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Biomedical subjects

J Ward

Publications and source records attributed to J Ward.

At least 271 records · Page 15Linked to original sources
PubMed1990

Atrioventricular Wenckebach point and progression to atrioventricular block in sinoatrial disease.

The value of measurement of the atrioventricular (AV) Wenckebach point at rest as a predictor of progression to AV block was investigated prospectively. Twenty-four patients with sinoatrial disease without evidence of conduction disturbance on 12-lead ECG or 24-hour ambulatory monitoring were paced with Medtronic Activitrax II, Medtronic Legend, or Telectronics Meta MV systems in AAI or AAIR modes. Patients were monitored for symptoms and evidence of AV block on 24-hour tapes. The mean age of the patients was 67 years (range: 42-88). There were 11 males and 13 females. The mean follow-up time was 10.7 +/- 5 months. Four patients required revision of pacing system as a result of development of AV block during follow-up. One other patient manifested intermittent second-degree AV block and remains in AAI. The AV Wenckebach points measured at 1 month postimplantation in the four patients who developed AV block requiring revision of system were 140, 125, 165, and 60 (mean 123 +/- 4). The mean AV Wenckebach point at first assessment in the remaining 20 patients was 153 +/- 24. The mean age of those requiring revision of system was 71 +/- 7 compared with 67 +/- 14 in those who did not. In this small series the frequency of development of significant AV block was 17%. This is markedly higher than in other recently reported series. The study demonstrates that an AV Wenckebach point above 120/min does not confer immunity from progression to AV block.

Adult↗
PubMed1990

Moclobemide versus placebo in the treatment of depression: a multicentre study in Belgium.

Moclobemide was compared with placebo for antidepressant activity, tolerance and safety in 2 parallel groups of 23 and 24 depressed patients. At the end of treatment (4 weeks or longer), 9 patients on moclobemide (41%) showed an improvement greater than or equal to 50% on the Hamilton Rating Scale for Depression, compared with only 4 (17%) of those on placebo. The overall assessment of efficacy was significantly better for moclobemide (good or very good results in 50% of patients) than for placebo (80% poor results). Moclobemide was well or very well tolerated by 85% of patients and placebo by 100%. Moclobemide was thus shown to be clearly more effective than placebo and only slightly less well tolerated.

Antidepressive Agents↗
PubMed1990

Moclobemide versus amitriptyline in the treatment of depression: two small double-blind multicentre studies in Belgium.

Moclobemide was compared with amitriptyline for antidepressant efficacy, safety and tolerance. Two studies were conducted, both over at least 4 weeks; in the first, 8 patients were given moclobemide in doses ranging from 300 to 328 mg, and 9 patients amitriptyline in doses of 75 to 96 mg; in the second, the numbers were 13 on moclobemide and 14 on amitriptyline, and the mean doses were 294-408 mg and 95-129 mg respectively. Both studies showed the 2 treatments to be equally effective, and there were no significant differences at any point. Moclobemide appeared slightly more effective and slightly better tolerated than amitriptyline, but the numbers were too small for any valid conclusion.

Adult↗
PubMed1989

Trauma malpractice claims related to trauma level designation.

The purpose of the present study was to review a one-state experience (Arizona) with trauma malpractice claims as a function of hospital trauma level designation. A total of 191 cases covering 7 years was reviewed and analyzed. Three categories of treatment facilities were compared: American College of Surgeons-categorized Level I hospitals, all other hospitals, and outpatient treatment facilities. Only 22 percent of the malpractice claims were found in Level I facilities, whereas 58 percent were found in other hospitals and 20 percent came from outpatient facilities. Not surprisingly, the indemnity awards were more than two times higher in other hospitals than in Level I hospitals. However, the legal dollars spent in defense per claim were two times higher in Level I than either outpatient hospitals or outpatient treatment facilities, suggesting that Level I malpractice claims are more defensible. We have identified six areas of high potential liability and have made some suggestions for the reduction of risk management in those areas.

Arizona↗
PubMed1989

Fusimotor mechanisms determining the afferent output of muscle spindles.

There is both direct and indirect evidence that stretch activation occurs in the dynamic bag1 fibres of the mammalian muscle spindle and that it is responsible for maintaining the high sensitivity of primary sensory endings in stretches great enough to break the resting actomyosin bonds responsible for the short-range stiffness of muscle fibres. However the direct observations of dynamic bag1 fibre behaviour during stretching were made on damaged fibres and during very slow stretches. Preliminary results of experiments employing faster stretches of intact muscle spindles are reported here. An image processing system is being developed to automate and facilitate analysis of sarcomere movements during stretch, release and activation of intrafusal fibres. Unequivocal evidence confirming the development of stretch activation has not yet been found. Boyd (1986a) believed that static bag2 and chain fibres are controlled by separate populations of static gamma motoneurones, while accepting that there is some degree of common innervation. His evidence and the functional implications are discussed.

Animals↗
PubMed1989

Predictive risk factors for periannular extension of native valve endocarditis. Clinical and echocardiographic analyses.

The study objective is to identify clinical, microbiologic, and/or echocardiographic risk factors present early in the course of native valve endocarditis that predict subsequent development of periannular extension of infection. A multivariate computer-generated analysis of 21 clinical-microbiologic parameters and 11 two-dimensional echocardiographic parameters in patients with native valve endocarditis was designed. These parameters were statistically compared in operated-on patients with native valve endocarditis with and without periannular extension of infection. The study took place in a 600-bed acute-care, nonreferral, municipal hospital primarily servicing an indigent patient population. Seventy-three documented episodes of native valve endocarditis occurred between the years of 1973 and 1987, including 29 operated-on patients with surgically confirmed periannular extension of infection and 44 operated-on patients without periannular extension of infection. Multivariate logistic-regression analyses of multiple clinical, microbiologic, and echocardiographic parameters which are potentially predictive of eventual periannular extension of native valve endocarditis were carried out. The only two independent parameters that significantly predicted periannular infection among patients with native valve endocarditis were (1) aortic valve involvement and (2) abuse of intravenous (IV) drugs (p less than 0.01; p less than 0.01, respectively, multivariate analysis). The relative risk of developing periannular extension of endocarditis among patients with aortic valve involvement and/or IV drug abuse was increased by approximately 2.5-fold compared with patients without these characteristics. Factors not significantly associated with increased risk of periannular extension of native valve endocarditis included the following: prolonged febrile morbidity; Staphylococcus aureus etiology; or two-dimensional echocardiographic demonstration of vegetations, large vegetations (greater than or equal to 1 cm), multiple vegetations, or enlargement of aortic root or annulus. These data suggest that patients with native aortic valve endocarditis, particularly in the setting of IV drug abuse, should be considered for routine, serial noninvasive evaluation for the early detection of periannular extension of their infection.

Adult↗
PubMed1989

Self perceived standards of care in women's health. An illustrative case.

This article compares the reality of cervical cancer screening rates in general practice with doctors' self perceived standards of care. It also examines other aspects of women's health care as revealed in a random sample of New South Wales general practitioners. The implications for continuing medical education and quality assurance are discussed.

Attitude of Health Personnel↗