13 results on '"Kellett JG"'
Search Results
2. Evaluation of systemic vasoconstriction and prognosis using thermography: a systematic review.
- Author
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Jensen RO, Lo R, Kellett JG, Graham CA, and Brabrand M
- Subjects
- Animals, Body Temperature, Humans, Infrared Rays, Prognosis, Thermography, Vasoconstriction
- Abstract
Purpose: This systematic review investigates whether infrared thermography (IRT) can measure systemic vasoconstriction and addresses the value of IRT in assessing circulatory deficiency and prognoses., Methods: Design was based on the PRISMA criteria and a systematic search of 6 databases was performed., Results: Of 3,198 records, five articles were included. Three clinical studies were identified; two found significant correlations between IRT obtained temperatures and mortality. An experimental study found an association between peripheral temperature and stroke volume. An animal study found that central-peripheral temperature differences correlated with shock index, mean arterial pressure, and disease progression., Conclusions: Data from the most valid study suggests that central-peripheral temperature differences should be investigated further, both on its own, and integrated with other variables.
- Published
- 2021
3. Differences in identification of patients' deterioration may hamper the success of clinical escalation protocols.
- Author
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De Bie AJR, Subbe CP, Bezemer R, Cooksley T, Kellett JG, Holland M, Bouwman RA, Bindels AJGH, and Korsten HHM
- Subjects
- Adult, Aged, Aged, 80 and over, Clinical Decision-Making, Critical Care statistics & numerical data, Denmark, Female, Humans, Internet, Male, Middle Aged, Netherlands, Prospective Studies, Risk Assessment, Surveys and Questionnaires, United Kingdom, Attitude of Health Personnel, Clinical Deterioration, Critical Illness therapy, Severity of Illness Index
- Abstract
Background: Timely and consistent recognition of a 'clinical crisis', a life threatening condition that demands immediate intervention, is essential to reduce 'failure to rescue' rates in general wards., Aim: To determine how different clinical caregivers define a 'clinical crisis' and how they respond to it., Design: An international survey., Methods: Clinicians working on general wards, intensive care units or emergency departments in the Netherlands, the United Kingdom and Denmark were asked to review ten scenarios based on common real-life cases. Then they were asked to grade the urgency and severity of the scenario, their degree of concern, their estimate for the risk for death and indicate their preferred action for escalation. The primary outcome was the scenarios with a National Early Warning Score (NEWS) ≥7 considered to be a 'clinical crisis'. Secondary outcomes included how often a rapid response system (RRS) was activated, and if this was influenced by the participant's professional role or experience. The data from all participants in all three countries was pooled for analysis., Results: A total of 150 clinicians participated in the survey. The highest percentage of clinicians that considered one of the three scenarios with a NEWS ≥7 as a 'clinical crisis' was 52%, while a RRS was activated by <50% of participants. Professional roles and job experience only had a minor influence on the recognition of a 'clinical crisis' and how it should be responded to., Conclusion: This international survey indicates that clinicians differ on what they consider to be a 'clinical crisis' and on how it should be managed. Even in cases with a markedly abnormal physiology (i.e. NEWS ≥7) many clinicians do not consider immediate activation of a RRS is required., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2019
- Full Text
- View/download PDF
4. Fever increases heart rate and respiratory rate; a prospective observational study of acutely admitted medical patients.
- Author
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Jensen MM, Kellett JG, Hallas P, and Brabrand M
- Subjects
- Cohort Studies, Humans, Patient Admission, Prospective Studies, Retrospective Studies, Critical Care, Heart Rate, Respiratory Rate
- Abstract
Background: The relationship between increase in body temperature, heart rate, and respiratory rate has only been studied in young, healthy subjects., Aim: To show the changes in heart and respiratory rate associated with fever in acutely admitted medical patients., Design: A prospective observational cohort study., Methods: Vital parameters from 4,493 patients were retrospectively extracted. Linear and multiple variable regression analysis was used to calculate the change in heart and temperature rate for every degree rise in temperature (i.e. ΔHR/°C and ΔRR/°C) in the entire study group and in those with low (<36.1°C), normal (36.1-38°C) and high (>38°C) body temperatures., Results: The ΔHR/°C and ΔRR/°C was 7.2±0.4 beats per minute (bpm) and 1.4 ±0.1 (1.2 to 1.62) breaths per minute (bpm). Adjusting for age, oxygen saturation and mean blood pressure, the results were 6.4±0.4 (5.7 to 7.1) bpm and 1.2±0.1 (1.0 to 1.4) bpm. In low, normal and high body temperature the ΔHR/°C were 2.7±1.9, 6.9±1.9 and 7.4±0.9 bpm, respectively; for ΔRR/°C the values were -0.5±0.5, 1.5±0.5 and 2.3±0.3 bpm, respectively., Conclusions: We only found a modest association between fever and changes in heart rate and respiratory rate.
- Published
- 2019
5. Respiratory Rate: The Forgotten Vital Sign-Make It Count!
- Author
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Loughlin PC, Sebat F, and Kellett JG
- Subjects
- Humans, Observer Variation, Patient Acuity, Monitoring, Physiologic methods, Monitoring, Physiologic standards, Respiratory Rate
- Published
- 2018
- Full Text
- View/download PDF
6. Prognostic value of infrared thermography in an emergency department.
- Author
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Holm JK, Kellett JG, Jensen NH, Hansen SN, Jensen K, and Brabrand M
- Subjects
- Denmark, Emergency Service, Hospital organization & administration, Female, Humans, Male, Prognosis, Prospective Studies, Spectroscopy, Near-Infrared methods, Body Temperature, Skin Temperature physiology, Thermography methods
- Abstract
Objective: In this study, we aimed to investigate the prognostic potential of infrared thermography in a population of medical patients admitted to the emergency department. Central-to-peripheral temperature gradients were analyzed for association with 30-day mortality., Methods: This prospective observational study included 198 medical patients admitted to the Emergency Department, at Odense University Hospital. A standardized thermal picture was taken and temperatures of the inner canthus, the earlobe, the nose tip, and the tip of the third finger were reported. The inner canthus was chosen as a marker for central temperature and the three others as markers for peripheral temperatures, resulting in three gradients per patient. Thirty-day follow-up was performed and 30-day mortality was reported., Results: One hundred and ninety-eight patients were included and the number of events was nine. The gradient between the inner canthus and the nose tip (ΔN) and the gradient between the inner canthus and the fingertip (ΔF) showed a significant association with 30-day mortality (ΔN: odds ratio: 1.31; 95% confidence interval: 1.05-1.64 and ΔF: odds ratio: 1.27; 95% confidence interval: 1.02-1.57)., Conclusion: ΔN and ΔF showed a significant association with 30-day mortality, suggesting a prognostic value. However, this was a small pilot study with few events. Larger studies are warranted for confirmation of these findings.
- Published
- 2018
- Full Text
- View/download PDF
7. The European Journal of Case Reports in Internal Medicine The First Two Years.
- Author
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Kellett JG
- Abstract
Competing Interests: Conflicts of Interests: The Author declare that there are no competing interests.
- Published
- 2016
- Full Text
- View/download PDF
8. Collaborative Audit of Risk Evaluation in Medical Emergency Treatment (CARE-MET I) - an international pilot.
- Author
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Subbe CP, Gauntlett W, and Kellett JG
- Subjects
- Aged, Cooperative Behavior, Coronary Care Units statistics & numerical data, Critical Illness therapy, Female, Hospital Mortality, Humans, Intensive Care Units statistics & numerical data, International Cooperation, Length of Stay statistics & numerical data, Male, Middle Aged, Outcome Assessment, Health Care statistics & numerical data, Pilot Projects, Predictive Value of Tests, Risk Factors, Triage standards, Triage statistics & numerical data, Critical Illness mortality, Emergency Service, Hospital standards, Emergency Service, Hospital statistics & numerical data, Hospitalization statistics & numerical data, Medical Audit statistics & numerical data
- Abstract
Background: The absence of an accepted model for risk-adjustment of acute medical admissions leads to suboptimal clinical triage and serves as a disincentive to compare outcomes in different hospitals. The Simple Clinical Score (SCS) is a model based on 16 clinical parameters affecting hospital mortality., Methods: We undertook a feasibility pilot in 21 hospitals in Europe and New Zealand each collecting data for 12 or more consecutive medical emergency admissions. Data from 281 patients was analysed., Results: Severity of illness as estimated by SCS was related to risk of admission to the Intensive Care Unit (p<0.001) but not to the Coronary Care Unit. Mortality increased from 0% in the Very Low Risk group to 22% in the Very High Risk Group (p<0.0001). Very low scores were associated with earlier discharge as opposed to very high scores (mean length of stay of 2.4 days vs 5.6 days, p<0.001). There were differences in the pattern of discharges in different hospitals with comparable SCS data. Clinicians reported no significant problems with the collection of data for the score in a number of different health care settings., Conclusion: The SCS appears to be a feasible tool to assist clinical triage of medical emergency admissions. The ability to view the profile of the SCS for different clinical centres opens up the possibility of accurate comparison of outcomes across clinical centres without distortion by different regional standards of health care. This pilot study demonstrates that the adoption of the SCS is practical across an international range of hospitals., (Copyright 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)
- Published
- 2010
- Full Text
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9. Synthesising the 12-lead electrocardiogram: Trends and challenges.
- Author
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Finlay DD, Nugent CD, Kellett JG, Donnelly MP, McCullagh PJ, and Black ND
- Abstract
An area of electrocardiography which has received much interest of late is that of synthesising the 12-lead ECG from a reduced number of leads. The main advantage of this approach is obvious, as fewer recording sites are required to capture the same information. This, in turn, streamlines the ECG acquisition process with little detriment to the integrity of information used for interpretation. In the current article, we provide an overview of ECG synthesis along with a description of various 'limited lead' systems that have been reported in the literature. Based on this, several suggestions as to what the ECG of the future may entail have been made.
- Published
- 2007
- Full Text
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10. Whither the rationale for thrombolytic agent administration? A retrospective review of traditional intuitive decision-making using a decision analysis model.
- Author
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Kellett JG and O'Riordan J
- Subjects
- Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction drug therapy, Retrospective Studies, Risk Factors, Software, Decision Support Techniques, Myocardial Infarction epidemiology, Streptokinase therapeutic use, Thrombolytic Therapy
- Abstract
Of 50 consecutive patients admitted to Nenagh Hospital coronary care unit 50 per cent did not develop a myocardial infarction. Only 10 patients had definite evidence of infarction on admission. Of the 40 remaining patients, only 15 subsequently developed electrocardiographic and enzymatic confirmation of infarction. Streptokinase was administered to 5 patients who did not infarct, and was not given to 10 patients who did. These decisions to use or withhold thrombolytic therapy were retrospectively reviewed using a computer programme incorporating a decision analysis of the benefits and risks of thrombolysis. The programme examined four scenarios that used different estimates of the chance of death from infarction (pdiMI), and different safety profiles of thrombolytics. The scenario that assumed the worst safety profile and estimated pdiMI from patient age would have recommended thrombolytic treatment to the most with, and to the least without, acute infarction (i.e. 60 per cent of patients with an infarct and 8 per cent without an infarct would have been treated). Depending on the scenario assumed, the traditional intuitive method of decision-making gained from 0.08 and 0.25 quality adjusted life years (QALY's) for the average patient. Had decision analysis been used to guide these decisions these gains would have been enhanced by from 0.21 to 0.28 QALY's per patient, regardless of scenario used.
- Published
- 1993
- Full Text
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11. A thrombolytic decision tree.
- Author
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Kellett JG and O'Riordan J
- Subjects
- Age Factors, Aged, Humans, Male, Middle Aged, Risk Factors, Thrombolytic Therapy adverse effects, Decision Trees, Myocardial Infarction drug therapy, Software, Thrombolytic Therapy statistics & numerical data
- Abstract
We constructed a decision analysis model based on data in the medical literature to estimate the possible outcomes of thrombolytic therapy in patients 50 to 80 years old with possible myocardial infarction. We used the model to test the most likely effects of treatment (determined by averaging the values in reports of large studies) and the worst effects reported so far. The program begins by asking the patient's age, the hours from the onset of pain, and the probability of acute myocardial infarction. It then provides an opportunity to perform sensitivity analyses by changing the values for these variables and for the probability of death in the absence of thrombolytic therapy, as well as for the probability of major stroke and hemorrhage. The counterintuitive findings observed with this program are that the benefits of thrombolytic therapy increase with age and that young patients derive surprisingly little benefit from it.
- Published
- 1992
12. The characterization of growth factor activity in human brain.
- Author
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Kellett JG, Tanaka T, Rowe JM, Shiu RP, and Friesen HG
- Subjects
- Electrophoresis, Polyacrylamide Gel, Fibroblast Growth Factors, Humans, Isoelectric Focusing, Molecular Weight, Myelin Basic Protein analysis, Radioimmunoassay, Brain Chemistry, Peptides isolation & purification
- Abstract
The purification of fibroblast growth factor from bovine brain has been reported (Gospodarowicz, D., Bialecki, H., and Greenberg, G. (1978) J. Biol. Chem. 253, 3736-3743). Westall et al. (Westall, F. C., Lennon, V. A., and Gospodarowicz, D. (1978) Proc. Natl. Acad. Sci. U. S. A. 75, 4675-4678) showed that bovine brain fibroblast growth factor was composed of three fragments derived by limited proteolysis from myelin basic protein. In the present study using similar purification methods, we isolated a fraction enriched in growth factor activity from human brain. The mitogenic activity could not be resolved from myelin basic protein by chromatographic procedures but, upon isoelectric focusing, the mitogen and myelin basic protein were readily dissociated. At least two potent growth factors (pI values 7.2 to 7.4 and 8.1 to 8.6) were identified. Studies of a relatively crude basic extract of human brain suggested that the brain may contain a number of growth factors.
- Published
- 1981
13. The effect of growth hormone treatment on somatomedin levels in growth hormone-deficient children.
- Author
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Dean HJ, Kellett JG, Bala RM, Guyda HJ, Bhaumick B, Posner BI, and Friesen HG
- Subjects
- Adolescent, Adult, Body Height, Child, Child, Preschool, Dwarfism, Pituitary blood, Female, Growth, Growth Hormone deficiency, Humans, Insulin blood, Male, Dwarfism, Pituitary drug therapy, Growth Hormone therapeutic use, Somatomedins blood
- Abstract
Serum levels of immunoreactive somatomedin (IRSM) and insulin-like activity (ILAs) by receptor assay have been measured in 177 GH-deficient (GHD) children treated with 2 U GH three times weekly for 6-10 months. The overall mean (+/- SD) pretreatment IRSM and ILAs levels were 0.21 +/- 0.30 and 0.39 +/- 0.25 U/ml, respectively. Pretreatment IRSM and ILAs levels were in the normal range for chronological age and sex in 15.8% and 33% of these GHD children. Mean IRSM and ILAs levels increased after 1 month of therapy to 0.36 +/- 0.51 and 0.62 +/- 0.33 U/ml, respectively (P less than .0001). The increase in serum IRSM levels (from 0.2 to 2.0 U/ml) that normally occurs from 1-16 yr of age is also evident in untreated GHD children, albeit to a lesser extent. In addition, the mean increase in IRSM after GH was greater in older patients. However, individual responses varied greatly. An increase in IRSM or ILAs with an increase in height velocity (HV) was observed in the majority of children, but all other combinations occurred, including increased SM with decreased HV, decreased SM with increased HV, and decreased SM with decreased HV. In summary 1) age-dependent factors in GHD children importantly influence basal and treatment SM leels; 2) a basal SM level is not a very sensitive diagnostic test, since a significant proportion of GHD children have SM levels in the normal range; and, 3) SM levels in individual patients may not increase with GH therapy and, thus, cannot be used to predict a clinical response to GH therapy.
- Published
- 1982
- Full Text
- View/download PDF
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