St Thomas' Hospital

About: St Thomas' Hospital is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Pregnancy. The organization has 12105 authors who have published 15596 publications receiving 624309 citations. The organization is also known as: St Thomas's Hospital & St. Thomas's.

Melatonin for sleep problems in children with neurodevelopmental disorders: randomised double masked placebo controlled trial.

Abstract: Objective To assess the effectiveness and safety of melatonin in treating severe sleep problems in children with neurodevelopmental disorders. Design 12 week double masked randomised placebo controlled phase III trial. Setting 19 hospitals across England and Wales. Participants 146 children aged 3 years to 15 years 8 months were randomised. They had a range of neurological and developmental disorders and a severe sleep problem that had not responded to a standardised sleep behaviour advice booklet provided to parents four to six weeks before randomisation. A sleep problem was defined as the child not falling asleep within one hour of lights out or having less than six hours’ continuous sleep. Interventions Immediate release melatonin or matching placebo capsules administered 45 minutes before the child’s bedtime for a period of 12 weeks. All children started with a 0.5 mg capsule, which was increased through 2 mg, 6 mg, and 12 mg depending on their response to treatment. Main outcome measures Total sleep time at night after 12 weeks adjusted for baseline recorded in sleep diaries completed by the parent. Secondary outcomes included sleep onset latency, assessments of child behaviour, family functioning, and adverse events. Sleep was measured with diaries and actigraphy. Results Melatonin increased total sleep time by 22.4 minutes (95% confidence interval 0.5 to 44.3 minutes) measured by sleep diaries (n=110) and 13.3 (−15.5 to 42.2) measured by actigraphy (n=59). Melatonin reduced sleep onset latency measured by sleep diaries (−37.5 minutes, −55.3 to −19.7 minutes) and actigraphy (−45.3 minutes, −68.8 to −21.9 minutes) and was most effective for children with the longest sleep latency (P=0.009). Melatonin was associated with earlier waking times than placebo (29.9 minutes, 13.6 to 46.3 minutes). Child behaviour and family functioning outcomes showed some improvement and favoured use of melatonin. Adverse events were mild and similar between the two groups. Conclusions Children gained little additional sleep on melatonin; though they fell asleep significantly faster, waking times became earlier. Child behaviour and family functioning outcomes did not significantly improve. Melatonin was tolerable over this three month period. Comparisons with slow release melatonin preparations or melatonin analogues are required. Trial registration ISRCT No 05534585.

Estimation of changes in cardiac output from the arterial blood pressure waveform in the upper limb

Abstract: We have developed a new pulse contour cardiac output (PulseCO) algorithm based on frequency analysis studies of the arterial system. PulseCO was compared with thermodilution cardiac output (TDCO) in 10 patients undergoing cardiac surgery. Results from one patient were unsuitable for analysis. In the remaining nine patients, 142 TDCO determinations were compared with PulseCO after logarithmic transformation and after being normalized by the initial cardiac output in each patient. Each determination was usually the average of three measurements. Least squares regression gave y=0.77x (r2=0.81) and the limits of agreement were from –26% to +21%. The accuracy of PulseCO in determining short-term changes in cardiac output was assessed by comparing the ratios of consecutive PulseCO determinations with the ratios of the corresponding, consecutive TDCO determinations. Least squares regression gave y=0.71x (r2=0.70) and the limits of agreement were from –21% to +25%. After phenylephrine had been given to five patients, PulseCO showed an increase in systemic vascular resistance consistent with the known pharmacological actions of the drug. The PulseCO algorithm was incorporated into a computer program that acquires arterial pressure data from an analogue-to-digital converter and displays beat-to-beat trend values.

Epidemic methicillin-resistant Staphylococcus aureus

Abstract: We contrast the experiences, in our Health Authority in South-East London, with the particular epidemic methicillin-resistant Staphylococcus aureus (the EMRSA) strain that has recently spread widely around London and South-East England, and with the other MRSA (OMRSA) strains encountered there. Our isolates of the EMRSA were identical by chromosomal restriction enzyme analysis, and the chromosomal and plasmid phenotypes were similar to those described in North London and Eastern Australia. Experimental phage-typing distinguished them from OMRSA encountered in 1984 to 1986. Between 1984 and 1985, the EMRSA caused increased infection and patient colonization compared to the years 1969 to 1983. A change in infection control procedures was usually required to control the EMRSA and in 1986 isolates had returned to their pre-1984 levels. Between 1984 and 1986 OMRSA were still encountered, but did not spread or require changes in infection control procedures. The distribution of other resistant isolates was examined; c 94% of neomycin-resistant isolates were in-patients or clinic patients. Forty-five different phage-type/antibiogram patterns were found in 88 isolates from 66 patients between 1982 and 1985, and patient clusters were uncommon. The ability of the EMRSA to spread is discussed and is probably not purely organism related. Our experience supports the contention that some MRSA are truly epidemic, whilst others do not behave in this manner.