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Biomedical subjects

R R West

Publications and source records attributed to R R West.

At least 73 records · Page 4Linked to original sources
PubMed1987

The incidence and significance of early pericardial effusion after open heart surgery.

The presence and severity of postoperative pericardial effusions were studied echocardiographically in 114 consecutive patients (70 males, 44 females; mean age 56 +/- 10 years). An effusion was present in 35 patients at 3-5 days. An effusion was less common when a drainage tube was inserted for 24-36 h in the posterior as well as the anterior mediastinum than when only an anterior drain was used. Patients with effusions differed from those without in having more supraventricular arrhythmias, more wound infections, smaller total blood drainage and longer postoperative hospital stay. Three patients with posterior pericardial effusions developed cardiac tamponade 5-18 days postoperatively. The data show that pericardial effusions are associated with postoperative complications and suggest that effusion formation can be reduced by using posterior as well as anterior chest drains.

Cardiac Surgical Procedures↗
PubMed1987

High death rates: more deaths or earlier deaths?

In the analysis of mortality statistics high age-specific death rates could be interpreted as meaning more deaths (more disease), but they could equally well be interpreted as meaning earlier deaths (death at younger age). The distinction markedly affects the choice of hypotheses that may be advanced to explain variations in person, time and place and the design of subsequent, more detailed field studies to test the hypotheses. Furthermore, the majority of descriptive papers make no comparisons with a control disease and thereby break one of the ground rules of epidemiology. This paper shows how, in the example of the geographical variations within England and Wales of ischaemic heart disease, a control may be simply introduced and that much of the observed variation is not in the proportion who suffer heart disease deaths but is in the age at which deaths occur.

Adult↗
PubMed1987

Clinical prediction of Gardnerella vaginalis in general practice.

In a study of 162 women with vaginal symptoms the clinical features of increased discharge, yellow discharge, 'high cheese' odour and pH greater than 5 were statistically strongly associated with the presence of Gardnerella vaginalis, confirmed by microbiological culture. The sensitivities and specificities of these clinical tests, although not as high as those of previously described sideroom tests using the amine test and microscopy for 'clue cells' nevertheless allow the clinician to predict G. vaginalis reliably and initiate treatment at first consultation.

Family Planning Services↗
PubMed1986

Contribution of Gardnerella vaginalis to vaginitis in a general practice.

In a study of 154 adult women who presented to their general practitioner with vaginal symptoms 30 (20%) had Gardnerella vaginalis on its own and 51 (33%) had G vaginalis in combination with anaerobes or known pathogens. Thirty one (20%) patients were culture negative. Those who were culture negative had fewer symptoms and signs of vaginitis than those with G vaginalis alone or G vaginalis plus anaerobes. Those with known pathogens had more symptoms and signs than those with G vaginalis alone or G vaginalis plus anaerobes. Those with known pathogens plus G vaginalis had the most severe signs and symptoms of vaginitis. It is concluded that G vaginalis can cause vaginitis on its own, and it makes vaginitis worse when present with other organisms. G vaginalis was also found in 30 (21%) of the 138 control patients who, although they presented "asymptomatically," had worse signs than control patients without G vaginalis. It seems that G vaginalis can occur in a spectrum ranging from the uncomplaining patient to those with severe vaginitis.

Adolescent↗
PubMed1986

Effect of a lactation nurse on the success of breast-feeding: a randomised controlled trial.

An evaluation of a lactation nurse by means of a randomised controlled trial is described. The lactation nurse was employed to assist, support, and encourage mothers during the early weeks after parturition in hospital and at home. All mothers who breast-fed at least once were entered into the trial. Altogether 649 mothers were interviewed 12 months later to establish the duration of breast-feeding and to enquire after practices of and attitudes towards infant feeding. The lactation nurse significantly extended the duration of breast-feeding, particularly during the first four weeks and among women of lower social class. Although she did not reduce problems or change practices significantly, all the trends were consistently in the right direction. Mothers in the experimental group were more satisfied with the help they received than were mothers in the control group. It seems likely that the lactation nurse by consistent advice, assistance, support, and encouragement enabled mothers to cope more successfully with difficulties and that this led to significantly fewer ending breast-feeding prematurely.

Birth Order↗
PubMed1986

Lifestyle changes in long term survivors of acute myocardial infarction.

A retrospective questionnaire and interview study of 10 year survivors of uncomplicated myocardial infarction examined smoking, diet, exercise, weight, medication, and treatment since discharge from hospital in 1973-4 and made comparisons with controls (using the same questionnaire) and with normal populations (as reported by others). Long term survivors of myocardial infarction previously smoked more than controls; made more dietary changes than controls; and presently eat less butter, sugar, cake, and biscuits and drink less milk than controls; previously weighed more than controls; exercised less than controls both previously and presently; use more 'non-cardiac' as well as 'cardiac' drugs than controls; and are more depressed and more anxious than controls.

Adult↗
PubMed1985

Epidemiology for medical students: a controlled trial of three teaching methods.

Medical students taking a course in epidemiology for clinical practice were taught by either lectures, small group seminars or self-learning packages. Examination performances were no different for the three groups, but self-perceived mastery of learning objectives, and satisfaction with the course were higher for students who received self-learning packages. Sixty per cent of self instruction students found the teaching method was successful compared with 37% of the seminar students and only 19% who received lectures. A combination of self-instructional package and seminar would seem to hold most promise for a workable and effective course.

Education, Medical, Undergraduate↗
PubMed1985

Lactation nurse increases duration of breast feeding.

In a randomised controlled trial a lactation nurse assisted mothers during the early weeks after parturition both in hospital and at home. All mothers who started breast feeding were entered into the trial. The lactation nurse significantly extended duration in the study group compared with controls, particularly during the first four weeks and among women of lower social class.

Breast Feeding↗
PubMed1985

Long term survival of patients mobilised early after acute myocardial infarction.

A Welsh multicentre trial of early (fifth day) compared with late (tenth day) mobilisation in 742 patients after uncomplicated myocardial infarction, reported previously, found that there were no significant differences in survival during the first year, but a partial follow up beyond the first year survival showed a significantly reduced survival during the second and third years among patients mobilised early. A full 10 year follow up of all patients admitted to the trial was therefore carried out. A small difference in survival was confirmed, which reached about 5% at four years; but the difference was not statistically significant. Further analysis suggested the possibility of real differences in survival in certain subgroups, but the present evidence was not sufficient to provide contraindication to mobilisation five days after uncomplicated myocardial infarction.

Adult↗
PubMed1984

Clinical judgment in the diagnosis and management of frequency and dysuria in general practice.

In a study of 40 women with the urethral syndrome and 46 women with conventional urinary tract infection, none of whom was pregnant, general practitioners predicted the diagnosis correctly before the report on the midstream urine specimen was received, as evidenced by their management. They seemed to do this by balancing the symptom of dysuria with the psychological make up of the patient: patients with the urethral syndrome suffered appreciably less dysuria than patients with urinary tract infection; patients with the urethral syndrome suffered appreciably more psychological illness. This ability to distinguish between the two disorders has important clinical and economic implications.

Diagnosis, Differential↗
PubMed1984

Urethral syndrome: a self limiting illness.

Thirty nine adult women who were not pregnant and had the urethral syndrome in a general practice underwent detailed microbiological investigations. Patients monitored their own symptoms, and those with persisting symptoms were entered into a randomised controlled trial of treatment with doxycycline and placebo. Chlamydia trachomatis and Neisseria gonorrhoeae were not isolated and fastidious organisms were not causally associated with the urethral syndrome. Treatment with doxycycline showed no benefit; each episode of the urethral syndrome was short and self limiting and there were no recurrences in a median observation period of 12 months.

Adolescent↗
PubMed1984

Epidemiology for medical students: a course relevant to clinical practice.

A new course was designed to make epidemiology clinically relevant to medical undergraduates. The objectives were that students should (1) know the epidemiology of common diseases, (2) understand epidemiological concepts useful in diagnosis and treatment, and (3) be able to critically assess published medical evidence. Results of a written examination showed that objectives 1 and 2 had been 'easily' achieved by 80% and 68% of students respectively. Student opinion of the course, assessed by an anonymous questionnaire, showed that the majority of students considered the course to be an important part of medical education. Before the course 19% felt 'reasonably able' or 'very able' to achieve nine specific objectives related to epidemiological concepts in diagnosis and treatment. By the end of the course this had risen to 78%.

Education, Medical, Undergraduate↗
PubMed1984

Atherosclerosis and von Willebrand factor. I. Prevalence of severe von Willebrand's disease in western Europe and Israel.

The prevalence of von Willebrand's disease (VWD) in Western European countries and Israel was assessed. Possible patients were identified initially by questionnaire and those with plasma levels of von Willebrand factor antigen ( WFAg ; factor VIII related antigen) less than 1 u/dl (less than 1%) were confirmed by immunoradiometric assay performed at four reference centres. The prevalences of severe VWD in Scandinavian countries were similar to each other and about 10 times greater than those in other Western European countries. The prevalence in Israel was intermediate. The Registry will form the basis for future non- invasive epidemiological studies of atherosclerosis in these individuals.

Adolescent↗