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Biomedical subjects

D Cartwright

Publications and source records attributed to D Cartwright.

At least 19 recordsLinked to original sources
PubMed2004

Management of chronic heart failure in the community: role of a hospital based open access heart failure service.

OBJECTIVE: To evaluate the role of an open access heart failure service based at a teaching hospital for the diagnosis and treatment optimisation of patients with heart failure in the community and to identify measures that may further enhance the effectiveness of such a service. SUBJECTS: 963 patients with suspected heart failure seen over an eight year period referred by their general practitioners to the cardiology department at a district general hospital. MAIN OUTCOME MEASURES: Presence or absence of left ventricular systolic dysfunction (LVSD) (left ventricular ejection fraction < 50% on echocardiography), and determination of the risk factors and predictors of LVSD. RESULTS: The majority of the patients were women (60% v 40%) and elderly (mean age 68.8 years). On echocardiography, only 30.8% were found to have LVSD. Patients were more likely to have LVSD if they were men (42.3% v 23.1%, p < 0.001, relative risk (RR) 1.8), were > 60 years of age (33.5% v 20.8%, p < 0.001, RR 1.6), or had a history of diabetes (49.4% v 29.1%, p < 0.001, RR 1.7), ischaemic heart disease (36.5% v 29.1%, p = 0.04, RR 1.3), or atrial fibrillation (52.6% v 27.8%, p < 0.001, RR 1.9). An abnormal ECG (48.4% v 19.5%, p < 0.001, RR 2.5) and cardiothoracic ratio > 0.5 on chest radiograph (44.3% v 17.8%, p < 0.001, RR 2.5) were found to be good predictors of LVSD. A normal ECG (negative predictive value 80.5%) and a cardiothoracic ratio of < 0.5 (negative predictive value 82.2%) can be used as baseline measures to identify patients with lower risk of developing LVSD (combined negative predictive value 87.9%). CONCLUSIONS: An open access heart failure clinic is effective for the diagnosis and management of chronic heart failure in community based patients. The presence of risk factors and simple baseline tests can be used to identify patients with LVSD in the community. The introduction of a protocol based on these findings into a referral system can improve the efficiency and cost effectiveness of such a service.

Aged↗
PubMed2001

Enteral human IgG for prevention of necrotising enterocolitis: a placebo-controlled, randomised trial.

BACKGROUND: Neonatal necrotising enterocolitis is a serious, commonly fatal disease in premature neonates. Although feeding with expressed breast milk and other good nursery practices are partly protective, preventive measures are needed. Treating neonates enterally with a mixture of human IgA and IgG, prepared from donated blood, has been claimed to protect against necrotising enterocolitis. However, no IgA preparation is available in Australia. Our aim, therefore, was to identify whether or not enteral IgG could prevent the disorder. METHODS: We did a multicentre, double-blind, placebo- controlled trial. We randomly assigned 768 infants to receive human IgG 1200 mg/kg daily, and 761 to receive placebo, for up to 28 days. Treatment began at the same time as enteral feeding. The primary outcome measure was the proportion of infants who developed definite necrotising enterocolitis during the trial, and any deaths that resulted from the disorder in the treatment and placebo groups. Analysis was on an intention-to-treat basis. FINDINGS: 43 infants developed definite necrotising enterocolitis in the IgG group, ten of whom died. In the placebo group, 41 infants contracted the disorder and six died (p=0.47). 25 infants on IgG and 36 on placebo had suspect necrotising enterocolitis (p=0.14). INTERPRETATION: Supplementation of enteral feeds with human IgG does not reduce necrotising enterocolitis.

Double-Blind Method↗
PubMed2000

Focus on function in geriatric assessment and rehab.

In 1994, the province of Alberta, driven by the need for deficit reduction, began a major restructuring of the provincial health care system. An integral component of this new health structure was accountability for service delivery, including the use of outcome measures to determine service effectiveness. This paper describes the efforts of one program to evaluate the effectiveness of its service delivery, in terms of functional patient outcomes, in the midst of restructuring and budget constraints.

Activities of Daily Living↗
PubMed1999

Angiomyolipoma of the liver in fine-needle aspiration biopsies: its distinction from hepatocellular carcinoma.

BACKGROUND: Angiomyolipoma (AML) of the liver is an uncommon benign lesion that may be difficult to distinguish clinically, radiographically, and morphologically from hepatocellular carcinoma (HCC). METHODS: Fine-needle aspiration biopsies (FNAB) of three AMLs of the liver were compared with FNABs from eight cases of HCC. Immunoperoxidase stains for HMB-45, muscle specific actin, and CAM 5.2 were performed on two cell blocks and one resection of AML. RESULTS: All three AMLs yielded cellular aspirates. They were composed of clusters of cells with arborizing transgressing endothelium but no peripherally wrapping endothelium. Smooth muscle cells of AML showed fibrillar cytoplasm and indistinct cytoplasmic borders; HCC showed granular cytoplasm and distinct cytoplasmic borders. Extramedullary hematopoiesis was present only in AML. Mitotic figures were seen only in HCC. Intranuclear inclusions, nucleoli, and large, atypical cells were present in both AML and HCC. Fat was seen in only one case of AML and was scant. Immunoperoxidase stains for HMB-45 and smooth muscle actin were positive in AML and negative in adjacent normal liver. CAM 5.2 stain was negative in AML. CONCLUSIONS: The cytologic features seen on FNABs of AML are distinct from those of HCC. Immunoperoxidase stains can aid in the definitive diagnosis on FNAB. It is important to recognize AML on FNAB to allow conservative clinical management.

Actins↗
PubMed1997

Evaluating the FONE FIM: Part I. Construct validity.

Rasch analysis was used in this paper to evaluate the Motor component of the FONE FIM, the telephone version of the Functional Independence Measure (FIM). For this purpose, 132 patients discharged from an inpatient geriatric assessment and rehabilitation program were assessed by trained research assistants using the FONE FIM. The results at 5 weeks post-discharge were compared to the observation FIMs (OBS FIMs) done at home 6 weeks post-discharge. These patients had an average age of 79 years and presented with multiple, complex medical problems and significant functional decline. The FONE FIM and the OBS FIM were shown to share a strikingly similar item hierarchy, based on Rasch item difficulty measures. Only bladder management and climbing stairs were misfitting items as indicated by item fit statistics. The same 13-item set and 4-point scales were shown to be psychometrically optimal for both the FONE FIM and the OBS FIM based on the person separation index. Further research is required to address the issue of the optimal item set and scale levels from psychometric and clinical perspectives.

Activities of Daily Living↗
PubMed1997

Evaluating the FONE FIM: Part II. Concurrent validity & influencing factors.

The "motor" (activities of daily living) component of the FONE FIM, the telephone version of the Functional Independence Measure (FIM) was evaluated in a cohort of 132 patients who had been discharged to home from a geriatric inpatient assessment and rehabilitation program. In the current study, Rasch person ability measures were derived from telephone assessments 5 weeks after discharge and in-home assessments 1 week later. Concordance between the modes was shown to be satisfactory for the Rasch measures based on intraclass correlation coefficients. However, the telephone mode consistently generated lower estimates than did the observational mode. This was due to the fact that the telephone mode underestimated motor function for the majority of patients who were at higher levels of cognition and motor function, but overestimated for patients who were at lower levels of cognition and motor function. At the item level, concordance, as determined by Kappa statistics, was better when the FONE FIM responses came from the patient rather than proxy respondents, and when the assessments were done by more experienced rather than less experienced raters. Based on these findings, a mixed strategy, the telephone mode for patients capable of responding to the FONE FIM and in-home assessments for those who are incapable, is recommended.

Activities of Daily Living↗
PubMed1995

Lacrimal gland lymphoma: a cytomorphologic and immunophenotypic study.

The cytomorphology of lacrimal gland lymphoma has not been specifically described. Herein we present six cases of histologically proven lacrimal gland lymphoma which we analyzed using fine-needle aspiration cytology, cell suspension immunophenotype analysis, and immunoglobulin gene rearrangement studies. Fine-needle aspiration cytology revealed atypical populations of cells comprised of either monomorphic small round lymphocytes with or without plasmacytoid features (4 cases), a mixed population of small and large irregular lymphocytes (1 case), or a population of large irregular lymphocytes (1 case). The initial cytologic diagnosis was malignant lymphoma in all six cases. Cell suspension immunophenotype analysis demonstrated that the lesions were composed predominantly of B-cells that expressed monotypic surface immunoglobulin. Three cases demonstrated an immunoglobulin heavy chain gene rearrangement. The atypical cytologic features and the abnormal immunophenotype were consistently predictive of malignant lymphoma. Given that these lesions are small and biopsy material is often limited, fine-needle aspiration offers the advantage of providing tissue that is ideal for cytologic and cell suspension immunophenotype evaluation, obviating the need to provide surgical biopsy material for this purpose. We conclude that fine-needle aspiration can identify malignant lymphoid lesions of the lacrimal gland and may serve as a valuable adjunct in the assessment of these lesions. Additional study is warranted to determine whether fine-needle aspiration can reliably distinguish between benign and malignant lymphoid proliferations of the lacrimal gland.

Aged↗
PubMed1995

Ventilator circuitry in neonatal intensive care: extending the period between changes from 4 to 7 days. A pilot study.

OBJECTIVE: To determine the effect of increasing the time span between changes of disposable ventilator tubing from 4 to 7 days. DESIGN: A prospective non-randomised study comparing levels of bacterial colonisation amongst babies who had ventilator circuits changed on either the 4th or 7th day. Data was collected sequentially with data collection from the '4-day group' preceding data collection from the '7-day group'. SETTING: A tertiary neonatal intensive care nursery. PATIENTS: All babies requiring ventilation at the time when data collection was possible. Ten babies were included in the first group (4 days) and 33 babies in the second group. INTERVENTIONS: Inspiratory and expiratory lines were swabbed and water from the humidifier trap sampled before the line was changed at either 4 or 7 days. Results of routine endotracheal aspirates, taken before and after the change of circuitry, were noted. MAIN OUTCOME MEASURE: The level of bacterial contamination of ventilator circuits. RESULTS AND CONCLUSIONS: In this small sample, no differences were found in terms of bacterial colonisation of ventilator lines. This has resulted in a change of practice in the hospital and a cost saving of over $15,000.

Equipment Contamination↗
PubMed1994

Elimination of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit after hand washing with triclosan.

Evaluating hand wash products in terms of user acceptability and effectiveness against methicillin-resistant Staphylococcus aureus (MRSA) has been part of a long-term strategy to eliminate endemic MRSA from the neonatal intensive care unit at the Royal Women's Hospital (Brisbane). Following the introduction of a new hand wash disinfectant (triclosan 1% wt/vol), new cases of MRSA colonization were monitored for 12 months. In addition, the use of antibiotics, the incidence of multi-resistant Gram-negative cultures and neonatal infections were noted. No changes were made to any procedures or protocols during the trial. All babies colonized with MRSA had been discharged from the nursery within 7 months of the introduction of triclosan and in the subsequent 9 months no new MRSA isolates had been reported. Reduction in the use of vancomycin has resulted in a cost saving of approximately $A17,000. The total number of Gram-negative isolates has not increased, although Pseudomonas aeruginosa is now reported more often. Compared with the previous 12 months, fewer antibiotics were prescribed and fewer nosocomial infections recorded (P < 0.05).

Colony Count, Microbial↗
PubMed1993

Pharmacokinetics of dexamethasone following single-dose intravenous administration to extremely low birth weight infants.

The single-dose pharmacokinetics of dexamethasone were studied in 7 extremely low birth weight infants of mean (+/- SD) gestational age 25.6 +/- 0.5 weeks suffering bronchopulmonary dysplasia. A mean peak dexamethasone concentration of 250.5 +/- 70.7 ng/ml was obtained following an intravenous bolus dose (0.369 +/- 0.04 mg/kg dexamethasone) of dexamethasone sodium phosphate. Dexamethasone was measured in plasma by HPLC. Mean clearance (0.143 +/- 0.028 litres/kg/h) was approximately half that reported previously in children and adults, while the half-life (9.26 +/- 3.34 h) was 2- to 3-fold longer than in these patients. The volume of distribution (1.9 +/- 0.483 litres/kg) was larger than reported in a previous study in adults, but was similar to that determined in pediatric and adult patients in another study.

Bronchopulmonary Dysplasia↗
PubMed1991

Closure of the ductus arteriosus: determinant factor in the appearance of transient peripheral pulmonary stenosis of the neonate.

We speculated that a relationship may exist between transient peripheral pulmonary stenosis and the closure of the ductus arteriosus. Fifty preterm infants had pulmonary artery and ductal color Doppler flow velocity assessments performed before and after closure of the ductus arteriosus. No flow turbulence or increase in velocity was observed immediately after birth, although a significant discrepancy in size was observed between the main pulmonary artery and its two branches. After closure of the ductus, 15 infants had signs of transient peripheral pulmonary stenosis of the left pulmonary artery in association with a significant decrease of diameter at the origin of the same artery. In all 50 infants, no significant gradient was observed in the right pulmonary artery. We conclude that, at least in the preterm infant, transient peripheral pulmonary stenosis is not present at birth but is an acquired phenomenon closely related to closure of the ductus arteriosus.

Blood Flow Velocity↗
PubMed1990

Effect of intermittent positive pressure ventilation on diastolic ventricular filling patterns in premature infants.

Eleven preterm newborn infants had a Doppler echocardiographic examination of their ventricular filling patterns during intermittent positive pressure ventilation. Peak velocity during early ventricular filling (VE) and during atrial systole (VA) and diastolic velocity-time integral of early (IE) and late (IA) ventricular filling caused by atrial contraction were measured. The ratios of VE/VA and IE/IA were also calculated. Diastolic peak velocities, as well as the diastolic velocity-time integral of early and late ventricular filling measured through the mitral valve were significantly higher during inspiration. The peak of the wave representing the velocity during atrial systole (A) was always higher than the peak of the wave representing the velocity of early ventricular filling (E). As a result, the ratio of these two variables (E/A) was always less than 1, showing no significant variation from inspiration to expiration. The flow patterns into the right ventricle were the opposite of those observed through the mitral valve. During inspiration, a significant decrease (p less than 0.001) in peak and time integral velocities of both the early ventricular filling and atrial systole waves was observed. Heart rate did not vary with respiration. It is concluded that during positive pressure ventilation, inspiration decreases right ventricular filling and enhances left ventricular filling. Opposite changes are recorded during expiration. Early and late phases of diastolic filling are equally affected. These changes are different from those observed during spontaneous breathing and should be taken into account in the assessment of diastolic ventricular function in preterm infants requiring assisted ventilation.

Blood Flow Velocity↗
PubMed1986

Horrible Harry.

Explore the source record for details and available documents.

Adult↗
PubMed1984

The effect of hypocarbia on the cardiovascular system of puppies.

Respiratory alkalosis (hypocapnia) is used to treat persistent pulmonary hypertension in newborns. With the exception of the brain, there are no data on the effects of hypocapnia on organ blood flow in the neonate. Therefore, we examined the effects of 2 h of hypocapnia on blood pressure, oxygen consumption, cardiac output and organ blood flows in puppies. In six animals (group I), reducing the PaCO2 to 21.8 +/- 1.5 mm Hg (pH 7.62 +/- 0.04) caused an immediate and sustained reduction in cerebral blood flow (40%) and in myocardial blood flow (25%). There were no significant changes in arterial blood pressure, total body oxygen consumption, cardiac output, right and left ventricular rate-pressure product, or blood flow to the gut, liver, muscle, and kidneys. In four control animals (group II)(PaCO2 39.8 +/- 3.0, pH 7.38 +/- 0.04), there were no changes in any of the measured variables (arterial blood pressure, total body oxygen consumption, cardiac output, or blood flow to any organ, including brain and heart) during 2 h of normocarbic ventilation. We did not determine whether the reductions in cerebral and myocardial blood flows were detrimental. We suspect that they were not because the animals did not develop metabolic acidosis and they had normal cardiac outputs, and ventricular rate-pressure products throughout the study.

Acid-Base Equilibrium↗