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Rajesh Shah

Publications and source records attributed to Rajesh Shah.

10 recordsLinked to original sources
PubMed2007

UK waiting time targets in lung cancer treatment: are they achievable? Results of a prospective tracking study.

BACKGROUND: Recent guidelines have specified a number of waiting time targets to prevent delay in the treatment of lung cancer. This study was carried out to assess the quality of lung cancer services and compare with national recommendations. METHODS: All newly diagnosed cases of lung cancer presenting to our institution via general practitioner referral were entered into a prospective tracking study by a dedicated audit officer. From September 2003 to March 2005 a total of 247 patients were entered into the study. Of these 133 (54%) were referred by general practitioners and the remainder 114 (46%) were internal referrals. The Cancer Plan waiting time targets are mainly applicable to GP referrals, which formed the study group. RESULTS: All the patients were seen in chest out-patients clinic within the recommended two weeks period. However there was a delay in starting all forms of treatment. The median waiting time to any form of treatment was 60 days (recommendation 62 days for all patients). CONCLUSION: This data demonstrates that although patients receive out patient consultation in the recommended time period, the National Cancer Plan 62 days GP referral to treatment target is not being achieved. A concerted effort by all clinicians is required to meet the prescribed target times.

Adult↗
PubMed2006

Evaluation of cardiac involvement in hypereosinophilic syndrome: complementary roles of transthoracic, transesophageal, and contrast echocardiography.

Hypereosinophilic syndrome is a rare but important systemic disease with multiple clinical presentations. Approximately 40% of these cases have cardiac involvement. Echocardiography is the most easily available and versatile imaging modality in assessing cardiac involvement in this disease process. As described and reviewed in this case, it may be the first imaging modality to raise suspicion of this disease entity. Hence, clinicians interpreting echocardiograms and caring for patients need to be aware of the manifestations and complementary roles of various echo techniques in delineating cardiac involvement. Furthermore, the importance of a thorough history and laboratory review prior to echocardiography may provide valuable clues which may otherwise be missed.

Adult↗
PubMed2005

Intensive care unit readmission after elective coronary artery bypass grafting.

Prospective data of 3,120 consecutive patients who had elective coronary artery bypass were analyzed to identify patient profile, cost, outcome and predictors of those readmitted to the intensive care unit. Group A (n=3,002) had a single intensive care unit admission and group B (n=118) were readmitted within 30 days after surgery. Parsonnet score, EuroSCORE, age, body mass index, chronic obstructive airway disease, peripheral vascular disease, renal dysfunction, unstable angina, congestive cardiac failure, and poor left ventricular function were higher in group B. Bypass and crossclamp times were longer, and the prevalence of inotropic and balloon pump support, arrhythmias, myocardial infarction, re-exploration, blood loss and transfusion, cerebrovascular accident, wound infection, sternal dehiscence, and multisystem failure were higher in group B. Despite a 4-fold increase in cost of care, the mortality rate (32.4%) of patients readmitted to intensive care was 23-times higher than routine patients (1.4%). Crossclamp time>80 min, Parsonnet score>10, EuroSCORE>9, sternal dehiscence, ventricular arrhythmias, and renal failure predicted readmission.

Aged↗
PubMed2004

Staged pulmonary and hepatic metastasectomy in colorectal cancer--is it worth it?

OBJECTIVES: Resection of isolated pulmonary and hepatic metastases from colorectal cancer can offer potential cure. However, little data is available to determine the results of staged hepatic and pulmonary resections in the same patient. METHODS: We retrospectively reviewed all patients who underwent staged hepatic and pulmonary metastasectomy for colorectal cancer in our institute from September 1998 to May 2002. Probability of survival was estimated by the Kaplan-Meier method. RESULTS: Thirty-three metastasectomies (seven redo) were carried out in 26 patients. There were 19 male and 7 female patients with a mean age of 61 years (range 34-76 years). The mean disease-free interval for hepatic and pulmonary resection was 21.8 and 23.9 months, respectively. Sternotomy, thoracotomy and video assisted thoracoscopic approach were used in 3.03, 72.7 and 24.2% of patients, respectively. Wedge excision, lobectomy and pneumonectomy were carried out in 87.87, 9.09 and 3.03% of cases, respectively. There was one hospital death following acute respiratory failure after pneumonectomy. Mean follow-up was 23.3 months (range 2-71 months). The mean survival after last pulmonary resection was 34.7 months (SE 3.03 and 95% CI of 28.8-40.6). CONCLUSIONS: Our results support aggressive surgical management of pulmonary and hepatic metastases in colorectal cancer.

Adult↗
PubMed2003

Use of telemedicine in evading cholera outbreak in Mahakumbh Mela, Prayag, UP, India: an encouraging experience.

Telemedicine (TM) services a process in which expert medical advice from afar is provided using electronic signals to transfer the medical data from one site to another. As a pilot project to assess the efficacy of TM in developing countries like India, a telemedicine center was set up at the main hospital of Mahakumbh mela--a grand religious fair, at Prayag, a city in north India. The daily reporting of the in-patient and outpatient cases at the fair revealed a surge of diarrhea cases among the pilgrims at the fair. This information was communicated to the referral center at Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), which, with the help of its microbiology department, conducted microbiological examinations of stool samples and rectal swabs of patients along with various water samples. Vibrio cholerae was isolated in 22.6% (7/31) of the samples. This information was immediately relayed to the Main Hospital at the fair online, and then to the health authorities, who took strict and prompt measures to improve hygiene. Subsequently, the number of diarrhea cases decreased considerably in a matter of a few days, and thus an epidemic disaster was averted, which could have created havoc in such a large gathering.

Aged↗
PubMed2002

Interfacial resistance in solubilization kinetics.

An experiment has been designed to measure the kinetics of solubilization of oils in a micellar solution. The results show a very large range of behaviors, but in one system the solubilization rate is determined completely by what is called the interfacial resistance, which quite likely arises out of the structural changes that micelles see. The model given here is successful in showing that this resistance is not the usual resistance due to diffusion and that it is quite prelevant in systems that are chemically similar but other conditions varying widely (Appendix). We conclude by showing that some of the existing theories of interfacial resistance are not reasonable, suggest how the real system may be more complex, and show that the interfacial conductance k* proportional c(m)(-1) at large surfactant concentrations where c(m) is the concentration of micelles.

Journal Article↗
PubMedDate not supplied

Titration of carvedilol in elderly heart failure patients.

Physicians may withhold beta blockers from elderly heart failure patients based on perceptions of poor tolerability in this group. This study analyzed the success and tolerability of carvedilol titration in elderly (70 years and older) and younger (younger than 70) heart failure patients (n=360). The mean duration of titration was similar in both groups. The target carvedilol dosage (50 mg/d) was achieved by 55.3% and 62.0%, and a partial dose was achieved by 44.7% and 35.5% (p=0.028) of elderly and younger patients, respectively. The mean achieved dosage was lower in elderly patients than in younger patients (42.4+/-27.2 mg/d vs. 55.1+/-30.1 mg/d; p<0.0001), possibly due to significant between-group differences in baseline characteristics or rates of target dose achieved. When adjusted for body weight, the mean achieved dose was similar in elderly (0.58+/-0.32 mg/kg/d) and younger (0.64+/-0.30 mg/kg/d) patients (p=nonsignificant). Adverse events were more frequent in the elderly but did not appear to significantly impact titration duration or carvedilol dose achieved when corrected for body weight. In conclusion, carvedilol should not be withheld from elderly heart failure patients based on perceptions of poor potential tolerability.

Adrenergic beta-Antagonists↗