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Biomedical subjects

Lutz Beckert

Publications and source records attributed to Lutz Beckert.

13 recordsLinked to original sources
PubMed2006

Asthmatics: too drunk to drive? The time curve of exhaled ethanol levels after use of Salamol in normal subjects.

Salamol, a new chlorofluorocarbon-free metered dose inhaler (MDI) containing salbutamol with small amounts of ethanol as a co-solvent, has been introduced in New Zealand. We evaluated the effect of breath alcohol levels after two inhalations from this MDI, and plotted a time-response curve. We tested 16 healthy volunteers. The breath alcohol levels rose to 1932 mcg/L immediately after inhalation with a standardised technique. We concluded that in all normal subjects their breath test was negative after 3 minutes, and at least a 5 minute wait post Salamol inhalation is necessary before roadside breath testing should be undertaken, otherwise a failed breath test is likely.

Administration, Inhalation↗
PubMed2006

The role of CT pulmonary angiography in patients with suspected pulmonary embolism admitted to general medicine.

BACKGROUND: CT pulmonary angiography (CTPA), D-dimer testing, and pre-test probability scoring have greatly improved the ability to manage patients with suspected pulmonary embolism. International guidelines suggest combining these investigations for the best yield. We have been investigating the use of CTPA in patients with suspected pulmonary embolism (PE) admitted to the Department of General Medicine at Christchurch Hospital, New Zealand. METHODS: A retrospective audit of 100 patients with suspected pulmonary embolism who had a CTPA performed between October 2003 and April 2004. RESULTS: CTPA was positive for PE in 31% of admissions. The pre-test probability was documented in only 4% of admissions. All patients with PE had a significantly elevated D-dimer (> 499 ng/mL). Wells score calculated by the investigators showed 59 (59%) to have a low, 33 (33%) a moderate, and 8 (8%) a high risk for PE. Of these, PE was diagnosed in 9 (15%), 15 (45%), and 7 (88%) respectively; 93% of patients had a blood gas performed, yet only 77% had the D-dimer measured. No patient with a measured and negative D-dimer had a diagnosis of a PE; 32 CTPAs were performed on 32 patients out of hours. CONCLUSION: There was a very low uptake of the formal use of pre-test probability scores by medical registrars. This audit confirms that, in patients with low or moderate risk of PE and a negative D-dimer, an alternative diagnosis should be considered. The management of suspected venous thromboembolism (VTE) could be improved; it is likely that after hours CTPA could be reduced.

Angiography↗
PubMed2006

Inflammatory bowel disease and the lung: is there a link between surgery and bronchiectasis?

PURPOSE: One-third of patients with inflammatory bowel disease (IBD) has extracolonic manifestations. Inflammatory bowel-associated pulmonary disease is one of the less commonly recognized and more recently described manifestations. Here, we report the experience of our patients with inflammatory bowel-associated bronchiectasis. METHODS: A retrospective analysis of case notes of patients with IBD and respiratory manifestations was undertaken. Relevant demographic, clinical, radiological, and pulmonary physiology laboratory results were reviewed. RESULTS: Ten patients with IBD and bronchiectasis were identified. Eight developed respiratory symptoms after surgery for IBD. Five of the ten had ulcerative colitis. Their lung function abnormality is mild to moderate in severity. Small airways disease (forced expiratory flow between 25-75% is <50%) was evident in seven of the ten patients. CONCLUSIONS: This preliminary study supports an association between surgery for IBD and development of symptomatic lung disease, particularly bronchiectasis, in susceptible patients. The pulmonary manifestations of IBD in some patients may only become clinically significant after surgery and the withdrawal of medical treatment.

Aged↗
PubMed2005

Heathrow to ICU direct.

We present the case of a witnessed massive pulmonary embolism (PE) resulting in pulseless electrical activity (PEA) following a long-haul flight. Our patient was successfully treated with cardiopulmonary resuscitation (CPR) and thrombolysis in the Emergency Department at Christchurch Hospital and went on to complete her honeymoon in New Zealand.

Adult↗
PubMed2005

Latex-enhanced immunoassay d-dimer and blood gases can exclude pulmonary embolism in low-risk patients presenting to an acute care setting.

BACKGROUND: Pulmonary embolism (PE) is common, and diagnosis is often difficult. Investigation has traditionally required expensive imaging procedures that are frequently nondiagnostic. Consequently, current practice favors noninvasive diagnosis of PE using algorithms combining risk assessment and d-dimer. Despite the proven safety of this approach, concern persists about such strategies to exclude PE, largely due to variable d-dimer sensitivity. The aim of this study was to prospectively assess the safety of a new algorithm combining a novel, rapid d-dimer test (IL Test; Instrumentation Laboratory; Lexington, MA), Pa(O2) measurement, and risk factor assessment in excluding PE in subjects presenting to an acute care setting. METHODS: All patients aged 18 to 60 years presenting to the emergency department of Christchurch Hospital with suspected PE underwent measurement of d-dimer (IL Test latex-enhanced immunoassay) and Pa(O2), and were assessed for the presence of major clinical risk factors. Those with no risk factors, normal d-dimer findings, and Pa(O2) > or = 80 mm Hg (study arm A) were discharged and followed up by telephone questionnaires over 12 months. Those with elevated d-dimer levels, Pa(O2) < 80 mm Hg, or one or more risk factors (study arm B) were managed as per hospital guidelines. Outcome data were collected on these patients. Our primary outcome was incidence of PE in group A during the first 3-month follow-up period. RESULTS: Three hundred twenty-eight patients were enrolled, of whom 149 were assigned to group A and 179 were assigned to group B. In none of the group A patients was PE diagnosed over the subsequent 3-month period (0%; 95% confidence interval, 0 to 2.1%). PE was diagnosed in 37 group A patients (21%). CONCLUSIONS: The latex-enhanced immunoassay d-dimer and normal arterial oxygen pressure levels can safely exclude PE in a low-risk population presenting to an acute care setting. While these results cannot be extrapolated to all patients with suspected PE, they do confirm the safety of this approach in a population with a low underlying risk of PE.

Blood Gas Analysis↗
PubMed2004

Tutorial dynamics and participation in small groups: a student perspective in a multicultural setting.

AIM: This study investigated the language and cultural backgrounds of medical students, and explored their perspectives of the influences on student participation in small-group tutorial settings. METHOD: A task group of students and staff from a variety of cultural backgrounds designed a cross-sectional survey using an anonymous questionnaire. The survey was conducted at the Christchurch School of Medicine and Health Sciences (a campus of the University of Otago). Students attending a 4th-year and a 5th-year lecture were invited to participate. RESULTS: Seventy-five percent of students enrolled in the medical course responded to the survey. Half of the sample self-identified as New Zealand European or Maori. Sixty-four percent of students identified English as their first language. Ninety-one percent of students stated a preference for small-group tutorials rather than lectures. Most students reported that there was a 'lack of prior preparation' by students in these tutorials (no statistically significant difference between students with English as first or second language). Two thirds of students (66%) students felt there was a lack of full participation in small-group teaching. Personality, cultural, and language differences were perceived as contributing factors to the lack of participation. CONCLUSIONS: Lack of participation should not be assumed to be due to language difficulties. Barriers to participation are perceived differently by students from a variety of language and cultural backgrounds. Moreover, interactions between students who dominate and under-participate may influence student participation. Further research is needed to determine whether language and cultural backgrounds affect students' participation in small group teaching.

Asian People↗
PubMed2003

Understanding of pulse oximetry among hospital staff.

AIM: To assess the level of understanding of pulse oximetry in a hospital setting and identify training needs. METHODS: Twenty nine nurses and 34 doctors anonymously completed a questionnaire survey previously used by researchers in Exeter, UK. Respondents were required to explain the basic principles of pulse oximetry and demonstrate an understanding of the physiological factors limiting its accuracy. They were asked to apply their knowledge in different clinical scenarios. RESULTS: A higher proportion of nurses than doctors demonstrated an awareness of the physiological limitations of pulse oximetry. The majority of respondents correctly identified normal ranges for adult patients. Twenty nine per cent of respondents did not know how a pulse oximeter worked. Respondents failed to recognise the clinical implications of low oxygen saturations in many of the hypothetical scenarios. Only 16% of respondents had received any formal training in the use of pulse oximetry, with 65% identifying a need for more training. CONCLUSIONS: Medical and nursing staff at Christchurch Hospital have a good understanding of pulse oximetry. A higher proportion of participants were aware of checking vital signs when the oximeter reading was unreliable, than in the original UK study cohort. A need was identified for further education in this core technique. Staff training may increase the clinical value of pulse oximetry.

Adult↗
PubMed2003

A needs-based study and examination skills course improves students' performance.

BACKGROUND: Adult learning theory suggests that learning is most effective when related to need, when driven by the learner and when it is flexible. We describe the effect of an educational intervention that was driven by student need, and largely designed by students. METHODS: We undertook a needs assessment of fifth year medical students' study needs. Based on this, we helped them design a course to meet these needs. This was predominantly related to study skills and a practice objective structured clinical examination (OSCE). We evaluated the course by asking for student opinion and by measuring the effect on student performance in a high stakes medical school examination (written examination and OSCE). FINDINGS: Despite the course being run voluntarily and in after-hours sessions, 80-90% of the medical student class attended each session. Student performance on the end of year examinations was significantly enhanced in the year of the intervention, compared with previous years and with students from other schools sitting identical examinations in the same year. INTERPRETATION: Learning activities that are directly based on student needs, that focus on study and examination techniques, and that are largely student-driven, result in effective and valuable outcomes.

Community Participation↗
PubMed2002

Assessment of snorers in primary care: straight path to treatment.

Habitual snoring needs to be taken seriously, both as a symptom of other sleep disorders and as a condition in its own right. GPs approached by patients with problematic snoring face a dilemma regarding whether (and to which service) those patients should be referred for a specialist opinion. Using the Sparks Chart, snoring patients can be grouped according to the two symptomatic dimensions of excessive daytime sleepiness and nocturnal hypoxaemia. We believe that the approach outlined in this article offers GPs a coherent and pragmatic guideline for referring and/or managing problematic snoring by using a simple questionnaire and pulse oximetry. The method has the potential to improve primary and secondary liaison. Most importantly, it offers patients a straight path to treatment.

Decision Support Techniques↗