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Articles by J George
Total Records ( 4 ) for J George
  H Clough , J George and A. Duncan

Non-bacterial thrombotic endocarditis or marantic endocarditis is an uncommon and frequently terminal condition. We report non-bacterial thrombotic endocarditis presenting as a psychotic illness. The underlying cause was found to be adenocarcinoma of the lung. The patient was nursed on a specialist joint medical/psychiatric unit. Many medical illnesses can present with psychosis in older people: this is the first case report of this presentation in non-bacterial thrombotic endocarditis.

  C. Y Lee , J George , R. A Elliott and K. Stewart

Background: information on medication use and risk factors among older people residing in retirement villages and their uptake of medication reviews are scant.

Objectives: to identify medication use issues and risk factors for medication-related problems among retirement village residents and to evaluate the uptake of government-subsidised Home Medicines Review (HMR) services in this population.

Design: cross-sectional, mail survey.

Setting: retirement villages in Victoria, Australia.

Participants: members of the Residents of Retirement Villages of Victoria residing in retirement villages (2,116, aged 54–100 years).

Methods: a questionnaire was developed incorporating validated scales and items to measure medication risk, medication adherence, co-morbidity, disability, information on medication use, health and the uptake of HMR services. Questionnaires were mailed to participants for self-completion and returned using reply-paid envelopes.

Results: of the 2,116 respondents (70.7% response rate), 2,006 (94.8%; 95% confidence interval (CI) 93.9–95.7%) reported using prescribed medications. Three or more health conditions were present in 993 (46.9%; 95% CI 44.8–49.0%) respondents. Five or more regular medications were used by 988 (46.7%; 95% CI 44.6–48.8%) respondents. Twelve or more tablets/capsules per day were used by 229 (10.8%; 95% CI 9.5–12.1%) respondents. The use of narrow therapeutic index medications was reported by 264 (12.5%; 95% CI 11.1–13.9%) respondents. Changes to medication regimens in the previous 3 months were reported by 356 (16.8%; 95% CI 15.2–18.4%) respondents. One or more medication-related risk factors were seen in 1,374 (64.9%; 95% CI 62.9–66.9%) respondents. Of these at-risk residents, 76 (5.5%; 95% CI 4.5–6.5%) reported receiving an HMR in the previous 12 months, who were older (P < 0.001), were using more medicines (P < 0.001) and had greater disability (P = 0.002).

Conclusions: reasons for the low uptake of medication reviews in retirement village residents despite the high prevalence of medication risk require further investigation.

  J Sun , K Hartvigsen , M. Y Chou , Y Zhang , G. K Sukhova , J Zhang , M Lopez Ilasaca , C. J Diehl , N Yakov , D Harats , J George , J. L Witztum , P Libby , H Ploegh and G. P. Shi

Background— Adaptive immunity and innate immunity play important roles in atherogenesis. Invariant chain (CD74) mediates antigen-presenting cell antigen presentation and T-cell activation. This study tested the hypothesis that CD74-deficient mice have reduced numbers of active T cells and resist atherogenesis.

Methods and Results— In low-density lipoprotein receptor–deficient (Ldlr–/–) mice, CD74 deficiency (Ldlr–/–Cd74–/–) significantly reduced atherosclerosis and CD25+-activated T cells in the atheromata. Although Ldlr–/–Cd74–/– mice had decreased levels of plasma immunoglobulin (Ig) G1, IgG2b, and IgG2c against malondialdehyde-modified LDL (MDA-LDL), presumably as a result of impaired antigen-presenting cell function, Ldlr–/–Cd74–/– mice showed higher levels of anti–MDA-LDL IgM and IgG3. After immunization with MDA-LDL, Ldlr–/–Cd74–/– mice had lower levels of all anti–MDA-LDL Ig isotypes compared with Ldlr–/– mice. As anticipated, only Ldlr–/– splenocytes responded to in vitro stimulation with MDA-LDL, producing Th1/Th2 cytokines. Heat shock protein-65 immunization enhanced atherogenesis in Ldlr–/– mice, but Ldlr–/– Cd74–/– mice remained protected. Compared with Ldlr–/– mice, Ldlr–/–Cd74–/– mice had higher anti–MDA-LDL autoantibody titers, fewer lesion CD25+-activated T cells, impaired release of Th1/Th2 cytokines from antigen-presenting cells after heat shock protein-65 stimulation, and reduced levels of all plasma anti–heat shock protein-65 Ig isotypes. Cytofluorimetry of splenocytes and peritoneal cavity cells of MDA-LDL– or heat shock protein-65–immunized mice showed increased percentages of autoantibody-producing marginal zone B and B-1 cells in Ldlr–/–Cd74–/– mice compared with Ldlr–/– mice.

Conclusions— Invariant chain deficiency in Ldlr–/– mice reduced atherosclerosis. This finding was associated with an impaired adaptive immune response to disease-specific antigens. Concomitantly, an unexpected increase in the number of innate-like peripheral B-1 cell populations occurred, resulting in increased IgM/IgG3 titers to the oxidation-specific epitopes.

  D Stewart , J George , C Bond , L Diack , J Cleland , D McCaig , S Cunningham , K MacLure and S. Harkness

Objective. To develop and validate an assessment tool, based on the ‘Royal College of General Practitioners’ (RCGP) Video Assessment Tool’, for assessment of pharmacist prescribers’ consultation skills.

Methods. Competency areas of the RCGP tool were left unchanged but performance criteria for each were modified to reflect pharmacist prescribing. Each criterion and the overall consultation were rated from 1 (poor) to 5 (excellent).

A purposive sample of 10 experienced prescribing pharmacists was selected. Each pharmacist identified, recruited and consented two patients. Video recordings of consultations were assessed independently by two randomly assigned GPs, experienced in the use of the RCGP tool, using the newly developed scale. Inter-rater reliability was assessed. Construct validity was assessed by comparing the assessor score with a patient satisfaction score. Spearman's rho was used to test the correlation between the two scores.

Results. The RCGP tool was modified to give the ‘Pharmacist Consultation Assessment Tool’ (PharmaCAT). The median overall PharmaCAT consultation rating was 3. There was good agreement between the two assessors for total scores (intraclass correlation coefficient = 0.694).

Fourteen (78%) patient satisfaction questionnaires were returned; most (n = 13, 93%) agreed/strongly agreed that they were entirely satisfied with the consultation. Correlations between average total scores on PharmaCAT and the patient satisfaction questionnaire were weak (Spearman's rho = 0.142 and 0.242 for both assessors).

Conclusions. The PharmaCAT has been tested in the pharmacist prescriber setting. The tool had discriminatory power across different domains and inter-rater reliability. The PharmaCAT has potential to be used as a formative and/or summative assessment tool.

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