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Biomedical subjects

Neil McIntosh

Publications and source records attributed to Neil McIntosh.

7 recordsLinked to original sources
PubMed2003

Hypoxic oxygen fluctuations produce less severe retinopathy than hyperoxic fluctuations in a rat model of retinopathy of prematurity.

The aim of this study was to investigate whether the mean around which arterial oxygen fluctuations take place was important in a unique animal model of oxygen-induced retinopathy. Retinopathy of prematurity (ROP) is associated with fluctuating arterial oxygen. A recent retrospective study suggested that management of high-risk preterm infants at lower oxygen saturations was associated with less severe ROP. Rat pups were raised in a variable oxygen environment around a high (24%), normal (21%) or low (17%) mean inspired oxygen for 14 d. Rat pups raised in the high (24%) mean variable oxygen environment had more retarded retinal vascular development than did rats raised in an environment that fluctuated around 21% mean oxygen. In contrast, rats raised in a lower mean (17%) but still variable oxygen environment had no discernible retinal differences from controls raised in constant room air. Rats raised in a relatively hypoxic but variable oxygen environment develop less severe retinal vascular abnormalities than those raised in variable oxygen around higher oxygen means.

Animals↗
PubMed2002

Mismatched concepts in a neonatal intensive care unit (NICU): further issues for computer decision support?

BACKGROUND: Common concepts and definitions are important for the effective practice of medicine. In an intensive care unit clear understanding of terminology and communication between different staff groups may be critical for optimal care. If computerised decision support tools are to be successfully deployed in these high intensity environments, all staff must understand the concepts and information that is to be portrayed. OBJECTIVE: To examine the similarity of language and concepts related to newborn infants and their care in staff groups with different experience. METHODS: An experimental study in a tertiary regional neonatal intensive care unit involved 32 staff in 4 groups with varying experience (junior and senior / nurses and doctors). A psychologist developed a lexicon of clinical actions and a second lexicon of possible patient descriptors applicable to newborn infants receiving all degrees of neonatal care by conducting interviews with staff on the unit. Card sorting experiments were performed on the terms in the action and descriptor lexicons, the staff being asked to group words that were related to the same or similar concepts. The card sort data were analysed using conventional cluster analysis to produce tree-diagrams or dendrograms and then by distance matrix analysis to give cumulative probability plots. RESULTS: Differences were shown in the way various classes of staff and staff with different experience mentally map clinical concepts. Clinical actions were grouped more randomly by nurses and by those with less experience with a polarisation between senior doctors and junior nurses. Descriptors were classed more definitively and similarly by junior and senior nurses and senior doctors but more randomly and quite differently by junior doctors. Thus there were differences seen between nurses and doctors with different roles within the unit and differences related to experience. CONCLUSIONS: Concepts are used differently by various staff groups in a neonatal unit: this may have an impact on the effectiveness of computerised decision aids unless it is taken into account during their development.

Adult↗
PubMed1993

The pain of heel prick and its measurement in preterm infants.

Variability of physiological parameters was used as a measure of stress in the newborn infant. There was a significant increase in variability of the heart rate (P < 0.01) when the stab of the heel prick occurred in addition to the other elements of the procedure (positioning, warming, alcohol swab cleansing and squeezing). This dummy procedure itself caused some increase in variability although this was not significant at the 5% level. There were similar significant increases in variability of the respiratory rate and O2 and CO2 tensions in the blood (P < 0.05) during the stab procedure.

Carbon Dioxide↗
PubMed1989

Cutaneous hypersensitivity following peripheral tissue damage in newborn infants and its reversal with topical anaesthesia.

The flexion reflex threshold has been used as a measure of sensation in a group of premature infants born at 27-32 weeks postmenstrual age. The threshold in an area of local tissue damage created by routine heel lances was half the threshold on the intact heel on the other side. This indicated a hypersensitivity to tissue damage analogous to tenderness or hyperalgesia reported in adults. In a double-blind study, treatment of the damaged area with the topical anaesthetic cream, EMLA, was found to reverse this hypersensitivity or in other words increase the flexion reflex threshold. Treatment with placebo had no effect. The results show that the newborn infant central nervous system is capable of mounting a chronic pain response to local injury which can be reduced by local anaesthetic.

Anesthetics, Local↗
PubMedDate not supplied

Role and experience determine decision support interface requirements in a neonatal intensive care environment.

The aim of this paper is to describe a novel approach to the analysis of data obtained from card-sorting experiments. These experiments were performed as a part of the initial phase of a project, called NEONATE. One of the aims of the project is to develop decision support tools for the neonatal intensive care environment. Physical card-sorts were performed using clinical "action" and patient "descriptor" words. Thirty-two staff (eight junior nurses, eight senior nurses, eight junior doctors, and eight senior doctors) participated in the actions card-sorts and the same number of staff participated in separate descriptors card-sorting experiments. To check for consistency, the card-sorts were replicated for nurses during the action card-sorts. The card-sort data were analysed using hierarchical cluster analysis to produce tree-diagrams or dendrograms. Differences were shown in the way various classes of staff with different levels of experience mentally map clinical concepts. Clinical actions were grouped more loosely by nurses and by those with less experience, with a polarisation between senior doctors and junior nurses. Descriptors were classed more definitively and similarly by nurses and senior doctors but in a less structured way and quite differently by junior doctors. This paper presents a summary of the differences in the card-sort data for the various staff categories. It is shown that concepts are used differently by various staff groups in a neonatal unit and that this may diminish the effectiveness of computerised decision aids unless it is explored during their development.

Computational Biology↗
PubMedDate not supplied

Intensive care monitoring: past, present and future.

Monitoring is the serial evaluation of time-stamped data, and the volume of such data in an intensive care unit is huge. Clinical and biochemical data may be available at hourly or more frequent intervals but physiological data are 'continuous'. Although sophisticated monitors display the physiological data in multiple and varied combinations, staff are challenged by the frequency of the false alarms and lack of knowledge of the patterns from which they could predict problems. All these data, together with large amounts of clinical data, lead to information overload. In this paper, the case is made for the development of automatic decision-support system based on statistical and probabilistic analysis of data patterns appropriate for the level of cognition of the user (nurses and juniors at the bedside rather than consultants). Such decision support could both reduce the false-positive alarms that frustrate clinical staff, and improve the early detection of pathophysiological events. We have used the development of a pneumothorax as our paradigm. Our data indicate that the clinical diagnosis of pneumothorax takes a median of 127 minutes, but using short decision algorithms based on routinely available monitoring data, most can be detected within 10-15 minutes of occurrence.

Algorithms↗