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Biomedical subjects

N Chambers

Publications and source records attributed to N Chambers.

15 recordsLinked to original sources
PubMed2005

Cardiac herniation following pneumonectomy--an old complication revisited.

Cardiac herniation is a recognised complication of pneumonectomy when a pericardial defect has been made during resection. This complication is very rare and, with the increasing preference for more limited resections, is even less frequently encountered now than it was several decades ago. Uncorrected cardiac herniation is usually lethal, with a high incidence of morbidity and mortality even after correction. We present a case of left-sided cardiac herniation following intrapericardial pneumonectomy to illustrate the difficulty of making this rare diagnosis. Aetiology, pathophysiology, clinical picture and diagnosis of cardiac herniation are reviewed. We also describe the treatment and prevention of this serious complication. Cardiac herniation should be considered in any patient with acute deterioration after pneumonectomy.

Cardiomyopathies↗
PubMed2003

Postoperative pseudoepileptic seizures in a known epileptic: complications in recovery.

A 47-yr-old woman underwent general anaesthesia for a squint correction. She had previously suffered a cerebral venous thrombosis, presenting as grand mal seizures during recovery from general anaesthesia for minor surgery. Subsequently, she was affected by Jacksonian limb seizures and petit mal epilepsy and had required long-term rehabilitation, and anticonvulsant and anticoagulant therapy. On arrival in recovery on this occasion, with a laryngeal mask airway (LMA) in place, she started to convulse. The seizures were initially treated with midazolam i.v., but they recurred. Whilst observing the seizure pattern and excluding the differential diagnoses, evidence emerged that psychological factors had played a large part in her clinical picture. Her differential diagnosis had recently been amended to include 'pseudoseizures'. A firm, supportive approach caused the 'convulsions' to cease within a few hours.

Anesthesia Recovery Period↗
PubMed2002

Remifentanil and the tunnelling phase of paediatric ventriculoperitoneal shunt insertion. A double-blind, randomised, prospective study.

Sixty-two children were randomly allocated to receive, during inhalational anaesthesia with isoflurane and nitrous oxide, either 1.0 microg x kg(-1) remifentanil (n = 33) or saline (n = 29) just before the tunnelling phase of ventriculoperitoneal shunt insertion, in a double-blind study. The remifentanil group showed little stress response to tunnelling as indicated by median (interquartile range [range]) change in heart rate -5.2 (-11.4 to 9.8 [-19.4 to 30.4])%, mean arterial pressure -5.0 (-20.8 to 15.5 [-40.9 to 42.9])% or plasma norepinephrine -13.5 (-38.1 to -2.5 [-77.7 to 81.5])% compared with the saline group, in which the changes were 20.1 (11.5-36.1 [2.1-83.1])%, 42.7 (27.1-56.8 [3.2-73.5])% and 13.3 (0.8-70.0 [-45.2 to 337.5])%, respectively (p < 0.001 for all comparisons). These changes were consistent across most different age categories. The cardiovascular response in the saline group lasted for 8 (4-15 [0-39]) min. Tracheal extubation occurred after 3 (2-4 [1-8]) min in the remifentanil group and 3 (2-6 [0-15]) min in the saline group (p = 0.29), with transfer to the recovery area and discharge to the ward, respectively, 4 (4-5 [1-10]) min and 9 (7-13 [2-32]) min in the remifentanil group and 7 (4-8 [2-18]) min and 14 (10-19 [7-44]) min in the saline group (p = 0.06 and 0.01, respectively). Postoperatively there was some evidence of respiratory depression and increased oxygen requirements in all age categories, but this was similar in both groups. Overall, the maximum increase from baseline in transcutaneous carbon dioxide tension was 41.2 (11.3-66.7 [-2.0 to 141.7])% in the remifentanil group compared with 30.7 (20.5-55.1 [1.7-159])% in the saline group (p = 0.8), and the time taken for transcutaneous carbon dioxide tension to decrease to < 6.0 kPa was 4 (0-13 [0-60]) min compared with 7 (0-13 [0-60]) min, respectively (p = 0.75). There was no difference between the two groups in postoperative analgesic requirements or in blood loss and there were no significant side-effects. We conclude that remifentanil is an appropriate and safe analgesic to provide balanced anaesthesia to cover the tunnelling phase of paediatric ventriculoperitoneal shunt insertion.

Age Factors↗
PubMed2001

The availability of plutonium and americium in Irish Sea sediments for re-dissolution.

The availability of plutonium and americium, for re-dissolution from offshore sediments into Irish Sea water, has been examined. Sediments collected from the mud-patch near the Cumbrian coast were characterized in terms of spatial location, particle size, partitioning of radionuclides with respect to physico-chemical bonds and availability of actinides for release into seawater. Sequential extraction investigations revealed that plutonium was predominantly associated with strongly bound sesquioxide and organic complex fractions. Americium was associated mainly with the organic complex fraction, but a significant fraction was in carbonate form. Sediment/water re-dissolution experiments with and without stirring were compared to simulate the effect of disturbing bed sediment. After 1 week, neither set of re-dissolution data provided significant trends between dissolved activity and time. Stirred systems appeared to release 2.5 times more plutonium and americium into seawater than unstirred systems. Measured 239,240Pu and 241Am distribution coefficients (Kd values) were both typically approximately 10(5) l kg(-1). 241Am Kd values are an order of magnitude lower than previously reported for the north-eastern Irish Sea, but similar to western Irish Sea values. Overall, the fractions of plutonium and americium available for re-dissolution from bed sediment are very low at < 0.1%, with proportionally more plutonium being released than americium. These findings lend further support for the extrapolation of laboratory-derived information to environmental conditions.

Actinoid Series Elements↗
PubMed1999

Close encounters: the use of critical reflective analysis as an evaluation tool in teaching and learning.

Teaching and learning are complex activities which, when combined with professional practice-based activity, take on additional dimension and depth. This makes the use of traditional, product-based evaluation problematic in that a purely empirical approach does not facilitate thorough evaluation of every facet of such an encounter. This paper describes the use of critical reflective analysis as an alternative method of evaluation. The reflective framework facilitating this process has been adapted from three key sources: patterns of nursing knowledge; evaluative paradigms based upon knowledge - constitutive interests; descriptors for a reflective practicum. The reflective activity is structured around a teaching and learning encounter in a care-based setting and focuses on 'doing the drug round'. Descriptive vignettes are used to facilitate reflection-on-action and, through critical reflective analysis, the author identifies the essential value (e-value-ation) of the encounter in terms of credibility, utility and worth.

Education, Nursing, Graduate↗
PubMed1998

'We have to put up with it--don't we?' The experience of being the registered nurse on duty, managing a violent incident involving an elderly patient: a phenomenological study.

The incidence of violence directed towards nurses is well known. However, despite guidelines and training aimed at preventing or minimizing these incidents, recent reports indicate an increase in their occurrence. This phenomenological study investigated the experiences of five registered nurses who had to manage a violent incident involving an elderly patient. The purpose of this was to discover what these nurses 'know' about the structure of such an experience and, through the use of Colaizzi's method of data analysis, present this knowledge in the form of an exhaustive description of the experience. Taped interviews were used to collect the data. The analytical process revealed that the experience is structured around five themes: professional competence, nursing identity, powerlessness and oppression, loss (neglected and deserted) and strategies for survival. The discussion analyses these themes and the relationships between them, highlighting the issues of nurse autonomy and exercising accountability. The implications for nursing practice, education and research include recognition of nurses as a professional group to enable autonomous practice, the ways in which nurses' perceptions of nursing knowledge may affect their educative role and the need to extend this study further to provide answers to the questions raised therein.

Dangerous Behavior↗
PubMed1997

Teacher accuracy in the identification of pre-school pupils with hearing loss.

Teachers of 110 pre-school pupils used a questionnaire to identify which children they thought would fail a hearing screening. Following screening, the data was compared to both audiometric only, and combined audiometric and tymponometric screening results. Teachers identified one out of six pupils who failed audiometric screening, and one out of seven who failed combined screening. We concluded that teachers could not accurately identify pupils with hearing problems and should not be used to detect hearing losses in pupils without prior education and training.

Acoustic Impedance Tests↗
PubMed1995

Addressing the patient's agenda in the reorganization of antenatal and infant health care: experience in one general practice.

BACKGROUND: Antenatal care is outdated and largely unevaluated. The study practice is committed to involving patients in their own health care. It was decided to use the views of patients to guide a review of antenatal and infant health services. AIM: The study, carried out in 1993, was designed to find out what patients' priorities were, and what they thought were the strengths and weaknesses in the organization and delivery of antenatal and infant health care. METHOD: A total of 52 women attending antenatal appointments were interviewed at the practice using an interview topic guide within a qualitative research framework. Fourteen parents attending a day centre with their under five-year-olds participated in two focus groups. The findings of the interviews and focus group discussions were compared. RESULTS: The interviews revealed a high level of satisfaction with midwife care, although some changes in the organization of antenatal bookings and classes were indicated. Parents expected to be seen switfly at home or at the surgery when their infant was ill, and these high expectations were not always met. There was some degree of confusion and frustration over the role of the health visitor. The views expressed in the focus groups were broadly similar to those expressed in the interviews. CONCLUSION: The findings suggested that there was considerable potential for developing the role of both the midwife and the health visitor, and integrating their work more closely in the primary health care team. Examples are given of how these findings have altered the organization and delivery of antenatal and infant health care in the practice. The study showed that finding out and acting upon the views of patients is a practical way forward in the reshaping of services.

Adolescent↗
PubMed1993

Hepatic cryosurgery with and without the Bair Hugger.

Hypothermia is a significant clinical problem during hepatic cryosurgery, which at times causes the procedure to be halted until the patient's body temperature can be raised. This study examines the effects of the Bair Hugger (a warming device) on body temperature during hepatic cryosurgery. Twenty-eight cases of hepatic cryosurgery were performed without the Bair Hugger, while 44 cases included the Bair Hugger. The lowest mean temperature was significantly lower in the group without the Bair Hugger (34.2 degrees C vs. 35.3 degrees C; P < 0.0001). In addition, this group showed a significantly greater mean change in temperature during the procedure (1.81 degrees C vs. 0.73 degrees C; P < 0.0001). No patient in the Bair Hugger group reached the point of clinically significant hypothermia. In conclusion, the Bair Hugger is safe and very effective in regulating body temperature and it is an essential piece of equipment performing hepatic cryosurgery.

Cryosurgery↗