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Biomedical subjects

M Britton

Publications and source records attributed to M Britton.

At least 37 records · Page 2Linked to original sources
PubMed2000

Management of minor head injuries in emergency departments in Sweden. Time for a new strategy?

OBJECTIVE: To study how patients with minor head injuries are currently managed. DESIGN: Questionnaire to senior residents in emergency departments and data from registers covering all in-hospital care in Sweden. SETTING: All 92 emergency departments in Sweden. RESULTS: The response rate to the questionnaire was 100%. In Sweden, 75 emergency departments treat patients with minor head injuries. Four departments are paediatric. General surgeons are the main providers (87%) of care for patients with minor head injuries. All hospitals admit patients with a history of unconsciousness or amnesia. Skull radiography is not used routinely. The estimated use of computed tomography (CT) varies between 2% and 80%, the mean being 22%. The need for CT, or the result thereof, is not the deciding factor for admission. In 1996, 16877 patients were treated as inpatients for minor head injuries, (191/100000 inhabitants). The admission rates varied widely among departments, and the total figures have been constant since 1987. The mean hospital stay was 1.6 days, so a large number of hospital days are consumed. The resources more than cover routine CT investigations for those seeking care, and hospital care for those with abnormal findings or special needs. CONCLUSION: In Sweden, patients with minor head injuries are routinely admitted to hospital for observation. The estimated use of CT varies considerably. No clinics report using CT to triage patients for admission, a strategy that would be consistent with effectiveness and economic arguments.

Adolescent↗
PubMed1999

[Sensitive quality indicators stimulate improvement of care].

For the past four years, 52 of the approximately 80 departments of medicine in Sweden have collected data on key indicators of quality of care with regards to acute myocardial infarction, stroke, anticoagulant treatment, and diabetes. The results are analysed centrally, each department being supplied with feedback in the form of overall results, and comparison of its own values with the respective means. Gradual general improvement has been discernible over time, though there is still room for improvement at some departments. There have been isolated instances of manifest changes in indicator values associated with major departmental reorganisation, probably reflecting real deterioration in quality of care. Thus, indicator monitoring would appear a sensitive means of promoting qualitative improvement.

Anticoagulants↗
PubMed1998

[Computed tomography as an alternative to observation in brain concussion].

In Sweden, patients with minor head injury (i.e., history of loss of consciousness or posttraumatic amnesia) are routinely admitted for neurological observation. The article reports the results of a small study of current clinical practices at St Göran's Hospital in Stockholm, and briefly reviews published reports of different management strategies. The findings suggest that computed tomography scanning might constitute better management than routine hospitalisation, both medically and economically. However, further investigation from a Swedish perspective is needed before any evidence-based recommendations can be made.

Adolescent↗
PubMed1997

Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies.

OBJECTIVES: To identify clinical characteristics of elderly inpatients that predict their chance of falling (phase 1) and to use these characteristics to derive a risk assessment tool and to evaluate its power in predicting falls (phases 2 and 3). DESIGN: Phase 1: a prospective case-control study. Phases 2 and 3: prospective evaluations of the derived risk assessment tool in predicting falls in two cohorts. SETTING: Elderly care units of St Thomas's Hospital (phase 1 and 2) and Kent and Canterbury Hospital (phase 3). SUBJECTS: Elderly hospital inpatients (aged > or = 65 years): 116 cases and 116 controls in phase 1,217 patients in phase 2, and 331 in phase 3. MAIN OUTCOME MEASURES: 21 separate clinical characteristics were assessed in phase 1, including the abbreviated mental test score, modified Barthel index, a transfer and mobility score obtained by combining the transfer and mobility sections of the Barthel index, and several nursing judgements. RESULTS: In phase 1 five factors were independently associated with a higher risk of falls: fall as a presenting complaint (odds ratio 4.64 (95% confidence interval 2.59 to 8.33); a transfer and mobility score of 3 or 4 (2.10 (1.22 to 3.61)); and primary nurses' judgment that a patient was agitated (20.9 (9.62 to 45.62)), needed frequent toileting (2.48 (1.08 to 5.70)), and was visually impaired (3.56 (1.26 to 10.05)). A risk assessment score (range 0-5) was derived by scoring one point for each of these five factors. In phases 2 and 3 a risk assessment score > 2 was used to define high risk: the sensitivity and specificity of the score to predict falls during the following week was 93% and 88% respectively in phase 2 and 92% and 68% respectively in phase 3. CONCLUSION: This simple risk assessment tool predicted with clinically useful sensitivity and specificity a high percentage of falls among elderly hospital inpatients.

Accidental Falls↗
PubMed1997

[Home rehabilitation after stroke. Review of the literature].

To find an answer to the question whether domiciliary rehabilitation after stroke is better or cheaper than alternative forms of rehabilitation, a systematic literature review of controlled trials was performed. Three large and two smaller, more preliminary studies of all together a thousand patients were found and regarded methodologically acceptable. Efficacy as regards functional, emotional and qualitative outcome of patients was equivalent for various modes of care. So was the degree of stress, social function and quality of life for the main carers. Home treatment costed less than regular day care but more than routine care including a mixture of outpatient and day care, as considered required. Domiciliary rehabilitation seems to be a good and cost effective alternative for stroke patients who need and cannot manage frequent out-patients visits without ambulance or other exhausting and expensive transports.

Ambulatory Care↗
PubMed1996

Three new naphthyldihydroisoquinoline alkaloids from Ancistrocladus tectorius.

Three new 5--1'-linked naphthyldihydroisoquinoline alkaloids (1-3) have been isolated from the organic extract of Ancistrocladus tectorius. The gross structures of the compounds have been established using 1D and 2D NMR spectroscopy and difference NOE experiments. The absolute stereochemistry of 1, 2, and 3 was determined from CD spectral comparison and chemical degradation. Evidence is presented to show that two of the compounds exist exclusively in the keto form at C-8 of the isoquinoline system (2b, 3b).

Alkaloids↗
PubMed1994

Validation of four scales for the acute stage of stroke.

OBJECTIVES: To validate whether a simplified scale for the acute stage of stroke--the Scandinavian Stroke Supervision scale--is sufficient for monitoring symptom progression of prognostic importance. DESIGN: The capacity of the scale was compared to that of the Mathew, Toronto and Fugl-Meyer stroke scales and the Barthel ADL index. SETTING: The stroke unit of Danderyd Hospital, which cares for a defined population. SUBJECTS: Fifty noncomatose patients with objectively recorded symptoms at entry were examined over a period of 5 days by one physician (250 ratings/scale). The last 10 patients were also investigated by another doctor in the same manner (50 ratings/scale) and by nurses (50 ratings) the Scandinavian scale only. The amount of time required by each scale was tested in another 10 patients by two nurses (100 ratings/scale). INTERVENTIONS: Routine investigation and treatment. MAIN OUTCOME MEASURES: The reliability, validity, time requirement and correlation of the scales were evaluated, as was their ability to reveal progress of symptoms. RESULTS: All scales were highly significantly correlated. The interobserver agreement was excellent between the physicians but not as good between the physician and the nurses. The prediction of the outcome at discharge and after 3 months was very satisfactory for all of the scales with regard to the whole groups of patients, but none of them could predict the outcome for an individual with certainty. The Scandinavian Stroke Supervision scale was least time consuming, and had the fewest uncertainties expressed by the testers. This scale recorded the progression of slightly fewer symptoms, but did record those with a more serious impact on patient outcome. CONCLUSION: The time-saving, simplified Scandinavian scale was as reliable and as valid as the other scales, and detected deterioration that was important for patient outcome as satisfactorily as the other scales.

Acute Disease↗
PubMed1993

The role of autopsies in medical audit: examples from a department of medicine.

Autopsy findings from a representative sample of deaths in a clinic provide an opportunity for regular and systematic revision of medical diagnostics and treatment. A standardized analysis of the collected results can furnish useful figures for comparisons and follow-up. On this basis, new strategies for future improvement of medical care should be outlined. Autopsy results can also be used for medical audit concerning more limited items like the certification of death.

Aged↗
PubMed1993

The role of autopsy findings in multicenter treatment evaluations as exemplified by two aspirin trials.

In many treatment trials the aim is to prevent deaths from one type of disease. The cause of death evaluation is therefore of the utmost importance. A high autopsy rate is required, even as regards sudden deaths that cannot routinely be referred to as ischemic heart disease. Autopsies are also necessary for studying non-lethal and lethal side effects of the involved drug. Even in the best of cases the post-mortem rate is far from 100% and correctness of the cause of death evaluation is not ensured. If the treatment has prevented deaths from the cause studied, this gain must not be outweighed by increases of other causes of death, for the result to be considered reliably positive.

Aspirin↗
PubMed1993

Blood pressure after stroke. A one-year follow-up study.

BACKGROUND AND PURPOSE: Blood pressure changes in the year after acute stroke have been poorly documented. METHODS: We therefore studied blood pressure for 1 year after discharge from the hospital in 226 consecutive patients (mean age, 73 years) surviving an acute stroke. RESULTS: Marked increases (p < 0.001) in mean systolic and mean diastolic blood pressures were seen in two thirds (69%) of the patients 1 month after discharge, and blood pressure remained stable at this level during the remainder of the follow-up year. Similar blood pressure changes were seen irrespective of sex, final stroke diagnosis, or whether the patient had a history of hypertension before the stroke. Patients with a history of hypertension had significantly higher blood pressures (p < 0.001) throughout the follow-up year than previously normotensive patients. One month after discharge blood pressure was found to have decreased in 31% of the patients; these were older and had a higher mortality during the follow-up year than patients with blood pressure increases. About 20% of all patients suffered from orthostatism (defined as a decrease in systolic blood pressure of > or = 20 mm Hg when rising from the supine position to standing). CONCLUSIONS: We conclude that antihypertensive treatment should not be reduced before discharge from the hospital and that blood pressure should be checked about 1 month after discharge. We suggest that standing blood pressure also be measured to make an appropriate treatment decision.

Age Factors↗
PubMed1992

Cost effectiveness of primary stroke prevention in atrial fibrillation: Swedish national perspective.

OBJECTIVE: To assess the potential effects of primary prevention with anticoagulants or aspirin in atrial fibrillation on Swedish population. DESIGN: Analysis of cost effectiveness based on the following assumptions: about 83,000 people have atrial fibrillation in Sweden, of whom 22,000 would be potential candidates for treatment with anticoagulants and 55,000 for aspirin treatment; the annual 5% stroke rate is reduced by 64% (with anticoagulants) and 25% (with aspirin); incidence of intracranial haemorrhage of 0.3%, 1.3%, or 2.0% per year; direct and indirect costs of a stroke of Kr180,000 and Kr90,000; estimated annual cost of treatment is Kr5030 for anticoagulants and Kr100 for aspirin. SETTING: Total Swedish population. MAIN OUTCOME MEASURES: Direct and indirect costs of stroke saved, number of strokes prevented, and cost of preventive treatment. RESULTS: Depending on the rate of haemorrhagic complications 34 to 83 patients would need to be treated annually with anticoagulants to prevent one stroke; 83 patients would need to be treated with aspirin. Giving anticoagulant treatment only would reduce costs by Kr60 million if the incidence of intracranial haemorrhage were 0.3% but would imply a net expense if the complication rate exceeded 1.3%. The total savings from giving anticoagulant (22,000 patients) and aspirin (55,000 patients) treatment would be Kr175 million per year corresponding to 2 million pounds per million inhabitants each year. CONCLUSIONS: Treatment with anticoagulants and, if contraindications exist, with aspirin is cost effective provided that the risk of serious haemorrhage complications due to anticoagulants is kept low.

Aged↗