Search PubMed⌕ Search

Biomedical subjects

Peter A Cameron

Publications and source records attributed to Peter A Cameron.

13 recordsLinked to original sources
PubMed2003

Evaluation of WHO criteria for identifying patients with severe acute respiratory syndrome out of hospital: prospective observational study.

OBJECTIVES: To determine the clinical and radiological features of severe acute respiratory syndrome (SARS) and to evaluate the accuracy of the World Health Organization's guidelines on defining cases of SARS. DESIGN: Prospective observational study. SETTING: A newly set up SARS screening clinic in the emergency department of a university hospital in Hong Kong's New Territories. PARTICIPANTS: 556 hospital staff, patients, and relatives who attended the screening clinic and who had had contact with someone with SARS. MAIN OUTCOME MEASURE: Number of confirmed cases of SARS. RESULTS: Of the 556 people, 141 were admitted to hospital, and 97 had confirmed SARS. Fever, chills, malaise, myalgia, rigor, loss of appetite, vomiting, diarrhoea, and neck pain but not respiratory tract symptoms were significantly more common among the 97 patients than among the other patients. The overall accuracy of the WHO guidelines for identifying suspected SARS was 83% and their negative predictive value was 86% (95% confidence interval 83% to 89%). They had a sensitivity of 26% (17% to 36%) and a specificity of 96% (93% to 97%). CONCLUSIONS: Current WHO guidelines for diagnosing suspected SARS may not be sufficiently sensitive in assessing patients before admission to hospital. Daily follow up, evaluation of non-respiratory, systemic symptoms, and chest radiography would be better screening tools.

Adult↗
PubMed2003

Short-stay units and observation medicine: a systematic review.

OBJECTIVES: To conduct a systematic review of how short-stay observation units (SOUs) affect the efficiency of healthcare delivery and the quality of services provided. DATA SOURCES: MEDLINE, CINAHL, Best Evidence and The Cochrane Library were searched for the period 1 January 1960 to 31 July 2000. STUDY SELECTION: Studies were eligible if published in English and rated at National Health and Medical Research Council evidence levels I, II-1, II-2, or II-3; 12 comparative studies published between 1985 and 1998 met these criteria. DATA EXTRACTION: Data pertaining to clinical outcomes, length of stay, re-presentation rates, emergency department efficiency and costs of care were extracted and evaluated independently. DATA SYNTHESIS: As there was considerable heterogeneity in the patient populations and outcomes, results were summarised rather than subjected to meta-analysis. CONCLUSION: SOUs have the potential to increase patient satisfaction, reduce length of stay, improve the efficiency of emergency departments and improve cost effectiveness. However, SOUs have commonly been implemented alongside new clinical protocols, and it is not possible to distinguish the relative benefits of each. As demand increases, providing effective and cost-efficient care will become increasingly important. SOUs may help organisations that are attempting to streamline patient care while maintaining their quality of service delivery.

Delivery of Health Care↗
PubMed2002

Complaints from emergency department patients largely result from treatment and communication problems.

OBJECTIVE: Emergency department patient complaints are often justified and may lead to apology, remedial action or compensation. The aim of the present study was to analyse emergency department patient complaints in order to identify procedures or practices that require change and to make recommendations for intervention strategies aimed at decreasing complaint rates. METHODS: We undertook a retrospective analysis of patient complaints from 36 Victorian emergency departments during a 61 month period. Data were obtained from the Health Complaint Information Program (Health Services Commissioner). RESULTS: In all, 2,419 emergency department patients complained about a total of 3,418 separate issues (15.4% of all issues from all hospital departments). Of these, 1,157 complaints (47.80%) were received by telephone and 829 (34.3%) were received by letter; 1,526 (63.1 %) complaints were made by a person other than the patient. Highest complaint rates were received from patients who were female, born in non-English-speaking countries and very young or very old. One thousand one hundred and forty-one issues (33.4%) related to patient treatment, including inadequate treatment (329 issues) and inadequate diagnosis (249 issues); 1079 (31.6%) issues related to communication, including poor staff attitude, discourtesy and rudeness (444 issues); 407 (11.9%) issues related to delay in treatment. Overall, 2516 issues (73.6%) were resolved satisfactorily, usually by explanation or apology. Only 59 issues (1.7%) resulted in a procedure or policy change. Remedial action was taken in 109 issues (3.2%) and compensation was paid to eight patients. CONCLUSIONS: Communication remains a significant factor in emergency department patient dissatisfaction. While patient complaints have resulted in major changes to policy and procedure, research and intervention strategies into communication problems are indicated. In the short term, focused staff training is recommended.

Adolescent↗
PubMed2002

Knowledge of heart attack symptoms in a community survey of Victoria.

OBJECTIVE: To ascertain the level of knowledge of heart attack symptoms in the Victorian public. METHODS: This was a cross sectional telephone survey conducted during 2000-01. The questionnaire contained sections regarding participant demographics and knowledge of heart attack symptoms. RESULTS: A total of 1489 people completed the questionnaire (79% of eligible participants). The mean number of correct heart attack symptoms was 2.5 (95% CI 2.45, 2.60) (median three out of 10). Only 4.2% of participants reported at least five correct symptoms and 4.1% could not report any symptoms. A total of 84.6% of respondents reported chest pain as a symptom of heart attack. CONCLUSIONS: The Victorian public appears to lack the knowledge of the varied range of heart attack symptoms. Methods of disseminating information regarding symptoms and ways to reduce prehospital delay need to be devised, particularly methods which target the older 'at risk' population.

Adult↗
PubMedDate not supplied

Impact of acute chest pain Tc-99m sestamibi myocardial perfusion imaging on clinical management.

BACKGROUND: Previous studies have demonstrated the high sensitivity and specificity of technetium 99m sestamibi scintigraphy during acute chest pain myocardial perfusion imaging. However, no study has shown that this technique would alter clinical management in practice. METHODS AND RESULTS: One hundred twenty consecutive patients were injected with Tc-99m sestamibi (22 mCi) during pain; single photon emission computed tomography was performed 1 to 6 hours later. The population included inpatients and those who arrived at the emergency department with chest pain deemed to be at intermediate risk for myocardial ischemia. The requesting physician completed a questionnaire before the study, indicating the likelihood of cardiac disease and proposed management had the test not been available. Follow-up management was evaluated from medical records. There was a 34% reduction in total admissions and 59% in planned admissions to the coronary care unit (P <.001). Conversely, 7 patients had discharge cancelled and 17 required coronary care purely because of abnormal acute rest myocardial perfusion imaging results. Coronary angiography was reduced by 40% in a selected subgroup. CONCLUSIONS: In our population, acute rest myocardial perfusion imaging reduced total admissions and altered resource utilization. This may result in more appropriate triage of individual patients in the management algorithm, as well as potential cost savings.

Chest Pain↗