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Biomedical subjects

S Packham

Publications and source records attributed to S Packham.

9 recordsLinked to original sources
PubMed2003

Spontaneous pneumothorax: use of aspiration and outcomes of management by respiratory and general physicians.

BACKGROUND: Spontaneous pneumothorax is a common problem in hospital practice. Despite the publication of guidelines controversy over its initial management still exists, particularly over the use of simple aspiration. METHODS: The management of spontaneous pneumothorax by respiratory and general physicians at our hospital was analysed by retrospective case note review. Eighty five patients were identified over the study period (36 managed by respiratory and 49 by general physicians). RESULTS: There was a significantly greater use of simple aspiration by respiratory (81%) than general physicians (47%, p<0.001) and a higher rate of success in this group. As a result those patients managed by respiratory physicians had fewer intercostal drains inserted and significantly shorter length of stays (mean 5.6 (3.8) days respiratory group and 9.5 (6.8) days in general physicians group, p<0.05). CONCLUSIONS: The greater and more successful use of simple aspiration by respiratory physicians as an initial treatment for spontaneous pneumothorax resulted in improved outcomes and reduced length of hospital stays.

Clinical Competence↗
PubMed2001

Asthma admissions and thunderstorms: a study of pollen, fungal spores, rainfall, and ozone.

Asthma admissions have been reported to increase during thunderstorms. In some cases, this has been attributed to rises in pollen or fungal spore counts occurring alone or in combination with rainfall. We tested the hypothesis that thunderstorms in general are associated with asthma admissions, and investigated the possible roles of pollen, fungal spores, ozone, and other meteorological factors. We obtained data on multiple pollen and fungal spore counts, rainfall, temperature, ambient ozone concentrations, and asthma admissions for 32 dates when lightning strikes were recorded in the Cardiff/Newport area, and 64 matched dates in previous and subsequent years. Poisson regression models were used to investigate associations between admissions and proposed causative environmental factors. The number of asthma admissions was greater on days with thunderstorms than on control days (p<0.001). There were no associations or interactions between admissions and any pollen or fungal spore counts or rainfall. After adjusting for thunderstorms, there was an independent association between increasing ozone concentration, when temperature was included in the model, and increasing admissions (p=0.02). Asthma admissions are increased during thunderstorms. The effect is more marked in warmer weather, and is not explained by increases in grass pollen, total pollen or fungal spore counts, nor by an interaction between these and rainfall. There was an independent, positive association between ozone concentrations and asthma admissions.

Allergens↗
PubMed2000

Recent advances in the sleep apnoea/hypopnoea syndrome.

This review highlights some of the advances in sleep apnoea/hypopnoea syndrome made over the last few years, particularly in diagnosis and treatment. Recent evidence of the controversial associations of sleep apnoea/hypopnoea syndrome with increased morbidity and mortality, particularly from cardiovascular disease, is presented.

Accidents, Traffic↗
PubMed1998

Domiciliary nocturnal intermittent positive pressure ventilation in patients with respiratory failure due to severe COPD: long-term follow up and effect on survival.

BACKGROUND: There is increasing interest in the use of non-invasive nocturnal intermittent positive pressure ventilation (NIPPV) in the management of patients with chronic hypercapnoeic (type II) respiratory failure. Although this treatment enables patients requiring mechanical ventilatory support to the treated more readily at home, few studies have been done to demonstrate its long term benefits in chronic obstructive pulmonary disease (COPD) and the application of NIPPV in these circumstances remains controversial. METHODS: Eleven patients in severe stable chronic type II respiratory failure due to COPD who were unresponsive to conventional treatments experienced symptomatic hypercapnia when receiving sufficient supplementary oxygen to result in an arterial oxygen saturation (SaO2) of > 90%. They were assessed for treatment with NIPPV, and its effects were observed for over two years using arterial blood gas tensions, spirometric parameters and body mass index (BMI), survival, hospital admissions, use of general practitioner resources, and patient satisfaction. RESULTS: Hospital admissions and GP consultations were halved after one year compared with the year before NIPPV and there was a sustained improvement in arterial blood gas tensions at 12 and 24 months when breathing air, despite progressive deterioration in ventilatory function. BMI did not change during the period of observation. The median survival was 920 days, with no patient dying within the first 500 days. CONCLUSIONS: Domiciliary NIPPV results in improvements in arterial blood gas tensions which are sustained after two years of treatment and reduces both hospital admissions and general practitioner visits by patients with severe COPD in hypercapnoeic respiratory failure. It is well tolerated and, although there was no control group, survival appears to be prolonged when these results are compared with those of the NOTT and MRC (LTOT) trials.

Aged↗
PubMedDate not supplied

Tuberculosis in the elderly.

Tuberculosis is still a major cause of morbidity and mortality worldwide. Recent studies have suggested that even in the developed world its incidence in the elderly is increasing. Symptoms of active tuberculosis are non-specific and less pronounced in the elderly. Radiological features are more likely to be 'atypical' in the older subject and skin tests more frequently negative. This results in delay in diagnosis and higher mortality from tuberculosis in the aged population. A high degree of clinical suspicion is therefore required to ensure the diagnosis is not missed and appropriate treatment instigated.

Aged↗
PubMedDate not supplied

Black bronchoscopy.

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Aged↗
PubMedDate not supplied

Streetwise but clinic-shy.

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Acquired Immunodeficiency Syndrome↗