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Biomedical subjects

M J Marsh

Publications and source records attributed to M J Marsh.

36 records · Page 2Linked to original sources
PubMed1996

Treatment of recurrent acute wheezing episodes in infancy with oral salbutamol and prednisolone.

UNLABELLED: The aim of this study was to investigate the role of oral salbutamol and prednisolone in the treatment of acute episodes of wheezing in infants under 15 months of age. Sixty-two acute episodes of wheezing were studied in 59 babies (age range 3-14 months; mean 7 months), who had all suffered at least one previous wheezy episode. Patients were randomised to receive either salbutamol and prednisolone, salbutamol and placebo or double placebo. Parents were requested to keep a diary card record of twice daily scoring of their baby's symptoms over the next 14 days. A significantly greater number of treatment failures occurred in the placebo group compared to babies treated with oral salbutamol (relative risk 2.51; 95% confidence intervals for relative risk 1.09-5.79). There was no difference in the number of treatment failures between babies treated with a combination of salbutamol and placebo and those treated with salbutamol and prednisolone (relative risk 0.71; 95% confidence intervals for relative risk 0.18-2.80). CONCLUSION: This study demonstrates that oral salbutamol is beneficial in the treatment of acute episodes of wheezing in infancy. A combination of oral salbutamol and oral prednisolone appeared to have no additional benefit over treatment with oral salbutamol alone.

Administration, Oral↗
PubMed1996

Open-globe injury. Update on types of injuries and visual results.

PURPOSE: The purpose of the study is to evaluate a recent series of patients who presented with open-globe injuries and to compare this series with a previous series collected at the authors' institution to determine whether prognostic factors or visual outcomes have changed. METHODS: A retrospective review of 290 eyes of consecutive patients who presented to the Wilmer Ophthalmological Institute with open-globe injuries between December 1985 and January 1993 (group B) was compared with a series of 476 eyes with open-globe injury treated and evaluated at this institute between January 1970 and December 1981 (group A). For comparison, the outcomes evaluated included rates of enucleation and final visual acuity. RESULTS: Several factors identified previously in group A to correlate with visual outcomes also were found to correlate significantly (P < 0.001) with visual outcome in group B, including: (1) type of injury, (2) location and extent of injury, (3) initial visual acuity, (4) presence of an afferent pupillary defect, (5) lenticular involvement, (6) vitreous hemorrhage, and (7) type of intraocular foreign body. Overall visual outcomes differed significantly between the groups (P = 0.02). The incidence of enucleation was lower in group B (24%) than in group A (30%). However, the percentage of patients who achieved ambulatory visual acuity (5/200) or better was similar in both groups (57%, group A versus 55%, group B). CONCLUSION: Prognostic factors identified previously proved valid in this recent series. Visual outcomes have improved at this institution in the last 20 years for patients with severe ocular trauma, although visual potential for these patients is still limited.

Adolescent↗
PubMed1996

A comparison of pulmonary and femoral artery thermodilution cardiac indices in paediatric intensive care patients.

We have assessed the agreement between pulmonary artery and femoral artery (COLD) thermodilution measurements of the cardiac index (Cl) in a group of paediatric intensive care patients. The COLD method gave consistently higher cardiac index values than the pulmonary artery catheter (PAC); however, the difference was small, with a mean value of 0.19 l/min-1 m-2 or 4.4% of the mean cardiac index. This difference is not clinically important and suggests that, under these circumstances, the COLD system provides an acceptable alternative to the pulmonary artery catheter for measurement of the cardiac index at the bedside.

Cardiac Output↗
PubMed1995

Continuous haemodynamic monitoring in children: use of transoesophageal Doppler.

A wide range of invasive and non-invasive techniques for monitoring the haemodynamic condition of critically ill patients is now available. A general reluctance on the part of paediatric intensive care specialists to use pulmonary artery thermodilution catheters and the need for constant realignment of hand-held Doppler probes has necessitated the search for a technique which is relatively non-invasive and provides continuous information on the haemodynamic condition of critically ill paediatric patients. We sought to establish if transoesophageal Doppler fulfilled these criteria. Eleven children who had recently undergone cardiac surgery were studied. Median age was 39 months and weight 14.9 kg. Five simultaneous pairs of measurements of cardiac index (CI: thermodilution) and minute distance (MD: transoesophageal Doppler) were made, as a baseline, when each child was haemodynamically stable. Following a fluid challenge, five repeat pairs of measurements were made. The mean percentage changes for CI and MD were 16.4% (range 5.3-44%) and 16.6% (3.4-47.7%), respectively. The average coefficients of variation for measurements of CI and MD were 3.5% and 2.9%, respectively. The mean difference in percentage change between CI and MD was -0.5% (95% confidence interval for the bias -4% to 3%; limits of agreement -10.7 to +9.7%). Our study indicates that transoesophageal Doppler is reproducible, easy to use and provides clinically acceptable information when following changes in CI in haemodynamically stable paediatric patients.

Adolescent↗
PubMed1994

The Hering-Breuer deflationary reflex in the newborn infant.

Initial observations on healthy term infants using the forced partial expiratory flow-volume technique with an inflatable jacket suggested that this technique was stimulating the Hering-Breuer deflationary reflex, a reflex which has not been systematically studied in man. To investigate this fully, esophageal pressure, jacket pressure, flow and volume at the mouth were recorded during the forced partial expiratory flow-volume maneuver on 10 infants (mean age, 3.1 days; birth weight, 3533 g; gestation, 39.8 weeks). A total of 186 measurements were performed at different points in the respiratory cycle. In 159 (85%) recordings inspiratory effort was evident with a fall in esophageal pressure within 166 msec; in some cases this occurred before the jacket was fully inflated. This was associated with a reduction of 23.4 cm H2O in mean intrathoracic pressure, which was 2.5 times that occurring during normal tidal breathing. In the remaining 27 measurements a plateau pressure was associated with closure of the upper airway. When the squeeze was applied at low lung volumes (end-expiration) the inspiratory effort occurred significantly earlier (133 msec) and stronger (reducing peak intrathoracic pressure to 15.8 cm H2O) than when applied at end-inspiration (181 msec with a reduction in intrathoracic pressure to 25.2 cm H2O). The observed inspiratory response was highly consistent, representing the deflationary reflex as described by Hering and Breuer in 1868. The stronger and more rapid onset of inspiration at low lung volume supports the claim made by Breuer that it has a protective role on functional residual capacity (FRC) in young infants.

Female↗
PubMed1993

Laser treatment of choroidal neovascularization in patients with angioid streaks.

The benefit of laser photocoagulation to choroidal neovascularization secondary to angioid streaks remains controversial. To further expand our knowledge, we reviewed the records of 20 patients (24 eyes) with classic (well-defined) choroidal neovascularization secondary to angioid streaks, who were treated with laser between 1982 and 1991 at the Retinal Vascular Center of the Wilmer Institute. The choroidal neovascularization was extrafoveal in 18 (75%), juxtafoveal in two, subfoveal in three, and indeterminate in one eye. Seventeen of the 24 fellow eyes (71%) had a disciform scar or choroidal neovascularization, or both. Follow-up ranged from three months to nine years (mean, 3.5 years; median, two years). Lines of visual acuity change averaged -2.5 at three, -2.6 at six, -2.4 at 12, and -4.8 lines at 24 months. Choroidal neovascularization persisted in five of 24 eyes and recurred in nine of the remaining 19 eyes at risk. When the fellow eye had choroidal neovascularization, scar, or both, at the time of treatment, the rate of persistence or recurrence was 65% vs 33% if the fellow eye had no choroidal neovascularization, scar, or both. An average of four lines of visual acuity was lost when fellow eyes had choroidal neovascularization, scar, or both, vs one line when the fellow eye had no choroidal neovascularization or scar. Laser photocoagulation of choroidal neovascularization in patients with angioid streaks can result in closure of the choroidal neovascularization and stabilization of visual acuity.

Adult↗
PubMed1993

Response to added dead space in ventilated preterm neonates and outcome of trial of extubation.

The ventilatory response to an added external dead space was assessed in preterm babies, recovering from respiratory distress syndrome, immediately prior to extubation. All babies were ready for extubation as defined by routine clinical criteria. Baseline measurements of respiratory rate, tidal volume, and minute ventilation were made over a 2 min period using a computerized system consisting of a pneumotachometer connected directly to the proximal end of the endotracheal tube. The measurements were repeated after addition of an external dead space equivalent to 2 anatomical dead spaces (4.4 mL/kg body weight). Thirty-four babies were studied on 40 occasions. Twenty-four infants (60%) were successfully extubated and 16 (40%) required reintubation. Infants in the success and failure groups were matched for gestation at birth, postconceptional age and weight at the time of study, maximum ventilatory requirements, and treatment with methylxanthines. The added external dead space resulted in an increase in minute ventilation in 38 out of the 40 studies. Extubation success and failure groups were compared by expressing the minute ventilation after addition of the external dead space as a percentage of the baseline minute ventilation (%MV1). Successful extubation was associated with a higher median %MV1 compared with babies who failed extubation (156; range, 89.3 to 230; compared to 131; range, 75.2 to 165; P = 0.006). This test may be useful in deciding which babies could be successfully extubated.

Humans↗
PubMed1993

The effect of instrumental dead space on measurement of breathing pattern and pulmonary mechanics in the newborn.

The effect of the instrumental dead space on breathing pattern and the values of pulmonary mechanics was evaluated because of concern about the relatively large dead space of 26 mL in a commercially available system. Sixty-three healthy newborn infants were studied with a system as commercially supplied, and with the dead space eliminated using a 2 L/min biased flow. This led to a significant reduction in mean (+/- SD) values of respiratory rate from 56.8 (+/- 11.7) to 48.2 (+/- 11.7) breath/min (P < 0.0001), tidal volume from 5.2 (+/- 1.3) to 4.9 (+/- 0.9) mL/kg (P < 0.05), minute volume from 284 (+/- 68) to 220 (+/- 63) mL/min/kg (P < 0.0001), and work of breathing from 13.7 (+/- 6.6) to 11.8 (+/- 7.6) g.cm/kg (P < 0.02). There was a significant increase in dynamic lung compliance from 5.2 (+/- 1.5) to 5.6 (+/- 1.2) mL/cm H2O (P < 0.01) but no difference for total pulmonary resistance 39.6 (+/- 22.8) and 38.8 (+/- 22.2) cm H2O/L/sec. This shows that the instrumental dead space prevents measurement of the basal breathing patterns and alters the values of pulmonary mechanics. It is, therefore, important to use equipment with low dead space or make efforts to remove it by using a biased flow system such as we describe when measuring breathing patterns and pulmonary mechanics in the newborn.

Female↗
PubMedDate not supplied

Publications from multicentre clinical trials: statistical techniques and accessibility to the reader.

Articles from multicentre randomized clinical trials were analysed by methods adapted from Emerson and Colditz and Juzych et al. to compare the frequency with which different statistical methods are used by clinical trials investigators with the frequency used by other researchers, and to determine how much statistical knowledge is required to interpret the statistical treatment of data from clinical trials. We observed differences between the frequency of usage of statistical methods and the accessibility of the clinical trials publications and those of all medical research articles published by specific journals. Clinical trials publications are less accessible than others in medical journals to the reader who knows only descriptive statistics, t-tests, contingency tables, power calculations, and life table methods. Many more statistical methods must be known by a reader to understand fully publications regarding treatment group comparisons for the primary outcomes of interest from clinical trials.

Data Interpretation, Statistical↗
PubMedDate not supplied

Open globe injuries in children: a retrospective analysis.

PURPOSE: To study the outcome of open globe injuries in patients aged <14 years and compare the results between patients who presented approximately 30 years ago and a recent series. METHODS: Between January 1970 and January 1993, 180 eyes of children who presented with an open globe injury were retrospectively analyzed. Patients were divided into two groups. One group of children underwent treatment of an open globe injury between January 1970 and December 1981 (group A) and another between December 1985 and January 1993 (group B). Main outcome measures studied were final visual acuity and enucleation rates. Risk factors studied included age, race, sex, visual acuity, type of trauma, and various injury characteristics at presentation. RESULTS: The factors associated with visual outcomes included: age, type of injury, wound size, initial visual acuity, and retinal detachment. Final visual outcome and enucleation rates were not significantly different between the older series (group A) and the recent series (group B). Lenticular damage, location, posterior extent of the injury, and presence of an intraocular foreign body had been significant prognostic factors in the older series, but were not statistically associated with the prognosis in the recent series. CONCLUSION: The nature of the injury and the patient's age are the main determining factors in the outcome of open globe injuries in children.

Adolescent↗
PubMedDate not supplied

'Not for resuscitation': guidelines for decision making and documentation.

In 1991, the government's Chief Medical Officer made it clear that the responsibility for resuscitation policy lay with consultants, and that they should ensure this policy was understood by all staff caring for a patient, in particular junior medical staff. Since then, many hospitals and trusts have provided members of the multidisciplinary team with guidance on how to ensure that adequate and satisfactory communication is in place to record a patient's resuscitation status. However, as is common in the NHS, poor documentation is still evident. Guy's & St Thomas' Hospital Trust has been using a document since April 1998 which is clearly written, user friendly and does not contain ambiguous statements. With ongoing audit of this policy document we hope to reduce the incidence of inappropriate resuscitation attempts which are costly, both emotionally and financially, for all concerned.

Decision Making↗