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N Hallett

Publications and source records attributed to N Hallett.

8 recordsLinked to original sources
PubMed2001

Substitution of a nursing-led inpatient unit for acute services: randomized controlled trial of outcomes and cost of nursing-led intermediate care.

OBJECTIVES: To evaluate the outcome and cost of transfer to a nursing-led inpatient unit for 'intermediate care'. The unit was designed to replace a period of care in acute hospital wards and promote recovery before discharge to the community. DESIGN: Randomized controlled trial comparing outcomes of care on a nursing-led inpatient unit with the system of consultant-managed care on a range of acute hospital wards. SETTING: hospital wards in an acute inner-London National Health Service trust. SUBJECTS: 175 patients assessed to be medically stable but requiring further inpatient care, referred to the unit from acute wards. INTERVENTION: 89 patients were randomly allocated to care on the unit (nursing-led care with no routine medical intervention) and 86 to usual hospital care. MAIN OUTCOME MEASURES: Length of hospital stay, discharge destination, functional dependence (Barthel index) and direct healthcare costs. RESULTS: Care in the unit had no significant impact on discharge destination or dependence. Length of inpatient stay was significantly increased for the treatment group (P=0.036; 95% confidence interval 1.1-20.7 days). The daily cost of care was lower on the unit, but the mean total cost was pound sterlings 1044 higher-although the difference from the control was not significant (P=0.150; 95% confidence interval - pound sterlings 382 to pound sterlings 2471). CONCLUSIONS: The nursing-led inpatient unit led to longer hospital stays. Since length of stay is the main driver of costs, this model of care-at least as implemented here-may be more costly. However, since the unit may substitute for both secondary and primary care, longer-term follow-up is needed to determine whether patients are better prepared for discharge under this model of care, resulting in reduced primary-care costs.

Aged↗
PubMed1999

Relation of induced to spontaneous ventricular tachycardia from analysis of stored far-field implantable defibrillator electrograms.

Predischarge testing of implantable cardioverter-defibrillators is often used to tailor antitachycardia pacing algorithms based on the response of induced ventricular tachycardia (VT) to pacing. Despite this practice, little is known about the relation between VT induced at predischarge study and VT that occurs spontaneously. To clarify this relation, we identified 19 patients with VT induced at predischarge study and compared the characteristics of the induced VT with the first episode of spontaneous VT. VT morphology, tachycardia cycle length, and response to antitachycardia pacing were measured from far-field electrograms stored by the implantable cardioverter-defibrillator. All subjects had coronary artery disease and previous myocardial infarction. The mean time from baseline study until a spontaneous VT episode was 162+/-121 days. Analysis of far-field electrograms revealed that spontaneous VT was morphologically different from predischarge-induced VT in 13 of 19 cases (68%). The cycle length of induced VT was significantly shorter than spontaneous VT when VT morphologies were different but not when spontaneous and induced VT had an identical morphology. Antitachycardia pacing was effective in terminating 18 of 19 (95%) induced VTs and 14 of 18 (78%) spontaneous VTs. Antitachycardia pacing was effective in terminating 9 of 12 episodes of morphologically different spontaneous VTs and 5 of 6 episodes of morphologically identical spontaneous VTs (p = NS). Thus, the characteristics of VT induced at predischarge study correlate poorly with those of subsequent spontaneous VT episodes due to the induction of faster "nonclinical" VTs at predischarge testing. This may limit the applicability of predischarge testing in tailoring antitachycardia pacing algorithms.

Algorithms↗
PubMed1997

Characteristics of vocal fold adduction related to voice onset.

This study examined whether vocal fold kinematics prior to phonation differed between hard (glottal), normal, or breathy onsets in men and women. Glottal landmarks were identified and digitized from videotape recorded with a rigid laryngoscope during different voice onset types. Significant linear relationships (p < or = 0.0055) were found among onset types on measures of (a) gesture duration when moving from 80% to 20% of maximum distance during adduction, (b) maximum velocity, (c) duration between the completion of adduction and phonation onset, and (d) ratios of maximum velocity to maximum distance between the vocal processes, an estimate of stiffness. The gesture duration was greatest for breathy onsets and least for hard onsets, while the maximum velocity, latency between adduction and phonation onset, and estimated stiffness were greatest for hard onsets and least for breathy onsets. The results suggest that one trajectory seems to be used with increases in gesture duration being accompanied by decreases in articulator stiffness when moving from hard to normal to breathy voice onset types.

Adult↗
PubMed1997

Inadequacy of qualitative implantable cardioverter defibrillator electrogram analysis to distinguish supraventricular from ventricular tachycardia due to electrogram changes during normally conducted complexes.

Stored electrograms (EGMs) recorded from ICD leads are used to evaluate the appropriateness of ICD therapies. Stored EGMs different from sinus have been interpreted as ventricular in origin. We present a patient with an ICD for VT who received multiple shocks for a tachycardia with a stored EGM different than sinus, suggesting VT. An electrophysiological study demonstrated EGMs different than sinus during atrial pacing and induced supraventricular arrhythmias. This case points out the limitations of stored EGMs and suggests complete electrophysiological study with analysis of EGMs during induced arrhythmias should be performed prior to discharge.

Cardiac Pacing, Artificial↗
PubMed1988

BACUP--the first two years: evaluation of a national cancer information service.

The cancer information service of the British Association of Cancer United Patients (BACUP) was launched in October 1985 as a national service to patients and their relatives, the public, and health professionals. Information is provided by telephone and letter by seven nurses trained in oncology. In the first two years over 30,000 inquiries were received: 23,527 (80%) were from women; 9445 (32%) were from cancer patients 11,574 (39%) from relatives of patients, and 2869 (10%) from health professionals. Inquiries came from all over the United Kingdom and from all sections of society but users were predominantly middle class, aged between 30 and 49, and living in south east England. Information about specific cancer sites, treatment, and how to cope was most commonly sought. Nearly a third of all inquiries were related to breast cancer. Though the service is used more by particular groups focusing on particular diseases, clearly there is a need for a cancer information service in the UK.

Adolescent↗
PubMed1984

Mouthcare.

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Humans↗