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Biomedical subjects

P Holt

Publications and source records attributed to P Holt.

At least 55 records · Page 3Linked to original sources
PubMed1990

Prospective payment and the utilization of physical therapy service in the hospitalized elderly.

We studied the effect, in a university teaching hospital, of the prospective payment system (PPS) on utilization of physical therapy (PT), a non-reimbursable service; subjects were hospitalized patients aged 75 or older with non-PT-related diagnoses (myocardial infarction, pneumonia, congestive heart failure, and colectomy) and PT-related diagnoses (cerebrovascular accident and hip fracture). The proportion of patients referred for PT increased from 68 percent pre-PPS to 85 percent post-PPS for those with PT-related diagnoses and from 13 percent pre-PPS to 19 percent post-PPS for those with non-PT-related diagnoses. The mean number of sessions of PT decreased slightly for both groups: from 8.5 to 7.6 sessions for those with PT-related diagnoses and from 5.2 to 4.5 for those with non-PT-related diagnoses. In patients with PT-related diagnoses whose ambulatory status worsened during hospitalization, referrals for PT increased from 76 percent pre-PPS to 98 percent post-PPS. Referrals of comparable patients with non-PT-related diagnoses did not increase. Changes in provider education and efforts to reduce length of stay may account for these findings.

Aged↗
PubMed1990

Epidemiological survey of coeliac disease and inflammatory bowel disease in first-degree relatives of coeliac patients.

One hundred and sixty-two of 182 patients with coeliac disease provided satisfactory details of family size and the prevalence of coeliac disease and inflammatory bowel disease among their first-degree relatives. Patients ranged in age from 11 months to 79 years with a mean age of 41 (+/- 23) years. Twenty patients had at least one first-degree relative with coeliac disease: a total of 25 of 861 relatives were affected (prevalence = 2904/100,000) compared with an expected 0.9 cases (prevalence = 100/100,000; p less than 0.001). Six relatives had inflammatory bowel disease (prevalence = 697/100,000) compared with an expected 1.3 cases (prevalence = 150/100,000; p less than 0.001). Five of these had ulcerative colitis, and one had Crohn's disease. The relative risk of ulcerative colitis is, therefore, five times greater for first-degree relatives of people with coeliac disease than for the general population (95 per cent confidence interval, 4.7-7.2). There is a clear association between coeliac disease and ulcerative colitis, which may point to factors involved in the aetiology of colitis.

Adolescent↗
PubMed1989

Hand venous hypertension complicating arterio-venous fistula construction for haemodialysis.

Vascular complications of arterio-venous fistula construction for haemodialysis are rare. We report a patient who developed the hand venous hypertension syndrome with ulceration, 2 years after successful construction of a side-to-side radio-cephalic fistula at the wrist. The surgical treatment was ligation of the distended vein immediately distal to the fistula in the hand, and fistula function was preserved. The ulceration healed within 2 weeks of surgery. This complication had not been seen previously in the Dialysis Unit at Cardiff Royal Infirmary where, over the past 20 years, 800 fistulae have been constructed.

Adult↗
PubMed1988

AIDS and the surgeon.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Intraocular lens implantation: a model for the Third World.

Intracapsular cataract extraction has long been thought of as the appropriate technique to deal with the backlog of Third World cataract blindness. However, this operation may not be as sight effective as many believe. The authors offer their experience of intraocular lens implantation in the Torres Strait as a model for a more visually appropriate surgical cure for Third World cataract.

Cataract Extraction↗
PubMed1987

Interstitial and free lung cells in acute inflammation in the guinea-pig.

Different cell types were studied in bronchoalveolar lavage fluid (BAL) and solid lung tissue of guinea-pigs. Whereas alveolar macrophages (AM) and eosinophils predominated in BAL, the proportion of AM and lymphocytes was highest in the lung tissue. After an inhalation exposure to LPS, the number of neutrophils increased rapidly in the lung tissue reaching a maximum after 4 hours, and more slowly in the airways reaching a maximum after 24 hours. This suggests that other mechanisms than secretion of chemotactic factors from AM, shown to be active up to 4 hours after exposure, are responsible for the later phase of the neutrophil invasion into the airways. Passive migration or other mediators may be involved.

Animals↗
PubMed1986

Does non-clinical decompression stress lead to brain damage in abalone divers?

Abalone divers are subject to considerable decompression stresses and could be at risk of progressive cognitive impairment. A sample of abalone divers was compared with a sample of fishermen, by means of a battery of neuropsychological tests. No evidence of cognitive impairment was found in the divers, in spite of evidence of their exposure to decompression stress. The implications for other professional divers and for recreational underwater divers who follow standard decompression protocols are reassuring.

Adult↗
PubMed1986

The acute haemodynamic effects of quinapril, a new non-sulfhydryl angiotensin converting enzyme inhibitor, in patients with severe congestive cardiac failure.

This study investigates the acute haemodynamic effects of Quinapril (CI-906) a new non-sulphydryl angiotensin converting enzyme inhibitor in 15 patients with refractory congestive cardiac failure. There were 14 males and 1 female mean age 59.5 years. After administration of Quinapril there was a significant reduction in mean arterial pressure (MAP) from 93.1 to 79 mmHg, systemic vascular resistance (SVR) from 1887 to 1349 dyn s cm-5 and PCW from 27.3 to 15.3 mmHg. This was accompanied by an increase in CO from 3.7 to 4.71/min, cardiac index (CI) from 1.97 to 2.51/min/m2 and Stroke volume index from 21.1 to 28.7 ml/m2. There was no significant change in heart rate (HR), right atrial pressure (RAP), or pulmonary vascular resistance. The peak effect on pulmonary capillary wedge pressure (PCW) and cardiac output (CO) occurred at 75-120 min after Quinapril administration. The maximum effect on mean arterial pressure (MAP) occurred slightly later at 120-150 min. SVR and CI exhibited 2 periods of peak effects, at 90 and 180 min. This time course is very similar to that observed in studies on the acute effects of Captopril. The significant improvement in haemodynamic measurements acutely, following administration of Quinapril 5 mg orally, suggests that this drug is worthy of further study in the management of patients with refractory congestive cardiac failure, in particular its long term effects.

Adult↗
PubMed1986

Can the site of origin of ventricular extrasystoles enhance the localisation of exercise-induced ischaemia?

Previous work from the Departments of Cardiology and Nuclear Medicine, Guy's Hospital, London, has enabled an atlas of the electrocardiographic appearances of ectopics from individual ventricular sites to be compiled. This has been used to investigate the relationship between regions of myocardial ischaemia and the site of origin of exercise-induced ventricular arrhythmias. Two hundred and ten patients underwent maximal exercise testing on a bicycle ergometer, prior to thallium scintigraphy. All 12 leads of the electrocardiogram were recorded simultaneously at rest, immediately post-exercise and then for several minutes afterwards. Thallium scintigraphy was performed immediately and 4 hours post-exercise. Twenty-nine patients of the 210 had ventricular arrhythmias on exercise. Two had dilated (congestive) cardiomyopathy, 1 had hypertrophic cardiomyopathy and 26 were subsequently proven to have ischaemic heart disease. Fifteen of those patients with coronary artery disease and ventricular arrhythmias had otherwise negative exercise tests. Patients with reversible posterior (circumflex) defects had right bundle branch block extrasystoles with a limb lead QRS axis of -60 degrees to -150 degrees. Reversible inferior defects demonstrated ectopic activity with left bundle branch block and a superior axis. Ectopics of septal origin could present with either right or left bundle branch block and an inferior axis from the upper septum, or superior axis from the lower septum. In patients with ischaemic heart disease the 12-lead electrocardiographic appearance of ventricular arrhythmias enables their site of origin to be localised thus suggesting ischaemia in a particular coronary artery territory.

Aged↗
PubMed1986

Antitachycardia pacing: a comparison of burst overdrive, self-searching and adaptive table scanning programs.

Eight patients with the Siemens Elema "Tachylog" generator implanted for management of paroxysmal reentrant tachycardia were studied to assess the safety and efficiency of three antitachycardia programs. The programs investigated were burst overdrive, self-searching, and adaptive table scanning. There were five males and three females aged 19-62 years. Seven had Wolff-Parkinson-White syndrome, and one had dual atrioventricular nodal pathways. Four had right atrial electrodes and four had right ventricular electrodes. Patients were studied lying, standing, and exercising in all three modes, and the appropriate long-term programs were chosen. The generator remained in a program for 1 month, it was interrogated and the memory was read, and then it was reprogrammed to a different antitachycardia mode. Burst overdrive was unsuitable for long-term use in four patients, producing atrial fibrillation in one and ventricular arrhythmias in three. In this group, self-searching and adaptive table scanning were safe and equally effective (mean number of attempts/tachycardia 6.97 and 6.3, respectively). In the four patients in whom all three programs could be used, burst overdrive proved to be most efficient, the mean number of attempts/tachycardia were 2.4 (cf 9.6 and 9.0 for self-searching and adaptive table scanning). Thus, burst overdrive was only suitable for long-term use in 50% of our patients, but when safe it was more efficient than the other two programs, especially in those with narrow termination windows on exercise.

Adult↗
PubMed1986

Strategies for the management of tachyarrhythmias.

Conversion of atrial fibrillation or flutter is electrical and, if drugs fail to prevent recurrence, low energy His bundle ablation with implantation of a rate responsive pacemaker is our routine. For re-entry tachycardia, antitachycardia pacers are often the method of choice. We use bipolar automatically actuated systems exclusively, functioning either as burst overdrive or critically timed stimulation. His bundle, or accessory pathway ablation, is considered a later choice. Ventricular arrhythmias are initially terminated by by Class I agents or cardioversion and then a trial of suppressive drugs used. If this fails, a combination of an antitachycardia pacemaker plus an automatic implantable defibrillator is implanted. Alternative options are ablation of the arrhythmogenic site, endomyocardial stripping, or an encircling ventriculotomy with cardiac transplantation as the final option considered.

Anti-Arrhythmia Agents↗
PubMed1985

Intravenous amiodarone in the acute termination of supraventricular arrhythmias.

This study was performed to ascertain whether intravenous amiodarone would revert supraventricular tachycardias to sinus rhythm, and if so, whether this effect depended upon the underlying mechanism of the arrhythmia. Fourteen patients were studied. Seven had Wolff-Parkinson-White (WPW) syndrome, 1 had dual atrioventricular nodal pathways and 1 an ectopic atrial tachycardia. Five patients had atrial fibrillation without accessory pathways. An atrial electrode was inserted to initiate tachycardias and record the electrogram. If tachycardias were stable for more than 5 min, amiodarone (5 mg/kg) diluted with dextrose saline was infused intravenously over 5 min. Two electrocardiographic leads and the right atrial electrogram were monitored. In 7 patients with atrial fibrillation (2 with accessory pathways), 6 did not revert to sinus rhythm, 1 reverted only after 1 hr. In 5 cases without accessory pathways the ventricular rate fell 5-10 min after commencing amiodarone. Four of the 5 patients with WPW syndrome and re-entrant tachycardias returned to sinus rhythm within 6 min of commencing the infusion (atrioventricular and ventriculoatrial times increased by 0-38% and 0-14% respectively). (Tachycardias terminated in the anterograde limb.) Three patients underwent intermittent right atrial stimulation for 1 hr. No tachycardias could be initiated for 30 min post amiodarone. The ectopic atrial tachycardia and that due to dual atrioventricular nodal pathways terminated within 7 and 2 min, respectively, of commencing intravenous amiodarone. Thus the use of intravenous amiodarone would be appropriate in the acute management of sustained supraventricular tachycardias.

Adolescent↗