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Biomedical subjects

J Royle

Publications and source records attributed to J Royle.

36 records · Page 2Linked to original sources
PubMed1994

The value of duplex scanning in surveillance of infra-inguinal vein and synthetic grafts.

The contribution of duplex scanning to improving early diagnosis of graft stenosis was evaluated in 195 patients after infrainguinal bypass procedures. Over a 31 month period. 406 duplex scans were obtained on 232 limbs with 191 vein and 41 polytetrafluoroethylene (PTFE) grafts. Peak systolic velocities > 200 cm/s with spectral broadening and lumen reduction on B-mode image were the criteria adopted for identification of a haemodynamically significant (> 50%) stenosis. Sixty-one stenoses were identified in 55 of the grafted limbs. Thirty-three of the 55 limbs had a subsequent angiogram. The angiogram showed graft occlusion in six limbs, graft stenosis in 18, and native artery stenosis in four. Twenty-one of the grafts had the angiogram within 1 month after the duplex had detected graft stenosis, and one (4.76%) became occluded in this interval. Seven had an angiogram more than 1 month after the duplex study, and five (71.4%) had become occluded. The angiographic study did not confirm a graft stenosis in five limbs. Three were submitted to operation and stenosis was confirmed. Seventeen graft thromboses were detected by duplex scanning. Graft thrombosis was demonstrated following a previous negative duplex scan in one of the 106 vein grafts (0.94%), and in four of 30 PTFE grafts (13.3%). Duplex scanning is effective in the detection of graft stenosis. The precise anatomical location is less accurate when in the region of an anastomosis. Early attention should be taken when duplex studies suggest critical stenosis because there is a high risk of occlusion. Polytetrafluoroethylene grafts tend to thrombose without a precursory focal stenosis.

Aftercare↗
PubMed1994

An anatomic source of false venous reflux with continuous wave Doppler.

BACKGROUND: The limitations of continuous wave (CW) Doppler have been recognized in the assessment of venous reflux since CW Doppler is not able to distinguish reflux signals from more than one vein. In our experience, some regions with venous reflux suggested by CW Doppler were noted to have no reflux in any individual vein during duplex studies. OBJECTIVE: The aim of the study was to assess the anatomic source of the venous reflux suggested by CW Doppler but not confirmed by duplex ultrasound. METHODS: Five hundred and fifty-one consecutive lower limbs with primary or recurrent varicose veins were examined with CW Doppler and subsequently by color-coded duplex ultrasound to assess the source of venous reflux. RESULTS: The duplex ultrasound study revealed no reflux in 44 specific regions (8%) where reflux had been indicated by CW Doppler. Two types of anatomy were noted. Two or more superficial veins joined the deep venous system via a common junction in 25 cases. A descending vein joined the deep venous system in 19 cases. CONCLUSION: A bidirectional Doppler signal in a region of venous junction without any incompetent veins can be misinterpreted as venous reflux. A careful examination of veins not only at the region of the junction, but also at some distance down the stem of the vein is important during CW Doppler or duplex assessment.

Femoral Vein↗
PubMed1977

Post-irradiation extracranial cerebrovascular disease.

It would seem that most reports of post-irradiation extracranial cerebrovascular disease concern the long-term effects of this form of therapy. Three such cases are described here. The features peculiar to this form of disease are its severity and very considerable extent. Radiologists and vascular surgeons contribute heavily to its diagnosis. Whilst it would appear that rarely in early cases a type of vascular lesion peculiar to radiation damage has been encountered, for the most part reports have emphasised the presence of very extensive and accelerated premature vascular aging and atherosclerosis as a fundamental lesion probably involving all laminae of the vessel. In addition extensive perivascular fibrosis and overlying post-irradiation skin atrophy can be seen. Therefore in patients presenting with cerebrovascular pathology even years after receiving radiation therapy, the neurologist and vascular surgeon must be prepared to recognise that extensive damage may underlie the patients' symptoms and that investigation and surgical repair may have to be undertaken forthwith if at all practicable.

Aged↗
PubMed1975

The management of popliteal aneurysms.

Twenty-three patients with 34 popliteal aneurysms were treated between 1963 and 1974. Nearly half of the aneurysms were the site of thrombosis when they first presented, and of these nearly half required a major amputation. Surgical treatment of aneurysms in which the popliteal artery was patent was satisfactory; the only failure occurred when a Dacron graft became occluded after eight years. A small group of patients was observed for an average of one year, during which time the thrombus in one aneurysm embolized and one aneurysm became occluded, necessitating an amputation. The results of this series suggest that the prognosis for a limb with popliteal aneurysm depends on the patency of the popliteal artery at the time of the initial presentation, and lends support to the belief that popliteal arteries with aneurysms are best reconstructed before the onset of a serious complication.

Adult↗
PubMed1975

Ruptured iliac aneurysms.

Iliac aneurysms are uncommon as compared with aneurysms of the abdominal aorta. Rupture is the most serious complication of aneurysms of both vessels. Considerable attention has been focused on the management of ruptured abdomonal aortic aneurysms, but ruptured iliac aneurysms have received little notice. The problems in the management of ten ruptured iliac aneurysms, seen over the last five years, together with the rarity of other reports of this condition, have stimulated this review.

Aged↗
PubMedDate not supplied

RN and RPN decision making across settings.

Nursing decision making was a focus of the Province-Wide Nursing Project (PWNP), a 3-year project to promote best nursing practice. In much of the growing literature on nursing decision making, it is assumed that there are differences in the way RNs and RPNs make decisions. However, there is little scientific evidence to support this assumption. The RN and RPN decision making across settings questionnaire was completed by nurses employed in the 23 agencies of the 4 Participating Complexes taking part in the project. The survey questions were subjected to factor analysis and reduced to five factors. Results revealed measurable differences between the way that RNs and RPNs made decisions. Both RNs and RPNs reported making decisions frequently and experiencing little difficulty in making them. However, there were statistically significant differences in the frequency with which RNs and RPNs perceived they made decisions and the difficulty they found in making them. To plan effective health care, it is important to take account of the strengths of different health care workers. There is a need for further research to investigate the reasons behind the differences revealed in these findings.

Adult↗
PubMedDate not supplied

The organizational environment and evidence-based nursing.

The Province-Wide Nursing Project (PWNP) was designed to remove some of the structural barriers that can impede the ability of nurses in selected health care settings to assess, implement and evaluate best nursing practice. Literature on capacity building and research utilization suggests that the organization is the most important factor in promoting best nursing practice. Therefore, managers and nursing leaders need to encourage the creation of optimum work environments. A survey undertaken by the PWNP Research Centre team assessed the extent to which the 23 agencies in the 4 Participating Complexes provided supportive environments for evidence-based practice. The Characteristics of Agencies in Participating Complexes: Demographics and Resources questionnaire investigated the resources available to help nurses improve their standards of practice in agencies participating in the project. Larger agencies, especially those associated with academic centres, had considerably more resources than agencies in smaller towns. Participation in the Province-Wide Nursing Project enabled agencies to develop strategies to improve the use of evidence in nursing practice.

Education, Nursing, Continuing↗
PubMedDate not supplied

Strategies for joint appointments.

The structure and policies governing joint appointments discussed above, are developed primarily through cooperation and collaboration between nursing service and education institutions. The joint appointee participates in the process of negotiation of salary, benefits and role responsibilities and exploration of the implications of the appointment for personal career development. Implementation and maintenance of the appointment requires the collaborative efforts of the joint appointee with both contracting agencies. Factors influencing the functioning of joint appointees have been identified and strategies to facilitate functioning presented. The joint appointee must be independent in thought and action yet adaptable to work within the boundaries of two social systems with differing values and expectations. Nursing management, peers and students can provide the support needed to overcome the frustrations and to achieve the rewards inherent in successful implementation of an exciting and innovative role.

Academic Medical Centers↗