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Sampson EL, Goldberg SE. Hospitals, people with cognitive impairment and agitation: how virtual reality could improve real world care. Age Ageing 2022; 51:6632476. [PMID: 35796133 DOI: 10.1093/ageing/afac160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elizabeth L Sampson
- Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London E1 8DE, UK.,Division of Psychiatry, University College London, London, W1T 7NF, UK
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Burgon C, Goldberg SE, van der Wardt V, Brewin C, Harwood RH. Apathy Measures in Older Adults and People with Dementia: A Systematic Review of Measurement Properties Using the COSMIN Methodology. Dement Geriatr Cogn Disord 2021; 50:111-123. [PMID: 33975314 DOI: 10.1159/000515678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Apathy is highly prevalent in dementia and is also seen in mild cognitive impairment and the general population. Apathy contributes to failure to undertake daily activities and can lead to health problems or crises. It is therefore important to assess apathy. However, there is currently no gold standard measure of apathy. A comprehensive systematic review of the measurement properties of apathy scales is required. METHODS A systematic review was registered with PROSPERO (ID: CRD42018094390). MEDLINE, Embase, PsycINFO, and CINAHL were searched for studies that aimed to develop or assess the validity or reliability of an apathy scale in participants over 65 years, living in the community. A systematic review was conducted in line with the COnsensus-based Standards for the selection of health Measurement INstruments procedure for reviewing patient-reported outcome measures. The studies' risk of bias was assessed, and all relevant measurement properties were assessed for quality. Results were pooled and rated using a modified Grading of Recommendations Assessment, Development, and Evaluation procedure. RESULTS Fifty-seven publications regarding 18 measures and 39 variations met the eligibility criteria. The methodological quality of individual studies ranged from inadequate to very good and measurement properties ranged from insufficient to sufficient. Similarly, the overall evidence for measurement properties ranged from very low to high quality. The Apathy Evaluation Scale (AES) and Lille Apathy Rating Scale (LARS) had sufficient content validity, reliability, construct validity, and where applicable, structural validity and internal consistency. CONCLUSION Numerous scales are available to assess apathy, with varying psychometric properties. The AES and LARS are recommended for measuring apathy in older adults and people living with dementia. The apathy dimension of the commonly used Neuropsychiatric Inventory should be limited to screening for apathy.
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Affiliation(s)
- Clare Burgon
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.,Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Veronika van der Wardt
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of General Medicine, Preventative and Rehabilitative Medicine, Philipps-Universität Marburg, Marburg, Germany
| | - Catherine Brewin
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.,Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom, .,Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom,
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Cowley A, Goldberg SE, Gordon AL, Logan PA. 496 NON-RANDOMISED FEASIBILITY STUDY OF THE REHABILITATION POTENTIAL ASSESSMENT TOOL (REPAT) IN FRAIL OLDER PEOPLE IN ACUTE SETTING. Age Ageing 2021. [DOI: 10.1093/ageing/afab118.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Clinicians are often required to decide about patients’ potential to respond to rehabilitation. ‘Rehabilitation potential’ can determine what services patients can access. In acute hospitals clinicians have limited time to assess and deliver rehabilitation which takes into account the complexities of frailty and ageing. We set out to evaluate whether the Rehabilitation Potential Assessment Tool (RePAT)—a 15 item assessment tool and training package which emphasises person-centred approaches—was feasible and could aid rehabilitation decisions.
Method
A non-randomised feasibility study with nested semi-structured interviews, set in the acute hospital, explored whether RePAT was deliverable and acceptable to staff, patient and carers. A maximum variation sample of physiotherapists and occupational therapists was recruited. Patient and carer participants were recruited from Healthcare of Older People wards. Staff and patient characteristics were summarised using descriptive statistics. Interview data were analysed thematically. Fidelity of completed RePAT items was assessed on how closely they matched tool guidance by two reviewers. Mean values of the two scores were calculated.
Results
Six staff participants were recruited and trained, and assessed a total of 26 patient participants using RePAT. Mean patient age was 86.16 (±6.39) years. 32% were vulnerable or mildly frail, 42% moderately frail and 26% severely or very severely frail using the Clinical Frailty Scale. Mean time to complete RePAT was 32.7 (±9.6) minutes. 13 out of 15 RePAT items achieved fidelity. RePAT was acceptable and tolerated by staff and patients. Staff participants reported RePAT enabled them to consider the complex and dynamic nature of rehabilitation decisions in a more structured and consistent way.
Conclusion
RePAT was found to be acceptable and tolerated by staff, carers and patients. It allowed clinicians to make explicit their reasoning behind rehabilitation potential decision-making and encouraged them to become more cognisant of ethical dilemmas and biases.
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Affiliation(s)
- A Cowley
- Nottingham University Hospitals NHS Trust
| | - S E Goldberg
- Faculty of Medicine and Health Sciences, University of Nottingham
| | - A L Gordon
- School of Medicine, University of Nottingham
- University Hospitals of Derby and Burton NHS Foundation Trust
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham
| | - P A Logan
- School of Medicine, University of Nottingham
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham
- Nottingham CityCare Partnership CIC
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Cowley A, Goldberg SE, Gordon AL, Kerr M, Logan P. Exploring rehabilitation potential in older people living with frailty: a qualitative focus group study. BMC Geriatr 2021; 21:165. [PMID: 33676401 PMCID: PMC7937269 DOI: 10.1186/s12877-021-02107-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Rehabilitation interventions are frequently cited as key in supporting frail older people's recovery following periods of decompensation and acute ill-health. Clinicians are required to make decisions about a patient's potential to respond to rehabilitation. 'Rehabilitation potential' decisions can determine access to services. In acute settings clinicians have limited time to assess and work with patients, families and carers. The complexities of ageing, recovery, rehabilitation and frailty may not be fully appreciated. This study aimed to explore multiple perspectives of the concept of rehabilitation potential and how it is assessed in older people living with frailty in the acute healthcare setting. METHODS Five focus groups with a purposive sample of 28 participants which included clinicians and members of the public were conducted. Analysis comprised a thematic approach using the Framework method. RESULTS Rehabilitation potential was found to encapsulate a complex decision-making process where clinicians judged an individual's ability to benefit from and participate in targeted rehabilitation. They asked, "Will it work?", "Is it wanted?" and "Is it available?" In order to predict who would benefit from rehabilitation interventions, clinicians assessed a range of holistic clinical and non-clinical factors. An iterative approach to assessment delivered by a multi-disciplinary team, centred around patient and carer needs and wants was needed to accommodate complexity. Participants believed that everyone had some form of potential but this was dependent on availability of rehabilitation resources and conceptualisations of frailty and rehabilitation. Tensions between iterative approaches to rehabilitation potential assessment and the realities of rapid decision making in the acute hospital setting were found. CONCLUSION Rehabilitation potential decisions involve a complex process of multidisciplinary decision-making and prognostication on the likely outcome and benefit from rehabilitation programmes. These findings lay the foundation for developing structured approaches to rehabilitation potential decision making tools and guidance.
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Affiliation(s)
- A Cowley
- Institute of Care Excellence, Nottingham University Hospitals NHS Trust, Derwent House, City Campus, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - S E Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - A L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - M Kerr
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - P Logan
- School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
- Nottingham CityCare Partnership CIC, Nottingham, UK
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Beaver J, Goldberg SE, Edgley A, Harwood RH. 'Socialised care futility' in the care of older people in hospital who call out repetitively: An ethnographic study. Int J Nurs Stud 2020; 107:103589. [PMID: 32446017 DOI: 10.1016/j.ijnurstu.2020.103589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND People living with dementia may call out repetitively, sometimes called disruptive vocalisation, or verbal agitation. In literature and policy, patients who call out repetitively are assumed to be expressing an unmet need, which should be met. Yet there has been little systematic study of this patient group in an acute hospital setting. OBJECTIVES To better understand patients who call out repetitively and to identify what care looks like in an acute hospital setting. DESIGN Ethnography. SETTINGS Ten acute geriatric medical wards in two hospitals. PARTICIPANTS 30 cognitively impaired patients who were calling out repetitively, and 15 members of hospital staff. METHODS Semi-structured interviews with hospital staff, 150 h of ward observations and informal conversations with staff, scrutiny of medical and nursing documentation, and measures of patient health status. RESULTS Patients who called out were moderately or severely cognitively impaired, often had delirium, were very physically disabled, and many were approaching the end of life. Most hospital staff were found to hold contradictory views: that calling out represents distress or unmet need, but that nothing can be done to alleviate the calling out. During informal conversations, most staff also tended to say that they intuitively recognised when intervening was likely to alleviate calling out. During observations, many staff appeared to and spoke of the ability to 'block' calling out. As a result we argue that social, emotional and physical needs may get overlooked. We argue that some calling out is due to a need that is unmeetable. We also found that while staff would talk about strategies for identifying need, observations and hospital documentation did not support evidence of systematic attempts to identify potential need. CONCLUSION Calling out repetitively within a hospital setting is difficult for staff to understand and to respond to. This is because many of these patients are severely cognitively impaired, often immobile and dependent on their professional carers. We argue that a form of socialised care futility is communicated between staff and is used to rationalise becoming unresponsive to calling-out. We explain this phenomenon as resulting from two protective mechanisms: defence of staff's professional identity as competent practitioners; and defence of staff as having personal morality. Socialised care futility risks good quality care, therefore systematic strategies to assess and manage possible need should be developed, even if calling out remains irresolvable in some cases.
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Affiliation(s)
- J Beaver
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2RD, United Kingdom. https://twitter.com/Jessica_Beaver
| | - S E Goldberg
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2RD, United Kingdom. https://twitter.com/se_goldberg
| | - A Edgley
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2RD, United Kingdom
| | - R H Harwood
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2RD, United Kingdom. https://twitter.com/RowanHarwood
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Stanyon MR, Goldberg SE, Astle A, Griffiths A, Gordon AL. The competencies of Registered Nurses working in care homes: a modified Delphi study. Age Ageing 2017; 46:582-588. [PMID: 28064168 PMCID: PMC5859996 DOI: 10.1093/ageing/afw244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/21/2016] [Indexed: 11/12/2022] Open
Abstract
Background registered Nurses (RNs) working in UK care homes receive most of their training in acute hospitals. At present the role of care home nursing is underdeveloped and it is seen as a low status career. We describe here research to define core competencies for RNs working in UK care homes. Methods a two-stage process was adopted. A systematic literature review and focus groups with stakeholders provided an initial list of competencies. The competency list was modified over three rounds of a Delphi process with a multi-disciplinary expert panel of 28 members. Results twenty-two competencies entered the consensus process, all competencies were amended and six split. Thirty-one competencies were scored in round two, eight were agreed as essential, one competency was split into two. Twenty-four competencies were submitted for scoring in round three. In total, 22 competencies were agreed as essential for RNs working in care homes. A further 10 competencies did not reach consensus. Conclusion the output of this study is an expert-consensus list of competencies for RNs working in care homes. This would be a firm basis on which to build a curriculum for this staff group.
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Affiliation(s)
- Miriam Ruth Stanyon
- University of Nottingham, Division of Psychiatry & Applied Psychology, Institute of Mental Health, School of Medicine, Nottingham
, United Kingdom
| | - Sarah Elizabeth Goldberg
- University of Nottingham, Division of Rehabilitation and Ageing, Queens Medical Centre Medical School Nottingham, Nottingham NG7 2UH
, United Kingdom
| | - Anita Astle
- Wren Hall Nursing Home, Nottingham, United Kingdom
| | - Amanda Griffiths
- University of Nottingham, Division of Psychiatry and Applied Psychology, School of Medicine, Yang Fujia Building Jubilee Campus Wollaton Road, Nottingham NG81BB, United Kingdom
| | - Adam Lee Gordon
- University of Nottingham, Division of Medical Sciences and Graduate Entry Medicine, Medical School, Royal Derby Hospital Uttoxeter Road, Derby DE22 3DT, United Kingdom
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Goldberg SE, Cooper J, Blundell A, Gordon AL, Masud T, Moorchilot R. Development of a curriculum for advanced nurse practitioners working with older people with frailty in the acute hospital through a modified Delphi process. Age Ageing 2016; 45:48-53. [PMID: 26764394 DOI: 10.1093/ageing/afv178] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND advanced nurse practitioners (ANPs) are experienced nurses who undertake some activities traditionally performed by medical staff. There are four pillars of advanced practice: advanced clinical skills, leadership, education and research. ANPs are starting to specialise in the management of older adults with frailty in the acute hospital. However, the role and competencies required for this have not been well defined. This study aimed to establish an expert consensus on the role description and essential competencies for ANPs working with older people with frailty to develop a curriculum. METHODS a literature review and workshops including multi-professional and lay representatives generated a role description and a list of 69 competencies. A modified Delphi process was then conducted with three rounds involving a panel of 31 experts including representatives from the RCN, BGS Education and Training Committee, BGS Senior Nurses and Practitioners Group, Chartered Society of Physiotherapy Older People Network, College of Occupational Therapists Older People Specialist Section and lay representatives. Consensus on the statements was established by 70% panel agreement. RESULTS the role description reached 100% agreement within three rounds. Twenty-five essential competencies were agreed after Round 1, increasing to 43 after Round 2 and 49 after Round 3. CONCLUSION this Delphi study has allowed, for the first time, a national panel of clinical experts and lay representatives to refine and agree a set of competencies for ANPs working with older people with frailty. It is the first step towards ensuring consistency in the training of ANPs in geriatric medicine.
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Affiliation(s)
| | - Jo Cooper
- Corporate, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Adrian Blundell
- Health Care of the Older Person, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Adam Lee Gordon
- Health Care of the Older Person, Nottingham University Hospitals NHS Trust, Nottingham, UK Division of Rehabilitation and Ageing, Medical School Queens Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK Present address: Medical School Royal Derby Hospital, Derby, UK
| | - Tahir Masud
- Health Care of the Older Person, Nottingham University Hospitals NHS Trust, Nottingham, UK Division of Rehabilitation and Ageing, Medical School Queens Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Ravisankar Moorchilot
- Health Care of the Older Person, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Goldberg SE. Demand management: implementing your own program. Fam Pract Manag 1998; 5:49-50, 55-6, 59-62. [PMID: 10186582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- S E Goldberg
- United Medical Associates, Binghamton, N.Y., USA
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Ginsberg PC, Weiner P, Klaus R, Herring W, Goldberg SE. Emphysematous pyelonephritis, ureteritis, and cystitis: report of a case. J Am Osteopath Assoc 1988; 88:895-8. [PMID: 3215797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Lindenbaum G, Larrieu AJ, Goldberg SE, Wolk LA, Ghosh SC, Ablaza SG, Fernandez J. Diagnosis and management of traumatic ventricular septal defect. J Trauma 1987; 27:1289-93. [PMID: 2960827 DOI: 10.1097/00005373-198711000-00015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Four cases of ventricular septal defect secondary to stab wounds of the heart are presented. One of three patients arriving at the Emergency Department in shock and who were resuscitated required an emergency thoracotomy. These patients had immediate repair of their external cardiac wounds in the Operating Room. Cases 1 and 3 developed heart failure and loud systolic murmur postoperatively. Case 4 was treated with chest tube for a left hemothorax and developed heart failure after discharge. In Cases 1, 2, and 3, 2-D echocardiography detected and located a VSD. In Case 3 Doppler measurement showed elevated RV pressure (45 mm Hg) and decreased peak tricuspid to mitral flow ratio (0.36, normal = 0.6). All patients underwent cardiac catheterization. In Case 4 there was associated mitral regurgitation. Cases 1 and 3 had pulmonary to systemic flow ratios greater than 3:1. Cases 1, 3, and 4 underwent operative repair. In Case 1 the VSD was closed with a dacron patch, and in Cases 3 and 4 it was sutured with Teflon pledgets. In Case 4 a puncture wound of the mitral valve annulus was simultaneously repaired. All patients are alive but in Case 1 postoperative 2-D echocardiography demonstrated partial dehiscence of the patch which has not required reoperation and in Case 3 post-repair 2-D echocardiography and Doppler flow studies have shown an intact VSD repair. This series of post-traumatic VSD demonstrates its varying clinical presentation and the diagnostic and followup benefits offered by 2-D echocardiography, especially when combined with Doppler flow measures.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Lindenbaum
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA 19141
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Kochar G, Kotler MN, Hartman J, Goldberg SE, Parry W, Parameswaran R, Scanlon M. Thrombosed aorta resulting in spinal cord ischemia and paraplegia in ischemic cardiomyopathy. Am Heart J 1987; 113:1510-3. [PMID: 3591620 DOI: 10.1016/0002-8703(87)90670-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Goldman AP, Kotler MN, Goldberg SE, Parameswaran R, Parry W. The uses of two-dimensional Doppler echocardiographic techniques preoperatively and postoperatively in a ventricular septal defect caused by penetrating trauma. Ann Thorac Surg 1985; 40:625-7. [PMID: 4074013 DOI: 10.1016/s0003-4975(10)60365-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Doppler echocardiography was used to determine the site and size of a ventricular septal defect in a patient with a penetrating wound of the heart. Additional physiological measurements by Doppler study, including pulmonary artery pressure and degree of left-to-right shunting, were helpful in deciding on surgical closure of the defect as the definitive therapy in this patient. Associated intracardiac defects (e.g., mitral or tricuspid regurgitation) can be excluded by Doppler echocardiography.
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Ruben GD, Goldberg SE, Cope C, Cohen EA. Preoperative angiographic assessment of saphenous vein for arterial bypass surgery. J Med Soc N J 1985; 82:651-3. [PMID: 3862869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
The effectiveness of yellow-tinted lenses (Norton Visitor Wrap-Around) on contrast thresholds for achromatic sinusoidal gratings was measured on a large sample of healthy, young adults. These measurements were compared with those obtained through luminance-matched neutral goggles. Contrast sensitivity functions for stationary and drifting (2 cycles per second) gratings were measured on two groups of subjects. The results of both experiments show that those subjects demonstrating a subjective preference preferred the yellow tint to the neutral lenses by 2:1. Despite the subjective impression, however, contrast thresholds obtained with the yellow and neutral lenses were not statistically different for either the stationary or drifting gratings.
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Abstract
Although low ECG voltage has been associated with pericardial effusion, its diagnostic usefulness in such patients is unclear. When we examined the relationship between the volume of pericardial effusion and low voltage in 28 patients who underwent pericardial drainage, 14 patients exhibited low voltage (sum of limb lead QRS amplitudes of 30 mm or less). In eight patients, the QRS amplitude was 5 mm or less in each of the standard leads (absolute low voltage). There was no significant correlation between the volume of the effusion and the QRS amplitude (r = -0.30). This correlation did not improve (r = -0.37) when patients with left ventricular hypertrophy were excluded. Following pericardial drainage, the QRS amplitude increased in 21 of 24 patients and decreased in three. Low voltage persisted in nine patients; the pericardium was thickened in seven of the nine. Analysis of the sensitivity and specificity revealed acceptable sensitivity only with large effusions and no left ventricular hypertrophy. Absolute low voltage appeared to be specific in the diagnosis of moderate and large effusions among patients with pericardial effusion selected for this study.
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