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Biomedical subjects

J Ferguson

Publications and source records attributed to J Ferguson.

At least 55 records · Page 3Linked to original sources
PubMed2003

An evaluation of a telemedicine fracture review clinic.

Telemedicine is being widely used in the treatment of patients with minor injuries in north-east Scotland. A telemedicine fracture review clinic has been developed. During a one-month study period there were a total of 67 review appointments and 88 new patients. Fifty individual patients were reviewed and 10 were seen on more than one occasion. The mean number of reviews for all patients was 2.3. Thirty-six patients had initially been seen by telemedicine, six of whom (17%) had to come to Aberdeen for part of their treatment. Fourteen patients reviewed by telemedicine had initially been seen in person. All patients were safely managed and normal guidelines were followed. There is scope for significant expansion of this service, since 131 patients were seen in a fracture clinic in Aberdeen who lived close to a minor injury unit with telemedicine and X-ray facilities. The majority of these patients were likely to have had injuries suitable to be followed up using telemedicine.

Fractures, Bone↗
PubMed2003

A role for tele-education in the centralization of accident and emergency services.

We evaluated the use of tele-education to provide an induction programme for accident and emergency senior house officers (SHOs) in three remote locations, and compared their performance with that of SHOs receiving the same induction programme in the conventional manner. Both groups of doctors performed similarly in a pre-course multiple-choice question (MCQ) paper, and showed comparable improvement following the induction programme lectures. Sound quality and levels of interactivity were identified as areas for improvement in the tele-education programme. Tele-education might allow doctors based in peripheral units similar access to high-quality teaching to that enjoyed by those in larger hospitals. Further experience and evaluation are required to optimize this method of education delivery.

Education, Distance↗
PubMed2002

Guidelines for dosimetry and calibration in ultraviolet radiation therapy: a report of a British Photodermatology Group workshop.

This report examines the dosimetry of ultraviolet (UV) radiation applied to dermatological treatments, and considers the definition of the radiation quantities and their measurement. Guidelines are offered for preferred measurement techniques and standard methods of dosimetry. The recommendations have been graded according to the American Joint Committee on Cancer classification of strength of recommendation and quality of evidence (summarized in Appendix 5).

Humans↗
PubMed2002

Taking treatment to the patient: development of a home TL-01 ultraviolet B phototherapy service.

BACKGROUND: While most patients requiring phototherapy can attend for hospital-based out-patient ultraviolet (UV) B therapy, a significant number cannot attend because of geographical, work, economic and other reasons. OBJECTIVES: To determine whether there was a need for home phototherapy in the Tayside area and, if so, to establish protocols and then to assess if such a service would be workable. METHODS: Patients referred from dermatology out-patient clinics in Tayside for narrow-band UVB (TL-01) phototherapy completed a pilot questionnaire that was followed by a two-phase project. In phase 1, patients with psoriasis were trained to use the home phototherapy equipment (HoPE) within the hospital department under nursing supervision while a teaching package and protocols were developed. In phase 2, home phototherapy was made available for patient use in the community, supported by a specialist home phototherapy nurse. Waldmann UV100 home therapy units were used, with accurate dosimetry. Detailed treatment records were kept and questionnaires were used to assess acceptability and costs of therapy. RESULTS: Fifty-two pilot questionnaires were completed. Forty-two per cent of respondents found hospital phototherapy inconvenient and 75% felt phototherapy at home would be helpful. In phase 1, seven of 10 patients trained to use the HoPE completed therapy with the HoPE unit alone, reaching minimal residual activity (MRA) or clearance in a median of 18 exposures (median dose 10.38 J cm-2). In phase 2, 32 courses of home phototherapy were given to 30 patients. Of 23 with psoriasis, 18 reached clearance or MRA in a median of 22.5 exposures (median dose 9.84 J cm-2). Although self-reported erythema rates appeared higher than expected, all post-treatment questionnaire respondents would choose home phototherapy over hospital therapy if required in the future. CONCLUSIONS: UVB (TL-01) home phototherapy is a useful practical development that has fulfilled a need in our catchment area. Where appropriate training and support teams are available it appears to be similar in effectiveness to hospital therapy, to be safe and to be cost-effective for patients.

Adult↗
PubMed2002

A randomized, observer-blinded trial of twice vs. three times weekly narrowband ultraviolet B phototherapy for chronic plaque psoriasis.

BACKGROUND: The optimum treatment frequency for narrowband (TL-01) ultraviolet B (NB-UVB) in psoriasis is not yet known. We have previously found three times weekly to be preferable to five times weekly treatment in our population. OBJECTIVES: To compare twice weekly with three times weekly NB-UVB phototherapy in chronic plaque psoriasis. METHODS: In an observer-blinded, randomized comparison, patients with chronic plaque psoriasis referred from dermatology out-patient clinics in Tayside for NB-UVB phototherapy received either twice weekly (Monday and Friday) or three times weekly (Monday, Wednesday and Friday) whole-body NB-UVB phototherapy following our standard departmental treatment protocol. Treatment was continued to clearance or until the fourth treatment after minimal residual activity (MRA) was first documented. Number of days in treatment, number of treatments, total dose and time to relapse were recorded. RESULTS: In total, 113 patients were recruited, skin phototypes I-III: 58 in the twice weekly and 55 in the three times weekly group. Forty patients in the twice weekly group reached clearance/MRA, as did 44 in the three times weekly group. It took 1.5 (95% confidence interval 1.3-1.7) times longer to reach clearance/MRA with twice weekly therapy, a geometric mean of 88 vs. 58 days (P < 0.0001). Small differences in numbers of treatments and total dose to reach clearance tended to favour three times weekly therapy, but these were not significant. CONCLUSIONS: Three times weekly NB-UVB clears psoriasis significantly faster than twice weekly treatment, and therefore is preferable for most patients.

Adolescent↗
PubMed2002

A health impact assessment model for environmental changes attributable to development projects.

STUDY OBJECTIVE: European Union legislation requires large industrial and civil development projects to undergo environmental impact assessment. The study objective was to identify environmental health risk estimates for these developments from the epidemiological literature and to develop, and apply these within, a mathematical health impact assessment model. DESIGN AND RESULTS: In the UK, good practice guidelines have set out environmental issues to be considered in development projects, but little attention is given to direct health effects. Broad quantifiable risks were identified for four-air, chemicals, noise, and road traffic-of 14 standard environmental effects. A mathematical model was constructed that is based on people moving between different health states over their lifetime. Age related hazard functions are applied to cause specific measures of mortality and morbidity. A hypothetical example for a development creating air and chemical pollutants is given. CONCLUSIONS: A mathematical model applying epidemiological risks to an exposed population can provide quantification of environmental health effects. The approach may in future find application during project development, and by public health regulatory authorities for environmental health impact assessment.

Air Pollution↗
PubMed2002

Evaluation of a pilot telemedicine network for accident and emergency work.

A pilot accident and emergency teleconsulting service was established in Scotland. It was based at the accident and emergency department of the main hospital in Aberdeen. There were three peripheral sites in rural Grampian (Peterhead, Turriff and Huntly) and one in the Shetland Isles. The videoconferencing equipment used was connected by ISDN at 384 kbit/s. During the 15 months of the study, 1998 videoconference calls were made, of which 402 (20%) calls were made to the accident and emergency department for clinical consultations. The majority of the clinical calls (95%) were made between 09:00 and 17:00, and more than 90% were completed within 20 min. During the majority of calls (87%) one or more X-ray images were transmitted. The majority of patients (89%) received treatment without transportation to the main centre in Aberdeen. The present study demonstrated that accident and emergency teleconsultations can be technically reliable, effective in reducing the number of patient transfers and acceptable to the referring clinicians. As a result, approximately 1.5 million has been made available by the government to develop a national system for Scotland.

Attitude of Health Personnel↗
PubMed2002

Community coronary units: strategies to promote pre-hospital thrombolysis.

Early diagnosis and the early delivery of pre-hospital thrombolysis in cases of acute myocardial infarction (AMI) have been shown to decrease mortality. Despite strong evidence of its benefits, pre-hospital thrombolysis rates are still worryingly low. The challenge is to empower community practitioners to deliver thrombolysis. In the Grampian region there is a network of community hospitals which have been equipped with both videoconferencing and remote telemetry equipment. This allows realtime consultation with the local accident and emergency department and coronary care unit. Early trials of the system show that clinical information can be viewed in realtime, with transfer of a 12-lead electrocardiogram at 60 s intervals. This will give general practitioners unprecedented access to specialist advice. Our aim is to use a combination of teaching and decision support technology to ensure that all patients with AMI have the opportunity to access timely and appropriate prehospital thrombolysis.

Acute Disease↗
PubMed2002

Air sea rescue, telemedicine style.

Historically, requests from shipping in UK coastal waters for emergency medical advice have been handled on an ad hoc basis by various accident and emergency departments on behalf of the Coastguard. A formal contract to provide this service has recently been established with the Aberdeen Royal Infirmary in Scotland and the Royal Alexandra Hospital in Portsmouth, England. A pre-contract audit showed that the involvement of medical professionals in the evacuation decision improved the quality of triage and intervention. The medical staff at both hospitals received training in giving medical advice and the level of medical knowledge that could reasonably be expected of ships crews. Providing advice to commercial airlines developed from the maritime service. In association with a private company, staff at the Aberdeen Royal Infirmary have developed procedures to support cabin crew and medical professionals on board (initial figures suggest that a medical professional is present on about 45% of flights). At present, although there are insufficient data to draw any firm conclusions, it appears that up to two-thirds of diversions could be avoided using this service.

Aerospace Medicine↗
PubMed2002

Can paediatric radiographs be accurately interpreted using an inter-hospital telemedicine system?

Children make up a significant proportion of attendances at accident and emergency departments but there is little published information about the use of telemedicine for viewing paediatric radiographs in the emergency setting. The radiographs and case-notes of 30 children were randomly selected from attendances at an accident and emergency department and were then transmitted over a telemedicine link equipped with a document camera. The doctor recorded the diagnosis and proposed management, along with the confidence in diagnosis and satisfaction with the image. This process was repeated using hardcopy radiographs and a standard viewing box. Five accident and emergency specialists took part in the study; there were in total 300 radiograph viewings. There was one missed fracture out of 75 positive radiographs viewed by telemedicine compared with no missed fractures on direct inspection of the film. Thirteen radiographs viewed over the telemedicine link were thought to be positive or suspicious of injury when the formal report was of no bony injury. The sensitivity of fracture diagnosis using telemedicine was 98.6% compared with 100% on direct inspection of the film, and specificities were 82.6% and 86.6%, respectively. Our study suggests that telemedicine can be used to aid diagnosis and make management decisions in children with minor trauma.

Adolescent↗
PubMed2001

Adult-to-adult living donor liver transplantation for fulminant hepatic failure.

The outcome of fulminant hepatic failure without timely liver transplantation is poor. We describe a 19-year-old woman with fulminant hepatic failure due to acute hepatitis B infection who received a living donor liver transplant from her sister. The donor's recovery was uneventful, allowing hospital discharge on Day 6. Two months after transplantation the recipient developed a biliary stricture requiring surgery. One year after transplantation, her liver function was normal.

Adult↗
PubMed2001

Effects of advanced candidate anticonvulsants under two rodent models of 'counting'.

The behavioral effects of a variety of advanced candidate anticonvulsants for organophosphate-induced seizures were evaluated under two rodent 'counting' models. Rats pressed the left of two levers a number of times (a 'run') before pressing the right lever. The targeted performance was a run of 12. The training contingency was a targeted percentile schedule, which provided food if the current run was closer to 12 than two-thirds of the most recent runs. Baseline performance was well controlled by the target, with mean run lengths slightly less than 12. Once this performance was acquired, half the subjects were switched to a procedure providing food following runs of different lengths with a probability yoked to previous percentile schedule performance. The two procedures generate comparable baseline performances, but behavioral disruptions generate reinforcement loss only under the yoked procedure. Atropine, scopolamine, azaprophen, aprophen, trihexyphenidyl, procyclidine, benactyzine, biperiden and diazepam were tested. All produced dose-related decreases in overall run length and response rate. Responding was disrupted more readily under the yoked procedure than under the percentile procedure. Only atropine affected responding at doses below those effective against soman-induced seizures. Of the present candidates, trihexyphenidyl, procyclidine, benactyzine and biperiden appear most promising for further development.

Animals↗
PubMed2001

Tailoring clinical management practices to meet the special needs of adolescents: sexually transmitted infections.

Sexually transmitted infections are a major health risk to all sexually active adolescents and improving clinical management for this age group is of major importance. Currently, adolescents are managed in the same way as adults. This paper summarizes recommendations by the World Health Organization that services be more responsive to adolescent concerns about confidentiality, risk assessment be more attuned to their sexual behavioral patterns, and services be tailored to give more time for counseling, assessment of stage of maturity and continuity of reproductive health care.

Adolescent↗
PubMed2001

Comparison of the flow capacity of free arterial grafts and saphenous vein grafts for coronary bypass surgery.

UNLABELLED: There is controversy regarding the flow reserve and capacity of arterial conduits to meet the needs of the myocardium. This study compared flow in 22 free arterial bypasses to 15 saphenous vein grafts in procedures involving twenty patients. To assess the maximal flow possible, (flow capacity) graft flow was measured using a calibrated pump while perfusing blood cardioplegia through the conduit and distal anastomosis during cardiac arrest (no competitive flow). This assessment was subsequently confirmed with whole blood during myocardial contraction while on cardiopulmonary bypass. Twenty-two free arterial grafts were used; 15 right internal mammary artery grafts, 4 right gastroepiploic grafts, 3 inferior epigastric artery grafts, and 3 sequential bypasses. Free arterial conduit flow ranged from 50 to 180cc/ml, with an average flow of 102.5+/-28.5ml/min as compared to saphenous vein graft flow, 102+/-28 ml/min. No correlation of flow with the conduit size was found. Arterial graft flow demonstrated a mild correlation with the size of the native coronary artery bypassed (R=0.47, P</=0.02). CONCLUSIONS: Basal flow through free arterial grafts is equivalent to saphenous vein grafts and is primarily determined by the native coronary vessels. The flow reserve for free arterial conduits is more than adequate for coronary bypass surgery.

Adult↗
PubMed2001

New sunscreens confer improved protection for photosensitive patients in the blue light region.

BACKGROUND: Some patients with photosensitivity disorders are sensitive to visible radiation. As current commercial sunscreens do not significantly absorb in this region, there is a lack of effective topical photoprotection. To meet this need a new range of sunscreens has been developed incorporating zinc oxide and pigmentary grade titanium dioxide as active ingredients. OBJECTIVES: To determine the effectiveness of the new sunscreens in providing protection for patients with visible radiation photosensitivity. METHODS: In the first part of this study, an in vitro transmission spectrum was obtained. The properties of the new sunscreens, as well as a range of commercial agents, were compared, and a new parameter, photosensitivity protection factor (PPF), was developed. This was used to predict the likely degree of protection the various sunscreens would provide for patients with photosensitivity extending into the visible region. In the second in vivo part of the study, patients with known visible (blue) light photosensitivity were tested using light at 430 +/- 30 nm and the protection factor (PF) at this wavelength was determined. RESULTS: Mean +/- SD PPFs for the new sunscreens were between 5.4 +/- 0.3 and 9.6 +/- 0.3, compared with 4.1 +/- 0.1 for Sun E45 (sun protection factor, SPF 25) and 4.2 +/- 0.1 for RoC Total (SPF 25). The derived in vivo PF for Sun E45 ranged between 1 and 4 (median 2). For the new sunscreens the range was 3 to > 10 (median 8). CONCLUSIONS: This study demonstrates that the new sunscreens do provide protection for patients with sensitivity to visible light (blue light region).

Adult↗