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Biomedical subjects

J Lindsay

Publications and source records attributed to J Lindsay.

At least 19 recordsLinked to original sources
PubMed1992

Methicillin-resistant Staphylococcus aureus colonization in a long-term-care facility.

OBJECTIVE: To study the prevalence and risk factors for colonization with MRSA at a long-term-care facility. DESIGN: Cross-sectional surveillance culture survey. SETTING: A 233-bed university-affiliated long-term-care facility. MEASUREMENTS: Surveillance cultures for MRSA were performed on patients of two adjacent nursing units and on new admissions to the entire facility over a 4-month period. RESULTS: On the chronic medical unit, where patients known to be colonized had been cohorted, 20 of 38 (52.6%) were colonized vs 3 of 67 (4.5%) on the skilled/intermediate unit (P less than 0.001), suggesting that little intra-facility spread of MRSA occurs. Twenty-four of 55 (43.6%) chronic medical admissions were colonized vs 6 of 63 (9.5%) admitted to the other units (P less than 0.001). Thirteen of 30 (43.3%) admissions were not previously known to be colonized. By univariate analysis, colonized admissions were younger and more often male; had more listed diagnoses, including pressure sores, a previous positive MRSA culture, and urinary incontinence; were more often fed by feeding tube; and had longer durations of hospital stay prior to admission. Logistic regression analysis showed that the most powerful independent predictors of colonization at admission were: a prior positive culture for MRSA (OR 8.8, 95% CI 2.4, 32.4), male sex (OR 8.2, 95% CI 2.3, 29.7), urinary incontinence (OR 3.8, 95% CI 1.4, 10.4), and presence of pressure sores (OR 2.9, 95% CI 0.9, 9.2). CONCLUSIONS: Unrecognized colonization of nursing home residents with MRSA is common, and nursing homes are unwittingly repositories for patients colonized with MRSA following acute hospitalization. Gloving and careful attention to handwashing may limit spread of MRSA within nursing homes, and identification of colonized patients may be facilitated by targeted surveillance cultures of the most debilitated patients at admission.

Aged↗
PubMed1991

Ventricular late potentials in myotonic dystrophy.

OBJECTIVE: To determine the prevalence of ventricular late potentials, as determined by signal-averaged electrocardiography, in patients with myotonic dystrophy. DESIGN: Cross sectional, with blinded analysis of all electrocardiographic data. SETTING: Outpatient departments of a Veterans Affairs medical center and a tertiary care private hospital. PARTICIPANTS: Twenty-four patients with myotonic dystrophy. Patients were excluded from the study if they had either a history suggestive of significant ventricular arrhythmias or electrocardiographic evidence of a bundle-branch block. Two comparison groups were also formed; one group included 44 healthy employees at the tertiary hospital and the other, 30 cardiac patients with inducible ventricular tachycardia. MAIN RESULTS: A time-domain analysis of the signal-averaged electrocardiograms showed that 75% of patients with myotonic dystrophy met one criterion for the presence of late potentials, 67% met two criteria, and 29% met all three criteria. Spectrotemporal mapping in these patients showed markedly abnormal spectral peaks with a mean factor of normality that was significantly lower than that of the normal volunteers; the frequency of electrocardiographic abnormalities approached that seen in patients with known ventricular tachycardia. The presence of late potentials correlated directly with the length of the PR interval and inversely with left ventricular fractional shortening. CONCLUSIONS: In our study, the prevalence of late potentials on signal-averaged electrocardiography in patients with myotonic dystrophy approached that seen in cardiac patients with inducible ventricular tachycardia. It is possible that ventricular arrhythmias play a role in the occurrence of sudden death in some patients with myotonic dystrophy.

Adult↗
PubMed1991

A comparison of multilesion percutaneous transluminal coronary angioplasty in elderly patients (greater than 70 years) and younger subjects.

Results of multilesion percutaneous transluminal coronary angioplasty (PTCA) were compared in 210 elderly patients (70 to 92 years, [group I] and 210 younger patients (40 to 69 years, [group II]. The elderly patients included more women (43% versus 24%) and patients with unstable angina (73% versus 55%). PTCA was successful in 87% of lesions in group I and in 94% in group II (p less than 0.001). Only circumflex artery dilatation was less successful in group I (78% versus 91%, p less than 0.002). PTCA was successful in all lesions of at least one vessel in 89% of group I patients and in 94% of group II patients (p less than 0.06). Successful dilatation of all lesions was achieved in 77% of group I and in 85% of group II patients (p less than 0.05). Complication rates were similar for both groups. These data demonstrate a high rate of success and safety in elderly patients undergoing multilesion PTCA despite the presence of several risk factors (advanced age, female sex, unstable angina). The lower PTCA success rate in these patients compared with younger subjects is almost entirely attributable to reduced success for circumflex artery lesions.

Age Factors↗
PubMed1990

Probe angioplasty of total coronary occlusion using the Probing Catheter technique.

Coronary angioplasty (PTCA) of total coronary occlusion is limited by the inability of guidewires and conventional dilating catheters to cross all such lesions. A new technique was therefore prospectively evaluated for PTCA of these lesions using the ultra-low-profile Probe "balloon on a wire" device. An intracoronary Probing Catheter was used to facilitate crossing the stenosis with a guidewire and then to deliver a Probe into the obstruction for balloon dilatation. This technique was utilized in 64 consecutive patients with "absolute" coronary occlusions demonstrating no angiographically detectable antegrade coronary flow. Successful dilatation was achieved in 47 (73%). Among 33 occlusions of less than 3 mo duration 31 (94%) were successfully dilated whereas only 16 of 31 more chronic occlusions were dilated (P less than .01). Chronic occlusions with a tapered morphology and those located more than 1 cm from a branch point were more frequently dilatable. There were no serious complications including no vessel perforations with this technique. The Probing Catheter technique offers a safe and effective method for the dilatation of recent coronary occlusions by using balloon on a wire technology.

Angioplasty, Balloon, Coronary↗
PubMed1990

Use of continuous ambulatory peritoneal dialysis in a nursing home: patient characteristics, technique success, and survival predictors.

Forty-four end-stage renal disease (ESRD) patients admitted to a nursing home were treated with continuous ambulatory peritoneal dialysis (CAPD). The technical feasibility of using CAPD in this setting was demonstrated by an acceptable peritonitis rate (1.3 episodes per patient-year), acute hospitalization rate (18.5 days per patient-year), and only two technique failures. However, 6-month and 12-month survival rates were 53% and 29%, respectively. Survival analysis using the Cox model showed that patients with better functional status on admission measured by activity of daily living scores and who had previously been in an outpatient dialysis program before admission survived longer and were more often discharged.

Activities of Daily Living↗
PubMed1989

Probabilistic division systems modeling the generation of mosaic fields.

The explanation of mosaic pattern in chimeric organs analyzed by in situ methods requires modeling of specific hypotheses. The use of computer simulations to achieve this has led to the conclusion that finely variegated mixtures of cell lineage within chimeric tissues does not require extensive cell movement. Cell division models were used to determine the distribution of patch size as mosaic fields are generated. The results establish that these distributions are sensitive to the proportion of the two cell types which comprise the mosaic.

Animals↗
PubMed1989

Usefulness of fish oil supplements in preventing clinical evidence of restenosis after percutaneous transluminal coronary angioplasty.

This study assesses the effect of dietary supplements with high dose omega-3 fatty acid (N3FA) on the frequency of clinical restenosis during the 6 months after successful percutaneous transluminal coronary angioplasty (PTCA). One hundred ninety-four patients (214 significant coronary narrowings) were randomized after successful PTCA to receive conventional medical therapy or to an identical regimen supplemented by high dose N3FA (4.5 g/day). Enrollment required angina pectoris and successful dilatation of all significant coronary narrowings. The subjects were randomly assigned to either no N3FA (control, n = 99) or N3FA supplementation (n = 95). After a 1-week trial period, 11 (group 2) declined further treatment because of side effects. The remaining 84 subjects (group 1) continued N3FA throughout the 6-month period. Monthly clinical follow-up was obtained in all patients. Ninety-two percent of patients had cardiac testing for evaluation of recurrent ischemia. Except for a greater percentage of women in the group refusing N3FA supplementation (group 2), the 3 groups were similar in demographic data, medical history, dietary habits, history of previous PTCA and angiographic characteristics. Of the 194 subjects, 56 had clinical restenosis (45 by cardiac catheterization, 8 by exercise testing and 3 by symptoms alone [refused further clinical testing]). Reocclusion rates were: group 1 19%, group 2 46%, and control 35%. Analysis both in accordance with the principle of intention to treat and for subjects who actually received N3FA revealed a significant effect of N3FA on preventing clinical restenosis (p less than 0.04 and p = 0.008, respectively). These data suggest that high dose N3FA supplements reduce the clinical restenosis rate after successful PTCA.

Angiography↗
PubMed1989

Left ventricular filling patterns in aortic stenosis in patients older than 65 years of age.

Left ventricular (LV) filling patterns in 26 elderly (mean age 81 years) patients with severe aortic stenosis (AS) were evaluated using pulsed-wave Doppler echocardiography. Parameters of LV filling, including the ratio of the peak atrial velocity to the peak early diastolic velocity (A/E ratio) and the percent contribution of active atrial filling to total LV filling (%A), of these patients with AS (group I) were compared with 2 groups presumed to have abnormal LV filling: elderly patients (group II) and hypertensives with increased LV mass (group III), as well as with normal volunteers (group IV). The patients with AS had a broad range of LV inflow velocity patterns (A/E = 0.91 +/- 0.56, range 0.20 to 1.91; %A = 34.3 +/- 16.4, range 3.0 to 65), as compared with the consistently low A/E ratio (0.48 +/- 0.13) and %A (25 +/- 7) in the normal volunteers and the high A/E ratio and %A in the elderly (A/E = 1.48 +/- 0.28, %A = 49 +/- 11) and hypertensive (A/E = 1.41 +/- 0.32, %A = 49 +/- 8) groups. When comparing the data obtained by Doppler with hemodynamics at catheterization, the patients with AS and a high A/E ratio (A/E ratio greater than 1, n = 11) had lower LV mid-diastolic pressures (7 vs 18 mm Hg, p less than 0.001), lower pulmonary artery systolic pressures (33 vs 49 mm Hg, p less than 0.05) and less symptomatic heart failure than those patients with AS and a low A/E ratio (A/E less than 1). The aortic valve area was similar in these 2 subgroups (0.40 vs 0.37 cm2).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗