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Biomedical subjects

G Waddell

Publications and source records attributed to G Waddell.

At least 55 records · Page 3Linked to original sources
PubMed1991

Low back disability. A syndrome of Western civilization.

The epidemic of low back disability is a growing concern, and a whole new approach to low back disorders is suggested. This article looks at the theoretic and conceptual framework on which any real breakthrough in treatment depends.

Back Pain↗
PubMed1990

A double blind placebo controlled trial of the calcium entry blocking drug, nicardipine, in the treatment of vasospasm following severe head injury.

A double blind, placebo controlled trial of nicardipine in the treatment of high Doppler Flow Velocity (DFV) following severe head injury (Glasgow Coma Score (GSC) less than or equal to 8) was performed. Thirty patients with high DFV (greater than or equal to 100 cm/s for 6 h duration) on transcranial Doppler ultrasound, were treated with nicardipine or placebo for 24 h (2.5 mg/h, increasing in steps of 2.5 mg/h at 2 h intervals (maximum rate 7.5 mg/h) depending on response of DFV). DFV was measured hourly for 24 h and then every 12 h for 2 days. Nicardipine significantly reduced DFV below the threshold of 100 cm/s (16/19 cf placebo 3/11, chi-square p less than 0.001). In the nicardipine treated group maximum DFV was significantly reduced (p less than 0.001) and time with DFV below 100 was significantly longer. Rises in DFV were significantly reduced by the drug if the DFV was normal at the time of entry. High DFV returned on cessation of the infusion. No unexpected or adverse side effects were seen. No clinical benefit was demonstrable.

Adolescent↗
PubMed1989

Artificial intelligence in the prediction of operative findings in low back surgery.

In a prospective trial of 150 patients undergoing first time low back surgery for sciatica, the performance of a computer was compared to that of clinicians in predicting the likely operative findings. The results indicate that artificial intelligence techniques implemented on a computer can be used for predicting operative findings in low back surgery, can out-perform clinicians and can be used to develop better methods of human prediction.

Adult↗
PubMed1989

An historical perspective on low back pain and disability.

This review of low back pain and sciatica over the past 3500 years tries to put our present epidemic of low back disability into historical perspective. Backache has affected human beings throughout recorded history (Table 1). What has changed is how it has been understood and managed. Two key ideas in the nineteenth century laid the foundation for our modern approach to backache: that it came from the spine and that it was due to injury. Backache had always previously been considered a rheumatic condition. Only from that time were backache and sciatica considered and treated together. Their management was increasingly dominated by the new orthopedic principle of therapeutic rest. What is new is chronic disability due to simple backache. Apart from rare cases, this only began to appear in the late nineteenth century. It escalated after World War II. It appears to be closely related to changed understanding and management of backache: specifically to the idea that backache is due to serious spinal injury or degeneration and to medical prescription of rest. This is reinforced by the improved social support which makes rest possible. Sadly, we must conclude that much low back disability is iatrogenic.

Back Pain↗
PubMed1988

Artificial intelligence in the diagnosis of low-back pain and sciatica.

In a prospective trial of 200 patients with low-back pain or sciatica, the diagnostic performance of a computer was compared with that of a clinician in a variety of clinical settings. The results indicate that artificial intelligence techniques can be used for the differential diagnosis of low-back disorders, can outperform clinicians, and can be used to develop better methods of human differential diagnosis.

Back Pain↗
PubMed1988

Assessment of the outcome of low back surgery.

We aimed to develop a better understanding and method of rating the success or failure of low back surgery by studying 185 patients prospectively. Identical pre-operative and postoperative assessment by an independent observer included pain, disability, physical impairment, psychological distress and illness behaviour. Outcome was assessed by the patient, by the observer and by return to work. There was 96% follow-up at two years. Correlation co-efficients varied considerably between the various measures of outcome, both patient and observer appearing to base their assessment mainly on postoperative status rather than on any change produced by surgery. The observer was influenced most by postoperative pain, disability and physical impairment. Patients were influenced most by residual physical impairment, type of surgery and proportional change in disability. Return to work was moderately influenced by postoperative disability and to a larger extent by social and work-related factors. We developed a simple formula to judge overall success or failure which accurately reproduced the combined assessment of patient and observer. If surgical audit is to be meaningful it must be based on an improved understanding of how the outcome of surgery should be assessed.

Activities of Daily Living↗
PubMed1987

1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain.

Because there is increasing concern about low-back disability and its current medical management, this analysis attempts to construct a new theoretic framework for treatment. Observations of natural history and epidemiology suggest that low-back pain should be a benign, self-limiting condition, that low back-disability as opposed to pain is a relatively recent Western epidemic, and that the role of medicine in that epidemic must be critically examined. The traditional medical model of disease is contrasted with a biopsychosocial model of illness to analyze success and failure in low-back disorders. Studies of the mathematical relationship between the elements of illness in chronic low-back pain suggest that the biopsychosocial concept can be used as an operational model that explains many clinical observations. This model is used to compare rest and active rehabilitation for low-back pain. Rest is the commonest treatment prescribed after analgesics but is based on a doubtful rationale, and there is little evidence of any lasting benefit. There is, however, little doubt about the harmful effects--especially of prolonged bed rest. Conversely, there is no evidence that activity is harmful and, contrary to common belief, it does not necessarily make the pain worse. Experimental studies clearly show that controlled exercises not only restore function, reduce distress and illness behavior, and promote return to work, but actually reduce pain. Clinical studies confirm the value of active rehabilitation in practice. To achieve the goal of treating patients rather than spines, we must approach low-back disability as an illness rather than low-back pain as a purely physical disease. We must distinguish pain as a purely the symptoms and signs of distress and illness behavior from those of physical disease, and nominal from substantive diagnoses. Management must change from a negative philosophy of rest for pain to more active restoration of function. Only a new model and understanding of illness by physicians and patients alike makes real change possible.

Back Pain↗
PubMed1987

Clinical assessment of lumbar impairment.

Assessment of severity in low back injuries may be based on diagnosis, pain, disability, physical impairment, and capacity for work. It is important to distinguish between impairment and disability. Physical impairment is objective structural limitation; disability is the resulting loss of function. Disability can be assessed by the patient's report of restriction in activities of daily living: bending and lifting, sitting, standing, walking, traveling, socializing, sleep, sex, and putting on or taking off footwear. Detailed statistical analysis of 480 patients identified the most important elements of lumbar impairment as the anatomic and time patterns of pain, lumbar flexion, straight leg raising, neurologic signs, previous surgery, and spinal fractures. Methods of examination need to be improved. An anatomic chart is provided to calculate impairment in the individual patient. The patient's report of pain, disability, and capacity for work should then be compared with the physician's objective assessment of the injury, diagnosis, and lumbar impairment.

Absenteeism↗
PubMed1986

Diagnosis and decision making in lumbar disc prolapse and nerve entrapment.

This prospective study of 185 patients undergoing first-time lumbar surgery compared how accurately clinical criteria and water-soluble myelography predicted the operative findings. Clinical diagnostic criteria of nerve root pain, root irritation signs, and neurologic signs of root compression supplemented by myelography were shown to be much more accurate than myelography alone, both in predicting the presence or absence of nerve root involvement and in distinguishing disc prolapse from bony entrapment. Provided the clinical criteria were clearly defined, patients with three or more of the four criteria were usually found to have a disc prolapse while bony entrapment could frequently be identified with one or two criteria. It is concluded that although lumbar disc prolapse is well-recognized, in practice clinical assessment and diagnostic criteria need to be defined more clearly to match increasingly sophisticated radiology.

Adult↗
PubMed1986

A concept of illness tested as an improved basis for surgical decisions in low-back disorders.

In previous studies a model of illness based on analysis of the relationship between the different elements of illness at one pont in time was developed. This study prospectively tested this model and a number of associated hypotheses in 185 patients who had various types of surgery for low-back disorders: 49 had chemonucleolysis; 91, first-time disc operations; 20, fusions; and 25, repeat operations. Identical pre- and postoperative evaluations were performed with 96% of patients independently reviewed at an average of 26 months after surgery. The authors analyzed how physical and psychologic factors interacted to affect the outcome of surgery and attempted to explain other conflicting reports of how either physical or psychologic factors determined surgical outcome. It was found that physical outcome was almost entirely determined by physical factors, ie, accuracy of diagnosis of a surgically treatable lesion, operative findings, surgical procedure, and avoidance of complications. The most important psychologic disturbances were distress and abnormal illness behavior that could affect surgical outcome indirectly if inappropriate illness behavior led to inappropriate surgery and also directly affected subjective judgments of pain or disability--by patient or observer. Return to work was strongly influenced by additional occupational factors. All the main hypotheses were confirmed and this model or concept of illness is proposed as the basis for a fundamental reconsideration of clinical management and surgical decisions in low-back disorders.

Adult↗
PubMed1985

The natriuresis following oral administration of the calcium antagonists--nifedipine and nitrendipine.

Ten healthy individuals received in random order placebo, nifedipine 10 mg, nifedipine 20 mg, nitrendipine 10 mg and nitrendipine 20 mg as single oral administrations at weekly intervals. On the day before each treatment placebo was administered. Urine was collected for 6 h and then for 18 h after each administration. There was a significant increase in urine volume and sodium excretion after the drugs, but no change in potassium excretion. The effect was most evident in the 6 h after drug administration. The effect was no greater at the higher doses of either drug. A natriuretic-diuretic action of nifedipine and nitrendipine has been confirmed in man. The mechanism of the effect remains unclear.

Administration, Oral↗