scholarly journals A closed audit reviewing the electrocardiograms of patients presenting to the memory assessment team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S30-S30
Author(s):  
Joseph Heath ◽  
Maroulla Anderson ◽  
Jonathan Miles-Stokes
Keyword(s):  
Side Effects ◽  
Acetylcholinesterase Inhibitors ◽  
Left Ventricular ◽  
Cardiac Conduction ◽  
North West ◽  
Cardiac Side Effects ◽  
Memory Assessment ◽  
The North ◽  
Conduction Disorders ◽  
Clinically Significant

AimsTo review the ECGs of all patients referred to MAT services over the preceding 5 year period.BackgroundNeurodegenerative conditions such as Alzheimer's Disease can be treated with Acetylcholinesterase Inhibitors (AChEI) to slow down cognitive decline. Side effects of AChEIs include bradycardia, syncope and cardiac conduction disorders. An electrocardiograms (ECG) is completed prior to memory assessment team (MAT) medical assessments to screen for those who may be at risk of the cardiac side effects of AChEIs. ECGs may be included in the initial referral to the service or completed by the MAT. Given the predominantly elderly population referred to the MATs service, other incidental abnormalities are to be expected. Not all MAT referrals that are screened by memory nurses reach the threshold to be reviewed by the medical team and therefore not all ECGs are routinely reviewed, potentially missing clinically significant abnormalities.ResultA total of 1795 patients were identified as being referred to a single mental health unit in the North West on England over a five-year period. 781 (44%) of the patients had an ECG completed by the MAT, of which 452 (58%) showed an abnormality. Significant abnormalities that were previously unknown to the patients’ primary care provider include eight cases of Atrial Fibrillation (AF), four cases of Trifasciular Block, and 19 cases of Left Ventricular Hypertrophy (LVH). 64 (8%) of patients who had an ECG by the MAT had a bradycardia.ConclusionIn addition to identifying abnormalities that could interfere with memory medication, this audit showed that over half of the ECGs completed by the MAT had an atypical trace. Cardiology was consulted to identify which abnormalities were considered clinically significant and if not already known, the general practitioner (GP) was informed. A change in the local service means that all ECGs completed by the MAT are now screened at point of filling into the notes, so any future abnormalities are identified and followed up immediately.

scholarly journals Myocarditis in yound athletes

2015 ◽  
Vol 96 (4) ◽  
pp. 669-674
Author(s):  
E A Degtyareva ◽  
M G Kantemirova ◽  
O I Zhdanova ◽  
O N Trosheva
Keyword(s):  
Risk Factors ◽  
Left Ventricle ◽  
Myocardial Damage ◽  
Left Ventricular ◽  
Cardiac Conduction ◽  
Screening Tests ◽  
High Concentration ◽  
Infectious Risk ◽  
Conduction Disorders ◽  
High Concentrations

Aim. Development of informative differential diagnostic criteria of inflammatory myocardial involvement in young athletes. Methods. A total of 163 athletes (swimmers, football players and sailing athletes) aged 9 to 24 years (mean age 14.74±0,23 years, SD=3.03) were examined. Complete clinical and functional examination was performed. Remodeling of the left ventricle was studied in accordance with R. Devereux (1992) and B. Maron (2005) echocardiographic criteria. Myocardial morphometry results were compared with immunobiochemical markers of myocardial damage and titer of antimyocardial antibodies to the endothelium, cardiac conduction system, cardiomyocytes, and smooth muscle. Results. In 10 out of 40 athletes with echocardiographic signs of pathological remodeling of the left ventricle, the indicators of myocardial damage used as immunobiochemical screening tests, were increased, high titers of antimyocardial antibodies (more than 1:160), arrhythmias, sever conduction disorders, and high concentrations of infectious risk factors were revealed, allowing to diagnose subacute myocarditis. Conclusion. Subacute myocarditis should be excluded in athletes with echocardiographic signs of left ventricular myocardial remodeling and a high concentration of «infectious» risk factors based on immunobiochemical markers of myocardial damage and antimyocardial antibodies titer.

scholarly journals Ferritin level changes and erythroid improvement in a group of adult politransfused patients treated with Deferasirox

2018 ◽  
Vol 91 (3) ◽  
pp. 288-292 ◽  
Author(s):  
Andrada Viorica Parvu ◽  
Anca Bojan ◽  
Laura Urian ◽  
Tunde Torok ◽  
Iulia Andrea Zsoldos ◽  
...  
Keyword(s):  
Side Effects ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Ferritin Level ◽  
Elevated Serum ◽  
Iron Chelator ◽  
Red Blood Cell Transfusion ◽  
North West ◽  
The North ◽  
The Difference

Background and aims. Chelating agents therapy is recommended for polytransfused patients that have evidence of iron overload (an elevated serum ferritin or received over 20 units of red blood cell transfusions). Deferasirox showedefficacy and safety in maintaining or reducing body iron.Iron chelation therapy was associated with hematopoiesis improvement in transfusion-dependent patients.Our objectives were to analyze differences in ferritin level in adult polytransfused patients treated with Deferasirox, to estimate the erythroid improvement and variation of the number of red blood cell transfusion after introducing Deferasirox, to evaluate the side effects of the treatment.Methods. Retrospective study including all the adult polytransfused patients treated with Deferasirox in Hematology Departments of   three county hospitals in the North-West of Romania.         Results. We included 40 polytransfused patients treated with Deferasirox in standard doses. There was a significant reduction in serum ferritine from baseline for all the patients (Friedman test, χ2(2)=26.82, p<0.001). Safety profile of Deferasirox was good (three digestive side effects). RBCT were administered before (mean 2.43±1.09 units/month) and after starting Deferasirox (mean 1.40±0.97 units/month), the difference is statistically significant (Student Test, t(39)=6.98, p<0.001).Conclusions. Deferasirox proves to be an effective iron chelator, the serum level of ferritine decreased for all the patients during the treatment and 22.5 % of the patients developed an erythroid improvement. Safety and compliance were good.

THE VALUE OF THE MANAGED ENTRY OF NEW DRUGS

2003 ◽  
Vol 19 (1) ◽  
pp. 114-128 ◽  
Author(s):  
Katherine Payne ◽  
Linda M. Davies ◽  
Peter R. Noyce ◽  
Marjorie C. Weiss
Keyword(s):  
New Drugs ◽  
Policy And Practice ◽  
Expected Cost ◽  
North West ◽  
The North ◽  
Department Of Health ◽  
Health Authorities ◽  
Clinically Significant ◽  
Study Sites ◽  
Analytic Models

Objective: A United Kingdom Department of Health directive (EL[94]72) asked Health Authorities to manage the entry of new drugs into practice. There seem to be costs associated with the decision-making process of managed entry, but no clear evidence of benefit to patient populations. The objective of this study was to assess the potential costs and outcomes of different models of managed entry, using the example of donepezil in the North West Health Region of the U.K. National Health Service. This is a preliminary study designed to identify the key pieces of information required to evaluate the value of managed entry.Methods: Decision analytic models of three Health Authorities' approaches to manage the entry of donepezil were used to estimate the expected costs and effectiveness of the process. Resource use data were obtained from published sources and the relevant Health Authority. Probabilistic sensitivity analysis was used to determine the robustness of the results.Results: The process of managed entry of donepezil was associated with higher expected costs and higher expected outcome than no managed entry. The 95% confidence intervals for the net expected costs and net expected outcomes were relatively narrow and did not cross zero, which suggests a statistical difference between managed entry and no managed entry for donepezil. The incremental cost-effectiveness ratios for managed entry of donepezil indicate that, compared with no managed entry, there were substantial differences between the different models used in the three study sites. The expected cost per unit of cognitive function gained was between £18,000 in study site 001 to £28,000 in study site 010. The expected cost per person with a clinically significant improvement was between £140,000 and £230,000. The expected cost per QALY ranged from £470,000 to £19.3 million.Conclusions: Managed entry does not appear to be a worthwhile mechanism to introduce drugs into practice. However, poor accessibility and availability of data means that the results are highly uncertain. The lack of data presents serious obstacles for both researchers and policy makers wishing to develop evidence-based policy and practice.

scholarly journals The clinical course of hypertrophic cardiomyopathy and the role of polymorphisms in the intronic and promoter regions of the gene alpha-galactosidase A

2015 ◽  
Vol 22 (4) ◽  
pp. 61-65
Author(s):  
A. A. Poliakova ◽  
E. N. Semernin ◽  
A. Ya. Gudkova
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Clinical Course ◽  
Unknown Origin ◽  
Left Ventricular ◽  
Promoter Regions ◽  
North West ◽  
The North ◽  
Alpha Galactosidase ◽  
Gla Gene

The article reflects the importance of timely diagnosis sarcomeric and non sarcomeric hypertrophic cardiomyopathy (HCM). The results of the phenotypic and genotypic screenings aimed at identifying HCM phenocopies and, in particular Fabry disease, in the structure of left ventricular hypertrophy of unknown origin in patients of the North-West region of Russia. We analyzed the influence of polymorphisms in the intronic and promoter regions of the GLA gene on clinical course and the presence of extracardiac manifestations.

scholarly journals IMPROVING SURVIVAL IS NOT THE ONLY RELEVANT OUTCOME FOR PATIENTS SUFFERING FROM MALIGNANT PLEURAL MESOTHELIOMA AND THEIR CAREGIVERS: AN EXPLORATIVE STUDY (POINTINME_EXPLOR)

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
F. Grosso ◽  
G. Rota ◽  
M. Dacquino ◽  
S. Crivellari ◽  
S. Delfanti ◽  
...  
Keyword(s):  
Side Effects ◽  
Malignant Pleural Mesothelioma ◽  
Therapeutic Process ◽  
Patient Care Team ◽  
Care Process ◽  
Pleural Mesothelioma ◽  
North West ◽  
The North ◽  
The Relationship

Background: The study was aimed at exploring the patients’ and caregivers’ expectations on treatment outcomes, the understanding of the information delivered by the oncologists during the first and reevaluation visits and the role of the general practitioners (GP) in the management of patients suffering from advanced Malignant Pleural Mesothelioma (MPM) in the area of Casale Monferrato, in the North West of Italy, where the incidence of mesothelioma is more than 30 times higher than the median incidence in Europe. A multiprofessional mesothelioma unit involving specialists and also GPs has been created since 2012 to globally assist patients in each step of the diagnostic and therapeutic process. This study was conducted to better understand the need of MPM patients in our area and their satisfaction about the care provided within the unit. Methods: Patients and caregivers were asked to fill in a multiple-choice questionnaire after the first visit or the re-evaluation visits (the ones in which a new treatment program was communicated) asking what is most important as the result of treatment, how much the oncologist was clear in communicating the diagnosis, the therapeutic options, the side effects, the role of the GP in supporting the care process and the trust-relationship with both the referral oncologist and the GP. Patients were also asked about the importance of having a referral caregiver. Results: From March to August 2019, 31 consecutive patients, 18 males and 13 females, median age 71 (IQR 66-75) and 29 caregivers, 7 males and 22 females, median age 63 (IQR 49-67) were enrolled in the study. Improving survival was the most relevant expected outcome in 48% and 69% of patients and caregivers, respectively followed by maintenance of the quality of life (38% and 17%), having the minimal number of accesses in the hospital as possible (8% vs 4%) and improving symptoms (6% and 10%). Seventy-seven% of patients and 72% of caregivers stated that the communication of the diagnosis was very clear, 74% of patients and 72% of caregivers stated that explanations about treatments were very clear, 90% of both patients and caregivers stated that the communication of side effects was sufficiently clear. Ninety% of patients and 86% of caregivers are completely satisfied about the relationship with the referral oncologist whereas 58% of patients and 55% of caregivers are completely satisfied with the support given by the GP. Ninety-three% of patients think that having a referral caregiver is of utmost importance and 80% of patients appreciate the presence of a palliative expert in the patient-care team whereas 52% of patients think to require a psychological support. Conclusions: This study highlights that in the high incidence area of MPM of Casale Monferrato, only half of advanced MPM patients and less that 2/3 of caregivers think that improving survival is the most relevant treatment outcome. The majority of patients and caregivers state to have clear information about diagnosis, treatment and related side effects and feel satisfied about the relationship with the specialists of the mesothelioma unit.

scholarly journals Changing clinical patterns of Rhegmatogeneous Retinal Detachments during the COVID19 pandemic lockdown in the North West of the UK

2020 ◽  
pp. 112067212096548
Author(s):  
Kirti M Jasani ◽  
Tsveta Ivanova ◽  
Francesco Sabatino ◽  
Niall Patton ◽  
Felipe Dhawahir-Scala ◽  
...  
Keyword(s):  
Posterior Vitreous Detachment ◽  
Case Series ◽  
Lower Proportion ◽  
Consecutive Case ◽  
North West ◽  
The North ◽  
Case Series Study ◽  
Clinically Significant ◽  
The Uk ◽  
Series Study

Introduction: The UK Government imposed a COVID19 lockdown (LD) restricting all but essential activities from 24th March 2020. Subsequently, there has been a significant reduction in casualty attendances nationwide including for ophthalmic emergencies. We aim to study the presentation of rhegmatogenous retinal detachments (RRD) and significant vitreous haemorrhage caused by posterior vitreous detachment (PVD-VH) in three tertiary centres covering most of the North West of England in the 6 weeks before and during the lockdown. Methods: A retrospective multicenter non-randomised consecutive case series study was designed to collect information on all cases of RRD and PVD-VH requiring surgery presenting to the vitreoretinal departments of Manchester Royal Eye Hospital, East Lancashire NHS Foundation Trust and the Lancashire NHS Foundation Trust from 11th February to 4th May 2020. Results: A total of 137 eyes of 137 patients were identified between the three centres of which 132 eyes were operated for RRD. Of these, 86 (64.7%) were operated pre-LD compared with 46 eyes (34.8%) during LD. Forty-five out of 86 eyes (52.3%) were macula-off pre-LD compared with 31 out of 46 eyes (67.3%) during LD ( p = 0.06). There was lower proportion of non-PVD related RRD during LD (11 pre-LD to 1 during LD, p = 0.05). PVR was present in four cases during LD compared to 2 before ( p = 0.19). Conclusion: There was a clinically significant reduction in the overall incidence of RRD in our centres with an increase in the proportion of macula-off and proliferative vitreoretinopathy during the LD period compared to a similar period before.

SEM and TEM observations of sperm development in the testis of the freshwater fish Oreochromis mossambicus

1990 ◽  
Vol 48 (3) ◽  
pp. 58-59
Author(s):  
Daryl A. Cornish ◽  
George L. Smit
Keyword(s):  
Morphological Characteristics ◽  
Oreochromis Mossambicus ◽  
Breeding Cycle ◽  
Limited Information ◽  
North West ◽  
The North ◽  
Sem And Tem ◽  
Sperm Development ◽  
Ultrastructural Characteristics ◽  
The University

Oreochromis mossambicus is currently receiving much attention as a candidater species for aquaculture programs within Southern Africa. This has stimulated interest in its breeding cycle as well as the morphological characteristics of the gonads. Limited information is available on SEM and TEM observations of the male gonads. It is known that the testis of O. mossambicus is a paired, intra-abdominal structure of the lobular type, although further details of its characteristics are not known. Current investigations have shown that spermatids reach full maturity some two months after the female becomes gravid. Throughout the year, the testes contain spermatids at various stages of development although spermiogenesis appears to be maximal during November when spawning occurs. This paper describes the morphological and ultrastructural characteristics of the testes and spermatids.Specimens of this fish were collected at Syferkuil Dam, 8 km north- west of the University of the North over a twelve month period, sacrificed and the testes excised.

The North West Passage

2014 ◽  
Author(s):  
Roald Amundsen ◽  
Godfred Hansen
Keyword(s):  
North West ◽  
The North
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