184 research outputs found
Prolonged hypoxaemia after nebulised salbutamol
No full textPulse oximetry is increasingly used to assess hypoxaemia in respiratory illnesses. Six children presenting with acute asthma and prolonged falls in oxygen saturation values after treatment with salbutamol are described who were subsequently shown to have pneumonic consolidation on chest radiography.</p
Use of pulse oximetry in the hospital management of acute asthma in childhood
No full textOxyhemoglobin saturation values were recorded before and 10 minutes after 5 mg of nebulized salbutamol in 75 children (age, 1.5–14.6 years) admitted to hospital with acute asthma. Other assessments included heart rate, respiratory rate, peak expiratory flow rate, pulsus paradoxus, and an asthma severity score. All assessments were performed by the same observer (GC) and subsequent hospital care was transferred to the on‐call pediatricians, who were not told the initial saturation values. Six children required intravenous therapy after hospital admission when their symptoms were not improved after nebulized salbutamol. Cutoff points for each continuous variable were selected so that they identified at least 5 of these 6 children (i.e., with a sensitivity of at least 83 percent). The resulting specificities and positive predictive values were calculated for each variable before and after nebulized therapy. A postnebulizer saturation of less than 91 % had a sensitivity of 100% [95% confidence interval (CI), (54–1001 with a specificity of 98%] (95% CI, 92–100) and a positive predictive value of 86%. This was the best predictor of the need for intravenous (IV) therapy. Correlation coefficients were calculated for the 75 admissions and 2 others who required immediate IV treatment to determine how closely saturation values were related to the other recorded clinical variables. Saturation values were significantly, though weakly, correlated with asthma severity scores and prenebulizer heart rate, but they were not associated with any of the other variables. These results highlight the difficulties encountered when assessing acute asthma in a hospital population with a large number of preschool children. Saturation measurements are easy to obtain in all age groups and help identify those children who require intensive therapy and close supervision after hospital admission. © 1993 Wiley‐Liss, Inc.</p
Prevention of viral induced asthma attacks using inhaled budesonide
No full textThirty two preschool children were entered into a double blind, placebo controlled study using intermittent budesonide to treat viral induced wheeze. Active treatment was either 800 μg twice a day via a spacer or 1600 μg twice a day via a spacer and facemask in those children too young to use a mouthpiece. Treatment was started at the onset of an upper respiratory tract infection and continued for seven days or until symptoms had resolved for 24 hours. Each child remained in the study until they had completed using one pair of budesonide and placebo inhalers in random order without the need for additional oral prednisolone. Twenty five children completed 28 treatment pairs. All 25 families were asked to express a preference after completing their first treatment pair: 12 preferred budesonide and six preferred placebo; seven had no preference. Symptom scores were compared in 17 treatment pairs that were completed without the need for oral prednisolone. Mean day and night time wheeze in the first week after infection were significantly lower in those receiving budesonide. Intermittent inhalation of budesonide can modify the severity of wheezing in preschool children developing asthma after viral respiratory infections but improvements were modest with the doses used in this study.</p
The cost effectiveness of budesonide in severe asthmatics aged one to three years
No full textThe cost effectiveness of budesonide treatment was determined in a 6-month randomised, double blind, placebo controlled study of 40 asthmatic children aged one to three years with persistent asthma symptoms despite bronchodilator therapy. Budesonide produced a mean (± sd) of 62 (54) symptom-free days compared with 38 (36) for placebo. Direct costs were reduced with budesonide by fewer doctor consultations and fewer hospital admissions for shorter periods. Indirect cost benefits occurred through reductions in the days lost from work by parents and days lost from playgroup by the child because of asthma. Total costs/patient/year for a budesonide- and placebo-treated child were £1397.83 and £1891.43, respectively. The marginal cost effectiveness ratio was -£6.33 in favour of budesonide. Budesonide effectively reduces asthma symptoms compared to placebo and the additional drug costs are substantially offset by a reduced use of healthcare services and reduced indirect costs to childrens' families.</p
Prednisolone and salbutamol in the hospital treatment of acute asthma
No full textThe use of oral prednisolone (2 mg/kg) to treat children admitted to hospital with acute asthma was assessed in a placebo controlled study. Children were further randomised to receive either 0.5 mg/kg salbutamol every 30 minutes for the first three hours of admission, or 5 mg salbutamol every one to four hours as needed. Treatment was double blind and the assessor was unaware of the nebuliser regimen given. Children were examined before and after treatment with salbutamol on arrival and reassessed four hours after admission. Seventy children completed the study. Seventeen (46%) of 37 children receiving prednisolone and six (9%) of 33 receiving placebo were fit for discharge after four hours of treatment. There was no significant difference between the two nebuliser regimens. Clinical parameters indicative of asthma severity were improved in all groups. Between group comparisons at reassessment showed higher peak flows in those receiving prednisolone and nebulisers every 30 minutes but differences were not significant for other parameters. Objective parameters indicating steroid efficacy over placebo were minimal. Despite this, those receiving prednisolone were more readily identifiable as being fit for discharge within four hours of treatment.</p
Audit strategies to reduce hospital admissions for acute asthma
No full textAn eightfold rise in hospital admissions for acute asthma from 1971-85 prompted two studies to audit the admissions policy at the Royal Alexandra Hospital. In the first study the on call senior house officer (SHO) was replaced by an experienced registrar and over a four month period 53 children out of 158 were sent home from the receiving room compared with six out of 39 seen by the SHOs. In the second study an SHO training programme was established together with a home treatment package. Over a 12 month period the on call SHOs assessed 687 children with acute asthma; 229 (43.5%) were deemed fit to be sent home. Only seven of these were readmitted within one week. Diary symptom score cards filled in by parents indicated that children sent home without admission fared no worsed at home than those admitted and then discharged for the two weeks after leaving hospital. The development of strategies to improve assessment and immediate management in the hospital receiving room can reduce hospital admissions for acute asthma, allowing more children to be safely managed in the community.</p
Physiological consequences of early-life insult
No full textThe most commonly observed severe lung injuries in early life are the respiratory distress syndrome in premature infants and the acute respiratory distress syndrome in children. Both diseases are characterised by alveolar instability, fluid filled airspace and some degree of airway obstruction. In the acute phase, collapsed alveoli can be reopened with positive end-expiratory pressure and lung recruitment. New insight into the physiology of lung recruitment suggests that the shape of the pressure–volume curve is defined by the change in rate of alveolar opening and closing. Reduced lung volumes and severe ventilation maldistribution are found in the acute phase but may persist during childhood. Any severe lung injury in this early phase of life can cause significant structural and functional damage to the developing lung. Follow-up studies of children with chronic lung disease have shown that the functional abnormalities will improve but may still be present in later childhood
Whitmer - Frank P. Whitmer (ca. 1890)
No full textA.B.; Phi Kappa Psi. Born July 7, 1866, Shippensburg. Brother of S.E.W., class of 1890. Chief clerk and private secretary to B. & O.R.R. officials, Wheeling, W. Va., Piedmont, W. Va., Keyser, W. Va., Baltimore, Md., Cumberland, Md. and Philadelphia. Treas., sec. and gen. manager, Keyserland, Md. and Philadelphia. Treas., sec. and gen. manager, Keyser Electric Light Co., Keyser, W. Va., Died Nov. 9, 1925
Developing a handheld record for patients with cystic fibrosis
No full textOmendra Narayan,1 Siobhan Davies,1 Carly Tibbins,2 JH Martyn Rees,3 Warren Lenney,1,4 Francis J Gilchrist1,4 1Academic Department of Child Health, Royal Stoke University Hospital, Stoke-on-Trent, 2West Midlands Medicines for Children Research Network, Royal Stoke University Hospital, Stoke-on-Trent, 3Department of Paediatrics, Royal Shrewsbury Hospital, Shrewsbury, 4Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Stoke-on-Trent, UK Abstract: Patient handheld records (PHHRs) promote self-management and empower the holder to take a more active role in the management of their disease. They have been used successfully in improving preventative care for children and have contributed to improved adherence in a number of chronic illnesses. Despite the potential advantages, there are no standard PHHRs for patients with cystic fibrosis (CF). We report the consultation process that led to the development of a CF PHHR, describe the final document, and analyze the feedback from their use at our center. We have made the CF PHHR freely available online.Keywords: cystic fibrosis, pediatrics, patient and public involvement, patient handheld record
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