[Can admission to hospital be advoided?].
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Adolescent↗
Biomedical subjects
M Britton
Publications and source records attributed to M Britton.
Pre-industrial patterns in the colonial family in America: a content analysis of colonial magazines.
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Authoritarianism↗
Accuracy of bedside diagnosis in stroke.
The clinical diagnosis of the type of acute cerebrovascular diseases is often considered unreliable, although this has not been validated prospectively in representative patients. The accuracy of bedside diagnostics was, therefore, tested in 206 patients consecutively admitted to the Stroke Unit of the Serafimerlasarettet in Stockholm. Bedside diagnosis turned out to be correct in 69%. In 24% the diagnoses were altered after hospital investigation and in the remaining 7% no defined preliminary and/or final diagnosis could be made. When the diagnoses were considered "fairly certain" they were accurate in 87%, compared to 53% when regarded as only "probable". The diagnostic accuracy improved during the period studied. Sensitivity in identifying hemorrhages was much lower (39%) than for cerebral infarctions (83%). It is suggested that new investigational methods should be compared with what can be accomplished with bedside methods alone.
Aged↗
Disablement and quality of life after stroke.
This study concerns the quality of life of patients after stroke and how this is influenced by disablement and emotional factors. Ninety-six consecutive patients of mean age 71 years were followed for two years. At the end of that time 23% had experienced a recurrence of stroke and 27% were deceased. Of the survivors 76% were independent as regards activities of daily life (ADL) and lived in their own homes. Age as well as initial function were prognostically important factors. Patients who could participate in interviews marked on a visual analogue scale their evaluation of quality of life before and after stroke. Most of them had experienced a decrease and no improvement was observed during the two years. The deterioration was more pronounced in ADL dependent patients than among the independent. However, depression and anxiety were found to be of similar importance for quality of life as was physical disablement. These findings call for a greater emphasis on psychological support in the care of post stroke patients. The visual analogue scale can be a useful tool for detecting special needs.
Activities of Daily Living↗
Non-rheumatic atrial fibrillation as a risk factor for stroke.
The association between non-rheumatic atrial fibrillation (AF) and stroke has been studied in 402 patients consecutively admitted to a stroke unit. Brain infarction patients with sinus rhythm (n = 196) and non-rheumatic AF (n = 92) were further compared. Some findings supported an embolic origin of the stroke: half of the deceased AF patients (n = 24) at autopsy either had left atrial thrombosis or arterial embolism compared to none of the ten with sinus rhythm. Patients with AF also had a higher mortality and more severe brain lesions, findings compatible with a sudden occlusion of blood flow. However, these differences might also be explained by an atherothrombotic occlusion with impaired autoregulation in the ischaemic region in conjunction with heart failure, which was more common in the AF patients. Other findings supporting an atherothrombotic mechanism were: the prevalence of AF was higher (19-29%) in all kinds of stroke, including haemorrhage, than in age-matched controls (3-9%). Also patients with previous AF and no present embolic source resembled the whole AF group and differed from patients with sinus rhythm. Thus embolism is a plausible cause of stroke in many AF patients, whereas an atherothrombotic origin is more likely in others. Characteristics identifying the mechanism in an individual case were not found.
Aged↗
Progression of stroke after arrival at hospital.
In order to investigate the frequency, extent and importance of progression of stroke symptoms after arrival at hospital, 402 consecutive patients were studied. Speech ability, extremity and facial pareses were evaluated and graded on four occasions during hospitalization. Deterioration was noted in 43% of the patients; it was fairly marked in 25%. The frequency among the few patients with cerebral haemorrhage was much the same as in those with infarction. Limb motor function was affected in most cases. Half of the progressions occurred within the first 24 h after admission. Patients with progression stayed longer in hospital, were more disabled at discharge and more often needed further institutional care than those without progression, although the initial dysfunction was similar in the two groups. No characteristics were found that would help to identify a risk of deterioration. Thus, progression of stroke symptoms after arrival at hospital is a common and serious problem, whose solution calls for vigorous research.
Aged↗
Blood pressure course in patients with acute stroke and matched controls.
The natural course of blood pressure (BP) was studied after emergency hospitalization in 209 consecutive stroke patients and as many age and sex matched controls. Histories of hypertension were more common among patients than controls (46% vs 26%). On admission 69% of the stroke group and 36% of the controls had BP greater than or equal to 170/100 mm Hg. In the first four days there was a spontaneous BP decline, which was greater the higher the initial values. During the whole hospitalization though, stroke patients with previous hypertension had the highest BP levels and previously normotensive controls the lowest. Even if WHO as well as the Joint Committee for Stroke have recommended cautious antihypertensive therapy in stroke patients with extreme hypertension, such therapy is not evaluated. If this is to be done, the present findings have to be taken into consideration. Stroke controls, matched according to the initial BP level, will thus be required.
Adult↗
Comparative clinical features in patients with myasthenia gravis with systemic lupus erythematosus.
The occurrence of myasthenia gravis (MG) with systemic lupus erythematosus (SLE) seems to be more common than random association alone would predict. Moreover, both share immunologic aspects, tissue-directed antibodies and T and B cell abnormalities. To our knowledge, 7 cases of MG in association with SLE have been reported in the English literature in the last 15 yr; in 6 of the 7 cases, MG preceded the SLE; in only 1 reported case and in our case, SLE preceded the MG. The disease that develops later predominates in the prognosis for each patient.
Adult↗