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Biomedical subjects

B T Williams

Publications and source records attributed to B T Williams.

At least 19 recordsLinked to original sources
PubMed1992

Nurse practitioners in accident and emergency departments: what do they do?

OBJECTIVE: To determine the distribution and scope of nurse practitioner schemes in accident and emergency departments in England and Wales; to describe the caseloads of doctors and nurse practitioners on two representative days; and to estimate the number of patients managed by nurse practitioners in the year to 31 March 1991. DESIGN: A postal survey of accident and emergency departments and a content analysis of case notes of new patients attending a representative sample of accident and emergency departments on two days. SETTING: All accident and emergency departments in England and Wales. PARTICIPANTS SURVEY: 560 nurses in charge of accident and emergency departments. Census: case notes of 5814 patients in 37 accident and emergency departments. MAIN OUTCOME MEASURES SURVEY: number of accident and emergency departments with nurse practitioner schemes. Census: demographic and clinical characteristics of new patients attending and whether nurse practitioner or doctor made diagnoses and ordered investigations, treatments, referrals, discharges. RESULTS: 513 replies (92%) from 465 surveyed functioning accident and emergency departments and 48 departments recently closed. 27 (6%) departments used designated nurse practitioners and 159 (34%) "unofficial" nurse practitioners. Only 530 (9%) of the 5814 patients in the census were managed entirely or mainly by nurse practitioners, with higher proportions in ophthalmic departments (nearly 30%) and minor casualty departments (over 40%) than in major departments (3%). Most patients managed by nurse practitioners (86%) had minor trauma. In the year ending 31 March 1991 an estimated 390,000 (95% confidence interval 260,000 to 520,000) patients out of a total of 12.5 million (3.1%, 2.1% to 4.1%) were clinically managed by a nurse practitioner. CONCLUSIONS: Designated nurse practitioner schemes are rare. The volume and range of nurse practitioner work in major general accident and emergency departments is small compared with those in specialised and minor accident and emergency departments.

Emergencies↗
PubMed1992

Randomised controlled trial of cost-effectiveness of lithotripsy and open cholecystectomy as treatments for gallbladder stones.

Inpatient extracorporeal shockwave lithotripsy for treatment of gallbladder stones has not previously been compared with open cholecystectomy in terms of cost-effectiveness. In a randomised controlled trial, 163 patients, stratified by gallstone bulk (over 4 cm3 or not), were randomised to lithotripsy or cholecystectomy (38 large-bulk and 27 small-bulk cholecystectomy; 37 large-bulk and 61 small-bulk lithotripsy) and followed up for 1 year. Both treatments gave significant health gains in terms of a reduction in episodes of biliary pain, improved perceived health status, and symptom relief, but few differences between treatments were found. There was some evidence that biliary-pain episodes were less severe after cholecystectomy. Cholecystectomy patients also had greater improvements in mean health gain for three related symptoms: vomiting, feeling sick, and fatty-food upset. However, there were no differences between groups in perceived health status. Among lithotripsy patients, health gain was not related to stone clearance. Lithotripsy was more expensive than cholecystectomy, principally because of the costs of the inpatient stay and adjuvant bile-salt therapy. Conventional lithotripsy appears at least as cost-effective as cholecystectomy for patients with small-bulk stones but less cost-effective for those with large-bulk stones. To some extent treatment choice can be guided by patient preference.

Adult↗
PubMed1992

Disseminated strongyloidiasis in a World War II Veteran with metastatic undifferentiated carcinoma of neuroendocrine type.

This case of disseminated strongyloidiasis illustrates the need for a high index of suspicion and effective screening for this pathogen in certain high-risk patient populations before giving immunosuppressive therapy. A complete travel and military history should be obtained. In the United States, persons with a history of military service in endemic areas, emigrants from endemic areas, patients in institutions, and residents of the Southeast should have careful evaluation for strongyloidiasis. Eosinophilia may or may not be present. Stool examinations are not sufficient to rule out the diagnosis. When available, the ELISA screening test for serodiagnosis may be useful. Duodenal aspirates or bronchoalveolar lavage may be necessary to confirm the diagnosis.

Adrenal Cortex Hormones↗
PubMed1992

Microalbuminuria associated with diabetic neuropathy.

OBJECTIVE: To test the hypothesis that microalbuminuria may show an independent statistical association with diabetic neuropathy. RESEARCH DESIGN AND METHODS: An observational study of a prospectively identified cohort was conducted at the University Medical Center. The cohort consisted of 78 consecutive diabetic patients who fulfilled the criteria of having diabetes for greater than 10 yr, a normal serum creatinine, urine negative for macroalbuminuria by a commonly used dipstick method, a blood glucose less than 13.8 mM (less than 250 mg/dl), and an HbA1 less than 11% (normal range 5.5-8.5%). Medical record review established the presence of chronic complications of diabetes. Urine albumin level was measured by radioimmunoassay. Albumin concn greater than or equal to 15 mg/L was used as a cutoff value for microalbuminuria. RESULTS: Twenty-five of 78 patients (32%) showed microalbuminuria. Of these, 51% had neuropathy, 39% had retinopathy, 35% arterial hypertension, 17% peripheral vascular disease, and 15% ischemic heart disease. After adjusting for age, sex, and type and duration of diabetes, diabetic neuropathy and hypertension showed a significant association with microalbuminuria. After adjusting for other diabetic complications, diabetic neuropathy showed a significant association with microalbuminuria. CONCLUSIONS: Microalbuminuria is independently associated with diabetic neuropathy. This association lends support to the theory of a vascular etiology for diabetic distal symmetrical neuropathy.

Albuminuria↗
PubMed1979

Biochemical testing for acute medical emergencies in four district general hospitals.

Comparable samples of 200 medical emergency admissions in four district general hospitals showed a threefold difference in the mean number of biochemical test values provided per patient, nearly all of which were obtained from blood specimens. Hospitals had consistently high or low mean numbers of values per patient for specific tests and clinical presentations and whether first or repeat tests were considered. Only 30 out of 188 different test types were reported at all four hospitals. Clinicians and chemical pathologists might benefit from regular expert advice on the most discriminating use of test information in cases with various clinical presentations.

Clinical Laboratory Techniques↗
PubMed1979

Thallium-201 myocardial imaging in assessment of results of aortocoronary bypass surgery.

Thirty-six patients were assessed by thallium-201 myocardial imaging before and after aortocoronary bypass operations and the results were compared with evaluation based on symptomatic assessment, exercise testing, and electrocardiography. After operation, the majority of patients were free from symptoms or symptomatically improved with increased exercise duration. Perioperative myocardial damage was shown in eight patients and myocardial ischaemia in 15 patients when assessed by thallium imaging during exercise. Thallium imaging proved more sensitive than electrocardiography in the demonstration of perioperative infarction and in the detection of postoperative ischaemia. Exercise electrocardiography may be misleading after aortocoronary bypass operations. Thallium imaging offers a simple, objective evaluation of the results of revascularisation procedures, throws light on the mechanisms of relief of angina by operation, and helps in the assessment of the patient whose progress is unsatisfactory after operation.

Adult↗
PubMed1979

Haemodynamic effects of disopyramide in patients after open-heart surgery.

Disopyramide phosphate was administered intravenously in a dose of 1.2 mg/kg body weight over one minute to nine patients after open-heart surgery and coronary artery bypass grafting. The haemodynamic changes were studied during and for 30 minutes after drug administration. Heart rate was unchanged throughout the study. During infusion the only significant changes were an increase in systemic blood pressure and systolic impedance signifying a direct increase in peripheral arterial resistance. Systemic blood pressure remained significantly higher for 10 minutes and systolic impedance for 30 minutes. Immediately after infusion max. dPower/dT, a measure of ventricular contractility, was significantly depressed for 15 minutes. Both cardiac output and aortic flow were significantly depressed for 30 minutes. DPTI/TTI, an estimate of subendocardial supply/demand ratio, showed an insignificant increase throughout the study. This study shows that intravenous disopyramide starts acting within 45 seconds of the start of infusion, directly increases peripheral arterial resistance, has a breif negative inotropic action, and does not reduce subendocardial blood flow.

Adult↗
PubMed1979

Omental abscess: an unusual complication of cesarean section.

A case of an omental abscess following low transverse cesarean section is described. The incidence of cesarean section is rising, and with this rise one might expect an increase in the number and types of complications. A review of the literature fails to demonstrate any mention of this particular complication. In the evaluation of patients, one must consider not only the known but also the possible.

Abscess↗
PubMed1978

Haemodynamic effects of buprenorphine after heart surgery.

The effect of buprenorphine on the cardiovascular system was examined in 11 patients during the period of reduced cardiac reserve after open-heart surgery. Within 10 minutes of giving the full analgesic dose (5 microgram/kg) intravenously the mean heart rate had fallen significantly by six beats/min. Although in two patients the mean arterial pressure fell by 24 mm Hg, there was no overall change in mean arterial pressure, cardiac output, or peripheral resistance. In a further six patients buprenorphine was used successfully as the sole analgesic after open-heart surgery. Buprenorphine appears to be safer than morphine for use in patients with reduced cardiac reserve and is of similar analgesic efficacy.

Adult↗
PubMed1978

NHS locally organised research scheme: regional research committees and the way they work.

Regional research committees vary so widely in size, composition, and their methods of judging proposals that the standards of adjudication may also vary. Once the research has started it tends to be poorly monitored, and comparatively little attempt is made to discover whether the inexperienced researcher's ability has been promoted. Fostering the research spirit entails more than the provision of funds, and some regional health authorities may need to establish more formal ways of supervising and evaluating the research they support.

Education, Medical↗
PubMed1978

Measurement of the circulatory effects of dobutamine, a new inotropic agent, in patients following cardiac surgery.

The use of an extractable aortic electromagnetic flow probe to provide a continuous on-line display of ascending aortic flow and cardiac output following open heart surgery is described. Utilizing this equipment, the hemodynamic actions of dobutamine and isoprenaline are compared in 14 patients immediately following cardiac surgery. The study confirmed an inotropic action produced by dobutamine at a heart rate 10 to 15 per cent lower than isoprenaline, with less peripheral vascular action. Arterial and coronary sinus blood analyses revealed little difference in the myocardial metabolic actions of either drug. Because inotropic drugs produce only relatively small increases in stroke volume in this group of patients, the rise in cardiac output caused by these agents is more dependent on the effects upon heart rate rather than improved myocardial contractile state and consequently dobutamine has little advantage over isoprenaline in this situation.

Adult↗
PubMed1978

Physiotherapy: its prescription and implementation for orthopaedic out-patients.

During a three-month period, 1462 (29%) of the new out-patients seen by 18 orthopaedic surgeons were prescribed physiotherapy. The rates of referral among the surgeons ranged widely, from 15% to 56%, and the differing characteristics of the patients did not account for these variations. For specific conditions examined, physiotherapy appeared to be one of a range of possible therapies. The majority of prescriptions gave clinical details and specified the type of treatment, but its duration was specified in less than half; the frequency and aims of treatment were hardly ever given. Nearly 90% of the patients completed their course. Fourteen different types of treatment were applied, but only four of these--heat, exercises, electrical stimulation, and traction--were applied to more than 3% of the patients. Physiotherapists nearly always carried out the treatments prescribed and augmented them in nearly a quarter of cases, usually with heat and/or exercises.

England↗
PubMed1978

Coronary artery ectasia--a variant of occlusive coronary arteriosclerosis.

In a study of 1000 consecutive coronary arteriograms, 12 patients (all men) had coronary artery ectasia. Ectasia was found most frequently in the circumflex or right coronary artery. Only 1 patient had ectasia in the left anterior descending coronary artery. In 11 patients, ectasia of one artery was associated with severe stenosis or occlusion of other vessels, typical of arteriosclerosis. Histology from an ectatic segment in one of this group showed changes of severe arteriosclerosis with extensive intimal fibrosis and destruction of the media. One patient had a mixed collagen vascular disease. Measurement of coronary sinus flow in 2 patients with coronary artery ectasia showed flows in the range of patients with non-ectatic coronary artery disease. At cardiac surgery flows down the graft to ectatic arteries were in the same range as in grafts to non-ectatic vessels. Patients with coronary artery ectasia should be anticoagulated.

Adult↗