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Biomedical subjects

J Carlisle

Publications and source records attributed to J Carlisle.

At least 19 recordsLinked to original sources
PubMed2006

Relationship between perioperative troponin elevation and other indicators of myocardial injury in vascular surgery patients.

BACKGROUND: In 2000 the European Society of Cardiology and the American College of Cardiology published a consensus document revising the definition of myocardial infarction. The usefulness of this revised definition has been challenged. It has been suggested that, rather than any release of cardiac troponin being potentially diagnostic of myocardial infarction, a diagnostic threshold consistent with significant myocardial injury should be defined. METHODS: We studied 65 patients undergoing elective major vascular surgery to examine the relationship between the magnitude of cardiac troponin I (cTnI) and creatine kinase MB fraction (CK-MB) release and clinical signs or symptoms of myocardial injury. cTnI and CK-MB concentrations were measured preoperatively and on the first 4 postoperative days using the ACCESS assay (Beckmann). Patients were considered to have suffered a perioperative myocardial infarction if they had either symptoms or ECG changes consistent with this diagnosis, together with cTnI release. RESULTS: Peak postoperative cTnI concentrations above the lower detection limit of the ACCESS assay (0.06 microg litre(-1)) occurred in 26 patients. Eight of these patients displayed symptoms or ECG changes consistent with myocardial injury. A cTnI level greater than 0.68 microg litre(-1) was found to be consistent with the clinical diagnosis of myocardial infarction. The optimal cut-off for the diagnosis of MI using CK-MB was 40.4 microg litre(-1). CONCLUSIONS: These data suggest that further studies are required to define the optimal cardiac troponin diagnostic threshold for the diagnosis of myocardial infarction in the non-cardiac surgery population.

Aged↗
PubMed2006

Concerns over confidentiality may deter adolescents from consulting their doctors. A qualitative exploration.

OBJECTIVES: Young people who are concerned that consultations may not remain confidential are reluctant to consult their doctors, especially about sensitive issues. This study sought to identify issues and concerns of adolescents, and their parents, in relation to confidentiality and teenagers' personal health information. SETTING: Recruitment was conducted in paediatric dermatology and general surgery outpatient clinics, and on general surgery paediatric wards. Interviews were conducted in subjects' own homes. METHODS: Semistructured interviews were used for this exploratory qualitative study. Interviews were carried out with 11 young women and nine young men aged 14-17. Parents of 18 of the young people were interviewed separately. Transcripts of tape recorded interviews provided the basis for a framework analysis. RESULTS: Young women were more concerned than young men, and older teenagers more concerned than younger teenagers, about people other than their general practitioner (GP) having access to their health information. Young people with little experience of the healthcare system were less happy than those with greater knowledge of the National Health Service (NHS) for non-medical staff to access their health information. As they grow older, adolescents become increasingly concerned that their health information should remain confidential. CONCLUSION: Young people's willingness to be open in consultations could be enhanced by doctors taking time to explain to them that their discussion is completely confidential. Alternatively, if for any reason confidentiality cannot be assured, doctors should explain why.

Adolescent↗
PubMed2004

Defining the needs of patients with intellectual disabilities in the high security psychiatric hospitals in England.

BACKGROUND: Previous studies have suggested that a substantial proportion of the patients with intellectual disabilities (ID) in the high security psychiatric hospitals (HSPHs) should be transferred to more appropriate services to cater for their specific needs in the longer term. METHOD: The individual and placement needs of high secure psychiatric patients detained under the legal category of mental impairment or severe mental impairment were assessed in a cross-sectional survey. RESULTS: Patients had a large number of needs (on average 10.8), about a third of which were rated as unmet and therefore represented significant continuing problems. Approximately one-third of the sample could be moved out of HSPHs if appropriate alternatives were available. Factors associated with the continued need for high security included higher treatment and security needs, younger age, recent violent conduct and their index offence profile. CONCLUSIONS: High security services are still required for a number of patients with ID. New and existing services need to be configured to meet specific profiles of need and provide long-term rehabilitation and specialist care. DECLARATION OF INTEREST: This was part of a larger project funded by grants from the High Security Psychiatric Services Commissioning Board and Department of Health.

Adult↗
PubMed2004

An audit of the process of developing the Health Improvement Programme into Strategic and Financial Framework in two health authorities.

Health Improvement Programmes (HImPs) are a means of documenting the health needs of a population and are intended to be translated into commissioning decisions by the Strategic and Financial Framework (SaFF). This paper examines some major influences on the process of translating the HImP into the SaFF. The Directors of Public Health in two Health Authorities were concerned that the development of the SaFF did not always represent a clear progression from the HImP. An audit to pinpoint where commissioning decisions did not match the identified health improvement needs in two Health Authorities was carried out between November 2000 and February 2001. The overall findings confirmed that needs identified in the HImPs were not fully reflected in the service provision described in the final SaFFs. The audit provided evidence that was useful in identifying major issues and influences that facilitated or hindered the development of the SaFF from the HImP. Some of the ways in which HImP priorities disappeared from the SaFF and non-HImP priorities appeared in it were also distinguished. The conclusion is that a clear, criterion-based process should enable health and social care communities and Primary Care Trusts to develop a more responsible commissioning process in future, and specific recommendations to that effect are made.

Health Services Needs and Demand↗
PubMed1999

Measuring quality of life in secure care: comparison of mentally ill and personality disordered patients.

Improving quality of life for patients is emerging as a legitimate goal for UK inpatient forensic mental health services. The Lancashire Quality of Life Profile (LQOLP), which has been used widely to measure well-being in community settings, was trialed on an inpatient population being cared for under conditions of high security. Two groups of male patients, drawn from within the same institution but with markedly different clinical conditions, i.e. schizophrenia (N = 47) and personality disorder (N = 48), were interviewed using the LQOLP. Although both groups had been cared for under largely similar environmental conditions over similar lengths of time (9.5 years), the subjective global well-being of the two groups differed systematically as did other objective and subjective well-being measures. However, analysis found that the variations in global well-being could not be attributed readily to factors covered by the interview, including either current mood or personality. Possible reasons for these findings and implications for the use of the LQOLP under conditions of high security are discussed.

Adult↗
PubMed1998

Seroepidemiology of invasive pneumococcal disease in Queensland, 1990 to 1997.

Serotypes responsible for 842 cases of invasive pneumococcal disease in Queensland between February 1990 and October 1997 were identified. Type 14 caused 37.5% of episodes in children aged 0-4 years and 19.2% of adult cases. Types 6A, 6B, 14, 18C, and 19F were significantly more frequent in young children while types 3, 4, 7F, 9V and 23F predominated in adults. The regional incidence of type 14 and 7F disease differed significantly in Southeast and Far North Queensland. Coverage for 87% of children aged less than 5 years in this study would be provided by a recently advocated polysaccharide-protein conjugate vaccine containing capsular antigens of types 4, 6B, 9V, 14, 18C, 19F and 23F. Similarly, more than 90% of adults would be covered by the currently available 23- valent polysaccaride vaccine.

Adolescent↗
PubMed1998

Defining the physician's duty to warn: consensus statement of Ontario's Medical Expert Panel on Duty to Inform.

Ontario's Medical Expert Panel on Duty to Inform was formed to consider the duty of Ontario physicians in circumstances where a patient threatens to kill or cause serious bodily harm to a third party. The panel was concerned about the implications of any duty to inform on the integrity of the physician-patient relationship, particularly with respect to confidentiality. The panel agreed that regulations safeguarding the confidentiality of patient information ought to be changed only if there is a critical reason for doing so, but, after deliberation, the panel members concluded that the need to protect the public from serious risk of harm is a paramount concern that should supersede the duty of confidentiality. The recommendations reported here were endorsed in principle by the panelists and the groups they represented (the Royal College of Physicians and Surgeons of Canada, the Canadian Medical Protective Association, the College of Physicians and Surgeons of Ontario, the Ontario College of Family Physicians and the Ontario Medical Association) and are being implemented by the College of Physicians and Surgeons of Ontario.

Advisory Committees↗
PubMed1997

Emergence of further serotypes of multiple drug-resistant Streptococcus pneumoniae in Queensland.

We describe 27 cases of multiple drug-resistant pneumococcal infection in Queensland children (7 cases) and adults (20 cases), between February 1995 and October 1996. Seven patients had invasive disease. Serotypes were those commonly associated with paediatric infections and included types 19F (15 strains), 14 (6), 23F (4), 6A (1) and 19A (1). No rifampicin or vancomycin resistance was encountered. However, pneumococci fully resistant to cotrimoxazole, erythromycin and tetracycline were isolated from 25 of 27 cases (93%). Strains with high level resistance to penicillin and chloramphenicol were also recovered from 16 (59%) and 19 (70%) patients respectively. Twelve of 16 penicillin-resistant isolates showed intermediate resistance to ceftriaxone and two strains were fully resistant to this antibiotic. Clones of types 19F and 14 pneumococci, each with two distinctive resistance patterns, appear to be established in south-east Queensland.

Adult↗
PubMed1997

Risk assessments for acute violence to third parties: a review of the literature.

OBJECTIVES: To provide an overview of risk assessments for acute violence to third parties by combining a clinical and research focus and to offer guidelines to physicians conducting clinical assessments. METHOD: A computerized literature search of the MEDLINE and PSYCHINFO data bases from 1967 to 1996 was completed using the key words violence, aggression, dangerous behaviour, risk, risk assessment, risk factors, and practice guidelines. The search yielded 116 relevant references, 26 of which were original research articles on risk factor identification. A secondary search, based on the citations from the primary search, yielded an additional 8 general discussion articles. RESULTS: Risk assessments may be conducted using different methods, although all methods should be systematic and comprehensive. Research shows that risk assessments do have validity for use in short-term prediction and that it is possible to develop clinical guidelines in this area. A combined clinical and research approach holds the most promise for improving the accuracy of probability estimates, and most published guides and tools rely on such a combination. CONCLUSIONS: Risk assessments are an important and necessary part of the clinical examination. Because this field has sufficiently evolved, there is abundant literature to refer to when determining what constitutes an acceptable assessment for risk of violence to third parties and when it is appropriate to conduct such an examination.

Duty to Warn↗
PubMed1996

External review for promotion and tenure in schools of nursing.

To obtain information about external review for tenure and/or promotion, the faculty affairs committee in a large nursing program located in the southeastern United States conducted a survey among programs that award a doctoral degree in nursing. Research questions focused on general tenure and promotion policies, policies and procedures regarding the use of external review, and perceived advantages and disadvantages of external review. A 22-item survey was sent to 53 institutions with a total of 34 usable surveys being returned. Findings revealed that a majority of the schools used external review, especially for tenure decisions and promotion to the associate and professor rank. Promotion and tenure criteria from individual schools were usually sent to reviewers along with the candidates' curriculum vitae and manuscripts. Candidates usually participated in the selection of external reviewers, but contact with reviewers was usually instituted by the administration within the institution. It was also felt that the advantage of external review far outweighed any disadvantages.

Career Mobility↗
PubMed1988

First myocardial infarction: age and ejection fraction identify a low-risk group.

This study examines patients with a first myocardial infarction (MI) (about 70% of the population, n = 2089), and identifies factors associated with 1-year cardiac mortality in patients discharged alive. With the use of multivarate analysis of variables observed at hospital discharge in patients with a first MI, age was the most important predictor, followed by left ventricular ejection fraction (LVEF) (determined in 56%) and other variables. Based on this finding, age subsets (less than or equal to 50, 51 to 70, greater than 70 years) were related to LVEF groups (less than or equal to 0.40, 0.41 to 0.50, greater than 0.50). Patients with a first MI who were less than 50 years of age with LVEF greater than 0.40 and patients between 51 and 70 years of age with LVEF greater than 0.50 had a very low risk for 1-year cardiac death, 1.2 +/- 1.1% (95% confidence interval). Such patients comprised 47% of individuals with a first MI having an LVEF determination. Mortality in the remaining patients less than 70 years was 7.4 +/- 3.5%. Mortality for patients greater than 70 years was high, 22.2 +/- 6.6%. Thus with LVEF as the only predischarge test, a sizable low risk group can be identified among patients with a first MI.

Age Factors↗
PubMed1987

Influence of obesity on morbidity and mortality after acute myocardial infarction.

The influence of being overweight or obese on hospital and late (1 year) mortality and reinfarction was studied in 1760 patients with acute myocardial infarction. Body mass index (BMI) was used to categorize patients as normal weight (BMI less than 25), overweight (BMI 25 to 30), and obese (BMI greater than 30). Clinical features and prognosis were compared in 658 normal weight patients, 884 overweight patients, and 218 obese patients. Complications during hospitalization and 1-year reinfarction rates following discharge were similar among the weight subsets. Hospital mortality was 13% in obese patients, similar to the 14% hospital mortality in normal weight patients, but significantly more than that in overweight patients (9%, p less than 0.05). When stratified according to age, 30% of obese patients greater than or equal to 65 years died in the hospital, compared to 13% of overweight patients (p less than 0.001), and 17% of normal weight patients (p less than 0.01). In patients less than 65 years, the obese group had a 6% mortality compared to a hospital mortality of 5% in overweight and 8% in normal weight groups (NS). In a multivariate analysis, obesity was an independent predictor of hospital death in the older, but not in the younger patient subset. One-year mortality for patients discharged from the hospital was significantly less in obese than in normal weight patients (7% vs 13%, p less than 0.05), but not different from the 11% mortality rate in overweight patients. Differences in mortality disappeared when patients were age stratified.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Myocardial infarction in young patients: an analysis by age subsets.

We examined, in age subsets, 2643 patients with acute myocardial infarction. Clinical features and 1 year morbidity and mortality were compared in 203 young patients (less than 45 years), 1671 patients 46 to 70 years old, and 769 elderly patients (greater than 70 years). Ninety-two percent of young patients were men, and a family history of premature coronary artery disease was more common in young patients (41% compared with 28% of middle-aged and 12% of elderly patients). More young patients were currently smoking cigarettes (82% compared with 56% of middle-aged and 24% of elderly patients), and only 8% of young patients had never smoked. Previous myocardial infarction and history of angina pectoris or congestive heart failure were less common (p less than .001) in the young patients than in middle-aged and elderly patients. In-hospital mortality was only 2.5% for young patients, compared with 9.0% in middle-aged and 21.4% in elderly patients (both p less than .001). Postdischarge 1 year mortality was also strikingly low in young patients, at 2.6% compared with 10.3% in middle-aged and 24.4% in elderly patients. The incidence of reinfarction during the 1 year of follow-up was similar in all subsets. The statistical significance of 65 variables as predictors of 1 year mortality and reinfarction was tested and the following found to be significant (p less than .05): hospital discharge on antiarrhythmic drugs, digoxin, or diuretics; history of previous myocardial infarction or congestive heart failure; chest x-ray findings of heart failure; low ejection fraction; and atrial fibrillation. Thus, young patients entering the hospital have an excellent 1 year prognosis, but those with prior infarction in whom there are selected abnormal findings at hospital discharge comprise a subgroup that may benefit from early aggressive management.

Adult↗
PubMed1984

Pseudotumor cerebri caused by a synthetic vitamin A preparation.

Pseudotumor cerebri developed in a 14-year-old girl with nodulocystic acne, who was taking excessive amounts of a synthetic vitamin A derivative. Although hypervitaminosis A has reportedly caused pseudotumor, Accutane has not previously been implicated.

Acne Vulgaris↗
PubMed1984

Systemic-pulmonary shunts in infants and children. Early and late results.

From September, 1978, to January, 1983, 44 cyanotic infants and children underwent a systemic-pulmonary artery shunt for the treatment of reduced pulmonary blood flow. Age ranged from 18 hours to 4 years (mean age = 0.49 years). Weight ranged from 1.7 kg to 13.2 kg (mean weight = 4.9 kg). There were 12 classic Blalock-Taussig shunts, five central polytetrafluoroethylene shunts, six interposition modified Blalock-Taussig shunts, and 21 Great Ormond Street type of modified Blalock-Taussig shunts. No direct aorta-pulmonary artery anastomoses were performed. There was one postoperative death (1/44 = 2.3%) in a 1,700 gm neonate born with pulmonary atresia and intact ventricular septum (shunt patent). Four shunts required early revision: one thrombosed central shunt, a kinked patent interposition Blalock-Taussig shunt, a small but patent Blalock-Taussig shunt, and one excessive Great Ormond Street type of Blalock-Taussig shunt. Two late deaths were probably shunt-related: one Blalock-Taussig and one central. All four types of shunts provided good palliation, but the Great Ormond Street type of Blalock-Taussig shunt is our preferred shunt because of (1) low operative risk, (2) predictable patency (100% in our series), (3) lack of distortion of pulmonary arterial anatomy, and (4) technical ease of insertion as well as takedown.

Birth Weight↗