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Biomedical subjects

D W Yates

Publications and source records attributed to D W Yates.

At least 37 records · Page 2Linked to original sources
PubMed1994

The emergency department and the community: a model for improved cooperation.

Improved emergency care may be achieved by closer integration of hospital and community management. This has been promoted in Salford by the appointment of an Emergency Services Practice Manager jointly funded by the Family Health Services Authority and Salford Health Authority. Communication has improved, complementary working relationships developed and health promotion initiatives established.

Attitude of Health Personnel↗
PubMed1993

Biomechanical factors in patient selection for radiography after head injury.

In order to assess the predictive value of certain biomechanical parameters for skull fracture after head injury, a prospective analysis was undertaken of a series of 5416 head-injured patients. In each case an assessment was made at presentation as to the velocity of impact and the physical properties of the impacting agent. The incidence of skull vault fracture was then calculated for injuries sustained at different velocities and for different types of contact. The incidence of fracture was also calculated with respect to the presence of post-traumatic amnesia (PTA). The incidences (95 per cent confidence intervals) of skull fracture at low, medium and high speeds were 0.17 (0.0427-0.433), 1.99 (1.47-2.63) and 10.2 (7.41-12.6) per cent respectively. Fractures tended to occur with greater frequency after impacts against broad hard surfaces or small objects rather than against broad soft objects. The percentage incidence of fracture in adults suffering more than 5 min of PTA was 17.93 (12.4-23.5) compared with 0.674 (0.372-1.1) in those without amnesia. Patient selection for skull radiography after an apparently minor head injury can be guided by an assessment of post-traumatic amnesia and the biomechanics of the injury.

Adolescent↗
PubMed1993

Trauma audit: clinical judgement or statistical analysis?

Comparisons have been made between two methods currently used to assess the effectiveness of management of major trauma. These are the review of fatal cases by senior clinicians and the use of statistical analysis of severity scores. The former was assessed by a re-examination of the Coroners' reports of 508 patients reviewed by senior clinicians at the request of The Royal College of Surgeons of England Working Party on the Management of Patients with Major Injuries. The latter was based on the 665 fatalities on the files of the UK Major Trauma Outcome Study. The two groups of patients had comparable age and sex profiles and broadly similar ranges of injury severity. There were major differences between and inconsistencies within the two assessments. Clinicians more frequently judged death avoidable in those with very severe injuries. In contrast, the statistical analysis suggested, paradoxically, that the proportion of avoidable deaths in those patients who had minor injuries was less than the proportion of avoidable deaths in those who had more serious injuries. These variations underline the limited values of retrospective peer review and will not encourage clinicians to adopt currently available statistical methods. Further refinements of anatomical and physiological scoring systems and their integration to provide a statistically valid and clinically acceptable measure of outcome are essential prerequisites to the wider introduction and success of trauma audit.

Adolescent↗
PubMed1993

Regional cerebral blood flow and carbon dioxide reactivity after noncerebral injury in the rat.

A loss of cerebral autoregulation and vascular reactivity to CO2 has been reported after a direct head injury; however, little has been published concerning the effect of CO2 after peripheral injury. In the present study, the effects of extracranial injury (bilateral hindlimb ischaemia followed by reperfusion) were studied on regional cerebral blood flow in the hypothalamus and cortex and on the changes in these blood flows induced by altering PaCO2 in the conscious rat. After release of the tourniquets, when fluid was being lost from the circulation into the postischaemic hindlimbs, there was a decrease in regional cerebral blood flow (rCBF). Administration of CO2 at this time markedly increased rCBF. There was no evidence that cerebrovascular responsiveness to hypercapnia was impaired after peripheral injury in the rat.

Animals↗
PubMed1992

Preliminary analysis of the care of injured patients in 33 British hospitals: first report of the United Kingdom major trauma outcome study.

OBJECTIVE: To measure the effectiveness of management of major trauma in the United Kingdom. DESIGN: Review of the care of all seriously injured patients seen over two years. SETTING: 33 hospitals which receive patients who have sustained major trauma. SUBJECTS: 14,648 injured patients admitted for more than three days, transferred or admitted into an intensive care bed, or dying from their injuries. MAIN OUTCOME MEASURE: Death or survival in hospital within three months of the injury. RESULTS: 21% of seriously injured patients (1299) took longer than one hour to reach hospital. Time before arrival at hospital was not related to severity of injury. A senior house officer was in charge of initial hospital resuscitation in 57% (826/1445) of patients with an injury severity score > or = 16. More senior staff were commonly responsible for definitive operations, but only 46% (165/355) of patients judged to require early operation arrived in theatre within two hours. Mortality for 6111 patients sustaining blunt trauma and treated in the 14 busiest hospitals was significantly higher (actual 408, predicted 295.6, p < 0.001) than in a comparable North American dataset. Large differences in the 14 hospitals assessed could not be explained by variations in case load or facilities. In contrast, the outcome of the 4.1% (597) of patients with penetrating injuries was better than that of a comparable group in the United States. Analysis of the 415 penetrating injuries with complete data showed that 15 patients died (19.3 predicted; p = 0.04). CONCLUSIONS: The initial management of major trauma in the United Kingdom remains unsatisfactory. There are delays in providing experienced staff and timely operations. Mortality varies inexplicably between hospitals and, for blunt trauma, is generally higher than in the United States.

Emergency Medical Services↗
PubMed1991

A system for measuring the severity of temporary and permanent disability after injury.

500 patients have been questioned about activities of daily living and mobility 4 and 26 weeks after injury in order to assess the extent of temporary and permanent disability following minor and major trauma. Only those who sustained single injuries have been assessed, resulting in a relatively small number of serious injuries in the sample. In other respects, the population is representative of the daytime attendance at a busy emergency department. Most patients sustained injuries with an Abbreviated Injury Scale (AIS) of 1 or 2 (96%); it is clear that the AIS is unable to distinguish between most small injuries. Assessment was by interview. Although subjective, this has produced results that have face validity and discriminate between a wide variety of injuries. The methodology may be useful in the development of a "disability score," but much more data will be required before this can be achieved.

Accidents, Home↗
PubMed1991

X-ray reporting in accident and emergency departments--an area for improvements in efficiency.

All Accident and Emergency departments in England seeing more than 20,000 new patients each year were surveyed for the extent and mechanism of their radiological reporting service. A total of 190 of the 210 departments replied, 39% of these departments were not satisfied with the service available to them. A 'hot' reporting service was available in 2.6% of departments and 49% did not have films reported in under 48 h. The methods used to detect radiological abnormalities missed by the A&E doctor were investigated further. A total of 60% of departments had a traditional reporting system but 29% had introduced systems that required the A&E doctor to include his or her radiological diagnosis with the films prior to their being returned to the X-ray department for reporting. This allowed rapid audit of radiological assessment. Its introduction to all A&E departments is recommended.

Accidents↗
PubMed1990

How to perform a diagnostic peritoneal lavage.

Peritoneal lavage can be a very helpful investigation in the initial management of trauma patients. The technique demands some basic surgical skills but has been shown to be relatively safe and accurate when performed by appropriately trained junior doctors.

Abdominal Injuries↗
PubMed1988

Hydroxyethylvaline adduct formation in haemoglobin as a biological monitor of cigarette smoke intake.

The ethylene oxide adduct formed on the N-terminal valine in haemoglobin was investigated as a biological monitor of tobacco smoke intake. The modified method developed for the determination of the hydroxyethylvaline adduct (HOEtVal) involved reaction of globin with pentafluorophenyl isothiocyanate, extraction of the HOEtVal thiohydantoin product, derivatization of this by trimethylsilylation and quantitation by capillary gas chromatography with selective ion monitoring mass spectrometry using a tetradeuterated internal standard. The method was applied to globin samples from 26 habitual cigarette smokers and 24 non-smokers. There was a significant correlation between cigarette smoke intake as measured by the average number of cigarettes smoked per day and HOEtVal levels (r = 0.537, p less than 0.01). Background levels were found in non-smokers (mean 49.9 pmol/g Hb, range 22-106 pmol/g Hb). Smoking increased these levels by 71 pmol/g Hb/10 cigarettes per day. Cotinine levels in plasma of the smokers were determined by GC-NPD using 2-methyl-4-nitroaniline as internal standard. For non-smokers cotinine was determined by GC-MS selective ion monitoring using d3-methylcotinine as internal standard. There was no correlation between number of cigarettes smoked per day and cotinine levels (r = 0.297, p greater than 0.05) although cotinine was correlated with HOEtVal (r = 0.43, p less than 0.01). The HOEtVal adduct levels thus appear to be a suitable biomonitor for exposure to hydroxyethylating agents in cigarette smoke, reflecting an integrated dose over the erythrocyte lifetime. This is in contrast to plasma cotinine determinations which reflect only the previous day's exposure to nicotine in smoke.

Biomarkers↗
PubMed1988

Adenotonsillar hypertrophy and cor pulmonale.

Pulmonary hypertension is a known complication of chronic upper airway obstruction resulting from adenotonsillar hypertrophy. Surgical removal of the hypertrophic tissue usually leads to rapid improvement. Although anaesthetic management is potentially hazardous, little has been written on this aspect. Six paediatric patients (all male) are reported here, and a suitable anaesthetic technique is described.

Adenoidectomy↗