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Biomedical subjects

J Wardrope

Publications and source records attributed to J Wardrope.

At least 55 records · Page 3Linked to original sources
PubMed1999

Thrombolysis in acute myocardial infarction: the safety and efficiency of treatment in the accident and emergency department.

OBJECTIVES: To assess the safety and efficiency with which the accident and emergency (A&E) department provides thrombolytic treatment for patients with acute myocardial infarction (AMI). METHODS: A prospective observational study based in a teaching hospital for one year. All patients who presented with the clinical and electrocardiographic indications for thrombolytic treatment were studied. Patients were grouped according to route of admission. After logarithmic transformation, the "door to needle times" of the groups were compared using a two tailed Student's t test. Arrhythmias and complications after thrombolytic treatment were noted. The appropriateness of the treatment was assessed retrospectively by review of the clinical records and electrocardiograms, judged against locally agreed eligibility criteria. RESULTS: Data from 153 patients were analysed; 138/153 (90%) patients were admitted via the A&E department. The shortest door to needle times were seen in those patients thrombolysed by A&E staff within the A&E department (mean 43.8 minutes). The transfer of A&E patients to the coronary care unit (CCU) was associated with a significant increase in the door to needle time (mean 58.8 minutes, p = 0.004). Only one malignant arrhythmia occurred during the administration of thrombolysis in the A&E department, and this was managed effectively. No arrhythmias occurred during transfer of thrombolysed patients to the CCU. In every case, the decision to administer thrombolysis was retrospectively judged to have been appropriate. CONCLUSIONS: The A&E department provides appropriate, safe, and timely thrombolytic treatment for patients with AMI. Transferring A&E patients to the CCU before thrombolysis is associated with an unnecessary treatment delay.

Aged↗
PubMed1996

Do the national performance tables really indicate the performance of accident and emergency departments?

OBJECTIVE: To determine the current practice of nurse triage in accident and emergency departments in England, and to examine the relation between triage systems and performance in the Department of Health comparative performance guide. DESIGN: A postal questionnaire was sent to all consultants in accident and emergency medicine in England. RESULTS: 151 responses were analysed, representing 72% of the departments seeing at least 15,000 new patients annually. Triage systems vary widely throughout departments, ranging between advanced triage, partial triage, and "eyeballing". There is no standardisation of the process or duration of triage. There appears to be no standard method of measuring the time to immediate assessment. There is no correlation between the quality of initial assessment and performance in the tables. CONCLUSION: The national performance figures do not correlate with the quality of the initial assessment; comparisons based on these figures are therefore misleading. More effective performance indicators are available, which would provide a truer indication of the quality of accident and emergency services.

Emergency Service, Hospital↗
PubMed1994

What should doctors wear in the accident and emergency department? Patients' perception.

In many accident and emergency (A&E) departments doctors still wear white coats or their ordinary clothes, rather than a type of uniform, which, should it become contaminated, can be changed easily for a clean uniform. Before a change of clothing to a uniform could be considered in an inner-city A&E department, a study was carried out to assess the public's perception towards different styles of dress. Three hundred and twenty-nine questionnaires were returned by minor injury patients requiring a radiograph. The study was carried out over 3 weeks in January 1993. Each week a different style of dress was worn: week 1--white coats, week 2--normal clothing and week 3--theatre greens. The majority of patients thought that style of dress was important but did not alter their attitude towards the A&E medical staff. Therefore, there is no reason why doctors should not wear a more appropriate uniform that can be changed easily when contaminated.

Emergency Service, Hospital↗
PubMed1993

Acute amitriptyline withdrawal and hyponatraemia. A case report.

The tricyclic antidepressants (TCAs) are commonly used in the treatment of depression and, perhaps due to the nature of the condition being treated, figure prominently in cases of deliberate overdosage, where the toxicity of amitriptyline has been well established. However, the abrupt cessation of TCA administration can also be detrimental to the patient, triggering withdrawal phenomena often characterised by an exacerbation of the symptoms for which the patient was originally treated. We present a biochemically proven case of amitriptyline withdrawal where the clinical features at presentation made it difficult to distinguish from acute toxicity. The patient's neurological signs and distended bladder suggested amitriptyline toxicity, whereas the history and signs of cholinergic hyperactivity were consistent with acute withdrawal. The diagnosis was confirmed at a later date when further history and a biochemical analysis of plasma TCA concentrations became available. Hyponatraemia may have exacerbated the condition of the patient, whether or not it was caused by amitriptyline.

Acute Disease↗
PubMed1990

One year's experience of major trauma outcome study methodology.

OBJECTIVE: To assess the feasibility and the validity of an audit using major trauma outcome study methods in an accident and emergency department. DESIGN: Prospective audit of all cases of trauma in patients admitted to a hospital from an accident and emergency department. SETTING: Accident and emergency department in a teaching hospital. PATIENTS: 1577 Patients admitted with trauma, of whom 695 met the inclusion criteria for the study--that is, were admitted for more than three days, or admitted to intensive care, or died. 17 Patients were excluded because of failure to trace their notes. OUTCOME MEASURES: Review of case notes with TRISS (trauma score, injury severity score) methodology to compare expected and observed survival. RESULTS: Most (421/678) admissions were due to single orthopaedic injury. Serious injury was uncommon with only 43 patients having injury severity scores greater than 15. The calculated probability of survival matched the observed outcome for most of the seriously injured patients, with only two unexpected deaths. However, 36 of the 61 deaths in the 678 patients occurred in elderly patients with a fractured neck of the femur, and all of these patients had a high probability of survival predicted by TRISS methodology. CONCLUSIONS: Application of TRISS methodology seems to be valid for seriously injured patients except for elderly patients with single orthopaedic injuries, in whom there were major differences between observed and expected outcomes. Using outcome norms from the United States may not be applicable for this group. IMPLICATIONS: Audit of management of major injuries should be carried out by every hospital, and the methodology of the major trauma outcome study is an excellent system for carrying out such audit. The study of all patients admitted with trauma requires appreciable extra resources, but most hospitals should be able to monitor the care of seriously injured patients as their numbers are much fewer.

Adolescent↗
PubMed1989

Traumatic deaths in the Sheffield and Barnsley areas.

The details of inquests concerning 104 deaths due to trauma were studied in the Sheffield and Barnsley Coroner's district for the year 1986. Fifty-four of these patients did not reach hospital alive. In those patients where some form of resuscitation was attempted, the hospital notes were reviewed and the deaths occurring unexpectedly were identified using TRISS methodology. This method uses the Trauma Score, the Injury Severity Score and the patient's age to predict the probability of survival in an injured patient. It showed that some of the deaths were unexpected and the implications of these findings are discussed.

Female↗