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Biomedical subjects

I Roberts

Publications and source records attributed to I Roberts.

At least 145 records · Page 8Linked to original sources
PubMed1998

Prophylactic antiepileptic agents after head injury: a systematic review.

OBJECTIVE: To determine the effectiveness and safety of prophylactic antiepileptic agents in the management of acute traumatic head injury. METHODS: Systematic review of randomised controlled trials identified using MEDLINE, EMBASE, CINAHL, Dewent Biotechnology abstracts, and specialised databases of randomised controlled trials, by searching reference lists and contacting investigators. RESULTS: Ten eligible randomised controlled trials were identified, including 2036 patients. The pooled relative risk (RR) for early seizure prevention was 0.34 (95% confidence interval (95%CI) 0.21-0.54); based on this estimate, for every 100 patients treated, 10 would be kept seizure free in the first week. Seizure control in the acute phase was not accompanied by a reduction in mortality (RR=1.15; 95% CI 0.89-1.51), a reduction in death and neurological disability (RR=1.49; 95% CI 1.06-2.08 for carbamazepine and RR=0.96; 95% CI 0.72-1.26 for phenytoin) or a reduction in late seizures (pooled RR=1.28; 95% CI 0.90-1.81). The pooled relative risk for skin rashes was 1.57 (95% CI 0.90-2.75). CONCLUSIONS: Prophylactic antiepileptic drugs are effective in reducing early seizures, but there is no evidence that treatment with such drugs reduces the occurrence of late seizures, or has any effect on death and neurological disability. Insufficient evidence is available to establish the net benefit of prophylactic treatment at any time after injury.

Acute Disease↗
PubMed1998

Absence of evidence for the effectiveness of five interventions routinely used in the intensive care management of severe head injury: a systematic review.

OBJECTIVES: To assess the effectiveness of interventions routinely used in the intensive care management of severe head injury, specifically, the effectiveness of hyperventilation, mannitol, CSF drainage, barbiturates, and corticosteroids. METHODS: Systematic review of all unconfounded randomised trials, published or unpublished, that were available by August 1996. RESULTS: None of the interventions has been reliably shown to reduce death or disability after severe head injury. One trial of hyperventilation was identified of 77 participants. The relative risk for death was 0.73 (95% confidence interval (95% CI) 0.36-1.49), and for death or disability it was 1.14 (95% CI 0.82-1.58). One trial of mannitol was identified of 41 participants. The relative risk for death was 1.75 (95% CI 0.48-6.38), no data were available for disability. No randomised trials of CSF drainage were identified. Two randomised trials of barbiturate therapy were identified, including 126 participants. The pooled relative risk for death was 1.12 (95% CI 0.81-1.54). Disability data were available for one trial. The relative risk for death or disability was 0.96 (95% CI 0.62-1.49). Thirteen randomised trials of corticosteroids were identified, comprising 2073 participants. The pooled relative risk for death was 0.95 (0.84 to 1.07) and for death or disability it was 1.01 (95% CI 0.91 to 1.11). On the basis of the currently available randomised evidence, for every intervention studied it is impossible to refute either a moderate increase or a moderate decrease in the risk of death or disability. CONCLUSION: Existing trials have been too small to support or refute the existence of a real benefit from using hyperventilation, mannitol, CSF drainage, barbiturates, or corticosteroids. Further large scale randomised trials of these interventions are required.

Adrenal Cortex Hormones↗
PubMed1998

Measurement of cerebral blood flow in newborn infants using near infrared spectroscopy with indocyanine green.

Cerebral blood flow (CBF) measurement by near infrared spectroscopy (NIRS) using oxyhemoglobin (HbO2) as a tracer (CBF-HbO2) needs rapid changes in arterial oxygen saturation (SaO2) which often cannot be achieved in many sick infants. An alternative method based on the same adaptation of the Fick principle using i.v. injection of the dye indocyanine green (ICG) is described (CBF-ICG). Six mechanically ventilated infants (age 26-38 wk, birth weight 0.885-3.730 kg) requiring supplementary oxygen therapy were studied within 72 h of birth. For CBF-ICG measurements, ICG (0.1 mg x kg-1 was injected via an umbilical venous catheter, and blood ICG concentration was measured by an optical umbilical artery catheter and brain ICG concentration was measured by NIRS. For CBF-HbO2 measurements the inspired oxygen concentration was rapidly increased, blood HbO2 concentration was calculated from SaO2 measured by pulse oximetry, and brain HbO2 concentration was measured by NIRS. A series of CBF measurements were performed using each method before and after altering the arterial carbon dioxide tension (PaCO2). Mean CBF values from repeated measurements by each method at any given PaCO2 were used to compare the methods. The SD of single measurements within an individual subject by CBF-ICG was 15%, and by CBF-HbO2, 24%. The relationship between the methods was mean CBF-ICG = (1.13 x mean CBF-HbO2) - 2.76 mL x 100 g-1 x min-1 HbO2 (r = 0.93, p < 0.001). The mean difference between the methods (CBF-ICG - CBF-HbO2) was -0.25 mL x 100 g-1 x min-1 (95% confidence interval 6.30 to -6.80). The methods were in good agreement, and the use of i.v. ICG permitted rapid and repeated CBF measurements in the sickest infants at greatest risk of cerebral injury.

Brain↗
PubMed1998

Children's exposure to traffic and pedestrian injuries.

OBJECTIVES: The purpose of this study was to estimate children's exposure to traffic (number of streets crossed) and to determine the role of exposure in pedestrian injury. METHODS: Questionnaires were distributed to a random sample of 4080 first- and fourth-grade children in 43 Montreal schools. RESULTS: When analyzed by police district, injury and exposure rates were positively correlated (r2 = 0.53). Crossings were similar by sex but increased with age and were inversely related to socioeconomic status. CONCLUSIONS: These results suggest that although children's exposure to traffic could be reduced by transporting them to school, a more reasonable prevention strategy involves environmental changes.

Accidents, Traffic↗
PubMed1998

Cord blood transplantation (CBT) in hemoglobinopathies. Eurocord.

Patients with beta-thalassemia (Hbeta th) and sickle cell anemia (SCA) can be treated with bone marrow transplantation. Stem cells from cord blood have several theoretical advantages, however, the place of cord blood transplant for hemoglobinopathies has not yet been established. We report here the EUROCORD experience of 10 patients (Hbeta th = 7, SCA = 3) transplanted with related cord blood.

Anemia, Sickle Cell↗
PubMed1997

Corticosteroids in acute traumatic brain injury: systematic review of randomised controlled trials.

OBJECTIVE: To quantify the effectiveness and safety of corticosteroids in the treatment of acute traumatic brain injury. DESIGN: Systematic review of randomised controlled trials of corticosteroids in acute traumatic brain injury. Summary odds ratios were estimated as an inverse variance weighted average of the odds ratios for each study. SETTING: Randomised trials available by March 1996. SUBJECTS: The included trials with outcome data comprised 2073 randomised participants. RESULTS: The effect of corticosteroids on the risk of death was reported in 13 included trials. The pooled odds ratio for the 13 trials was 0.91 (95% confidence interval 0.74 to 1.12). Pooled absolute risk reduction was 1.8% (-2.5% to 5.7%). For the 10 trials that reported death or disability the pooled odds ratio was 0.90 (0.72 to 1.11). For infections of any type the pooled odds ratio was 0.92 (0.69 to 1.23) and for the seven trials reporting gastrointestinal bleeding it was 1.05 (0.44 to 2.52). With only those trials with the best quality of concealment of allocation, the pooled odds ratio estimates for death and death or disability became closer to unity. CONCLUSIONS: This systematic review of randomised controlled trials of corticosteroids in acute traumatic brain injury shows that there remains considerable uncertainty over their effects. Neither moderate benefits nor moderate harmful effects can be excluded. The widely practicable nature of the drugs and the importance of the health problem suggest that large simple trials are feasible and worth while to establish whether there are any benefits from use of corticosteroids in this setting.

Acute Disease↗
PubMed1997

Influence of changing travel patterns on child death rates from injury: trend analysis.

OBJECTIVES: To examine trends in child mortality from unintentional injury between 1985 and 1992 and to find how changes in modes of travel contributed to these trends. DESIGN: Poisson regression modelling using data from death certificates, censuses, and national travel surveys. SETTING: England and Wales. SUBJECTS: Resident children aged 0-14. MAIN OUTCOME MEASURES: Deaths from unintentional injury and poisoning. RESULTS: Child deaths from injury declined by 34% (95% confidence interval 28% to 40%) per 100,000 population between 1985 and 1992. Substantial decreases in each of the leading causes of death from injury contributed to this overall decline. On average, children walked and cycled less distance and travelled substantially more miles by car in 1992 compared with 1985. Deaths from road traffic accidents declined for pedestrians by 24% per mile walked and for cyclists by 20% per mile cycled, substantially less than the declines per 100,000 population of 37% and 38% respectively. In contrast, deaths of occupants of motor vehicles declined by 42% per mile travelled by car compared with a 21% decline per 100,000 population. CONCLUSIONS: If trends in child mortality from injury continue the government's target to reduce the rate by 33% by the year 2005 will be achieved. A substantial proportion of the decline in pedestrian traffic and pedal cycling deaths, however, seems to have been achieved at the expense of children's walking and cycling activities. Changes in travel patterns may exact a considerable price in terms of future health problems.

Accidents, Traffic↗
PubMed1997

Children in cars.

Explore the source record for details and available documents.

Accidents, Traffic↗
PubMed1997

Migraine: a risk factor for motor vehicle driver injury?

To test the hypothesis that migraine is associated with motor vehicle driver injury, data collected from 10,529 individuals on personal history of migraine and motor vehicle injury were analysed cross-sectionally. In multiple logistic regression analyses, the adjusted odds ratio for motor vehicle driver injury associated with migraine was 2.3 [95% confidence interval (CI) 1.9-2.7]. After excluding those who also had a history of head injury, the odds ratio was 1.5 (95% CI: 1.2-2.0). These results suggest that migraine may be associated with a 50% increase in the risk of motor vehicle driver injury and that in this population may account for as many as one in every 20 motor vehicle driver injuries. These findings require confirmation in prospective studies of motor vehicle driver injuries.

Accidents, Traffic↗
PubMed1997

Airway management training using the laryngeal mask airway: a comparison of two different training programmes.

Nurses without prior experience in the use of the laryngeal mask airway (LMA) were randomly allocated to one of two groups to be trained in the emergency technique of insertion of an LMA. Group A (32 nurses) were trained only on a manikin and group B (20 nurses) were trained on a manikin and with live anaesthetised patient practice in theatre (five successful insertions). Without further practice, both groups were asked to insert an LMA in a live patient in theatre 3 months after initial training. Three attempts per nurse were allowed. In group A, 75% passed the LMA successfully at the first attempt, 22% at the second attempt and 3% (one nurse) at the third attempt. In group B, 80% were successful at first attempt and 20% at the second attempt. Skill performance and retention were shown to be high following either training method, with no significant difference between the performance of either group (chi 2). We have shown that manikin-only training in the emergency technique for LMA insertion is as effective as live patient training. It is proposed that manikin training alone may be adopted as a future training modality if, as is expected, the use of the LMA in resuscitation becomes more commonplace.

Cardiopulmonary Resuscitation↗