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Biomedical subjects

R R West

Publications and source records attributed to R R West.

At least 19 recordsLinked to original sources
PubMed1992

Median sternotomy wound dehiscence: a retrospective case control study of risk factors and outcome.

Over a 5-year period from 1985 to 1989, 2760 patients underwent open heart surgery at the University Hospital of Wales. Of these, 44 (1.6%, 35 men, mean age 61 years) developed median sternotomy dehiscence 2-40 (median 9) days after surgery. Infection was an associated factor in 18 patients (41%) and Staphylococcus aureus the predominant isolate in seven of those. Thirty-seven patients underwent rewiring of the sternotomy wound and seven patients underwent debridement, removal of wires and delayed closure. In those undergoing rewiring, sternal stability was maintained in 34 patients (92%). There were seven deaths (16%), of which two were considered to be wound-related. Median hospital stay of survivors was 34 (range 16-84) days. Comparison with 88 matched controls by univariate analysis showed preoperative chronic obstructive airways disease, reduced FEV1/FVC ratio (both P < 0.001) and smoking (P < 0.05) were all more common in the dehiscence group. In addition, reoperation for bleeding (P < 0.05), prolonged bypass time, postoperative ventilation period and length of stay in the intensive care unit (all P < 0.001) were more common in the study group.

Cardiac Surgical Procedures↗
PubMed1979

Randomised multicentre trial of early mobilisation after uncomplicated myocardial infarction.

In a multicentre trial 742 patients in 13 hospitals in Wales were randomly allocated on the fifth day after uncomplicated myocardial infarction to be mobilised on the fifth or the tenth day. The trial shows no difference in first year mortality, nor in morbidity assessed after a median period of 13 months. Follow-up after one year suggests an unexplained lower mortality during the second and third years in the late mobilisation group.

Adult↗
PubMed1978

Variation in rates of hospital admission for appendicitis in Wales.

In a study designed to investigate the variations in rates of admission to hospital for appendicitis in Wales Hospital Activity Analysis listings were analysed according to the sex and age of the patients and the month and day of the week of admission. The incidence of hospitalisation was greatest among boys aged 10-14 and girls aged 15-19. The number of admissions was higher on weekdays than at weekends, but there were no seasonal variations. Durations of stay differed between the 17 health districts. We conclude that admission rates vary mainly because of differing hospital admission policies. Admission is not wholly governed by the sudden onset of abdominal pain; other factors include the threshold of consultation of each patient, the referral habits of general practitioners, the availability of hospital beds, and the degree to which doctors and patients expect admission.

Adolescent↗
PubMed1978

The water story.

Explore the source record for details and available documents.

Calcium↗
PubMed1978

Sudden infant death syndrome in Cardiff, association with epidemic influenza and with temperature - 1955-1974.

The effects of social class, season, low temperature and sudden falls in temperature are investigated in 286 cases of Sudden Infant Death Syndrome in Cardiff in the years 1955--1974. The association with low temperature was striking: unsuspected hypothermia may be an important feature of these deaths. Sudden infant death incidence was associated with influenza A but not influenza B epidemics.

Cold Temperature↗
PubMed1977

Cervical cancer: Age at registration and age at death.

The 5-year survival of women with localized (early-stage) cervical cancer is much higher than for women with non-localized (late-stage) cancer, but women with localized cancer tend also to be younger than those with advanced cancer. A new method of presenting the long-term survival is suggested, and the registrations of cervical cancers in South Wales are analysed in terms of average age at registration and average age at death. The observed average age at death was very close to 59 years regardless of stage (and age) at diagnosis, and calculations of expected ages at death of the whole populations suggest that more than half the advantage in survival shown by early stage cancers over late stage cancers is due to diagnosis of the former in younger women.

Age Factors↗
PubMed1976

Regional variations in need for and provision and use of child health services in England and Wales.

An analysis of indicators of the need for and provision and use of child health services in the 15 pre- 1974 hospital board regions in England and Wales showed that need and provisions were badly matched. There was a high degree of correlation between the indices within each of the three groups, indicating that a region with a small provision in one area of child health services would tend to have few resources in other areas also. Statistics on the use of services relate more to the provision of those services than to the need for them. Regions with large resources will justify these resources by claiming that their use statistics indicate needs, whereas they really indicate met demands. It is more important to identify demands and needs that are not being met.

Birth Rate↗
PubMed1976

Randomised controlled trial of antibiotics in patients with cough and purulent sputum.

Two hundred and twelve adults with cough and purulent sputum of up to one week's duration were allocated randomly to treatment with doxycycline or placebo capsules for up to 10 days. Cough, purulent sputum, feeling "off colour," and time off work lasted as long in treatment and control groups, but running nose persisted for a shorter time in the doxycycline group. The number of new episodes of lower respiratory tract infections, vaginal infections, gastrointestinal upsets, and otitis media over the next six months were the same in both groups, but fewer new upper respiratory infections were experienced by the doxycycline-treated patients. There is no consensus among doctors about using antibiotics in patients with cough and purulent sputum, and these results indicate that otherwise healthy people with these symptoms will usually get better without antibiotic treatment.

Adolescent↗
PubMed1976

Mortality from ischaemic heart disease--inter-town variation and its association with climate in England and Wales.

In both seasonal and inter-town variation, the mortality from ischaemic heart disease in England and Wales in 1969-71 is very highly correlated with temperature. Also in the inter-town variation, IHD mortality is highly correlated with rainfall and with socio-economic index. It is postulated that the same mechanism of body cooling underlies seasonal, inter-town and socio-economic variations in IHD mortality. The first law of thermodynamics states the heat and energy are equivalent. Therefore to maintain body temperature against an increased thermal gradient (caused by a lower environmental temperature as in seasonal variation, or a temperature-rainfall interaction as in inter-town variation) more energy must be expended by the body or, alternatively, the body must reduce heat loss by increasing thermal insulation. It is to be expected that there will be many accompanying changes in physiological parameters and several of these are discussed.

Age Factors↗
PubMed1976

Accuracy of cancer registration.

In South Wales cancer registration is done principally by means of the Hospital Activity Analysis. Altogether 1460 hospital records of cancer patients (19% of the 1972 registrations received by May 1973) were studied and the principal items of information required for cancer registrations by the Office of Population Censuses and Surveys were copied and subsequently compared with the corresponding registrations at the Welsh Hospital Board's cancer bureau. Differences between these 're-registrations' and the original registrations were analysed item by item. There were 234 registrations with errors in the diagnostic summary (although 110 of these would cause misclassification only under the fourth digit of the ICD code), 164 with errors in date of birth (36 of which would cause classification in the wrong WHO age group) and 198 with errors in the date of registration (112 of which were wrongly ascribed to the year 1972). Error and omission rates were particularly high for NHS number, occupation, place of birth, and histology.

Diagnostic Errors↗
PubMed1975

Cost-benefit analysis of long-term haemodialysis for chronic renal failure.

A cost-benefit analysis of long-term maintenance haemodialysis indicates that there is a large gulf between the cost of the service and "economic" benefit. The difference may be considered to represent one estimate of the price society is prepared to pay to maintain life. Using "best estimates" from available data we found the implicit social value of maintaining a patient on haemodialysis to be approximately pounds 4720 per annum in hospital or pounds 2600 at home. The analysis would suggest that society must look carefully at alternative uses for health expenditure before extending indiscriminately to large sections of the population these treatment programmes or other similarly expensive.

Costs and Cost Analysis↗