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Biomedical subjects

S Nadel

Publications and source records attributed to S Nadel.

At least 55 records · Page 3Linked to original sources
PubMed1995

Morbidity and severity of illness during interhospital transfer: impact of a specialised paediatric retrieval team.

OBJECTIVE: To evaluate the morbidity and severity of illness during interhospital transfer of critically ill children by a specialised paediatric retrieval team. DESIGN: Prospective, descriptive study. SETTING: Hospitals without paediatric intensive care facilities in and around the London area, and a paediatric intensive care unit at a tertiary centre. SUBJECTS: 51 critically ill children transferred to the paediatric intensive care unit. MAIN OUTCOME MEASURES: Adverse events related to equipment and physiological deterioration during transfer. Paediatric risk of mortality score before and after retrieval. Therapeutic intervention score before and after arrival of retrieval team. RESULTS: Two (4%) patients had preventable physiological deterioration during transport. There were no adverse events related to equipment. Severity of illness decreased during stabilisation and transport by the retrieval team, suggested by the difference between risk of mortality scores before and after retrieval (P < 0.001). The median (range) difference between the two scores was 3.0 (-6 to 17). Interventions during stabilisation by the retrieval team increased, demonstrated by the difference between intervention scores before and after retrieval, median (range) difference between the two scores being 6 (-8 to 38) (P < 0.001). CONCLUSIONS: Our study indicates that a specialised paediatric retrieval team can rapidly deliver intensive care to critically ill children awaiting transfer. Such children can be transferred to a paediatric intensive care unit with minimal morbidity and mortality related to transport. There was no deterioration in the clinical condition of most patients during transfer.

Child↗
PubMed1993

Kawasaki disease.

The cause of Kawasaki disease remains a mystery. Since its original description, many theories regarding the etiology of this serious childhood illness have been proposed, only to be refuted on closer scrutiny. The past year has seen important advances in our understanding of the pathophysiology of Kawasaki disease. Probably the most exciting advance has been the description of the mechanisms underlying the immunologic derangements seen in Kawasaki disease, together with evidence that this mysterious illness may be caused by a toxin that acts as a superantigen.

Child↗
PubMed1987

Improved accuracy of single-energy computed tomography bone mineral determination using threshold analysis.

Single-energy CT for bone-mineral determination underestimates the degree of mineralization because of error caused by fat in the marrow space. A correction using set theory and threshold analysis was developed to reduce this error. Corrections between 4.7% and 130.9% of fat-induced error are observed. The amount of correction is related directly to the amount of osteopenia present, and is patient specific. This technique may be appropriate for clinical evaluation because the major application of quantitative CT (QCT) is for bone mineral analysis in a population with increasing marrow space fat over time. This technique may allow reduction of the uncertainty of normal data developed using single energy QCT, thereby making the technique more sensitive to early detection of osteopenia.

Adipose Tissue↗
PubMedDate not supplied

Noninvasive measurement of cardiac output in critically ill children.

This study was performed to evaluate the hemodynamic status of children admitted to the intensive care unit, using suprasternal and transesophageal Doppler ultrasound, and to establish a suitable noninvasive technique to monitor trends in cardiac output in critically ill children. Twenty children were studied over a period of 6 months. The median age was 32.5 months and weight 14.5 kg. Minute distance (MD), which is a linear cardiac output parameter, was assessed. Seven simultaneous pairs of measurements of MD were made using transesophageal Doppler (TED) and suprasternal Doppler (SSD) by the same operator. Following a fluid challenge, seven repeat pairs of measurements were made. The mean percentage changes for MD by TED and SSD were 21.84 (SD 9.97) and 5.75 (SD 7.32). The average coefficients of variation for measurements of MD by TED and SSD were 2.34% and 15.98%, respectively. The mean difference in percentage change between MD, measured by TED and SSD, was 27.59 with a 95% confidence interval and wide limits of agreement. The repeatability of TED measurements was good, but the measurements by SSD were wide and erratic with poor reproducibility. Our study shows that TED is easy to use, reliable, and very useful for monitoring hemodynamic changes in critically ill children.

Adolescent↗