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Biomedical subjects

J Hooper

Publications and source records attributed to J Hooper.

At least 73 records · Page 4Linked to original sources
PubMed1995

Tutorial software for clinical chemistry incorporating interactive multimedia clinical cases.

We have developed computer-based clinical case histories incorporating multimedia elements to aid the learning of medicine in a problem-based manner. Topics have been developed in the specialty of Clinical Biochemistry but the approach used is suitable for any branch of clinical medicine. Each topic has material aimed at medical students and also postgraduate candidates for professional examinations. A browser program is also incorporated. Emphasis is made on interaction through the case and modeling of real-life decisions in diagnosis and treatment. Advantages of the program are self-paced learning, assessment of understanding, feedback, and emphasis on deep understanding of the basic physiological and biochemical processes underlying clinical problems.

Chemistry, Clinical↗
PubMed1994

Three-point restraints as a risk factor for chest injury in the elderly.

As the number of drivers over the age of 65 years increases, new trauma patterns are emerging. The use of lap-shoulder restraints, in this population, is beginning to play an important role in new findings about their injuries. Restraint use in motor vehicle crash victims, in relation to average AIS score, ISS, and number of hospital and ICU days, was studied at a level I trauma center. The control group consisted of 100 patients between the ages of 35 and 45 years, who were involved in motor vehicle impacts (MVIs) from January 1990 through January 1992. The study group consisted of 120 patients over the age of 65 years who were involved in MVIs from January 1987 through January 1992. In the control group, restraint use was associated with a lower average AIS score--3.39 versus 7.35 for the unrestrained victims. In addition, the restrained victims spent fewer days in the ICU--0.08 versus 0.30 days for the unrestrained victims; and fewer hospital days--1.08 versus 2.0 days for the unrestrained victims. The general pattern of lower average AIS scores in restrained victims was also seen in the study group. However, in the study group, lap-shoulder belt-restrained patients had higher average AIS scores, in the chest region, than unrestrained patients--0.92 (SE 1.60) versus 0.71 (SE 1.47), respectively. These findings indicate that physicians must be aware of restraint patterns of chest injury in elderly patients. Aggressive triage criteria and vigorous pulmonary toilet, especially in patients with rib fractures, sternal fractures, and pulmonary contusions, should become integral parts of trauma resuscitation protocols in elderly patients.

Age Factors↗
PubMed1994

Lack of cardioprotective efficacy of allopurinol in coronary artery surgery.

OBJECTIVE: To examine the cardioprotective efficacy of allopurinol in patients undergoing elective coronary artery surgery. DESIGN: Prospective randomised trial. SETTING: London teaching hospital. PATIENTS: Twenty patients with at least moderately good left ventricular function undergoing elective coronary artery surgery and requiring at least two bypass grafts. INTERVENTIONS: Patients were randomised to receive allopurinol (1200 mg in two divided doses) or to act as controls. MAIN OUTCOME MEASURE: The primary determinant of the efficacy of myocardial protection was serial measurement (preoperatively and subsequently at one, six, 24, and 72 hours after the end of cardiopulmonary bypass) of cardiac troponin T (cTnT) a highly sensitive and specific marker of myocardial damage. Additional evidence was provided by serial measurement of the MB-isoenzyme of creatine kinase (CK-MB) and myoglobin, ECG changes, and clinical outcome. RESULTS: There was no significant difference in age, ejection fraction, number of grafts, bypass times, or cross clamp times between the two groups. In both groups there was a highly significant (p < 0.01) rise in cTnT, CK-MB, and myoglobin. Peak concentrations were reached between one (CK-MB and myoglobin) and six hours (cTnT) after the end of cardiopulmonary bypass. At 72 hours cTnT concentrations were six times higher than baseline concentrations whereas CK-MB and myoglobin were approximately double baseline concentrations. There was no significant difference in cTnT, CK-MB, or myoglobin between the allopurinol and control groups at any time. There was no diagnostic ECG evidence of perioperative infarction in any patient. CONCLUSION: Unlike previous reports this study did not show that allopurinol had a cardioprotective effect in patients with good left ventricular function undergoing elective coronary artery surgery.

Allopurinol↗
PubMed1993

Characteristics of normal larynges under flexible fiberscopic and stroboscopic examination: an Australian perspective.

The purpose of this study was to investigate the structure and function of larynges of 35 subjects with normal voices. Volunteers aged between 20 and 50 years with no history of voice disorders or laryngeal surgery, no current allergies, no formal voice training, and no hyperactive gag reflex were required to perform various vocal manoeuvres that were carried out under continuous and stroboscopic light. An assessment form was devised to record the condition and function of the larynx. The videotapes of the procedure were rated by experienced judges. The Australian Fiberscopic Profile was devised to record the relevant parameters under continuous light. Videostroboscopic ratings were carried out using the Bless protocol rating. High interjudge agreement was found across the two rating profiles.

Adolescent↗
PubMed1993

Capillary blood glucose measurements in hospital inpatients using portable glucose meters.

BACKGROUND: The use of portable glucose meters by nursing staff to perform bedside capillary blood glucose measurements is standard practice in the management of diabetic hospital inpatients. Few studies, however, have examined the practical limitations or the cost of this technology. AIM: To investigate the performance and cost of capillary blood glucose measurements using portable glucose meters in a hospital inpatient population being managed for diabetes mellitus. METHODS: The setting was a 500 bed metropolitan University Teaching hospital, with 22 meters (Glucometer-M) in routine use by about 450 accredited nursing staff. The Glucometer-M was also compared with an operator-independent meter (Hemocue) to assess the effect of operator bias on the overall efficacy and cost of the programme. RESULTS: Retrospective analysis of Glucometer-M reagent strips and comparison of measurements (n = 72) with the Hemocue revealed a marked operator bias which diminished accuracy and increased costs. The significant proportion of low haematocrits (< 30%) in the hospital population limited the applicability of the Glucometer-M which only operates reliably over the haematocrit range 35-50%. The excess of blood glucose measurements was highlighted by both a hospital ward audit and the frequency which exceeded that of routine electrolyte assays. CONCLUSIONS: Reliable bedside estimation of capillary blood glucose levels in hospitals requires a meter which is accurate, has negligible operator bias, is largely unaffected by haematocrit, and has insignificant risk of cross-contamination. At present only the Hemocue fulfils these specifications. Irrespective of meter choice, it is necessary to develop criteria for glucose measurements and monitor adherence.

Australia↗
PubMed1992

The importance of activity and pretreatment in the prevention of suxamethonium myalgias.

We have studied the effectiveness of pretreatment with atracurium 0.05 mg kg-1 and placebo before administration of suxamethonium, in the prevention of postoperative myalgia in inpatients having surgery in which rapid postoperative mobilization was possible (vaginal hysterectomy). On the second day after operation, the patients pretreated with atracurium had significantly fewer postoperative myalgias than those receiving placebo (P < 0.025). All patients were significantly more active on the second day compared with the first day after operation (P < 0.025). Possible causal relationships are discussed.

Adult↗
PubMed1991

Blood lactate and mixed venous-arterial PCO2 gradient as indices of poor peripheral perfusion following cardiopulmonary bypass surgery.

Conventional indices of tissue perfusion after surgery involving cardiopulmonary bypass (CPB) may not accurately reflect disordered cell metabolism. Venous hypercarbia leading to an increased veno-arterial difference in CO2 tensions (V-aCO2 gradient) has been shown to reflect critical reductions in systemic and pulmonary blood flow that occur during cardiorespiratory arrest and septic shock. We therefore measured plasma lactate levels and V-aCO2 gradients in 10 patients (mean age 57.2 years) following CPB and compared them with conventional indices of tissue perfusion. Plasma lactate levels, cardiac index (CI) and oxygen uptake (VO2) all increased significantly (p less than 0.05 vs baseline levels) up to 3 h following surgery. Oxygen delivery (DO2) did not change. Plasma lactate levels correlated significantly with CI (r = 0.47, p less than 0.01). V-aCO2 fell significantly with time (p less than 0.01 vs baseline). There was an inverse relationship between V-aCO2 and cardiac index and V-aCO2 and lactate (r = -0.37, p less than 0.05; r = -0.3, p less than 0.05 respectively). We conclude that blood lactate, CI and VO2 increase progressively following CPB. An increase in lactate was associated with a decrease in V-aCO2. An increase in V-aCO2 was not therefore associated with evidence of inadequate tissue perfusion as indicated by an increased blood lactate concentration.

Acidosis, Lactic↗
PubMed1991

'Solubile': decision-making in the diagnosis of jaundice.

We have designed a computer program 'Solubile' to aid clinicians in the diagnosis of jaundice. Based on Bayes' theorem, 'Solubile' uses up to 47 items of information about the patient to produce the most probable diagnosis from 22 possible diseases. In a prospective analysis of 50 patients, 74% were correctly diagnosed in first place and 94% within the first three choices. The possibility of using 'Solubile' at differing locations was tested by prospectively diagnosing 100 cases at a second centre having a significantly different patient population. 75% of these patients were correctly diagnosed in first place and 89% within the first three choices. The diagnostic ability of 'Solubile' was compared with that of 20 clinicians of various grades. The clinicians correctly diagnosed 49.5% of cases (Solubile 74%) and placed 68.5% (Solubile 94%) within the first three choices. 'Solubile' will be of use to aid clinicians in aspects of the diagnosis and management of jaundice.

Bayes Theorem↗
PubMed1989

Full-time women general practitioners--an invaluable asset.

It has been said that women doctors do not fulfil the same role as men doctors in general practice. This is inaccurate as previous studies of workload in general practice have not excluded from the analyses women principals who are part time, that is, have a less than full profit share at parity. In a postal questionnaire to 501 women principals 308 (62%) replied, of whom 143 (46%) were full time with respect to profit share. Respondents were asked to record aspects of workload over a four-week period for themselves and three of their full-time men partners. Analysis of their responses showed that they did an equal workload to their full-time men partners in terms of number of surgeries, length of surgeries and number of home visits. Equal numbers of full-time women did out-of-hours work as their men partners and the number of nights and weekends on-call as well as use of deputies were similar. The analysis also showed that full-time women did more specialized clinics than men, thus emphasizing the special role of women doctors in preventive care.

Employment↗
PubMed1989

Part-time women general practitioners--workload and remuneration.

A postal questionnaire survey was conducted comparing the workload and remuneration of part-time women principals in group practices in the Northern and Oxford regions. Part time was defined as receiving less than a full profit share at parity. Of 501 women principals 308 (62%) responded of whom 146 (47%) were part-time. Respondents were asked to record aspects of workload over a four-week period for themselves and their full-time partner who did the most sessions within the practice. The results showed that although two-thirds of the part-timers had 50% or less of a full profit share, part-time principals overall did about 76% of the daytime clinical work (surgeries and home visits) done by their full-time partners, excluding specialized clinics. The lower the profit share the wider this discrepancy. Although 33% of the respondents did not out-of-hours work, the remainder did more than their profit share would indicate. Twenty per cent of the 116 principals with 40% or more of a full profit share and 57% of the 30 principals with less than 40% of a full profit share felt that their share was unfair. Lack of involvement in practice business and feeling that opinions did not carry equal weight were associated with feelings of unfairness.

Female↗
PubMed1988

Case finding in the elderly: does the primary care team already know enough?

The needs of an elderly population in one general practice were assessed by the primary health care team. A simple questionnaire was filled in as far as possible by members of the team on known social and functional criteria for each patient aged over 75. The questionnaire was complete for 100 of 118 elderly patients. The information was accurate for over 95% of the criteria as verified by information held by the health authority. This information will now be used for yearly reviews of each patient based on opportunistic contacts. This is a simple method of collating information that is already known. If such information was available to health authorities it would give them an idea of the type and extent of the support services needed for elderly people.

Activities of Daily Living↗