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Biomedical subjects

T Crofts

Publications and source records attributed to T Crofts.

4 recordsLinked to original sources
PubMed2002

Missed opportunities? Management of patients with alcohol problems in a surgical ward.

Patients with alcohol problems necessitate treatment with counselling, and hospital admission for alcohol related complaints presents an ideal opportunity for this. This paper aims to examine the management of patients with alcohol related complaints on a surgical ward. Patients were interviewed to analyse the extent of their alcohol problem and counselling received, and doctors completed a questionnaire about counselling they offered. Forty seven out of 435 patients (10.8%) had alcohol related complaints; 28 of these 47 were alcohol dependent; 22 out of 28 alcohol dependent patients were not spoken to about their alcohol consumption on this admission. Thirteen doctors responsible for hospital admissions completed the questionnaire: although an alcohol history was almost always taken, counselling was rarely offered. In conclusion, the management of patients with alcohol problems in the emergency admission was sub-optimal. The treatment most needed was counselling, and this ideal opportunity for intervention was almost always missed.

Alcoholism↗
PubMed1998

Immediate reproducibility of upper limit of vulnerability measurements in patients undergoing transvenous implantable cardioverter defibrillator implantation.

INTRODUCTION: Measurement of the upper limit of vulnerability (ULV) with monophasic T wave shocks has been proposed as a patient-specific measurement of defibrillation efficacy that results in fewer episodes of ventricular fibrillation (VF) than measurement of a defibrillation efficacy curve. METHODS AND RESULTS: We sought to determine the magnitude of variance in ULV in 63 consecutive patients undergoing implantation of an implantable cardioverter defibrillator (ICD). We measured ULV as the strength at or above which VF is not induced when a stimulus is delivered at 310 msec after an 8-beat ventricular pacing drive at 400 msec. Defibrillation threshold (DFT) was measured in patients with an active can device using a biphasic waveform and the binary search method beginning at 12 J. Sixty-three patients were studied; they had a mean age of 62 +/- 12 years and a mean ejection fraction of 35% +/- 15%. Three quarters of patients had an ischemic cardiomyopathy. Each patient underwent 4.5 +/- 0.8 measurements of ULV. Monophasic ULV correlated poorly with biphasic DFT (R between 0.19 and 0.28, P = 0.04 to 0.17). There was no change in ULV between second to third, third to fourth, and first to last measurement in 22% to 41% of patients. The reliability coefficient was 0.87. A ULV > or = 20 J was found in eight patients. The only predictor of high ULV was a high DFT. CONCLUSION: Monophasic ULVs do not closely predict biphasic active can DFTs using a standard protocol. High DFTs were predicted by high ULVs. There was little variation in the acute measurement of ULV between trials. These findings have important implications for using ULV measurements to determine changes in DFTs after interventions. The methodology of determining ULV is critical to its use for predicting DFTs and programming ICDs.

Defibrillators, Implantable↗