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Biomedical subjects

C Jagger

Publications and source records attributed to C Jagger.

At least 73 records · Page 4Linked to original sources
PubMed1995

Terminal illness: views of patients and their lay carers.

This paper examines the responses of 28 terminally ill patients and their lay carers to identical questions about the patients' experiences in the month prior to their admission to an inpatient hospice. No statistically significant differences were found between the reports of patients or carers regarding the patients' activities of daily living, their physical symptoms, or the evaluations of the care they received. Discrepancies between accounts were most likely to concern the presence or absence of psychological symptoms, the degree of distress caused to patients by their symptoms, and the main symptoms experienced by the patient on their admission to the hospice. It is suggested that the accounts of patients' experiences given by their carers can be used as a valid source of information.

Activities of Daily Living↗
PubMed1995

A subjective health indicator for follow-up. A randomised trial after treatment of displaced intracapsular hip fractures.

We report a randomised prospective trial of the early results of three types of treatment for displaced intracapsular hip fractures. We used a questionnaire sent to patients at about six months (Nottingham Health Profile, NHP) in addition to clinical assessments. There was a 67.4% usable response to the questionnaire, similar to that in other studies using the NHP. There were more responders from younger patients, those walking independently before injury and those with higher mental test scores on admission. In the younger group (65 to 79 years) we found a trend for better scores in most NHP indices after the use of a bipolar prosthesis rather than a unipolar prosthesis or internal fixation, particularly for social function, pain and physical mobility. Postal assessment using the NHP gave a satisfactory response rate even in the elderly, and can provide an extra assessment to complement or replace hospital follow-up in some circumstances.

Activities of Daily Living↗
PubMed1994

Clinical significance of venous reflux detected by duplex scanning.

Duplex scanning was used to determine the presence of valvular incompetence in the major veins of 274 legs with venous disease. Using multivariate logistic regression analysis the significance of valvular function in each vein in relation to the clinical condition of the limb was calculated. Superficial femoral, profunda femoris and short saphenous vein function did not correlate with the clinical state of the limb; common femoral, popliteal and long saphenous vein function did. A table was constructed from the statistical model such that the relative contribution made by each vein could be estimated for limbs with different patterns of venous insufficiency. This model should now be tested in a prospective study and, if validated, could be used to improve decision making in venous surgery.

Femoral Vein↗
PubMed1994

The outcome of a medical examination for applicants to Leicestershire homes for older people.

Medical screening of applicants to residential homes for older people has been shown to redirect inappropriate applications, although other outcomes have not been reported. This study assessed 117 applicants, of whom 63% were medically examined and offered medically directed interventions if indicated. All applicants were then reassessed at 6 and 12 weeks. No significant differences in survival, or changes in cognitive score, disability, incontinence or self-reported health were found between intervention and control groups. Intervention did redirect some applicants to more appropriate care and resulted in significantly greater improvements in morale. These results raised the question of whether it is appropriate for medical assessment to be used primarily to enforce admission criteria in the absence of other significant health benefits. However, the greater improvements in morale of the intervention group did indicate some benefit from the medical examination.

Activities of Daily Living↗
PubMed1994

Maternal blood group in otitis media with effusion.

Risk factors for otitis media with effusion (OME) have proved difficult to apply in selecting persistent cases, or those otherwise requiring intervention. Explanations may include low predictive values of individual factors and the costs of data collection. In this study, profiles on 225 children from conception to age 7 years were compiled from medical and Health Authority records and structured interviews with parents. On the grounds that nearly all cases receiving medical intervention after waiting and onward referral are more than transitory (although many persistent cases will not receive such attention) this was taken as the dependent variable--a marker of persistence. Established risk factors and maternal blood group A were considered singly to predict intervention, then in combination using logistic regression. Maternal blood group A gave a relative risk (RR) for intervention of 2.82. The noted occurrence of an attack of acute otitis media (AOM) before the first birthday gave a RR of 6.13. When these two factors were used together, the RR climbed steeply to 26.77. These findings suggest that further research is justified into the nature of the influence of blood group A on OME, and the use of combinations of risk factors to give enhanced prediction.

Blood Group Antigens↗
PubMed1994

The mortality of elderly people with diabetes.

To assess the full effect of diabetes on survival in elderly subjects, residents of Melton Mowbray aged 65, 70, 75, 80, and 85 years were screened by glucose tolerance test and followed up for 4.5 years. Death occurred in 56 of 520 normal subjects, 9 of 44 subjects with impaired glucose tolerance, 7 of 19 newly diagnosed diabetic subjects, and 27 of 52 known diabetic subjects. Diabetic subjects were 4.5 times (95% confidence interval 2.9-7.0) more likely to die than subjects with normal glucose tolerance. Thus elderly diabetic subjects have a substantially increased risk of death compared to their normal glucose tolerant peers.

Age Factors↗
PubMed1994

A postal survey evaluation of prostatectomy.

BACKGROUND: The aims of this study were to determine the prevalence of urinary symptoms after prostatectomy, and the relationship between pre- and post-operative symptoms. METHODS: A retrospective postal survey was carried out, on an unselected series of patients in Leicestershire, one to two years after transurethral resection. Four hundred and sixty-five men received a questionnaire, and of these 78 per cent responded. RESULTS: The operation relieved 92 per cent of all preoperative urge-incontinence, but 3 per cent of those who were continent beforehand developed urge-incontinence. Urgency and hesitancy also responded well. Nocturia, frequency and dribbling were the least responsive. There was a general tendency for symptoms to persist rather than develop post-operatively. CONCLUSIONS: Prostatectomy is an effective intervention, particularly for cases with urge-incontinence, urgency, incontinence or hesitancy. These results are consistent with those of other, prospective, studies. Postal surveys may provide a cheap and effective method of evaluating local prostatectomy services.

Aged↗
PubMed1993

Residential care for elderly people: a decade of change.

OBJECTIVE: To determine the changes between 1979 and 1990 in demography and dependency levels in elderly people in residential care. DESIGN: Censuses of those aged 65 years and over in any type of residential care at midnight on 11 December 1979 and 27 November 1990. SETTING: Leicestershire District Health Authority (population 865,133, 1991 census), coterminous with county and social services boundaries. MAIN OUTCOME MEASURES: Age, sex, length of stay, and dependency levels (measured by activities of daily living). RESULTS: In 1990 (1979), 6079 (4678) elderly people were enumerated in 241 (133) establishments, a 30% increase in the numbers of elderly people in residential care and an 82% increase in the number of establishments between 1979 and 1990. Dependency levels rose between 1979 and 1990 in all but the geriatric sector, the greatest increases being found in private residential homes where the largest percentage increase in the number of residents had occurred. CONCLUSIONS: Dependency levels in residential care have risen substantially, particularly in the private sector, even beyond levels expected from the greater numbers of elderly people. With the impending move to community care, dependency levels are likely to rise further, and more appropriate staff training and medical input to homes will become necessary.

Activities of Daily Living↗
PubMed1993

Changing trends in the management of lower-limb ischaemia: a 17-year review.

Over a 17-year period, 2930 vascular procedures were performed for chronic lower-limb occlusive disease. During this time, the total vascular surgical workload rose significantly as a result of an increase in the rates of arterial reconstruction and percutaneous transluminal angioplasty. Although the major lower-limb amputation rate did not change significantly, there was a decrease in the above- to below-knee ratio. In addition, there were significant increases in the percentage of patients treated over the age of 75 years and the proportion of attempted revascularizations before amputation. The mortality rates for arterial reconstruction, percutaneous transluminal angioplasty and amputation did not change significantly during the study period. The duration of hospital stay increased significantly for patients undergoing amputation and decreased significantly for those receiving arterial reconstruction.

Age Factors↗
PubMed1993

Effects of the development of modern vascular services on amputation rates in Leicester, U.K.: a preliminary report.

We have reviewed 3036 consecutive patients who underwent arterial reconstruction, percutaneous transluminal angioplasty, or a major amputation for lower limb peripheral vascular disease in Leicester between 1974 and 1990. Patient data were obtained from the Hospitals Activity Analysis database, which codes all patient discharges according to diagnosis and treatment. During this 17-year study period, 1132 patients have undergone arterial reconstruction, 706 patients have undergone percutaneous transluminal angioplasty, and 1198 patients have undergone major amputation. The results show that the number of arterial reconstructions and angioplasties for lower limb arterial occlusive disease has increased over the last 17 years. The total amputation rate has decreased slightly during the period studied, but overall the decrease has not been significant.

Amputation, Surgical↗
PubMed1993

Factors associated with decline in function, institutionalization and mortality of elderly people.

Movements between dependency states, institutionalization and death are investigated in a general practice cohort of people aged 75 years and over with follow-up at 5 and 7 years from initial interview. Initially, 1203 people were interviewed, 1124 living in the community and 79 in institutions. By 5 years, 42% (510) had died and by 7 years 58% (700) had died. Dependency was defined as requiring help or aids with at least one activity of daily living (ADL). Of those initially independent, 34% were still independent 7 years later. Women at each age were more likely to become dependent whilst men had higher mortality. Those rating their health as fair or poor were more likely to lose independence at both 5 and 7 years than those rating their health as good. These differences remained, even after adjustment for age, sex and baseline ADL status. With the assumption that once institutionalized a person did not return to live in the community (an assumption upheld by the present data), 7% (79/1124) of those initially resident in the community were institutionalized during the 7 years; the rates for men (6%) being slightly lower than for women (7.5%).

Activities of Daily Living↗
PubMed1993

Efficacy of deep venous thrombosis prophylaxis in trauma patients and identification of high-risk groups.

The incidence of deep venous thrombosis (DVT) and the efficacy of prophylactic measures were prospectively evaluated in all patients admitted to a level I trauma center during 1991. Patients with Injury Severity Scores (ISS) > 9 who survived a minimum of 48 hours (n = 395) were monitored using venous Doppler and ultrasound studies during hospitalization (total, 1308 studies). Two hundred eighty-one patients (71%) were randomly assigned to low-dose heparin or sequential compression devices. There were 18 cases of lower extremity DVT (4.6%) and four cases (1.0%) of pulmonary emboli (PE), three of which were fatal. Eight patients (2.9%) on prophylaxis and 10 (8.8%) without prophylaxis developed DVT (p < 0.02 by Chi-square). There were two PEs in each group. Fourteen of these 18 patients sustained blunt trauma and included seven spinal fractures or subluxations (four paraplegic) and four severe head injuries. This represented 14.0% of 50 patients admitted with spinal injuries and 4.3% of 92 patients with severe head injuries. Compared with those with no neurologic injury (7 of 253 or 2.7%), the risk of DVT is significantly higher in the spinal injury patients (p < 0.001, Chi-square) and twice as high as in the head injury group, although not statistically significant (p = 0.4, Chi-square). Three of the four patients with penetrating trauma and DVT had venous injuries. We conclude that DVT prophylaxis can significantly reduce the incidence of DVT in trauma patients with ISS > 9. Patients with severe neurologic injuries (particularly spinal cord) are at high risk for DVT and PE and may be considered for a prophylactic Greenfield filter.

Adult↗
PubMed1993

Reassessing the role of arteriograms in the management of posterior knee dislocations.

Vascular injury has been reported in up to one third of patients with posterior knee dislocations, which has led to the routine use of arteriograms in the management of these injuries. Recent studies have shown physical examination (PE) is reliable in detecting significant vascular injuries requiring surgery from other mechanisms. We hypothesized that PE would be similarly sufficient to assess popliteal injury in patients with posterior knee dislocations. To test this, we reviewed the records of all 37 patients with 38 such injuries at our institution over the past 5 years. The average age was 29.5 years, and 31 patients (81.5%) had other associated injuries. All dislocations were the result of blunt trauma. Two patients (5.3%) had hard signs (distal ischemia and no pulses) that clearly indicated vascular injury. Total occlusions of the popliteal artery were seen on arteriograms in both cases and these were successfully treated surgically with reversed saphenous vein bypass grafts. The remaining 36 dislocations manifested no hard signs of vascular injury (absent pulses, distal ischemia, active bleeding, bruit/thrill). Nineteen patients (50.0%) had normal vascular examination results, did not receive arteriograms, and had no adverse sequelae, with a mean follow-up of 9.3 months (range 1 day-43 months). Sixteen patients with 17 dislocations (44.7%) underwent arteriography and the findings appeared normal in ten extremities; nine of these extremities had normal pulses and one had a diminished but palpable pulse. A minimal injury (intimal defect, 3; narrowing, 4) was demonstrated in seven extremities, five with normal pulses and two with diminished pulses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Simulated home delivery in hospital: a randomised controlled trial.

OBJECTIVES: To compare the outcome of two methods of maternity care during the antenatal period and at delivery. One was to be midwife-led for both antenatal care and delivery, the latter taking place in rooms similar to those in one's own home to simulate home confinement. The other would be consultant-led with the mothers labouring in the delivery suite rooms with resuscitation equipment for both mother and baby in evidence, monitors present and a delivery bed on which both anaesthetic and obstetric procedures could be easily and safely carried out. DESIGN: Randomised controlled trial. SETTING: Leicester Royal Infirmary Maternity Hospital. SUBJECTS: Of 3510 women who were randomised, 2304 were assigned to the midwife-led scheme and 1206 were assigned to the consultant-led scheme. MAIN OUTCOME MEASURES: Complications in the antenatal, intrapartum and postpartum periods were compared as was maternal morbidity and fetal mortality and morbidity. Satisfaction of the women with care over different periods of the pregnancy and birth were assessed. RESULTS: There were few significant differences in antepartum, intrapartum and postpartum events between the two groups. There was no difference in the percentage of mothers and babies discharged home alive and well. Generally higher levels of satisfaction with care antenatally and during labour and delivery were shown in those women allocated to midwife care.

Adult↗
PubMed1993

A prospective study of nausea and vomiting during pregnancy.

The symptoms of nausea and vomiting in pregnancy were described by 363 pregnant women who kept daily symptom diaries. All delivered a single live baby. The majority of information collected was prospective, with the median day from last menstrual period to initial interview by the study midwife being day 57. It was found that 80% of women had symptoms, 28% experienced nausea only, while 52% had nausea and vomiting. The mean number of days from last menstrual period to onset and cessation of symptoms was 39 and 84, respectively, and 40% of women's symptoms ended abruptly. Cessation of symptoms occurred at approximately the same day from the last menstrual period whether they had begun early or later, severely or mildly [corrected]. The median total number of hours of nausea per pregnancy in those 292 women experiencing symptoms was 56, with peak symptoms occurring in the ninth week. Eighty five per cent of women experienced days with two episodes of nausea. Fifty three per cent of episodes of vomiting occurred between 06.00 hours and 12.00 hours. The symptom complex can be defined as episodic daytime pregnancy sickness. Among the study population, 206 women were in paid employment. Seventy three of these women (35%) spent a mean of 62 hours away from their paid work because of symptoms of nausea and vomiting, showing the socioeconomic significance of this condition. The detailed information gathered should help in the investigation of the aetiology of nausea and vomiting during pregnancy.

Adolescent↗
PubMed1992

Social intervention and the elderly: a randomized controlled trial.

A randomized controlled trial was set up in 1985 to test the effect of social intervention over 3 years among elderly people, aged 75 and above, living alone. The sampling frame was the age/sex register of a large group practice of 12 general practitioners serving the town of Melton Mowbray, Leicestershire, England, with a list size of approximately 32,000 patients. A total of 523 elderly people living alone in 1985 were identified, interviewed, and randomized into experimental and control groups. A lay worker offered the experimental group (n = 261) individual packages of support that aimed at enhanced social contacts. The outcome measures, approximately 3 years later in 1988, were mortality; changes in physical status; demand for medical, paramedical, social, and voluntary services; and changes in a number of subjective variables (morale, loneliness, and self-perceived health). No significant differences were found for any of the variables with the exception of self-perceived health status, where the experimental group showed significantly greater improvements than did the control group. More importantly, half the elderly in this sample declined several offers of help.

Activities of Daily Living↗
PubMed1992

The importance of clinical details when reporting accident and emergency radiographs.

The effect of clinical information on the accuracy of reporting accident and emergency (A&E) radiographs was studied in two A&E officers and five radiologists involved in their daily reporting. Each was shown 50 sets of radiographs, 30 subtle fractures and 20 controls. In one half the clinical history and precise localization was provided, and in the other half no such information was given. After an interval of 6 months the radiographs were viewed again with the amount of information reversed. The observers were asked to determine the presence of injury, describe its site, and indicate how sure they were of their diagnosis. Correct diagnosis was improved from 72.3 per cent to 80.3 per cent overall, and from 68.1 per cent to 81.4 per cent in the fracture group. All observers improved their performance with clinical details. The results confirm that accurate clinical details improve injury location.

Accidents↗