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Biomedical subjects

G Jackson

Publications and source records attributed to G Jackson.

At least 37 records · Page 2Linked to original sources
PubMed1997

Information delivery: the provision of written information for patients following coronary angiography and post-discharge management.

To improve management of risk factors in patients diagnosed with significant coronary artery disease after day case angiography, we gave patients a discharge information sheet emphasising the importance of prognostic therapy, risk factors and follow-up. The sheet was evaluated in 40 patients. A nurse talked through the information sheet with the patients after their angiogram and helped to complete relevant sections. One group of patients was given a copy of the sheet to take home, while the second group remained a 'verbal information only' group. Providing written information resulted in improvements in follow-up regarding blood pressure and drug therapy checks, but there was no significant difference between the groups in the follow-up management of cholesterol or in patient awareness of their cholesterol level. Patients were not likely to remember the sheet, even though a nurse had talked them through it, unless it was backed up with a written copy which could be taken away. It became apparent that the vast majority of patients remembered a pictorial representation of the extent of their disease (routinely provided) in contrast to the relatively disappointing numbers (43%) who remembered the information sheet. To evaluate further the importance of content and style in effective information delivery, we are evaluating the combination of written information with a visual representation of the heart.

Coronary Angiography↗
PubMed1996

Is there a cocaine syndrome? Dysmorphic and anthropometric assessment of infants exposed to cocaine.

It was suggested that a "fetal cocaine syndrome" exists. The objective of this study was to systematically investigate whether or not a "cocaine syndrome" exists. The setting was Parkland Memorial Hospital, a large urban public hospital in Dallas, TX, where approximately 15,000 infants are delivered annually. Infants who tested positive by urinalysis for cocaine (n = 25) were included in this study. Controls negative for cocaine (n = 25) were matched to cocaine-exposed infants for estimated gestational age, sex, and race. A standardized dysmorphology examination (135 features) and a series of anthropometric measures (n = 22) were done for each cocaine-exposed and control infant by an observer blinded to drug-exposure status. Fetal growth retardation characterized cocaine-exposed infants. No characteristic pattern of minor dysmorphic or anthropometric features of the face, limbs, or torso was observed among cocaine-exposed infants. Cocaine-exposed infants lack a facial gestalt or torso/limb features that would characterize a syndrome. If a "cocaine syndrome" that can be characterized dysmorphologically and/or anthropometrically exists, its occurrence seems infrequent.

Abnormalities, Drug-Induced↗
PubMed1996

The treatment of common mental disorders by a community team based in primary care: a cost-effectiveness study.

Thirty patients suffering from new episodes of depression or anxiety disorders seen by a hospital-based psychiatric service were matched for severity of illness with 30 patients seen by a community mental health team based upon primary care. These patients were drawn from a total of 108 such patients seen in the community and 57 seen by the hospital service. Clinical and social outcomes were similar in both groups, and neither was clearly superior in terms of quality of clinical information recorded. However, patients treated in the community were seen more quickly, had more continuity of care and were more satisfied with the service. Health services costs were less for those patients treated in the community, because patients were less likely to be admitted. With one atypical patient excluded, treatment by the community team is more cost effective. The greater number of patients seen by the primary-care-based service means that there is no overall cost saving to the NHS.

Adolescent↗
PubMed1996

Feasibility study of respiratory questionnaire and peak flow recordings in autobody shop workers exposed to isocyanate-containing spray paint: observations and limitations.

Diisocyanates, highly reactive monomers which cross-link polyurethane, are the most widely recognized causes of occupational asthma. Many exposed workers are end-users, including autobody spray painters who form a large population at risk. Neither the factors which determine incidence rate nor strategies for control have been adequately studied in this setting. We have conducted a cross-sectional survey of 23 (about one in five) autobody shops in the New Haven area to determine the feasibility of clinical epidemiological studies in this population. Among 102 workers, there was a high rate of airway symptoms consistent with occupational asthma (19.6%). Symptoms were most prevalent among those with the greatest opportunity for exposure (dedicated spray painters) and least among office workers; part-time painters had intermediate rates. Atopy was not associated with risk while smoking seemed to correlate with symptoms. Regular use of air-supplied respirators appeared to be associated with lower risk among workers who painted part- or full-time. We were unable to validate the questionnaire responses with peak expiratory flow record data attempted on a 1/3 sample of the workers. Despite intensive training and effort, subject compliance was limited. Among those who provided adequate data (24 of 38), only two demonstrated unequivocal evidence of labile airways; two others demonstrated lesser changes consistent with an occupational effect on flow rates. There was no clear association between these findings and either questionnaire responses or exposure classification. Overall, the survey suggests that there is a high prevalence of airway symptoms among workers in autobody shops, at least in part due to work-related asthma. However, there is need for both methodological and substantive research in this setting to document rates of occupational asthma and to develop a scientific basis for its effective control.

Asthma↗
PubMed1996

Extra-articular features of benign joint hypermobility syndrome.

To define the phenotype of patients with benign joint hypermobility syndrome (BJHS), we studied 58 consecutive patients (mean age 37 yr) presenting to a rheumatology clinic and 30 controls. Patients underwent rheumatological and ophthalmic examination, hypermobility scoring, echocardiography, measurement of bone mineral density (BMD), and skin thickness, elasticity and light transmissibility. The median hypermobility score was 5/9 Beighton and 31/56 Contompasis. Eighteen (31%) patients complained of significant arthralgia. Six (10%) patients and two (7%) controls had mitral valve prolapse (MVP) (chi(2) = 0.27, P = NS). Neither MVP nor aortic diameters showed a correlation with hypermobility score. There was no significant reduction in BMD. There was a significant correlation between hypermobility and light transmissibility of the skin (r = 0.71, P < 0.0001 Contompasis; r = 0.47, P < 0.05 Beighton) and skin stretchiness (r = 0.49, P < 0.05 Contompasis; r = 0.39, P < 0.05 Beighton). On ophthalmic examination, 14 (41%) patients had upper eyelid laxity. Thus, patients with BJHS do not have an increased prevalence of significant cardiac, bone, skin or eye abnormalities, helping differentiate BJHS from other more serious hereditary disorders of connective tissue.

Adolescent↗
PubMed1996

The latex dilemma: an actual case.

Health care institutions across the country are dealing with a relatively new phenomenon: staff sensitivity to latex. This article presents the issues involved through an actual case and the response of one institution.

Adult↗
PubMed1996

Risk factor management: the cardiologist's perspective.

Risk factors are associated with disease and are not necessarily causative; as they are additive they should not be judged in isolation. Thus, 'mild blood pressure' does not imply a 'mild' risk in a cigarette-smoking, hypertensive diabetic. Cardiologists are usually fortunate, in that they see patients when there is already evidence of disease (ie, when secondary prevention is the issue, which is much less contentious than primary prevention). In the 'whizz-bang' specialty of cardiology, a balloon can remove in a matter of seconds what a lipidologist has toiled over for years. Attention to detail may not come easily in a stressful world: it is the detail of prevention that is likely to slow the progression of disease and induce regression rather than angioplasty or bypass surgery. In the presence of coronary artery disease, the essence of management is the team approach, the patient being the most important member of the team. Furthermore, the factors that need the most concentrated effort include cigarette smoking, hypertension, and hyperlipidaemia. As risk factors are additive, treatment of one should not make another one worse. Some drugs for hypertension can exacerbate hyperlipidaemia or impair glucose tolerance (eg thiazides), while ACE inhibitors can beneficially decrease insulin resistance in diabetes. Therapy must be tailored to the individual, but the overall prognostic benefits of drugs that might have slightly adverse metabolic profiles (such as beta-blockers) must not be ignored. Science is often a loser when faced with the power of marketing. When one risk factor (eg hypertension) is present, it is important to be vigorous in treating other factors (eg hyperlipidaemia) with general advice and support, as well as with specific drug therapy if indicated. There are two individuals that tend to lack education in risk factors--the patient and the cardiologist. The patient is a victim of poor investment in prevention, while the cardiologist is put off by a perceived lack of balance from the medical protagonists.

Adult↗
PubMed1996

Local government reorganisation in Scotland and Wales.

This article describes the new local authority structure that comes into effect in Scotland and Wales on 1 April 1996. The relationship between the new 'unitary' authorities and other administrative areas is discussed briefly and some key demographic data are presented. References are given to other sources of statistical information.

Adolescent↗
PubMed1996

A study of lipid profile before and after coronary artery bypass grafting.

This study was undertaken to establish the variability in the levels of total cholesterol (TC), total triglyceride (TG), low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol before and after coronary artery bypass graft (CABG) surgery, in order to determine postoperatively when an accurate assessment can be made of the lipid status. During a prospective study over 4 months, fasting venous samples were taken pre- and postoperatively on day 5, and in the 4th, 8th and 12th weeks. Ninety-six patients admitted to the cardiothoracic and cardiac wards for CABG were recruited to the study. The mean preoperative levels were: TC 5.94 (+/- 0.1 mmol/l), LDL cholesterol 4.02 (+/- 0.09mmol/l) and HDL cholesterol 1.00 (+/- 0.03mmol/l). These were significantly different (p < 0.01) from the levels on the 5th postoperative day when the mean level of TC was 4.14 (+/- 0.084mmol/l), LDL cholesterol was 2.45 (+/- 0.07mmol/l) and HDL cholesterol was 0.74 (+/- 0.03mmol/l). By the 4th postoperative week, mean TC (5.73 +/- 0.13mmol/l), LDL cholesterol (3.79 +/- 0.14mmol/l) and HDL cholesterol (1.03 +/- 0.04mmol/l) did not vary significantly from the mean preoperative values. There was no significant difference in the mean TG levels pre- and postoperatively. The mean TC, LDL cholesterol and HDL cholesterol rise to preoperative levels by the 4th week after CABG. Thus, an accurate assessment of patients' lipid status can be made from this period. An earlier postoperative assessment may be falsely reassuring.

Adult↗