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Biomedical subjects

B Gregson

Publications and source records attributed to B Gregson.

At least 19 recordsLinked to original sources
PubMed2006

Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial.

INTRODUCTION: Intraventricular hemorrhage (IVH), either independent of or as an extension of intracranial bleed, is thought to carry a grave prognosis. Although the effect of IVH on outcome in patients with subarachnoid hemorrhage has been extensively reviewed in the literature, reports of spontaneous intracerebral hemorrhage (ICH) in similar situations have been infrequent. The association of hydrocephalus in such situations and its influence on outcome is also uncertain. PATIENTS AND METHODS: As a sub-analysis of data obtained through the international Surgical Trial in Intracerebral Hemorrhage (STICH), the impact of IVH, with or without the presence of hydrocephalus, on outcome in patients with spontaneous ICH was analyzed. CT scans of randomized patients were examined for IVH and/or hydrocephalus. Other characteristics of hematoma were evaluated to see if they influenced outcome, as defined by the STICH protocol. RESULTS: Favorable outcomes were more frequent when IVH was absent (31.4% vs. 15.1%; p < 0.00001). The presence of hydrocephalus lowered the likelihood of favorable outcome still further to 11.5% (p = 0.031). In patients with IVH, early surgical intervention had a more favorable outcome (17.8%) compared to initial conservative management (12.4%) (p = 0.141). CONCLUSION: The presence of IVH and hydrocephalus are independent predictors of poor outcome in spontaneous ICH. Early surgery is of some benefit in those with IVH.

Cerebral Hemorrhage↗
PubMed2006

Variability in pupil size estimation.

BACKGROUND: The clinical estimation of pupil size and reactivity is central to the neurological assessment of patients, particularly those with or at risk of neurological damage. Health care professionals who examine pupils have differing levels of skill and training, yet their recordings are passed along the patient care pathway and can influence care decisions. The aim of this study was to determine if any statistical differences existed in the estimation of pupil size by different groups of health care professionals. METHODS: A total of 102 health care professionals working in the critical care environment were asked to estimate and record the pupil size of a series of 12 artificial eyes with varying pupil diameter and iris colour. All estimations were performed indoors under ambient lighting conditions. RESULTS: Our results established a statistically significant difference between staff groups in the estimation of pupil size. CONCLUSION: The demonstrated variability in pupil size estimation may not be clinically significant. However, it remains desirable to have consistency of measurement throughout the patient care pathway.

Analysis of Variance↗
PubMed2006

Comparison of image quality, diagnostic confidence and interobserver variability in contrast enhanced MR angiography and 2D time of flight angiography in evaluation of carotid stenosis.

The aim of this study was to compare image quality, level of diagnostic confidence and interobserver agreement in assessment of carotid stenosis with contrast enhanced MR angiography (CE MRA) in comparison with 2D time of flight MR angiography (2D TOF MRA). 60 carotid arteries in 30 patients were examined by three observers. Image quality and diagnostic confidence were assessed on the basis of a visual analogue scale. Interobserver variability was assessed with the help of intraclass correlation coefficient. Median values on the visual analogue scale for image quality and diagnostic confidence were higher for CE MRA compared with 2D TOF MRA for all three observers. Higher intraclass correlation values were recorded for interobserver variability for CE MRA compared with 2D TOF MRA both for visual estimation of carotid stenosis as well as for measurement of carotid stenosis on the basis of North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) criteria. CE MRA provides better image quality, higher level of diagnostic confidence and more interobserver agreement compared with 2D TOF MRA.

Artifacts↗
PubMed2005

Effect of awake Carotid Endarterectomy under local anaesthesia on peri-operative blood pressure: blood pressure is normalised when carotid stenosis is treated under local anaesthesia.

BACKGROUND: Carotid Endarterectomy can be performed under local, regional or general anaesthesia. One of the most important effects of the type of anaesthetic used is on the systemic blood pressure. Although variations in blood pressure during and following carotid endarterectomy have been studied previously, the effects of awake carotid endarterectomy under local anaesthesia on blood pressure and its comparison with similar procedures under similar types of anaesthesia have not. METHODS: Peri-operative blood pressure measurements were collected from the records of 25 consecutive patients for each of the following five procedures; Carotid Endarterectomy under general anaesthesia (CEAGA), Anterior Cervical Discectomy and Fusion under general anaesthesia (ACDF), Cerebral Angiography under local anaesthesia (ANG), Carotid Endarterectomy patients under local anaesthesia who were symptomatic (CEALAS) and Carotid Endarterectomy patients under local anaesthesia who were asymptomatic (CEALAA). The recordings were then analysed to find out if there were any clinically significant variations in peri-operative blood pressure. FINDINGS: There is a significant and consistent difference when the pre-operative value was compared with the 4 hour and 24 hour post-operative recordings between the local and general anaesthetic groups for carotid endarterectomy. Carotid endarterectomy reduces the systolic and diastolic blood pressures post-operatively when performed under local anaesthesia and only the diastolic pressure was reduced when performed under general anaesthesia. CONCLUSION: The study provides evidence about the effect of carotid endarterectomy on the systemic blood pressure and its variations when performed under different types of anaesthesia. There is significant post-operative reduction in both the systolic and diastolic blood pressure values and the intraoperative fluctuation is minimal when local anaesthesia is used. Further studies are required to find out how this affects the long-term blood pressure and clinical outcome of the patient.

Anesthesia, General↗
PubMed2003

Endovascular treatment of anterior communicating artery aneurysms: results of clinical and radiological outcome in Newcastle.

The results of endovascular management of anterior communicating artery aneurysms (ACoAA) using Guglielmi Detachable Coils (GDC) are presented. We detail the clinical and radiological features, and postoperative clinical and radiological outcome in a consecutive series of patients. We have prospectively collected comprehensive data on our patients with SAH since 1989. This study reports on patients admitted between January 1990 and December 1998, and focuses on 30 patients who had their ACoAA endovascularly treated. An independent observer (TE) carried out long-term follow-up in January 2002. Statistical analysis was performed to study the relationship between clinical factors, the radiological morphology of aneurysms and the long-term outcome. The age ranged from 25 to 74 years (median: 54) and endovascularly treated ACoAA were more common in women, 19 (63%) compared with men, 11 (37%). Seventy-seven per cent were in good grade (WFNS 1 & 2) before treatment. Three patients rebled before treatment. The aneurysms were less than 10 mm in maximal diameter in 27/30 patients. The follow-up period was from 1 to 53 months (mean 32.5, median 36.6 months). Excellent outcome was recorded for 11 patients (36.7%), good in seven patients (23.3%), fair in three patients (10%) and poor in four cases (13.3%). Five patients had died (mortality 16.7%). Favourable outcome was achieved in younger patients, women, and in those who presented in grades 1 and 2. The long-term radiological follow-up revealed residual necks in 13 patients. Only one has required retreatment and no rebleed has occurred in 3-6 years. This study reports a contemporary experience with the endovascular management of ACoAA. Long-term stability of the coil and good outcome is demonstrated. Endovascular treatment using GDC is an efficient technique for treating acutely ruptured ACoAA with little additional morbidity. The clinical and radiological results are comparable with those in the literature.

Adult↗
PubMed2001

A review of the literature on women's views on their maternity care in the community in the UK.

OBJECTIVES: to review the UK literature relating to women's views on community-based maternity care between 1970 and 1998. DESIGN: UK research studies examining community-based maternity care were identified by searching several electronic databases using defined search terms. Data extraction was carried out by two or more independent reviewers using a pro-forma. Findings are summarised in this paper. FINDINGS: a total of 624 papers were retrieved and 241 met inclusion criteria. Only 40 papers included some form of comparison group. Examples from more recent and relevant papers focusing on women's views of their maternity care are described and discussed. Women expressed high levels of satisfaction with care. However, there are serious gaps in the research evidence. CONCLUSION AND POLICY IMPLICATIONS: most of the papers included in the review were descriptive and few studies were of a size and quality to enable findings to be generalised to other groups and settings. More information is needed on the care process. There is a need for research studies to examine consumer views where different groups of women experience different care processes.

Attitude to Health↗
PubMed2001

Serum concentration of adhesion molecules in patients with delayed ischaemic neurological deficit after aneurysmal subarachnoid haemorrhage: the immunoglobulin and selectin superfamilies.

OBJECTIVES: Adhesion molecules are involved in the pathogenesis of cerebral ischaemia and may play a part in the pathophysiology of delayed ischaemic neurological deficit (DIND) after aneurysmal subarachnoid haemorrhage. It was hypothesised that after aneurysmal subarachnoid haemorrhage, adhesion molecules may play a part in the pathophysiology of DIND as reflected by significantly altered serum concentrations in patients with and without DIND. METHODS: In a prospective study, mean serum concentrations of ICAM-1, VCAM-1, PECAM, and E, P, and L-selectin were compared between patients without (n=23) and with (n=13) DIND in patients with World Federation of Neurological Surgeons (WFNS) grades 1 or 2 subarachnoid haemorrhage. Serum was sampled from patients within 2 days of haemorrhage and on alternate days until discharge. Concentrations of adhesion molecules were measured by standard procedures using commercially available enzyme linked immunoabsorbent assays. RESULTS: There were non-significant differences in serum concentrations of ICAM-1 (290.8 ng/ml v 238.4 ng/ml, p=0.0525), VCAM-1 (553.2 ng/ml v 425.8 ng/ml, p=0.053), and PECAM (22.0 ng/ml v 21.0 ng/ml, p=0.56) between patients without and with DIND respectively. The E-selectin concentration between the two patient groups (44.0 ng/ml v 37.4 ng/ml, p=0.33) was similar. The P-selectin concentration, however, was significantly higher in patients with DIND compared with those patients without DIND (149.5 ng/ml v 112.9 ng/ml, p=0.039). By contrast, serum L-selectin concentrations were significantly lower in patients with DIND (633.8 ng/ml v 897.9 ng/ml, p=0.013). CONCLUSIONS: Of all the adhesion molecules examined in this study, P and L-selectin are involved in the pathophysiology of DIND after aneurysmal subarachnoid haemorrhage.

Adult↗
PubMed2000

The selectin superfamily: the role of selectin adhesion molecules in delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage.

Cerebral ischaemia and reperfusion injury may be exacerbated by leukocyte recruitment and activation. Adhesion molecules play a pivotal role in leukocyte recruitment. We report a prospective study of the potential role of the selectin family of adhesion molecules (E-, P- and L-selectin) in delayed cerebral ischaemia (DID) following aneurysmal subarachnoid haemorrhage. In patients with good grade SAH, we have compared serum concentrations of E-, P- and L-selectin, between patients who do, and do not develop delayed cerebral ischaemia. There was no difference in E-selectin concentration between the two groups (44.0 ng/ml vs. 37.4 ng/ml). Serum P-selectin concentration was significantly higher in patients with DID compared to those patients without DID (149.5 ng/ml vs. 112.9 ng/ml, p = 0.039). Serum L-selectin concentrations were significantly lower in patients with DID (633.8 ng/ml vs 897.9 ng/ml, p = 0.013). We conclude that P- and L-selectin are involved in the pathogenesis of DID following aneurysmal subarachnoid haemorrhage. The results of this study do not elucidate the exact role of each selectin in DID.

Brain↗
PubMed2000

Continuous monitoring of ICP and CPP following ICH and its relationship to clinical, radiological and surgical parameters.

Sixty-two patients with a spontaneous supratentorial haemorrhage had continuous Intracranial Pressure (ICP) and Cerebral Perfusion Pressure (CPP) monitoring. In addition to the recordings of physiological data their past medical history, presenting neurological state, Computed Tomograph (CT) findings, daily Glasgow Coma Score (GCS) and outcome were noted. The mean age was 57.6 years (sd 13.3). Onset of recording, after ictus was at a mean of 32.6 hours (sd 26.0). Average length of recording was 62.0 hours (sd 39.8). Thirty-one patients had evacuation of haematoma, 6 insertion of External Ventricular Drain (EVD). Preoperative measures of ICP were significantly related to delayed neurological deterioration, death within three days and Glasgow Outcome Scale (GOS) at neurosurgical discharge. No such relationships existed with preoperative measures of CPP and neither ICP nor CPP was related to outcome at 6 months. Post-operative measures of both ICP and CPP demonstrated a significant relationship with death within three days of ictus and GOS at neurosurgical discharge. Again no relationship existed with these parameters and outcome at six months. Surgical evacuation of haematoma acted to significantly reduce ICP and improve CPP. Given that these factors seem to be related to deterioration, death and early outcome, it would seem that surgery could play a role in reducing mortality and improving outcome following Intra cerebral Haemorrhage (ICH).

Blood Pressure↗
PubMed2000

Surgery in intracerebral hemorrhage. The uncertainty continues.

BACKGROUND AND PURPOSE: Primary intracerebral hemorrhage (ICH) accounts for 10% to 20% of stroke but carries the highest rates of mortality and morbidity of all stroke subtypes. Current treatment, however, is varied and haphazard. The most recent Cochrane systematic review refers to 4 prospective, randomized controlled trials. We present a further meta-analysis to include 3 new trials. In addition, we review the trials of Chen et al and McKissock et al and discuss aspects of their quality that, we believe, prevent their inclusion in modern day meta-analysis. METHODS: Literature databases and articles were searched from 1966 to October 1999. Using the end points of death and dependency, the results of the 7 identified randomized trials were expressed as odds ratios. All available data were then analyzed with meta-analysis techniques. Analysis of relevant subsets of trials was also carried out. RESULTS: Meta-analysis of all 7 trials shows a trend toward a higher chance of death and dependency after surgery (OR 1.20; 95% CI 0.83 to 1.74). Meta-analysis was also carried out after exclusion of the Chen and McKissock trials for reasons discussed in the text. This meta-analysis suggests a benefit from surgery, with a reduction in the chances of death and dependency after surgical treatment by a factor of 0.63 (OR 0.63; 95% CI 0.35 to 1.14). CONCLUSIONS: When meta-analysis is restricted to modern-day, post-CT, well-constructed, balanced trials, a trend for surgery to reduce the chances of death and dependency is found. Perhaps, then, in the modern era of CT, good neuroanesthesia, intensive care, and the operating microscope, surgery has a role in the treatment of supratentorial intracerebral hemorrhage. The results of a large, multicenter, randomized controlled trial are urgently needed, and the ongoing International Surgical Trial of Intracerebral Hemorrhage should fulfill this objective.

Cerebral Hemorrhage↗
PubMed2000

Predicting place of discharge from hospital for patients with a stroke or hip fracture on admission.

OBJECTIVES: To determine the predictive power of patient and service characteristics on place of discharge following hospital admission for an acute stroke and for hip fracture. METHODS: Prospective cohort of 440 acute stroke and 572 hip fracture patients aged 65 years or over admitted from home to six district general hospitals and associated community hospitals, three in the North and three in the South of England. RESULTS: Age, marital status, living arrangements, mental health status at admission, pre-admission self-rated disability, pre-admission use of home-care services, post-admission staff assessments of functional dependency as measured by Barthel Index and of confusion as measured by the modified Crichton Royal Behavioural Rating Scale and nursing staffs' expectation of place of discharge are all significantly related to place of discharge for stroke and hip fracture participants. Logistic regression correctly predicted discharge destination for 87% of stroke patients from data available at time of admission and 83% of hip fracture patients. Of the 30% of stroke patients discharged to an institution, the model correctly predicted 73%. However, of the 19% of hip fracture patients discharged to an institution, only 28% were correctly predicted. CONCLUSIONS: Data about older patients admitted to hospital with an acute condition should be routinely collected by hospital staff to inform clinical management and to permit risk-adjusted audit.

Aftercare↗
PubMed1998

Outcomes following acute hospital care for stroke or hip fracture: how useful is an assessment of anxiety or depression for older people?

OBJECTIVE: To investigate the association between severe life events and mental health outcomes following acute hospital care for older patients with acute stroke or fractured neck of femur. DESIGN: Prospective longitudinal survey of stroke and hip fracture patients admitted to hospital from admission to 6-month follow-up. SETTING: Six district general hospitals, three in the North and three in the South of England. PARTICIPANTS: 642 patients admitted to hospital with an acute stroke (268) or hip fracture (374) resident in a private household at 6 months follow-up. MAIN OUTCOME MEASURES: Hospital Anxiety and Depression Scale, cognitive items of the Survey Psychiatric Assessment Scale, Clackmannan Disability Scale, Severe Life Events Inventory, Wenger Social Support Network Typology. RESULTS: 47% of 6-month survivors of stroke or hip fracture resident in private households had a possible psychiatric illness: dementia (13%), anxiety or depression (41%). 57% had severe or very severe disability and 48% experienced additional life events (17% two or more) after hospital admission. Severe disability was strongly associated with a higher prevalence of anxiety (p < 0.0005) or depression (p < 0.0001). Social contact was associated with a lower prevalence of anxiety (p < 0.01) or depression (p < 0.0001) and social support network type was strongly associated with depression (p < 0.001) but not anxiety (p = 0.096). Number of severe life events was associated with anxiety (p < 0.001) but not depression (p = 0.058). CONCLUSION: Disability is probably a more robust outcome measure than assessments of mental health for older people in uncontrolled studies.

Aged↗
PubMed1989

Prolonging life at home: what is the cost?

This paper describes one of the first attempts at an economic evaluation of a community care initiative for elderly mentally infirm people and their carers. It is demonstrated that community support provided mainly through an innovative Family Support Unit (FSU) is almost three times more costly than that which would otherwise be provided. However, FSU support results in prolonged life at home for elderly mentally infirm people, thus saving costly long-term care beds. If life at home is preferable to long-term care, FSU care can be judged cost effective. However, regarding implementation of such schemes, cash-limited local authorities appear to be forced to take on schemes which, despite being cost effective when taking a broad range of resources into account, cost more than they save as far as the local authority itself is concerned.

Aged↗
PubMed1984

Factors influencing the feeding of first-born infants.

Influences on the choice and use of an infant feeding method by primigravidae were studied from late pregnancy until six months after delivery. Data were collected by home interviews and postal questionnaires, and from hospital case-notes. Three-quarters of the women had chosen a method before their first hospital visit and most adhered to their choice. Mothers named midwives and health visitors more often than other health professionals as appropriate for discussions about feeding. However, there was little evidence of the influence of health professionals apart from an association between hospital feeding practices and duration of breast feeding. The major influences on mothers were socio-cultural. Findings suggest that breast feeding can be encouraged by a wide dissemination of information, by enabling mothers to discuss feeding with their preferred professional, by respecting an early choice of method, and by encouraging demand feeding which should begin soon after delivery.

Attitude↗