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Biomedical subjects

I Woods

Publications and source records attributed to I Woods.

14 recordsLinked to original sources
PubMed2001

Cardiovascular optimization for high-risk surgery.

Controversy still exists concerning the strategy of targeting so-called supranormal levels of oxygen delivery as a means of improving outcome from high-risk surgery. The pathogenesis of postoperative morbidity is not fully defined; however, it seems likely that the gastrointestinal tract plays a pivotal role, particularly as a source of endotoxin, which is a potent stimulator of the inflammatory response. Delayed recovery of gastrointestinal function also is a major contributor to postoperative morbidity. Demonstration of a significant reduction in gut ischemia, endotoxemia, postoperative inflammatory response, and morbidity in a high-risk general surgical population as a result of perioperative hemodynamic optimization would be a highly worthwhile study.

Cardiotonic Agents↗
PubMed2000

Perioperative optimisation of fluid management improves outcome.

Mortality from high-risk surgery is close to 10% (20% with emergency). Poor outcome is linked to tissue hypoperfusion. Optimising fluid therapy has a good pathophysiological basis related to microvascular flow to the tissues and the risk of multiple organ failure. Metaanalysis showed the higher the risk of surgery the greater the benefit of fluid and flow optimisation. A direct technique (blood pressure is indirect) to manage fluid therapy measuring tissues perfusions has not yet fulfilled criteria (easiness, accuracy, less invasiveness). At present pulmonary artery catheter with continuous output measurement is the choice. The aim of the study is to assess the impact of fluid management to increase blood flow in high-risk surgical patient.

Fluid Therapy↗
PubMed1999

Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery.

OBJECTIVES: To determine whether preoperative optimisation of oxygen delivery improves outcome after major elective surgery, and to determine whether the inotropes, adrenaline and dopexamine, used to enhance oxygen delivery influence outcome. DESIGN: Randomised controlled trial with double blinding between inotrope groups. SETTING: York District Hospital, England. SUBJECTS: 138 patients undergoing major elective surgery who were at risk of developing postoperative complications either because of the surgery or the presence of coexistent medical conditions. INTERVENTIONS: Patients were randomised into three groups. Two groups received invasive haemodynamic monitoring, fluid, and either adrenaline or dopexamine to increase oxygen delivery. Inotropic support was continued during surgery and for at least 12 hours afterwards. The third group (control) received routine perioperative care. MAIN OUTCOME MEASURES: Hospital mortality and morbidity. RESULTS: Overall, 3/92 (3%) preoptimised patients died compared with 8/46 controls (17%) (P=0.007). There were no differences in mortality between the treatment groups, but 14/46 (30%) patients in the dopexamine group developed complications compared with 24/46 (52%) patients in the adrenaline group (difference 22%, 95% confidence interval 2% to 41%) and 28 patients (61%) in the control group (31%, 11% to 50%). The use of dopexamine was associated with a decreased length of stay in hospital. CONCLUSION: Routine preoperative optimisation of patients undergoing major elective surgery would be a significant and cost effective improvement in perioperative care.

Aged↗
PubMed1995

Post-intensive care interviews: implications for future practice.

The measurement of outcome from intensive care, including the long-term physiological and psychological effects of disease and intensive therapy has tended to receive scanty attention. Little consideration has been given to the implications this may have for the patients, relatives and for future practice. Patients were interviewed in their own homes after 6 months of recovery, to allow freedom of expression and comfort within their own environment (territory). This study demonstrates that data generated by face-to-face interviews can be of immense importance to intensivists in assessing the effectiveness of services and promoting changes in clinical practice. It also shows a need for a long-term follow-up service encompassing community and hospital.

Adolescent↗
PubMed1994

Intravenous sedation in accident and emergency departments: a nationwide survey.

Anonymous questionnaires regarding the practice of intravenous sedation were sent to all accident and emergency departments in England and Wales. The response rate was 63%. Intravenous sedation was used by 94% of the departments who replied. In 19% of these departments it was administered only by middle grade or senior grade clinicians, while in the remaining 81% sedation was also administered by junior grade clinicians. Diazepam, midazolam and opioids were the most commonly used agents. The use of monitoring was variable. In 16% of the units no monitoring was used routinely. ECG monitoring was carried out by 48% of the departments, non-invasive blood pressure monitoring by 67% and pulse oximetry by 65%. Our findings indicate there is a need for guidelines regarding patient selection, the choice of drugs and the monitoring of patients.

Analgesics, Opioid↗
PubMed1990

Validity and reproducibility of a screening examination for neurological abnormality in persons exposed to methylmercury.

The validity and reliability of methods of screening for neurologic abnormality were assessed as part of an investigation of an outbreak of methylmercury exposure in two northern Canadian communities. Four hundred and forty-five Cree Indians were examined by one of five neurologists in a complete neurologic examination and by a trained paramedical observer in a short screening examination which included a selection of tests from the complete examination. The screening examinations were recorded on videotape and those for 176 men were reviewed by the five neurologists and the paramedical observer 1 year after the field studies. The prevalence of abnormality assessed in the field screening examination was greater than that assessed during the complete neurologic examination, for neurologic features included in both examinations. However, agreement between examinations in identifying individuals with abnormality was poor with the sensitivity of the screening examination falling under 50% for half of the neurologic features examined. In contrast, specificity was over 80% for 14 of 18 features. Review of the videotapes revealed marked interobserver variation in the assessment of the prevalence of neurologic abnormality and poor agreement with the neurologic examinations in the identification of abnormality in individuals, with kappa less than 0.2 for most neurologic features. The levels of agreement between the neurologic examinations and the screening examinations conducted in the field and by videotape review suggest that neither screening examination provides equivalent information in the identification of the presence of abnormality to that obtained in the neurologic examination.

Female↗
PubMed1987

Danger of using core/peripheral temperature gradient as a guide to therapy in shock.

During the treatment of 26 shocked patients, measurements were made of the central blood to peripheral skin temperature gradient. No significant correlation was found between this gradient and cardiac index (CI), or systemic vascular resistance (SVR) or its index (SVRI). There was no significant correlation between the change in gradient and the changes in CI, SVR or SVRI in any single patient. We conclude that it is incorrect to base any judgment of a patient's hemodynamic status on a core/peripheral temperature gradient during shock, and it is irrational to initiate therapy based on this measurement.

Cardiac Output↗
PubMed1983

Pethidine, atropine, metoclopramide and the lower oesophageal sphincter.

The effects of an intramuscular injection of pethidine (1.5 mg/kg) plus atropine 0.5 mg, or pethidine (1.5 mg/kg) plus atropine 0.5 mg plus metoclopramide 10 mg on the lower oesophageal sphincter pressure have been studied manometrically in human volunteers. The mean barrier pressure in the former group was significantly lower than the baseline for the 75 minutes studied. In the latter group the mean barrier pressure was significantly lower than the baseline value for the first 45 minutes only of the study. The addition of atropine 0.5 mg to pethidine 1.5 mg/kg further lowers the barrier pressure when compared with the depression seen with pethidine alone in a previous study. While the addition of intramuscular metoclopramide to the mixture of pethidine and atropine fails to return the mean barrier pressure to the baseline value, it does raise the mean barrier pressure to a level which is probably above the opening pressure of the lower oesophageal sphincter.

Adult↗
PubMedDate not supplied

Conference report: community-based health promotion--state of the art and recommendations for the future.

The evaluators of the Henry J. Kaiser Family Foundation Community Health Promotion Grants Program in the West and the Foundation brought together 21 researchers, funders, and community organizers with a variety of perspectives on community-based health promotion to share what has been learned to date and how that knowledge should be applied in the future. The two-day conference was divided into three sessions, covering conceptual, implementation, and evaluation issues. Specific topics were selected by the organizers with input from participants. Two papers were presented in each session, followed by comments from discussants and a general discussion involving the entire group. The dominant theme of the conference was the relationship between communities and outside institutions, focusing on problems with the current state of relations and how they might be improved in the future. All viewed building partnerships between communities and institutions as a desirable goal; however, the challenges involved in building effective partnerships are considerable and require a substantial investment to make them work. Recommendations that emerged from the discussions included explicitly acknowledging the diverse interests of the parties in community-based programs at the earliest stages of program planning; making a concerted effort to bridge the cultural gaps that exist among the parties; structuring funding to allow enough lead time for partnerships to develop or using social reconnaissance to identify strong existing partnerships; and integrating the evaluation more closely into the process of program development.

Community Participation↗