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Biomedical subjects

J Dale

Publications and source records attributed to J Dale.

At least 127 records · Page 7Linked to original sources
PubMed1992

Wound dressings on FP10 and GP10.

Although the full range of wound care products is not available in the community, new items are slowly being added to the list. Nurses have a responsibility to keep up-to-date with developments, particularly since nurse prescribing is imminent. Manufacturers' literature should be read frequently to keep up-to-date with additions and amendments.

Bandages↗
PubMed1991

Safety of high doses of low molecular weight heparin (Fragmin) in acute myocardial infarction. A dose-finding study.

We postulated that low molecular weight heparin (LMWH) in doses producing plasma levels in the range of 0.6-1.0 anti-Xa U/ml may reduce the incidence of left ventricular thrombi (LVT) secondary to acute anterior wall myocardial infarction (AAMI). In an open, dose-finding study, 72 patients with acute myocardial infarction (AMI) were treated with Fragmin (KABI) 240-360 anti-Xa U/kg/24h subcutaneously for 6-10 days. 300 anti-Xa U/kg/24h given as 2 or 3 injections resulted in a mean plasma concentration of about 0.8 anti-a U/ml. There were 3 minor haemorrhages, all in a subgroup of 22 patients also being treated with 0.3 g aspirin orally per day after 1.5 mill. U streptokinase intravenously on admission. In the 38 patients with AAMI receiving 300 anti-Xa U/kg/24h there were only 3 LVT during the period of treatment (8%). In conclusion, 300 anti-Xa U Fragmin/kg/24h s.c to patients with AMI appears safe, but minor haemorrhage may occur in patients receiving aspirin concomitantly. Although these data are limited, the low incidence of LVT in patients with AAMI suggests efficacy of this dose of Fragmin to prevent LVT.

Adult↗
PubMed1991

Half the aggro.

A project at a London hospital is helping to iron out friction between the A&E department and local GPs, write Judith Green and colleagues.

Emergency Service, Hospital↗
PubMed1991

How do nurses working in hospital accident and emergency departments perceive local general practitioners? A study in six English hospitals.

One hundred and forty-three Accident and Emergency nurses working in six departments in contrasting districts of England completed questionnaires about their perception of local general practice. Much of general practice was perceived as being performed unsatisfactorily. Out-of-hours accessibility, caring for patients with 'difficult' or psychosocial problems, advising on health service usage, and minor surgery and first aid were all thought to be performed particularly badly. In addition, there was considerable inter-district variation with the views expressed in inner London being especially negative. To some extent these views may reflect real short-comings in general practice, but they are likely to be coloured by the disproportionate experience A&E departments inevitably have of patients who are dissatisfied in some way with their GP service. In addition, other factors such as departmental 'culture' and the separation that exists between hospital and community health professionals may have an important influence. The effect such negative perceptions have on the relationship between A&E departments and general practitioners, and the quality of care provided to patients attending A&W with primary care problems are discussed.

Attitude of Health Personnel↗
PubMed1991

Trimming energy costs. A well-conceived conservation program can provide significant savings for hospitals.

Healthcare facilities can realize significant savings on their energy costs if they adopt an effective energy management program. For hospitals beginning such a program, an energy audit is a good first step. Auditors observe and evaluate all energy-using systems and study factors that affect energy use. They then write a report containing on-site observations, an analysis of at least one year's energy bills, and recommendations for low-cost and no-cost energy-reducing measures and capital projects, including new installations and retrofits. Lighting is one area where costs can be cut significantly. During the past few years a revolution in lighting technology has provided many choices for new installation and retrofit. Many utility companies have established rebate programs for certain relamping projects. In addition, integrated heating, ventilating, and air-conditioning systems can present hospitals opportunities to improve patient comfort and energy efficiency. Maintaining and upgrading system boilers and chillers and installing equipment designed to adapt efficiently to changing seasonal needs can generate significant energy savings. Improved energy distribution and control systems should also be a part of a hospital's energy management program.

Air Conditioning↗
PubMed1991

Weight change in cardiac transplant patients.

The perception exists that excessive weight gain commonly occurs after cardiac transplantation. To examine this perception, 91 transplant patients from one to eight years post-transplant responded to a questionnaire eliciting data on premorbid and post-transplant weights, exercise frequency, and fat intake. Only 37% of subjects weighed more post-transplant than premorbidly. More than half of the subjects were over their ideal weights premorbidly and post-transplant. On t-test there was no significant difference (p less than .05) between weight gainers and weight losers in exercise frequency (t = .63; p = .53), or fat intake (t = -.80; p = .43). Findings of the study dispute the perception of excessive weight gain post-transplantation. This perception may be due to the comparison of cachectic pre-transplant weight with well weight post-transplant. Since more than half of the subjects were over their ideal weight post-transplantation, teaching regarding weight control remains important. Future research on effective methods of weight control is needed.

Adult↗
PubMed1990

Factors influencing general practitioners' management of psychosocial and physical problems: a study using case vignettes.

The reactions of a random sample of 72 Oxfordshire general practitioners to case vignettes illustrating psychosocial and physical presentations were assessed with a set of attitude rating scales. Two main underlying factors appeared to influence responses. The first reflected positive attitudes to both physical and psychosocial problems, and was associated with postgraduate experience in psychiatry and with older age. The second, reflecting measures of flexibility and responsibility for outcome, was associated with younger age and not having received vocational training. Other characteristics of the practitioners and their practices were not significantly related to these factors, and there was considerable unexplained variance. In addition, certain sex differences emerged: men general practitioners rated their ability to manage cases more highly than did their women colleagues, while women practitioners experienced more anxiety. These findings suggest that personal traits and qualities may remain a stronger determinant of general practitioners' reactions to patients' problems than formal training and qualifications.

Adult↗
PubMed1989

[Streptokinase treatment in acute myocardial infarction].

Myocardial necrosis develops gradually after coronary artery occlusion, and in man is completed after several hours. Most infarctions are precipitated by thrombi, and early fibrinolytic treatment should therefore be the rational therapy. Recanalization is achieved in three of four patients whether streptokinase is applied intracoronary or intravenously. Early treatment limits the size of the infarct, and he myocardial function is preserved better in patients treated with streptokinase than in others. Very early treatment, started within one hour from the onset of nitroglycerin-resistant chest pain, may prevent infarction in some patients. Streptokinase reduces mortality after infarction, in total by as much as 25 per cent, and even considerably more when infusion is started early. There is some risk of bleeding, but serious bleeding episodes are rare. Intracoronary application has no advantages as compared with intravenous infusion. Unless there are strong contra-indications, patients with nitroglycerin-resistant chest pain and abnormal ECG should receive streptokinase intravenously in a dose of 1.5 x 10(6) units. Most patients treated with streptokinase should be given acetylsalicylic acid.

Humans↗
PubMed1989

Psychiatric diagnoses in patients who have chronic fatigue syndrome.

Patients with persistent fatigue are often suspected of having psychiatric illnesses, particularly depression. The authors used the Diagnostic Interview Schedule to assess the lifetime prevalence of psychiatric disorders in 28 patients who met Centers for Disease Control case definition criteria for chronic fatigue syndrome. Compared with studies of the general population and studies of chronically medically ill patients who received the same structured interview, the rates of psychiatric illness in patients with the chronic fatigue syndrome appeared high. An examination of the medical histories of the 28 patients indicated that psychiatric disorders more often preceded the chronic fatigue than followed it.

Adult↗
PubMed1988

Effect of very early intravenous streptokinase infusion in patients with evolving myocardial infarction.

The effect of very early infusion of 1.5 X 10(6) U of streptokinase intravenously was studied in 29 patients with nitroglycerin-resistant chest pain and ST-segment elevation. Infarct size was estimated from maximal LD1 isoenzyme levels, and the diagnosis confirmed by CK-MB determination. Thrombolytic therapy was started within 1 hour of pain onset in 11 patients (group A), between 1 and 2 hours in 10 (group B), and later than 2 hours in eight patients (group C). Marked differences appeared between the groups. Thus, three patients in group A and one patient in group B did not develop infarction, all had critical LAD stenoses. Three patients in group C died in shock without bleeding. Further, the average maximal LD1 values in the 22 patients who survived their infarction differed significantly between the groups, and were 12.6, 19.1 and 36.2 mu kat/l in groups A, B and C, respectively. In conclusion, very early intravenous streptokinase infusion probably reduces myocardial necrosis, and possible prevents infarction in some patients.

Adult↗
PubMed1987

Hemostasis after open-heart surgery with extreme or moderate hemodilution.

Patients who received aortic disc valves during cardiopulmonary bypass (CPB) with extreme hemodilution, obtained with preoperative blood withdrawal, infusion of acetate solution and use of blood-free priming fluid, bled less than patients operated with moderate dilution. One hour after CPB with extreme dilution when the autologous blood had been reinfused, platelet adhesiveness was twice as high as in the moderate dilution group. Other parameters of platelet function, coagulation and fibrinolysis did not differ between the groups. The higher number of reactive platelets may therefore have contributed to the improved hemostasis after extreme dilution. Later, thrombocytosis with hyperreactive platelets and hyperfibrinogenemia developed in all patients. This might predispose for thrombosis.

Aortic Valve↗
PubMed1987

Failure of combined acetylsalicylic acid and dipyridamole to prevent occlusion of aortocoronary venous bypass graft.

Patients scheduled to receive at least three aortocoronary venous bypass grafts were randomized to active medication or to placebo. The former were given dipyridamole (DP) preoperatively and acetylsalicylic acid (ASA) was added after the operation. For the next 3 months they received DP 75 mg and ASA 325 mg thrice daily. The placebo regimen was identical and the study was conducted with double-blind technique. One patient in each group died. DP-ASA was discontinued in six patients because of gastrointestinal side effects (bleeding peptic ulcer in 2 cases). Angiography after 3 months revealed the patency rate of individual grafts to be 68% in the DP-ASA group and 77% in the placebo group. DP-ASA therefore did not prevent occlusion of aortocoronary venous bypass grafts.

Aspirin↗
PubMed1987

Determination of cardiac output with a modified Fick method using estimated instead of measured oxygen consumption.

Cardiac output (CO) was determined with a modification of the Fick method using estimated, instead of measured, oxygen consumption values. This avoids several possible sources of error in connection with air sampling and oxygen content analysis, thus a relaxed, steady state is obtained more easily. Using the thermodilution technique a good correlation with CO values was found (r = 0.92, p less than 0.001). We conclude that the modified Fick method is simple, accurate and offers reproducible CO estimates in the majority of patients.

Adolescent↗