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Biomedical subjects

R Allan

Publications and source records attributed to R Allan.

60 records · Page 4Linked to original sources
PubMedDate not supplied

Conversion rates for prehospital paroxysmal supraventricular tachycardia (PSVT) with the addition of adenosine: a before-and-after trial.

OBJECTIVE: To determine whether the prehospital administration of adenosine to adults with stable and unstable paroxysmal supraventricular tachycardia (PSVT) influences conversion rate (CR) to sinus rhythm, scene time, use of synchronized electrical cardioversion (SEC), and accuracy of rhythm strip interpretation by paramedics. METHODS: This before-and-after study compared a retrospective control group (CG) prior to the introduction of adenosine with a prospective treatment group (TG) following the addition of adenosine to the PSVT treatment protocol in a large urban advanced life support emergency medical services system. The population represented patients > or = 18 years of age with PSVT diagnosed by the paramedic (defined as spontaneous onset of a regular narrow-complex tachycardia between 140 and 250 beats/minute). RESULTS: The CG comprised 74 calls and the TG 137 calls. The overall CR was higher in the TG (59% vs 32%, p < 0.001). The SEC and spontaneous conversion rates remained unchanged. The proportion of untreated patients with PSVT decreased from 26% CG to 12% TG (p < 0.01). Scene times were longer in the TG (26 vs 19 minutes, p < 0.001). Agreement between paramedic and physician rhythm strip interpretations was fair to moderate (CG kappa 0.43 [95% CI: 0.14, 0.72]; TG kappa 0.37 [95% CI: 0.13, 0.61]). CONCLUSIONS: The introduction of adenosine was associated with a significant increase in the prehospital CR of stable and unstable PSVT, while the SEC and spontaneous conversion rates were similar in each group; however, scene times were longer in the TG and paramedic accuracy in rhythm strip interpretation remained fair to moderate.

Adenosine↗
PubMedDate not supplied

A controlled trial of a behavioral and educational intervention following coronary artery bypass surgery.

PURPOSE: Patients who have undergone coronary artery bypass graft surgery (CABG) are obvious candidates for rehabilitation programs because of the potential for progression of disease. Such programs have been shown to foster risk-factor modification, improve quality of life, and prolong survival among post-myocardial infarction (MI) patients. However, the efficacy of these programs has not been established among patients who have undergone CABG. METHODS: A randomized controlled trial was employed to evaluate whether a behavioral and educational cardiac rehabilitation program was effective in modifying cardiovascular disease risk factors and improving quality of life in a cohort of 86 patients after CABG. Patients were recruited from the cardiac ward of a large teaching hospital and were block-randomized to either an intervention group or routine care. Subjects in the intervention group attended 6 weekly group sessions following hospital discharge, and booster sessions at 8 months and 1 year. They also received a personalized behavior modification program based on their baseline risk factors. Risk factor and quality of life measures were recorded at baseline (6 weeks after surgery), 4 months, 8 months, and 1 year. RESULTS: The results indicated few differences between the study groups. However, the intervention group's aerobic capacity (VO2max) improved over that of the routine care group. With regard to the quality of life variables, all patients tended to improve steadily over time. CONCLUSIONS: The relatively moderate success of this intervention program compared with various post-MI studies may be indicative of differences between the treatment needs of patients after acute myocardial infarction or CABG. Future post-CABG rehabilitation research should explore these patients' unique treatment needs, and investigate a variety of program strategies.

Behavior Therapy↗