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Biomedical subjects

C Packham

Publications and source records attributed to C Packham.

At least 19 recordsLinked to original sources
PubMed2000

Mortality of patients admitted with a suspected acute myocardial infarction in whom the diagnosis is not confirmed.

AIMS: To examine the survival of patients admitted with a suspected acute myocardial infarction in whom the diagnosis was not confirmed ('possible myocardial infarction'). METHODS AND RESULTS: A cohort study based on the Nottingham Heart Attack Register of 1716 sequential patients discharged alive from two acute teaching hospitals following admission in 1992. The main outcome was mortality following hospital discharge after 5 years of follow-up. Survival of the cohort of patients in whom myocardial infarction was suspected but not confirmed was 58% (95% C.I. 56 to 60%) after 5 years of follow-up, compared with an expected survival of 76% in an age/sex matched general population. Patients with ECG abnormalities that were not diagnostic of myocardial infarction had a 5-year survival of 56%, compared with 77% in those without such changes (P<0.00001). In the 703 patients who died in the first 5 years of follow-up, the cause of death was cardiovascular in at least 53% of cases. Survival following hospital discharge was worse than that in patients discharged alive in the same year following a confirmed myocardial infarction (63% vs 69% after 4 years of follow-up P=0.0016). CONCLUSION: Patients in this study had a substantially increased risk of death in the 5 years after discharge from hospital, compared with an age- and sex-matched population, and worse than patients discharged following a confirmed myocardial infarction. Almost half of those with ECG changes at the time of their admission died over the next 5 years. As over half of all deaths in this cohort were due to cardiovascular causes, further work is needed to identify patients at high and low risk of subsequent mortality who may warrant investigation and treatment following hospital discharge.

Aged↗
PubMed2000

Identifying the risk of death following hospital discharge in patients admitted with a suspected acute myocardial infarction in whom the diagnosis is not confirmed.

AIMS: To describe clinical factors, available at the time of discharge, that predicted survival of patients admitted with a suspected acute myocardial infarction in whom the diagnosis was not confirmed. METHODS AND RESULTS: A cohort study based on the Nottingham Heart Attack Register of 1716 sequential patients discharged alive from two acute teaching hospitals following admission in 1992. The main outcome was identification of high and low mortality risk groups over 5 years of follow-up. Overall 5-year survival was 58% (95% CI 56 to 60%). Having abnormal cardiac enzyme changes or an abnormal ECG that was insufficient to meet established diagnostic criteria of myocardial infarction, or both, identified three groups with a 5 year survival of 77%, 60% or 51%. Multivariate methods were used to develop a risk score from seven variables available at the time of discharge (age, sex, past history of myocardial infarction, ECG abnormalities, cardiac enzyme abnormalities, Killip score of 2 or 3 on admission and being discharged on a diuretic). Quartiles of this risk score then identified four groups with 5 year survival ranging from 89% to 25%. CONCLUSION: Among the study cohort, it was possible to identify subgroups with a markedly different risk of subsequent mortality from clinical indicators that were readily available at the time of hospital discharge. Risk stratification has the potential to improve targeting of subsequent secondary preventive efforts, but further work is required to ascertain whether cardiovascular risk can be modified through a more intensive approach to management.

Aged↗
PubMed1999

Statin prescribing in Nottingham general practices: a cross-sectional study.

BACKGROUND: The aim of the study was to determine the effect of deprivation on variations in statin prescribing in Nottingham general practices. Deprivation is used as a measure of population cardiovascular morbidity and need for statin treatment. The setting was all 118 general practices in contract with Nottingham Health Authority. METHODS: A cross-sectional study was undertaken. Statin prescribing in general practice during 1996 was related to indices of practice deprivation based on enumeration district (ED) level data from the 1991 Census. The relationship between statin prescribing per 1000 patients aged 35-69 and practice deprivation (measured both as Townsend score and as Jarman UPA(8) score) with additional adjustment for practice characteristics (number of partners, training status, total list size, fundholding status) cardiovascular prescribing costs net of lipid prescribing and hospital activity (total and medical admissions and new general practitioner total and medical out-patient referrals) for each practice. RESULTS: The prescription of statins during 1996 varied between nil and 14.1 'statin-years' of prescribing per 1000 patients aged 35-69. There was a significant inverse relationship between the rate of statin prescribing and the level of deprivation of that practice (p < 0.0001). Deprivation, as measured by Townsend index, accounted for 13 per cent of the total variability in statin prescribing, which rose to 19 per cent after adjustment. The prescribing of other lipid lowering agents of the fibrate class was positively associated with statin prescribing (p=0.001) and this association persisted after adjusting for deprivation. None of the other practice characteristics were found to be significantly associated with rates of statin prescribing. CONCLUSIONS: General practices with high deprivation indices serve more deprived populations with a higher prevalence of cardiovascular disease, and may be assumed to have a greater need for statins. Despite this, practices with higher deprivation indices prescribed fewer statins to their patients than less deprived practices. It was not possible to identify whether the more deprived general practices had successfully identified at risk individuals but it is likely that special efforts are needed to increase the uptake of effective health care in their patients.

Adult↗
PubMed1999

Cardiac rehabilitation: socially deprived patients are less likely to attend but patients ineligible for thrombolysis are less likely to be invited.

OBJECTIVE: To identify factors associated with the uptake of cardiac rehabilitation following acute myocardial infarction. DESIGN: Retrospective analysis using multivariate logistic regression modelling. SETTING: Two large teaching hospitals in Nottingham. PATIENTS: Cohorts of patients admitted with acute myocardial infarction in 1992 and 1996. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Factors in multivariate analysis found to be associated with attendance at cardiac rehabilitation. Use of secondary prevention in those who were and were not invited and those who did and did not attend cardiac rehabilitation. RESULTS: 58% of all patients were offered cardiac rehabilitation. Attendance rates were 60% in 1992 and 74% in 1996. Invitations were more likely to be offered to younger patients, those who had received thrombolysis, and to patients admitted to one of the two Nottingham hospitals. Use of secondary prevention was only 48% in 1992 but this increased to 80% in 1996. Patients not receiving secondary prevention were less likely to be invited to cardiac rehabilitation. Social deprivation was the only factor significantly associated with poor uptake of cardiac rehabilitation in both years. There was no difference in the use of secondary prevention between those who did and did not attend cardiac rehabilitation. CONCLUSION: Those invited to attend a cardiac rehabilitation programme are likely to be in a good prognosis group, comprising those who are young and have received thrombolysis. Those at greatest risk, particularly patients from socially deprived areas, seem to be missing out on the potential benefits of cardiac rehabilitation. High risk patients should be specifically targeted to ensure that they are invited to, and encouraged to, attend a programme of cardiac rehabilitation.

Adult↗
PubMed1999

Latex gloves.

Explore the source record for details and available documents.

Gloves, Surgical↗
PubMed1997

Recovery of some common solvents from an adhesive commercial skin adsorption pad by thermal desorption-gas chromatography.

A thermal desorption-gas chromatography (GC) system was developed for use with commercial adhesive plasters used for monitoring exposure of hands to common solvents. The efficiency of solvent adsorption on the activated carbon pads located on the plasters was determined for acetone, trichloroethylene, D-limonene, methanol, ethyl methyl ketone, toluene, tetrachloroethylene and m-xylene. The degree of solvent recovery for the system was also investigated for each solvent, as was its sensitivity and reproducibility. All solvents exhibited > 90% adsorption on the pads at spiking levels of 100-200 ng for each solvent, except for m-xylene and d-limonene. Solvent recovery was dependent on the volatility of the solvent at spiking volumes of about 1 microliter per pad with solvents with boiling points above 110 degrees C showing recoveries of < 75%. Increasing primary desorption times and temperatures increased these values. The precision was good with RSD < 5% for all solvents over the range 0.5-5.0 microliters of applied solvent. It was possible to detect 15-60 ng of each solvent component within solvent mixtures on the pads with the exception of D-limonene. It is concluded that all solvents tested except D-limonene can be determined on the pads under the conditions for thermal desorption-GC analysis described. The pads were used under protective gloves with six workers using xylene isomers as solvent in the workplace, when apparent solvent breakthrough through their gloves was observed.

Chemical Industry↗
PubMed1995

How do economic status and social support influence survival after initial recovery from acute myocardial infarction?

There is much interest in the influence of psychosocial factors and social deprivation on health. This study investigates the influence of economic status (as measured by car-ownership) and social support on survival after acute myocardial infarction (AMI). In addition, the possible influence of stressful life events and satisfaction with home, social and working/retirement life is also assessed. Cases with suspected AMI were identified through the Anglo-Scandinavian Study of Early Thrombolysis (ASSET). 1701 English patients completed a questionnaire. Patients were followed for between 4.7 and 6.3 years, with the single outcome measure being death from all causes. 1283 patients surviving 7 days were included in presented statistical analyses using Cox's regression. After adjusting for a broad range of clinical variables, patients with no car were at approximately 40% higher risk of dying following AMI than car-owners (hazard ratio 1.4, P = 0.007, 95% CI 1.1-1.8). Lack of social contacts or being unmarried were not significantly associated with survival after adjusting for car-ownership and clinical variables. Economic status and survival after AMI are associated. With the dominant psychosocial prognostic indicator in this study being economic status, attention focuses on the growing gap between the socially deprived and the more affluent, and its effects on health.

Aged↗
PubMed1993

The effects of non respiratory exposure to substances.

Contact dermatitis can be avoided but still features prominently in compensation claims. Christopher Packham and Ray Russell-Fell argue that control of non-respiratory substances should be given greater attention by those responsible for workplace health and safety.

Acute Disease↗
PubMed1989

Deputising: one practice's experience.

Deputising services, either commercial organisations or doctors' co-operatives, play a necessary, although not perhaps desirable, part in providing general medical services to many less privileged and high demand areas of the country. They are probably here to stay and their use appears to be increasing. This report looks at one practice's use of a deputising service.

Adolescent↗