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Biomedical subjects

K N Williams

Publications and source records attributed to K N Williams.

At least 19 recordsLinked to original sources
PubMed1991

Unexpected, difficult laryngoscopy: a prospective survey in routine general surgery.

A prospective study of unexpected, difficult laryngoscopy was carried out. During a 7-month period, all general surgery patients in whom the trachea was intubated were assessed; only those with obvious neck pathology were excluded. Ease or difficulty of laryngoscopy was graded by a standard method. There were no grade 4 cases and no failed intubations in a total of 1387 cases. There were significant differences in the results recorded by different individuals; this did not correlate with seniority or with the type of surgery. Four factors have been identified which help to explain these discrepancies. These findings are analysed in relation to the training of junior staff, with particular reference to obstetric anaesthesia.

Anesthesia, Obstetrical↗
PubMed1990

Epidural haematoma requiring surgical decompression following repeated cervical epidural steroid injections for chronic pain.

We report a case of epidural haematoma following a steroid injection into the cervical epidural space. The complication occurred on the seventh such injection over a 2 year period for chronic spinal pain. Surgical decompression over the seventh cervical and the upper 3 thoracic vertebrae was required to alleviate the symptoms of paralysis and anaesthesia. The patient subsequently required skin grafting to the surgical site and two trans-urethral resections of the prostate gland during his 6 week hospital admission. He made a full recovery.

Chronic Disease↗
PubMed1990

Postpartum depressive disorders: changing trends.

For centuries, there has been speculation regarding the etiology of postpartum depression. An improved diagnostic classification has emerged, however, as the universality of the syndrome has been recognized and the role of hormonal, genetic, and obstetric variables considered. In addition, different cultures have different perceptions of the needs of the new mother. The emphasis in investigative work now appears to be in the psychosocial and psychodynamic areas. Our recent research focused on identification of risk factors early in pregnancy, including a history of depression, separation from one or both parents in childhood or adolescence, poor parental emotional support in childhood and adulthood, poor relationship with husband or partner, economic problems, and dissatisfaction with amount of education. We suggest that physicians, nurses, and mental health professionals be aware of the emotional status of their patients, familiarize themselves with the risk factors, and initiate a program of careful postpartum follow-up. These measures will help to improve recognition and management of the woman at risk for postpartum depression.

Depressive Disorder↗
PubMed1989

The oesophageal detector device. A prospective trial on 100 patients.

Misplacement of a tracheal tube in the oesophagus remains a significant cause of mortality and morbidity in anaesthesia, despite decades of effort aimed at prevention, or perhaps more importantly, detection, of such an event. We have evaluated a cheap, simple and quick device which relies mainly on the reflation or otherwise of an Ellick's evacuator applied to the supposed 'tracheal' tube. Identical tracheal tubes were passed into the trachea and oesophagus of 100 patients; the left and right position in the mouth was chosen at random. The test was conducted by a second anaesthetist, not present at intubation, and unaware of which tube was in the trachea. There were no false positive results and the correct deduction of which was the tracheal tube was reached in 100 tests using this device. Its use is recommended for widespread evaluation as a valuable adjunct to existing methods of detecting misplacement.

Adolescent↗
PubMed1982

Computerised cardiological case notes.

Optical Mark Reader forms have been used by the Cardiac Department at St Thomas's Hospital for six years to store clinical and haemodynamic data by computer. Forms are completed by clinical staff in outpatients and also for those patients undergoing cardiac catheterisation. Three documents are used to record the symptoms and signs at the clinical consultation, the results of relevant investigations, and the important findings at cardiac catheterisation. These documents are fed into a computer and data from them, together with a limited quantity of types information, are used to produce full clinical reports for our colleagues and the case notes. There reports have saved much secretarial and medical time. A variety of analyses is available for research and management purposes.

Cardiac Catheterization↗
PubMed1980

Self-administration of D-Ala2-Met-enkephalinamide at hypothalamic self-stimulation sites.

The relationship between the action of enkephalin and the reinforcing action of electrical stimulation in the posterior lateral hypothalamus of the rat was studied with the self-administration approach. Adult male albino rats implanted with a combination cannula and stimulation electrode in hypothalamus were pretested for the reinforcing effects of electrical stimulation. Only subjects that self-stimulated at moderate to high rates were given self-administration tests. The chamber for the self-administration tests was fitted with one lever at each end of a rectangular plexiglass box. In a session, one lever was 'active', the other not. The active lever, if depressed, yielded 20 nl of CSF (artificial cerebrospinal fluid), or CSF in which one of the test substances was dissolved. Each subject was tested repeatedly for the reinforcing effects first of a control solution (CSF), then of D-Ala2-Met-enkephalin (DALA), a long-acting synthetic analogue of enkephalin, then of morphine, and then of opioids mixed with naltrexone or naloxone. Following these tests, the subjects were once again given self-stimulation tests to ascertain the functional integrity of the 'reward' system after the repeated self-administration tests. The results demonstrate that when the test solution was DALA instead of CSF the subjects pressed the active lever at a higher rate than for CSF, and they exhausted the supply more rapidly than for CSF. The rate on the active lever was also significantly higher than on the inactive lever. DALA at 1 and 5 microgram/microliter concentrations proved more reinforcing than at 0.1 microgram/microliter. Naltrexone did not block the reinforcing effect of DALA, whereas naloxone blocked DALA-induced reinforcement. These data extend the report of ventricular methionine-enkephalin positive reinforcement to DALA injected directly into the lateral hypothalamus.

Animals↗
PubMed1978

A computer system for clinical microbiology.

The Department of Clinical Microbiology at St Thomas' Hospital has been producing bacteriological reports on a computer for more than three years and is now producing some 2300 reports per week. The system is operated entirely by laboratory staff without special training, and involves the use of optical mark reader (OMR) forms as worksheets, automatic validation and release of most reports, the use of local terminals, and scrutiny of reports by pathologists using a visual display unit. The OMR worksheet records not only the final result but also most of the tests and observations made on the samples; it is the only working document used by technicians. One specialist clinic submits its laboratory requests on an OMR form, which is subsequently used to record the results. The reports are printed and also filed in the computer to produce analyses for hospital, laboratory, and clinical management.

Computers↗
PubMed1978

Use, costs, and quality of medical services: impact of the New Mexico peer review system. A 1971-1975 study.

To assess the effect of areawide peer review (such as that conducted by Professional Standards Review Organizations [PSROs]) on use, cost and quality of medical services, we evaluated 4 years of data on the efforts of the New Mexico Experimental Medical Care Review Organization in reviewing medical services for the Medicaid population. Utilization review had no demonstrable impact on hospital use; hospital days per 100 eligible persons rose 5.0% and 43.4% for persons enrolled all 4 years in Aid to Families with Dependent Children (AFDC) and Aid to the Permanently and Totally Disabled, respectively. Peer review produced no net dollar savings; over 4 years, the amount paid for all services per AFDC-eligible person rose 85%. Peer review improved the quality of ambulatory care through large reductions (75%) in medically unnecessary injections. If these findings are replicated elsewhere, they suggest that the goal of the PSRO program to control costs by curtailing utilization may be difficult to achieve, the quality of care goal may be pursued successfully, and the PSRO mission should be focused more on the latter.

Ambulatory Care↗
PubMed1978

Auditory temporal resolution: effects of sensation level.

Experienced Ss identified (2IFC) the signal complex that contained a gap. When the complexes were of the same frequency, gap detection remained constant over the durations employed (up to 300 msec). When duration of the signal was 10 msec no changes in gap threshold occurred over the range of frequency disparities between signals (up to 120 Hz at F0 = 1 kHz). However, as signal duration increased (beyond 10 msec) there was an increase in gap threshold with increased frequency disparity. The degradation in gap threshold was greater for longer-duration events. Gap threshold was shown to decrease as a function of increase in intensity of the signals.

Acoustic Stimulation↗
PubMed1976

Signal onset and task variables in auditory evoked potentials.

Two auditory evoked potential studies were run to determine the effects of stimulus rise times on amplitude of N1-P2 onset and offset potentials. Onset potentials were reduced with increased onset durations. No consistent relationship was found in N1-P2 offset potentials as a function of stimulus rise time. The effects of listening tasks and stimulus duration were also examined.

Acoustic Stimulation↗
PubMed1976

Effect of medical care review on the use of injections: a study of the New Mexico Experimental Medical Care Review Organization.

Evaluation of peer review activities in the New Mexico Medicaid program (1971 to 1973) showed that it can affect aspects of quality, that is, the appropriateness of the use of injections as judged by medical criteria. Use of injections, nearly 50% of which were antibiotics, declined by more than 60%, from 41 to 16 per 100 ambulatory visits. Still, at the end of the study, 40% of the injections given were considered medically unnecessary. Analyses showed that [1] groups used injections more appropriately; [2] for solo physicians, being board-certified, being a doctor of medicine, and being a pediatrician were all associated with more proper use of injections; [3] 6% of the physicians gave 40% of the medically unnecessary injections, but even their behavior changed dramatically for the better as a result of the peer review system.

Age Factors↗
PubMed1976

Quality assurance today and tomorrow: forecast for the future.

We review here the definition, history, and current findings of quality assessment. Difficulties with quality assessment center principally on methods problems, including using the medical record as a source of information, using process versus outcome criteria, and ignoring decision analysis methods in establishing quality criteria. One overriding issue is placing a value on health and, by extension, on quality assurance and assessment efforts; another is the degree to which improvements in the quality of care can be achieved through changes in physician practices. Several sets of recommendations address these topics. With the assumption that such recommendations could be acted on in a transition period, a hypothetical quality assurance system is described for the 1980s and beyond. This system is based on preservation of the fee-for-service system, adoption of a national health insurance plan, and minimal federal involvement in quality of care decisions at the regional level.

Delivery of Health Care↗