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Biomedical subjects

F Knight

Publications and source records attributed to F Knight.

At least 19 recordsLinked to original sources
PubMed2005

Retrospective observational case-control study comparing prehospital thrombolytic therapy for ST-elevation myocardial infarction with in-hospital thrombolytic therapy for patients from same area.

OBJECTIVES: To compare a system of prehospital thrombolytic therapy, delivered by paramedics under medical guidance, with in-hospital thrombolytic therapy in meeting National Service Framework (NSF) targets for treatment of acute myocardial infarction at a District General Hospital setting in England. DESIGN: Retrospective observational case-control study comparing patients with suspected acute myocardial infarction (AMI) treated with thrombolytic therapy in the prehospital environment with patients treated in hospital. SETTING: Wyre Forest District and Worcestershire Royal Hospital, UK. PARTICIPANTS: (A) All patients who received prehospital thrombolytic therapy for suspected AMI accompanied by electrocardiographic features considered diagnostic.(B) Patients who received thrombolytic therapy after arrival at hospital for the same indication, matched with group A by age, gender and postcode. MAIN OUTCOME MEASURES: 1. Call to needle time. 2. Percentage of patients treated within one hour of calling for medical help. 3. Appropriateness of thrombolytic therapy. 4. Safety of thrombolytic therapy RESULTS: 1. The median call to needle time for patients treated before arriving in hospital (n = 27) was 40 minutes with an inter-quartile range 25-112 (mean 43 minutes). Patients from the same area who were treated in hospital (n = 27) had a median time of 106 minutes with an inter-quartile range 50-285 (mean 126 minutes). This represents a median time saved by prehospital treatment of 66 minutes. 2. 60 minutes after medical contact, 96 % of patients treated before arrival in hospital had received thrombolytic therapy; this compares with 4% of patients from similar areas treated in hospital. 3. Myocardial infarction was confirmed in 92% (25/27) of patients who received prehospital thrombolytic therapy and similarly 92% (25/27) of those given in-hospital thrombolytic therapy. 4. No major bleeding occurred in either group. Group A suffered fewer in-hospital deaths than group B (1 versus 4). Cardiogenic shock (3 patients) and ventricular arrhythmia (5 patients) were seen only in group B. CONCLUSION: Paramedic-delivered thrombolytic therapy can be delivered appropriately, safely, and effectively. Time gains are substantial and can meet the national targets for early thrombolytic therapy in the majority of patients.

Electrocardiography↗
PubMed1998

Adolescent issues in renal treatment.

Everyone who helps to care for a growing and developing child has the potential to impact the future. Families provide the greatest influence and bear the major responsibility, but physicians, nurses, dietitians, social workers, teachers, camp counselors, and others who work with children make a direct contribution toward the development of the child's self image and image of the world around them. At no other time in an individual's life do other people have such awesome power and responsibility. Families and caregivers working together on behalf of a child may be likened to an extended family; their combined efforts are needed to help promote the resilience that children need to cope with serious chronic illness.

Adolescent↗
PubMed1996

A pilot study of the introduction of audit into nursing homes.

In 1993, all 37 private nursing homes in Mid-Staffordshire were invited to take part in this study, and 16 agreed. Over 1 year, a nurse audit facilitator visited these homes to teach staff, and stimulate and assist with audit projects. At the beginning and end of the 12-month period, the residents were assessed by administered questionnaires and by the short Geriatric Depression Scale. Thirteen of the 16 homes undertook at least one audit project during the study (ten of these had never previously carried out audit). Ten homes made at least one major procedural change during the study. Of the 570 residents of the 16 homes, 138 answered both questionnaires. The main reasons for non-inclusion were poor mental and physical conditions. Satisfaction levels improved significantly in six out of the 11 aspects of care studied. The mean Geriatric Depression Score in these 138 residents fell from 4.73 at the start, to 4.25 at the end of the study (p = 0.02). The fall in the mean score was significantly greater in the ten homes that had made at least one major change (from 4.40 to 3.81) than in the six homes that had made no major change (from 5.33 to 5.17). The introduction of audit into co-operative private nursing homes is associated with improvements in the standards of care, but it is uncertain whether this is a direct consequence of the audit carried out, or is due to the non-specific effects of an outside assessor visiting the homes. There is a need for methods of assessment that can be applied to higher proportions of nursing home residents.

Activities of Daily Living↗
PubMed1994

Epidemiology of behavioral and emotional problems among children of Jamaica and the United States: parent reports for ages 6 to 11.

Research on child behavior problems requires standardized methodology in order to identify similarities and differences between societies. The present study compared parent-reported behavior problems of 360 Jamaican and 946 U.S. children aged 6 to 11. It revealed few differences in individual, total, internalizing (e.g., depression), and externalizing (e.g., fighting) problem scores as a function of nationality, gender, or age. Findings from this and other studies indicate the feasibility of a common methodology in cross-national studies of children's problems, but also the need for further refinement.

Affective Symptoms↗
PubMed1993

Hemodialysis of the infant or small child with chronic renal failure.

Hemodialysis of the infant or small child with chronic renal failure is often considered technically difficult or impossible. At Children's Hospital, however, chronic hemodialysis has proved to be safe and effective, and a vital component in the overall care of these complex patients. Although the ultimate goal is renal transplantation, chronic hemodialysis can provide an excellent primary or alternative treatment when peritoneal dialysis has failed or is not an option.

Age Factors↗
PubMed1992

Jamaican and American adult perspectives on child psychopathology: further exploration of the threshold model.

Although several factors determine whether children receive psychological intervention, cultural determinants may be particularly influential. Cultural factors may influence adults' levels of concern over child psychopathology. This possibility was explored by comparing adult attitudes in two socioculturally different societies. Jamaican and American parents, teachers, and clinicians (total N = 382) judged vignettes of two children, one with overcontrolled (e.g., fearfulness) and one with undercontrolled (e.g., fighting) problems. Regression analyses revealed that although years of education affected some adult ratings, culture had the most profound effect.

Attitude↗
PubMed1992

A peer support group for adolescent dialysis patients.

Adolescents with chronic renal failure face unique problems often best understood by peers with the same condition. An adolescent peer support group can be a valuable tool to foster peer relationships and enhance self-esteem. Moreover, nurses can learn to be effective group leaders.

Adolescent↗
PubMed1990

GM-1 treatment of Alzheimer's disease. A pilot study of safety and efficacy.

A double-blind, placebo-controlled pilot study was conducted to evaluate the safety and efficacy of treatment of patients with Alzheimer's disease using monosialoganglioside GM-1, a neurotrophic factor. Of 46 patients enrolled, 42 completed all study requirements. Nineteen patients received 100 mg of GM-1 by daily intramuscular injection for 12 weeks. Twenty-three patients received placebo. Case evaluations were done at baseline, week 12, and week 24 and included both cognitive and psychosocial scales. Study results suggested that the treatment was safe, yet offered no overall symptomatic benefit to patients with mild-to-moderate Alzheimer's disease. Whether or not GM-1 therapy may offer protective benefit by slowing or arresting the progression of the disease remains unclear, since the results of the cognitive evaluations suggested that neither the GM-1 group nor the placebo group declined significantly during the 24-week study.

Affect↗
PubMed1989

Over- and undercontrolled clinic referral problems of Jamaican and American children and adolescents: the culture general and the culture specific.

Child behavior problems and corresponding clinic referral patterns may be significantly influenced by cultural factors. Prevailing values and childrearing practices within a culture may discourage development of some child problems while fostering others. We explored this possibility, focusing on clinic referral problems of two different societies: (a) Jamaica, where the Afro-British culture discourages child aggression and other undercontrolled behavior and possibly fosters inhibition and other overcontrolled behavior, and (b) the United States, where undercontrolled child behavior is seemingly more generally accepted. We coded clinic-referred problems listed by parents of Jamaican and American youngsters (N = 720). Cross-cultural differences were striking: Overcontrolled problems were noted more often for Jamaican than American youngsters, whereas the converse was true for undercontrolled problems. These and other findings suggest that factors such as culture and sex may be linked to substantial differences in the problems for which youngsters of different countries are treated in clinics.

Adolescent↗
PubMed1986

Measuring liver span. Bedside examination versus ultrasound and scintiscan.

In 75 hospital patients an estimation of liver span was made independently by students (I), fellows (II), and consultants (III). These bedside estimates were made three times at full inspiration in a right parasagittal line one third of the sternal length from the midline by palpation, direct, and indirect percussion. These bedside estimates were compared to each other and to ultrasound in full inspiration in the supine position and to scintiscan in quiet respiration. We found that bedside estimate of liver span by direct percussion was accurate as ultrasound, but that indirect percussion estimate of liver span was inaccurate. Scintiscanning during quiet respiration over-estimates the liver span in comparison to ultrasound. Previous suggestions that clinical estimates of liver span should be abandoned may be in error.

Humans↗
PubMed1976

Role of cannabis in psychiatric disturbance.

Clinical observation suggests that cannabis is implicated in some types of psychiatric disturbance. A record of admissions to two urban and four rural hospitals in Jamaica is examined along with details of individual cases. One-third of male admissions to the psychiatric hospital have used cannabis. Of 74 males admitted to another psychiatric service over a 12-month period, 29 had used cannabis. Ten of these patients were diagnosed as "ganja psychosis," and four others were classified as "marijuana-modified mania." At another psychiatric service, 54 of 223 admissions (24.2%) for functional psychosis presented with cannabis usage as a comtributory factor. These 54 patients included 14 and seven cases of hypomanic and depressive reactions, respectively. At three other rural general hospitals, psychiatric admissions for psychosis showed 11 of 51, seven of 18, and 39 of 75 patients, respectively, in whom cannabis was considered directly responsible. These findings lend support to the idea of causation of illness or modification of existing illness. The negative findings of controlled studies in the same country are not inconsistent. A suggested classification for adverse reactions to cannabis offered by one author is recommended, because it is in accord with common local clinical experience.

Adult↗