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Biomedical subjects

J Fothergill

Publications and source records attributed to J Fothergill.

At least 19 recordsLinked to original sources
PubMed1997

Patients unaware of their HIV status present to inner city accident and emergency department with respiratory complications.

OBJECTIVE: To examine the clinical presentations and management of patients presenting to an accident and emergency (A&E) department with an AIDS defining illness (ADI). METHODS: Presentations of patients in the A&E department with ADI were reviewed retrospectively. The age, sex, ethnic origin, risk factor for HIV infection, route of referral to hospital, presenting complaint, triage category, referral from A&E, admission under medical specialists, diagnosis, and survival from ADI were noted for each patient. RESULTS: 133 patients were registered at St Mary's Hospital in London with ADI during 1994. A significant minority of these patients (25/133) presented to the hospital without prior knowledge of their HIV positive status. Thirty two patients presented to the A&E department with their ADI. Of these, 13/32 (41%) were unaware of the HIV serostatus. All 13 patients had an acute respiratory disease (Pneumocystis carinii pneumonia or pulmonary tuberculosis). In contrast, patients aware of their HIV positive status (19/32) presented to the A&E department with a wide range of non-pulmonary ADI. CONCLUSIONS: The study emphasises the importance of respiratory complications in patients who present with a ADI to emergency departments but are unaware of their HIV positivity. These patients presented solely with Pneumocystis carinii pneumonia or pulmonary tuberculosis, conditions in which early diagnosis and treatment significantly reduce morbidity and mortality.

AIDS-Related Opportunistic Infections↗
PubMed1997

Reproducibility of the signal averaged P wave: time and frequency domain analysis.

OBJECTIVE: To assess the reproducibility of time and frequency domain variables derived from the signal averaged P wave. DESIGN: Longitudinal within patient study. SETTING: Regional cardiothoracic centre. PATIENTS: 20 patients (10 with documented paroxysmal atrial fibrillation and 10 normal controls) were studied on three occasions to assess the reproducibility of repeated signal averaged P wave recordings. Digital P wave recordings were made on a further 10 patients on a single occasion and the recordings signal averaged twice in order to assess the reproducibility of the averaging system itself in the absence of biological variation. MAIN OUTCOME MEASURES: P wave duration, spatial velocity, and energies contained in frequency bands from 20, 30, and 60-150 Hz of the P wave spectrum were measured after P wave specific signal averaging. Coefficients of reproducibility were calculated for paired signal averaged P waves derived by signal averaging the same digital recordings on two separate occasions, for recordings performed in the same patients immediately after each other ("back to back") and those performed one week apart. RESULTS: System reproducibility when the same digital P wave recordings were signal averaged on two separate occasions was high (< 11% for all variables). For P wave duration the coefficient of reproducibility was 11.4% for back to back recordings and 13.1% for those one week apart. The reproducibility of spatial velocity and P wave energy was low. Variation in P wave morphology was noted when successive P waves from the same subject were examined. If recordings with the same P wave morphology were analysed the reproducibility of spatial velocity and P wave energy improved but remained significantly poorer than that for P wave duration. CONCLUSIONS: P wave duration is reproducible within subjects in the short and medium term. Frequency domain and spatial velocity analysis are poorly reproducible, due more to spontaneous variation in P wave morphology than to instability of the signal averaging process. This may limit the utility of signal averaged P wave variables other than duration for the prediction of atrial arrhythmia.

Adult↗
PubMed1997

Signal averaged P wave compared with standard electrocardiography or echocardiography for prediction of atrial fibrillation after coronary bypass grafting.

OBJECTIVE: To define the clinical value of the signal averaged P wave (SAPW) and to compare it with the standard electrocardiogram (ECG), echocardiogram, and clinical assessment for the prediction of atrial fibrillation after coronary bypass grafting (CABG). DESIGN: Prospective validation cohort study. SETTING: Regional cardiothoracic centre. PATIENTS: 201 unselected patients undergoing first elective CABG were recruited over six months. Patients requiring concomitant valve surgery were excluded. MAIN OUTCOME MEASURES: Age, sex, cardiothoracic ratio, and cardioactive drugs were noted. P wave specific SAPW recordings, ECG, and M mode echocardiograms from which left atrial diameter was measured were performed within 24 hours of surgery. Filtered P wave duration (SAPWD), spatial velocity, and energy were calculated from the SAPW. From the ECG, lead II P wave duration, P terminal force in lead V1, total P wave duration, and isoelectric interval were measured. Patients had Holter monitoring for 48 hours postoperatively and daily ECGs until discharge. RESULTS: Two patients died (1%) and 10 were unsuitable for analysis (5%). Of the remaining 189, 51 (27%) had atrial fibrillation (AF) lasting > 1 hour at a mean of 2 (0.5 to 7) days after CABG. Of the variables examined, only SAPWD (AF group 148 (SD 12), v 142 (14) ms, P = 0.008) and male sex (AF group 96%, v 78%, P < 0.01) were significantly different. A prospectively defined SAPWD of > 141 ms predicted atrial fibrillation with positive and negative predictive accuracies of 34% and 83%. Logistic regression analysis identified both male sex and SAPWD as significant independent predictors of postoperative atrial fibrillation. CONCLUSIONS: Signal averaged P wave duration was a better predictor of atrial fibrillation after coronary bypass grafting than standard electrocardiographic or echocardiographic criteria. The predictive value of this test is such that it is likely to be useful in the design of prospective trials of prophylactic antiarrhythmic treatment but is of limited use using current techniques in the clinical management of individual patients.

Atrial Fibrillation↗
PubMed1996

Thunderstorm associated asthma: a detailed analysis of environmental factors.

OBJECTIVES: To seek associations between meteorological factors, concentrations of air pollutants or pollen, and an asthma epidemic which occurred in London on 24 and 25 June 1994 after a thunderstorm. DESIGN: Retrospective study of patients' accident and emergency department records, with bivariate and multivariate analysis of environmental factors and data collection for the two months surrounding the epidemic. SETTING: The accident and emergency department of St Mary's Hospital in west central London. SUBJECTS: 148 patients presenting with asthma between 1 June and 31 July 1994, of whom 40 presented in the 24 hours after the storm. RESULTS: The asthma epidemic was significantly associated with a drop in air temperature six hours previously and a high grass pollen concentration nine hours previously. Non-epidemic asthma was significantly associated with lightning strikes, increase in humidity or sulphur dioxide concentration, a drop in temperature or high rainfall the previous day, and a decrease in maximum air pressure or changes in grass pollen counts over the previous two days. CONCLUSIONS: New episodes of asthma during the epidemic on 24 and 25 June 1994 were associated with a fall in air temperature and a rise in grass pollen concentration. Non-epidemic asthma was significantly associated with a greater number of environmental changes. This may indicate that the patients with thunderstorm associated asthma were a separate population, sensitive to different environmental stimuli.

Air Pollutants↗
PubMed1996

Primary care in London: an evaluation of general practitioners working in an inner city accident and emergency department.

OBJECTIVE: To determine the characteristics of primary care attenders to St Mary's Hospital accident and emergency (A&E) department, evaluate the effects of the introduction of general practitioners (GPs) on patient care in A&E, and make recommendations for the provision of GPs in appropriate A&E departments. DESIGN: Prospective survey over a six week period. METHODS: Data collected from the attendances of 970 consecutive patients triaged with "minor" primary care problems, whether seen by A&E doctors or by GPs working in A&E, were analysed. RESULTS: During the study period 1078 patients (16.6%) were triaged as suitable for primary care. The A&E GPs saw 58.4% of these patients. The majority of primary care patients were young British residents, 71.1% of whom were registered with a GP. Sixty per cent of patients lived within St Mary's catchment area. Of those registered patients asked why they attended A&E, 27.1% thought their problem inappropriate for their GP. A&E doctors were more likely to investigate patients and arrange hospital follow up than GPs, who arranged community follow up in 80% of patients needing further care. CONCLUSIONS: The demand for primary care at St Mary's necessitates the provision of a primary care service, albeit for the first visit only. This can be provided by GPs in A&E. The features of the patients using the service suggests that discouraging first attendance is unrealistic, but using the visit to educate patients and return them to the care of the community is not.

Adolescent↗
PubMed1996

The cost of overseas visitors to an inner city accident and emergency department.

OBJECTIVE: To estimate, in a metropolitan accident and emergency (A&E) department, the annual cost of treating overseas visitors whose countries of origin do not have reciprocal arrangements with Britain. METHODS: The study was retrospective. A 24 h period (00.01 h to 24.00 h inclusive) on consecutive days in consecutive weeks (that is, Monday in week 1, Tuesday in week 2, etc) was costed over 52 weeks (1.8.92-31.7.93 inclusive) and extrapolated to 365 days. All visitors between those dates were divided into eligible (from countries with a reciprocal agreement) or non-eligible (from countries without a reciprocal agreement). Costs were calculated for medical and nursing care, investigation and treatment, and fixed costs. RESULTS: The annual St Mary's Hospital A&E budget for the study period (01/08/92 to 31/07/93) was 2,612,200 pounds; the average medical and nursing cost per major or minor case was 66.88 pounds and 20.08 pounds respectively. Investigation, treatment, and fixed costs were 16.31 pounds per patient. In total 2704 non-eligible patients (498 major and 2206 minor cases) were treated at a cost of 121,705 pounds (95% confidence interval 114,234 pounds to 129,176 pounds), which was 4.7% of the total annual budget. CONCLUSIONS: The cost of non-eligible patients to the NHS is substantial. One possible solution would be for visitors from countries which do not offer subsidised emergency treatment to British nationals to purchase health insurance compulsorily on or before entry to Britain. The revenue could be used to improve standards of care for all A&E patients.

Confidence Intervals↗
PubMed1996

Radiographic interpretation by nurse practitioners in a minor injuries unit.

OBJECTIVE: To compare nurse practitioners with senior house officers (SHOs) for their ability to request and interpret correctly a limited range of x ray views of patients attending a minor injuries unit. DESIGN: Retrospective analysis of case records. METHODS: 150 accident and emergency (A&E) records with x ray requests were randomly selected from the SHOs' first, second, and third 2-month period of their 6-month appointments; 150 record cards were randomly selected from a nearby minor injuries unit over the same period. Copies of the records were reviewed blind and a decision made as to whether x ray requests were appropriate; x ray interpretation was compared with that of a consultant radiologist. RESULTS: 106 x rays were taken on the MIU patients (71%) and 124 on the A&E patients (83%). There was no statistically significant differences in the ability of the nurse practitioners and the SHOs to request and interpret appropriate x rays. In both groups the decision to carry out an x ray was considered appropriate in 70% of patients; x rays were positive in about one third. The sensitivity of radiological interpretation was 93% in both groups, and there were 2% missed positives. CONCLUSIONS: Appropriately trained nursae practitioners are at least as good as SHOs in recognising the need for an x ray and are as competent in their interpretation.

Adolescent↗
PubMed1996

Nurse practitioners.

Explore the source record for details and available documents.

Emergency Service, Hospital↗
PubMed1996

The rising prevalence of HIV-1 infection in patients attending an inner city accident and emergency department.

The recently published findings of the unlinked anonymous HIV prevalence study in England and Wales showed unchanging HIV prevalence in groups such as homo/bisexual men, and declining rates in non-injecting heterosexual men attending genitourinary medicine clinics. However, this multicentre study did detect a significant rise in seroprevalence rates in pregnant women in England and Wales and sentinel groups within hospitals in London, warning that changing patterns of HIV infection might account for these variable results. In 1992-1993 a seroprevalence study of adult patients attending the accident and emergency department at St. Mary's Hospital in West Central London showed a rate of HIV-1 infection of 1 in 77. We have repeated the seroprevalence study over the same calendar months in 1994-1995 to gain further information about HIV positive patients attending the department and to see whether a change in the patterns of HIV infection in the population served by St Mary's Hospital had occurred.

Adult↗
PubMed1996

"Crack lung" caused by an impure preparation.

Pulmonary complications of crack cocaine have been reported mainly from American centres. Crack usage is now on the increase in the UK. Three cases of "crack lung" are reported in patients who acquired the drug from the same source. The pulmonary syndrome they developed was due to an impure form of crack.

Adult↗
PubMed1995

The use of anti-depressants and benzodiazepines in the perpetrators and victims of accidents.

The objective of this study was to determine whether there is a greater incidence of psychotropic drugs in the blood of those 'responsible' for an accident compared with those not 'responsible' for an accident. Blood samples were taken from people involved in accidents presenting at the accident and emergency departments of two teaching hospitals over a five-month period and analysed for the presence of alcohol, tricyclic anti-depressants (TCAs) and benzodiazepines (BZs). Details of the accident were used to produce a test group (accidents where a drug may have contributed) and a control group (accidents where the presence of a drug could not have been a factor). In total, 229 samples were collected. The only criterion for inclusion in the study was that the accident was of sufficient severity to merit the routine taking of a blood sample, in which case an additional amount was taken for the purposes of this investigation. In all, 63 samples (27.5%) were positive for at least one of alcohol, TCA or BZ. Of the accidents represented by these samples, 48 could have been caused by the presence of the drug (responsible group) and 15 could not (not responsible group). There was a significantly greater representation of TCAs and BZs in the blood taken from the responsible group compared with the not responsible group (P < 0.0045).

Accidents↗
PubMed1994

Evidence for a new cytochrome P450 form induced by 3-methylcholanthrene in rats.

Evidence is presented for a new 3-methylcholanthrene (3MC)-induced form of cytochrome P450, P450MCX, in rat liver microsomes. P450MCX was co-purified with CYP1A1 from 3MC-treated male Sprague-Dawley rats but was resolved by gel electrophoresis. The M(r) of P450MCX (56,700) was intermediate between CYP1A1 (57,000) and CYP1A2 (54,800). Monoclonal antibodies showed that P450MCX was immunorelated to both CYP1A1 and CYP1A2 but not to CYP2B1, CYP2C6 or CYP3A1. Immunoreactive P450MCX was not detectable in liver microsomes from untreated rats but was highly induced by 3MC and Aroclor 1254, although not induced by isosafrole. The N-terminal amino acid sequence of P450MCX, obtained from an electroblotted sample resolved on SDS-PAGE, did not match any known cytochrome P450 or other protein. P450MCX may be a new member of the CYP1 family.

Amino Acid Sequence↗
PubMed1994

An optical technique for the measurement of thoracic wall movement during high-frequency jet ventilation.

Instrumentation for use in high-frequency jet ventilation is not currently capable of providing information suitable for predicting gas exchange. Whilst techniques for the accurate measurement of tidal volume during jet ventilation are now available, the relationship between tidal volume and the efficiency of gas exchange varies with frequency and inspiratory/expiratory time (I:E) ratio. We report technical details of a new non-invasive instrument capable of accurately measuring displacement of the thoracic wall at high frequencies and without electrical connection to the patient. It is hoped that use of this instrument will allow the calculation of an efficiency index for the transduction of airway pressure changes into peripheral expansion. It is also hoped that this index may be of value in predicting the gas exchange response to changes in jet parameters.

Equipment Design↗
PubMed1989

Insect immunity: isolation from immune blood of the dipteran Phormia terranovae of two insect antibacterial peptides with sequence homology to rabbit lung macrophage bactericidal peptides.

We have isolated from the hemolymph of immunized larvae of the dipteran insect Phormia terranovae two peptides that are selectively active against Gram-positive bacteria. They are positively charged peptides of 40 residues containing three intramolecular disulfide bridges and differ from one another by only a single amino acid. These peptides are neither functionally nor structurally related to any known insect immune response peptides but show significant homology to microbicidal cationic peptides from mammalian granulocytes (defensins). We propose the name "insect defensins" for these insect antibiotic peptides.

Amino Acid Sequence↗
PubMed1989

The structures of human C1r and C1s and their relationship to other serine proteases.

The recent sequencing of the C1 subcomponents has allowed comparison with other molecules of homologous primary structure. Where tertiary structures are available for at least one member of the family it is possible to make further progress by modelling the amino acid sequence of the complement protein into the three-dimensional coordinates of the directly determined structure, thereby obtaining an approximation of the structure of the complement protein. Molecular modelling allows structure-function relationships to be explored and suggests further experiments that may be amenable to techniques such as site-directed mutagenesis.

Amino Acid Sequence↗