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J Kellett

Publications and source records attributed to J Kellett.

At least 19 recordsLinked to original sources
PubMed1998

A preliminary report: a new scale to identify the pseudodementia syndrome.

BACKGROUND: The literature was reviewed to abstract items which were claimed to distinguish organic dementia from pseudodementia. Their discriminating powers were tested in a prospective study. Eighteen of these items were selected to create a questionnaire which should distinguish organic dementia from pseudodementia. The gold standard was the final diagnosis given by a consultant psychiatrist 12-14 months later. METHOD: One hundred and twenty-eight patients referred to our service with a differential diagnosis of depressive pseudodementia were screened using a checklist of 44 characteristic features (in the form of questions with 'yes' or 'no' answers) which were claimed in the literature of differentiate between organic dementia and depressive pseudodementia. This checklist covers the areas of history, clinical data, insight and performance. RESULTS: Forty points (questions) out of the 44 in the checklist showed significant discriminating power to differentiate dementia from depressive pseudodementia (p < 0.01). A principal component and factor analysis was performed from which 18 questions were extracted. The shortened questionnaire was able to classify (43/44 cases) 98% of dementia cases and (60/63) 95% of depression correctly. A new definition has been introduced for 'pseudodementia' as a syndrome of reversible subjective or objective cognitive problems caused by non-organic disorder. Thus depressive pseudodementia may be classified into two subtypes. Type I is a group of patients who have depressive symptoms with subject complaint of dysmnesia without measurable intellectual deficits. Type II is a group of patients who have depressive symptoms and show poor cognitive performance based on poor concentration not due to organic disorder.

Aged↗
PubMed1998

Thrombolytic therapy guided by a decision analysis model: are there potential benefits for patient management?

BACKGROUND: Although thrombolytic therapy improves the outcome of myocardial infarction, it is associated with increased risks of stroke and bleeding; these risks may outweigh the benefits of therapy. The risks and benefits of thrombolysis, for any individual clinical situation, can be explicitly estimated by means of decision analysis. HYPOTHESIS: The aim of this study was to compare the actual use of thrombolytic agents for suspected acute myocardial infarction (AMI) with the management preferred by a decision analysis model. METHODS: Admission data prospectively obtained in 262 consecutive patients admitted to a rural community hospital's coronary care unit with suspected AMI, as well as clinical decisions and outcomes, were reviewed and analyzed. RESULTS: Seventeen deaths from AMI and no major strokes were observed, compared with 18.30 deaths and 0.85 major strokes predicted by a decision analysis model. Forty-seven of 84 patients with confirmed AMI and 3 of 178 without AMI were given a thrombolytic agent, compared with 65 patients with and 7 without AMI who had decision analysis-guided therapy. Decision analysis-guided therapy could have saved 3.7 additional lives and gained 29.6 life years, but produced 0.4 extra strokes. Changing the quality adjustment for stroke or heart failure would not have altered the treatment preferred by decision analysis in any of the 262 cases studied. Some patients were predicted to benefit considerably from thrombolysis with little extra risk of stroke and vice versa: all cases must, therefore, be assessed individually. CONCLUSIONS: A decision analysis model can guide thrombolytic therapy by promptly defining its risks and benefits.

Adult↗
PubMed1997

Likely gains in life expectancy of patients with coronary artery disease treated with HMG-CoA reductase inhibitors, as predicted by a decision analysis model.

OBJECTIVE: To estimate the likely gains in life expectancy of patients with coronary artery disease treated with HMG-CoA reductase inhibitors based on published reports and the results of the 4S and the West of Scotland Study. DESIGN: Decision analysis. MAIN OUTCOME: Four likely scenarios of the effect of treatment with HMG-CoA reductase inhibitors on the life expectancy of medically and surgically managed coronary artery disease were modelled. RESULTS: Regardless of the scenario, treatment with HMG-CoA reductase inhibitors was estimated to provide a gain in life expectancy for medically managed patients of all ages with coronary artery disease, ranging from 4.6 to 10.1 quality adjusted life years (QALYs) for a 40 year old with three vessel disease (depending on the scenario assumed), to 0.2 QALYs for a 80 year old with two vessel disease. These gains were always greater than those predicted after bypass alone. If the use of HMG-CoA reductase inhibitors produces the same reduction in cardiac mortality after bypass as it does in medically managed patients it will increase the benefits of operation except for patients with two vessel disease over 70 years of age. Conversely, if HMG-CoA reductase inhibitors do not influence the course of coronary artery disease after bypass, the benefits of operation over medical treatment with HMG-CoA reductase inhibitors are either reduced or lost completely, ranging from a loss of -5.6 QALYs for a 40 year old with two vessel disease to a gain of 1.5 QALYs for 55 to 60 year old patients with left main stem disease. CONCLUSION: Although their effect on the progression of coronary artery disease after bypass must be defined, it is probable that HMG-CoA reductase inhibitors will produce considerable gains in life expectancy for patients with coronary artery disease.

Acyl Coenzyme A↗
PubMed1997

Early diagnosis of acute myocardial infarction by either electrocardiogram or a logistic regression model: portability of a predictive instrument of acute cardiac ischemia to a small rural coronary care unit.

OBJECTIVE: To test the ability of a logistic regression model (LRM) that predicts acute cardiac ischemia to make an early diagnosis of acute myocardial infarction (AMI); the ability of the LRM to predict AMI was also compared with the presenting electrocardiogram (ECG). SETTING: A small rural Irish coronary care unit. METHODS: Clinical and ECG data required by the LRM to predict acute coronary ischemia were recorded in 600 consecutive patients admitted with suspected AMI. Estimates of the LRM were ranked into equal deciles in declining probability of acute cardiac ischemia (pACI), and presenting ECGs were placed into one of seven categories. RESULTS: At presentation 50% of AMI patients were in the two LRM deciles with the highest pACI, and 49% of AMI patients had ECGs with greater than 2 mm ST elevation associated with reciprocal changes. ECG categories had a 76% sensitivity for the early diagnosis of AMI and the LRM had an 84% sensitivity. The specificity, accuracy and positive predictive value for the ECG categories were 92%, 84% and 85%, respectively. The specificity, accuracy and positive predictive value of the LRM were 84%, 84% and 75%, respectively. The areas under the receiver operating characteristic curve of the LRM and ECG categories were almost identical (91% and 90%, respectively). CONCLUSION: AMI can be diagnosed early with comparable accuracy either by placing presenting ECGs into one of seven categories, or by the LRM. The best method and 'cut-off' point for the diagnosis of AMI varies according to clinical circumstances. Categorizing ECGs requires more skill in ECG interpretation, but takes less time. The previously reported performances of the LRM were replicated, confirming portability of its use into different clinical settings and patient populations.

Acute Disease↗
PubMed1996

Ethics committees.

Explore the source record for details and available documents.

Alzheimer Disease↗
PubMed1995

Referral for coronary angiography after exercise testing: traditional decision-making versus decision analysis.

To audit the referral decisions made by a single cardiologist for coronary angiography after exercise testing, we retrospectively reviewed the charts of 303 consecutive patients in a community hospital. The outcomes of these decisions, in terms of angiograms performed and quality-adjusted life expectancy gains as predicted by a decision analysis model, were compared with the theoretical decisions that would have been made using the model. The 97 patients sent for angiography exercised for a shorter time (5.6 +/- 3.1 vs. 6.9 +/- 3.2 min, p < 0.001) had more ST deviation (2.7 +/- 1.4 vs. 1.7 +/- 1.0 mm, p < 0.001), more angina (53.6 vs. 36.9% of patients, p < 0.01) and were more likely to have had a previous myocardial infarction (59.8 vs. 33.5% of patients, p < 0.001) than the 206 not referred. However, of those not referred, 137 were each predicted to gain up to 5.7 quality-adjusted life years (QALYs) from bypass surgery. The overall predicted gain from the cardiologist's decisions was only 0.1 +/- 2.5 QALYs/patient. Had the decisions been made using the model, the mean gain would have been 1.9 +/- 1.3 QALYs/patient, and an extra 128 patients would have been sent for angiography. Decision analysis makes consistent decisions with defined risks and benefits. Such decisions can be reproduced, reviewed and analysed, whereas traditional decision-making may inconsistently reflect the clinician's beliefs and values.

Aged↗
PubMed1991

Low levels of cryofibrinogenaemia and peripheral circulatory dysfunction.

Over 12 months of general internal medicine practice in a small community, three premenopausal women, and a man presented with peripheral circulatory complaints. All were found to have cryofibrinogen, a cold-precipitable abnormal fibrinogen complex, in their blood. None had cryofibrinogen levels above 100mg per 100ml. The plasma of 195 other patients were screened. Cryofibrinogen was found in only one of these samples, that of a 23 year old women with active lupus erythematosis. These case reports suggest a relationship between low levels of cryofibrinogenaemia and mild circulatory disorders.

Adolescent↗