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Biomedical subjects

H R Anderson

Publications and source records attributed to H R Anderson.

At least 163 records · Page 9Linked to original sources
PubMed1983

Pulmonary function in mechanically-ventilated patients during 24-hour use of a hygroscopic condensor humidifier.

Hygroscopic condensor humidifiers (HCH) are reportedly capable of humidifying even the driest of ventilator source gases with at least 30 mg H2O/liter of ventilation. To assess the adequacy of the HCH during mechanical ventilation, we studied 26 patients over a 72-hour period (alternating 24-hour periods of humidification by a conventional cascade and the HCH). In these patients, we found no significant difference in static lung compliance, airway resistance, PaO2, and PaCO2 on either system. Additionally, estimates of sputum volume (over a four-hour collection period) and clearance of aerosolized 99mTc labelled DTPA (in five of these patients) also showed no significant differences between the two systems. We conclude that the HCH is capable of supplying necessary heat and moisture to most mechanically-ventilated patients for at least a period of 24 hours.

Adult↗
PubMed1983

Decision-making in acute asthma.

The management of an eight-year-old child with acute asthma was investigated by putting a semi-structured patient management problem (PMP) to 618 general practitioners. Of the 321 (52 per cent) who replied, 112 (35 per cent) would arrange for immediate admission to hospital and a further 154 (48 per cent) would have the child admitted after 30 minutes when initial home treatment appeared not to be working. Among those who would treat at home there was considerable variation in the type and intensity of treatment given. The more recently qualified were more likely to admit immediately or to treat vigorously at home (with intravenous steroids and/or aminophylline); no other characteristic of the doctor or the practice was related to admission decision or to treatment. Expectations concerning the immediate hospital management of the patient also varied widely. Comparison of the expected hospital management with actual management recorded in hospital case-notes suggested that general practitioners overestimate the use of intensive treatments (steroids, intravenous drip, oxygen) and investigations (blood gases, lung function tests, chest radiograph).

Asthma↗
PubMed1982

An investigation of 140 deaths associated with volatile substance abuse in the United Kingdom (1971-1981).

1 In the UK, from 1971 to 81, 140 deaths associated with volatile substance abuse (VSA) were identified from press reports and a variety of other sources. Data about each death were obtained from inquest proceedings, post-mortem and toxicological reports, and death certificates. 2 Based on the year 1981, in which 39 deaths occurred, VSA deaths accounted for over 1% of deaths from all causes, and nearly 2% of deaths from injury and poisoning in males aged 10-19 years. 3 The median age was 16.8 years (range 11-63), and 79% were under age 20. The male to female ratio was 13:1. 4 Death rates were highest in conurbations, and in Scotland, Northern Ireland and Northern England. Deaths tended to be more frequent among manual social classes but this association was not marked. 5 The chief substances were butane (28%), solvents in adhesives (23%), other solvents (26%), aerosols (15%) and fire extinguishing agent (5%). Solvents in adhesives were more important with increasing age. 6 Most deaths occurred alone, at home. In about 41% of cases, death appeared to be only indirectly associated with VSA (trauma 8%, plastic bag over head 19%, and inhalation of stomach contents 14%). In 49% death was attributed to the direct toxic effects of the substance; this proportion was highest with aerosols and lowest with solvents in adhesives. 7 The implications of these findings for prevention, monitoring and research are discussed.

Age Factors↗
PubMed1982

Evaluating health education in asthma -- developing the methodology: preliminary communication.

The results are reported of a preliminary study to a controlled trial evaluating health education in asthma. A questionnaire designed to assess asthma morbidity in the previous twelve months and knowledge of the condition was administered to 50 asthma patients. An independent assessment of morbidity was made by the patient's general practitioners, utilizing case notes and their knowledge of the patients. For each aspect of morbidity, `severe' asthma as assessed by doctors tended to be associated with increasing disability on questionnaire assessment. Overall, questionnaire `morbidity scores' were significantly higher in the doctors' `severe' group. Patients' level of knowledge was low, but no significant correlation was found between patients' level of knowledge and level of morbidity.The findings suggest that there is a need for health education in asthma, and that the questionnaire used is a valid tool for measuring the impact of such education on patients' morbidity. An outline of the controlled trial for evaluation of health education is given.

Activities of Daily Living↗
PubMed1980

Trends in the hospital care of acute childhood asthma 1970-8: a regional study.

In the South-west Thames Region over the period 1970-8 the number of admissions for asthma in children aged 5-14 years increased from 256 to 684, an increase of 167%. Factors associated with this trend were investigated by an analysis of routine hospital statistics and examination of case notes for 1970 and 1978 from every hospital in the region. The trend was caused partly by an increase in readmission rates. There was a more than fivefold increase in self-referrals; these patients had less severe asthma on admission and a higher readmission rate than patients referred by general practitioners. Drug management before and after admission changed considerably over the nine years, as did hospital investigations. Overall, there was little change in the level of severity on admission. The increase in admissions was not associated with a reduction in deaths from asthma in the region and occurred in spite of major advances in the drug control of asthma; this indicates an inadequacy of ambulatory care. The shift in the balance of care towards the hospital and the increasing adoption of a primary care function by the hospital indicate a need for hospitals and general practice to agree jointly on management policies for acute asthma.

Acute Disease↗
PubMed1980

Efficacy of transfusion therapy for one to two years in patients with sickle cell disease and cerebrovascular accidents.

Since 1974 we have entered 12 children with sickle cell disease and strokes on a transfusion protocol to maintain hemoglobin S less than 20%. Serial arteriography, EEGs, brain or CT scans, and neuropsychologic testing were also obtained. Transfusion has been stopped in ten patients after one to two years. Seven of these ten patients have had second strokes five weeks to 11 months after cessation of transfusion (median three months). Arteriography was normal at the time of the initial stroke in two patients; one of these had a second stroke. Arteriograms did not improve during transfusion therapy. EEGs and brain and CT scans were occasionally useful at the time of the initial stroke but were of little value in following these patients. Neuropsychologic testing indicated severe impairment of sensory-motor and cognitive processes at the time of the initial stroke and was useful in following improvement or deterioration and in designing remedial education programs. We conclude that short-term transfusion therapy will not prevent second strokes once transfusion is stopped and that arteriography is of limited value in these patients.

Anemia, Sickle Cell↗
PubMed1980

Distractibility and memory deficits in long-term survivors of acute lymphoblastic leukemia.

A comprehensive neuropsychological test battery was administered to 37 long-term survivors of acute lymphoblastic leukemia and 18 newly diagnosed acute lymphoblastic leukemia patients in an attempt to identify patterns of neuropsychological performance. Newly diagnosed patients between 7 and 15 years of age generally obtained scores within normal limits. On most measures of intelligence long-term survivors within the same age range obtained mean test scores approximately 1 standard deviation below the population mean. Fourteen of 30 long-term survivors under 16 years of age exhibited a pattern of test scores suggestive of memory deficits and distractibility which may have interfered with academic achievement. Only one patient over 8 years of age at diagnosis produced a similar pattern of scores. We conclude that young children treated for acute lymphoblastic leukemia are at risk for the development of neuropsychological dysfunction and that appropriate programs for identification and academic remediation should be instituted.

Adolescent↗
PubMed1979

Respiratory abnormalities, smoking habits and ventilatory capacity in a highland community in Papua New Guinea: prevalence and effect on mortality.

The prevalence of chronic lung disease was investigated in 1284 adult residents of 11 villages situated at 1800 m in the Highlands of Papua New Guinea. Chronic cough, shortness of breath on exertion, bronchial hypersecretion, and adventitious chest sounds were increasingly common in both sexes from middle life onwards, and were associated with an irreversible obstructive ventilatory defect. Over the age of 45 years, 20% of men and 10% of women had an FEV1/FVC % less than 60%. The prevalence of active asthma was 0.25%. The smoking of home-grown, air-cured tobacco was not associated with chronic respiratory symptoms or reduction of ventilatory capacity. Smoking was, however, associated with recent cough symptom, bronchial hypersecretion and adventitiae. Mortality over the subsequent 5 years was increased 2--3 fold in those with adventitiae, but was not related to smoking status. The aetiological relevance of wood smoke in the houses and acute chest infections remains to be clarified.

Adolescent↗
PubMed1979

Chronic lung disease in the Papua New Guinea Highlands.

In the Eastern Highlands of Papua New Guinea 46 men and 24 women with chronic lung disease underwent clinical and lung function investigations. In all cases the sole or predominant abnormality was irreversible airways obstruction, probably from chronic bronchitis with variable amounts of acompanying emphysema. There were close similarities to chronic obstructife lung disease in European populations in terms of symptoms, airways obstruction, transfer factor, and radiographic emphysema and inflammatory changes. Bronchiectasis and local fibrosis were present in a few subjects, but previous reports that pulmonary and pleural fibrosis are features of the disease were not confirmed. Possibly environmental and genetic factors may increase the associated blood gas disturbances leading to pulmonary hypertension. Unlike chronic obstructive lung disease in European populations, tobacco smoking is not an important aetiological factor. Although there is no direct evidence, the most likely possibilities are domestic wood smoke and acute chest infections.

Adult↗
PubMed1978

Variations in the lung size of children in Papua New Guinea: genetic and environmental factors.

In Papua New Guinea, rural village children of both sexes living in the highlands (1500--2000 m) were found to have mean values of forced vital capacity 27 per cent greater than children at sea level. Urban children with an apparently lower level of habitual activity had a lung size similar to that of rural children living at the same altitude. In a number of healthy children of coastal parents reared in the highlands and of highland parents reared on the coast, the size of the lung was, in general, appropriate for the altitude rather than for the parentage. These findings suggest that the highland--coastal difference is probably environmental rather than genetic in origin.

Adolescent↗
PubMed1978

Increase in hospitalisation for childhood asthma.

Asthma admissions among children under 15 years of age have increased nearly three-fold over the period 1959-73. The possible reasons for this increase have been examined using available data supplemented by the results of a special study of hospital disease indexes and case notes. Changes in diagnostic coding and trends in diagnostic fashion do not appear to be important. Part of the increase may be due to an increase in readmission rates. Changes in admission criteria resulting from changes in therapy, organisation of care, and illness behaviour have been considered. However, on present evidence an increase in morbidity cannot be excluded, and this could be investigated by repeat prevalence surveys of schoolchildren. If morbidity remains unchanged, admission policies for children with asthma should be reviewed.

Adolescent↗