Search PubMed⌕ Search

Biomedical subjects

A Nicholas

Publications and source records attributed to A Nicholas.

12 recordsLinked to original sources
PubMed2000

The effect of a picture archiving and communications system (PACS) on diagnostic performance in the accident and emergency department.

OBJECTIVE: A study has been conducted to identify the benefits to the accident and emergency (A&E) department of a hospital wide Picture Archiving and Communications System (PACS). METHODS: The study was conducted in two parts: firstly while the hospital was using conventional radiographic films, and secondly when the PACS was in operation. For each part of the study, the diagnoses of radiographic images made by A&E clinicians were compared with those made by radiologists. This resulted in the estimation of the incidence of false negative findings by the A&E staff. The management of patients with such findings was studied to identify those for whom a change of treatment was required. Such data for the two periods, when film and when PACS was used, were compared. RESULTS: It was found that the overall rate of misdiagnoses across all A&E patients who had radiography was low in both periods and there was a significant reduction when PACS was used (1.5% for film and 0.7% for PACS, 95% CI for difference between proportions: -0.014 to -0.0034), but the rate of serious misdiagnoses involving patient recall did not change significantly (95% CI for difference between proportions: -0.0059 to +0.0001). CONCLUSIONS: When PACS was used the diagnostic performance by A&E staff improved by reducing false negative interpretations but the rate of serious misdiagnosis did not change.

Diagnostic Errors↗
PubMed1998

The case for early intervention with pre-school dysfluent children.

This paper aims to provide support for the hypothesis that early intervention with young dysfluent children is more successful over a shorter period of time than if speech and language therapy is delayed. The case histories of children between the ages of 3;06 and 5;11 years and 8;00 and 10;11 years who attended the Michael Palin Centre in a one year period were analysed. Those children whose histories included four or more risk factors were included in the study. The amount and duration of speech and language therapy along with the outcome was measured. Outcome was measured by the presence of stammering and parental and child concern. Preliminary findings indicate that the hypothesis will be supported. Full statistical analysis will be presented at the conference. Implications of the findings for service delivery will be discussed.

Age Factors↗
PubMed1987

Duration of vaginal bleeding and trisomy at prenatal diagnosis.

In the case-control study of 118 women with autosomal trisomy identified at prenatal diagnosis and their 442 karyotypically normal matched controls, we found that there was no overall association between risk of trisomy and the presence of vaginal bleeding during pregnancy. However, a lengthy duration of bleeding appears to predict increased risk of trisomy.

Amniocentesis↗
PubMed1979

Reversal of impaired splenic function in patients with nephritis or vasculitis (or both) by plasma exchange.

By studying the clearance of autologous labeled antibody-coated or heat-damaged erythrocytes, we showed that reversible blockade of the splenic component of reticuloendothelial function existed in 14 of 15 patients referred for treatment of nephritis or vasculitis. In 10 patients treated by plasma exchange--alone in three and combined with steroids and cytotoxic drugs in six--reversal of splenic blockade followed in nine, and in the three patients treated solely by plasma exchange this reversal was demonstrated to occur within 48 hours of the procedure. Only gradual reversal of splenic blockade was found in three of five patients treated by steroids with or without cytotoxic drugs; no change in splenic function was observed in two. When circulating immune complexes were detected by a C1q-binding assay, there was, in serial studies, an approximate inverse correlation between splenic function and the level of C1q-binding material, though hyposplenism was also a feature of patients in whom the C1q-binding assay was negative.

Antigen-Antibody Complex↗
PubMed1978

Splenic red cell pooling: a diagnostic feature in polycythaemia.

Total red cell volumes and splenic red cell pools were measured in 31 patients with polycythaemia. 22 had polycythaemia vera (PV), 12 of whom had clinically detectable splenomegaly, and nine patients had secondary polycythaemia (PS). The mean red cell pool was 192.8 ml (SD 126.6) in PV (all cases), and 130.9 ml (SD 28.4 ml) in PV without splenomegaly; it was 61.1 ml (SD 8.3 ml) in PS. When expressed relative to spleen size (in cm), differences were even more striking: PV (all cases)--mean 13.7 ml/cm (SD 4.3); PV without splenomegaly--mean 12.7 ml/cm (SD 2.2); PS--mean 6.6 ml/cm (SD 1.2). Measurement of splenic red cell pool thus appears to be a valuable diagnostic tool for distinguishing between PV and PS. The findings point to the presence in PV of a splenic structural abnormality which is not simply an effect of the increased circulating red cell mass.

Adult↗