PubMed Health⌕ Search

Biomedical subjects

C R Walsh

Publications and source records attributed to C R Walsh.

8 recordsLinked to original sources
PubMed2000

Clinical trials of unfractionated heparin and low-molecular-weight heparin in addition to aspirin for the treatment of unstable angina pectoris: do the results apply to all patients?

We sought to determine how the results of available randomized controlled trials of intravenous unfractionated heparin (UH) and low-molecular weight heparin (LMWH) apply to unselected patients with unstable angina pectoris (UAP). Although UH is widely used in addition to aspirin for treatment of UAP, the evidence is weak for a net benefit over aspirin alone. LMWH preparations may confer a net benefit over UH for the treatment of UAP in clinical trials. It is not clear, however, how trial results are generalized to unselected patients with UAP. Using criteria from the Agency for Health Care Policy and Research Unstable Angina Clinical Practice Guideline, we identified 277 consecutive patients with primary UAP. Exclusion criteria were applied from 6 trials of UH in addition to aspirin and 5 trials of LMWH in addition to aspirin for the treatment of UAP. Clinical outcomes were compared among ineligible and eligible patients for trial enrollment. Patients meeting exclusion criteria were older and had more extensive coexisting medical illness than eligible patients for trial enrollment. Thirty-eight percent to 42% of our study population met > or = 1 exclusion criteria for each of the 6 trials of UH, and 14% to 46% met > or = 1 exclusion criteria for each of the 5 LMWH trials. The 1-year all-cause death rate was higher in UH ineligible patients compared with UH eligible patients (16% vs 4%, p = 0.003) and in LMWH ineligible patients compared with LMWH eligible patients (16% vs 7%, p = 0.005). Thus, clinical trials of UH and LMWH may have limited generalizability to unselected patients with UAP, many of whom have characteristics that would exclude them from trial enrollment and put them at risk for adverse outcomes.

Adult↗
PubMed1999

Characteristics and prognosis of patients with suspected acute myocardial infarction and elevated MB relative index but normal total creatine kinase.

"MB Leak" patients who develop an elevated MB relative index with a normal total creatine kinase (CK) level are not as well characterized as those who have diagnostic enzyme elevations in the setting of ST elevation (elevation) or non-ST elevation acute myocardial infarction (AMI). During a 1-year period, we studied all patients hospitalized in an urban academic hospital with suspected AMI who developed an elevated MB relative index within 24 hours of presentation. Of 595 patients, 44% had MB Leak, 34% had non-ST elevation AMI and 22% had ST elevation AMI. Patients with MB Leak and non-ST elevation AMI were significantly older than those with ST elevation AMI (mean ages 69, 71, and 63 years, respectively; p <0.001), and were more likely to have previous AMI (55%, 46%, 12%; p <0.001) or past coronary revascularization (40%, 19%, 12%; p <0.001). The in-hospital death rate of patients with MB Leak was half that of patients with non-ST elevation AMI or ST elevation AMI (6%, 12%, 12%; p = 0.03). By 1 year after presentation, the death rate of patients with MB Leak (17%) was intermediate between that of non-ST elevation AMI (24%) and ST elevation AMI (14%). Within the MB Leak group, those with elevated absolute CK-MB levels were at highest risk. In a multivariable model using MB Leak as the referent, the relative risks for 1 year death were 1.4 (95% confidence interval, 0.9 to 2.2) for patients with non-ST elevation AMI and 1.7 (0.8 to 3.4) for patients with ST elevation AMI. Patients with MB Leak are at high risk for cardiovascular events in the hospital and for death by 1 year. Therefore, they may benefit from early aggressive therapy and risk stratification. These results suggest that CK-MB should be measured in all patients with suspected AMI, regardless of their total CK level.

Aged↗
PubMed1993

Neutrophil adhesion in central nervous system ischemia in rabbits.

Activated neutrophils appear to be directly involved in potentiating central nervous system ischemic injury. After initial endothelial adherence, neutrophils can potentiate ischemia by causing capillary plugging and infiltrating ischemic tissue to release toxic metabolites. We used an endothelial component adherence assay to characterize neutrophil adhesion following reversible central nervous system ischemia. Rabbit spinal cord ischemia was produced by 40 min of reversible arterial occlusion. Neutrophils were isolated using density gradient centrifugation and adherence to laminin or fibronectin was determined using a myeloperoxidase assay. The baseline (N = 26) percentage of adherent neutrophils was 3.8 +/- 0.3/5.6 +/- 0.6 (laminin/fibronectin), sham-operated controls (2 h post) (N = 6) 3.3 +/- 0.5/3.9 +/- 0.4, 30 min post ischemia (N = 6) 2.5 +/- 1.1/4.1 +/-1.9, 2 h (N = 6) 7.6 +/- 1.4/9.9 +/- 2.6 (p < .05 to baseline and sham), 18 h (N = 8) 4.9 +/- 1.5/7.1 +/- 3.1, and 42 h (N = 6) 3.4 +/- 0.4/6.6 +/- 2.1. Concurrent serum fibrinogen values were baseline 142 +/- 12, sham (18 h) 141 +/- 14, 2 h 166 +/- 21, 18 h 512 +/- 43 (p < .01), and 42 h 580 +/- 86 (p < .01). These results suggest that neutrophil adherence is increased after acute central nervous system ischemia. There appears to be a limited period of increased adherence that occurs earlier than other acute phase reactants.

Acute Disease↗
PubMedDate not supplied

Collaborative practice: a coordinated approach to patient care.

Mr. Michael is a patient who was cared for at our institution when surgery for a severe rheumatoid neck deformity was planned for him. This article demonstrates how preplanning, collaborative practice, and communication among the health care team members successfully facilitated a positive outcome for this patient.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Attributes of mentors as perceived by orthopaedic nurses.

Mentoring in nursing is a concept that merits close scrutiny in today's chaotic health care environment. Mentors can shape a positive environment for nurses to nurture career development, satisfaction and leadership. One of the issues of mentoring is that there is no agreement as to the role and functions of a mentor. Most of the controversy deals with the similarities and differences between mentors and preceptors. The purposes of this study were to identify attributes of mentors as perceived by orthopaedic nurses and to identify who orthopaedic nurses feel are the most appropriate persons to serve as mentors. This may enable nursing leaders to develop specific programs and strategies to increase job satisfaction and nurse retention among orthopaedic nurses.

Attitude of Health Personnel↗
PubMedDate not supplied

A joint protocol for home skeletal traction.

Cost-effective delivery of quality patient care is a major focus of the orthopaedic advanced practice nurse's practice. Long-term skeletal traction therapy for select fractures of the pelvis remains a treatment option for certain patients. The purposes of this article are to describe the development of a joint proposal for home skeletal traction therapy and to analyze the cost savings involved by reviewing a case study of a home traction patient.

Adult↗