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Biomedical subjects

N W Goodman

Publications and source records attributed to N W Goodman.

At least 127 records · Page 7Linked to original sources
PubMed1984

The validity of informed consent in a clinical study.

Patients, aged 36 to 78 years, who had participated in two studies that included the ventilatory effects of postoperative analgesia, returned a questionnaire canvassing their views of the procedure for obtaining consent and the conduct of the study. Fourteen of 18 patients from one study, and all 18 from the second, returned their questionnaires. Thirty of the 32 patients were satisfied with the pre-operative explanation. Eleven patients felt obliged to take part, not because of coercion, but from a sense of duty to others. The breathing tests caused discomfort to eight patients but only one of them found this more than expected from the pre-operative explanation. Only two patients, both in the second study, said that they would not volunteer again for a similar study. There was no suggestion that the age of the patient or the fact that they were undergoing major surgery had any influence on their attitudes or comprehension. It may be prudent to use this type of questionnaire to evaluate the response of patients to some research projects.

Aged↗
PubMed1984

Ventilatory effects of pre- and postoperative diamorphine. A comparison of extradural with intramuscular administration.

Twenty-two patients were studied before and after major abdominal vascular surgery to determine the effect on ventilation of 5 mg diamorphine given either extradurally or intramuscularly. Diamorphine depressed ventilation maximally at 30 minutes when given by either route. Before operation resting ventilation was reduced by 33% after extradural and 17% after intramuscular diamorphine; PaCO2 increased by an average of 0.5 kPa (either route); ventilation at 7.3 kPa PaCO2 was reduced 40% after extradural and 33% after intramuscular diamorphine. After operation the effect of diamorphine on ventilation was qualitatively similar but resting baseline ventilation was increased from 9.4 to 10.9 litres/minute. The highest individual PaCO2 values were found during the pre-operative study: 6.5 kPa after extradural diamorphine, 6.4 kPa after intramuscular diamorphine. Pain relief was unsatisfactory after intramuscular diamorphine. Four out of six patients requested further analgesia by 3 hours after administration. No patient who received extradural diamorphine required further analgesia for at least 6 hours.

Adult↗
PubMed1983

Haemodynamic effects of infusions of diisopropyl phenol (ICI 35 868) during nitrous oxide anaesthesia in man.

The haemodynamic effects of diisopropyl phenol in cremophor EL at infusion rates of 50-55 and 100 micrograms kg-1 min-1 in combination with inhalation of 67% nitrous oxide have been studied during spontaneous and controlled ventilation in patients premedicated with morphine and atropine. Under all the conditions studied diisopropyl phenol supplementation of nitrous oxide anaesthesia was associated with a decreased arterial pressure (-20% to -31%) compared with the awake patient, related to a decrease in cardiac output (-27% to 29%) and an increase in systemic vascular resistance (+8% to +30%) during surgery, but to a decrease in cardiac output (-19%) and a decrease in systemic vascular resistance (-17%) during anaesthesia without surgery. Doubling the infusion rate of diisopropyl phenol caused no significant haemodynamic changes during either spontaneous or controlled ventilation. The haemodynamic manifestations of sympathetic nerve activity in response to laryngoscopy and intubation were poorly suppressed by diisopropyl phenol.

Aged↗
PubMed1973

Efferent control of arterial chemoreceptors mediated by glossopharyngeal fibres and artifacts introduced by stimulation techniques.

1. In anaesthetized cats, stimulation of the cut carotid sinus nerve generally caused a reduction in discharge in afferent fibres peeled from the nerve distal to the stimulating electrodes, though this was somewhat variable. In four out of five fibres the inhibition was reduced or abolished by close intra-arterial injection of atropine. Only single fibres were used.2. There was a risk of adventitious excitation of the afferent fibre by stimulus escape. Some of the features of this excitation and the ease with which it occurred were investigated using an isolated length of vagus, baroreceptor fibres and chemoreceptor fibres. Low concentrations of local anaesthetic could raise the threshold for adventitious excitation whilst not affecting the normal passage of impulses.3. During stimulation of the efferent components of the sinus nerve, a continuous check for adventitious excitation was kept, utilizing the fact that chemoreceptor fibres show a minimum inter-spike interval of about 10 msec.4. The true inhibition of discharge would seem to be vasomotor in origin.

Action Potentials↗
PubMed1973

The significance of the timing of chemoreceptor impulses for their effect upon respiration.

Alveolar partial pressure of carbon dioxide (PACO2) and alveolar partial pressure of oxygen (PAO2) oscillate at the frequency of respiration and the oscillations persist into the arterial blood as oscillations of arterial partial pressure of carbon dioxide (PaCO2) and arterial partial pressure of oxygen (PaO2). Arterial chemoreceptors respond quickly enough to changes in PaCO2 and PaO2 for the arterial oscillations to give rise to oscillations in their afferent discharge at the frequency of respiration. The respiratory centre responds with short latency to afferent impulses reaching it. If a burst of impulses reaches it during an inspiration, the depth of that inspiration, is increased but if the burst arrives during expiration, the succeeding inspiration is little affected. Thus if the peaks of chemoreceptor afferent discharge coincide with inspiration, they have a greater effect on respiration than if they coincide with expiration. The phase relation between the activity of the respiratory centre and the oscillations it produces is determined, inter alia, by the frequency of respiration and the heart output. Thus it may well change in exercise.

Animals↗
PubMedDate not supplied

Clinical governance.

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Medical Audit↗
PubMedDate not supplied

Who will challenge evidence-based medicine?

Evidence based medicine (EBM), which lays special emphasis on the formal gathering and synthesis of research data by systematic review and meta-analysis, is intuitively attractive as a way of determining best treatments. However, questions remain unanswered about the underlying assumptions of EBM. There is little true dialogue between its critics and its advocates, although the latter have had considerable disagreements among themselves in the correspondence columns of medical journals about the precise way in which its methods should be used. EBM medicine is in danger of becoming a new and unchallengeable orthodoxy following its own political agenda.

Humans↗
PubMedDate not supplied

Science as sin.

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Diffusion of Innovation↗