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Biomedical subjects

C A Vincent

Publications and source records attributed to C A Vincent.

30 records · Page 2Linked to original sources
PubMed1990

Obstetric accidents: a review of 64 cases.

OBJECTIVE: To identify the causes of obstetric accidents. DESIGN AND SETTING: Analysis of case records at the Medical Protection Society's London office covering the five years 1982-6. SUBJECTS: Cases that had come to litigation which had resulted in stillbirth, perinatal or neonatal death, central nervous system damage to the baby, or maternal death and in which there was an opinion from a senior obstetrician consulted by the society. Of 147 cases reviewed, 64 met the criteria for the study. MAIN OUTCOME MEASURES: The principal findings of the expert reviewers. RESULTS: Three major topics of concern emerged common to most of the 64 cases. These were inadequate fetal heart monitoring, mismanagement of forceps, and inadequate supervision by senior staff. In 11 of the 64 cases cardiotocography was omitted, in 19 cases the trace was missing, in six cases the trace was unreadable, and in 14 of the remaining 28 cases signs of fetal distress went unnoticed or were ignored. In 31 cases forceps were used to aid delivery or were tried and abandoned in favour of caesarean section. In 16 cases two or more attempts to use forceps were made. Five infant deaths were directly attributed to mismanaged forceps. In 20 cases senior staff were criticised by the expert reviewer for failure to come to the labour ward. In many of these cases they may have given advice over the telephone, but the inadequacy of records made it impossible to tell. In these cases the labour and birth were managed by junior staff, usually a senior house officer. In six cases when senior staff did come they suggested that no action was needed. CONCLUSION: These few cases should not be dismissed as isolated incidents in obstetric practice in Britain. They reflect more general problems--namely, concerning the ability of junior doctors to interpret fetal heart traces accurately, their ability to use forceps, and the participation of senior staff in running a labour ward and delivery suite.

Adolescent↗
PubMed1990

The treatment of tension headache by acupuncture: a controlled single case design with time series analysis.

A single case design, with time series analysis, was employed to evaluate the efficacy of acupuncture in the treatment of tension headache. Fourteen patients were given eight weekly treatments, four of true acupuncture and four of sham in random order. Mean pain in medication scores were reduced by 52% and 54% respectively at initial follow-up. Reductions in pain scores of over 50% were achieved by half the patients and the significance of these changes confirmed by time series analysis. The majority of patients maintained their gains at four month follow-up. True acupuncture was shown to be significantly superior to sham, demonstrating a specific therapeutic action, in four patients. In the remainder no difference was observed. Possible mechanisms for these effects are discussed. Acupuncture is a potentially valuable treatment for tension headache but further research is needed.

Acupuncture Analgesia↗
PubMed1989

The significance of needle placement site in acupuncture.

Traditional acupuncturists claim that correct needling of classical acupuncture loci is associated with a characteristic set of sensations usually referred to as 'Teh Chi'. The studies reported here examine this claim. In the first a multiple adjective sensation rating scale was developed and administered to 125 patients receiving acupuncture treatment. The results were subjected to principal components analysis and the first factor to emerge provided some support for the constellation of sensations corresponding to Teh Chi. In the second study the scale was used in a randomised controlled mixed single/double blind experiment in which 65 volunteers were stimulated at three classical and three non-classical (sham) needling sites by either a trained acupuncturist (single blind) or an anaesthetist (double blind). The results of the second study did not support the contention that the sensations of Teh Chi occur more frequently at classical acupuncture needling sites. The implications of the results for the practice of acupuncture are discussed.

Acupuncture Therapy↗
PubMed1989

A controlled trial of the treatment of migraine by acupuncture.

A randomised controlled trial comparing true and sham acupuncture was conducted on 30 patients suffering from chronic migraine. Diary measures of headache and medication intake were recorded throughout the study, and measures of headache quality, anxiety, and pain behaviour were taken. The credibility of the true and sham treatment procedures was also assessed. True acupuncture was significantly more effective than the control procedure in reducing the pain of migraine headache. Posttreatment reductions in pain scores and medication of 43 and 38%, respectively, were recorded in the true acupuncture group and were maintained at 4-month and 1-year follow-up.

Acupuncture Therapy↗
PubMed1988

Use of advisers in the diagnosis and management of abdominal pain in accident and emergency departments.

The performance of senior house officers (SHOs) and their advisers in accident and emergency departments was compared in the diagnosis of abdominal pain in 711 patients. Accuracy of diagnosis was 63 per cent for advisers and 54 per cent for SHOs. Overall, the adviser improves the diagnosis of the SHO in only 6 per cent of cases. The SHOs refer accurately in 94 per cent of cases, and the advisers improve the SHO referrals in only 1 per cent of patients. It is argued that the time-consuming process of calling a surgeon away from a ward or theatre to advise in the receiving room is of little value, and avoidance of this step would enable patients to be admitted more rapidly.

Abdomen, Acute↗
PubMed1988

Accuracy of detection of radiographic abnormalities by junior doctors.

This study assessed the ability of junior doctors in accident and emergency to detect radiographic abnormalities. Their assessments of 505 radiographs taken at nights and weekends over a period of 8 months and showing abnormalities were examined. Each assessment by a senior house officer (SHO) was compared with the subsequent diagnosis of a radiologist of senior registrar or consultant status. An error rate of 35% was found. For abnormalities with clinically significant consequences the error rate was 39%. Although this error rate appears high the results are consistent with those of earlier studies in that missed positive radiographs constitute 2.8% of the total number of radiographs taken in the period. It is considered that the proportion of missed abnormalities gives a truer index of SHOs' abilities. No improvement in performance was evident over the 6-month period of the SHOs tenure of post. It is argued that it is unrealistic to expect accident and emergency SHOs to acquire this complex skill simply through experience and that more formal training and guidance is needed.

Clinical Competence↗
PubMed1987

The use of the accident and emergency department.

Many studies have shown that a high proportion of patients attending accident and emergency (A&E) departments have only trivial or non-urgent complaints. A&E staff treat these inappropriate attenders while recognizing that this detracts from the care given to more serious cases. Dwindling resources and higher attendances make it a matter of necessity that inappropriate attenders be treated by general practitioners or equivalent primary care services. In this study, the authors examined the feasibility of methods of reducing inappropriate attendance. The authors investigated patients' ability to accurately assess the urgency of their condition and, hence, their need for A&E services. The authors concluded that there is probably no practical way of reducing inappropriate attendance that does not involve risk to a proportion of patients. The possibility of extending the role of the A&E department to provide more general primary care is discussed.

Accidents↗
PubMed1987

Acupuncture for some common disorders: a review of evaluative research.

This paper reviews the use of acupuncture to treat several disorders where pain is not the primary symptom. Studies on asthma have shown a small but consistent short-term therapeutic effect of acupuncture. One study of long-term effects found no improvement in asthma after acupuncture while the other reported a modest effect on symptom relief but with a greater impact on medication reduction. Further studies of the long-term effects of acupuncture on asthma would seem desirable even though the currently available findings are equivocal. Sufficient work has now been carried out on sensorineural deafness to conclude that acupuncture has no worthwhile effects on this condition. Only two studies have been carried out on tinnitus; they indicate that the effects of short courses of acupuncture are at best slight. There are some encouraging findings for acupuncture treatment of hypertension, although the study was seriously flawed by the lack of a no treatment control group. With regard to giving up smoking it seems that acupuncture may assist during the withdrawal period and that it compares favourably with other forms of treatment; whether there is any specific effect of the acupuncture is not yet clear. As with other attempts to stop people smoking, however, there is a high relapse rate. The trials of acupuncture on psychiatric disorders have suffered from the lack of detailed assessment and control groups; no conclusions can be drawn without further studies. The studies on weight loss similarly do not permit any firm conclusions about the usefulness of acupuncture.

Acupuncture Therapy↗
PubMedDate not supplied

Measuring intra-operative interference from distraction and interruption observed in the operating theatre.

An observational tool was developed to record distraction and interruption in the operating theatre during surgery. Observed events were assigned to pre-defined categories and rated in relation to the level of team involvement - the sum of which was treated as a measure of intra-operative interference. Many events (0.29 +/- 0.02 per min) were observed and rated in 50 general operations sampled from a single operating theatre. The rating of individual events (r(s) = 0.65) and of cases (r(s) = 0.89) correlated between independent observers. Interference levels (1.04 +/- 0.07/min) also correlated with door opening frequency (0.68 +/- 0.03/min) (r = 0.47, p < 0.001). Some sources of interference were intrinsic to the work of the surgical team, including equipment, procedure and environment, while others were extraneous, including bleepers, phone calls and external staff. The findings highlight the need to further develop measures of interference, to assess its variation, intensity and its effect on surgical team performance.

Anesthesiology↗