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Biomedical subjects

J M Rowley

Publications and source records attributed to J M Rowley.

24 records · Page 2Linked to original sources
PubMed1982

Early reporting of myocardial infarction: impact of an experiment in patient education.

Many deaths from myocardial infarction occur before medical help is sought. A campaign was mounted in Nottingham ("Nottingham Heartwatch") to encourage early reporting. A total of 13 828 men and women aged 40 and over registered with three general practices were asked to telephone a hospital-based number if they developed chest pain lasting for more than 10 minutes. Patients from study practices reported chest pain earlier after our invitation than they had before and also earlier than patients from control practices. While accepting the advice to call early some patients from the study practices ignored our special number and telephoned their general practitioner. The calls received on the Heartwatch line yielded a lower percentage of definite and probable infarcts than the calls received by the patients' own doctors. The way in which the characteristics of the study practices might have influenced this difference is discussed since it has considerable implications for larger-scale attempts to bring patients with suspected myocardial infarction under medical care at the earliest opportunity.

Adult↗
PubMed1980

Randomised placebo-controlled trial comparing oxprenolol with disopyramide phosphate in immediate treatment of suspected myocardial infarction.

473 patients with suspected acute myocardial infarction were entered into a randomised, double-blind, placebo-controlled comparison of disopyramide phosphate, 150 mg three times a day, and oxprenolol, 40 mg three times a day. When analysed on an intension-to-treat basis there was no significant difference in 6-week mortality between the groups, but patients who were able to continue on the active medications fared better than the patients who had to be withdrawn. The withdrawal rate because of heart failure in patients randomised to receive disopyramide was significantly increased. Patients receiving this agent also showed a reduced number of arrhythmic episodes on 24-h tape recordings but this trend did not achieve statistical significance. The results show that the early use of either oxprenolol or disopyramide phosphate in patients with suspected acute myocardial infarction is unlikely to improve mortality.

Acute Disease↗
PubMed1979

Legionnaires' disease: a clinical description of thirteen cases.

We describe 13 patients with legionnaires' disease in Nottingham, all presenting with lobar pneumonia. Six patients required artificial ventilation and 2 died. No common source of infection has yet been identified, but the disease appears to be prevalent and possibly endemic in this city.

Adult↗
PubMedDate not supplied

Electrocardiogram interpretation as a basis for thrombolysis.

OBJECTIVE: To assess the skills and opinions of different grades of doctors and cardiac-trained nurses in interpreting electrocardiographic changes when deciding upon administration of thrombolysis to patients with chest pain. DESIGN: A questionnaire was distributed to staff in several local hospitals. SUBJECTS AND METHODS: Participants were asked to assess 30 electrocardiograms (ECGs) and determine whether they would prescribe thrombolytic therapy on the basis of each one, assuming an associated typical history of acute myocardial infarction (AMI) and no contra-indications to treatment. They were asked to return the questionnaire anonymously, stating only their position. RESULTS: Of the 88 questionnaires, 61 were returned by 15 senior nurses, 10 house officers, 12 senior house officers, 10 medical registrars, eight consultant physicians and six consultant cardiologists. When electrocardiograms showed unequivocal evidence of acute myocardial infarction, all consultant cardiologists gave the correct answer, but only 75.5% of house officers diagnosed AMI. Cardiologists were most in favour of thrombolysis when left bundle branch block was present. Cardiac-trained nurses showed good decision-making skills. CONCLUSIONS: Staff involved in assessment of patients with chest pain should have specific training in electrocardiographic diagnosis of myocardial infarction in order to minimise in-hospital delay when thrombolysis is indicated. The management of patients with left bundle branch block remains uncertain; cardiologists are more likely to recommend thrombolytic therapy than any of the other participants in the study.

Cardiology↗