Biomedical subjects

Allister D Hargreaves

Publications and source records attributed to Allister D Hargreaves.

4 recordsLinked to original sources

PubMed2006

Malignant vasovagal syncope.

UNLABELLED: We report the case of a 21-year-old male whose frequent episodes of loss of consciousness in the dental surgery culminated in the postponement of treatment, pending further investigation. The patient was referred to a cardiologist and submitted to head-up tilt testing, which evoked prolonged asystole, associated with loss of consciousness and mild generalized twitching, confirming a diagnosis of malignant vasovagal syncope. Before dental treatment could be completed, the patient was successfully treated with disopyramide and dual-chamber pacemaker implantation. CLINICAL RELEVANCE: Dentistry can predispose patients to fainting (syncope or vasovagal episode) owing to fear, pain, unusual sights and smells, anxiety, fatigue and fasting, so knowledge of extreme forms of this response are of relevance.

Adult↗

PubMed2005

TIMI Risk Score predicts early readmission.

AIM: To assess if the TIMI Risk Score could predict early readmission. PARTICIPANTS: 869 consecutive admissions to a Scottish district general hospital with suspected acute coronary syndrome. METHODS: A computerised clinical information system was interrogated to verify readmission. Area under the receiver operator characteristic curve and chi-square test for trend between TIMI Risk Score and readmission rate were calculated. RESULTS: Median follow up was 73 days. There was a strong association between TIMI Risk Score and readmission rate (chi-square test for trend, p<0.001), with an area under the receiver operator characteristic curve of 0.60 (95% C.I. 0.55-0.65). CONCLUSION: The TIMI Risk Score can predict readmission. This study reinforces its utility as a tool for identifying patients more likely to benefit from aggressive intervention.

Coronary Disease↗

PubMed2005

Age-dependent differences in presentation, risk factor profile, and outcome of suspected acute coronary syndrome.

OBJECTIVES: To compare the presenting complaint, risk factors, and outcome of suspected acute coronary syndrome (ACS) in those aged 65 and older with those of a younger cohort. DESIGN: Prospective observational cohort study. SETTING: A typical Scottish district general hospital covering a population of 150,000. PARTICIPANTS: Patients presenting with suspected ACS (N=869) over a 6-month period. MEASUREMENTS: Main presenting complaint and major risk factors including electrocardiogram (ECG) changes. Primary outcome measures were percutaneous coronary intervention, recurrent myocardial infarction, and death at 3-month follow-up. RESULTS: Four hundred seventy-seven (55%) were aged 65 and older. Older patients were less likely to present with chest pain and more likely to present with breathlessness or collapse. They had fewer major risk factors for heart disease. There was a higher proportion with ischemic ECG changes, elevated troponin, and major acute coronary events at follow-up. Older patients were less likely to be accepted for angiography even though they were more likely than the younger cohort to have significant coronary artery disease when angiography was performed (chi-square test, P<.01 for all above). CONCLUSION: Older patients with suspected ACS were more likely to present atypically and have worse outcomes than their younger counterparts, despite having fewer major risk factors. The results highlight the importance of age as a predictor of adverse outcome and suggest that clinicians need to ensure equitable access to angiography for older patients.

Age Factors↗

PubMed2004

A randomised controlled trial of senior Lay Health Mentoring in older people with ischaemic heart disease: The Braveheart Project.

OBJECTIVE: to examine the effects and feasibility of educating and empowering older people with ischaemic heart disease using trained senior lay health mentors. DESIGN: randomised controlled trial with blinded evaluation. SETTING: Falkirk and District Royal Infirmary. PARTICIPANTS: inpatients and outpatients aged 60 or over attending secondary care with a diagnosis of angina or acute myocardial infarction. Three-hundred and nineteen entered and 289 completed exit assessments. The intervention group took part in mentoring groups for 1 year, meeting monthly for 2 hours, each led by two trained lay health mentors in addition to standard care. MAIN OUTCOME MEASURES: primary outcome measures were changes in coronary risk factors, medication usage and actual use of secondary care health services. Secondary outcomes were total and cardiovascular events; changes in medication compliance, non-medical support requirement, health status and psychological functioning, and social inclusion. RESULTS: there were significant improvements in a reported current exercise score (mean +0.33, +0.02 to +0.52), in the average time spent walking per week by 72 minutes (+1 to +137 minutes), and in the SF36 Physical Functioning Score (+6.1, +2.4 to +9.5). There was a 1.0% reduction in total fat (95% CI -3.0% to -0.6%) and a 0.6% reduction in saturated fat (95% CI -1.5% to -0.03%). The intervention group showed reduced outpatient attendance for coronary heart disease (-0.25 appointments, -0.61 to -0.08). Attendance rates were high. Socio-economic grouping did not affect participation. CONCLUSIONS: Lay Health Mentoring is feasible, practical and inclusive, positively influencing diet, physical activity, and health resource utilisation in older subjects with ischaemic heart disease without causing harm.

Aged↗