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Biomedical subjects

F Shann

Publications and source records attributed to F Shann.

At least 55 records · Page 3Linked to original sources
PubMed1996

Comparison of rectal, axillary, and forehead temperatures.

OBJECTIVE: To assess whether axillary and forehead temperatures accurately reflect the rectal temperature (the criterion standard) DESIGN: Prospective study with calculation of paired axillary-rectal and forehead-rectal temperature differences and their SDs. SETTING: Referral hospital. PARTICIPANTS: Convenience sample of 120 patients, with 20 patients in each of six age groups (ie, < 1 month, 1 to 5 months, 6 to 11 months, 12 to 23 months, 2 to 14 years, and adults) RESULTS: In newborns, the rectal temperature was equal to the axillary temperature plus 0.2 degrees C for each week of age up to 5 weeks; forehead strip thermometers gave inaccurate readings in this age group. In patients older than 1 month, the mean difference (SD) between the rectal and axillary temperatures was 1.04 degrees C (0.45 degrees C); thus the axillary temperature was adjusted by adding 1 degree C, and no adjusted axillary temperature differed from the rectal temperature by more than 1 degree C. The mean difference (SD) between the forehead temperature that was measured by the best forehead liquid crystal strip thermometer (FeverScan) and the rectal temperature was 0.14 degrees C (0.60 degrees C); 10 forehead temperatures differed from the rectal temperature by more than 1 degree C. CONCLUSIONS: Previous studies that have suggested that axillary and forehead temperatures do not provide a reliable guide to the rectal temperature have all used inappropriate methods of analysis (correlation coefficients or sensitivity and specificity); previous studies that have based their conclusions on the correct method of analysis (paired differences and their SDs) have all found that the axillary temperature gives a good indication of the rectal temperature. The axillary temperature can be measured safely at any age, and the axillary temperature plus 1 degree C is a good guide to the rectal temperature in patients older than 1 month. Forehead strip thermometers are easy to use, but they do not estimate the rectal temperature as accurately as the axillary temperature does.

Adolescent↗
PubMed1995

The management of pneumonia in children in developing countries.

Pneumonia kills about 3 million children every year in developing countries, and it is now clear that most fatal pneumonia is caused by Haemophilus influenzae or Streptococcus pneumoniae. To reduce mortality associated with pneumonia, the World Health Organization has developed guidelines for the treatment of children in developing countries who have cough or difficulty breathing: children without tachypnea or chest indrawing do not need antibiotic therapy; children with tachypnea but no chest indrawing should have antibiotic therapy at home; and children with chest indrawing should be admitted to the hospital for intramuscular injections of benzylpenicillin or chloramphenicol. Universal application of these guidelines would save the lives of approximately 600,000 children every year. Other important issues are oxygen therapy, fluid restriction, limitation of the use of acetaminophen, pneumonia in neonates, and the emergence of antibiotic resistance. There is an urgent need for vaccines that protect infants against infection with S. pneumoniae and all strains of H. influenzae, including nonserotypeable strains.

Acetaminophen↗
PubMed1993

Cerebral herniation during bacterial meningitis in children.

OBJECTIVE: To see whether the incidence of cerebral herniation is increased immediately after lumbar puncture in children with bacterial meningitis and whether any children with herniation have normal results on cranial computed tomography. DESIGN: Retrospective review of case notes; computed tomograms were read again. SETTING: Large paediatric teaching hospital. SUBJECTS: 445 children over 30 days old admitted to hospital with bacterial meningitis. MAIN OUTCOME MEASURES: Timing of herniation in relation to lumbar puncture; findings on computed tomography in children with herniation. RESULTS: Cerebral herniation was detected in 19 (4.3%) of the 445 children (21 episodes; herniation occurred twice in two children). Herniation occurred in 14 (45%) of the 31 children who died. Nineteen episodes of herniation occurred in the 17 children who had a lumbar puncture; 12 of the episodes occurred in the first 12 hours after the lumbar puncture and seven over six other 12 hour periods (odds ratio 32.6 (95% confidence interval 8.5 to 117.3); p < 0.001). The results of cranial computed tomography were normal in five (36%) of the 14 episodes of herniation in which scanning was performed at about the time of herniation. CONCLUSIONS: The temporal relation between lumbar puncture and herniation strongly suggests that a lumbar puncture may cause herniation in some patients, and normal results on computed tomography do not mean that it is safe to do a lumbar puncture in a child with bacterial meningitis.

Adolescent↗
PubMed1992

A review of therapeutic monitoring of chloramphenicol in patients with Haemophilus influenzae meningitis.

Two hundred and seventy-seven serum chloramphenicol concentrations in 90 patients with Haemophilus influenzae type b meningitis were analysed retrospectively. Most patients were given chloramphenicol 25 mg/kg 6 hourly initially. Chloramphenicol concentrations were categorized as pre-dose ('trough') or post-dose ('peak'). Twenty-six per cent of the results were in the potentially toxic range (above 30 mg/L), and 18% were below 10 mg/L. Analysis of 46 pre- and post-dose measurements showed that for the intravenous (i.v.) route of administration, 23% of the pre-dose concentrations were higher than the corresponding post-dose levels and, for the oral route, 42% of the pre-dose levels were higher. Multivariate analysis of covariance demonstrated that chloramphenicol concentrations decreased significantly with increasing number of days of treatment and that the decline was steeper with i.v. administration. The results of this study emphasize the need for therapeutic monitoring of chloramphenicol concentrations, and suggest that chloramphenicol should be given as a loading dose of 40 mg/kg, followed by 25 mg/kg per dose 8 hourly for 3-4 days and then 6 hourly.

Administration, Oral↗
PubMed1992

ECMO in newborn infants: the Melbourne experience.

At the Royal Children's Hospital, Melbourne, extracorporeal membrane oxygenation (ECMO) has been used in the treatment of newborn infants with life-threatening respiratory or cardiac failure since May 1989. The main indications for the use of ECMO are that the disease is reversible, the surviving infant is likely to be normal and there is an 80% likelihood of death without ECMO. Sixteen of 22 (73%) newborn infants have survived at least 6 months after ECMO. Fourteen of 16 (87.5%) infants receiving ECMO (who did not have a congenital diaphragmatic hernia) were functionally normal survivors; the other two infants died. Two of six infants with congenital diaphragmatic hernia who received ECMO were discharged and survived to have normal neurological and respiratory function at 6 month follow up. These results are similar to results from other centres internationally. It would appear that ECMO is a useful therapy for near-term newborn infants with otherwise fatal cardiorespiratory failure.

Australia↗