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Linda Hands

Publications and source records attributed to Linda Hands.

6 recordsLinked to original sources
PubMed2004

Duplex ultrasonography predicts safety of radial artery harvest in the presence of an abnormal Allen test.

BACKGROUND: The Allen test is commonly used to assess collateral hand circulation before radial artery harvest for coronary artery bypass grafting. However there is no consensus as to whether an abnormal Allen test is an absolute or relative contraindication to radial artery harvesting. We assessed the safety of harvesting the radial artery using arterial duplex ultrasonography in patients with an abnormal Allen test. METHODS: Two hundred and eighty-seven consecutive patients scheduled for total arterial coronary revascularisation underwent preoperative Allen tests over a 34-month period. Patients with an abnormal Allen test underwent duplex ultrasonography preoperatively to assess the adequacy of the ulnar collateral supply and the suitability of the radial artery for harvesting. RESULTS: Two hundred and forty-four patients (85%) had a normal left Allen test and proceeded directly to radial artery harvest. Forty-three patients (15%) with an abnormal left Allen test underwent duplex ultrasonography scans and of those, 5 patients had an abnormal scan. These patients underwent scanning of the contralateral forearm. Three patients had a normal right forearm arterial duplex scan and the right radial artery was harvested. The mean diameter of the radial and ulnar arteries was not significantly different between the patients with normal and abnormal duplex ultrasonograms. There were no ischemic hand complications in this series. CONCLUSIONS: The Allen test is a quick, easy, and reliable screening test before radial artery harvesting in the majority of patients. Duplex ultrasonography predicts safe radial artery harvest in the majority of patients with an abnormal Allen test.

Algorithms↗
PubMed2003

A Technology-assisted approach to integrating healthcare in the community.

The fragmentary nature of healthcare provision in the United Kingdom presents particular problems for many patients with vascular disease. The management and organization of this disease are also costly for the National Health Service (NHS). Hence, so any attempt to keep hospital visits to the minimum while at the same time aiding effective treatment is to be welcomed. Information in the current NHS is stored in various places and access to it is restricted. There is no central, complete, patient record that is accessible to all healthcare professionals at the various levels of care. There is also no mechanism that allows the patient to interact with his or her local nurse and/or doctor/general practitioner (at primary-care level) involving the specialist/consultant (at secondary-care level). The concept and conduct of an ulcer care program for such patients are described in this paper. Nurse-led, this novel approach uses an innovative information technology system to bring together the isolated 'islands' of knowledge and information held by both the patient and healthcare professionals involved in their care. The technology described here combines both store and forward and real-time video. Informal feedback from patients, community nurses, doctors/general practitioners, and specialists/consultants suggests that such an approach is well received. However, we conclude with a discussion of the complexities involved in the interaction between technology and people and the implications for the management of healthcare.

Communication↗
PubMed2003

The effect of telemedicine on consultation time.

We have implemented an 'evidence-based referral' for primary care patients in dermatology, cardiology and peripheral vascular disease. Telemedicine clinics bring together a district nurse, patient and vascular surgeon to discuss diagnosis, management and care. During a 30-month study, a total of 30 patients participated in telemedicine clinics. The mean consultation time fell from 23 to 10 min. In parallel, the type of consultation changed from dermatology to vascular surgery. Nineteen patients participated in vascular telemedicine clinics over the last 16 months of the study. The average consultation time was 10 min (SD 1), which included discussion of the case and negotiation of its management. The average consultation time in the equivalent outpatient clinic in the same hospital for the same consultant was 15 min. The acquisition of the relevant information in primary care could lead to a reduction of 75% in outpatient clinic appointments.

Ambulatory Care Facilities↗
PubMed2003

Femoro-femoral arterial bypass is an effective and durable treatment for symptomatic unilateral iliac artery occlusion.

AIMS: This study was designed to determine the effectiveness of femoro-femoral arterial bypass (FFB) operation at hospital discharge and 1 year after operation, and to determine the role of long saphenous vein (LSV) as a conduit. METHODS AND RESULTS: A retrospective review was undertaken of 161 consecutive patients (median age, 66 years; range, 44-97 years) who had femoro-femoral grafts during the 12 years from July 1987 to March 1999. The indication for operation was claudication in 66 patients and critical ischaemia in 95. A synthetic graft was used in 123 patients and LSV in 38. Six patients with LSV had a previously infected synthetic graft and 2 a previously occluded synthetic graft. In-hospital operative mortality was 13 (8.1%). One year postoperatively, known mortality was 29, fifteen patients were lost to follow-up putting 1-year mortality at 18.0-27.3%. Eight of these had LSV as the conduit. At discharge from hospital, the median improvement in the ankle brachial pressure index was 0.3 (range, 0-1.0) overall, and 0.32 for patients with LSV (range 0-1.0). Among the 117 known survivors at 1 year, secondary graft patency was 107 confirmed by Doppler or duplex (91.5%) overall, and 25 (89.3%) for LSV; 100 (85.5%) maintained symptomatic improvement, 11 (9.4%) were experiencing no benefit and 6 (5.1%) were worse, of whom 2 had undergone amputation. In patients in whom LSV was used, 22 (78.8%) remained symptomatically improved, 3 (10.7%) experienced no benefit, 3 deteriorated and one had an amputation. CONCLUSIONS: One year following FFB, at least 18.0% of patients were dead. Among possible survivors to 1-year, graft patency was at least 78.8% and at least 75.8% remained clinically improved. FFB is effective in the treatment of unilateral iliac artery occlusion. LSV is as effective as a synthetic conduit.

Adult↗
PubMed2002

An integrated nursing and telemedicine approach to vascular care.

We have developed a telemedicine approach to vascular care for patients being managed in primary care. District nurses visit patients in their homes. Clinical information and digital photographs can be sent by email to the vascular surgeon for assessment. Where appropriate a preliminary teleconsultation between the patient and a vascular surgeon, with the nurse in attendance, is held at the primary care centre and the management of the patient is agreed. This may include referral to surgery. Over eight months six patients with diabetes and peripheral ulcers participated in the vascular telemedicine clinic. The average consultation time was 12 min (SD 4), which included discussion of the case and negotiation of its management. Important outcomes of the new system were the ability to schedule patients for rapid referral and to have completed the management of the case during the teleconsultation.

Diabetic Foot↗