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Biomedical subjects

J Keates

Publications and source records attributed to J Keates.

10 recordsLinked to original sources
PubMed2000

Screening to the converted: an educational intervention in African American churches.

BACKGROUND: African American women have higher incidences of breast and cervical cancers and African American men present with more advanced stages of colon and prostate cancers than do their non-African American counterparts. Since the church is central to the organization of the African American community, the authors set out to determine whether a church-directed educational project could influence parishioners to obtain cancer screening. METHODS: Three African American churches having memberships of 250, 500, and 1,500, respectively, were selected for their different socioeconomic strata: one congregation was composed mostly of working poor, the second was more affluent, and the third consisted primarily of retirees. During a five-week summer period, appropriate literature, health fairs, testimonials by cancer survivors, and visits by representatives of the medical community were used to increase awareness of cancer screening. Surveys regarding cancer-screening behaviors were distributed at the end of church services. Using the guidelines established by the American Cancer Society, individual recommendations for screening examinations were developed and sent to parishioners based on their survey responses. RESULTS: Of 437 parishioners surveyed (73% female, 27% male), 75% were 40 years old or older. Many reported up-to-date screening for breast (84%), cervical (78%), colon (62%), and prostate (89%) cancers. The results were remarkably similar in all three churches. Telephone follow-up seven months after the survey directed at the 120 parishioners identified as noncompliant for at least one cancer screening revealed that 49% had obtained the appropriate screenings. CONCLUSIONS: These African American churchgoers were well screened compared with estimated national averages, possibly due to previous efforts of the activist ministers in the churches selected. The message for cancer screening is heeded when delivered through the African American church.

Adult↗
PubMed1987

Does atenolol improve physical and psychological function after coronary artery bypass surgery: a controlled study.

A double-blind prospective randomized trial of atenolol (100 mg once daily) was carried out on 88 patients (78 men) awaiting coronary artery bypass graft surgery. Standardized ratings of both psychiatric morbidity and functional capacity were made before, 3 months (n = 82) and 12 months (n = 81) after surgery. One year after surgery men in the atenolol group had a significantly shorter treadmill exercise time than those on placebo (7.21 +/- 0.28 min vs 8.32 +/- 0.40 min; p less than 0.05), but the frequency of reported anginal attacks during the year was similar in both drug groups. Improvement in functional capacity (measured in exercise time) in the 71 men following surgery was related to both physical and psychological variables assessed before the operation. Men with more severe occlusive disease, lower neuroticism and higher extraversion scores pre-operatively showed greater percentage improvement in exercise time after surgery. Women had significantly levels of psychiatric morbidity and shorter treadmill exercise time than men both before and after surgery. Of the psychiatric and psychological variables, only ratings of Type A behaviour fell significantly in the atenolol group (170.9 +/- 5.3 vs 163.0 +/- 5.2; p less than 0.05). This change, which is probably not clinically important, occurred independently of any reduction in either overall psychiatric morbidity score or ratings of somatic symptoms mediated by beta-adrenergic receptors. The atenolol group reported more side-effects of both psychological and physical symptoms than the placebo group. We do not recommend the routine use of atenolol after bypass graft surgery. Our findings failed to support the suggestion that Type A characteristics may reflect an underlying sympathetic nervous system reactivity.

Angina Pectoris↗
PubMed1984

Early exercise testing and elective coronary artery bypass surgery after uncomplicated myocardial infarction. Effect on morbidity and mortality.

One hundred and nineteen consecutive patients were studied prospectively after uncomplicated myocardial infarction by maximal exercise electrocardiography at two weeks and coronary angiography at six weeks. At angiography 87 patients had a stenosis greater than 70% in one major coronary artery supplying residual viable myocardium outside the infarction zone. In 82 (94%) of these the 12 lead maximal exercise electrocardiogram correctly identified these areas of ischaemic but viable myocardium. Based on ST criteria alone five patients had a false negative exercise electrocardiogram for additional disease. Nevertheless, three developed angina or a significant fall in systolic blood pressure or both at a low workload. On the basis of the anatomical lesions, symptoms, and the results of the European Coronary Surgery Study Group 55 patients were allocated for surgery. Of these, 54 underwent coronary artery bypass grafting within three months of myocardial infarction. One patient died perioperatively and another died after a reinfarction at four months while awaiting surgery. The remaining 53 were symptom free during a mean follow up period of 37 months. Sixty four patients received medical treatment. At angiography 32, 24, and eight patients had one, two, and three vessel coronary disease respectively. The exercise electrocardiogram correctly predicted the anatomy in 60 (94%), with two false positive and two false negative results for additional disease. The eight patients with three vessel disease treated medically had generalised inoperable disease, and at follow up three had died after a further infarction and five remained symptomatic with full medical treatment. Thus of those designated as at high risk and considered suitable for surgery the 37 month survival was 53 or 54 patients treated surgicall7y.

Adult↗
PubMed1983

Traumatic right coronary artery--right atrial fistula.

Traumatic coronary artery fistulae and intracardiac shunts due to penetrating wounds of the heart are rare, with only 19 reported cases in the literature. The communication, which may involve one or both coronary arteries, is classified into two major types depending on whether the drainage is into the left or right heart. We report a right coronary artery (RCA) right atrial fistula (RA) secondary to shrapnel injury in 1944.

Angina Pectoris↗
PubMed1975

False aneurysm as a late complication of anterior dislocation of the shoulder.

A review of the leterature since 1947 fails to show a report of a false aneurysm with uncomplicated anterior shoulder dislocation. If this potential late complication is to be diagnosed and treated before the patient is released from followup medical care, careful attention must be given to alterations in the radial pulse prior to reduction. Patients who demonstrate an abnormal radial pulse which reverts to normal following reduction should have an angiogram. Pathological findings to the underlying axillary artery must be repaired promptly. Anterior dislocations of the shoulder account for approximately 50% of all dislocations and tend to be most frequent in healthy males. Late vascular complications associated with this injury are infrequent and can therefore be easily overlooked as illustrated in this report.

Aneurysm↗
PubMedDate not supplied

Unstable angina: early and late results of operative treatment.

Between January 1978 and May 1980 at King's College Hospital 68 patients of 300 patients treated consecutively by coronary artery bypass grafting (CABG) had presented with unstable angina. There were 58 males and 10 females age range 26 to 69 years, mean 54 years. Thirty-one patients (45%) had definite evidence of previous myocardial infarction, 4 had diabetes mellitus and 7 had left main stem stenosis greater than 50%. Seven cases (9.7%) required pre or peri-operative intra-aortic balloon pump assistance. Two subsets within this group of 68 patients with unstable angina were recognised. Fifty seven patients had CABG alone without any additional surgical procedure and there were 2 peri-operative deaths (mortality 3.5%). In 11 patients who had CABG plus additional surgical procedures including valve replacement or left ventricular aneurysmectomy there were 3 peri-operative deaths (mortality 27%). The overall mortality of the 68 patients was 5 deaths (7.4%). These results indicate that the operative mortality in patients with unstable angina having CABG alone is not significantly higher than the overall mortality at that time for the patients who had CABG for stable angina (2.4%).

Adult↗