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Biomedical subjects

C Way

Publications and source records attributed to C Way.

11 recordsLinked to original sources
PubMed2006

Perioperative fluid therapy in children: a survey of current prescribing practice.

BACKGROUND: Fluid therapy in children may be associated with iatrogenic hyponatraemia. We surveyed anaesthetists' current fluid prescribing practice during the perioperative period, departmental fluid protocols and awareness of the concerns of the Royal College of Paediatrics and Child Health (RCPCH) about the use of dextrose 4%/saline 0.18% in children. METHODS: Questionnaire survey of 477 consultant anaesthetists in two training areas in the UK. RESULTS: Responses were received from 289 anaesthetists (60.6%)--responses from the 203 consultants that anaesthetized children were analysed. A total of 67.7% did not have a local departmental policy for fluid prescription, and 58.1% were unaware of the concerns of RCPCH. A total of 60.1% of anaesthetists said that they prescribed hypotonic dextrose saline solutions in the intraoperative period and 75.2% did so in the postoperative period. Anaesthetists working in specialist paediatric hospitals were 5.1 times more likely to prescribe isotonic fluids intraoperatively than those working in district hospitals (95% CI 1.48-17.65, P=0.01), but they all prescribed hypotonic dextrose saline solutions postoperatively. The Holliday and Segar formula for maintenance fluid was quoted by 81.8% of anaesthetists; only 5.9% of anaesthetists would restrict fluids in the immediate postoperative period. Anaesthetists working in specialist paediatric hospitals were 13.2 times more likely to restrict fluids postoperatively than those working in district hospitals (95% CI 2.8-61.8, P=0.001). CONCLUSIONS: The prescription of hypotonic dextrose saline solutions by anaesthetists may be putting children at risk from iatrogenic hyponatraemia. Departmental protocols for perioperative fluid prescription in children are uncommon. We suggest that national guidance is required.

Child↗
PubMed1997

Neuroprotection after spinal cord injury: state of the science.

Advances in the basic and clinical sciences are improving our ability to alter the course of injury that occurs after acute spinal cord trauma. Methylprednisolone, naloxone, GM-1 ganglioside, tirilazad mesylate and other agents have been or are currently being subjected to rigorous testing to determine their ability to protect compromised but viable cellular elements and improve the functional outcome of survivors. The authors summarize mechanisms of secondary (spinal cord) injury, discuss derivative pharmacotherapy, review clinical trial findings and raise issues related to future research. Special attention is directed to the Maryland studies of GM-1 ganglioside and the National Acute Spinal Cord Injury trials. Preliminary work regarding the roles of excitatory amino acids, endogenous opioid peptides, calcium channel blockers and nerve growth factors in secondary injury are also outlined.

Humans↗
PubMed1995

Precision and accuracy of clinical and radiological signs in premature infants at risk of patent ductus arteriosus.

OBJECTIVE: To determine the precision (interobserver agreement) and accuracy (agreement with criterion standard) of clinical and radiological signs in premature infants at risk of patent ductus arteriosus (PDA) with left-to-right shunting. DESIGN: Masked comparison of clinical and radiological examination with Doppler flow echocardiography (criterion standard). SETTING: Neonatal intensive care unit. PATIENTS: One hundred infants with birth weights less than 1750 g were studied once between days 3 and 7 of life. A third of the cohort was intubated at the time of study. INTERVENTION: Five independent observers noted the presence or absence of an increased pulse volume, an active precordium, a heart murmur, a cardiothoracic ratio greater than 60%, increased pulmonary vascular markings on a concurrent chest x-ray film, and a relative increase of the cardiothoracic ratio compared with that from the previous chest x-ray film. Pulsed and color flow Doppler echocardiography was performed within 4 hours. All 100 tapes were reviewed by a second pediatric cardiologist. RESULTS: Twenty-three infants had a PDA with left-to-right shunting. The precision of clinical signs was modest, with average kappa values of 0.15 for pulse volume, 0.32 for precordium, and 0.41 for murmur. Pulse quality (43%) and murmur (42%) had the highest mean sensitivities. Corresponding specificities were 74% for pulse volume and 87% for murmur. The combination of a cardiac murmur with an abnormal pulse volume had the highest positive predictive value (77%). The radiological examination did not improve the observers' ability to distinguish between patients with and without PDA. CONCLUSIONS: The precision and accuracy of clinical and radiological signs of a PDA with left-to-right shunting are unsatisfactory. Therefore, Doppler flow echocardiography is required to diagnose PDA confidently in preterm infants between days 3 and 7 of life.

Ductus Arteriosus, Patent↗
PubMed1994

Development and preliminary testing of the neurological assessment instrument.

The purpose of this study was to test a neurological assessment instrument (NAI), used to assess neurological function in adults with acute brain lesions. Instrument items were designed to reflect different aspects of neurological function and assess consciousness along the arousal/awareness continuum as described by Plum and Posner. Content of the NAI was validated by 10 neuroscience expert physicians, nurses and speech pathologists. Reliability was tested with one pair of raters on 39 neurologically stable patients with acute brain lesions. Based on preliminary findings, the critical preliminary steps have been taken towards establishing a reliable and valid instrument with the potential of improving the assessment of neurological function in patients with acute brain lesions.

Adolescent↗
PubMed1993

Methylprednisolone after spinal cord injury.

The assumption that maximal spinal cord injury occurs at the moment of trauma is being challenged by emerging evidence that cellular injury continues after the acute event. Efforts are now being made to alter the course of secondary injury in order to improve the functional outcome of survivors. Methylprednisolone has been studied in two clinical trials--the National Acute Spinal Cord Injury Studies (NASCIS I, NASCIS II)--to determine its ability to protect compromised but viable cellular elements, and thus improve outcome. The purpose of this paper is threefold: (1) to explore the putative mechanisms of secondary spinal cord injury, (2) to examine the role of methylprednisolone in spinal cord injury, and (3) to discuss the findings and clinical implications of NASCIS I and NASCIS II.

Humans↗
PubMed1983

Trial of low doses of aspirin as prophylaxis in sickle cell disease.

The effects of low doses of aspirin on the frequency and severity of painful vaso-occlusive crises were evaluated in children with sickle hemoglobinopathies. Aspirin was compared with placebo in 49 patients in a double-blind crossover study. Careful monitoring of patients revealed an average of 1.1 painful crises per patient year. During the 21 months of study, 70% of patients had a maximum of two painful crises, and 25% experienced four or more. The frequency and severity of crises were not affected by aspirin therapy. In view of aspirin's demonstrated effect on platelet function, we suggest that platelets do not contribute to the initiation or progression of the vaso-occlusive process.

Adolescent↗
PubMed1977

Behavioural types of rape.

The previous and subsequent convictions of all those charged with rape in 1961 were studied, together with circumstances of the criminal offence. The proportion of victims whose names were published in newspapers was high (26 per cent) and a high proportion of accused were acquitted (22 per cent). They fell fairly obviously into paedophiliac rapes of girls under 14 (30 per cent), "aggressive" rapists (20 per cent) with a record of other aggressive offences, and "others" (50 per cent) with few if any other convictions. Various aspects of the records of these groups are considered. The paedophiles tended to have a wider age range and more often pleaded or were found guilty, and more of them received a medical disposal, rare in others. A small but similar proportion of acquitted and convicted were subsequently convicted of another rape.

Adult↗
PubMedDate not supplied

The Glasgow Coma Scale: time for change.

OBJECTIVE: To summarize and evaluate evidence on the psychometric properties of the Glasgow Coma Scale (GCS). RESULTS: This instrument attempts to capture the phenomenon of consciousness with three gross indicators of nervous system function. Although the GCS does capture consciousness to a limited extent and has pragmatic utility for practitioners, it suffers serious limitations for clinical monitoring and prediction and is being eclipsed by a variety of other instruments. CONCLUSION: In spite of its acknowledged shortcomings and the emergence of parallel instruments with greater reliability and validity, the GCS continues to enjoy a privileged, but unwarranted, position in clinical and investigational contexts.

Consciousness Disorders↗