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Full-Text Articles in Medicine and Health Sciences
Portal And Systemic Haemodynamic Action Of N-Acetylcysteine In Patients With Stable Cirrhosis, Alison Jones, I Bangash, I.A.D Bouchier, P Hayes
Portal And Systemic Haemodynamic Action Of N-Acetylcysteine In Patients With Stable Cirrhosis, Alison Jones, I Bangash, I.A.D Bouchier, P Hayes
Alison L Jones
The effects of intravenous N-acetylcysteine on hepatic and systemic haemodynamics were investigated in 11 patients with stable cirrhosis (eight alcohol; two primary bilary cirrhosis; one cryptogenic). N-acetylcysteine administration had no effect on the mean heart rate or mean arterial blood pressure despite a significant fall in systemic and pulmonary vascular resistance. Cardiac index increased but estimated liver blood flow and portal venous pressure did not change significantly. Administration of N-acetylcysteine resulted in increased oxygen delivery to the tissues because of the increased cardiac index but this was not accompanied by a rise in either arteriovenous oxygen extraction ratio or mean …
Cognitive Skills Underlying Driving In Patients Discharged Following Self-Poisoning With Central Nervous System Depressant Drugs, Tharaka Dassanayake, Patricia Michie, Alison Jones, Trevor Mallard, Ian Whyte, Gregory Carter
Cognitive Skills Underlying Driving In Patients Discharged Following Self-Poisoning With Central Nervous System Depressant Drugs, Tharaka Dassanayake, Patricia Michie, Alison Jones, Trevor Mallard, Ian Whyte, Gregory Carter
Alison L Jones
Background: Central nervous system–depressant (CNS-Ds) drugs can impair cognitive functions and driving. They are also the most common drugs taken in overdose in hospital-treated episodes of self-poisoning. In Australia most of these patients are discharged within 48 h, while they still have possible subclinical drug effects. We aimed to determine whether patients treated for self-poisoning with CNS-Ds are impaired in the Trail-Making Test (TMT, parts A and B), a neuropsychological test that is known to correlate with driving performance. Methods: This study was a conducted from November 2008 to April 2011 in a referral center for poisonings in New South …
Severity Scores For Poisoned Patients: Reasons And Rationale, A Proudfoot, Alison Jones
Severity Scores For Poisoned Patients: Reasons And Rationale, A Proudfoot, Alison Jones
Alison L Jones
No abstract provided.
Measuring Plasma Salicylate Concentrations In All Patients With Drug Overdose Or Altered Consciousness: Is It Necessary?, David Wood, Paul Dargan, Alison Jones
Measuring Plasma Salicylate Concentrations In All Patients With Drug Overdose Or Altered Consciousness: Is It Necessary?, David Wood, Paul Dargan, Alison Jones
Alison L Jones
Background: Salicylate self poisoning is potentially fatal. Plasma salicylate concentrations can be used to guide management when taken in the context of clinical features of toxicity and acid base status. Previous studies in the USA and Hong Kong have shown that routine measurement of plasma salicylate concentrations in all overdose patients is inappropriate, but there have been no previous studies in the UK. Methods: A retrospective case note study from 1 February 2001 to 31 January 2002 was undertaken at the emergency department of St. Thomas’ Hospital, London. Records were reviewed and information on demographic data, history, details of salicylate …
Risk Of Road Traffic Accidents In Patients Discharged Following Treatment For Psychotropic Drug Overdose: A Self-Controlled Case Series Study In Australia, Tharaka L. Dassanayake, Alison L. Jones, Patricia Michie, Gregory Carter, Patrick Mcelduff, Barrie J. Stokes, Ian Whyte
Risk Of Road Traffic Accidents In Patients Discharged Following Treatment For Psychotropic Drug Overdose: A Self-Controlled Case Series Study In Australia, Tharaka L. Dassanayake, Alison L. Jones, Patricia Michie, Gregory Carter, Patrick Mcelduff, Barrie J. Stokes, Ian Whyte
Alison L Jones
Background: Use of psychotropic drugs is known to impair driving and increase the risk of road traffic accidents. They are also the most common drugs taken in overdose in hospital-treated episodes of self-poisoning. Most patients who take psychotropic drug overdoses are discharged within 48 hours, while they still have possible subclinical drug effects. Objective: Using a self-controlled case series design, we aimed to determine whether patients with psychotropic drug overdose are at a higher risk of a traffic accident in the period following discharge compared with a control period not associated with hospital-treated drug overdose. Methodology: Using the New South …
Should All Patients With Unexplained Anaemia Be Screened For Chronic Lead Poisoning?, I Gawarammana, Paul Dargan, S Woodcock, M Sculley, Ivan House, David Wood, Alison Jones
Should All Patients With Unexplained Anaemia Be Screened For Chronic Lead Poisoning?, I Gawarammana, Paul Dargan, S Woodcock, M Sculley, Ivan House, David Wood, Alison Jones
Alison L Jones
No abstract provided.
Portal And Systemic Haemodynamic Response To Acute And Chronic Administration Of Low And High Dose Isosorbide-5-Mononitrate In Patients With Cirrhosis, Alison Jones, I Bangash, James Walker, K Simpson, N Finlayson, P Hayes
Portal And Systemic Haemodynamic Response To Acute And Chronic Administration Of Low And High Dose Isosorbide-5-Mononitrate In Patients With Cirrhosis, Alison Jones, I Bangash, James Walker, K Simpson, N Finlayson, P Hayes
Alison L Jones
Oral isosorbide-5-mononitrate (Is-5-Mn) was given in doses of 10 and 40 mg acutely and chronically (twice daily for four weeks), allowing a nitrate free interval to 25 patients with cirrhosis. Both 10 mg and 40 mg Is-S-Mn reduced the hepatic venous pressure gradient acutely and chronically, without evidence of tolerance. This was achieved by a reduction in the wedged hepatic venous pressure. The effect on mean azygos blood flow was variable with no significant mean change seen acutely or after chronic use with either dose. The variability was dependent not on the dose used but on the initial azygos flow; …
Gut Decontamination Of Acutely Poisoned Patients: What Do Doctors Really Know About It?, David Wood, S Greene, Alison Jones, Paul Dargan
Gut Decontamination Of Acutely Poisoned Patients: What Do Doctors Really Know About It?, David Wood, S Greene, Alison Jones, Paul Dargan
Alison L Jones
There are consensus guidelines on the appropriate use of gut decontamination in the management of poisoned patients. This study demonstrates that few doctors have read these guidelines and that they have poor knowledge of the use of gut decontamination, which can be improved with specific clinical toxicology teaching. Future guidelines should be published in journals more widely read by those doctors treating poisoned patients.
Drug Abusers And Poisoned Patients: A Potential Source Of Organs For Transplantation?, Alison Jones, K Simpson
Drug Abusers And Poisoned Patients: A Potential Source Of Organs For Transplantation?, Alison Jones, K Simpson
Alison L Jones
One of the major constraints to transplantation of solid organs is lack of availability of grafts and any attempt to use all available donors is to be welcomed. We address the possibility of expanding the transplant donor pool by inclusion of more patients who have suffered intoxication with drugs premortem. Particularly important in this context is the exclusion of organ-specific damage, and also infective risk to the potential recipient due to viral causes in the donor.
Analysis Of Serial Serum Alpha-Fetoprotein Concentrations In Patients With Cirrhosis, Alison Jones, J Plevris, C Shearing, I.A.D Bouchier, P Hayes
Analysis Of Serial Serum Alpha-Fetoprotein Concentrations In Patients With Cirrhosis, Alison Jones, J Plevris, C Shearing, I.A.D Bouchier, P Hayes
Alison L Jones
No abstract provided.
Initial Management Of Poisoned Patients In The Out-Of-Hospital Environment, Alison Jones
Initial Management Of Poisoned Patients In The Out-Of-Hospital Environment, Alison Jones
Alison L Jones
Poisoning and suspected poisoning are very common problems in pre-hospital emergency care. The challenge is to identify the 1-2% of individuals who have taken sufficient toxin to be at risk of developing serious sequelae and use and develop effective methods of preventing such sequelae. Few randomised controlled clinical trials are available, and management decisions often have to be made on isolated case reports in the more unusual cases of poisoning. Care of the unconscious poisoned patient includes care of the airway, breathing, and circulation. Clues to the aetiology of poisoning in such cases may be gained from clinical signs which …
Cognitive Impairment In Patients Clinically Recovered From Central Nervous System Depressant Drug Overdose, Tharaka Dassanayake, Patricia Michie, Alison Jones, Gregory Carter, Trevor Mallard, Ian Whyte
Cognitive Impairment In Patients Clinically Recovered From Central Nervous System Depressant Drug Overdose, Tharaka Dassanayake, Patricia Michie, Alison Jones, Gregory Carter, Trevor Mallard, Ian Whyte
Alison L Jones
Central nervous system depressant drugs (CNS-Ds) are known to impair cognitive functions. Overdose of these drugs is common, and most of the hospital-treated patients are discharged within 24 to 48 hours. No previous studies have examined whether they have residual impairment at the time of discharge. Our aim was to evaluate whether patients with CNS-D overdose are impaired in cognitive domains important in daily activities at that time. We compared visuomotor skills (Trail-Making Test A and Choice Reaction Time), executive functions (viz attentional set-shifting: Trail-Making Test B; and planning: Stockings of Cambridge Task from the Cambridge Neuropsychological Test Automated Battery), …
Should A Lower Treatment Line Be Used When Treating Paracetamol Poisoning In Patients With Chronic Alcoholism? A Case Against, Paul Dargan, Alison Jones
Should A Lower Treatment Line Be Used When Treating Paracetamol Poisoning In Patients With Chronic Alcoholism? A Case Against, Paul Dargan, Alison Jones
Alison L Jones
The widespread practice of using a lower plasma paracetamol (acetaminophen) concentration threshold for the treatment of paracetamol poisoning in patients with chronic alcoholism has been introduced on the basis of anecdotal case reports. In animals, acute alcohol loading inhibits toxic metabolic activation of paracetamol whilst chronic alcohol administration results in cytochrome P450 (CYP) 2E1 induction with increased toxic metabolic activation of paracetamol by CYP2E1 and increased hepatotoxicity. However, due to species differences in CYP expression, activity and induction, it is not possible extrapolate the results of these animal studies to clinical situations in humans. Isoenzymes are also responsible for the …
Pharmacokinetics Of N-Acetylcysteine Are Altered In Patients With Chronic Liver Disease, Alison Jones, D Jarvie, D Simpson, P Hayes, L Prescott
Pharmacokinetics Of N-Acetylcysteine Are Altered In Patients With Chronic Liver Disease, Alison Jones, D Jarvie, D Simpson, P Hayes, L Prescott
Alison L Jones
The threshold plasma paracetamol concentration at which N-acetylcysteine (NAC) treatment is recommended to treat paracetamol poisoning in a patient with induced liver enzymens (for example, with chronic liver disease or taking anticonvulsant drugs) is 50% lower than in a patient without induces liver enzymes. More patients with chronic liver disease might therefore be expected to be exposed to NAC treatment than previously. In addition, there is increasing use of NAC in patients with chronic liver disease for multiorgan failure or hepatorenal syndrome. Little is known of NAC's pharmacokinetics properties in patiens with cirrhosis.
Doctors And Nurses Estimation Of The Weight Of Patients: A Preventable Source Of Systematic Error, S Greene, Paul Dargan, G Shin, Alison Jones
Doctors And Nurses Estimation Of The Weight Of Patients: A Preventable Source Of Systematic Error, S Greene, Paul Dargan, G Shin, Alison Jones
Alison L Jones
Background: Although accurate determination of body weight is important in the management of the poisoned patient, many patients have their weight estimated rather than formally measured. Objective: To determine how good medical staff are at estimating patients*** body weights. Methods: Medical staff were asked to estimate the weight of six patients on a poisons ward. Estimated and actual patient weights were statistically compared. Results: Medical staff produced a large range of estimated weights for all patients. Patient weight was incorrectly estimated by greater than 10% in 61% of individual estimations. There was poor statistical correlation between actual and estimated weight. …
The Effect Of Nitric Oxide Synthase Inhibition On Portal Pressure And Azygos Blood Flow In Patients With Cirrhosis, E Forrest, Alison Jones, John Dillon, James Walker, P Hayes
The Effect Of Nitric Oxide Synthase Inhibition On Portal Pressure And Azygos Blood Flow In Patients With Cirrhosis, E Forrest, Alison Jones, John Dillon, James Walker, P Hayes
Alison L Jones
It has been proposed that the hyperdynamic circulation found in cirrhosis is mediated by nitric oxide released through the induction of nitric oxide synthase. To investigate this the effect of the nitric oxide synthase inhibitor, N~-monomethyl-L-arginine (LNMMA), was studied upon the portal circulation. After a 30-min infusion of 3 mg/kg of L-NMMA there was a significant fall in heart rate from 83.2+_4.4 to 74.2-+3.9 bpm (p=0.005), and a significant rise in mean arterial pressure from 91.6+_2.2 to 103.7+_3.2 mmHg, p=0.004). There was, however, no change in hepatic venous pressure gradient (16.7+_1.5 to I6.1+_1.7 mmHg, p=0.477) nor in azygos venous blood …
Improvement In The Management Of Acutely Poisoned Patients Using An Electronic Database, Prospective Audit And Targeted Educational Intervention, S Greene, David Wood, I Gawarammana, C Warren-Gash, Nick Drake, Alison Jones, Paul Dargan
Improvement In The Management Of Acutely Poisoned Patients Using An Electronic Database, Prospective Audit And Targeted Educational Intervention, S Greene, David Wood, I Gawarammana, C Warren-Gash, Nick Drake, Alison Jones, Paul Dargan
Alison L Jones
Problem: The need to improve the clinical assessment and management of acutely poisoned patients presenting to an NHS hospital emergency department (ED). Design: Creation of an electronic clinical toxicology database to prospectively collect all aspects of clinical information on poisoned-patient presentations. Systematic analysis of collated information to identify shortfalls in patient assessment and management. Bimonthly audit meetings, and design and implementation of educational interventions to address identified shortfalls. Ongoing audit to demonstrate continued improvement in patient care. Background and setting: ED in tertiary-level inner-city London teaching hospital. Study conducted by staff from the ED and clinical toxicology service. Key measures …
Soluble Adhesion Molecules And Interleukin-2 Receptor Concentrations In Patients With Autoimmune Chronic Hepatitis, K Simpson, Alison Jones, A. Howie Forbes, P Hayes
Soluble Adhesion Molecules And Interleukin-2 Receptor Concentrations In Patients With Autoimmune Chronic Hepatitis, K Simpson, Alison Jones, A. Howie Forbes, P Hayes
Alison L Jones
To test the hypothesis that elevated serum levels of intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), (s)E-selectin, (s)P-selectin and soluble interleukin-2 receptor (sIL-2R) occur in patients with biochemically inactive autoimmune hepatitis (AICH) compared with controls. Such a finding would suggest continued immune activation, which in the long-term would contribute to the development of cirrhosis in such patients.