Biomedical subjects

J Kellett

Publications and source records attributed to J Kellett.

41 records · Page 3Linked to original sources

PubMedDate not supplied

Cannonball metastases with favourable prognosis.

BACKGROUND: Secondary 'cannonball' metastases to the lung are frequent and usually associated with disseminated malignancy and poor prognosis. AIM: To report the case of a patient with metastatic pulmonary endometrial stromal sarcoma who had a previous hysterectomy for benign uterine fibroids and no past history of malignancy. RESULT: A 70-year-old female presented with cannonball metastases in her lung. Four years previously she had a hysterectomy for 'fibroids'. Review of the original histology revealed endometrial stromal sarcoma, similar to the lung metastasis. She currently has a good prognosis. CONCLUSION: A patient with 'cannonball' metastases can have a favourable prognosis. A female patient with a previous hysterectomy for uterine fibroids, should be considered to have metastatic sarcoma until proven otherwise.

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PubMedDate not supplied

Differences between self-referred and physician-referred hospital admissions.

AIM: Compare self- and physician-referred hospital admissions. METHODS: Analysis of data prospectively collected on 3,076 consecutive acute medical admissions to a small hospital. RESULTS: Self-referred patients were younger (50.6 vs. 63.7 years) and more likely to be smokers and drinkers. Conversely, physician-referred patients were more likely to present later, be ex-smokers, ex-drinkers and have poor prior health. More self-referred admissions were related to parasuicide and/or alcohol (27% vs. 4.5%). The physical, x-ray and laboratory findings of both types of patient were similar. Although self-referred patients had a shorter length of stay (3.8 days vs. 6.0 days) and a lower death rate (1.5% vs. 3.8%),they had higher 30-day readmission rates (14.6% vs. 8.5%). CONCLUSION: Self-referred patients are less sick than those referred for hospital admission by a physician, have less psychosocial support, more alcohol-related illness and are nearly twice as likely to be readmitted within 30 days of discharge

Acute Disease↗

PubMedDate not supplied

Assessment of dementia in elderly outpatients: a comparative study of European centers and consensus statement.

Large numbers of elderly patients, suspected of having dementia, need medical evaluation, often in early phases of their illness. A complete outpatient assessment clearly could be advantageous. Thirty-five centers from 15 European countries, known to their scientific gerontological and geriatric societies to have experience in outpatient care for elderly patients with dementia, participated in an effort to develop a consensus statement for the assessment needs of these patients. The comparison of the centers showed that a wide variety of approaches was currently in practice. Differences appeared to be mainly based on local facilities and organization. A consensus for diagnostic outpatient assessment was easily reached. Diagnosis should be based on DSM-IV criteria, which requires a standardized assessment (including neuropsychological, functional and technical evaluation) and should be multidisciplinary. An assessment of dementia of elderly outpatients appears to be very feasible - a consensus approach with minimum diagnostic requirements is presented.

Journal Article↗

PubMedDate not supplied

Comparison of "accelerated" tissue plasminogen activator with streptokinase for treatment of suspected myocardial infarction.

PURPOSE: A computerized decision analysis, based on the results of published clinical trials, assessed the risks, benefits, and costs of different thrombolytic regimens for suspected myocardial infarction (MI) throughout the likely range of clinical circumstances. DATA SOURCE: Medline search and articles' bibliographies. STUDY SELECTION: All studies reporting efficacy and side effects of thrombolysis. DATA ANALYSIS: Life-expectancy outcomes of thrombolytic therapies for possible MI modeled by decision analysis. RESULTS: The analysis allows a clinician to estimate the benefits, risks, and relative costs of thrombolytic therapies throughout the likely range of individual clinical circumstances. When applied, for example, to the average patient in ISIS-2, estimated gains are 150 quality-adjusted days of life (QALDs) from treatment with streptokinase (SK) and 255 QALDs with "accelerated" tPA (tPA). tPA costs $1,686 more than SK, taking into account the cost of lifelong care of the extra strokes incurred. Nevertheless, the chances of stroke above which thrombolysis is not preferred are 5.0% for SK and 8.0% for tPA, with tPA remaining the preferred treatment for six hours after symptom onset; thereafter, SK is marginally preferred, but at much lower cost. Both regimens are beneficial in older patients provided the chances of MI and death are "average" or greater. CONCLUSION: When the chances of MI and death are known, decision analysis can be a useful bedside tool to guide thrombolytic therapy and subsequently, if needed, to review and defend the treatment decisions made.

Adult↗

PubMedDate not supplied

Decision support and the appropriate use of fibrinolysis in myocardial infarction.

CONTEXT: For patients with suspected acute myocardial infarction, decisions about fibrinolytic therapy must account for trade-offs between risks and benefits, which vary according to the clinical characteristics of the patient. OBJECTIVE: To assess whether use of a decision-support computer program (DSCP) improves the selection of appropriate candidates for fibrinolytic therapy among patients with suspected acute myocardial infarction. DESIGN: Before-and-after trial at a small rural hospital in Ireland. INTERVENTION: DSCP based on a previously published decision-analysis model. With input of patient characteristics (e.g., age, sex, duration of symptoms, findings on electrocardiography) at initial evaluation, the DSCP predicts the likelihood of different outcomes (e.g., mortality, stroke) and life expectancy with and without fibrinolysis. PATIENTS: 894 consecutive patients (262 before DSCP was introduced, 632 after) admitted to the coronary care unit with suspected acute myocardial infarction between January 1993 and July 1999. OUTCOME MEASURES: Proportion of appropriate candidates (ST-segment elevation > 2 mm on electrocardiogram, symptom duration < or = 6 hours) receiving fibrinolysis before and after implementation of DSCP. RESULTS: In general, patients admitted before and after DSCP implementation had similar clinical characteristics. The preintervention group presented somewhat earlier after the onset of symptoms (5.4 hours for preintervention vs. 7.2 hours for postintervention; P < 0.01) but had fewer confirmed acute myocardial infarctions (32% vs. 38%; P = 0.13). The proportion of appropriate patients receiving fibrinolysis before and after DSCP was nearly identical (66.7% vs. 68.9%; P > 0.2). Patients who received fibrinolysis after implementation of DSCP tended to be older (66.7 years vs. 63.8 years; P = 0.11) and were more likely to be female (36% vs. 26%; P > 0.2) than those who received fibrinolysis before DSCP implementation. The door-to-needle time decreased significantly from 88 minutes to 67 minutes after implementation of DSCP (P < 0.01). CONCLUSION: Although overall rates of fibrinolysis did not change after implementation of DSCP, fibrinolytics may have been more appropriately directed toward higher risk patients who may be more likely to benefit from them.

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