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Biomedical subjects

B D Harrison

Publications and source records attributed to B D Harrison.

At least 19 recordsLinked to original sources
PubMed1992

A criterion based audit of inpatient asthma care. Closing the feedback loop.

We have assessed the care of patients admitted to a specialist respiratory medical ward acutely ill with asthma, using a criterion based audit derived from a standard management protocol already in use in our hospitals. The audit was first performed from 01.01.90 to 31.08.90; after implementing certain changes, the audit was repeated from 1.12.90 to 31.1.91. Special attention was paid in each audit review to pre-admission measures, inpatient management and pre-discharge and follow-up management. During both audit periods, of a total of 78 patients, 74 patients gave a reason for the worsening of their asthma; 59 had had PEF measured and 58 had received systemic steroids before admission; 77 patients had full objective assessment of severity on admission; 76 patients were discharged on oral steroids; 62 had PEF meters for home monitoring; and 65 of the 68 patients who lived in our district were seen again within six weeks as outpatients in the chest clinic. However, only 30/55 (54%) had PEF variability of 20% or less (our criterion for appropriateness of discharge, in the first audit period) and only 32/55 had a written check on their inhaler technique in the first audit period. By relaxing our PEF criterion for discharge (in line with national guidelines), by introducing a stamp for recording that inhaler technique had been checked, and with encouragement and exhortation from senior staff, we improved our performance of meeting the set standards to 17 of 23 (74%) patients for PEF variability and to 22 of 23 (96%) patients for written check on inhaler technique in the second audit period.(ABSTRACT TRUNCATED AT 250 WORDS)

Aftercare↗
PubMed1991

Audit in respiratory disease.

Respiratory medical audit is discussed in terms of Structure, Process and Outcome with a description of the audit Feedback Loop of monitoring, assessment, improvement followed by further monitoring and assessment. Methods of monitoring include sentinel case, criterion-based, small group comparison, surveys and peer review. There are professional, social and pragmatic reasons for audit which is the responsibility of the provider professionals and requires adequate resources.

Humans↗
PubMed1991

Airflow limitation in sarcoidosis--a study of pulmonary function in 107 patients with newly diagnosed disease.

One hundred and seven patients with sarcoidosis attended for pulmonary function testing within 2 weeks of diagnosis. In four Stage 0, 42 Stage I, 32 Stage II, 26 Stage III and three Stage IV patients physiological abnormalities increased with increasing stage. The commonest abnormality, airflow limitation, occurred in 61 patients; a low transfer factor occurred in 29; a restrictive defect, the least common abnormality, occurred in seven. Fifty-nine patients and 30 of those with evidence of airways obstruction never smoked. None of the 52 patients with airflow limitation tested after bronchodilator inhalation demonstrated significant reversibility. All patients with obstruction had evidence of small airways narrowing. The majority had an FEV1/FVC ratio below 75%. Fourteen patients also had a low peak expiratory flow indicative of large airway narrowing. Airflow limitation occurs in all stages of sarcoidosis and should always be looked for in patients with sarcoidosis who have respiratory symptoms.

Adult↗
PubMed1991

Nuclear location of the 16K non-structural protein of tobacco rattle virus.

An antiserum, elicited by a synthetic peptide coupled to bovine serum albumin, reacted specifically with the non-structural 16K protein of tobacco rattle virus. The protein was detected in extracts of systemically infected Nicotiana clevelandii leaves, but only in those made with the aid of SDS, urea and 2-mercaptoethanol. Immunogold labelling of ultrathin sections showed that the protein was mainly associated with nuclei, but was also present in the cytoplasm. These observations suggest that the 16K protein binds to macromolecular components of infected cells, especially in nuclei, but do not clarify its function.

Amino Acid Sequence↗
PubMed1990

The outcome of community acquired pneumonia treated on the intensive care unit.

Eighteen patients with community acquired pneumonia required intensive care for severe or progressive hypoxaemia, rising arterial carbon dioxide tension or respiratory arrest, and 17 received intermittent positive pressure ventilation. Thirteen survived to leave hospital and 12 are long term survivors. Ventilation was started within 4 days of admission in all cases and was continued for up to 34 days; six patients required ventilation for over 3 weeks. The most common medical complication was renal failure. The most common iatrogenic complication was pneumothorax. We believe that all the hypoxic patients would have died from their hypoxia had it not been corrected. We estimated that up to 5% of patients admitted with community acquired pneumonia need intensive care. This study demonstrates the effectiveness of such care, which is multidisciplinary, demanding, and may need to be prolonged.

Carbon Dioxide↗
PubMed1990

Bronchoscopic and bronchographic findings in 12 patients with sarcoidosis and severe or progressive airways obstruction.

Twelve patients (8 men), aged 33-67 (mean 49) years, with histologically proved sarcoidosis underwent bronchoscopy. All had symptoms, signs (wheeze in 11, high pitched inspiratory "squeaks" in six, stridor in three), and physiological abnormalities characteristic of severe or worsening airways obstruction. Eleven patients also underwent bronchography. At the time of bronchoscopy four patients had stage II, one stage III, and seven stage IV sarcoidosis. All patients had a peak expiratory flow (PEF) of 70% predicted or less and a maximum expiratory flow at 50% (MEF50) and 25% (MEF25) of vital capacity below 35% predicted. The ratio of their forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ranged from 37% to 65%. Fibreoptic bronchoscopy showed single or multiple areas of segmental bronchial stenoses in 10 patients, two of whom had stenotic webs. Bronchography showed that the sites and severity of stenoses were more widespread than suspected from the bronchoscopic findings. Five of the 11 patients undergoing bronchography had bronchiectasis, which was restricted to the upper lobes in three and a lower lobe in one and affected both upper and lower lobes in one patient. The bronchiectasis had not been suspected or diagnosed from the chest radiography or the bronchoscopy.

Adult↗
PubMed1990

An attempt to determine the optimal duration of hospital stay following a severe attack of asthma.

The optimal duration of hospital stay following admission for acute severe asthma is difficult to determine. An asthmatic is at particularly high risk of sudden death in the 6-12 weeks after admission, and too early hospital discharge may add to this risk. Thirty patients hospitalised for severe asthma recorded peak flows thrice daily for 8 weeks following discharge. Peak flow charts were reviewed at monthly intervals, and dips were divided into 'minor' (peak flow less than 75% of the patient's best), 'major' (less than 50%) and 'catastrophic' (less than 30%). Fourteen of the 30 patients had major dips (including 4 who had catastrophic dips as well). Four of these 14 patients were readmitted with acute severe asthma during the 8 weeks follow-up period; in contrast, none of the 16 patients without major dips required readmission. The only in-hospital factor that correlated with and was predictive of (p less than 0.001) multiple major dips post-discharge was the peak flow variability in the 24 hours before discharge, defined as [(highest-lowest peak flow)/highest] x 100. Thirteen of the 14 patients with major dips had pre-discharge peak flow variation greater than 20% compared with only 2 of the 16 without major dips. We believe it is unwise to discharge asthmatics from hospital until the diurnal variation in their peak flow is below 20%. Discharging them before this target is reached puts them at increased risk of further severe attacks of asthma requiring re-hospitalisation.

Acute Disease↗
PubMed1989

Prediction of microbial aetiology at admission to hospital for pneumonia from the presenting clinical features. British Thoracic Society Pneumonia Research Subcommittee.

The selection of initial antimicrobial treatment in a patient with community acquired pneumonia is an important clinical decision. Because this decision is usually made before the results of specific microbiological tests are available, we attempted to determine how well the presenting clinical features would allow prediction of microbial aetiology in 441 adults admitted to hospital with pneumonia. Five of 90 variable available on admission were selected for inclusion in a multivariate discriminant function analysis because of their strong association with one or more of the major aetiological subsets (Mycoplasma pneumoniae, Streptococcus pneumoniae, "other," and undetermined). These variables were age, number of days ill before admission, presence or absence of bloody sputum and of lobar infiltration on chest radiograph, and white blood cell count. The microbial aetiology was correctly predicted by this discriminant function analysis in only 42% of cases, which gives a quantitative estimate of the degree of difficulty encountered in determining the microbial aetiology at the time of admission for pneumonia. When a similar discriminant function analysis was applied to the third of patients in whom the microbial aetiology was never determined, most of these cases were predicted to be due to Streptococcus pneumoniae.

Adolescent↗
PubMed1988

Molecular variation in vector-borne plant viruses: epidemiological significance.

Patterns of variation are examined in four groups of plant viruses, with special reference to their particle proteins and to changes in vector transmissibility and specificity. In the nepoviruses and potyviruses, non-circulative transmission, by nematodes and aphids respectively, seems dependent on structural features on the surface of the virus particles. The N-terminal part of the particle protein may play the key role in potyviruses. Similarly in the luteoviruses, and possibly in the geminiviruses, specificity of circulative transmission by aphids, whiteflies and leafhoppers is linked to the antigenic specificity of the virus particles. Among naturally occurring isolates of the same virus, variation seems often to be discontinuous, and is predominantly of two sorts. Minor variations, characterized by loss of an epitope or substitutions of a few amino acids, can be associated with loss of transmissibility in luteoviruses and potyviruses, or have no effect. Major variations are associated with differences in vector specificity and seem likely to involve radical genetic changes that have evolved over long periods. The adaptation of virus particle proteins for transmission by vectors probably results in conservation of the genes that encode them, and in greater conservation of some parts of these genes than of others.

Amino Acid Sequence↗
PubMed1988

Lymphocytic interstitial pneumonitis in association with Sjogren's syndrome.

We describe a patient with Sjogren's syndrome who developed what appeared to be fibrosing alveolitis. Transbronchial lung biopsy indicated lymphocytic interstitial pneumonitis (LIP), rather than fibrosing alveolitis, which was treated successfully with steroids. Both conditions are well recognized in association with Sjogren's syndrome and the distinction is important in view of the good response to therapy of LIP.

Diagnosis, Differential↗
PubMed1986

Need for intravenous hydrocortisone in addition to oral prednisolone in patients admitted to hospital with severe asthma without ventilatory failure.

52 severely ill asthmatic patients requiring acute admission to hospital entered a double-blind placebo-controlled trial to determine whether intravenous hydrocortisone given in addition to high-dose oral prednisolone and standard bronchodilator therapy accelerated recovery. Patients who had been given parenteral steroids before admission, by comparison with those who had not received such treatment, had been deteriorating for a shorter period before admission, had received more injected or nebulised bronchodilator therapy, and had higher admission peak flows. As judged by peak flow measurements 24 h after admission, parenteral steroids had no effect on the outcome, irrespective of whether they were given before or after (ie, intravenous hydrocortisone) admission. There is no evidence for the continued use of intravenous hydrocortisone in addition to oral prednisolone and bronchodilator therapy in patients admitted to hospital with severe asthma without ventilatory failure.

Acute Disease↗
PubMed1979

Changes in arterial blood gases during and after a period of oxygen breathing in patients with chronic hypercapnic respiratory failure and in patients with asthma.

1. Ten patients with chronic hypercapnic respiratory failure (group 1) and eight patients with asthma (group 2) breathed pure O2 from an MC mask for 60 min. Blood gases were measured during this period and for the subsequent 45 min. 2. In mine of ten patients in group 1 and in all eight patients in group 2 arterial O2 tension (Pa,O2) fell to values lower than had been obtained before O2 was given. 3. These undershoots in Pa,O2 are unrelated to changing CO2 stores or to hypoventilation, and are more likely due to persistence of altered ventilation-perfusion ratios associated with O2 breathing. 4. Magnitude of the undershoots is usually small, and periods of less than 15 min of O2 are unlikely to be harmful.

Adolescent↗