no significant difference between the smoking and nonsmoking households in change in lung function over 5 years (fall in FEV1 in smoking households, 10.3% vs. 11.2% in nonsmoking households; P = 0.87). We conclude that in a group of children with cystic fibrosis followed over 5 years, there was little reduction in passive smoking exposure. We did not show a relationship between such exposure and decline in lung function. A larger study will be necessary to determine whether such an effect is present. .

Adolescent↗
PubMed2000

Prophylactic antibiotics for cystic fibrosis.

BACKGROUND: Patients with cystic fibrosis are sometimes prescribed antibiotics to take continuously on a prophylactic (preventative) basis. This approach is most commonly used in infants where the objective is to reduce pulmonary infection with Staphylococcus aureus and prevent lung damage. This approach may also be used in older patients. This review evaluates the evidence for the effectiveness of this approach and considers potential adverse effects. OBJECTIVES: To compare continuous oral antibiotic prophylaxis with no prophylaxis (short courses of oral antibiotics given as clinically indicated) in patients with cystic fibrosis. This review considers both the effectiveness of prophylaxis (bacteria isolated from the respiratory tract, requirement for additional antibiotic treatment, lung function, survival) and the adverse effects. SEARCH STRATEGY: The Cochrane Cystic Fibrosis and Genetic Disorders Group clinical trials register was used. This comprises references identified from a comprehensive search of electronic databases, as well as hand searching relevant journals and conference abstracts. Companies manufacturing anti-staphylococcal antibiotics were also approached for unpublished data. Date of the most recent search of the Group's specialised register: November 1999. SELECTION CRITERIA: All randomised or pseudo-randomised trials where continuous oral prophylactic antibiotics, given for a period of at least one year, were compared to intermittent antibiotic therapy given "as required." Cystic fibrosis patients of any disease severity were considered. DATA COLLECTION AND ANALYSIS: Trials were assessed for eligibility, methodological quality and data extraction by two reviewers (AS & SW). The following outcomes were assessed: lung function; nutrition (weight standard deviation score); survival; requirement for additional antibiotic treatment; isolates of pathogens from the respiratory tract; occurrence of adverse reactions to prophylactic antibiotics. MAIN RESULTS: Only two studies, totalling 66 patients (over half of whom were infants), were suitable for inclusion in the review. A reduced prevalence of Staphylococcus aureus in the respiratory secretions was seen in children receiving anti-staphylococcal antibiotic prophylaxis, although no effect was seen on other common pathogens. This is associated with a reduced requirement for additional courses of oral antibiotics and fewer hospital admissions in the first two years of life in patients receiving prophylaxis. No effect on infant lung function has been shown after one year of prophylactic treatment. Data are not available on adverse effects of the interventions. As the duration of the studies reviewed has been of two years or less, conclusions cannot be drawn about the long term effects of prophylaxis on acquisition of Pseudomonas aeruginosa and survival. REVIEWER'S CONCLUSIONS: Anti-staphylococcal antibiotic prophylaxis may be of benefit when commenced early in infancy and continued up to two years of age. There is insufficient evidence from this review to say whether use in older children, or adults, or for periods of over two year is beneficial.

Adult↗
PubMed2000

Leishmania donovani: development and characterisation of a kinetoplast DNA probe and its use in the detection of parasites.

The polymerase chain reaction is used increasingly widely for the diagnosis of both cutaneous and visceral leishmaniasis and for the identification of asymptomatic carriers in the population in endemic disease areas. The use of complex-specific hybridisation probes in conjunction with the polymerase chain reaction increases the specificity as well as the sensitivity of the diagnostic procedure as it discriminates between different infecting Leishmania species. A minicircle kinetoplast DNA probe, B4 Rsa, which hybridizes to all members of the Leishmania (L.) donovani complex has been identified and characterised. It is a segment of a minicircle highly conserved in Bangladeshi and Indian L. (L.) donovani isolates.

Animals↗
PubMed2000

Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis: a European consensus.

Cystic fibrosis (CF) is the most common lethal hereditary disorder with autosomal recessive heredity in caucasians. The majority of CF patients suffer from chronic respiratory infection with the opportunistic bacterial pathogen Pseudomonas aeruginosa. No consensus among clinicians has been reached so far concerning antibiotic treatment against P. aeruginosa in CF patients. Consensus answers to 24 important questions in this context, based on current evidence, are presented, given by a panel of 34 European experts. Questions addressed and answered are: The diagnosis of P. aeruginosa lung colonization in CF; The impact of P. aeruginosa on the clinical state of CF patients; The assessment of P. aeruginosa susceptibility against antibiotics and the importance of these results for the clinician; The use of monotherapy versus combination therapy; The development of microbial resistance; The achievement of optimal airway concentrations; The effects of subinhibitory concentrations of antibiotics on P. aeruginosa; Statements on the pharmacokinetics of antibiotics in CF patients; Recommendations for doses and dosing intervals and length of treatment regimens; and Toxic side effects due to repeated antibiotic therapy was addressed. The expert panel answered further questions on the use of fluoroquinolones in children with CF, on the administration of nebulized antibiotics and whether prevention of P. aeruginosa lung colonization is possible in CF using antibiotic therapy. Problems of antibiotic therapy at home and in the hospital were addressed, a consensus statement on regular maintenance treatment, or treatment on demand, was given and different routes of administration of antibiotics were recommended for different clinical situations. Finally, the factors which determine the choice of the antibiotic, the dosage, and the duration of the treatment in cystic fibrosis patients were addressed and the design of future antibiotic studies in the context of Pseudomonas aeruginosa lung infection in cystic fibrosis patients were recommended.

Anti-Bacterial Agents↗
PubMed2000

Rationalised prescribing for community acquired pneumonia: a closed loop audit.

AIMS: To audit the management of community acquired pneumonia before and after the introduction of a protocol. To determine the aetiology of pneumonia using routine investigations and polymerase chain reaction (PCR). METHODS: Retrospective and prospective audit following the introduction of a management protocol. Prospective cases were investigated routinely and with PCR on blood and nasopharyngeal aspirate. RESULTS: There was a significant increase in rational prescribing following introduction of the protocol with 75% of children receiving intravenous penicillin or erythromycin compared with 26% beforehand. Of 89 children in the prospective group, 51 microbiological diagnoses were achieved in 48 children. Seven children had Streptococcus pneumoniae infection, 14 had Mycoplasma infection, six had pertussis, and one had Chlamydia pneumoniae infection. Twenty three children had a viral cause of which respiratory syncytial virus was commonest. CONCLUSIONS: Introduction of the protocol led to improved prescribing. PCR increased the diagnostic yield and the results support the management protocol.

Adolescent↗
PubMed1998

The role of mental health nursing in the prevention of child sexual abuse and the therapeutic care of survivors.

This paper is primarily designed to stimulate discussion and debate on the role of the mental health nurse dealing with survivors of sexual abuse. The authors contend that, in reality, all nurses should be prepared through education and training to treat the sufferers of emotional and spiritual pain, regardless of from where the hurting stems. The need for nurses to open their eyes and acknowledge the agony and distress caused to children as a result of abuse by adults is highlighted. So too is the necessity for nurses to enhance their own unique and specific practice. Nurses (and particularly mental health nurses) have a role in promoting a healthy generation of children--children who are looked after and protected by caregivers and not by caretakers. As the result of nurses advocating healthy caregiving and healthy relationships children may never need to suffer from inhumane and denigrating acts against their very beings. Nurses have no excuse for being unable to imagine child sexual abuse. Therefore they have no excuse for not being prepared to deal with the resulting, excruciating pain. It is both uncaring and inhumane for nurses not to be prepared to accept the sharing of such emotionally painful and disturbing experiences. Mental health nurses have a genuine role in offering therapeutic care to victims and survivors. This paper concludes by exploring and examining the nurse's role in counselling survivors of child sexual abuse.

Adult↗
PubMed1998

Clinical predictors of hypoxaemia in children with pneumonia.

A prospective study to determine which clinical factors identified children with acute lower respiratory infection who were hypoxaemic and at risk of death was done over a 9-month period on children under 5 years of age admitted to a district hospital in rural Zambia. Of 158 children studied, 55 (35%) were found to be hypoxaemic and 23 (14.6%) died. For the subgroup of children under 1 year of age, a respiratory rate of > 70 was the only significant predictor of hypoxaemia (p < 0.001, sensitivity 63%, specificity 89%). In older children, only the presence of crepitations/bronchial breathing was predictive (p = 0.018, sensitivity 75%, specificity 57%). The likelihood of death was increased in those children with low oxygen saturation (p = 0.021) and poor nutrition (p = 0.007). It is concluded that, on the basis of raised respiratory rate, the WHO guidelines are likely to identify children under 1 year of age who are hypoxaemic. However, it may be necessary to include auscultatory findings in the guidelines to recognize hypoxaemia in older children in order to ensure that they receive appropriate treatment with oxygen. This study demonstrates that hypoxaemia and malnutrition are risk factors for death.

Acute Disease↗
PubMed1998

Impact of a case management protocol for childhood pneumonia in a rural Zambian hospital.

This study aimed to assess the impact of adopting the WHO case management protocol for childhood pneumonia in a district hospital in rural Zambia. The subjects were children under 5 years of age with a diagnosis of pneumonia, admitted in the 9-month period following introduction of the WHO protocol. Management and outcome were compared with a historical control group admitted during the same period in the previous year. There were 158 children in the intervention group and 135 controls with similar age and sex distribution. Both groups were malnourished (mean weight-for-age Z score in subjects = -1.91, in controls = -1.83). There was no significant difference in the numbers receiving parenteral antibiotics or supplementary fluids in each group. However, children in the intervention group were significantly more likely to receive oxygen (odds ratio 4.7, 95% confidence interval 2.8-8.1, p < 0.0001). Mortality was significantly greater in the control group (case fatality rate, 25%) compared with the intervention group (case fatality rate, 15%; chi 2 = 4.6; p = 0.032). The introduction of the WHO protocol for management of childhood pneumonia and training of staff in its use was accompanied by a fall in mortality from this condition in a rural hospital. The improved survival rate may be related to the more frequent use of oxygen.

Anti-Bacterial Agents↗
PubMed1998

Does illness experience influence the recall of medical information?

Recall of a storyboard description of an unfamiliar illness was assessed in 66 healthy children and 40 children with chronic illness (cystic fibrosis or asthma). A significant interaction between verbal intelligence quotient and illness experience (p < 0.001) suggested that more able sick children may be resistant to learning new medical information.

Analysis of Variance↗
PubMed1998

Suicide: a statement of suffering.

This article is designed to focus on the provision of nursing care in general medical wards following the admission of persons who have attempted suicide or who have a previous history of attempting suicide. The authors explore, analyse and synthesize how nurses, as key players in the health care team, may begin by recognizing the uniqueness of the individual, and by cotravelling therapeutically with the person on part of his or her journey towards recovery and healing. Efforts are made to demonstrate how nurses can influence the health gain of this group of people and their families. Professional attitudes and related ethical aspects, such as autonomy, respect for autonomy and paternalism, are also examined within the context of the nursing care of people who have attempted suicide. The need to enhance sensitive and caring communication skills for nurses who work with this group of people is tentatively considered. Some reasoning about why there may be difficulties in specific areas of communication such as empathy are contested and explored.

Attitude of Health Personnel↗