Search PubMed⌕ Search

Biomedical subjects

C V Ruckley

Publications and source records attributed to C V Ruckley.

At least 199 records · Page 11Linked to original sources
PubMed1982

Pulmonary embolism in surgical patients: 1959-79.

The Edinburgh surgical statistics (audit) have been analysed for the years 1959, 1964, 1969, 1974, and 1979 to determine the trends in pulmonary embolism in surgical patients who died. There was a total of 61,038 operations, 1528 postoperative deaths, 804 necropsies, and 158 reported pulmonary emboli. The incidence of embolism diagnosed clinically and at necropsy fell throughout the period. This fall held good after corrections for necropsy rates, prognosis, and proportions of major operations. Although the overall necropsy rate fell from 58% to 40%, in patients expected to have a good prognosis the rate rose from 68% to 75%. Necropsy-proved embolism in "good prognosis" patients fell from 0.5% to 0.15% per 100 major operations. The main reduction has taken place since most surgeons in the area adopted methods of prophylaxis against venous thrombosis, but a direct relationship is not proved by this study.

Aged↗
PubMed1981

A five-day ward as part of a comprehensive surgical service.

The role of a five-day ward was examined as part of an audit of the work of a general surgical unit. The four levels of care for elective operations were main ward, five-day ward, major day care, and minor day care. In a prospective study 2000 consecutive patients were followed through their hospital courses from the first referral to the surgical clinic to the postoperative follow-up visit. The aim was to measure the surgical needs of this population and to determine the rates of success or failure in carrying through the planned care. One thousand and forty-five (52%) of the referred patients were put on waiting lists, and of these, 975 (93%) completed their hospital course within the two years of the study. The surgeons chose five-day ward care for 28% of the patients, major and minor day care for 8% and 33% respectively, leaving only 30% who were judged to require care in the main ward. Selections were validated by postoperative interview, which showed that 82% had followed the expected hospital course, and by monitoring deviations from planned care. Four per cent of the five-day ward patients required transfer to the main ward and 3.3% required readmission. Patients managed in the five-day ward were on average younger and the conditions less urgent than those in the main ward. We conclude that a five-day ward can fulfil a large and important part of a general surgical service provided that its function is closely integrated with other parts of the service and that patients are accurately assessed in the outpatient clinic.

Adult↗
PubMed1981

Surgical decision making.

The decision-making process in a general surgical outpatient clinic has been studied by following the course of 2000 consecutive newly referred patients of whom 1045 were put on surgical waiting lists. Surgeons were asked to record their reasons for selection for each of four levels of care: main ward, 5-day ward, day bed unit or minor outpatient surgery. Selections were influenced by social and psychological factors in 12 per cent of patients, the remaining 88 per cent were determined by the medical history or physical condition. The decision was assessed by monitoring the progress in hospital and the outcome at a follow-up clinic. In 84 per cent of patients arrangements had gone according to plan. Eleven (1.75 per cent) of 5-day or day care patients were transferred to a higher level of care and 13 (1.4 per cent) of the total series were re-admitted. Surgeons were asked to forecast the duration of postoperative stay. Thirty-six per cent were discharged on the day forecast, 63 per cent within 24 h and 75 per cent within 48 h. Forecasts of length of stay for hernias and varicose veins were accurate but were usually underestimated for major surgery. It is concluded that for the majority of general surgical patients the selection of the level of care and the forecast of postoperative stay were sufficiently reliable to allow confident and definite advice to be given to the patient and to allow resources to be efficiently used.

Decision Making↗
PubMed1980

Day-bed units.

Explore the source record for details and available documents.

Ambulatory Surgical Procedures↗
PubMed1979

Operations for hernia and varicose veins in a day-bed unit.

Over eight years (1970-8) 1055 patients underwent operations for hernia or "major" varicose veins in a day-bed unit. Here, 608 were discharged home on the day of operation, 262 were transferred to a convalescent hospital for 48 hours, and 161 were retained in the acute ward as part of a controlled trial. Special emphasis was placed on selection and preadmission screening. Failure of planning was uncommon in that only 2.5% were detained in hospital and 1% had to be readmitted. About one-quarter of the patients had complications but these were generally trivial and were satisfactorily treated by the community nursing sisters or general practitioners, or both. Analysis of the total operations for hernia or varicose veins in the unit over the past 19 years shows that, whereas formerly all patients with these conditions were admitted to the main surgical ward, nowadays almost all are managed either by day care or in a five-day ward.

Adult↗
PubMed1979

Work of a day-bed unit 1972-8.

From 1972 to 1978 inclusive 32 311 patients were managed in a 24-bedded day-bed unit in a district general hospital. The principal specialties using this were urology, gastroenterology, general surgery, gynaecology, haematology, orthopaedics, and radiology. Patient selection, a high standard of secretarial work, and good liaison with general practitioners, the community nursing service, and the ambulance service are most important. Day care forms a large, important, and increasing part of the work of the hospital, and without it many of the specialties would be unable to cope with the demand, and their waiting lists would lengthen continuously.

Ambulatory Surgical Procedures↗
PubMed1978

Smoking and risk factors in deep vein thrombosis.

The incidence of deep vein thrombosis (DVT) as diagnosed by the 125I fibrinogen test (125IFT) was determined in a series of 300 newly admitted medical and 201 surgical patients. 6 medical patients died before 125IFT screening could be completed. The incidence of DVT was 14% in medical patients and 18% in surgical patients. Increasing age, a malignant condition and a past history of thromboembolism all increased the risk of DVT. Increasing levels of cigarette smoking were found to be associated with a reduced incidence of DVT. Although statistical significance was achieved at only the 10% level for this finding it is in agreement with the results from studies on patients with myocardial infarction. The protective effect of cigarrette smoking was observed at all ages, and in both medical and surgical patients.

Adult↗
PubMed1978

beta-thromboglobulin and deep vein thrombosis.

The measurement of plasma beta-thromboglobulin as a potential diagnostic test for venous thrombosis has been investigated in 16 normal volunteers, 24 patients presenting with deep vein thrombosis (DVT) or pulmonary embolism and 46 patients screened by 125I fibrinogen test (IFT) for post-operative DVT. The normal mean was 33 ng/ml (range 15-117 ng/ml). Of the 24 patients with clinical thrombotic disease 22 presented with DVT confirmed by phlebogram or IFT and 2 presented with embolism confirmed by lung scan. At the time of first presentation 12 out of 24 had betaTG values greater than 70 ng/ml. All except 3 of this group of 24 patients had values of greater than 70 ng/ml at some stage during a subsequent week of daily sampling. DVT was detected in 13 out of 46 screened post-operative patients. There was a rise om betaTG observed within 24 hr of the IFT becoming positive but the mean rise did not reach significance at the 5% level. An association between DVT and high betaTG values has been confirmed. However, its clinical value cannot yet be fully elucidated until factors, probably related to blood sampling and clearance, are further investigated.

Beta-Globulins↗
PubMed1978

Dextran and intermittent pneumatic compression in prevention of postoperative deep vein thrombosis: multiunit trial.

Seven general surgical units co-operated in a clinical trial of dextran 70 and pneumatic calf compression alone and in combination in the preventing of 125I-fibrinogen-detectable deep vein thrombosis in 305 patients. Both dextran regimens were significantly more effective than pneumatic compression alone. Pulmonary embolism was diagnosed in 14 patients, but there was no significant difference in incidence among the three treatment groups. In patients receiving dextran there was no greater median operative blood loss but there was a significantly greater incidence of postoperative bleeding complications.

Aged↗