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Biomedical subjects

E Wright

Publications and source records attributed to E Wright.

At least 163 records · Page 9Linked to original sources
PubMed1975

Observer agreement in evaluating coronary angiograms.

The reliability of interpretation of coronary arteriography as a diagnostic tool was investigated in a sub-study of the VA Cooperative Study of Surgical Treatment for Coronary Arterial Occlusive Disease. Twenty-two physicians with varying levels of experience read 13 cine angiograms -- blind -- on two different occasions. Analysis of inter- and intraobserver variability showed that angiographic items about which observers were most inconsistent from one reading to the other had the largest interobserver disagreement as well. They were the distal portions of the left anterior descending and left circumflex arteries. Among the items on which there was most consistent agreement -- namely, the right main coronary artery and presence of ventricular aneurysm -- there was most often agreement between observers as well. When individual readers were evaluated, some observers were far more consistent in their own readings of all the angiographic items than others. This intraobserver agreement in turn correlated fairly well with how often they agreed with the other observers and with how much experience they reported having in reading coronary cineangiograms.

Angina Pectoris↗
PubMedDate not supplied

Cholesterol levels in normal Irish adults: the Mater Hospital Cholesterol Screening Survey.

Serum samples from 954 Irish adults (604 males, 350 females) aged 18 to 65 years were analyzed within 24 hours of receipt for non-fasting total serum cholesterol levels. The subjects were volunteer blood donors (Blood Transfusion Service Board, Pelican House, Dublin) presenting from June 1990 to February 1991. Serum cholesterol increased significantly with age in both males and females. Mean serum cholesterol in males increased from 4.5 (+/- 0.9) mmol/l in those < 25 years, to 5.7 (+/- 1.0) mmol/l at age 55-64 years. In females, mean serum cholesterol increased from 4.3 (+/- 0.9) mmol/l less than 25 years to 6.2 (+/- 0.8) mmol/l at age 55-64 years. Options for reporting cholesterol ranges are discussed. The overall mean cholesterol concentration of 5.1 mmol/l seen in this study is lower than that reported for comparable studies of U.K. and American subjects, but higher than observed in Japanese individuals. Almost 48% of the studied population had a serum cholesterol value less than 5 mmol/l and over 56% had levels less than 5.2 mmol/l.

Adolescent↗
PubMedDate not supplied

Idiopathic gait disorder among in-patients with acquired gait disorders admitted to a children's hospital.

Many children are admitted to hospital for treatment of an acquired gait disorder. Some gait disorders have a definite underlying physical cause and some are idiopathic. A literature review shows that there have been few attempts to estimate the incidence or prevalence of idiopathic gait disorder in children. The economic and social impact may be substantial with regard to therapy and investigations and school absence, respectively. This study attempted to estimate the incidence and impact of idiopathic gait disorder in a tertiary children's hospital. It evaluated prospectively all the children admitted with a gait disorder requiring physiotherapy treatment at Birmingham Children's Hospital, using a standardized pro-forma, during a 3-month period between March-June 1999. One hundred and three children (aged 2-16 years) were admitted with gait disorders (57 female and 46 male). Eight had an idiopathic gait disorder. All eight children exhibited significant functional impairment, pain and school absence. Idiopathic gait disorder accounted for 8% of children admitted to hospital with an acquired gait disorder and had an annual incidence of at least 2-4 per 100,000 children. The economic and social impact of these disorders is, therefore, substantial, especially with regard to diagnosis, investigations, treatment and school absence.

Adolescent↗
PubMedDate not supplied

Abnormal electrical stimulus of an intra-aortic balloon pump with concurrent support with continuous veno-venous hemodialysis.

Malfunction of electronic medical support apparatus utilized in the ICU usually causes system failure. We report several occurrences of a potentially dangerous interaction between a continuous veno-venous hemodialysis (CVVHD) system and an intra-aortic balloon pump (IABP) counterpulsation device in four patients requiring both systems. The patients had acute renal failure in the face of multi-organ failure and were dependent upon the balloon pump for pressure support. Electrical interference created by the roller pump action of the CVVHD system was identified by the balloon pump as cardiac in origin, and it responded by inflation and deflation. As the blood pump rate was reduced, the interference reduced to the point of complete cessation when the blood pump was shut down. Whereas one patient transiently had a significant drop of mean arterial pressure (from 70 +/- 4 to 40 +/- 2 mm Hg) the other observed occurrences had no clinically significant sequelae. Electrocardiogram (ECG) tracings identified the abnormal stimulus and systematic review identified as potential sources for the creation of this interference static electricity buildup, piezoelectric properties of the polyvinyl chloride tubing, and, possibly but less likely, radiofrequency interference. A newer generation ECG cable and advanced cardiac rhythm recognition software (CardioSync) have been introduced with the Datascope System 98, and the ECG interference, although still occasionally present, does not cause erratic inflation and deflation of the intra-aortic balloon pump. Interference between different electrical support systems may occur, and we suggest that the systems be tested for compatibility before combined use and that older equipment be more rigorously tested for potential clinically significant interference.

Aged↗
PubMedDate not supplied

Introduction of a switch that can reverse blood flow direction on-line during hemodialysis.

In several circumstances in hemodialysis, the regular direction of blood flow has to be reversed or changed, such as in access dysfunction or insufficient blood flow being obtained through the arterial port, as well as to measure actual access blood flow in fistulas or grafts by using the formula Qa = Qb((1-R)/R), where R represents recirculation in the reversed line configuration. We invented a disposable switch device made from standard blood line tubing that can be introduced into the dialysis circuit and allows for on-line reversal of lines, without needing to manually disconnect and reconnect tubing or interrupt the hemodialysis procedure. Over a period of eight months, 16 patients (8 arteriovenous fistula, 8 PTFE) underwent 193 hemodialysis sessions with the switch in place. Circuit pressures, pump, and actual blood flows measured with ultrasound dilution were monitored before and after reversing the lines. Switching was accomplished within 1-2 seconds. Arterial circuit (r = 0.99), venous circuit pressures (r = 0.6), and actual pump flow (364 +/- 56 vs. 350 +/- 57 ml/min; r = 0.73) correlated very well preswitching and postswitching (p < 0.0001). Dialysis circuit flow measured with an ultrasound dilution technique decreased from 364 +/- 56 (230-480) ml/min preswitching to 350 +/- 57 (220-490) ml/min postswitching (p < 0.001). No difficulties or complications were observed. This switch device is a useful addition to the technology of hemodialysis in that it greatly facilitates the procedure of reversing the lines in an extracorporeal circuit while not significantly interfering with circuit pressures and connections.

Blood Circulation↗
PubMedDate not supplied

Screening for retinopathy of prematurity: are a lid speculum and scleral indentation necessary?

We wanted to investigate the value of using a lid speculum and scleral indentation in performing binocular indirect ophthalmoscopy (BIO) in neonates at risk of retinopathy of prematurity (ROP). We performed a prospective masked comparison of BIO examinations using either a lid speculum and scleral indentation (SI) or no scleral indentation (NSI), in our neonatal intensive care unit. We did 57 consecutive BIO examinations of infants weighing less than 1500 g and/or having a gestational age of less than 32 weeks. With NSI, zone I ROP was reliably seen in 53 of 57 examinations; the superior, nasal, and temporal aspects of zone II were seen in 45 of 57 examinations; inferior zone II, in 22 of 57 examinations; and zone III in 1 of 57 examinations. SI facilitated complete peripheral fundus examination in all cases but had to be abandoned in two infants due to acute changes in oxygen saturation levels. Five infants developed threshold disease, and in two of them details of the active ROP ridge were missed with NSI. The gentle use of an eyelid speculum and globe rotation allows rapid and relatively atraumatic assessment of the peripheral fundus, even in babies who are being ventilated. Although threshold ROP may be diagnosed by observation of posterior retinal vessel dilation and tortuosity ("plus" disease), accurate grading of ROP is likely to require SI. In the absence of clearly developed "plus" disease, borderline or prethreshold disease may occasionally be missed using BIO with NSI. SI is necessary to examine the inferior midperipheral retinal vasculature (zone II) and the far peripheral temporal retina (zone III) and is associated with few complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Fundus Oculi↗
PubMedDate not supplied

Registered nurses' opionions on an extended role concept.

Using a Likert-type questionnaire, opinions of 800 professional registered nurses in Texas, selected at random, were surveyed on the extended role concept as reflected by the family nurse clinician (FNC). Thirty percent of the questionnaires were returned and used for data analysis. The survey found that the nurses' years of nursing experience, employment status, field of employment, and education background influenced their opinions on the extent they thought the FNC could assume the defined responsibilities, the areas of the health care delivery system in which the FNC could exert a positive influence, and anticipated problem areas for the practicing FNC. Strongly supportive of the role, the nurses favored the FNC's assuming considerable responsibility in the delivery of primary health care.

Attitude of Health Personnel↗