Biomedical subjects
D R Thompson
Publications and source records attributed to D R Thompson.
Cardiac rehabilitation services in England and Wales: a national survey.
We sent a short postal questionnaire to 244 centres in England and Wales that admitted patients with cardiac conditions. In total, 199 (81%) of the centres claimed to provide a cardiac rehabilitation service. Of these, 25 were randomly selected as a representative sample and visited in order to obtain detailed information concerning the provision of services. Most (18 (72%)) of the centres had commenced their rehabilitation programme within the previous 5 years, usually at the instigation of interested staff. Patient entry to cardiac rehabilitation programmes was restricted; women (who represented only 15% of attenders), elderly people (excluded in 10 (40%) centres), and those with more complex problems, such as angina or heart failure, were under-represented. The central components of all programmes were education and exercise training but there was a wide range in the quantity and quality of service provision. Most (22 (88%)) programmes were hospital out-patient based, one (4%) was hospital in-patient based, one (4%) was community-based and one (4%) was home-based. The staffing and funding of programmes was variable, with 7 (28%) having no identified funding. There are wide variations in the resources currently available for the rehabilitation of patients with coronary heart disease. There is a need for clearer direction of these services, in particular to determine minimum service provision. Guidelines are necessary to give a framework for this relatively new and rapidly expanding service.
Effect of simulated rain, coat length and exposure to natural climatic conditions on the efficacy of a topical formulation of eprinomectin against endoparasites of cattle.
A series of five controlled studies involving 114 cattle were conducted in Australia, North America and the United Kingdom to examine the effect of simulated rain, coat length and exposure to natural climatic conditions, on the efficacy of a topical formulation of eprinomectin against nematode parasites of cattle. In all trials infections were induced with a range of bovine nematode species and treatment was applied when the majority of nematodes were mature. In one study, simulated rain was applied to cattle ending one hour before treatment or beginning one, three or six hours after treatment. In a second study cattle had short (1 cm) or long (3-6 cm) haircoats at the time of treatment. Three other studies were conducted using cattle housed indoors or exposed to various natural climatic conditions. Nematode counts were determined using standard techniques and the efficacy of treatment was assessed relative to vehicle-treated controls. Regardless of the timing of simulated rain relative to treatment, eprinomectin was at least 99.9% effective (P < 0.01) against Haemonchus placei, Ostertagia ostertagi. Trichostrongylus axei and Cooperia spp. There were also no differences (p > 0.10) in efficacy between treatment administered to dry or wet cattle, or treatment administered before or after simulated rainfall. Efficacies against O. ostertagi, T. axei, Cooperia ancophora and Dictyocaulus viviparus were > 99.5% (p < 0.01) regardless of the length of the haircoat at the application site. Exposure of treated cattle to sunshine and precipitation had no effect on anthelmintic efficacy (p > 0.10) with efficacies of greater than 99.5% being maintained against H. placei, O. ostertagi (adult and fourth-stage larvae), T. axei, Cooperia spp., Nematodirus helvetianus (adult and inhibited fourth-stage larvae) and Oesophagostomum radiatum. These findings indicate that eprinomectin (500 micrograms/kg) in a topical formulation is a safe and highly effective nematocide for cattle regardless of their coat length and this high level of efficacy is maintained in cattle exposed to a wide variety of climatic conditions.
Nematocidal efficacy of eprinomectin, delivered topically, in naturally infected cattle.
OBJECTIVE: To assess the nematocidal efficacy of eprinomectin in naturally infected cattle. ANIMALS: 62 (31 eprinomectin-treated and 31 control) beef mixed-breed or Holstein cattle, either 6 to 11 or 48 to 96 months old. PROCEDURE: Cattle were housed 21 to 27 days before treatment to allow parasites to reach maturity. Animals were grouped by sex, ranked by weight, and randomly assigned to treatment group. Fecal flotation was done to identify cattle with intestinal nematode infections. Treatment groups were: 1--eprinomectin topical vehicle (1 ml/10 kg) and 2--eprinomectin topical solution (1 ml/10 kg). Cattle were euthanatized by replicate on day 14 or 15, and standard procedures were used to recover of pulmonary, abomasal, small intestinal, and large intestinal nematodes. RESULTS: Eprinomectin efficacy across all trials was 100% against adult Trichostrongylus axei, Haemonchus placei, Oesophagostomum radiatum, and Dictyocaulus viviparus, as well a fourth-stage larval Oes radiatum, Ostertagia ostertagi, Nematodirus helvetianus, and Cooperia spp. Efficacy against adult O ostertagi, Cooperia oncophora, C punctata, C surnabada, C spatulata, N helvetianus, Trichuris sp, and Trichuris fourth-stage larvae was 99.9 and 99.8, 99.6, 98.9, 98.3, 99.7, 97.8, and 84.3%, respectively. All results were significant (P < 0.01) except those for C spatulata. Adverse reactions were not observed. CONCLUSION AND CLINICAL RELEVANCE: Eprinomectin is a safe and effective nematocide against naturally acquired nematode infections in cattle when administered at a dosage of 500 micrograms/kg. Milk and meat withholding is not necessary when using this product.
Optimizing muscle-to-cardiac timing for aortomyoplasty.
A new surgical approach to support failing hearts is known as aortomyoplasty-a technique in which the latissimus dorsi muscle is wrapped around the aorta and stimulated during cardiac diastole to provide chronic diastolic counterpulsation. We hypothesized that the timing of muscle contraction within the cardiac cycle effects the amount of diastolic augmentation during counterpulsation. In dogs (n = 9, 20-25 kg), the effect of muscle-to-cardiac timing on hemodynamic outcome of aortomyoplasty was measured. Muscle stimulation was initiated at the dicrotic notch and stimulus durations were systematically increased. Mean diastolic aortic pressure was maximized when stimulation terminated at the ensuing R-wave. Peak left-ventricular pressure was minimized when muscle stimulation terminated before the ensuing R-wave. The endocardial-viability ratio (a ratio of aortic diastolic pressure augmentation to left-ventricular pressure reduction) was maximized when stimulus terminated at the ensuing R-wave. Muscle-to-cardiac timing influences the effectiveness of counterpulsation during aortomyoplasty.
Meteorological factors and the time of onset of chest pain in acute myocardial infarction.
Analysis of the time of onset of chest pain in 2254 patients with a myocardial infarction admitted to a coronary care unit in Leicester during a 10-year period shows an association with temperature and humidity. During both the most cold and humid times of the year, the relationship is a strong one. A generalized linear model with a log link was used to fit the data and the backward elimination selection procedure suggested a humid, cold day might help to trigger the occurrence of myocardial infarction. In addition, cold weather was found to have a stronger effect on the male population while those men aged between 50 and 70 years were more sensitive to the effect of high humidity.
Getting research into practice.
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From research to practice: one organizational model for promoting research-based practice.
This paper describes a framework used by the National Institute for Nursing in Oxford to integrate research, development and practice. With the increasing attention given to the topic of how research findings are implemented into clinical practice, it was felt important to share the challenges that have arisen in attempting to combine traditional research activities with more practice-based development work. The emerging conceptual framework, structures and functions are described, highlighting the variety of partnerships to be established in order to achieve the goal of integrating research into practice. While the underpinning principles of the framework-generating knowledge, implementing research into practice and evaluating the effectiveness of programmes-are not new, it is the way they have been combined within an organizational structure that could be helpful to others considering such a strategy. Both the strengths and weaknesses of the framework are discussed, a number of conclusions drawn as to its robustness and consideration given to its replication.
Cardiac rehabilitation in the United Kingdom: guidelines and audit standards. National Institute for Nursing, the British Cardiac Society and the Royal College of Physicians of London.
This paper summarises a multidisciplinary workshop convened to prepare clinical guidelines and audit standards in cardiac rehabilitation in the United Kingdom. The workshop developed a three element model of the rehabilitation process and identified needs relating to medical and psychosocial care and the potential contributions of exercise, education, secondary prevention, and vocational advice. Draft clinical standards are proposed as a basis for locally developed guidelines and further research.
Cardiac rehabilitation: how can it be improved?
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Administration of thrombolytic therapy to patients with acute myocardial infarction.
The publication of large randomised trials such as ISIS 2 (1988) and AIMS (1990), provided striking evidence as to the effectiveness of thrombolytic therapy in reducing early mortality and morbidity in patients suffering acute myocardial infarction. This article will provide an overview of the use of thrombolytic agents in modern cardiac care, with particular reference to their impact on the Accident and Emergency department.
The experiences of patients and their partners 1 month after a heart attack.
The purpose of this study was to explore any patterns that may be evident in the experiences of 20 patients and their partners 1 month after a first heart attack. An interpretive research approach was used to illuminate the illness experience of patients and its impact on their partners. Semi-structured interviews were conducted with the participants, and qualitative analysis of the data revealed six major categories. These were: expectations about advice and information; feelings about the future; reactions of the partner; playing down the significance of the heart attack; wanting to get back to normal; and the effect on the couple's relationship. These findings are discussed in relation to the theoretical literature and other empirical research. The results of this study may provide pointers to the implications for practice of nurses, particularly on ways to improve support for patients and their partners during early convalescence.
Field efficacy of an ivermectin jetting fluid for control of the sheep body louse Bovicola (Damalinia) ovis in New Zealand.
The efficacy of an ivermectin jetting fluid against the sheep body louse, Bovicola (Damalinia) ovis, in long-woolled sheep was investigated in three field trials. In all trials, louse populations in hand-jetted sheep were reduced to nondetectable numbers within 2 weeks of treatment. Bv comparison, shorn and unshorn control sheep maintained detectable infestations for the duration of the trials.
Subclavian venous catheterization: greater success rate for less experienced operators using ultrasound guidance.
OBJECTIVE: To determine if ultrasound guidance can be safely performed and improve success rates for subclavian venous catheterization performed by less experienced operators. DESIGN: Prospective, randomized study. SETTING: Twenty-bed trauma-surgical-medical intensive care unit in a 524-bed, community, tertiary care, teaching hospital. PATIENTS: After the decision for central venous cannulation was made, informed consent was obtained, and less experienced operators then attempted to insert subclavian catheters in 33 critical care patients. INTERVENTIONS: Catheter placements were attempted, either by landmark technique, ultrasound technique, or by landmark attempts with ultrasound salvage. Catheterization techniques to be used were randomized using a random number table. MEASUREMENTS AND MAIN RESULTS: Fifty-three placement procedures were attempted in 33 patients. One procedure was excluded from data analysis. Successful catheterizations, occurrence rates of complications, number of attempts, and number of catheter kits used were recorded. In the analysis, 52 catheterization procedures were studied. Twelve (44%) catheters were successfully placed from 27 attempts using the landmark technique vs. 23 (92%) successful catheterizations during 25 ultrasound procedures (p = .0003). Fifteen failed landmark technique attempts had ultrasound salvage attempted, with 12 (80%) catheters successfully inserted. Eleven complications (minor) occurred in 27 attempts of subclavian venous catheterization using conventional landmark technique vs. one complication (minor) in 25 attempts of subclavian venous catheterization with ultrasound guidance (p = .002). There were no major complications in either group. The landmark group required an average of 2.5 venipunctures and 1.4 catheter kits per attempted catheterization. The ultrasound group required an average of 1.4 venipuncture attempts and 1.0 insertion kit. The statistical significance in differences in groups for the average number of venipunctures was p = .0007 and average number of kits used was p = .0003. CONCLUSIONS: Ultrasound guidance improves the success rate of subclavian venous catheterization performed by less experienced operators. There were no major complications in either group. Ultrasound guidance is usually successful in allowing performance of subclavian venous catheterizations when landmark techniques fail.
Circadian rhythms and the onset of acute myocardial infarction.
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Seasonal variation in heavy metal levels in tissues of common guillemots, Uria aalge from northwest Scotland.
Mercury, cadmium, zinc, and copper concentrations were analyzed in three samples of common guillemot (in April, June, and November). Levels measured were uniformly low, and not enough to have any toxic effects. Adult guillemots had significantly more cadmium in their livers and kidneys than juveniles, with juvenile levels ranging from 25% to 89% of adult levels. Mercury concentrations in liver and kidney were also higher in adults. Juvenile levels represented from 80% to 94% of adults, but there were no age differences in feather and muscle mercury. Mercury levels declined throughout the year in internal tissues from April through June to November. There was a strong seasonal fluctuation in cadmium levels in liver and kidney, rising significantly between April and June and declining in both adult and juvenile birds. The influences of seasonal processes (namely breeding and moult) and seasonal dietary differences as causative factors in the changes in metal burdens are discussed. These findings have implications for the use of seabirds as monitors of heavy metals in the marine environment.
Coronary care unit patients' and nurses' ratings of intensity of ischaemic chest pain.
In 100 patients admitted to a coronary care unit with a history of chest pain thought to be due to myocardial infarction, the intensity of pain was independently rated by the patient and the primary nurse caring for the patient soon after admission. Pain intensity was assessed using a visual analogue scale designed to yield a score of 0-100. 10 experienced coronary care nurses who had participated in a short programme of pain assessment and management were included in the study. A strong positive correlation between the patients' and nurses' ratings was found. Possible explanations for these findings are discussed.
The care and rehabilitation of cardiac patients and their families: a report of a study tour of the USA.
I visited four centres of clinical cardiac care and rehabilitation to examine, compare and discuss the development of nursing research and practice and the application of this knowledge to patients and their families after a heart attack or cardiac surgery. The key areas examined were the organisation of services, specific interventions, and outcome and evaluation criteria. American care and rehabilitation services generally appear to be more directed towards the family and involve a wide range of health professionals from different disciplines. The systems, when compared to their British counterparts, are more structured in terms of organisation, coordination and evaluation, and are more geared towards cost-containment, effectiveness and efficiency. However, although British systems are increasingly emulating the American ones, they are in many respects more innovative, flexible and tailored to individual needs.