PubMed Health⌕ Search

Biomedical subjects

F Evans

Publications and source records attributed to F Evans.

17 recordsLinked to original sources
PubMed2006

An audit of gynaecological procedures in Jehovah's Witnesses in an inner city hospital.

A retrospective study of Jehovah Witness women between January 1994 and December 2003 was performed. Gynaecologists are concerned about operating on Jehovah's Witnesses because of the potential for haemorrhage during surgery. Jehovah's Witnesses do not accept donor blood but some will permit their own blood to be stored pre-operatively and administered during surgery if deemed necessary. Approximately 150,000 Jehovah's Witnesses live in the UK but little on gynaecological procedures in Jehovah's Witnesses has been published. There were 64 procedures (14 major, 18 intermediate and 32 minor) in 53 women with a median age of 42 years. There were no perioperative deaths, but postoperative anaemia was common. Our study showed that major, intermediate and minor gynaecological procedures can be performed without significant morbidity on Jehovah's Witnesses but a protocol should be available to outline management of those who refuse blood.

Adolescent↗
PubMed2000

Phytochemical and pharmacological studies on Monechma ciliatum.

The leaves of Monechma ciliatum were found to contain alkaloids, glycosides, proteins, tannins and saponins. The hot methanol extract (HME) of the leaves, previously found to have potent oxytocic effect in various species was fractionated in various solvents and the fractions analysed chemically and also assayed on the rat uterus in an attempt to identify the chemical constituents present and in particular the oxytocic principle. Positive reaction with ninhydrin spray suggests that the oxytocic constituent is an amino acidic derivative.

Animals↗
PubMed1999

Bioassay-directed isolation of oxytocic principles from the methanol extract of Monechma ciliatum.

The hot methanol extract (HME) of Monechma ciliatum which has been reported to have potent oxytocic activity was purified by fractionation in an attempt to isolate the oxytocic principle. Thin layer analysis indicated that the oxytocic fraction was very polar. A positive reaction with ninhydrin-spray suggested that it is an amino acid/protein. Repeated column chromatography (CC) on silica gel followed by sephadex LH-20 column, accompanied by bioassay of the fractions on the rat isolated uterus enabled partial isolation of the oxytocic principle (P3) to be achieved. Although the exact structure of P3 could not be identified from the present study, various spectral analyses suggest that it is a small peptide made up of tyrosine, leucine and a third component which is probably serine. It is interesting to note that the parent compound, oxytocin, is also a peptide with tyrosine and leucine in its structure.

Animals↗
PubMed1997

Effect of electrode position on outcome of low-energy intracardiac cardioversion of atrial fibrillation.

The aim of this study was to evaluate the new method of low-energy, catheter-based intracardiac cardioversion in patients with chronic atrial fibrillation (AF) and to compare 2 different lead positions. Accordingly, we prospectively studied 80 consecutive patients with chronic AF (9.8 +/- 7.9 months) who were randomly assigned to undergo internal cardioversion either via defibrillation electrodes placed in the right atrium and coronary sinus (coronary sinus group) or via defibrillation electrodes placed in the right atrium and left pulmonary artery (pulmonary artery group). Intracardiac shocks were delivered by an external defibrillator synchronized to the QRS complex. After conversion, all patients were treated orally with sotalol (mean daily dose, 189 +/- 63 mg/day). For conversion to sinus rhythm, the overall mean energy requirement was 5.6 +/- 3.1 J. In the coronary sinus group, cardioversion was achieved in 35 of 38 patients at a mean energy level of 4.1 +/- 2.3 J (range 1.0 to 9.9), and in the pulmonary artery group in 39 of 42 patients with 7.2 +/- 3.1 J (range 2.5 to 14.8). Although there was no difference with regard to success rate, the energy differed significantly between the 2 groups (p < 0.01). Mean lead impedance was 56.4 +/- 7.0 omega and 54.6 +/- 8.5 omega, respectively (p = NS). No serious complications were observed in either lead group. At a mean follow-up of 14.2 +/- 7.0 months, 54% and 56%, respectively, of patients who had been converted successfully remained in sinus rhythm. Thus, low-energy biphasic shocks delivered between the right atrium and coronary sinus or pulmonary artery are equally effective for cardioversion of patients with chronic AF. The energy requirements for conversion from a pulmonary artery electrode position are higher than for the coronary sinus position.

Administration, Oral↗
PubMed1997

A comparison of treatment of atrial fibrillation with low-energy intracardiac cardioversion and conventional external cardioversion.

AIM: Low-energy (1 to 15 J), catheter-based intracardiac cardioversion was compared with transthoracic external cardioversion (360 J) in a prospective, cross-over clinical trial. METHODS AND RESULTS: In 187 consecutive patients with chronic atrial fibrillation, over a period of a mean of 10.0 +/- 7.3 (SD) months, 217 cardioversion attempts were made. Intracardiac shocks were randomly applied between two 6-F catheters located in either the right atrium and coronary sinus or between the right atrium and left pulmonary artery. When a cardioversion attempt with one method failed, the other method was implemented. After cardioversion, all patients were treated orally with sotalol with a mean daily dose of 174 +/- 54 mg. Internal cardioversion was more effective than external cardioversion (65/70 = 93% vs 92/117 = 79%, P < 0.01). The mean energy for successful cardioversion was 5.8 +/- 3.2 J for the internal and 313 +/- 71 J for the external cardioversion group. At a mean follow-up of 12.5 +/- 6.4 months, 48% (38%) of the patients treated with internal (external) cardioversion were in sinus rhythm (P < 0.05). In 22 of 25 patients in whom external cardioversion failed, sinus rhythm was restored with internal cardioversion at a mean energy of 6.5 +/- 3.0 J. Overweight patients had twice the risk of unsuccessful external cardioversion. CONCLUSIONS: Internal cardioversion is effective in restoring sinus rhythm. It might be indicated in patients in whom external cardioversion had failed or in whom external cardioversion is assumed to be difficult or even contraindicated.

Adult↗
PubMed1997

Pain relief with oral cannabinoids in familial Mediterranean fever.

Cannabinoids have analgesic and, possibly, anti-inflammatory properties but their clinical use has been restricted by legislation. This is the first United Kingdom report of the controlled use of a standardised pharmaceutical preparation of cannabinoids in capsular form. The therapy was assessed in a patient with familial Mediterranean fever, who presented with chronic relapsing pain and inflammation of gastrointestinal origin. After determining a suitable analgesic dosage, a double-blind placebo-controlled cross-over trial was conducted using 50 mg tetrahydrocannabinol daily in five doses in the active weeks and measuring effects on parameters of inflammation and pain. Although no anti-inflammatory effects of tetrahydrocannabinol were detected during the trial, a highly significant reduction (p < 0.001) in additional analgesic requirements was achieved. Future study designs can now incorporate prescribable forms of cannabinoids but the choice of previous cannabis users only as patients has clinical limitations. Cannabis naive patients would tolerate controlled investigations but may generate medicolegal problems.

Administration, Oral↗
PubMed1997

Does reducing capacitance have potential for further miniaturisation of implantable defibrillators?

OBJECTIVE: To determine whether considerably smaller capacitors could replace 125 microF capacitors as the standard for use in implantable defibrillators. METHODS: Measured energy, impedance, voltage, and current delivered were compared at defibrillation threshold in 10 mongrel dogs for defibrillation using 75 microF and 125 microF capacitors alternated randomly. Defibrillation was attempted with biphasic shocks of comparable tilt between an endocardial lead in the right ventricular apex and a "dummy" active can of an experimental implantable device placed in the subpectoral position. RESULTS: A reduction of capacitor size of 40% was associated with an increase in voltage of 21% and in current of 22%. With a 65% tilt, no significant differences were found between the two capacitances with respect to the impedance or energy required for defibrillation. CONCLUSIONS: Multiple advances in electrode material, electrode configuration, shock morphology, and shock polarity have reduced defibrillation energy requirements. Smaller capacitors could be used in implantable cardioverter/defibrillators without a major decrease in effectiveness.

Animals↗
PubMed1996

Improving accelerometer-based rate adaptive pacing by means of second-generation signal processing.

Accelerometer-based rate adaptive pacing has gained widespread clinical use. Limitations exist for the distinction between walking upstairs and downstairs. It was the aim of this study to evaluate a new signal processing algorithm for more physiological rate adaptation. A custom-made pacemaker incorporating an accelerometer was randomly fixed to the left or right chest of 16 pacemaker patients (7 females, age: 64 +/- 11 years), 18 elderly study participants (6 females, age: 62 +/- 11 years), and 15 students (7 females age: 23 +/- 2 years). Study participants walked on level ground, upstairs and downstairs at five different step rates (72, 84, 96, 108, and 120 steps/min) controlled by an acoustic quartz metronome. The accelerometer signals, recorded on a portable data recorder, were analyzed with respect to frequency content, peak average of the mean acceleration, and morphology characteristics of the acceleration signal above and below zero baseline. By calculating the quotient of the signal's duration above and below zero baseline, a reliable discrimination between walking upstairs and downstairs was possible. A correction of the Leaky integrator signal by the new quotient yielded a more adequate rate adaptation to walking up and downstairs to represent at the patient's daily life activities. A more physiological rate adaptation can be achieved when using not only the accelerometer signal's amplitude, but applying additionally the morphology criterium of the acceleration signal's content in the positive and negative direction.

Acceleration↗
PubMed1995

Critical limb ischaemia in patients over 80 years of age: options in a district general hospital.

A total of 114 reconstructions were performed in 82 octogenarian patients and the results compared with those of 33 patients who had primary amputation. The operative mortality rate was higher after amputation (45 versus 11 per cent) and the mean survival less (25 versus 34 months). Quality of life assessment using a Rosser scale suggested that, although there was no improvement in the 38 per cent with a failed reconstruction, there was a significant improvement in the 62 per cent whose reconstruction remained patent. There was minimal improvement in quality of life after primary amputation and this was due to relief of pain. Costs (including the costs of revisions and community costs) were assessed in detail. Although the mean total operative costs of reconstruction were higher than those of amputation (10,222 pounds versus 6475 pounds) this was more than offset by the high community costs of amputation. The total cost of reconstruction was 13,546 pounds, compared with 33,095 pounds for amputation. Following reconstruction 66 per cent of those patients independent before critical limb ischaemia occurred were able to return to their own home; only 33 per cent of amputees were able to do so.

Aged↗
PubMed1994

Quality of life: is it a practical tool in patients with vascular disease?

With increasing pressure on resources, health care managers are interested in evaluating both drug and surgical treatments. A single measure of the quality of life of patients may be a useful tool in such an evaluation. We have assessed two methods of measuring quality of life in this preliminary study and have found them to be useful and simple to assess in patients undergoing vascular surgery. Changes between the preoperative values and postoperative values correlate well with the clinical impression.

Activities of Daily Living↗
PubMed1986

Alcohol and drug abuse treatment in three different populations: is there improvement and is it predictable?

Prior research had shown that alcohol and drug abuse treatments were effective and that the results of treatments could be predicted from pretreatment information regarding the patient's employment, family, and especially psychiatric problems. However, this research had been conducted entirely with adult male service veterans, largely from lower socioeconomic strata. Three treatment centers were included in the present study to examine these conclusions with other populations containing adolescents, females, and patients from higher socioeconomic strata. Data from the Addiction Severity Index was collected at treatment admission and again at independent follow-up, 6 months later. Results confirmed prior observations. Both alcohol and drug abuse treatments showed substantial improvements in the chemical use problems of their patients and in the important areas of employment, criminal behavior, family relations, and psychological health. As in earlier reports, a global measure of the nature and extent of pretreatment psychiatric problems was the single best predictor of treatment response for both alcoholics and drug-dependent samples.

Adult↗
PubMed1985

New data from the Addiction Severity Index. Reliability and validity in three centers.

The Addiction Severity Index (ASI) is a clinical/research instrument which has been in wide use during the past 6 years to assess the treatment problems found in alcohol- and drug-abusing patients. In a study of male veterans, a preliminary evaluation of the ASI has indicated reliability and validity. The present report presents an expanded examination of these issues; 181 subjects from three treatment centers were studied. Results of concurrent reliability studies indicate that trained technicians can estimate the severity of patients' treatment problems with an average concordance of .89. Test-retest studies show that the information obtained from the ASI is consistent over a 3-day interval, even with different interviewers. Comparisons of the ASI severity ratings and composite measures with a battery of previously validated tests indicate evidence of concurrent and discriminant validity. The reliability and validity results were consistent across subgroups of patients categorized by age, race, sex, primary drug problem, and treatment center. The authors discuss the strengths and limitations of the instrument based upon 5 years of use. The overall conclusion is that the ASI is a reliable and valid instrument that has a wide range of clinical and research applications, and that it may offer advantages in the examination of important issues such as the prediction of treatment outcome, the comparison of different forms of treatment, and the "matching" of patients to treatments.

Adult↗
PubMed1984

Needs assessment under the Maternal and Child Health Services Block Grant: Massachusetts.

The Massachusetts maternal and child health (MCH) agency has developed a needs assessment process which includes four components: a statistical measure of need based on indirect, proxy health and social indicators; clinical standards for services to be provided; an advisory process which guides decision making and involves constituency groups; and a management system for implementing funds distribution, namely open competitive bidding in response to a Request for Proposals. In Fiscal Years 1982 and 1983, the process was applied statewide in the distribution of primary prenatal (MIC) and pediatric (C&Y) care services and lead poisoning prevention projects. Both processes resulted in clearer definitions of services to be provided under contract to the state as well as redistribution of funds to serve localities that had previously received no resources. Although the needs assessment process does not provide a direct measure of unmet need in a complex system of private and public services, it can be used to advocate for increased MCH funding and guide the distribution of new MCH service dollars.

Child Health Services↗