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Biomedical subjects

D Ingram

Publications and source records attributed to D Ingram.

At least 73 records · Page 4Linked to original sources
PubMed1986

Effect of whooping cough in infancy on subsequent lung function and bronchial reactivity.

Thirty-six children younger than 1 yr of age hospitalized for whooping cough approximately 9 yr previously (cases) were compared with 36 control children of the same age and sex. Subjects were sampled from participants in an earlier large field study of the long-term sequelae of whooping cough. Respiratory symptoms were more common in cases, although the differences were not statistically significant. Cases were significantly more likely either to be atopic or to have a family history of wheezing illness. There were no significant differences between cases and control subjects in lung function indices derived from maximal expiratory flow volume loops or from single-breath nitrogen washout tests or in bronchial reactivity as judged by the histamine challenge PC20. The evidence from both the present and the earlier study indicates that whooping cough is unlikely to be a causal factor in later respiratory illnesses and symptoms and that no deficit in lung function can be detected in later childhood. The disease may, however, occur more frequently or be more easily recognized in children with environmental or constitutional factors that predispose to respiratory morbidity.

Asthma↗
PubMed1985

The pharmacokinetics and dynamics of oxprenolol: a simulation study with six subjects.

Experimental results of plasma concentration determinations and lowering of exercise heart rate for six subjects taking a conventional tablet and a sustained release preparation of oxprenolol have been analysed by a comprehensive computer simulation model. Individual plasma values were simulated using a lest squares procedure and the results were applied to evaluate individual release patterns following dosage with the sustained release preparation. Application of the model to the lowering of exercise heart rate indicated that the response is in a steady state with the plasma values and that the response-concentration relation is of the saturable, Emax, type. The parameters for this were evaluated for each subject for the results after a dose of a conventional tablet. These parameters were applicable to the results after dosage with a sustained release preparation. The method should be applicable to other sustained release preparations.

Adult↗
PubMed1984

Computer simulation to predict patient responses to alterations in the ventilation regime.

We have developed a technique for simulating artificially ventilated patients using a computer model of the respiratory system and have investigated its ability to predict the patient's response to alterations in the ventilation regime. The majority of those studied were in a stable condition following cardiac surgery. Predictions for PaO2 showed a reasonable correlation with measured values (r = 0.94), although individual predictions could differ appreciably (SEE = +/- 17.3 mmHg). Predictions for PaCO2 correlated less well (r = 0.89, SEE = +/- 2.0 mmHg) and there was a consistent tendency to overestimate this variable. The least accurate predictions were those for PvO2 (r = 0.61, SEE = +/- 3.8 mmHg). Errors in prediction were attributable to deficiencies in the model (most importantly the three-compartment lung and the modelling of CO2 production, storage and excretion), compounded by unpredictable alterations in the patient's physiology (mainly Vo2, Vco2 and Qt). However, allowing for accepted clinical variability and routine measurement accuracy, the predictions are generally reasonable. This suggests that, with some further modifications, computer modelling of this, and other, systems may prove to be a clinically and educationally useful technique.

Adult↗
PubMed1984

Perforated peptic ulcer--a seasonal disease?

All hospital admissions for perforated peptic ulcer in the State of Western Australia from 1971 to 1981 inclusive were used to study the seasonal fluctuation, prevalence and mortality. This represented 1187 admissions. A significant seasonal peak was found during November, December and January. There was a marked reduction in admissions in the last three years, i.e. 1979-81, representing a 35% drop from previous levels. The overall mortality was 6.6%, but was 1.8% in patients less than 65 years, and 17.3% in patients 65 years or older.

Aged↗
PubMed1983

The use of computerized learning in intensive care: an evaluation of a new teaching program.

A computer-assisted learning program in respiratory intensive care was introduced into the undergraduate curriculum at University College Hospital. Educational effectiveness was assessed. This method of learning was found to be highly acceptable to students. The improvement in students knowledge of the subject was up to three times greater in those who used the computer program, than a control group of students who received only teaching by conventional means, (P = 0 X 016). The results of a questionnaire designed to elicit students' attitudes to this learning experience are discussed.

Anesthesiology↗
PubMed1982

Acute pancreatitis in identical twins.

Identical twins, 34-years-old at the time, developed abdominal pain of similar character while at a holiday resort. Both had drunk a greater amount of alcohol than usual, approximately eight 200-mL glasses of beer. The symptoms in one twin forced him to present to hospital where his plasma amylase level was found to be 2300 u/L. The other had the same symptoms, but did not present to hospital; however, when the symptoms later recurred, he also was found to have pancreatitis. Acute pancreatitis occurring simultaneously in identical twins has been reported only on one previous occasion.

Acute Disease↗
PubMed1982

Self-instruction and assessment in techniques of intensive care using a computer model of the respiratory system.

There are considerable logistical difficulties involved in providing an adequate training programme for each new doctor when starting intensive care. One solution is to use an interactive computer terminal and provide programmes for self-instruction and assessment. Using a computer model of the respiratory system linked to a computer-assisted instructional driver we have developed instructional exercises on the management of artificial ventilation and the treatment of respiratory failure. Each teaching session contains explanatory text, multiple choice questions and model simulations. The student can interact with the simulations, appropriate assistance being provided when required, while his answers are marked and assessed with further explanation when necessary. The use of computer models adds a new dimension to computer-assisted learning techniques and is particularly applicable to intensive care medicine.

Computer-Assisted Instruction↗
PubMed1981

Heterogeneity of the rabbit collecting tubule: localization of mineralocorticoid hormone action to the cortical portion.

This study was designed to examine the sodium, potassium, and chloride transport rates across the cortical and outer medullary collecting tubule and to localize the action of mineralocorticoid hormone. Rabbit collecting tubules were dissected from the cortex (CCT), the outer stripe of the outer medulla (OMCT0), or the inner stripe of the outer medulla (OMCTi). From normal rabbits, the transepithelial voltage was -20.8 +/- 2.7 mV in CCT, -4.2 +/- 1.4 mV in OMCT0, and +10.6 +/- 2.3 mV in OMCTi. From DOCA-treated rabbits, only the CCT voltage was different (-42.9 mV). Net sodium absorption across the CCT increased ith DOCA-treatment from 23 +/- 5 to 54 +/- 8 pEq . mm-1 . min-1, whereas net potassium secretion increased from 15 +/- 2 to 43 +/- 5 pEq . min-1 . min-1. Net chloride absorption was significant only in DOCA-treated rabbits. The OMCTi, in contrast, displayed no net transport of sodium, potassium, or chloride and had a lower rate coefficient for sodium efflux than did the CCT. DOCA treatment had no effect on any transport rate measured in this segment. The OMCT0 has small potassium secretion, which did not increase with DOCA treatment. The collecting tubule is heterogeneous along its length with respect to ion transport. Mineralocorticoid-hormone-sensitive sodium absorption is present predominantly, if not exclusively, in the cortical collecting tubule.

Animals↗
PubMed1980

An evaluation of the clinical potential of a comprehensive model of human respiration in artificially ventilated patients.

1. We have investigated the feasibility of accurately simulating the respiratory function of artificially ventilated patients, using a computer model of the respiratory system. Twelve patients artificially ventilated after uncomplicated cardiac bypass surgery was studied. 2. The basic information required to simulate individual ventilated subjects was measured or derived. A program was written to enable key model parameters to be adjusted automatically to match model predictions to these clinical measurements. On completion of this matching procedure all the variables computed by the model were compared with patient values (measured or derived) and their accuracy was assessed. 3. The matching algorithm successfully optimized parameters of the model representing metabolic activity, tissue respiratory quotient, venous admixture, physiological dead space and total body bicarbonate to match measured values for oxygen consumption, carbon dioxide production, Pa, O2, PaCO2, and arterial HCO3- respectively. Other variables compared arise from the solution of equations within the model and correlation between model and patient values is generally good (r greater than 0.9). However, values of Pv-, O2 correlate less well (r = 0.85). Factors affecting the accuracy of patient simulation are discussed and some deficiencies analysed. 4. The creation of an accurate, steady-state representation of a patient by the model opens up the possibility of using it interactively as an aid to clinical management. Some possible future developments of the technique are discussed.

Blood↗
PubMed1980

'MacDope': a simulation of drug disposition in the human body: applications in clinical pharmacokinetics.

1 We have described a novel approach to absorption, distribution, metabolism and elimination of drugs in which the patient is described using 23 Patient Factors and drugs by up to 50 Drug Factors. Kinetic behavior of a drug results from the interaction of patient and drug factors according to equations describing an eight compartment model. In this model non-linear processes (protein binding, hepatic drug metabolism and renal tubular transport) are handled by derivations of the law of mass action which have been generalised to permit the consequences of multiple drugs interacting at single macromolecular sites to be correctly calculated. 2 The mathematical description of this model is provided in a companion paper and solution of the equations is only possible using a digital computer. The computer programme is provided with an interactional format which makes operation independent of mathematical skills. Patients are defined by age, sex, height and weight with, or without, organ dysfunction; the programme then generates appropriate factors. Drug enters the system when a prescription is type on the keyboard and required Drug Factors are then retrieved from the disc flies. Drug concentrations in plasma or body fluids are given as simple graphs as a function of time, or in tabular form. 3 Any of the Patient or Drug Factors may be altered before, or during a run and up to three drugs may be simulated at one time thus permitting certain kinetic interactions to be examined. The scope of the simulator is illustrated using aspirin: pH dependent gastric absorption, first-order conversion of aspirin to salicylate, partly first order and partly saturable hepatic metabolism of salicylate, and the complex renal handling of this drug are all represented. Interaction of phenytoin with salicylate has been examined quantitatively to suggest limited clinical relevance for the observed displacement of phenytoin from serum albumin. The use of the simulator in a short course of pharmacokinetics is briefly described.

Aspirin↗
PubMed1980

Controlled trial of intermittent aerosol therapy with sodium 2-mercaptoethane sulphonate in cystic fibrosis.

Twenty-seven patients with cystic fibrosis completed a controlled trial comparing the effects of an inhaled mucolytic drug, sodium-2-mercaptoethane sulphonate (Mistabron, UCB Pharmaceutical Division, Brussels, Belgium), with inhaled iso-osmolar hypertonic saline. As a group the 22 patients with chronic sputum production showed small but statistically significant improvement in pulmonary function tests after Mistabron therapy, both when compared with a control period, and with iso-osmolar saline results. Subjective measurements by diary card failed to show any changes. No significant changes were found in five patients with no measurable sputum production. The inhalations were given after physiotherapy and were well tolerated. There were no significant side effects. The results suggest that Mistabron has a beneficial therapeutic effect unrelated to its high osmolality, and the intermittent inhalation of Mistabron may have a role in the treatment of selected patients with cystic fibrosis.

Adolescent↗
PubMed1979

Inversion of subject NP and Aux in children's questions.

Bellugi has proposed a stage of language acquisition in which children invert subject NP and Aux in yes-no but not wh questions. It was proposed that this stage would be found in a sampling of questions from young children. Cross-sectional samples of questions were collected from young children between 2:0 and 3:11. The results did not bear out this expectation. Based on percentages of inversion, none showed this stage. The results are discussed in terms of the importance of frequency in determining stages of acquisition and the use of children's data as psychological evidence for linguistic rules.

Child, Preschool↗