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Biomedical subjects

P Leman

Publications and source records attributed to P Leman.

At least 19 recordsLinked to original sources
PubMed2006

Paracetamol availability and recent changes in paracetamol poisoning: is the 1998 legislation limiting availability of paracetamol being followed?

OBJECTIVE: To determine the degree of adherence to legislation introduced in 1998 restricting the availability of over the counter paracetamol. DESIGN: A prospective observational study. SETTING: An emergency department in an inner city London teaching hospital. Pharmacy and non-pharmacy outlets in south London. MAIN OUTCOME MEASURES: (1) The source of paracetamol ingested by 107 patients presenting with an acute paracetamol overdose (2001-2003) and (2) the ability to purchase paracetamol from pharmacy and non-pharmacy outlets in a manner contravening paracetamol pack size legislation (2004). RESULTS: Potentially toxic amounts of paracetamol in excess of pack size restrictions were purchased in 70% (17 of 24) of outlets. Forty six per cent of patients who had ingested a potentially toxic dose of paracetamol obtained the tablets in a manner contravening the 1998 legislation. CONCLUSION: Legislation limiting the availability of over the counter paracetamol is not being adhered to in south London. A significant number of patients ingesting a potentially toxic dose of paracetamol report purchasing the tablets in a manner contravening the legislation. Studies that attempt to assess the impact of the legislation need to be interpreted in the context of these results. Measures to enforce current legislation may help to reduce the severity of paracetamol poisoning in the UK.

Acetaminophen↗
PubMed2005

Flucloxacillin alone or combined with benzylpenicillin to treat lower limb cellulitis: a randomised controlled trial.

OBJECTIVE: To determine whether using intravenous benzylpenicillin in addition to intravenous flucloxacillin would result in a more rapid clinical response in patients with lower limb cellulitis. METHODS: This was a randomised controlled trial set in an inner city teaching hospital, comprising 81 patients with lower limb cellulitis requiring intravenous antibiotics. The main outcome measure was the mean number of doses of antibiotic required until clinical response. RESULTS: The mean number of doses required was 8.47 (95% confidence interval (CI) 7.09 to 9.86) in the benzylpenicillin and flucloxacillin combined group. In the flucloxacillin only group it was 8.71 doses (95% CI 6.90 to 10.5), a mean difference of -0.24 doses (95% CI -2.48 to 2.01, p = 0.83). Other markers of treatment efficacy showed no difference between groups at review the following day; temperature decrease (mean difference -0.07 degrees C, 95% CI -0.76 to 0.62, p = 0.84), or diameter decrease of affected area (mean difference -34 mm, 95% CI -99 to 31, p = 0.30). Patient subjective assessments were also similar between the different drug regimen; improvement on a visual analogue scale of pain/discomfort from admission to first review (mean difference 10 mm, 95% CI -12.6 to 14.2, p = 0.91) and on second review (mean difference 15 mm, 95% CI -18.6 to 21.6, p = 0.88). Patient overall subjective feelings of improvement on first review (p = 0.32) and on second review (p = 0.64) were also similar. CONCLUSIONS: This study provides no evidence to support the addition of intravenous benzylpenicillin to intravenous flucloxacillin in the treatment of lower limb cellulitis.

Adult↗
PubMed2004

Making an IMPACT on emergency department flow: improving patient processing assisted by consultant at triage.

OBJECTIVES: To assess whether initial patient consult by senior clinicians reduces numbers of patients waiting to be seen as an indirect measure of waiting time throughout the emergency department (ED). METHODS: An emergency medicine consultant and a senior ED nurse (G or F grade), known as the IMPACT team, staffed the triage area for four periods of four hours per week, Monday to Friday between 9 am to 5 pm for three months between December 2001 and February 2002 when staffing levels permitted. Patients normally triaged by a nurse in this area instead had an early consultation with the IMPACT team. Data were collected prospectively on all patients seen by the IMPACT team. The number of patients waiting to be seen (for triage, in majors and in minors) was assessed every two hours during the IMPACT sessions and at corresponding times when no IMPACT team was operational. RESULTS: There was an overall reduction in the number of patients waiting to be seen in the department from 18.3 to 5.5 (p<0.0001) at formal two hourly assessments. The largest difference was seen in minors. Of the patients seen at triage by the IMPACT team, 48.9% were discharged home immediately after assessment and treatment. With the IMPACT team present, no patient waited more than four hours for initial clinical consult. CONCLUSIONS: By using a senior clinical team for initial patient consultation, the numbers of patients waiting fell dramatically throughout the ED. Many patients can be effectively treated and discharged after initial consult by the IMPACT team.

Appointments and Schedules↗
PubMed2004

Improving access to diagnostics: an evaluation of a satellite laboratory service in the emergency department.

OBJECTIVES: To measure the impact of a satellite laboratory upon laboratory result turnaround times and clinical decision making times. DESIGN: A prospective cohort study, the intervention group had blood tests sent Monday to Friday 12 noon to 8 pm and the control group had blood tests sent outside these hours. The data were collected over a six week period before the laboratory was opened, and a subsequent six week period. SETTING: An urban teaching hospital emergency department. PARTICIPANTS: 1065 patients requiring blood tests. MAIN OUTCOME MEASURE: Time from the blood sample being sent to the laboratory to the results being available on the clinician's computer. RESULTS: The time to haematology (blood count) results in the intervention group decreased by 47.2 minutes (95% CI 38.3 to 56.1, p<0.001) after the laboratory was opened. The corresponding control group times were unchanged (0.6 minutes; -13.8 to 15.0, p = 0.94). Similar sized differences were also seen for haemostasis (d-dimer) testing 66.1 (41.8 to 90.4) minutes compared with -14.2 (-47.1 to 18.7) and chemistry 41.3 (30.3 to 52.2) compared with -4.2 (-17.4 to 8.9) testing. Decisions to discharge patients were significantly faster (28.2 minutes, 13.5 to 42.8, p<0.0001) in the intervention group after the laboratory was opened (controls; -2.6 minutes -27.0 to 21.7). No change was seen with decisions to admit patients. There was a trend for earlier laboratory results modifying intravenous drug or fluids orders, or both (p = 0.06) CONCLUSION: A comprehensive satellite laboratory service is an important adjunct to improve the timeliness of care in the emergency department.

Decision Making↗
PubMed2003

Randomised controlled trial of the onset of analgesic efficacy of dexketoprofen and diclofenac in lower limb injury.

OBJECTIVE: To assess the time of onset and difference in analgesic efficacy of oral dexketoprofen compared with oral diclofenac in patients with acute lower limb injury. DESIGN: A prospective, double blind, randomised controlled trial. INTERVENTIONS: Patients who fitted the study criteria were given either 25 mg oral dexketoprofen trometamol or 50 mg sodium diclofenac immediately after triage; baseline and 15 minute pain scores were then recorded for one hour. RESULTS: 122 patients were studied (diclofenac = 57 and dexketoprofen = 65). There were no significant differences in age, sex, type of injury, or baseline pain scores between the two groups. The differences in group mean pain scores between diclofenac and dexketoprofen at 15, 30, 45, and 60 minutes were; 0.53 (95% confidence intervals -0.03 to 1.09), 0.70 (0.16 to 1.24), 0.89 (0.32 to 1.47), and 0.83 (0.21 to 1.45). Odds ratios for a decrease in pain score of at least 1 from baseline (on the 11 point scale) when given dexketoprofen rather than diclofenac at 15, 30, 45, and 60 minutes were; 2.66 (1.19 to 5.98), 3.52 (1.60 to 7.73), 4.48 (1.72 to 11.65), and 5.54 (1.90 to 16.15). Corresponding odds ratios for a decrease in pain score of >/=2 were; 6.88 (1.48 to 32.0), 3.79 (1.59 to 9.01), 5.19 (2.29 to 11.78), and 5.87 (2.68 to 12.88). CONCLUSIONS: Dexketoprofen trometamol is an effective and rapidly acting analgesic for the treatment of acute musculoskeletal injuries.

Acute Disease↗
PubMed2002

Validity of urinalysis and microscopy for detecting urinary tract infection in the emergency department.

This study assessed the validity of standard urinalysis, urinalysis for leucocyte esterase and nitrites, and urgent microscopy in the diagnosis of urinary tract infection (UTI) in 60 female patients with a triage diagnosis of UTI. There were 24 (40%) proven UTIs after culture. Simple urinalysis was sensitive for UTI (95.8%) but the positive predictive value was only 45.1%. The addition of leucocyte esterase and nitrite urinalysis testing did not improve the sensitivity, but if both of these were positive the positive predictive value improved to 100%. Urgent microscopy alone was sensitive (100%) but non-specific (38.9%). The specificity of the diagnosis improved to 94.4% for organism counts of >or=10/microl and to 88.9% for leucocyte counts of >or=50/microl. The negative predictive value of no detectable leucocytes on microscopy was 94.7%. Screening for UTI in the emergency department (ED) population is improved by the addition of leucocyte esterase and nitrite test. A positive urinalysis test for leucocytes and nitrites, or urinalysis positive at levels of >or=500 leucocytes or >or=5 g/l protein should confirm a clinical diagnosis of UTI. Urgent urine microscopy should be performed only if the above criteria are not met yet a minimum of one urinalysis result is positive.

Adult↗
PubMed2001

A case-control study of food poisoning seen at an accident and emergency department.

We investigated the hypothesis that sporadic food poisoning is a result of the consumption of food cooked or prepared outside the home. We did a case-control study, set in an urban emergency department, to find out the odds ratios for the risk of food poisoning associated with various patterns of consumption. We found that recent eating out (exposure on the day of or day before presentation) was associated with an odds ratio of 2.41 (95% CI 1.29-4.50) for presenting with food poisoning.

Adult↗
PubMed2001

Pain management.

Explore the source record for details and available documents.

Analgesics↗
PubMed2001

Clinical and microbiological features of suspect sporadic food poisoning cases presenting to an accident and emergency department.

During a five-month period all patients presenting to an inner-city accident and emergency department with suspected food poisoning were assessed for relevant clinical and microbiological features. There were 102 patients in the study period (0.3% of all attendances). Fifty-two stool samples were processed and 11 were culture positive (21% of those sampled, 11% of all cases). The two commonest organisms were Campylobacter (6) and Salmonella (4). A logistic regression analysis showed that, of the continuous variables, a higher temperature (odds ratio [OR] 2.72, 95% confidence interval [CI] 1.36 to 5.46) was predictive of stool culture positivity, and age was negatively predictive (OR 0.88, 95% CI 0.78 to 0.98). Of the dichotomous variables only a history of fever (OR 3.94, 95% CI 1.07 to 14.5) was predictive of stool culture positivity. The presence of nausea (OR 0.11, 95% CI 0.03 to 0.43) or vomiting (OR 0.22, 95% CI 0.06 to 0.80), and the absence of abdominal tenderness, had a negative predictive value for stool culture positivity. No patient without a history of abdominal pain and diarrhoea had a positive stool culture.

Abdominal Pain↗
PubMed1999

Questionnaire survey of interpreter use in accident and emergency departments in the UK.

OBJECTIVE: To determine the support for a national telephone interpreter service from accident and emergency (A&E) departments across the UK, and the factors that may influence that support. To determine the nature of interpreter needs for these departments. METHODS: Postal questionnaire survey of 255 A&E departments in the UK. RESULTS: A total of 197 replies were received, a response rate of 77.3%. Altogether 186 respondents answered the question on support for a national telephone interpreter service and 124 (66.7%) would support one. Those departments in favour were no more likely to have required an interpreter in the last seven days (chi 2 = 0.16, df = 1, p = 0.69), be in the inner city (Fisher's exact test, two sided probability, p = 1), have predominantly local population needs compared with tourist needs (chi 2 = 0.65, df = 1, p = 0.42), or be current users of a telephone interpreter service (chi 2 = 0.01, df = 1, p = 0.93). Seventy-nine of 180 (42.9%) departments had used some form of interpreter in the seven days preceding completion of the survey. Seventy-six of 86 (88.4%) of those departments using face to face interpreters had experienced difficulty obtaining an interpreter out of hours. Nationally, the following proportion of all A&E departments listed the named language as occurring among the three most common languages requiring interpretation: French 0.46 (95% confidence interval 0.42 to 0.50), Urdu 0.30 (0.26 to 0.34), and German 0.24 (0.21 to 0.27). CONCLUSIONS: There is widespread need and support for a national telephone interpreter service that would match the requirements of 24 hour emergency health care provision.

Communication Barriers↗
PubMed1999

Malaria in inner London.

This retrospective analysis was performed to describe the malarial cases treated in an inner London hospital during a single year (1996). A total of 44 case records were available for review, 40 (90.9%) were due to Plasmodium falciparum. Thirty-seven patients were admitted to hospital, there were no deaths. Only two (4.5%) patients had taken adequate malarial prophylaxis. A total of 119 inpatient bed-days were utilized in the treatment of malaria in 1 year. In 75 (63%) of these bed-days, observation was the only reason for continued inpatient treatment. The commonest laboratory findings are mild elevation of serum bilirubin to a mean of 28 micromol/l, and a low platelet count to a mean of 124x10(12)/l. A bilirubin greater than 20 micromol/l was found in 72.9% of patients (95% CI; 58.7-87.3%). The platelet count was less than 150x10(12)/l in 77.3% of patients (95%, CI; 64.9-89.7%). We found that malaria is not uncommon in inner London. Whilst most cases are admitted few complications are usually seen. Many cases may well be able to be treated with a brief hospital admission, possibly to an accident and emergency observation ward.

Adolescent↗
PubMed1997

Interpreter use in an inner city accident and emergency department.

OBJECTIVE: To determine the extent of communication problems that arose from patients whose primary language was non-English presenting to an inner city accident and emergency (A&E) department. METHODS: A prospective survey over seven consecutive days during September 1995. All adult patients other than those directly referred by their general practitioner to an inpatient team had a questionnaire completed by the A&E doctor first seeing the patient. The doctor recorded language ability and form of interpreter used, and estimated any prolongation of the consultation and ability to improve communication by the use of additional services. RESULTS: 103 patients (17%) did not speak English as their primary language; 55 patients (9.1% of the study population) had an English language ability rated as other than good, and 16 (29%) of these consultations could have been improved by the use of additional interpreter services; 28 patients overall (4.6% of the study population) required the use of an interpreter, who was usually a relative. CONCLUSIONS: A significant number of patients presenting to A&E have difficulty in communicating in English. These consultations could often have been improved by the use of additional interpreter services. Telephone interpreter services may provide the answer for use in A&E departments because of their instant and 24 hour availability.

Communication Barriers↗