101 results on '"Gordon Lyons"'
Search Results
2. Critical airway management in the intensive care unit: homogeneity in practice?
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Gordon Lyons, Andy Higgs, Hervé Quintard, and Julien Pottecher
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medicine.medical_specialty ,Anesthesiology and Pain Medicine ,law ,business.industry ,Homogeneity (statistics) ,medicine.medical_treatment ,medicine ,Airway management ,Intensive care medicine ,business ,Intensive care unit ,law.invention - Published
- 2019
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3. Effectiveness of Technology Types in Employment-Related Outcomes for People with Intellectual and Developmental Disabilities: an Extension Meta-analysis
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Michael L. Wehmeyer, Michael Arthur-Kelly, Despoina Damianidou, Judith Foggett, and Gordon Lyons
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030506 rehabilitation ,business.product_category ,Social work ,Universal design ,05 social sciences ,Applied psychology ,050301 education ,Intervention effect ,03 medical and health sciences ,Work (electrical) ,Meta-analysis ,Laptop ,Work setting ,Psychology (miscellaneous) ,Use of technology ,0305 other medical science ,business ,Psychology ,0503 education ,Social Sciences (miscellaneous) - Abstract
The aim of this study was to extend a recently published meta-analysis that explored the impact of technology use to support employment-related outcomes for people with intellectual and developmental disabilities by focusing on the impact of types of technology and work settings. A further analysis of the same single-subject experimental design studies conducted from 2004 to 2016 was undertaken in this study. Percentage of non-overlapping data (PND) scores measuring the intervention effect was used and compared across types of technology and work settings. The relationships between the types of technology and the presence of universal design features were also examined. Findings revealed significant differences in the effects of the technology use between (a) pictorial prompts and (1) auditory prompting devices, (2) desktop and laptop computers, and (3) palmtops, and (b) real and simulated work setting. Significant relationships between the presence of universal design features and types of technology were also found. Devices using pictorial prompts had a lower frequency of universal design features present while the video-assisted training, palmtops, and desktop and laptop computers group had significantly greater frequency of the use of universal design features. Overall, the effect of the use of technology seemed to differ when viewed by type of technology or by work setting. Further research is required regarding (1) technology use to promote employment-related outcomes in real work settings, (2) the effect of more sophisticated types of technology in real work settings, and (3) the features incorporated into the technology. more...
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- 2018
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4. Observational Data on Socio-Communicative Phenomena in Classrooms Supporting Students with Profound Intellectual and Multiple Disability (PIMD): Advancing Theory Development on Learning and Engagement Through Data Analysis
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Bea Maes, Gordon Lyons, Kim Colyvas, Michael Arthur-Kelly, and Phil Foreman
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030506 rehabilitation ,education.field_of_study ,Social work ,Descriptive statistics ,Multiple disabilities ,05 social sciences ,Population ,Psychological intervention ,050301 education ,Development theory ,Developmental psychology ,03 medical and health sciences ,Learning theory ,Observational study ,Psychology (miscellaneous) ,0305 other medical science ,education ,Psychology ,0503 education ,Social Sciences (miscellaneous) - Abstract
Theories of learning and engagement in persons with profound intellectual and multiple disability (PIMD) are essential as a basis for empirical investigations into the effectiveness or otherwise of educational and other interventions. In this paper, a selected descriptive analysis of observational data on the social and communicative experiences of a sample of eight school students aged between 5 and 13 with profound intellectual and multiple disability is reported. The observed frequency of various socio-communicative phenomena as well as potential relationships amongst social groupings and communication indicators in two types of school settings are outlined. These results inform a concluding discussion of theoretical perspectives on the nature of inputs to, and responses indicative of learning in this population of individuals with high and complex support needs. more...
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- 2017
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5. The half-life of infusion fluids
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Gordon Lyons and Robert G. Hahn
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Mechanical ventilation ,Aldosterone ,business.industry ,medicine.medical_treatment ,Volume overload ,Half-life ,030208 emergency & critical care medicine ,Plasma Substitutes ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,chemistry ,030202 anesthesiology ,Interstitial fluid ,Anesthesia ,Respiration ,Medicine ,General anaesthesia ,business - Abstract
An understanding of the half-life (T1/2) of infused fluids can help prevent iatrogenic problems such as volume overload and postoperative interstitial oedema. Simulations show that a prolongation of the T1/2 for crystalloid fluid increases the plasma volume and promotes accumulation of fluid in the interstitial fluid space. The T1/2 for crystalloids is usually 20 to 40 min in conscious humans but might extend to 80 min or longer in the presence of preoperative stress, dehydration, blood loss of more...
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- 2016
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6. The Reported Effects of a Systematic Professional Learning Program on the Knowledge, Skills, and Concerns of Australian Early Childhood Educators who Support Young Children Displaying or at Risk of Challenging Behaviours
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Fuk Chuen 何褔全 Ho, Tania De Bortoli, Fran Baker, Michael Arthur-Kelly, Genevieve Farrell, Warren Fairfax, Frank Hinchey, Gordon Lyons, and Watinee Opartkiattikul
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Early childhood education ,Medical education ,Health (social science) ,business.industry ,Challenging behaviour ,05 social sciences ,Professional development ,050301 education ,Health Professions (miscellaneous) ,Coaching ,Education ,Developmental psychology ,Professional learning community ,Developmental and Educational Psychology ,0501 psychology and cognitive sciences ,Early childhood ,Action research ,business ,Psychology ,0503 education ,At-risk students ,050104 developmental & child psychology - Abstract
High-quality early childhood education is a vital experience for young children with and without disabilities. Social and communication experiences in the context of play represent a core curriculum that sets a foundation for later learning and participation. Using a new self-report instrument, this article describes data collected in a large-scale professional learning project in NSW, Australia, that aimed to support early childhood teachers, paraprofessionals and other personnel who directly work with young children, including individuals who present or are at risk of challenging behaviours. Using a case application model of remote and direct coaching support and intervention centred on the input of expert practitioners, the reports of participants were collected before and after a series of three sequential workshops with embedded action research processes for participants. The program was designed to increase social and communicative exchanges and reduce the likelihood of challenging behaviour... more...
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- 2016
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7. Uterine tilt for caesarean section
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Peter Kranke and Gordon Lyons
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medicine.medical_specialty ,Obstetrics ,business.industry ,Cesarean Section ,medicine.medical_treatment ,Anesthesia, Spinal ,Anesthesiology and Pain Medicine ,Tilt (optics) ,Pregnancy ,medicine ,Supine Position ,Humans ,Caesarean section ,Female ,Cardiac Output ,business ,Monitoring, Physiologic - Published
- 2018
8. Amniotic fluid embolism
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Mitko Kocarev and Gordon Lyons
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- 2018
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9. Thromboembolism
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Gordon Lyons and Mitko Kocarev
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- 2018
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10. Technology use to support employment-related outcomes for people with intellectual and developmental disability: an updated meta-analysis
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Michael L. Wehmeyer, Michael Arthur-Kelly, Gordon Lyons, and Despoina Damianidou
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Gerontology ,030506 rehabilitation ,05 social sciences ,Review ,medicine.disease ,03 medical and health sciences ,Psychiatry and Mental health ,Assistive technology ,Meta-analysis ,Intervention (counseling) ,Intellectual disability ,Developmental and Educational Psychology ,medicine ,0501 psychology and cognitive sciences ,0305 other medical science ,Psychology ,050104 developmental & child psychology - Abstract
OBJECTIVES: The aim of this study is to update and extend an original meta-analysis which included papers published up to and including 2003 and investigated the impact of technology use on employment-related outcomes for people with intellectual and developmental disability. METHODS: Following on from the original meta-analysis, this study is a meta-analysis of pertinent single-subject experimental design studies conducted from 2004 to 2016 and employs the same metric methods as the original contribution. RESULTS: The results are generally consistent with those of the original meta-analysis, namely, applied cognitive technology effectively supports employment-related outcomes for people with intellectual and developmental disability. Nevertheless, significant differences in the intervention effects were found (a) between groups of individuals with varying levels of disability, and (b) between interventions utilizing technology with and without universal design features. CONCLUSIONS: In line with the original contribution, applied cognitive technology seems to support people with intellectual and developmental disabilities to better achieve employment-related outcomes. More research is needed though to explore the impact of different types of technology on employment-related outcomes. more...
- Published
- 2018
11. Deep Assessment: A Novel Framework for Improving the Care of People with Very Advanced Alzheimer’s Disease
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Ami Eidels, Aimee Mavratzakis, Michael Arthur-Kelly, and Gordon Lyons
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Adult ,Male ,Article Subject ,Best practice ,Applied psychology ,Population ,lcsh:Medicine ,Disease ,General Biochemistry, Genetics and Molecular Biology ,Severe cognitive impairments ,Quality of life (healthcare) ,Alzheimer Disease ,Parietal Lobe ,medicine ,Humans ,education ,education.field_of_study ,General Immunology and Microbiology ,lcsh:R ,Cognition ,General Medicine ,Middle Aged ,Decompression, Surgical ,medicine.disease ,Magnetic Resonance Imaging ,Radiography ,Vignette ,Female ,Sensorimotor Cortex ,Alzheimer's disease ,Psychology ,Research Article - Abstract
Best practice in understanding and caring for people with advanced Alzheimer’s disease presents extraordinary challenges. Their severe and deteriorating cognitive impairments are such that carers find progressive difficulty in authentically ascertaining and responding to interests, preferences, and needs. Deep assessment, a novel multifaceted framework drawn from research into the experiences of others with severe cognitive impairments, has potential to empower carers and other support professionals to develop an enhanced understanding of people with advanced Alzheimer’s disease and so deliver better calibrated care in attempts to maximize quality of life. Deep assessment uses a combination of techniques, namely, Behaviour State Observation, Triangulated Proxy Reporting, and Startle Reflex Modulation Measurement, to deliver a comprehensive and deep assessment of the inner states (awareness, preferences, likes, and dislikes) of people who cannot reliably self-report. This paper explains deep assessment and its current applications. It then suggests how it can be applied to people with advanced Alzheimer’s disease to develop others’ understanding of their inner states and to help improve their quality of life. An illustrative hypothetical vignette is used to amplify this framework. We discuss the potential utility and efficacy of this technique for this population and we also propose other human conditions that may benefit from research using a deep assessment approach. more...
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- 2015
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12. The Lyford Model of Classroom Management: Authentication through Continuing 'Reflections from the Field'
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Michael Arthur-Kelly, Margot Ford, and Gordon Lyons
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Classroom management ,Praxis ,media_common.quotation_subject ,Context (language use) ,General Medicine ,Rigour ,Grounded theory ,Authentication (law) ,Test (assessment) ,Pedagogy ,ComputingMilieux_COMPUTERSANDEDUCATION ,Sociology ,Diversity (business) ,media_common - Abstract
The Lyford model of classroom management was first published as the centrepiece of an Australian undergraduate classroom management textbook in 2011. It was conceptualised and developed by the text authors, drawing on a qualitative analysis of their professional experiences, knowledge, beliefs and understandings. Consequently additional data were sought to test the legitimacy and rigour of the model. Each year the first author has called for “Reflections from the field”: short stories written by practicing teachers explaining what they understood their theoretical and practical approaches to classroom management were in their various teaching contexts. Over six years 54 stories have been gathered and progressively analyzed using a qualitative grounded theory approach. This very rich and growing source of data has consistently delivered substantial evidence supporting the authenticity and utility of the model. The model has “stood the test of time” in that it continues to both accommodate and embrace the evolving positions of the authors, and also of a growing number of exemplary practicing teachers. This paper commences with an introduction into the authors’ views on classroom management as a context for then describing and explaining the Lyford model, and the grounded theoretical process by which it comes to be. The continuing data source: the positions put by a growing number of practicing classroom teachers; is then described, followed by a brief explanation of the continuing grounded theoretical process of analysis. To illuminate this analysis, extracts are included from selected “Reflections from the Field”, with analytic breadth coming from a diversity of smaller extracts, and scope coming from one full Reflection. The authors then discuss various points of interest emerging from this continuing analysis, including suggestions to academic peers around teaching classroom management, and suggestions to their preservice and early service colleagues around doing classroom management. more...
- Published
- 2015
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13. Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study
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N. El-Wahab, R. Fernando, Stephen C. Robson, Malachy O. Columb, N. P. Patel, Gordon Lyons, and S. Wilson
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medicine.medical_specialty ,Fetus ,business.industry ,Neuraxial blockade ,Umbilical artery ,Umbilical cord ,Surgery ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,medicine.artery ,Anesthesia ,Heart rate ,medicine ,Apgar score ,Vein ,Prospective cohort study ,business - Abstract
We have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labour analgesia using either combined spinal-epidural or epidural. One hundred and fifteen healthy women requesting neuraxial analgesia in the first stage of labour were randomly assigned to receive either combined spinal-epidural (n = 62) or epidural analgesia (n = 53). Fetal heart rate traces, recorded for 30 min before and 60 min after neuraxial block, were categorised as normal, suspicious or pathological according to national guidelines. Sixty-one fetal heart rate tracings were analysed in the combined spinal-epidural group and 52 in the epidural group. No significant differences were found in fetal heart rate patterns, Apgar scores or umbilical artery and vein acid-base status between groups. However, in both combined spinal-epidural and epidural groups, there was a significant increase in the incidence of abnormal fetal heart rate patterns following neuraxial analgesia (p < 0.0001); two before compared with eight after analgesia in the combined spinal-epidural group and zero before compared with 11 after in the epidural group. These changes comprised increased decelerations (p = 0.0045) (combined spinal-epidural group nine before and 14 after analgesia, epidural group four before and 16 after), increased late decelerations (p < 0.0001) (combined spinal-epidural group zero before and seven after analgesia, epidural group zero before and eight after), and a reduction in acceleration rate (p = 0.034) (combined spinal-epidural group mean (SD) 12.2 (6.7) h(-1) before and 9.9 (6.1) h(-1) after analgesia, epidural group 11.0 (7.3) h(-1) before and 8.4 (5.9) h(-1) after). These fetal heart rate changes did not affect neonatal outcome in this healthy population. more...
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- 2014
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14. Fetal Effects of Combined Spinal-Epidural Versus Epidural Labor Analgesia
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R. Fernando, S. Wilson, Malachy O. Columb, Stephen C. Robson, Gordon Lyons, N.P. Patel, and N. El-Wahab
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Double blind study ,Fetus ,Combined spinal epidural ,business.industry ,Anesthesia ,Medicine ,Labor analgesia ,business - Published
- 2015
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15. UNESCO Inclusion Policy and the Education of School Students with Profound Intellectual and Multiple Disabilities:Where to Now?
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Gordon Lyons and Michael Arthur-Kelly
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Work (electrical) ,Multiple disabilities ,Pedagogy ,ComputingMilieux_COMPUTERSANDEDUCATION ,Policy guidelines ,General Medicine ,Sociology ,Inclusion (education) ,Curriculum ,Human services ,School education - Abstract
The education of school students with profound intellectual and multiple disabilities presents diverse challenges to practitioners, families and policymakers. These challenges are philosophically and ethically complex, and impact curriculum, assessment and pedagogy. Given the international ascendancy of both the UNESCO Policy Guidelines on inclusion in education and the principles of inclusion for people with disabilities with respect to human services policy and practice, the authors build on their previous work to advocate for renewed debate about the nature of school education for these students, and put forward four pathways to inform this debate. more...
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- 2014
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16. Towards improved ways of knowing children with profound multiple disabilities: Introducing startle reflex modulation
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Michael Arthur-Kelly, Gordon Lyons, and Peter Walla
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Male ,Reflex, Startle ,Multiple disabilities ,Emotions ,Rehabilitation ,General Medicine ,Rigour ,Developmental psychology ,Quality of life (healthcare) ,Developmental Neuroscience ,Research Design ,Reflex ,Pediatrics, Perinatology and Child Health ,Moro reflex ,Quality of Life ,Humans ,Abnormalities, Multiple ,Attention ,Observational study ,Child ,Psychology ,Behavioral Research - Abstract
Objective: To propose startle reflex modulation (SRM) as an objective measure of emotions of children with profound multiple disabilities (PMD). Knowledge about emotion states of children with PMD is crucial to their individualised care and support. Proxy reporting, observational and physiological measures of emotion are reported in the literature. Despite advances in this science, the rigour of the findings and methods are contested. In this article, we introduce SRM; a neurophysiological measure untried with children with PMD, despite its well-known sensitivity to even subtle changes in affective processing without depending on explicit responses.Results: We propose a research agenda that aims to deliver a more comprehensive and accurate profile of the inner states of these children, based upon previous research undertaken using SRM.Conclusion: It is suggested that this objective measure has potential to provide useful information about the inner emotional states of children with PMD. more...
- Published
- 2013
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17. Collaborative stretching: A research agenda for enhancing the quality of lives of people with severe cognitive impairments
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Michael Arthur-Kelly and Gordon Lyons
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Value (ethics) ,Severe cognitive impairments ,Evidence-based practice ,Quality of life (healthcare) ,Vignette ,Service (economics) ,media_common.quotation_subject ,Applied psychology ,Quality (business) ,Psychology ,Cognitive impairment ,Social psychology ,media_common - Abstract
This paper explains and demonstrates the early application of collaborative stretching: a new and practical technique for enhancing the quality of lives of people in care – particularly those who have severe cognitive impairments. An introduction explains severe cognitive impairment and the notion of quality of life. This is followed by an explanation of the nature of, theory behind, and the key steps of collaborative stretching. An illustrative vignette is then presented to demonstrate its application, utility, and value in one care setting. The paper concludes with a discussion around advancing a research agenda for this technique, and its potential implications for care service managers. more...
- Published
- 2013
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18. Reflections on enhancing pre-service teacher education programmes to support inclusion: perspectives from New Zealand and Australia
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Gordon Lyons, Dean Sutherland, Sonja Macfarlane, Michael Arthur-Kelly, and Phil Foreman
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Political science ,Pedagogy ,Developmental and Educational Psychology ,Active listening ,Legislation ,Faculty development ,Pre-service teacher education ,Health Professions (miscellaneous) ,Inclusion (education) ,Key policy ,Teacher education ,Education - Abstract
Positive changes to pre-service teacher education programmes (PSTEPs), driven in part by changing worldwide policy frameworks around inclusion, are occurring, albeit slowly. After briefly reviewing international trends and key policy and legislation platforms in New Zealand and Australia, this paper explores some of the challenges in enhancing PSTEPs to take on more inclusive perspectives and content. Examples of innovative changes in one programme in New Zealand and one in Australia are then described and discussed, particularly around how these changes seek to address these challenges. Some key facilitators for enhancing PSTEPs are put forward, namely positioning and embedding policy and practice in national and international contexts; embracing practices; working with the broader education faculty around the integration of course structures and content; listening to the views of practicing teachers; exploring pre-service teachers’ values, beliefs, attitudes, knowledge and concerns about engaging with a... more...
- Published
- 2013
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19. The Education of Australian School Students With the Most Severe Intellectual Disabilities: Where Have We Been and Where Could We Go? A Discussion Primer
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Gordon Lyons and Michele Cassebohm
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Engineering ,Educational method ,Severe intellectual disabilities ,Australian Curriculum ,business.industry ,Publishing ,Project commissioning ,Pedagogy ,Special education ,business ,Futures contract ,Curriculum ,Education - Abstract
The education of Australian students with the most severe intellectual disabilities continues to present substantial challenges to policymakers, practitioners and families. These are complex and involve philosophy and ethics generally, and curriculum assessment and pedagogy specifically. In light of the various phases of development for an Australian Curriculum, the authors advocate for broad-based debate about the nature of education for these students. To prime discussion, this paper looks at the past, present and possible futures with respect to the education of Australian students with the most severe intellectual disabilities. more...
- Published
- 2012
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20. Student wellbeing for those with profound intellectual and multiple disabilities: Same, same but different?
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Gordon Lyons and Michele Cassebohm
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Psychiatry and Mental health ,Computer science ,Multiple disabilities ,business.industry ,Australian Curriculum ,Order (exchange) ,Pedagogy ,Subject (philosophy) ,Artificial intelligence ,business ,Curriculum - Abstract
The nature of student wellbeing, although now subject to some consensus, continues to engender debate. To improve student wellbeing, widely regarded to be an overarching non-academic outcome of schooling, it is generally argued that it must be consensually conceptualised in order to be operationally defined and made measurable. The new Australian Curriculum puts forward common educational curriculum and outcomes for all students – including those outcomes implicitly and explicitly related to student wellbeing, but for students with profound intellectual and multiple disabilities this is, argues the author, philosophically and practically problematic. The author puts forward a research-based conceptualisation of subjective wellbeing for these students and recommends this as a basis for guiding a continuing research agenda to improve their wellbeing. more...
- Published
- 2012
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21. Combined spinal epidural vs epidural labour analgesia: does initial intrathecal analgesia reduce the subsequent minimum local analgesic concentration of epidural bupivacaine?
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V. Sodhi, R. Fernando, Gordon Lyons, Sarah Armstrong, N. P. Patel, Malachy O. Columb, and J. K. Bray
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Bupivacaine ,medicine.medical_specialty ,business.industry ,Analgesic ,Intrathecal ,Surgery ,Fentanyl ,Labour analgesia ,Anesthesiology and Pain Medicine ,Opioid ,Anesthesia ,Heart rate ,medicine ,Ephedrine ,business ,medicine.drug - Abstract
Labour analgesia initiated using a combined spinal-epidural (CSE) technique may reduce subsequent epidural bupivacaine requirements compared with an epidural-only technique. We compared the minimum local analgesic concentrations (MLAC) of epidural bupivacaine following initial intrathecal or epidural injection. In a prospective, double-blind study, 115 women requesting epidural analgesia were randomly assigned to receive either an epidural with bupivacaine 20 mg and fentanyl 40 μg or a CSE with intrathecal bupivacaine 2.5 mg and fentanyl 5 μg. Analgesia was assessed using a visual analogue pain score. When further analgesia was requested, bupivacaine 20 ml was given, and the concentration was determined using the technique of up-down sequential allocation. The MLAC of bupivacaine in the epidural group was 0.032% wt/vol (95% CI 0.020-0.044) compared with 0.047% wt/vol (95% CI 0.042-0.052) in the CSE group. Bupivacaine requirements for the second injection were increased following intrathecal analgesia by a factor of 1.45 (p = 0.026) compared with epidural analgesia. more...
- Published
- 2012
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22. Role of prophylactic uterine artery balloon catheters in the management of women with suspected placenta accreta
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J. Sadashivaiah, A. Thein, Gordon Lyons, C.J. Hammond, R. Wilson, and H. McLure
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Adult ,medicine.medical_specialty ,Blood transfusion ,Placenta accreta ,medicine.medical_treatment ,Placenta Accreta ,law.invention ,Pregnancy ,law ,medicine.artery ,medicine ,Humans ,Blood Transfusion ,Uterine artery ,Retrospective Studies ,Hysterectomy ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Balloon catheter ,Obstetrics and Gynecology ,Interventional radiology ,Balloon Occlusion ,medicine.disease ,Magnetic Resonance Imaging ,Intensive care unit ,Surgery ,Uterine Artery ,Anesthesiology and Pain Medicine ,Female ,business - Abstract
Background Placenta praevia and accreta are leading causes of major obstetric haemorrhage and peripartum hysterectomy. Detection is largely based on a high index of clinical suspicion, though the diagnostic accuracy of radiological imaging is improving. Interventional radiological techniques can reduce blood loss and the incidence of hysterectomy. Methods We have reviewed our experience with bilateral prophylactic uterine artery balloon occlusion in the management of women with suspected placenta accreta. Thirteen women at high risk of major haemorrhage due to placenta praevia or suspected placenta accreta were retrospectively studied. Uterine artery balloons were placed prophylactically under neuraxial anaesthesia in the angiography suite followed by caesarean delivery in the obstetric operating theatre. Results Intraoperative blood loss and transfusion requirements were low in our case series. There were no hysterectomies or admissions to the intensive care unit. Fetal bradycardia necessitating immediate caesarean delivery occurred in two women (15.4%). Conclusion In our case series in women with suspected placenta accreta, prophylactic use of uterine artery balloons was associated with a low requirement for blood transfusion but with possible increased risk of fetal compromise. Performing the interventional procedure at a different site from the operative room complicated management. more...
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- 2011
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23. Double-space combined spinal-epidural technique for elective caesarean section: a review of 10 years’ experience in a UK teaching maternity unit
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H. McLure, Gordon Lyons, R. Wilson, and J. Sadashivaiah
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Anesthesia, Epidural ,medicine.medical_specialty ,Post-dural-puncture headache ,medicine.medical_treatment ,Anesthesia, Spinal ,Pregnancy ,medicine ,Anesthesia, Obstetrical ,Humans ,Caesarean section ,General anaesthesia ,Longitudinal Studies ,Hospitals, Teaching ,Accidental dural puncture ,Epidural blood patch ,Cesarean Section ,business.industry ,Obstetrics and Gynecology ,University hospital ,United Kingdom ,Surgery ,Anesthesiology and Pain Medicine ,Combined spinal epidural ,Elective Surgical Procedures ,Anesthesia ,Female ,Elective caesarean section ,medicine.symptom ,business - Abstract
Background In obstetric practice use of a regional technique with a low failure rate minimises the need to convert to general anaesthesia (GA). Previous studies have suggested that combined spinal-epidural anaesthesia (CSE) has a lower GA conversion rate than spinal or epidural anaesthesia alone. In addition, a double-space CSE may be associated with fewer failures than the needle-through-needle technique. However, whether this has an effect on GA conversion rate is unknown. We aimed to review our practice of the double-space CSE technique for elective caesarean section. Methods Data from 3519 elective caesarean sections performed between 1999 and 2008 using the double-space CSE technique were collected retrospectively from the electronic database, original case records and annual reviews collated by the Department of Obstetric Anaesthesia, St James's University Hospital, Leeds. Complications such as conversion to GA, accidental dural puncture (ADP), post-dural-puncture headache (PDPH) and blood patching were specifically reviewed. Results The GA conversion rate in our unit was 0.23% (1:440). The ADP rate was 0.7% (1:141) with a 52% incidence of severe PDPH. The overall need for blood patching was 0.4% (1:251). One in five epidurals was supplemented during caesarean section. Conclusion Compared to previously published work using spinal or needle-through-needle CSE anaesthesia we have found a lower GA conversion rate in our unit using the double-space CSE technique for elective caesarean section. more...
- Published
- 2010
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24. International consensus report on the investigation and management of primary immune thrombocytopenia
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Robert McMillan, Miguel A. Sanz, Douglas B. Cines, James B. Bussel, Adrian C. Newland, Francesco Rodeghiero, Beng H. Chong, John D. Grainger, Bertrand Godeau, Joan Young, Ian A. Greer, Beverley J. Hunt, Terry Gernsheimer, Shirley Watson, Drew Provan, Roberto Stasi, Victor S. Blanchette, Michael D. Tarantino, Gordon Lyons, Paula H. B. Bolton-Maggs, Paul Imbach, and David J. Kuter more...
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Adult ,Male ,NEONATAL ALLOIMMUNE THROMBOCYTOPENIA ,medicine.medical_specialty ,Consensus ,Gestational thrombocytopenia ,Immunology ,THROMBOPOIESIS-STIMULATING PEPTIBODY ,MEDLINE ,Disease ,Biochemistry ,law.invention ,Quality of life (healthcare) ,Randomized controlled trial ,QUALITY-OF-LIFE ,Pregnancy ,law ,ITP-STUDY-GROUP ,Severity of illness ,Humans ,Medicine ,Disease management (health) ,Child ,Intensive care medicine ,INTRAVENOUS ANTI-D ,Purpura, Thrombocytopenic, Idiopathic ,REFRACTORY AUTOIMMUNE CYTOPENIAS ,business.industry ,ANTI-CD20 MONOCLONAL-ANTIBODY ,Pregnancy Complications, Hematologic ,Cell Biology ,Hematology ,RANDOMIZED CONTROLLED-TRIAL ,medicine.disease ,HIGH-DOSE DEXAMETHASONE ,Clinical trial ,Child, Preschool ,Female ,business ,INFLAMMATORY-BOWEL-DISEASE - Abstract
Previously published guidelines for the diagnosis and management of primary immune thrombocytopenia (ITP) require updating largely due to the introduction of new classes of therapeutic agents, and a greater understanding of the disease pathophysiology. However, treatment-related decisions still remain principally dependent on clinical expertise or patient preference rather than high-quality clinical trial evidence. This consensus document aims to report on new data and provide consensus-based recommendations relating to diagnosis and treatment of ITP in adults, in children, and during pregnancy. The inclusion of summary tables within this document, supported by information tables in the online appendices, is intended to aid in clinical decision making. more...
- Published
- 2010
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25. Effect of i.v. phenylephrine or ephedrine on the ED50 of intrathecal bupivacaine with fentanyl for Caesarean section
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P. Belavadi, Gordon Lyons, M.C. Hennebry, J. Barnes, G.M. Stocks, Malachy O. Columb, and S. Wray
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Adult ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Anesthesia, Spinal ,Drug Administration Schedule ,Fentanyl ,Phenylephrine ,Double-Blind Method ,Pregnancy ,Anesthesia, Obstetrical ,Humans ,Vasoconstrictor Agents ,Medicine ,Drug Interactions ,Caesarean section ,Prospective Studies ,Ephedrine ,Bupivacaine ,Cesarean Section ,business.industry ,Local anesthetic ,Hemodynamics ,Hydrogen-Ion Concentration ,Surgery ,Anesthesiology and Pain Medicine ,Blood pressure ,Levobupivacaine ,Anesthesia ,Female ,Hypotension ,business ,medicine.drug - Abstract
Background. Prophylactic infusion of phenylephrine to prevent hypotension at Caesarean section has been shown to decrease the rostral spread of intrathecal plain levobupivacaine and intrathecal hyperbaric bupivacaine by a median of two dermatomes compared with ephedrine. The aim of this study was to determine the median effective dose (ED50) of intrathecal bupivacaine required to achieve a block to touch at the xiphisternum in patients undergoing Caesarean section when phenylephrine or ephedrine are used to prevent hypotension. Methods. Seventy women were randomized in two groups to receive either phenylephrine at a rate of 16.6 mg min 21 (concentration 1m gm l 21 ) or ephedrine at a rate of 1.5 mg min 21 (concentration 90 m gm l 21 ). Patients received varying doses of hyperbaric bupivacaine with fentanyl 25 mg using a double-blinded, up-down sequential allocation design. Effective doses were defined as anaesthesia to touch with ethyl chloride spray to the xiphisternum within 20 min. Results. The ED50 estimates of bupivacaine were similar in the two groups: 7.8 mg [95% confidence interval (CI) 6.7‐8.9] with phenylephrine and 7.6 mg (95% CI 6.8‐8.4) with ephedrine. Systolic blood pressure control was similar (P¼0.18) with vasopressors but heart rate was higher with ephedrine (P¼0.0014). Conclusions. Under the conditions of this study, we have shown that when phenylephrine or ephedrine were used to prevent post-spinal hypotension, the dosing requirement of hyperbaric bupivacaine was similar for intrathecal anaesthesia. Br J Anaesth 2009; 102: 806‐11 more...
- Published
- 2009
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26. Assessment of platelet inhibition secondary to clopidogrel and aspirin therapy in preoperative acute surgical patients measured by Thrombelastography® Platelet Mapping™
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Gordon Lyons, R. Sandhu, D.J. Gray, J. C. Berridge, and T.C. Collyer
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Adult ,Blood Platelets ,Male ,Ticlopidine ,Platelet Aggregation ,Preoperative care ,Preoperative Care ,medicine ,Humans ,Platelet ,Prospective Studies ,cardiovascular diseases ,Antipyretic ,Prospective cohort study ,Aged ,Aged, 80 and over ,Aspirin ,business.industry ,Middle Aged ,Clopidogrel ,Thrombelastography ,Anesthesiology and Pain Medicine ,Anesthesia ,Platelet aggregation inhibitor ,Female ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Increasing numbers of patients prescribed clopidogrel and aspirin are presenting for non-elective surgery. No consensus on the timing of surgery exists after withdrawal of antiplatelet and tests of platelet function are not routinely available. The Thrombelastography Platelet Mapping (TEG-PM) assay is designed to assess platelet inhibition secondary to antiplatelet therapy. We assessed its ability to detect platelet inhibition in preoperative acute surgical patients.We conducted a prospective observational study in three groups of preoperative patients: those taking clopidogrel or aspirin up to admission, and a control group. TEG-PM was performed on the day of admission and alternate days until surgery.Mean (SD) platelet thromboxane A(2) receptor inhibition in the control group was 17.5% (23.8) (n=20), 52.6% (32.3) (n=18) in the aspirin group, and 31.9% (27.6) (n=21) in the clopidogrel group (P0.01). Mean (SD) platelet adenosine diphosphate (ADP) receptor inhibition in the control group was 47.8% (18.9) (n=20), 52.6% (19.7) (n=18) in the aspirin group, and 71.5% (18.4) (n=21) in the clopidogrel group (P0.01). Among the clopidogrel group awaiting surgery, mean platelet ADP channel inhibition decreased on day 3 to 67.1% (24.7) (n=11), 48.8% (24.4) (n=4) on day 5, and 36.1% (15.9) (n=2) on day 7 (P=0.57).TEG-PM can identify statistically significant platelet inhibition after antiplatelet therapy; however, the overlap in platelet receptor inhibition between the three groups is likely to limit the clinical usefulness of this test. more...
- Published
- 2009
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27. Syphilis in pregnancy
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Gordon Lyons and Smita Oswal
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Pregnancy ,medicine.medical_specialty ,business.industry ,Refugee ,Incidence (epidemiology) ,medicine.medical_treatment ,Human immunodeficiency virus (HIV) ,medicine.disease ,medicine.disease_cause ,Anesthesiology and Pain Medicine ,Family medicine ,medicine ,Western world ,Syphilis ,Caesarean section ,business - Abstract
For several decades, syphilis has been out of sight, mind, and memory, but the incidence in the Western world is now on the rise again and it could once more become a major health concern. This change has followed the rapidly rising number of human immunodeficiency virus (HIV) positive individuals worldwide, together with the advent of health tourists, economic migrants, asylum seekers, and the easy availability of low-cost travel. Just as syphilis has all but disappeared as an entity in the working memory of most anaesthetists, it has suddenly re-emerged as a co-existing condition in women presenting for Caesarean section. Figure 1 shows the changing incidence of syphilis in the UK over the last 10 years. This review is intended to inform anaesthetists caring for women with syphilis. more...
- Published
- 2008
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28. Vanishing experience in training for obstetric general anaesthesia: an observational study
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Gordon Lyons and R.D. Searle
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Medical Audit ,medicine.medical_specialty ,Cesarean Section ,Obstetrics ,Prospective audit ,business.industry ,Data Collection ,General surgery ,medicine.medical_treatment ,Obstetrics and Gynecology ,University hospital ,United Kingdom ,Anesthesiology and Pain Medicine ,Obstetric anaesthesia ,Anesthesiology ,Education, Medical, Graduate ,medicine ,Anesthesia, Obstetrical ,Humans ,Observational study ,General anaesthesia ,Caesarean section ,Longitudinal Studies ,business ,Retrospective Studies - Abstract
Background Changes in the delivery of anaesthesia for caesarean section have meant that trainee experience in obstetric general anaesthesia has steadily declined. In the UK, working patterns for trainees have changed significantly with the introduction of the New Deal in 2000 and the European Working Time Directive in 2004. Because of an impression that training opportunities had worsened during this period we have reviewed data in obstetric general anaesthesia at St James's University Hospital since 1998. Methods Data were collected retrospectively from prospective audit information contained within annual reviews collated by the Department of Obstetric Anaesthesia, St James's University Hospital Leeds between 1998 and 2006. Results before and after the implementation of training changes in 2000 and 2004 were compared. Results Since 1998 the total number of obstetric general anaesthetics given per year has continued to decline. The number of trainees increased from 23 in 1998 to 40 in 2006, with the main increase occurring between 2002 and 2003. The mean number of obstetric general anaesthetics given per trainee fell to 1 per year in 2006. Conclusion Since 1998 training opportunities in general anaesthesia for caesarean section at St James's Hospital have continued to decline. This reflects both changing trends in the delivery of anaesthesia for caesarean section and also changes in training hours and trainee numbers. more...
- Published
- 2008
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29. A Comparison of Minimum Local Anesthetic Volumes and Doses of Epidural Bupivacaine (0.125% w/v and 0.25% w/v) for Analgesia in Labor
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Mitko G. Kocarev, Gordon Lyons, Malachy O. Columb, and Rowan C. Wilson
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Adult ,Adolescent ,medicine.drug_class ,Analgesic ,Pain relief ,Sequential allocation ,Bolus (medicine) ,Double-Blind Method ,Pregnancy ,Humans ,Medicine ,Anesthetics, Local ,Pain Measurement ,Bupivacaine ,Pain score ,Labor, Obstetric ,Dose-Response Relationship, Drug ,business.industry ,Local anesthetic ,Confidence interval ,Analgesia, Epidural ,Anesthesiology and Pain Medicine ,Anesthesia ,Female ,business ,medicine.drug - Abstract
BACKGROUND: In this study we sought to determine and compare the minimum local anesthetic volumes (MLAV) and doses (MLAD) of two concentrations of bupivacaine for epidural pain relief in labor, and to quantify the effect on dose. METHODS: Eighty women were randomized in a double-blind manner to receive a first bolus of either plain bupivacaine 0.125% (w/v) or 0.25% (w/v). The arbitrary starting volume was 15 mL. Subsequent volumes were decided by sequential allocation according to analgesic efficacy. A visual analog pain score ! 10 (0‐100) within 30 min, indicated effective analgesia. The next woman received a decrement of 2 mL. A failure of the visual analog pain score to reach ! 10 was followed by a 2 mL increment for the next woman. RESULTS: Using the formula of Dixon and Massey, MLAV and MLAD, with 95% confidence intervals (CI) were calculated for each concentration. MLAV was 13.6 mL (95% CI 12.4‐14.8), with bupivacaine 0.125% (w/v), and 9.2 mL (95% CI 6.9‐11.5) with bupivacaine 0.25% (w/v). The difference was highly significant (P ! 0.002). MLAD for these volumes were 17.0 mg (95% CI 15.5‐18.5), and 23.1 mg (17.2‐28.9), respectively (P ! 0.045). CONCLUSIONS: Bupivacaine 0.125% (w/v) when compared with 0.25% (w/v) produced equivalent analgesia with a 50% increase in volume, but with a 25% reduction in dose. Any reduction in dose, without loss of efficacy, reduces risk of toxicity and improves safety. (Anesth Analg 2007;104:412‐5) more...
- Published
- 2007
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30. Book Reviews
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Meeri Hellstén, Alison Madelaine, Slava Kalyuga, John T. E. Richardson, Margot Prior, and Gordon Lyons
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Developmental and Educational Psychology ,Media studies ,Experimental and Cognitive Psychology ,Psychology ,Classics ,Education - Abstract
Book Review : William O’Grady. How Children Learn Language. Cambridge: Cambridge University Press, 2005. ISBN 0-521-53192-6
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- 2006
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31. Chlorhexidine spray versus single use sachets for skin preparation before regional nerve blockade for elective caesarean section: an effectiveness, time and cost study
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K. Robins, Gordon Lyons, R. Wilson, M.O. Columb, and E. Watkins
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Adult ,medicine.medical_specialty ,Cost-Benefit Analysis ,medicine.medical_treatment ,law.invention ,Randomized controlled trial ,Pregnancy ,law ,medicine ,Humans ,Drug packaging ,Drug Packaging ,Skin ,Aerosols ,Single use ,Cesarean Section ,business.industry ,Chlorhexidine ,Obstetrics and Gynecology ,Nerve Block ,Surgery ,Pharmaceutical Solutions ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Nerve Blockade ,Anesthesia ,Nerve block ,Female ,Elective caesarean section ,business ,Disinfectants ,medicine.drug ,Skin preparation - Abstract
Introduction: The importance of skin preparation before regional nerve blockade to prevent infection remains unchallenged. A multi-use spray chlorhexidine may have benefits over single use sachets in terms of convenience and cost, but its efficacy is unknown. We conducted a prospective randomised trial to compare spray and sachet chlorhexidine. Methods: Elective caesarean section patients were randomised to receive chlorhexidine as a spray (chlorhexidine 0.5% in an alcoholic solution Hydrex DS Derma spray, Adams Healthcare, Leeds, UK) or sachet chlorhexidine (chlorhexidine 0.05% aqueous solution, Unisept, Seton. Leeds, UK) before a standardised combined spinal epidural technique. Skin colonisation was examined before skin preparation and again after epidural catheter removal. Results: Both techniques were effective in reducing skin colonisation ( P =0.0001). There was no difference in effectiveness between the groups, with the spray reducing skin colonisation from 88.5% before to 3% after catheter removal, compared with 90% to 12% in the sachet group. Time to achieve skin preparation was significantly reduced in the spray group (2.6 min compared to 4.5 min; P =0.02). The spray cost per patient was €0.01 compared to sachet €0.33. Conclusions: We suggest a chlorhexidine spray is as effective as single use sachets and is also quicker to apply and less costly. more...
- Published
- 2005
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32. Combined Spinal-Epidural Versus Epidural Labor Analgesia
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R. Fernando, Malachy O. Columb, Johanna K. Bray, Gordon Lyons, Sarah Armstrong, N.P. Patel, and V. Sodhi
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Bupivacaine ,Combined spinal epidural ,business.industry ,Anesthesia ,Analgesic ,medicine ,Labor analgesia ,business ,Intrathecal ,medicine.drug - Published
- 2013
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33. The Relative Motor Blocking Potencies of Intrathecal Ropivacaine: Effects of Concentration
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Michela Camorcia, Giorgio Capogna, Gordon Lyons, and Malachy O. Columb
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Adult ,medicine.drug_class ,Initial dose ,Intrathecal ,Statistics, Nonparametric ,Sequential allocation ,Motor block ,Double-Blind Method ,Pregnancy ,Confidence Intervals ,medicine ,Humans ,Ropivacaine ,Prospective Studies ,Injections, Spinal ,Relative efficacy ,Local anesthetic ,business.industry ,Amides ,Confidence interval ,Anesthesiology and Pain Medicine ,Anesthesia ,Neuromuscular Blockade ,Female ,business ,medicine.drug - Abstract
UNLABELLED This study established the median effective dose (ED(50)) for motor block of intrathecal 1% and 0.1% ropivacaine and determined the effects of the concentration of the solution injected on the motor block obtained. We enrolled into this prospective, randomized, double-blind, sequential allocation study 54 parturients undergoing elective Cesarean delivery under combined spinal-epidural technique. Parturients were randomized to receive intrathecal ropivacaine either 1% or 0.1%. The initial dose was chosen to be 4 mg, with subsequent doses being determined by the response of the previous patient (testing interval, 1 mg). The occurrence of any motor block in either lower limb within 5 min from the intrathecal injection of the study solution was considered effective. The motor block at 5 min was 6.1 mg for 1% ropivacaine (95% confidence interval [CI], 5.1-7.1) and was 9.1 mg (95% CI, 7.8-10.3) for 0.1% ropivacaine (P = 0.0013; 95% CI difference, 1.3-4.7). The relative efficacy ratio of the 2 concentrations was 1.5 (95% CI difference, 1.2-1.9) in favor of the larger concentration. The ED(50) of spinal ropivacaine to produce motor block in pregnant patients was significantly influenced by the concentration of the local anesthetic, with dose requirements being increased by 50% for the smaller concentration. IMPLICATIONS The minimum local anesthetic dose for motor block with 0.1% ropivacaine is 50% larger than the 1% concentration with a relative efficacy ratio of 1.5. Our findings suggest that more diluted local anesthetic solutions determine less motor block, and this may be considered in ambulant laboring parturients. more...
- Published
- 2004
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34. Epidural test dose with levobupivacaine and ropivacaine: determination of ED 50 motor block after spinal administration
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Malachy O. Columb, M. Camorcia, Gordon Lyons, and G. Capogna
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medicine.medical_specialty ,medicine.drug_class ,Analgesic ,Motor Activity ,Double-Blind Method ,Pregnancy ,medicine ,Humans ,Potency ,Ropivacaine ,Prospective Studies ,Anesthetics, Local ,Injections, Spinal ,Levobupivacaine ,Bupivacaine ,Dose-Response Relationship, Drug ,Cesarean Section ,business.industry ,Local anesthetic ,Amides ,Effective dose (pharmacology) ,Surgery ,Analgesia, Epidural ,Catheter ,Anesthesiology and Pain Medicine ,Anesthesia ,Analgesia, Obstetrical ,Female ,business ,medicine.drug - Abstract
Background When a test is required to detect a possible intrathecal catheter, many would seek to use the same local anaesthetic as that used for epidural analgesia. The rapid onset of inappropriate motor block after a local anaesthetic administered epidurally implies intrathecal spread. Because of claims of greater sensory–motor separation, or because of reduced potency compared with bupivacaine, the efficacy of the new local anaesthetics in intrathecal testing has been questioned. The aim of this study was to establish the feasibility of a test dose for an inadvertent intrathecal catheter using ropivacaine and levobupivacaine, and to establish the dose required. Methods Sixty women undergoing elective Caesarean section with a combined spinal– epidural technique were enrolled into this prospective, double‐blind sequential allocation study. The women were randomized to receive plain levobupivacaine 0.5% or ropivacaine 0.5% intrathecally. The dose was determined according to up–down sequential allocation. The end‐point was any evidence of lower limb motor block within 5 min of injection. Results The ED 50 motor block at 5 min was 4.8 mg (95% CI, 4.49, 5.28) for levobupivacaine and 5.9 mg (95% CI, 4.82, 6.98) for ropivacaine (95% CI difference, 0.052, 1.98) ( P =0.04). The estimated ED 95 motor block was 5.9 mg (95% CI 5.19, 6.71) for levobupivacaine and 8.3 mg (95% CI, 6.30, 10.44) for ropivacaine. The potency ratio between the two drugs was 0.83 (95% CI, 0.69, 0.99). Conclusions Both local anaesthetics produce evidence of motor block within 5 min of intrathecal injection and could serve as tests of intrathecal administration. Derived ED 95 values suggest 10 mg doses should be effective, but this study did not measure predictive value. Ropivacaine is less potent for motor block than levobupivacaine by a factor of 0.83 ( P more...
- Published
- 2004
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35. In vitro evidence of gender-related heparin resistance
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S Monte and Gordon Lyons
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Drug Resistance ,In Vitro Techniques ,Pregnancy ,medicine ,Humans ,Blood Coagulation ,Whole blood ,Sex Characteristics ,Saline control ,Dose-Response Relationship, Drug ,medicine.diagnostic_test ,Heparin ,business.industry ,Anticoagulants ,Obstetrics and Gynecology ,Venous blood ,Middle Aged ,Gender related ,Thromboelastography ,In vitro ,Thrombelastography ,Surgery ,Anesthesiology and Pain Medicine ,Coagulation ,Anesthesia ,Female ,business ,medicine.drug - Abstract
Coagulability varies among men, women, and pregnant women, along a spectrum where the blood of men is the least and that of pregnant women the most coagulable. The effects of differences in coagulation status on the action of heparin cannot be measured by specific laboratory tests such as aPTT or anti-Factor Xa assay. Thromboelastography which measures whole blood coagulation can assess the effect of heparin against differing backgrounds of coagulation. The aim of this in vitro study was to explore differences in heparin effect between men, women and pregnant women. Fifteen male and female staff volunteers, and 15 pregnant women approaching term, donated venous blood, which was added to four cups in two TEG 5000 analysers. In the cups of the analysers was 0.03 mL of saline control, or heparin 0.4, 0.6 or 1 unit/mL. TEG variables r and k, angle and MA were compared across the groups using two way ANOVA. All subject groups demonstrated a significant heparin effect, which was least in the control group and greatest with 1 unit/mL (P0.0001). Across the subject groups, from men to pregnant women, increasing coagulability was seen, with shortening of r and k (P0.04), and increasing angle and MA (P0.0001). A relationship between gender and heparin was significant for r and k (P0.02) but not for angle and MA. This result assists the case against a one-size-fits-all approach to policies on heparinisation. more...
- Published
- 2004
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36. Maternal mortality: a useful tool?
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Elizabeth Clarke and Gordon Lyons
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Pregnancy ,medicine.medical_specialty ,Complications of pregnancy ,Sanitation ,business.industry ,Developing country ,medicine.disease ,Sierra leone ,Anesthesiology and Pain Medicine ,Family planning ,Family medicine ,Basic education ,medicine ,Childbirth ,business - Abstract
Each year, as many as 600,000 women die from complications of pregnancy or childbirth, more than one death per minute. All but 2% of these deaths occur in the developing world. In Sierra Leone, a woman has a 1 in 6 chance of dying from a pregnancy-related illness during her child-bearing years. This compares with 1 in 4,600 in the UK. Women in the developing world are more likely to be deficient in money, basic education, good housing and efficient sanitation. They have limited access to, and poor quality of, maternal health services and are often unable to make reasonable choices regarding family planning and health during pregnancy. more...
- Published
- 2004
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37. Language
- Author
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Gordon Lyons
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business.industry ,030208 emergency & critical care medicine ,Publication bias ,Translating ,Linguistics ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Text mining ,030202 anesthesiology ,Humans ,Medicine ,business ,Publication Bias ,Language - Published
- 2016
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38. Minimum Analgesic Dose of Epidural Sufentanil for First-stage Labor Analgesia
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Gordon Lyons, R. Parpaglioni, Malachy O. Columb, Giorgio Capogna, and Celleno D
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Chemotherapy ,business.industry ,medicine.medical_treatment ,Analgesic ,Prostaglandin ,Induction of labor ,Sufentanil ,chemistry.chemical_compound ,Anesthesiology and Pain Medicine ,Lumbar ,chemistry ,Anesthesia ,medicine ,Gestation ,Stage (cooking) ,business ,medicine.drug - Abstract
Background The aim of this prospective, double-blind, sequential allocation study was to compare the effects of spontaneous and prostaglandin-induced labor on the minimum analgesic dose of epidural sufentanil in the first stage of labor. Methods Seventy healthy, nulliparous women, at more than 37 weeks' gestation with cervical dilatation from 2 to 4 cm, requesting epidural pain relief in labor were enrolled. The subjects were assigned to two different groups according to whether labor was spontaneous or induced with dinoprostone 0.5 mg. Parturients received 10 ml of the study solution through a lumbar epidural catheter. The initial dose was sufentanil 25 microg, and subsequent doses were determined by the response of the previous patient in the same group using up-down sequential allocation. The analgesic effectiveness was assessed using 100-mm visual analog pain scores. The up-down sequences were analyzed using the method of independent paired reversals and probit regression. Results The minimum analgesic dose of sufentanil in spontaneous labor was 22.2 microg (95% CI: 19.6, 22.8) and 27.3 microg (95% CI: 23.8, 30.9) in induced labor. The minimum analgesic dose of sufentanil in induced labor was significantly greater (P = 0.0014) than that in spontaneous labor (95% CI difference: 2.9, 9.3) by a factor of 1.3 (95% CI: 1.1, 1.5). Conclusion Prostaglandin induction of labor produces a significantly greater analgesic requirement than does spontaneous labor. more...
- Published
- 2001
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39. Failure to predict difficult tracheal intubation for emergency caesarean section
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Gordon Lyons, Malachy O. Columb, Gokcen Basaranoglu, and BAŞARANOĞLU, GÖKÇEN
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Laryngoscopy ,Anesthesia, General ,Young Adult ,Pregnancy ,Risk Factors ,Intubation, Intratracheal ,medicine ,Humans ,Intubation ,Caesarean section ,General anaesthesia ,Prospective Studies ,Emergency Treatment ,reproductive and urinary physiology ,medicine.diagnostic_test ,Cesarean Section ,business.industry ,Tracheal intubation ,Thyromental distance ,Confidence interval ,Surgery ,Logistic Models ,Anesthesiology and Pain Medicine ,Anesthesia ,Female ,business ,Mallampati score - Abstract
Background and aim Difficult tracheal intubation following induction of general anaesthesia for caesarean section is a cause of morbidity and mortality. Our aim was to evaluate five bedside predictors that might identify women with potential intubation difficulty immediately prior to emergency caesarean section. Patients and methods Women requiring emergency caesarean section with general anaesthesia and tracheal intubation who had been assessed by the same experienced anaesthesiologist preoperatively were included in this study. Mallampati score, sternomental distance, thyromental distance, interincisor gap and atlantooccipital extension were all measured. The same anaesthesiologist performed laryngoscopy and graded the laryngeal view according to Cormack and Lehane. Exact logistic regression was used to identify significant independent predictors for difficult intubation (Cormack and Lehane grades ≥ 3) with two-sided P value less than 0.05 considered as significant. Results In 3 years, 239 women were recruited. Cormack and Lehane grades of 2 or less (easy) were found in 225 and grade of at least 3 (difficult) in 14 women. Patients' characteristics (age, height, weight, BMI or weight gain) were not significantly associated with difficulty of intubation. The incidence of difficult intubation was 1/17 women [95% confidence interval (CI) from 1/31 to 1/10]. A positive result from any of the five predictors combined had a sensitivity of 0.21 (95%CI 0.05-0.51), a specificity of 0.92 (95%CI 0.88-0.96), a positive predictive value of 0.15 (95%CI 0.032-0.38) and a negative predictive value of 0.95 (95%CI 0.91-0.97) for a Cormack and Lehane grade of at least 3 at laryngoscopy. Conclusion Airway assessment using these tests cannot be relied upon to predict a difficult intubation at emergency caesarean section as the low sensitivity means that 79% (95%CI 49-95) of difficult intubations will be missed. more...
- Published
- 2010
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40. Local anaesthetic toxicity
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Dipesh Odedra and Gordon Lyons
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Anesthesiology and Pain Medicine ,business.industry ,Anesthesia ,Local anaesthetic toxicity ,Plasma concentration ,Toxicity ,High doses ,Medical practice ,Medicine ,Lipid emulsion ,Critical Care and Intensive Care Medicine ,Complication ,business - Abstract
Summary Local anaesthetic toxicity has been a known complication of local anaesthetics since use began in 1884 and it continues to be a problem in modern medical practice. Local anaesthetic toxicity occurs due to raised plasma concentrations following high doses or inadvertent intravenous administration. The clinical manifestations of toxicity are generally neurological, cardiac or both in origin. Prevention is the best approach for toxicity, but in the event of its occurrence, lipid emulsion infusion has been recommended as part of the treatment algorithm. more...
- Published
- 2010
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41. Training in obstetric general anaesthesia: a vanishing art?
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Gordon Lyons, A.P.C. Robinson, R. C. Wilson, and R. V. Johnson
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Inservice Training ,medicine.medical_treatment ,Medical audit ,MEDLINE ,Audit ,Anesthesia, General ,Anesthesiology ,Pregnancy ,medicine ,Anesthesia, Obstetrical ,Humans ,Caesarean section ,General anaesthesia ,Prospective Studies ,Retrospective Studies ,Medical Audit ,Cesarean Section ,business.industry ,Prospective audit ,Retrospective cohort study ,medicine.disease ,Obstetrics ,Occupational training ,Anesthesiology and Pain Medicine ,England ,Anesthesia ,Female ,Medical emergency ,business - Abstract
General anaesthesia in obstetric practice has largely been replaced by the use of regional techniques. We have studied this phenomenon and the subsequent impact on training in this technique both retrospectively and with a prospective audit. There has been a decline in the use of general anaesthesia for Caesarean section such that trainee anaesthetists are getting less practical exposure to this important procedure. Audit revealed a deficit with consultant involvement in training and heightened awareness has resulted in improved supervision. Possible implications for future consultant working practices are discussed. more...
- Published
- 2000
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42. Morbidity and mortality from obstetric anaesthesia in the 1990s
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A.P.C. Robinson and Gordon Lyons
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medicine.medical_specialty ,Anesthesiology and Pain Medicine ,Obstetric anaesthesia ,business.industry ,SAFER ,medicine ,MEDLINE ,Regional anaesthesia ,General anaesthesia ,Intensive care medicine ,business ,Developed country - Abstract
As anaesthetic-related maternal mortality reduces in the developed world, alternative indicators of obstetric anaesthetic quality are required. Serious morbidity is difficult to define and quantify, but can be reduced by the provision of effective critical care. Regional anaesthesia, although safer than general anaesthesia, is not without risks. Evidence-based strategies exist to reduce the risks. more...
- Published
- 1999
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43. Saving Mothers’ Lives: Confidential Enquiry into Maternal and Child Health 2003-5
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Gordon Lyons
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Medical Errors ,Maternal and child health ,business.industry ,Parturition ,Obstetrics and Gynecology ,United Kingdom ,Maternal Mortality ,Anesthesiology and Pain Medicine ,Nursing ,Anesthesiology ,Pregnancy ,Cause of Death ,Practice Guidelines as Topic ,Anesthesia, Obstetrical ,Humans ,Medicine ,Female ,Confidentiality ,business - Published
- 2008
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44. Urapidil versus nicardipine in preeclamptic toxaemia
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Pierre Diemunsch, Samain Emmanuel, Vincent Garcia, Gordon Lyons, and Julien Pottecher
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Pregnancy ,business.industry ,Nicardipine ,MEDLINE ,Urapidil ,medicine.disease ,law.invention ,Anesthesiology and Pain Medicine ,Multicenter study ,Randomized controlled trial ,law ,Anesthesia ,Medicine ,business ,Prospective cohort study ,medicine.drug - Published
- 2015
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45. Life Satisfaction for Children with Profound Intellectual and Multiple Disabilities
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Gordon Lyons and Michele Cassebohm
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Quality of life (healthcare) ,Multiple disabilities ,Emotional intelligence ,Intellectual disability ,medicine ,Life satisfaction ,Preference assessment ,medicine.disease ,Psychology ,Grounded theory ,Developmental psychology - Abstract
The concepts of quality of life and life satisfaction are ubiquitous, complex and intertwined. But for people with profound intellectual and multiple disabilities (PIMD) – who by most measures have a very low quality of life – understanding, assessing and improving quality of life and life satisfaction are very problematic. The first author’s research, briefly described in this chapter, investigated the nature of life satisfaction for children with such disabilities. The primary findings are a grounded theory about the nature of life satisfaction for children with PIMD, and a grounded theory about how others can (best) come to know them. The authors believe that this life satisfaction can be discerned, that children with PIMD often experience a reasonable quality of life and that their life satisfaction and quality of life can be improved. more...
- Published
- 2010
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46. Quality of Life for Persons with Intellectual Disabilities: A Review of the Literature
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Gordon Lyons
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Medical education ,Quality of life (healthcare) ,Intellectual disability ,medicine ,Life satisfaction ,medicine.disease ,Psychology - Abstract
This chapter presents a synopsis of the literature about quality of life (QOL) for persons with intellectual disabilities (ID). The primary purposes of this review are to outline the “evolution” of informative conceptual and theoretical perspectives and terms, summarize pertinent research, and to provide a scaffold of knowledge and understanding to empower readers to engage with the following chapters. more...
- Published
- 2010
- Full Text
- View/download PDF
47. Intraoperative awareness during general anesthesia for cesarean delivery
- Author
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Gordon Lyons and Kay Robins
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medicine.medical_specialty ,Consciousness ,medicine.drug_class ,Nitrous Oxide ,Amnesia ,Intraoperative Awareness ,Anesthesia, General ,Hypnotic ,Anesthesiology ,Pregnancy ,Monitoring, Intraoperative ,Medicine ,Anesthesia, Obstetrical ,Humans ,Intraoperative Complications ,Fetus ,business.industry ,Incidence (epidemiology) ,Malpractice ,medicine.disease ,Anesthesiology and Pain Medicine ,Anesthesia ,Bispectral index ,Anesthetic ,Mental Recall ,Female ,medicine.symptom ,business ,Complication ,medicine.drug - Abstract
Intraoperative awareness is defined as the spontaneous recall of an event occurring during general anesthesia. A move away from rigid anesthetic protocols, which were designed to limit drug transmission across the placenta, has reduced the incidence of awareness during cesarean delivery to approximately 0.26%. Nevertheless, it remains an undesirable complication with potential for the development of posttraumatic stress disorder. Assessing depth of anesthesia remains a challenge for the anesthesia provider as clinical signs are unreliable and there is no sensitive and specific monitor. Bispectral Index monitoring with the goal of scores more...
- Published
- 2009
48. Sensory testing of spinal anaesthesia for caesarean section: differential block and variability
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H. McLure, E. Watkins, Malachy O. Columb, M. Kocarev, and Gordon Lyons
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Adult ,Anesthesia, Epidural ,medicine.medical_treatment ,Block (permutation group theory) ,Sensation ,Sensory system ,Sensory analysis ,Anesthesia, Spinal ,law.invention ,Phenylephrine ,Stimulus modality ,Nerve Fibers ,Randomized controlled trial ,law ,Pregnancy ,Monitoring, Intraoperative ,medicine ,Anesthesia, Obstetrical ,Humans ,Vasoconstrictor Agents ,Caesarean section ,Pain Measurement ,Ephedrine ,business.industry ,Cesarean Section ,Infant, Newborn ,Obstetrics and Gynecology ,Reproducibility of Results ,Nerve Block ,Anesthesiology and Pain Medicine ,Friedman test ,Anesthesia ,Nerve block ,Female ,business - Abstract
The aim of this study was to determine if sensory block following spinal anaesthesia, measured with a range of devices, corresponded to the hierarchy of nerve fibre size in the area of differential block, and to compare the distribution and variability of recorded measurements.Women with singleton pregnancies36 weeks of gestation undergoing elective caesarean section under combined spinal-epidural anaesthesia were recruited. An identical spinal anaesthetic was given to all. A single researcher with no clinical role assessed block height at 20 min from the time of spinal injection. Six tests were used in random order to measure four sensory modalities: ethyl chloride (cold), calibrated Neuropen (sharp), standardized monofilament 10 g (pressure), Neurotip stroking (light touch), monofilament stroking (light touch), cotton wool (light touch). The cost of each method of testing was noted.The median differences between the four modalities were significant (Friedman test, P0.0001), but paired tests failed to find significant differences between Neuropen (sharp) and monofilament (pressure), monofilament (pressure) and Neurotip (light touch), and between tests for light touch. The tests for light touch had the least dermatomal spread and produced a unimodal distribution. The coefficient of variation was highest with ethyl chloride (24.1%) and the lowest with cotton wool (10.4%).Sensory fibre hierarchy could be identified. Tests for light touch showed the least variability. More expensive tests do not appear to have any advantage over the least expensive test, cotton wool. more...
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- 2008
49. Hyaluronidase reduces local anaesthetic volumes for sub-Tenon's anaesthesia
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Malachy O. Columb, C. Sri-Chandana, H. A. McLure, Gordon Lyons, and H. E. Schulenburg
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Chemosis ,Male ,medicine.medical_specialty ,Lidocaine ,medicine.drug_class ,medicine.medical_treatment ,Hyaluronoglucosaminidase ,Cataract Extraction ,Drug Administration Schedule ,Sequential allocation ,Double-Blind Method ,Hyaluronidase ,medicine ,Humans ,Anesthetics, Local ,Aged ,Pain Measurement ,Aged, 80 and over ,Local anaesthetic ,business.industry ,Local anesthetic ,Nerve Block ,Cataract surgery ,Middle Aged ,Confidence interval ,Surgery ,Anesthesiology and Pain Medicine ,Ambulatory Surgical Procedures ,Anesthesia ,Female ,sense organs ,medicine.symptom ,business ,medicine.drug - Abstract
Background Volumes of local anaesthetics for sub-Tenon's anaesthesia vary. Lower volumes produce less akinesia, whereas higher volumes increase chemosis and intra-ocular pressures. Hyaluronidase is often added to local anaesthetics to improve akinesia without increasing the volume of the injection, but this is controversial. This randomized, sequential allocation study examines the addition of hyaluronidase on the minimum local anaesthetic volume (MLAV) required for a sub-Tenon's block. Methods Sixty-two patients having sub-Tenon's blocks for cataract surgery were randomized into two groups. The control group (n=31) received 2% w/v lidocaine and the study group (n=31) received 2% w/v lidocaine with hyaluronidase 15 IU ml−1. Using parallel up–down sequential allocation from a 4 ml starting volume, the volumes in both groups were changed using a testing interval of 1 ml according to the quality of globe akinesia. The median effective local anaesthetic volume (MLAV) was calculated for both groups using probit regression. Results The groups were similar for age, sex, and ocular axial length. The MLAV in the hyaluronidase group was 2.6 ml [95% confidence interval (CI), 2.1–3.l] and 6.4 ml (95% CI, 5.1–8.1) in the control group (P Conclusions Hyaluronidase permits a significant 2.4-fold (95% CI, 1.8–3.4) reduction in MLAV for sub-Tenon's anaesthesia. more...
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- 2007
50. Opioid-related narcosis in a woman with myopathy receiving magnesium
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K. Robins and Gordon Lyons
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Adult ,Narcotic Antagonists ,Diagnosis, Differential ,Magnesium Sulfate ,Pre-Eclampsia ,Pregnancy ,Risk Factors ,Naloxone ,medicine ,Humans ,Respiratory system ,Stupor ,Myopathy ,Acidosis ,Morphine ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,Analgesics, Opioid ,Respiratory acidosis ,Proteinuria ,Anesthesiology and Pain Medicine ,Opioid ,Anesthesia ,Hypertension ,Analgesia, Obstetrical ,Anticonvulsants ,Female ,Acidosis, Respiratory ,medicine.symptom ,Blood Gas Analysis ,Complication ,business ,medicine.drug ,Myopathies, Structural, Congenital - Abstract
An Asian multiparous woman weighing 47 kg, who suffered from a rare myopathy, congenital fibre type disproportion, was given morphine 10 mg intramuscularly for labour analgesia. After delivery, she had diastolic hypertension and proteinuria and was prescribed magnesium sulphate. Some hours later she became unresponsive with little respiratory effort. Blood gas analysis revealed a respiratory acidosis. Naloxone administration reversed the symptoms. Further doses were required as the respiratory depression recurred. Opioid-related narcosis is the most likely diagnosis in this case. Other possible differential diagnoses were magnesium overdose or a post-ictal state. The presence of a myopathy could render this patient susceptible to the respiratory effects of opioids. Other explanations for an exaggerated and delayed response to opioids include co-administration of other respiratory depressant drugs such as magnesium sulphate, co-morbidity such as renal impairment and genetic variability in the metabolism of morphine. Robust guidelines and highlighting patients with risk factors are required to prevent this complication from recurring. more...
- Published
- 2007
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