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Search Results: 1 - 10 of 10147 matches for " Charles Gomersall "
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Critical care in the developing world - a challenge for us all
Charles D Gomersall
Critical Care , 2010, DOI: 10.1186/cc8871
Abstract: The paper in the previous issue by Du and colleagues [1] describing critical care in China illustrates the increasing recognition and provision of critical care that follows economic development. Given that the two countries with the most rapid economic development, China and India, are also the two most populous countries in the world, this translates into a huge potential demand for critical care.There are, however, a number of hurdles that need to be overcome in order to develop high quality intensive care, and the sheer size of the problem is mind-boggling: there are close to 2.9 million hospital beds in China. Current nursing provision in China is low, with a nurse:bed ratio of 1.37-2.02:1. This compares unfavourably with Western Europe, where 65% of ICUs surveyed in 1996 reported higher ratios [2]. Moreover, critical care training of both nurses and doctors is limited. The authors highlight the fact that, while knowledge of state of the art advances is relatively easily acquired from conferences, basic knowledge and skills are inadequately taught.Are these problems just for our colleagues in the developing world to deal with? The answer surely must be 'no'. Patients are patients whatever their nationality and, as such, we have a responsibility to help improve care beyond the confines of our own ICUs. So, how can we help? First we have to understand the problem by seeking more data on critical care outside developed countries. Papers such as that by Du and colleagues are a useful starting point and should be encouraged by journal editors. A worldwide registry of ICUs could provide even more useful and detailed data and a collaborative project to develop such a registry is currently underway [3]. Second, we can make educational material more widely available. This requires a change in attitude to intellectual property and sharing of resources. Why teach a handful of trainees in your unit when you could teach hundreds across the world? Why do we hand over copyrig
Pro/con clinical debate: Steroids are a key component in the treatment of SARS
Charles D Gomersall, Marcus J Kargel, Stephen E Lapinsky
Critical Care , 2004, DOI: 10.1186/cc2452
Abstract: Unfortunately, in the winter of 2004 SARS (severe acute respiratory syndrome) emerges in the world once again, and health care workers in your institution begin to develop the illness. Patients with SARS start to develop critical illness and you are asked to become involved in their care. You have read that during the first outbreak of SARS steroids were a commonly employed therapy. Despite this you worry about the adverse effects of steroid therapy, especially in critically ill patients.Charles D GomersallSARS is a potentially life-threatening disease caused by infection with SARS coronavirus. The early phase of the disease appears to be due to the virus itself whereas the later phase is thought to be due to an inflammatory response. Quantitative reverse transcriptase polymerase chain reaction of nasopharyngeal aspirates has shown that the viral load peaks at about 10 days from symptom onset [1], and serum concentrations of IL-6, IL-8, IL-16 and tumour necrosis factor-α are most markedly raised 8–14 days from disease onset [2]. In addition, the histological changes in the lungs of patients who died from SARS suggest cytokine dysregulation [3]. Thus, the available data suggest that the clinical manifestations of SARS in the second week of illness are predominantly due to an excessive immune response to viral infection rather than to infection itself. Because admission to the intensive care unit (ICU) occurs 8–9 days after symptom onset and the median duration of ICU stay is 8.5–14.5 days [4-6], it is likely that most critically ill patients are in this immunological phase. Therefore, a logical approach is to modify the immune response with anti-inflammatory agents such as corticosteroids.The majority of critically ill patients with SARS develop acute respiratory distress syndrome (ARDS); not only do the vast majority meet the criteria for ARDS [4-6] but also computed tomography of the lungs 22–54 days after the onset of ARDS shows changes consistent with late phase
Acute Mountain Sickness
Tim Gomersall
Scottish Universities Medical Journal , 2012,
Abstract: Tens of thousands of people are attracted to high altitude environments around the world every year either to experience a unique landscape or to revel in the satisfaction of a successful summit attempt. Doctors working in or around these locations will encounter altitude illness in a variety of forms. Indeed as mountaineering, skiing and rock climbing continue to be popular activities the prevalence of AMS remains at a high level.
Critical care resource allocation: trying to PREEDICCT outcomes without a crystal ball
Michael D Christian, Robert Fowler, Matthew P Muller, Charles Gomersall, Charles L Sprung, Nathaniel Hupert, David Fisman, Andrew Tillyard, David Zygun, John C Marshal, PREEDICCT Study Group
Critical Care , 2013, DOI: 10.1186/cc11842
Abstract: The International Forum of Acute Care Trialists (InFACT) was formed in 2009 and provided a platform for international critical care research collaboration during the 2009/10 influenza A(H1N1) pandemic [12]. Over the past 2 years, a number of working groups have emerged from InFACT focused upon improving the investigation and care of patients with severe respiratory illness. Arising from these efforts, in June 2012 an inter-national group of clinicians convened the first meeting of the Providing Resources for Effective and Ethical Decisions In Critical Care Triage (PREEDICCT) Study Group. The study group's aim is to develop decision support tools appropriate for triaging critically ill adult patients during epidemics, mass-casualty scenarios or other resource-limited settings. This meeting identified a number of knowledge gaps and research priorities in this area, and suggested a revised framework for the requirements of an adequate triage decision support tool.While purpose-built triage protocols focus on specific events (for example, pandemics), resource allocation decisions are part of everyday practice for critical care physicians worldwide. Several PREEDICCT members work in settings where there are chronically insufficient critical care resources to meet the demand [13]. Critical care physicians also make resource allocation decisions every day in high-income countries, as they decide who might benefit from ICU care, when to accept outside transfers and when insufficient capacity dictates external transfer of patients. Yet intensivists lack objective tools to support these decision-making processes. Further, practices and specific decisions are likely to vary widely by country, by hospital and by individual provider.The first significant shift in direction advocated by our group is to move away from attempting to use a physiologic score alone to predict outcomes. The rationale for basing triage tools on a physiologic score is that all critically ill patients com
Making moral decisions when resources are limited – an approach to triage in ICU patients with respiratory failure
GM Joynt, CD Gomersall
Southern African Journal of Critical Care , 2005,
Abstract: In a number of countries around the world there is evidence that the demand for intensive care unit (ICU) resources exceeds supply.1-5 Epidemiological evidence suggests that future demands on intensive care resources will increase, adding to the burden of provision.6 Southern Africa almost certainly faces similar challenges, although there is as yet little published medical literature documenting this.7 When ICU resources are critically constrained, there is an inevitable need to ration the use of ICU beds. This means that while some patients who will potentially benefit from ICU care will be able to receive it, others will not. Assuming an absolute deficiency of ICU resources (available beds and their accompanying manpower requirement, equipment and other resources), the inevitable consequence is that some deserving patients will be denied potentially life-saving ICU care. A critically important decision must therefore be made – which patients will be admitted and which patients will be refused ICU care, and on what basis. A structured process of decision making is vital to maximise consistency and the moral defensibility of these difficult decisions. This paper will describe possible approaches to making these decisions, discuss aspects of triage in patients with respiratory failure, and examine some of the consequences of ICU triage. SAJCC Vol. 21 (1) 2005: pp. 34-44
Expansion of Fairtrade Products in Chinese Market
Kathryn Gomersall,Mark Yaolin Wang
Journal of Sustainable Development , 2011, DOI: 10.5539/jsd.v5n1p23
Abstract: The consumption of Fairtrade goods in the developed world has gained in popularity over the last two decades, but Fairtrade products have only recently entered markets in China. While Western consumers’ attitudes to consumption of Fairtrade products have been well studied, little attention has been paid to the arrival of such concepts to the Chinese domestic market. This paper aims to begin to fill this gap by investigating Chinese consumers’ level of awareness and understanding of the Fairtrade concepts and whether the level of willingness to pay extra for Fairtrade products is associated with consumers’ socioeconomic characteristics. This paper reveals that the current level of awareness and understanding of Fairtrade principles in China is low. The level of willingness to pay extra is not closely associated with income level but with level of awareness and understanding of Fairtrade principles.
The selection of search sources influences the findings of a systematic review of people’s views: a case study in public health
Claire Stansfield, Josephine Kavanagh, Rebecca Rees, Alan Gomersall, James Thomas
BMC Medical Research Methodology , 2012, DOI: 10.1186/1471-2288-12-55
Abstract: The contribution of 25 search sources in locating 28 studies included within a systematic review on UK children’s views of body size, shape and weight was analysed retrospectively. The impact of utilising seven search sources chosen to identify UK-based literature on the review’s findings was assessed.Over a sixth (5 out of 28) of the studies were located only through supplementary searches of three sources. These five studies were of a disproportionally high quality compared with the other studies in the review. The retrieval of these studies added direction, detail and strength to the overall findings of the review. All studies in the review were located within 21 search sources. Precision for 21 sources ranged from 0.21% to 1.64%.For reducing geographical bias and increasing the coverage and context-specificity of systematic reviews of people’s perspectives and experiences, searching that is sensitive and aimed at reducing geographical bias in database sources is recommended.Systematic reviews of people’s views, understandings, beliefs and experiences (‘views studies’) are valuable to policy-makers in providing contextual information on interventions to inform their development, implementation and evaluation [1]. We describe ‘views studies’ as those that are centred on people’s own voices; these are often qualitative, but not always [1]. Undertaking a systematic literature search for these studies contributes to the rigour and quality of the review findings, but the process of identifying research on people’s views can be challenging. Studies on people’s views tend to be dispersed across a range of subject disciplines, are diverse in their terminology, and exist in various publication formats. People’s views of public health issues potentially cross over the fields of social science, the environment, health and medicine, education and psychology. They are contained across a range of literature search sources from large ubiquitous databases to smaller specialised
Efficacy of a synbiotic chewable tablet in the prevention of antibiotic-associated diarrhea  [PDF]
Charles Spielholz
Health (Health) , 2011, DOI: 10.4236/health.2011.32020
Abstract: Infection by Clostridium difficile, a complication of treatment with antibiotics, causes antibiotic- associated diarrhea (AAD) and can lead to colitis and pseudomembranous colitis. Incidence of C. difficile infection is increasing among the elderly undergoing antibiotics therapy confined to health care facilities, conditions that are expensive to treat, decrease the quality of life and are life threatening. Use of probiotics has been proposed as a method to decrease the incidence of AAD in health care facilities. To examine the efficacy of using probiotics, 120 nursing home residents undergoing antibiotic therapy were provided with a synbiotic tablet containing two probiotics, Saccharomyces boulardii and Bacillus coagulans, and a prebiotic, fructooligosaccharide. Residents were evaluated retrospectively for AAD and C. difficile infection. It was found that 95% of residents treated with antibiotics and taking the synbiotic tablet were free of AAD. More than 97% of the residents did not become infected with C. difficile. No adverse effects were reported. Minor side effects, gastrointestinal upset and nausea, were reported by less than 6% of the residents. The cause of the minor side effects was not known. Only 2.5% of the residents stopped taking the synbiotic tablet because of the gastrointestinal upset. These Results suggest that use of the synbiotic tablet prevents AAD and C. difficile infection in nursing home residents undergoing antibiotic therapy. It is concluded that this synbiotic tablet provides an easy to administer and safe approach to controlling AAD and C. difficile infection in residents in nursing homes.
Towards a Global Carbon Integrity System: Learning from the GFC1 and avoiding a GCC2  [PDF]
Charles Sampford
Low Carbon Economy (LCE) , 2011, DOI: 10.4236/lce.2011.24026
Abstract: This paper examines some of the central globalethical and governance challenges of climate change and carbon emissions reduction in relation to globalization, the ‘global financial crisis’ (GFC), and unsustainable conceptions of the ‘good life’,and argues in favour ofthe development of a global carbon ‘integrity system’. It is argued that a fundamental driver of our climate problems is the incipient spread of an unsustainable Western version of the ‘good life’, whereresource-intensive, high-carbon western lifestyles,although frequently criticized as unsustainable and deeply unsatisfying, appear to have established anunearned ethical legitimacy.While the ultimate solution to climate change is the development of low carbon lifestyles, the paper argues that it is also important that economic incentives support and stimulate that search: the sustainable versions of the good life provide an ethical pull, whilst the incentives provide an economic push. Yet, if we are going to secure sustainable low carbon lifestyles, it is argued, we need more than the ethical pull and the economic push. Each needs to be institutionalized – built into the governance of global, regional, national, sub-regional, corporate and professional institutions. Where currently weakness in each exacerbates the weaknesses in others,it is argued that governance reform is required in all areas supporting sustainable, low carbon versions of the good life.
Belief Structures, Common Policy Space and Health Care Reform: A Q Methodology Study  [PDF]
Charles Wilf
Psychology (PSYCH) , 2011, DOI: 10.4236/psych.2011.29143
Abstract: Debate on the merits of health care reform continues even after passage of the Affordable Care Act of 2010. Poll results confirm a split along political party and associated ideological lines with democrats more supportive and republicans generally opposed to the law. As parts of the law are now subject to increasing scrutiny, it may be instructive to question whether a party-centered or surrogate liberal/conservative dichotomy is the best representation of positions in the health care debate. Q Methodology reveals a more complex set of belief structures, suggesting that a simple dichotomy is misleading in terms of the values that underlie the role of health care in society. Five distinct belief structures were found, each with different concerns as to the purpose and potential benefits of various health care initiatives. In addition, Q Methodology allows for the formation of a common policy space within which all belief structures are independently in agreement in four specific areas. It is argued that this empirically derived consensus can serve as a basis for effective political engagement and policy implementation.
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