PubMed Health⌕ Search

Biomedical subjects

I M Ledingham

Publications and source records attributed to I M Ledingham.

At least 19 recordsLinked to original sources
PubMed1995

Telematics in undergraduate teaching.

The use of telematics in the practice of medicine has received much recent attention but little has been written about the use of these techniques in medical education. This is a report of a pilot study in which an interactive video-conference took place between medical students at the UAE University and their opposite numbers at Aberdeen University. In Aberdeen, the Dean of the Medical Faculty simultaneously taught Aberdeen and UAE students on a clinical case. He was able to confine his activities largely to the correction of misconceptions, the emphasis of important points and the addition of missing information, while the students themselves conducted most of the presentation. The UAE students presented their Community Health projects and had a spirited discussion on them with the Aberdeen students. Recent technological advances have so improved the quality of transmission of both visual and auditory images and at reasonable cost, using the ISDN telephone system, that the feasibility of using this medium as an aid to teaching has suddenly materialized. The experiment showed that the technology was adequate for easy, fully interactive teaching among students from different continents and with different cultural backgrounds. It is particularly suitable for the Arab world where it is the custom to teach males and females separately. The pilot study has pointed out the existence of a medium of communication and teaching which, if proved to be effective, could have far-reaching consequences in the undergraduate and postgraduate teaching of medicine.

Adult↗
PubMed1989

Comparison of propofol and midazolam for sedation in critically ill patients.

101 critically ill patients admitted to five intensive-care units were allocated randomly to receive a continuous intravenous infusion of either propofol or midazolam for sedation for up to 24 h. In addition, morphine was given to provide analgesia. The mean duration of infusion was 20.2 h (range 3.0-24.5) in the propofol group and 21.3 h (4.0-47.0) in the midazolam group and infusion rates were 1.77 mg/kg/h (range 0.40-5.00) and 0.10 mg/kg/h (0.01-0.26), respectively. The infusion rates were adjusted as necessary, and the desired level of sedation was achieved easily in most patients in both groups. There were slight falls in arterial pressure, but there were no significant differences between the groups. Heart rate was lower in patients who received propofol. Some small changes occurred in biochemical and haematological variables in both groups, but they were not clinically significant. There was no indication that either drug substantially impaired adrenal steroidogenesis. When the infusion was discontinued, there was less variability in recovery of consciousness in patients who had received propofol. In a subgroup of patients, weaning from mechanical ventilation was achieved significantly faster after discontinuation of propofol than of midazolam. Propofol proved to be a satisfactory agent for sedation of these critically ill patients and compared favourably with midazolam.

Adolescent↗
PubMed1989

Cell therapy in shock: a reasonable prospect or a lost cause?

Almost any insult to the body can set in motion the sequence of physiologic and biochemical changes leading to shock. In the absence of effective treatment widespread disruption of the body's biological mechanisms inevitably follows. This review will describe some of cellular and subcellular disturbances associated with the shock syndrome, the persistence of which lead to (multiple) organ failure. Current views as to the mechanisms of these disturbances will be outlined with particular reference to hypovolemic and septic shock. Finally, an indication will be given of the relevant therapeutic implications, now and in the future.

Cell Survival↗
PubMed1989

Critical abdominal sepsis.

Intra-abdominal sepsis is a heterogeneous condition which in its severe forms carries a high mortality. The systemic consequences of established major infection are the result of a complex pathophysiology whose mechanisms are imcompletely understood. It is clear that early appropriate therapy is vital in minimizing effects of intra-abdominal infection and to this end early recognition of sepsis is important. Clinical examination may be unhelpful in difficult cases and special investigations may aid diagnosis; a high index of suspicion is mandatory. Surgery is the mainstay of therapy but may be inadequate and supportive measures are an essential adjunct.

Acute Disease↗
PubMed1988

Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime, and microbiological surveillance for prevention of acquired infection in intensive care.

All 324 patients admitted over sixteen months to a general intensive therapy unit (ITU) were prospectively studied to assess the effect of a novel prophylactic antibiotic regimen on the incidence of acquired infection. Consecutive control (161 patients) and test (163 patients) groups were analyzed. In the control group, antibiotic administration was determined by clinical and microbiological evidence of infection. In the test group, treatment consisted of a triple regimen of selective decontamination of the digestive tract (polymyxin E, tobramycin, and amphotericin B) administered throughout the ITU stay, systemic cefotaxime administered for the initial four days, and regular microbiological screening of multiple sites. The test group showed a striking and consistent reduction in colonisation of the digestive tract with aerobic gram-negative bacilli, and there was a substantial reduction in the incidence of acquired infection (24% to 10%). Mortality in certain categories of patients was also reduced. There is now a considerable body of evidence to justify the more widespread use of this selective parenteral and enteral anti-sepsis regimen (SPEAR) in general intensive care practice.

Adult↗
PubMed1988

Provision of facilities for secondary transport of seriously ill patients in the United Kingdom.

A survey by questionnaire of 280 hospitals with general intensive care units was carried out to find out what facilities were provided for secondary transport of seriously ill patients in the United Kingdom. Replies were received from 181 units. Extrapolating from the survey data showed that about 10,000 patients were transported each year, although many units transferred only a few patients. An appreciable minority of units reported that facilities for secondary transport were inadequate and many were obliged to send inexperienced medical staff with patients. Almost half of the respondents thought that arrangements for transfer were unsatisfactory, but only a tenth said that they delayed or refused transfer for this reason. This undoubtedly reflects a policy of "making do" despite inadequate resources. We believe that these results support the concept of regional transport services, where each major unit would be adequately equipped and staffed and unnecessary duplication of resources avoided.

Ambulances↗
PubMed1988

Sickness scoring and response to treatment as predictors of outcome from critical illness.

A physiological sickness scoring system (SS), based on the APACHE II score, has been used to assess outcome from critical illness in 128 patients admitted to a general intensive care unit. Physiological data were collected on each patient from admission until death or discharge from the unit, and survival was recorded as survival to home. The admission SS correctly classified 80.6% of survivors, and 70.4% of non-survivors. Predictive power did not improve with time using the daily SS. However, when the proportional change in SS over time was included in the analysis, predictive power improved; and at day 4, 87.1% of survivors and 75% of non-survivors were correctly classified. At intermediate levels of sickness severity (admission score of 13-18), a reduction in SS of 30% by day 4 reduced the risk of death by 32%; at higher levels (greater than 18) a similar reduction in SS was associated with a 47% reduction in death-risk. Failure to obtain a reduction in score by day 4 was associated with increased risk of death. Survivors consistently showed a greater fall in SS by day 4 than non-survivors. The APACHE score and its modifications provide an accurate, unitary measure of physiological disturbance. Correction of abnormal physiology, and the measurement of responsiveness to therapy are important components in the prediction of outcome from critical illness.

Adult↗