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D J Vassallo

Publications and source records attributed to D J Vassallo.

At least 19 recordsLinked to original sources
PubMed2001

Experience with a low-cost telemedicine system in three developing countries.

The Swinfen Charitable Trust was established in 1998 with the aim of helping the poor, sick and disabled in the developing world. It does this by setting up simple telemedicine links based on email to support doctors in isolated hospitals. The first telemedicine link was established to support the lone orthopaedic surgeon at the Centre for the Rehabilitation of the Paralysed (CRP) in Savar, near Dhaka in Bangladesh, in July 1999. An evaluation of the 27 referrals made during the first year of operation showed that the telemedical advice had been useful and cost-effective. Based on the success of the Bangladesh project, the Swinfen Charitable Trust supplied digital cameras and tripods to more hospitals in other developing countries. These are Patan Hospital in Nepal (March 2000), Gizo Hospital in the Solomon Islands (March 2000), Helena Goldie Hospital on New Georgia in the Solomon Islands (September 2000) and LAMB Hospital in Bangladesh (September 2000).

Bangladesh↗
PubMed2001

An evaluation of the first year's experience with a low-cost telemedicine link in Bangladesh.

In July 1999, the Swinfen Charitable Trust in the UK established a telemedicine link in Bangladesh, between the Centre for the Rehabilitation of the Paralysed (CRP) in Dhaka and medical consultants abroad. This low-cost telemedicine system used a digital camera to capture still images, which were then transmitted by email. During the first 12 months, 27 telemedicine referrals were made. The following specialties were consulted: neurology (44%), orthopaedics (40%), rheumatology (8%), nephrology (4%) and paediatrics (4%). Initial email replies were received at the CRP within a day of referral in 70% of cases and within thee days in 100%, which shows that store-and-forward telemedicine can be both fast and reliable. Telemedicine consultation was complete within three days in 14 cases (52%) and within three weeks in 24 cases (89%). Referral was judged to be beneficial in 24 cases (89%), the benefits including establishment of the diagnosis, the provision of reassurance to the patient and referring doctor, and a change of management. Four patients (15% of the total) and their families were spared the considerable expense and unnecessary stress of travelling abroad for a second opinion, and the savings from this alone outweighed the set-up and running costs in Bangladesh. The latter are limited to an email account with an Internet service provider and the local-rate telephone call charges from the CRP. This successful telemedicine system is a model for further telemedicine projects in the developing world.

Adolescent↗
PubMed1999

Initial plastic surgery experience with the first telemedicine links for the British Forces.

In January 1998, the first telemedicine link for the British Defence Medical Services was established between the British military hospital in Sipovo, Bosnia and the Royal Hospital Haslar, the main triservice hospital in the UK. Further links were established later in the year. These simple links use a high-resolution digital camera, the Olympus C1400L and the C1400XL, to capture still images. These are then transmitted without loss of definition as electronic mail attachments to obtain specialist opinions in plastic surgery as well as in radiology, dermatology, orthopaedics, urology, ophthalmology, general medicine, maxillofacial surgery and pathology. Its use is illustrated by representative case reports from the first 11 referrals from Sipovo and elsewhere to the Plastic Surgery Department at Haslar. This system is suitable for use within both a military and a civilian context, anywhere in the world. It can readily be adapted for use by general practitioners and hospital doctors to facilitate referrals to plastic surgery departments.

Humans↗
PubMed1999

British-Czech co-operation in a mass casualty incident, Sipovo. From aeromedical evacuation from Bosnia to discharge from Central Military Hospital, Prague.

On Thursday 8 January 1998, a Czech Hip helicopter with 21 personnel on board crashed in Bos Krupa, northwest Bosnia, resulting in one of the largest mass casualty incidents involving peacekeepers in Bosnia since conflict broke out there in 1992. Seventeen patients were airlifted from the scene to the British Hospital Squadron in Sipovo, central Bosnia for resuscitation and initial treatment. The next day, six severely injured patients underwent aeromedical evacuation to the Central Military Hospital in Prague. The role of the British Defence Medical Services in this incident was documented in the first article of this two part series. This second article highlights the role of the Czech medical services following aeromedical evacuation of these six patients, and closes the audit trial by documenting the patients' progress and final outcome in Prague.

Accidents, Aviation↗
PubMed1999

Handsearching the Journal of the Royal Army Medical Corps for trials.

As part of the Cochrane Collaboration's international research endeavour, the authors carried out a handsearch of the RAMC Journal from 1948 to 1998, searching for randomised controlled trials (RCTs) and controlled clinical trials (CCTs). Ten trials were identified, of which 6 were RCTs and 4 were CCTs. The first trial was published in 1967. Four of the 10 identified trials were in the field of respiratory medicine, and 2 were in obstetrics and gynaecology. Of the 10 trials, only 3 had been found through a rigorous interrogation of Medline. The 7 newly identified trials were reported to the UK Cochrane Centre, and summary details of these trials were entered into Medline for use by clinicians and investigators in the future.

Adult↗
PubMed1999

Twelve months' experience with telemedicine for the British armed forces.

In 1998, a low-cost telemedicine system was established for the British armed forces in Bosnia. It involved a digital camera, computer, e-mail and a telephone link between the remote site and the UK. Images were transferred to a PC and forwarded to specialists in the UK, who replied within 24 hours. In the first 11 months of use, there were 60 referrals from one remote site. Clinical management following specialist advice was significantly altered in a third of these cases, with additional reassurance offered in 13% of cases. When other sites were connected the usage of the service doubled. This inexpensive system provided effective care to our patients, irrespective of location.

Bosnia and Herzegovina↗
PubMed1998

Mass casualty incident at Hospital Squadron Sipovo, Bosnia following a Czech hip helicopter crash, 8 Jan 1998.

On Thursday 8 January 1998, a Czech Hip helicopter with 21 personnel on board crashed shortly after take off from Bos Krupa, northwest Bosnia. Seventeen casualties (including six with severe injuries) were airlifted from the scene for treatment at the British Hospital Squadron in Sipovo before aeromedical evacuation the next day to Prague, or discharge to their unit. This was the largest mass casualty incident dealt with by the British Defence Medical Services since British troops deployed to Bosnia in 1992.

Accidents, Aviation↗
PubMed1998

The first telemedicine link for the British Forces.

In January 1998 a telemedicine link was established between the Hospital Squadron (from 22 Field Hospital) in Sipovo, Bosnia and the Royal Hospital Haslar, United Kingdom (UK). This link uses a high resolution digital camera, laptop computer, satellite telephone and a landline to obtain specialist opinions in radiology, dermatology, plastic surgery, orthopaedics, urology, ophthalmology, pathology and maxillo-facial surgery. This is the Defence Medical Services' first such link from an operational scenario. As such, this pilot study provides a useful testbed to enable clinicians in the three services to gain experience in this developing field, and to help determine the military applications of telemedicine.

Bosnia and Herzegovina↗
PubMed1998

Operational telemedicine.

A simple, effective digital camera and E-mail-based telemedicine system has been developed using commercially available equipment. Initial trials were successful and this system is now deployed in several operational units. A retrospective audit has shown it to be of value in 50% of referrals.

Humans↗
PubMed1997

"Shattered illusions--the Thiepval Barracks bombing, 7 October 1996".

The provisional IRA's ceasefire ended abruptly with the Canary Wharf bombing in London in February 1996. Hopes that violence would not return to Northern Ireland were shattered by the explosion of two car bombs in the headquarters of the British Army in Ulster in October 1996. The second bomb specifically targeted medical staff treating casualties from the first explosion. This article describes the medical aspects of this incident, including the extensive use of critical incident stress debriefing, and emphasises the implications for the major incident plans of medical centres and military hospitals.

Blast Injuries↗
PubMed1994

Antibiotic irrigation and conservative surgery for major aortic graft infection.

PURPOSE: Traditional surgical treatment for panprosthetic aortic graft infection entails radical excision of the graft, aortic stump closure, and extraanatomic revascularization of the lower limbs. This carries an early mortality rate of 24% to 45%. Amputation rates range from 11% to 37%. Multiple operations and prolonged hospital stay are usual. We have developed a more conservative management technique with the aim of improving outcome. METHODS: We describe an innovative method of treating the condition with prolonged, high-dose, local antibiotic irrigation therapy, systemic antibiotic treatment, surgical debridement, and graft conservation in a prospectively studied series of 10 patients. RESULTS: The actual 30-day patient survival rate is 90%, the 1-year survival rate is 80%, and the 4-year survival rate is 67%. Two patients died because of graft infection, and the third died, uninfected, of an unrelated cause. No limbs have been amputated. Only two patients required a second operation. Mean postoperative hospital stay was 32 days. The seven survivors have been closely followed up with regular computed tomography or indium scanning and clinical examination and appear to be free from infection at a mean of 61 months after cessation of irrigation therapy. CONCLUSION: The technique appears to represent a significant improvement in the management of this major complication of vascular surgery.

Adult↗
PubMed1994

The International Red Cross and Red Crescent Movement and lessons from its experience of war surgery.

This article describes the evolution, motivation and structure of the International Red Cross and Red Crescent Movement, and its contribution to international humanitarian law. It explains the respective roles of its three components: the National Societies, the International Federation of Red Cross and Red Crescent Societies, and the International Committee of the Red Cross (ICRC). It highlights the ICRC's experience of war surgery and emphasises the relevance of this for the military medical services, especially for the training of military surgeons and anaesthetists.

First Aid↗
PubMed1993

Necrotising fasciitis of the leg as a complication of ischiorectal abscess.

This case report describes the rare complication of necrotising fasciitis of the right thigh and calf after drainage of an ischiorectal abscess. The important early symptoms and signs of this life threatening infection, and the need for urgent treatment with aggressive surgical debridement and broad spectrum antibiotics, are emphasised in order to facilitate early recognition and prompt initiation of the appropriate therapy in future cases.

Abscess↗
PubMed1993

The centenary of the sinking of the Mediterranean Fleet flagship, HMS Victoria. What was the role of Malta fever?

This article commemorates the centenary of the tragic loss of the battleship HMS Victoria and 358 of her crew, together with the Commander-in-Chief of the Mediterranean Fleet, Vice-Admiral Sir George Tryon, as a result of an enigmatic order by Tryon himself. It also investigates the medical aspects and explores the contention that Tryon was suffering from Malta or Mediterranean fever (Brucellosis).

Brucellosis↗
PubMed1992

Introduction of a partial shift system for house officers in a teaching hospital.

OBJECTIVES: (1) To introduce a partial shift system to reduce the hours of work of preregistration house surgeons to an average of 64 a week to comply with the New Deal for junior doctors; (2) to test linking the partial shift concept to an existing structure of "on call" firms. DESIGN: Formal assessment after three months of a pilot partial shift system for eight house surgeons on three firms instituted on 1 November 1991, followed by questionnaire and interview evaluation at three and six months of a revised system implemented on 1 February 1992. SETTING: Department of general surgery at St Bartholomew's Hospital, London. SUBJECTS: 24 house surgeons attached to three surgical firms. RESULTS: In eight weeks each house surgeon worked one week (five shifts) of night duty, one week of "cover" (afternoon and evening) duty, and six weeks of normal daytime hours. Each weekday a house surgeon from the firm on call worked an extended daytime on call shift until 10 pm. Weekend duties were split between two house surgeons from the firm on call. A computer generated graphical display of the rota was used to facilitate leave planning. Average working hours were reduced to below 64 per week, including prospective cover, without detriment to patient care and educational standards. Within the shift system individual house surgeons could be on call with their own firm by day and at weekends. Opinions were equally divided among junior staff as to their preference for either on call or partial shift systems. CONCLUSIONS: The principles of this partial shift system are generally applicable and the model can readily be adopted by district general hospitals.

Attitude of Health Personnel↗