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Biomedical subjects

Peter Mansfield

Publications and source records attributed to Peter Mansfield.

10 recordsLinked to original sources
PubMed2006

Attendance of paediatricians at elective Caesarean sections performed under regional anaesthesia: is it warranted?

AIM: Whether or not a paediatric registrar or consultant paediatrician trained in advanced neonatal resuscitation is needed at elective Caesarean section (CS) deliveries remains controversial. The objective of this study was to provide recent population-based data comparing the need for resuscitation of babies born at >or=37 weeks gestation by elective CS under regional anaesthesia with those born by spontaneous, unassisted vertex vaginal delivery. METHODS: We performed a population-based cohort study in Tasmania using data collected between January 1998 and December 2003 inclusive. Data on all singleton births>or=37 weeks gestation was analysed from the Tasmanian Obstetric and Neonatal Audit database to determine the number and type of resuscitations, and the number of low 1-min Apgar scores for each mode of delivery. RESULTS: There were 31 820 singleton deliveries born at >or=37 weeks gestation over the 6-year period. Of these 21 733 (68.3%) were spontaneous unassisted vertex vaginal deliveries and 2918 (9.2%) were elective CSs performed under regional anaesthesia (2620 spinal and 298 epidural). The incidence of a 1-min Apgar score of <4 and a 1-min Apgar score of >or=4 and <7 for elective sections under spinal was significantly lower when compared with unassisted, spontaneous, vertex vaginal delivery at 0.57% and 11.8% respectively. The relative risks when compared with unassisted, spontaneous, vertex vaginal delivery were 0.36 (95% confidence interval (CI) 0.21-0.60, P<0.05) and 0.73 (95% CI 0.65-0.81, P<0.05), respectively. There was a small but statistically significant difference between unassisted, spontaneous, vertex vaginal delivery and elective CSs performed under regional anaesthesia in the requirement for resuscitation in the form of bag and mask ventilation. The relative risk for the need for bag and mask ventilation was 1.33 (95% CI 1.11-1.58, P<0.05) for spinal anaesthesia and 1.99 (95% CI 1.33-2.96, P<0.05) for epidural anaesthesia. There was no difference in the need for bag and mask ventilation or low 1-min Apgar scores between non-cephalic and cephalic presentation at elective CS under regional anaesthesia. CONCLUSION: Elective CSs performed under regional anaesthesia are low-risk deliveries. The slight increased requirement for bag and mask ventilation is not practically significant. Such deliveries do not require the routine attendance of experienced paediatric medical staff.

Anesthesia, Conduction↗
PubMed2005

Twenty years' experience of a telehealth service in the UK.

Since 1996 a small call centre has been operated to provide instant self-help, non-medical advice to members. Non-clinical advisers work under a medical director. The scheme grew to 1,200 member-families from a regional catchment area, peaking at 2,500 across the country. About 30-50 telephone calls are received each day and up to 1,000 Web visits per day; about 20-50 postal items are sent out daily to members. In a telephone poll during 2001, half of our current members said that they used the National Health Service about 70% less than before they joined, but a third said that they used complementary and alternative medicines 80% more. Half had gained in confidence by about 50% in managing their own health. Members most often join for alternative medical help with a specific problem, but stay if they begin to appreciate the help we can give them in regaining and keeping health in the round. Our retention of new members for a second year is only 10-20%. The 'barefoot' profession of telehealth adviser appears to meet a community need.

Complementary Therapies↗
PubMed2004

Single-enantiomer drugs: elegant science, disappointing effects.

Most new drugs are marketed as single enantiomers but many older agents are still available in racemic form. As these drugs reach the end of their patent life manufacturers become interested in marketing single enantiomer equivalents. This is called 'chiral switching' and it has been claimed that it will bring clinical benefits in terms of improved efficacy, more predictable pharmacokinetics or reduced toxicity. We reviewed the clinical evidence and prices for three recently marketed single enantiomer versions of widely used racemic drugs: escitalopram, esomeprazole and levosalbutamol. Claims of increased efficacy were based on comparisons of non-equivalent doses and any advantages seemed small and clinically unimportant. Prices of esomeprazole and levosalbutamol were higher than their racemic alternatives and we predict that these prices will remain high despite the market presence of generic versions of the racemates. Patent protection and a perception of superiority based on promotion rather than evidence will maintain price premiums for single enantiomer drugs that are not justified on the basis of clinical performance.

Albuterol↗
PubMed2004

Changing attitudes to 'the change'.

BACKGROUND: In order to practice efficiently, experienced doctors use heuristics (decision making shortcuts). In most cases decision making shortcuts improve the service we offer, allowing us to make appropriate decisions more quickly. However, occasionally shortcuts can mislead. It is important to reflect on the shortcuts we use so as to reduce the risk of mistakes. OBJECTIVE: This article examines the potential pitfalls of decision making shortcuts using hormone therapy (HT) in menopause as an example. DISCUSSION: Recent randomised controlled trials have changed the thinking on the risk-benefit ratio for HT. The previously assumed long term health benefits of HT for women during and beyond menopause resulted from shortcuts in decision making including 'association means causation' (observational data), 'experts know best' (the experience of gynaecologists seeing women with severe menopausal symptoms is applied to all women) and 'a biological theory to explain a phenomenon makes it likely to be true' (oestrogen has a positive effect on lipid profiles and so was assumed to be cardioprotective).

Attitude of Health Personnel↗
PubMed2003

The stain wars.

Explore the source record for details and available documents.

Drug Approval↗