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Biomedical subjects

W R Gransden

Publications and source records attributed to W R Gransden.

At least 19 recordsLinked to original sources
PubMed1999

A case of Fournier gangrene complicating idiopathic nephrotic syndrome of childhood.

A 10-year-old boy presenting with steroid resistant nephrotic syndrome developed Fournier gangrene of the scrotum. Antimicrobial drug therapy, intravenous albumin, excision of necrotic scrotum and left orchidectomy followed by skin grafting 3 weeks later led to an excellent cosmetic and medical result. Six months later he remains nephrotic on diuretic and angiotensin converting enzyme inhibitor medication.

Amoxicillin↗
PubMed1994

Septicaemia in the newborn and elderly.

Analysis of 5304 episodes of septicaemia at St Thomas' Hospital showed that both the elderly (> 65 years) and neonates accounted for increasing proportions between 1969 and 1992. In particular the increase was greatest for patients aged over 84 years who accounted for 3% of episodes in adults with community-acquired septicaemia in the 1970s compared with 13% in the 1990s. The change may be explained partly by demographic factors. The majority (85-90%) of elderly patients presented with fever, or leucocytosis or both. The urinary and gastrointestinal tracts were the most common foci for the elderly and they were less likely than other adults to have iv access associated sepsis. Among neonates Escherichia coli septicaemia became less common whereas there was little changes in the incidence of group B streptococcal septicaemia; coagulase-negative staphylococcal infection became more common. Overall mortality declined for both neonates and elderly patients. Poor outcome appeared related to the focus of infection, febrile response and age in the elderly and to the time of onset and organism in neonates.

Adolescent↗
PubMed1993

Towards a statistically oriented decision support system for the management of septicaemia.

The first decision-support system designed for the management of septicaemia was MYCIN. Although MYCIN played a vital role in the conception of knowledge-based systems, it never became an established clinical system. This paper describes an alternative decision-support system for septicaemia management currently under development at St. Thomas' Hospital (London) where a large database of septicaemia episodes has been compiled. The three statistical approaches that have been considered are described. These are (i) relative frequencies, (ii) the naive Bayes method and (iii) logistic regression. We also discuss how the concept of probabilistic influence diagrams could be of benefit to the development and implementation of the decision-support system.

Adult↗
PubMed1993

Clinical index to predict bacteraemia caused by staphylococci.

OBJECTIVES: To define risk factors associated with bacteraemia caused by Staphylococcus aureus or coagulase-negative staphylococci; and to use them to define patients in need of empiric anti-staphylococcal antibiotic treatment. DESIGN: Derivation set: observational, prospective study; validation set: retrospective analysis of a prospectively collected database. SETTING: Derivation set: Beilinson Medical Centre, Petah Tiqva, Israel--a 900-bed university hospital. Validation set: St Thomas's Hospital, London, UK--an 800-bed teaching hospital. SUBJECTS: All episodes of bacteraemia detected at Beilinson Medical Centre between March 1988 and September 1990 (derivation set, n = 1410), and at St Thomas's Hospital during 1987-1990 (validation set, n = 1040). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Percentage of staphylococcal bacteraemia in groups of patients defined by the models. RESULTS: The following factors were associated with Staphylococcus aureus bacteraemia: focus of infection (whether high or low risk), haemodialysis, intravenous drug abuse and infection acquired in the orthopaedic ward. A logistic model was used to divide the derivation set into three groups with percentages of Staphylococcus aureus bacteraemia of 1.8%, 13.2% and 33.7% (P < 0.0001); and the validation group 2.5%, 18.2% and 53.2% (P < 0.0001). Factors associated with coagulase-negative staphylococcal bacteraemia were: central or peripheral intravenous catheter as the focus of infection, a preterm neonate, the presence of a central intravenous catheter, low temperature, and a low white blood cell count. A second model including those factors was used to divide the derivation set into three groups with percentages of coagulase-negative staphylococcal bacteraemia of 1.9%, 22.8%, and 43% (P < 0.0001). In the validation set, the percentages were 2.9%, 22.4% and 31.0% (P < 0.001). CONCLUSIONS: The present study defines groups at high risk for staphylococcal bloodstream infection, in which empiric treatment should include an anti-staphylococcal drug.

Adolescent↗
PubMed1991

Predictors for bacteraemia.

In a study of 4104 episodes of septicaemia seen at St Thomas's Hospital between 1969 and 1989, predictors for the condition, other than age and hospital service, were difficult to identify, mainly as a result of the limited data available on the denominator groups. The collection of a small number of simple and readily assessed items of information on all patients with septicaemia did, however, allow the identification of some associations between certain groups of patients and particular species of bacteria and foci of infection. Until there is a substantially larger amount of accurate, complete and computerized data on all hospital patients, further recognition of predictors for bacteraemia will prove difficult to develop.

Adolescent↗
PubMed1991

4-Quinolone-resistant Neisseria gonorrhoeae in the United Kingdom.

The auxotype, serogroup and antimicrobial susceptibility of 977 clinical isolates of Neisseria gonorrhoeae obtained at St Thomas' Hospital, London, during 1989 were determined; 23 isolates from 15 patients were resistant to 4-quinolones. Twelve of the patients acquired their infection in the UK and these strains were generally sensitive to other antimicrobial agents; strains from 10 patients were of serogroup IB-6. Three patients acquired their strains outside the UK and these isolates were multi-resistant and of different serogroups.

Ciprofloxacin↗