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Biomedical subjects

N D Gillespie

Publications and source records attributed to N D Gillespie.

15 recordsLinked to original sources
PubMed2004

Improving thromboprophylaxis in elderly patients with non-valvular atrial fibrillation.

BACKGROUND: Non-valvular atrial fibrillation (NVAF) is more common in elderly people, and is one of the most powerful independent risk factors predisposing to stroke. This risk increases with age. Despite evidence that full dose anticoagulation reduces this risk, and Scottish Intercollegiate Guidelines, warfarin is still being under prescribed, especially in elderly individuals. OBJECTIVES: To audit warfarin prescribing in elderly hospital patients with NVAF, and assess whether audit feedback and evidence based guidelines improved warfarin usage. METHODS: Discharge summaries and medical notes were reviewed, and warfarin prescribing identified, for all patients with NVAF discharged from the Medicine for the Elderly Department between January 2001 and December 2002. This was done before (16 months) and after (7 months) audit results were presented at a departmental meeting, and evidence basedguidelines were produced. RESULTS: Warfarin prescribing significantly increased from 38/121 (31.4%) prior to audit feedback and the introduction of guidelines to 30/55 (54.5%), Chi2-test, p < 0.01. CONCLUSIONS: Older patients with NVAF were under prescribed warfarin. Audit feedback and the introduction of evidence based guidelines significantly increased anticoagulation usage.

Aged↗
PubMed2002

Perindopril improves six minute walking distance in older patients with left ventricular systolic dysfunction: a randomised double blind placebo controlled trial.

OBJECTIVE: To evaluate the effects of the angiotensin converting enzyme inhibitor perindopril on six minute walking distance and quality of life in very old patients with left ventricular systolic dysfunction. DESIGN: Prospective, double blind placebo controlled trial. SETTING: Medicine for the elderly day hospital. PATIENTS: 66 patients (average age 81) with left ventricular systolic dysfunction identified by echocardiography. INTERVENTIONS: 10 weeks of treatment with titrated doses of perindopril or placebo. MAIN OUTCOME MEASURES: Six minute walking distance 10 weeks following treatment, quality of life measurements including the Minnesota living with heart failure questionnaire and the 36 item short form health survey. RESULTS: In patients with left ventricular systolic dysfunction, six minute walking distance was significantly increased in the treatment group (37.1 m) compared with the placebo group (-0.3 m, p < 0.001). The medication was well tolerated and there were no significant adverse events. CONCLUSIONS: Six minute walking distance is improved considerably by treatment with perindopril in older patients with heart failure caused by left ventricular systolic dysfunction.

Aged↗
PubMed1999

A survey of attitudes and knowledge of geriatricians to driving in elderly patients.

OBJECTIVE: To assess the attitudes of consultant members of the British Geriatrics Society to elderly patients driving motor vehicles. DESIGN: An anonymous postal survey assessing knowledge and attitudes to driving in elderly people. A standardized questionnaire was used and five case histories were offered for interpretation. SETTING: The study was co-ordinated from a teaching hospital. SUBJECTS: The 709 consultant members of the British Geriatrics Society. Four hundred and eighteen responses were obtained, which represents a 59% response rate. RESULTS: 275 Respondents (68%) correctly realised that a person aged 70 had a duty to inform the Driving and Vehicle Licensing Authority (DVLA) about their eligibility to drive. The remainder did not. Most (315; 75%) believed that the overall responsibility for informing the DVLA was with the patient. If a patient was incapable of understanding advice on driving because of advanced dementia, 346 (83%) would breach patient confidentiality and inform the authority directly. Where a patient was fully capable of understanding medical advice but ignored it, 72% of geriatricians would have legitimately breached patient confidentiality and informed the DVLA. Most geriatricians (88%) saw their main role as one of providing advice on driving to patients and their families. Enforcing DVLA regulations was not seen as an appropriate function, unless the patient was a danger to themselves or other drivers. CONCLUSIONS: There is a wide variation in knowledge of driving regulations and attitudes to driving in elderly patients. Better education of geriatricians should improve awareness of when elderly drivers can safely continue to drive.

Aged↗
PubMed1997

Cross sectional study of contribution of clinical assessment and simple cardiac investigations to diagnosis of left ventricular systolic dysfunction in patients admitted with acute dyspnoea.

OBJECTIVE: To assess the comparative contribution of clinical assessment, electrocardiography, and chest radiography to the diagnosis of left ventricular systolic dysfunction in patients admitted to a general medical ward with acute dyspnoea. DESIGN: Prospective cross sectional study. SETTING: Acute medical admissions ward of a teaching hospital. SUBJECTS: 71 randomly selected patients admitted with acute dyspnoea. MAIN OUTCOME MEASURES: Sensitivity and specificity of each investigation and logistic regression analysis of each variable in identifying left ventricular systolic dysfunction. RESULTS: Clinical assessment in this cohort of patients with severe dyspnoea was generally sensitive (sensitivity 81%). Patients were divided into three groups on the basis of clinical assessment. In the first group (37 patients) the diagnosis of systolic dysfunction was clear, in the second (22) it was in doubt, and in the third (12) it was unlikely. The sensitivity of clinical assessment in identifying left ventricular systolic dysfunction was 81% and the specificity was 47%. The specificity of diagnosis was improved by electrocardiography (69%) and chest radiography (92%). Logistic regression analysis showed that isolated pulmonary crepitations were a comparatively poor predictor of left ventricular systolic dysfunction chi 2 = 10.215, P = 0.0014) but that a full clinical examination had reasonable predictive value (chi 2 = 24.82, P < 0.00001). The combination of clinical assessment and chest radiography improved the accuracy of diagnosis (chi 2 = 28.08, P < 0.00001), as did the combination of clinical assessment and electrocardiography (chi 2 = 32.41, P < 0.00001). CONCLUSION: Clinical assessment in patients admitted with acute dyspnoea is comparatively accurate. Patients with abnormal results on chest radiography, electrocardiography, and clinical examination have a high likelihood of having left ventricular systolic dysfunction. Echocardiography contributes little more to the diagnosis in these patients and may be more efficiently directed towards patients in whom the diagnosis is still in doubt after clinical assessment, chest radiography, and electrocardiography.

Acute Disease↗
PubMed1996

Interpretation of the emergency electrocardiogram by junior hospital doctors.

OBJECTIVE: To assess the ability of a cohort of junior hospital doctors to interpret ECGs which have immediate clinical relevance and influence subsequent management of patients. METHODS: 57 junior hospital doctors were interviewed and asked to complete a standard questionnaire which included eight ECGs for interpretation and a supplementary question relating to the administration of thrombolytic treatment. Each doctor was assessed over a 48 h period while they performed their daily clinical duties. RESULTS: The major abnormality of anterior myocardial infarction was recognised by almost all doctors. There was difficulty in the interpretation of posterior myocardial infarction and second degree heart block. Most myocardial infarctions would have been given satisfactory thrombolysis, but there was a reluctance to use this treatment in patients with posterior myocardial infarction and left bundle brach block. A few patients without myocardial infarction would have received thrombolytic treatment. CONCLUSIONS: There is varying ability among junior hospital doctors in the interpretation of the emergency electrocardiogram. The results are of concern as poor interpretation of the ECG can result in inappropriate management. As a result of the findings of this study it is proposed to introduce more formal training in the interpretation of clinically relevant ECG abnormalities for junior hospital doctors.

Clinical Competence↗
PubMed1996

Changing echocardiography request patterns between 1988 and 1993.

There is little published data on the demand for echocardiography services in the U.K. This retrospective survey of echocardiography request forms and reports was performed to assess potential changes in echocardiography request patterns between 1988 and 1993. These years were chosen as they were likely to reflect changes in clinical practice as a result of trials involving Angiotensin Converting Enzyme (ACE) inhibitors. A total of 400 consecutive request forms and reports were analysed. There was a 2.46 fold increase in the total number of echocardiograms performed between 1988 and 1993 with a disproportionate 12.5 fold increase in the relative number of requests for assessments of left ventricular function. This large increase is likely to be a result of recent major clinical trials which show morbidity and mortality benefits when patients with left ventricular systolic dysfunction (including those who are asymptomatic) are treated with ACE inhibitors. Future planning of the echocardiographic services should include provision for the increasing numbers of patients requiring assessment of left ventricular function.

Echocardiography↗