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Biomedical subjects

N Castle

Publications and source records attributed to N Castle.

13 recordsLinked to original sources
PubMed2006

What percentages of patients are suitable for prehospital thrombolysis?

OBJECTIVE: To apply the Joint Royal College Ambulance Liaison Committee (JRCALC) checklist to patients who were deemed eligible for thrombolytic therapy on arrival in an Accident & Emergency Department (A&E) to determine the proportion suitable for prehospital thrombolysis. DESIGN: Retrospective descriptive analysis. METHODS: The clinical notes of all patients thrombolysed in an A&E department in a year were reviewed against the JRCALC guidelines for prehospital thrombolysis. RESULTS: 14.2% of patients eligible for thrombolysis in a district general hospital were deemed suitable for prehospital thrombolysis according to the JRCALC criteria. The most common exclusion criteria were hyper/hypotension (50%), onset of symptoms (pain) >6 h previously (41.7%), or age >75 years (37%). Two or more contraindications to prehospital thrombolysis were present in 63.9% of patients. CONCLUSION: The JRCALC guidelines are an effective tool for identifying patients with potential contraindications to thrombolysis.

Adult↗
PubMed2002

Should ward nurses be using automatic external defibrillators as first responders to improve the outcome from cardiac arrest? A systematic review of the primary research.

INTRODUCTION: The outcome from in-hospital cardiac arrest has improved little since the implementation of cardiopulmonary resuscitation 40 years ago. Early defibrillation improves survival following ventricular fibrillation and pulseless ventricular tachycardia. The emergence of automatic external defibrillators and advisory defibrillators has been heralded as the answer to defibrillation delays in-hospital. AIM: To locate and evaluate the evidence supporting automatic external defibrillator use in-hospital on general wards. METHOD: A systematic review of indexed and grey literature to identify primary research. RESULTS: Fifteen in-hospital automatic external defibrillator studies were located, five met the inclusion criteria. CONCLUSIONS: There is limited primary research evaluating automatic external defibrillators in-hospital. Manual defibrillators remain the most commonly used device for in-hospital defibrillation. Automated external defibrillators offer an alternative to manual defibrillation providing they have a screen and manual override capability, and the technology for pacing is close to hand. For in-hospital automatic external defibrillator programmes to be effective a change in nursing philosophy must occur, and defibrillation must become an expected rather than an extended nursing role.

Cardiopulmonary Resuscitation↗
PubMed1999

Organizational and environmental factors associated with nursing home participation in managed care.

OBJECTIVE: To develop and test a model, based on resource dependence theory, that identifies the organizational and environmental characteristics associated with nursing home participation in managed care. DATA SOURCES AND STUDY SETTING: Data for statistical analysis derived from a survey of Directors of Nursing in a sample of nursing homes in eight states (n = 308). These data were merged with data from the On-line Survey Certification and Reporting System, the Medicare Managed Care State/County Data File, and the 1995 Area Resource File. STUDY DESIGN: Since the dependent variable is dichotomous, the logistic procedure was used to fit the regression. The analysis was weighted using SUDAAN. FINDINGS: Participation in a provider network, higher proportions of resident care covered by Medicare, providing IV therapy, greater availability of RNs and physical therapists, and Medicare HMO market penetration are associated with a greater likelihood of having a managed care contract. CONCLUSION: As more Medicare recipients enroll in HMOs, nursing home involvement in managed care is likely to increase. Interorganizational linkages enhance the likelihood of managed care participation. Nursing homes interested in managed care should consider upgrading staffing and providing at least some subacute services.

Contract Services↗
PubMed1998

The early management of meningococcal disease.

Meningococcal disease is a fulminant infection with an overall mortality of 8%. Mortality is significantly increased with meningococcal septicaemia, particularly when there has been a delay in the diagnosis. The trend from 1985 to 1995 has been an increase in incidence of this disease, and the relative importance of meningococcal disease has also increased following a fall in the incidence of invasive Haemophilus influenzae disease with childhood immunisation. The management of such cases can be complex and time critical. Patients with meningococcal septicaemia often require aggressive resuscitation, including airway support, intravenous colloid, and parenteral antibiotics; hypoglycaemia is also commonly seen, and inotropes may be needed to support the circulation. We examine the treatment strategies in the early management of meningococcal disease and provide an algorithm for use by ambulance personnel, general practitioners, accident and emergency clinicians, and paediatricians. The objective of this algorithm is to ensure that an optimally resuscitated patient is delivered to the definitive care facility.

Adult↗
PubMedDate not supplied

Racial differences in end-of-life care for patients with AIDS.

This study examines the place of death for persons with AIDS, and the adequacy of the pain treatment that they received in their final months of life. Variations in the use of pain treatment during three months before death and place of death by patient's characteristics such as gender, race/ethnicity, mode of transmission, and geographical location are examined. We used merged AIDS surveillance data and paid Medicaid claims data for the period between 1991 and 1998 to examine the outcomes. Multivariate analysis was done using logistic regressions. Overall, approximately half of the sample received an outpatient prescription for analgesics during the last three months of life. A majority of the decedents (62 percent) died in a hospital. Significant differences in pain treatment and place of death existed between members of racial minority groups and Whites. Higher rates of pain treatment and lower likelihood of dying in a hospital were noted among beneficiaries enrolled in a statewide HIV/AIDS-specific home- and community-based Medicaid-waiver program. Despite financial eligibility, racial minorities, especially African-Americans, were disadvantaged in their access to healthcare services during their last months of life; some of these racial differences appear to be mediated by the use of the waiver program. There was some evidence that access to home care services and case-management mechanisms such as those built into the waiver program were an effective means of facilitating palliative care by increasing the use of pain medication and reducing the likelihood of dying in a hospital.

Acquired Immunodeficiency Syndrome↗