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Biomedical subjects

W A McAdam

Publications and source records attributed to W A McAdam.

At least 19 recordsLinked to original sources
PubMed1991

Can computer aided teaching packages improve clinical care in patients with acute abdominal pain?

OBJECTIVE: To compare three methods of support for inexperienced staff in their diagnosis and management of patients with acute abdominal pain--namely, with (a) structured data collection forms, (b) real time computer aided decision support, and (c) computer based teaching packages. DESIGN: Prospective assessment of effects of methods of support on groups of doctors in one urban hospital and one rural hospital. SETTING: Accident and emergency department at Whipps Cross Hospital, London, and surgical wards of Airedale General Hospital, West Yorkshire. PATIENTS: Consecutive prospective series of all patients presenting to each hospital in specified time periods with acute abdominal pain; total patients in the various periods were 12,506. MAIN OUTCOME MEASURES: Diagnostic accuracy of participating doctors, admission rates of patients with non-specific abdominal pain, perforation rates in patients with appendicitis, negative laparotomy rates. RESULTS: Use of any one modality resulted in improved diagnostic accuracy and decision making performance. Use of structured forms plus computer feedback resulted in better performance than use of forms alone. Use of structured forms plus a computer teaching package gave results at least as good as those with direct feedback by computer. CONCLUSIONS: The results confirm earlier studies in suggesting that the use of computer aided decision support improves diagnostic and decision making performance when dealing with patients suffering from acute abdominal pain. That use of the computer for teaching gave results at least as good as with its use for direct feedback may be highly relevant for those who are apprehensive about the real time use of diagnostic computers in a clinical setting.

Abdominal Pain↗
PubMed1990

A comparison between enprostil and ranitidine in the management of gastric ulceration.

In a randomly allocated, double-blind, endoscopically controlled study, 98 patients with gastric ulcers were treated with either (a synthetic prostaglandin of E2-like structure) enprostil 70 micrograms b.d. or 150 mg ranitidine b.d. The healing rates at 4, 8 and 12 weeks were enprostil 57, 91 and 94% and for ranitidine 55, 88 and 98%, respectively. Following ulcer healing, half the patients were followed for 1 year without treatment and the others were given 70 micrograms enprostil nocte. Endoscopy was repeated in both groups after 6 and 12 months or if dyspeptic symptoms returned. The recurrence rate without maintenance at 6 and 12 months, following ranitidine therapy, was 67 and 75%, and after enprostil therapy 50 and 61%, respectively. On maintenance enprostil, the recurrence rates were 28 and 40%. Forty-seven per cent of patients who completed maintenance treatment had a proven ulcer recurrence within 6 months of stopping therapy. Diarrhoea was a common side-effect of enprostil therapy. Seven patients were withdrawn because of diarrhoea or abdominal pain.

Double-Blind Method↗
PubMed1990

Twelve years' experience of computer-aided diagnosis in a district general hospital.

This paper describes experience in a modern district general hospital with a small desktop system for computer-aided diagnosis of acute abdominal pain, over a 12-year period involving 5512 cases. When compared with a baseline year (1973) in which unaided performance was monitored, during an initial study period (1974-76) the diagnostic accuracy of junior staff rose by between 10 and 15%. This higher performance level was then maintained for a decade (1976-86) despite changes in staff. The perforation rate among appendicitis cases fell from 27% to 12.5%, accompanied by a smaller fall in negative laparotomy rates. The saving in surgical bednights devoted to acute abdominal pain was approximately 15%, and the notional cost of resources saved during the first 6 years of operation was 120,000 pounds. Other hospitals have shown--in the short term--benefits similar to those obtained at Airedale District General Hospital. The long-term benefits of the system at Airedale reinforce the conclusions of the earlier short-term trials that a comparable system should probably be offered to all DGHs in the UK, not as an exercise in 'artificial intelligence' but as an effective continuing stimulus to good clinical practice.

Abdominal Pain↗
PubMed1990

Highly selective vagotomy: use of a ligature carrier.

A ligature carrier for use in typing the neurovascular bundle along the lesser curve of the stomach during highly selective vagotomy is described. This is presented as a safe and efficient way of performing this part of the operation.

Humans↗
PubMed1988

Highly selective vagotomy: a 14-year experience.

Since August 1971, 244 highly selective vagotomies were performed for pyloric and duodenal ulceration by one surgeon (W.A.F.M.). There was one postoperative death. Twenty (8 per cent) patients were lost to follow-up. The remaining 223 patients were followed up for 1 to 14 years (mean 4.2 years). On the modified Visick grading system 83.4 per cent were Visick I or II and 16.6 per cent were Visick III or IV. The failures were mainly recurrences. The recurrence rate was 11.2 per cent. Certain factors were examined to try to elucidate those influencing recurrence rate but no significant prognostic indicator was found. Acid studies were analysed and no significant relationship between these and the development of a recurrence could be found. The second 100 vagotomies were better than the first as judged by the results of studies of insulin-stimulated acid. Finally, we question whether all recurrences should automatically be regarded as treatment failures and the patients classified as Visick IV.

Adolescent↗
PubMed1987

Does Caved-S decrease the gastric ulcer relapse rate during maintenance treatment with ranitidine?

Ninety-five patients with healed gastric ulcers were treated with ranitidine 150 mg at night plus either Caved-S two tablets twice daily, or an identical placebo preparation. Treatment was continued for 2 years: the recurrence rate after 1 year was 12.5% for single therapy and 19% for combined therapy, and 30 and 40% respectively after 2 years (differences not significant). No serious side-effects were encountered, but patients found the combination therapy difficult to take, and it conferred no clinical advantage. In a 3 month follow-up after stopping maintenance therapy, 11% of the patients had a symptomatic ulcer recurrence. It is therefore recommended that elderly patients with gastric ulceration should remain on maintenance therapy for life.

Adult↗
PubMed1985

Comparison between ranitidine and ranitidine plus Caved-S in the treatment of gastric ulceration.

In a double blind endoscopically controlled study, 100 patients with gastric ulcers were treated with either ranitidine or ranitidine plus Caved-S. On single therapy, 58% of ulcers were healed at four weeks, 92% at eight weeks and 96% at 12 weeks. Combination therapy did not alter the healing rate, nor improve on the control of dyspeptic symptoms. No difference in healing rate was found between good and poor drug compliance patients. This suggests that ranitidine may be equally effective at lower dosages. Thirty seven patients had developed their ulcer while taking non-steroidal anti-inflammatory drugs. These patients were mainly elderly women who had a higher risk of bleeding (p = 0.006) from a large ulcer (p = 0.009).

Aged↗
PubMed1985

Maintenance therapy: a two year comparison between Caved-S and cimetidine treatment in the prevention of symptomatic gastric ulcer recurrence.

Eighty two patients with an endoscopically healed gastric ulcer, were treated for two years with either Caved-S tablets, two twice daily or cimetidine 400 mg at night. During the first year, 12% (four out of 34) of the Caved-S group and 10% (four out of 41) of the cimetidine group had an ulcer recurrence. By the end of the second year, the recurrence rate was 29% (nine out of 31) in the Caved-S group, and 25% (eight out of 32) for the cimetidine group. Ulcer relapse occurred frequently in patients with either a dyspeptic history of over six months (p less than 0.05), or a past history of a gastric ulcer (p less than 0.001). Ulcers recurred rapidly after maintenance therapy; Caved-S two out of 22; cimetidine seven out of 23, within four months (NS). This study shows that long term maintenance therapy is safe and reasonably effective. The high recurrence rate after stopping treatment suggests that therapy in high risk or elderly patients should be for life.

Adult↗
PubMed1978

Cimetidine: an advance in gastric ulcer treatment?

Sixty patients with endoscopically confirmed gastric ulceration took part in a single-blind trial of cimetidine 1 g daily compared with conventional treatment--namely, carbenoxolone in patients aged under 60 and Caved-(S) in those over 60. Twenty-nine patients received cimetidine: in 12 (41%) ulcer healing was complete after one month, in 26 (90%) healing was complete after two months, and all ulcers were healed after three months of treatment. In the under-60s, ulcers were healed in a greater proportion of patients given cimetidine than in those given carbenoxolone. The difference, however, was significant only at the 5% level, which owing to small numbers was of doubtful clinical validity. In the over-60s cimetidine and Caved-(S) were of similar efficacy. The 54 patients with healed ulcers are being followed up for two years; so far there have been 16 recurrences (30%). Further trials are needed, which should include maintenance treatment aimed at lowering the unacceptably high recurrence rate.

Adult↗
PubMed1977

Clinical findings, early endoscopy, and multivariate analysis in patients bleeding from the upper gastrointestinal tract.

A simple system has been developed to identify patients with upper gastrointestinal tract haemorrhage who run a high risk of continued bleeding or rebleeding. The system is based on six items of patient data available at or soon after arrival in hospital. It was evaluated in a prospective study of 66 patients with upper gastrointestinal tract haemorrhage. Over half of the patients classified by the system into a high-risk category either continued bleeding or rebled after apparent cessation (as against one out of 33 patients in the low-risk category). The high-rish group also had a higher mortality (21%) than those in the low-risk group (nil). The addition or subtraction of early endoscopic findings made little difference to the accuracy of prognosis.

Age Factors↗
PubMed1976

Assessment of the results of surgery for varicose veins.

Fifty-six patients undergoing primary surgery for unilateral varicose veins by a standardized Trendelenburg procedure were reviewed postoperatively by a panel of three observers. Agreement between the observers was high in assessing symptomatic response (up to 98%), but only moderate in evaluation of any visual changes in affected legs (60%). Moreover, intr-observer agreement comparing symptomatic response and visual impression was very low (30-4%). It is suggested that inter-series comparisons should be made solely upon the response of specific symptoms to treatment.

Evaluation Studies as Topic↗
PubMed1976

Multiple recurring gastric erosions/aphthous ulcers).

Five patients are described who had repeated endoscopy because of continuing dyspeptic symptoms associated with a negative barium meal. They were found to have multiple recurring gastric erosions (aphthous ulcers). No common aetiological factor could be found, although four of these patients did have a mild or moderatley active superficial chronic gastritis. Conventional peptic ulcer therapy failed to control either symptoms or ulceration. Two patients finally came to gastric surgery (highly selective vagotomy), which resulted in the relief of symptoms and healing of the gastric aphthous ulceration.

Adult↗