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Biomedical subjects

J Wright

Publications and source records attributed to J Wright.

At least 253 records · Page 14Linked to original sources
PubMed1997

Characteristics of female victims of assault attending a Scottish accident and emergency department.

OBJECTIVE: To compare the characteristics of female victims of assault with those of male victims and to see if there is a difference between female victims of domestic assault and females assaulted by strangers or acquaintances. DESIGN: A two month prospective study (June and July 1995) of all assault victims attending a Scottish accident and emergency (A&E) department. SETTING: A large district general A&E department (the Royal Alexandra Hospital in Paisley) seeing 60,000 new patients per year with a catchment population of 200,000. RESULTS: 46 female victims of violence attended the A&E department (20% of the total of 235). In comparison with men, women were more likely to be assaulted in their homes (48% v 10%; P < 0.001), but were less likely to be assaulted with sharp weapons (7% v 28%; P = 0.003) and to require admission to hospital (P = 0.005). Nineteen women (41%) were victims of domestic assault. The victims of domestic assault were more likely to have been drinking (11% v 31%; P = 0.007) and to have a history of previous assault (63% v 22%; P = 0.002). This group also had a higher mean deprivation score and rate of unemployment, although the differences were not statistically significant. CONCLUSIONS: A&E staff should be aware of risk factors associated with domestic assault to aid recognition of victims. Using the current British Association for Accident and Emergency Medicine guidelines on domestic violence and closer liaison with police, social services, and general practitioners will help prevent further attacks.

Adolescent↗
PubMed1997

Coronary artery bypass graft surgery in dialysis patients.

OBJECTIVE: To examine the short term results and long term survival of patients on long term dialysis undergoing coronary artery bypass graft surgery. METHODS: A retrospective analysis of 19 patients on established dialysis who underwent coronary revascularisation between 1983 and 1995; 14 patients (73%) had class IV angina and five (25%) had unstable angina requiring heparin and nitrate infusions before surgery. RESULTS: The 30 day mortality was 5%. Follow up was completed in the remaining 18 patients. The mean follow up time was 34 months (range eight to 61). During the follow up period four patients died of cardiac causes. The actuarial survival at one, two, and three years was 87%, 78%, and 59%, respectively. The overall functional status was significantly improved compared to preoperative levels, with a mean Karnofsky score of 76% (p < 0.01) at three years. CONCLUSIONS: Coronary artery bypass graft surgery can be performed with increased but acceptable morbidity and mortality in chronic dialysis patients. It results in considerable improvement in symptoms and functional status. However, long term survival is limited and this requires further investigation.

Adult↗
PubMed1997

Hyperproinsulinaemia in acromegaly: evidence for abnormal pancreatic beta-cell function?

We investigated whether pancreatic beta-cell dysfunction has a role in the pathogenesis of glucose intolerance in acromegaly by comparing plasma intact proinsulin, immunoreactive insulin, C-peptide and glucose concentrations during a 75 g oral glucose load in six patients with active acromegaly and eight healthy volunteers. Only acromegalic patients with normal glucose tolerance were studied. Glucose concentrations were similar in acromegalic patients and controls. Acromegalic patients had higher fasting insulin (P < 0.005) and fasting C-peptide (P < 0.005) concentrations than controls. Although fasting proinsulin levels were higher in acromegalic patients than controls, this did not achieve statistical significance. Integrated insulin (P < 0.05), C-peptide (P < 0.05) and proinsulin (P < 0.005) concentrations were greater in acromegalic patients than control subjects. Integrated (P < 0.05) proinsulin:insulin molar ratios were higher in acromegalic patients than controls. Fasting and integrated insulin:C-peptide molar ratios were similar in acromegalic patients and controls. These results indicate that hyperproinsulinaemia contributes to the hyperinsulinaemia which characterizes active acromegaly. The disproportionate hyperproinsulinaemia in acromegaly suggests that prolonged and excessive growth hormone secretion may result in pancreatic beta-cell dysfunction which may predispose acromegalic subjects to glucose intolerance.

Acromegaly↗
PubMed1997

Assault patients attending a Scottish accident and emergency department.

Over 2 months in 1995, 235 assault patients attended the accident and emergency department of the Royal Alexandra Hospital, Paisley (2.4% of total new attendances). 80% were male and their mean age was 28 years (range 6-64); men were the assailants in over 90% of attacks. Alcohol had been consumed by 69% of the victims and 9% admitted to taking illicit drugs. The commonest place of assault was the street (44%) but women were more likely to be assaulted in their homes. Penetrating weapons were used in 23% of assaults. 60% of all injuries were to the head and neck. 27% of the victims were admitted to hospital. Paisley has an assault rate similar to that of other UK centres but the use of penetrating weapons is much higher than elsewhere.

Adolescent↗
PubMed1997

Evaluation of serum creatinine for estimating glomerular filtration rate in African Americans with hypertensive nephrosclerosis: results from the African-American Study of Kidney Disease and Hypertension (AASK) Pilot Study.

Measurement of GFR is considered the standard for estimating renal function. However, standardized accurate GFR methodology is expensive and cumbersome; therefore, estimates of GFR based on serum creatinine concentration have been employed. The purpose of the study presented here was to assess the accuracy and precision of using serum creatinine measurements to estimate GFR in the screen cohort of The African-American Study of Kidney Disease and Hypertension (AASK) Pilot Study. GFR was estimated by four methods: 100/serum creatinine, Cockcroft-Gault equation, creatinine clearance from 24-h urine collection, and a new regression equation derived from the pilot study data. These methods were compared with renal clearance of 125I-iothalamate GFR (GFR1) in 193 hypertensive (diastolic blood pressure > or = 95 mm Hg) African-American screen (142 men, 51 women). A second GFR (GFR2) was performed in 98 screen who were eligible (GFR1 25-70 mL/min per 1.73 m2) for the pilot study. Accuracy was assessed by the difference of 125I-iothalamate GFR-estimated GFR (delta GFR), and precision was estimated from the combined root mean squared error (CRMSE) and the coefficient of determination (r2). The results for accuracy (+/- SD) and precision were as follows: (1) 100/Scr, delta GFR = -0.76 +/- 16.5, CRMSE = 16.5, r2 = 0.69; (2) Cockcroft-Gault, delta GFR = 9.56 +/- 14.9, CRMSE = 17.7, r2 = 0.66; 3) 24-h creatinine clearance, delta GFR = 0.79 +/- 20.7, CRMSE = 20.7, r2 = 0.49; 4) New equation delta GFR = -0.08 +/- 12.8, CRMSE 12.7, r2 = 0.75. In comparison, a second GFR (GFR2, N = 98) had delta GFR = 1.36 +/- 8.48, CRMSE 8.6, r2 = 0.75. Estimates based on 100/SCr and the new equation were the most precise. It was concluded that GFR estimated by serum creatinine is superior to outpatient 24-h urine creatinine clearance in this population. Serum creatinine values can be used to provide a reasonably accurate estimate of GFR in hypertensive African Americans.

Adult↗
PubMed1997

School injuries in the west of Scotland: estimate of incidence and health service costs.

Injuries are an important cause of morbidity and mortality in childhood. Injuries at school account for up to 30% of accident and emergency department attendances in school age children in England and Wales. Routine school reports are a possible source of information on these injuries, but work in other countries indicates that schools under-report injuries to children, making it difficult to estimate incidence. Over a four-week period, children attending an Accident and Emergency Department at a District General Hospital in the West of Scotland as a result of a school accident were compared to those included in routine school incident reports in the area for the same time period. One hundred and forty-eight children were identified as attending the Accident and Emergency Department after sustaining an injury which met the definition of a school accident. This would indicate a rate of injuries resulting in hospital treatment of 47 per 1,000 pupils per year. The prospective data collection identified school under-reporting of accidents requiring hospital treatment of 705%. This information obtained allowed estimation of hospital costs to the NHS. The cost of the Accident and Emergency Department attendances, out-patient treatment and in-patient costs for this group of children was estimated at Pounds 7,715. At this rate, the cost of hospital treatment for school accidents for Argyll and Clyde Health Board is estimated at Pounds 134,760 per year. Applied to the Scottish population, costs would be over Pounds 1.8 million per year. These figures supply the first UK estimates of health care costs of school accidents, and hence assist services in deciding the priority to accord school accident prevention.

Adolescent↗
PubMed1997

Topical tetracycline: potential for allergic reaction or bacterial resistance.

The high incidence of allergic reactions to some common dental antibiotics, primarily topical penicillins, has led to general concerns about all topical antibiotics. The development of resistant bacterial strains and efforts to reserve key antibiotics for life-threatening infections have also limited topical use of antibiotics. Delivery technologies providing for site-specific drug delivery have renewed interest in the use of topical antimicrobials to treat adult periodontitis. Topical tetracycline has an extremely low sensitizing potential and is not one of the antibiotics reserved by the medical community for use in life-threatening situations. Despite tetracycline's widespread dermatologic use and increasing use in adjunctive treatment of adult periodontitis, the incidence of allergic response to topical tetracycline is very low. Also, it is unlikely to cause resistance when used locally for short durations--particularly at the high per-site concentrations achieved with tetracycline periodontal fiber. Studies with tetracycline fiber showed no significant change in the tetracycline susceptibility of gram-negative periodontal microorganisms.

Administration, Topical↗
PubMed1997

Mediastinitis in patients undergoing cardiopulmonary bypass: risk analysis and midterm results.

BACKGROUND: Deep sternal wound infection (mediastinitis) occurred in 21 out of 4043 consecutive patients who underwent a cardiopulmonary bypass procedure (incidence of 0.4%). METHODS: Clinical characteristics of patients who developed mediastinitis (group I) were compared to those of patients who had no mediastinal infection (group II). RESULTS: Hospital mortality was significantly higher in group I (14% vs 3.8%) (p<0.001). Mean hospital stay was longer in group I (36 days vs 7 days) (p<0.001). Multivariate analysis identified the following variables as significant risk factors for developing postoperative mediastinitis: diabetes; relative risk (RR)=3.02, 95% confidence limits (CL)=1.68-5.45, resternotomy for bleeding: RR=5.43, CL=1.85-15.92, associated leg wound infections; RR=16.55, CL=5.32-51.49, the need for 3 or more units of blood transfusion; RR=2.48, CL=1.82-3.39, obesity; RR 4.96, CL 2-12.25. Group I patients were categorised according to a recently proposed classification for mediastinitis (reference 1). Type I (n=17), mediastinitis presenting within 2 weeks following surgery in the absence of risk factors. Type II (n=2), mediastinitis presenting at 2-6 weeks following surgery in the absence of risk factors. Type IIIA (n=2), mediastinitis type I in the presence of one or more risk factor(s). Wound debridement and closed mediastinal irrigation was performed in 19 patients; 15 cases with type I, 2 with type II, and 2 with type IIIA. Primary closure without irrigation was performed in 2 type I patients. The primary intervention failed in 3 patients, two of whom died. A third patient died 4 weeks after an apparently successful treatment of type I mediastinitis. Midterm follow-up (mean of 18 months) of 18 patients showed that 16 patients were alive and well, there was one late death, and one patient had chronic wound pain. CONCLUSION: Diabetes, obesity, associated leg-wound infection, and the need for repeated blood transfusions are associated with high risk of mediastinitis. Closed mediastinal irrigation for mediastinitis type I can yield satisfactory functional and cosmetic midterm results.

Aged↗
PubMed1996

No way out.

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Abortion, Legal↗
PubMed1996

Do dentists refer orthodontic patients inappropriately?

One concern to both providers and consumers of orthodontic treatment is the length of new patient consultation waiting lists. A possible reason for the excessive length of these lists could be unnecessary referral of patients. This research project aimed to identify whether inappropriate referrals for new patient orthodontic consultations were a significant problem. The study was carried out in two FHSA areas in the north of England in two stages. The first part of the study involved an evaluation of GDP referral patterns to orthodontic secondary care providers. In the second part, information on the patients referred by the dentists was collected. We concluded that there was a marked variation in referral rates between the dentists and many patients were referred unnecessarily. Importantly, there was no association between dentists' referral rate and the number of inappropriate referrals made. It appears that referral guidelines for orthodontic treatment are necessary and they should be directed at all general dental practitioners.

Adolescent↗
PubMed1996

The diet dictators.

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Black or African American↗