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Results for “Royal Devon and Exeter Hospital”

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At least 19 recordsLinked to original sources
PubMed1994

Development and use of a gastropathy index for ranking the safety of non-steroidal anti-inflammatory drugs in the elderly.

This study, conducted at the Royal Devon & Exeter Hospital, Department of Geriatric Medicine, was carried out using 2987 sets of admission data. The number of patients taking non-steroidal anti-inflammatory drugs was identified together with a suite of clinical factors used to indicate the presence of gastrointestinal pathology. From this a gastropathy index was developed to establish a rank order for the individual drugs. Ketoprofen, piroxicam and fenbufen were all significantly associated with factors suggestive of gastropathy, whereas indomethacin, diclofenac and ibuprofen appeared relatively free of such association. Naproxen, azapropazone and mefenamic acid ranked in an intermediate category. This noninvasive analysis of routinely acquired data provides a potentially useful discriminator between individual non-steroidal anti-inflammatory drugs for this age group.

Aged↗
PubMed2002

Comparison of an 'intuitive' NHS hearing aid prescription method with DSL 4.1 targets for amplification.

This study aimed to evaluate current practice in a National Health Service Trust in setting hearing aid output to meet amplification targets prescribed by desired sensation level (DSL) using a range of NHS hearing aids. A consecutive sample of 33 patients was drawn from the hearing aid waiting list of the Royal Devon & Exeter Hospital (RD&E). The age range was 33-83 years. Patients not giving written consent and those with complex hearing losses were excluded. At review, pure-tone audiogram, uncomfortable loudness levels, real-ear coupler difference, user gain and maximum output were recorded. Data were entered into DSL 4.1 prescription software. Wilcoxon tests were used to compare the measured user gain and maximum output with DSL 4.1-generated targets. The results demonstrate significant differences (p<0.05) at 0.25, 0.5, 0.75, 1.5, 2, 3, 4 and 6 kHz between target and measured values for user gain. This study reveals that the routine intuitive method for prescribing hearing aids at the RD&E is not effective in meeting targets for amplified speech as prescribed by DSL.

Adult↗
PubMed1988

Mercury concentration in cord blood.

The mean mercury concentration measured in cord blood from 51 inner city babies born at Guy's Hospital was significantly higher (37 nmol/l v 20 nmol/l) than that from 17 babies born at the Royal Devon and Exeter Hospital, which serves a more rural population.

England↗
PubMed2000

Asthma after childhood pneumonia: six year follow up study.

OBJECTIVE: To establish the long term cumulative prevalence of asthma in children admitted to hospital with pneumonia and to examine the hypothesis that some children admitted to hospital with pneumonia may be presenting with undiagnosed asthma. DESIGN: Prospective study of a cohort of children previously admitted to hospital with pneumonia, followed up by postal questionnaires to their general practitioners and the children or their parents. SETTING: General practices in southwest England. PARTICIPANTS: 78 children admitted to the Royal Devon and Exeter Hospital between 1989 and 1991 with a diagnosis of pneumonia confirmed on independent review of x ray films. MAIN OUTCOME MEASURES: Any diagnosis of asthma, use of any treatment for asthma, and asthma symptom scores. RESULTS: On the basis of a 100% response rate from general practitioners and 86% from patients or parents, the cumulative prevalence of asthma was 45%. A diagnosis of asthma was associated with a family history of asthma (odds ratio 11.23; 95% confidence interval 2.57 to 56.36; P=0.0002). Mean symptom scores were higher for all children with asthma (mean score 2.4; chi(2)=14.88; P=0. 0001) and for children with asthma not being treated (mean 1.4; chi(2)=6.2; P=0.01) than for those without asthma (mean 0.2). CONCLUSIONS: A considerable proportion of children presenting to a district general hospital with pneumonia either already have unrecognised asthma or subsequently develop asthma. The high cumulative prevalence of asthma suggests that careful follow up of such children is worth while. Asthma is undertreated in these children; a structured symptom questionnaire may help to identify and reduce morbidity due to undertreatment.

Adolescent↗
PubMedDate not supplied

Individual quality of life in patients with leukaemia and lymphoma.

With increasingly sophisticated chemotherapy regimes being prescribed the quality of life of cancer patients has become a key outcome measure. Little has been reported concerning the experience of patients with haematological malignancy receiving chemotherapy. The objective of this study was to evaluate the clinical usefulness of a novel quality of life measure-the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) in a sample of patients with either leukaemia or lymphoma. Fifty-one patients from the haematology clinic and in-patient unit at The Royal Devon and Exeter Hospital completed the SEIQoL-DW; in addition, each patient completed the Hospital Anxiety and Depression Scale (HADS) and a ten item questionnaire covering aspects of their treatment and satisfaction with information provided. The practical application of the SEIQoL-DW is described and two patients quality of life profiles are illustrated for comparison. The relationship between quality of life, satisfaction with information provided and psychological distress as measured by the HADS is discussed.

Female↗
PubMed2002

Effect of Honan balloon compression on peribulbar anesthesia adequacy in cataract surgery.

PURPOSE: To ascertain whether a Honan balloon is necessary to produce effective peribulbar anesthesia in routine cataract surgery by evaluating its effect on intraocular pressure (IOP), surgeon assessment of the anesthesia's effectiveness, and patients' analgesic experience. SETTING: West of England Eye Unit, Royal Devon and Exeter Hospital, England. METHOD: Fifty eyes of 50 patients having routine phacoemulsification cataract extraction and intraocular lens implantation were randomized to have 10-minute ocular compression with the Honan balloon or no compression after peribulbar anesthesia. A single investigator gave all the peribulbar injections using a standard technique. The IOP was measured immediately before and 10 minutes after the injections. Two surgeons who were blinded to the randomization process performed the surgeries and completed an assessment questionnaire on various aspects of the peribulbar block. The patients also scored their level of analgesia during surgery. RESULTS: In the 26 patients who had Honan balloon compression, there was a significant reduction in IOP (mean 6.2 mm Hg; P <.05). In the 24 patients with no balloon compression, there were no significant changes in IOP 10 minutes after the peribulbar injections. There was no statistically significant difference in the surgeons' scores in any aspect of the peribulbar anesthesia (P >.05). All patients experienced a good level of analgesia. CONCLUSIONS: There was a significant reduction in IOP after Honan balloon ocular compression. However, there was no significant increase in IOP without balloon compression. The use of a Honan balloon did not appear to make a significant difference in the effectiveness of the peribulbar anesthesia to the surgeons or patients.

Aged↗
PubMed2006

Delivery of local anaesthetic via a sternal catheter to reduce the pain caused by sternal fractures: first case series using the new technique.

Sternal fractures cause considerable pain, and a proportion of patients require admission for analgesia. Local anaesthetic techniques have been used to reduce the pain from chest wall injuries and may reduce complications from these injuries. The use of a local anaesthetic delivered via a sternal catheter over a fractured sternum has been described in a patient whose pain was inadequately controlled with opiates. This technique was recently offered to patients in the emergency department at the Royal Devon and Exeter Hospital, Exeter, UK, and the experiences of patients and doctors are reported. Findings from this first case series suggest that the technique seems to be effective, well tolerated and acceptable to patients.

Accidents, Traffic↗
PubMed2002

Evaluation of the HemoCue compared with the Coulter STKS for measurement of neonatal haemoglobin.

OBJECTIVE: To compare the measurement of haemoglobin concentration ([Hb]) using the HemoCue haemoglobinometer with that using the Coulter STKS haemoglobinometer. DESIGN: Thirty two EDTA samples were taken from neonates. [Hb] was measured in these samples using the HemoCue; the samples were then transferred to the haematology laboratory for [Hb] determination with the Coulter STKS. In addition, [Hb] was determined in 50 different random EDTA neonatal samples already held in the laboratory, using the HemoCue and Coulter STKS. PATIENTS: Neonates in the intensive care and low dependency Units of the Royal Devon and Exeter Hospital. INTERVENTIONS: Samples were collected from arterial lines or by venepuncture or heel prick into an EDTA bottle. MAIN OUTCOME MEASURES: [Hb] using the HemoCue and Coulter STKS methods. RESULTS: The mean [Hb] measured using the HemoCue was 150.3 g/l (range 78-215) compared with 152.8 g/l (range 78-217) measured using the Coulter STKS, with a mean of the differences of 2.5 g/l. The standard deviation of the differences of the 82 samples was 3.73 g/l. The limits of agreement of the two methods (mean difference +/- 2SD) were -4.8 to +9.8 g/l. CONCLUSION: With adequate training and monitoring, the HemoCue can be used directly on the neonatal unit for rapid determination of [Hb] to within 7.5 g/l compared with the laboratory Coulter STKS, using much smaller sample volumes.

Hemoglobinometry↗
PubMedDate not supplied

Why should acute trusts be interested in cardiac rehabilitation?

This questionnaire survey of 100 ex-coronary care unit (CCU) patients in the Royal Devon and Exeter Hospital NHS Trust sought to determine patients' views (i.e. consumers' rather than professionals' views) regarding their perceived need for individual of group support following myocardial infarction, and whether the information received in hospital was adequate for their needs. A literature review of the evidence suggesting that cardiac rehabilitation is effective is included. Responses indicated that 42 of the 62 patients who responded (67.7%) felt that they would have benefited from a relaxation and/or support group, with 40 (69%) stating that they would have attended such a facility after discharge. The nature of the information offered by nursing staff while patients were in hospital was clearly that which was 'convenient' and 'unthreatening' for nurses to deliver. Only 35 respondents (56.4%) agreed that this information was adequate for their needs. These results indicate the preferences of our local consumers, whose views should be paramount in the contemporary NHS. There is a significant unmet demand for such services, which acute sector staff have the expertise to meet.

Adult↗
PubMedDate not supplied

Clinical evaluation of an electronic pressure-relieving mattress.

A 12-month clinical evaluation of the Talley Quattro Deep Cell 2000 mattress manufactured by Talley Medical was undertaken on both a trauma and surgical ward at the Royal Devon and Exeter Hospital. An identified registered nurse coordinated the evaluation with support from tissue viability clinical nurse specialists. Data on patients, including diagnosis, Waterlow score, pressure area condition and general comments by nurses and patients, were collected. The evaluation involved 35 patients who were at high- to very-high risk of pressure sore formation. The results showed that 16 out of 40 sores healed during the evaluation period and 16 sores remained unchanged. Only one patient developed broken skin while nursed on the mattress. Seventeen patients maintained tissue integrity. Although the study was limited the results suggest that the Talley Quattro Deep Cell 2000 mattress is useful in preventing and managing pressure sores in high- to very high-risk patients.

Aged↗
PubMedDate not supplied

Implementing a research project on the development of diabetes.

The Exeter Research Alliance for Diabetes is a research project recently implemented at the Royal Devon and Exeter Hospital. The project investigates the genetic and environmental influences on the development of diabetes and its associated complications. This article describes the process of instigating the study from an initial research idea through to the implementation of the project.

Biomedical Research↗
PubMed1997

Managing pressure relief in a special needs nursing scheme.

People admitted to the Royal Devon and Exeter Hospital, who require continued long term nursing care and fulfil at least one of seven identified criteria, can be referred to a special needs scheme for placement in a private local nursing home supported by education, free loan of electronic pressure-relieving equipment and visits to monitor progress. A clinical nurse specialist in tissue viability is also available for advice and the supply of equipment to any residents with tissue viability problems who are referred by nursing home staff. From a total of 293 referrals during the first four years of this scheme, 155 patients have been supported in nursing homes through the scheme. At the time of placement, 71 patients (46%) had pressure sores, all of whom received the free loan of an electronic mattress. A further 21 patients, whose skin integrity was at high risk, also received mattresses. The sores ranged from Grade 2 to Grade 4 (Stirling grading scale). During the study period, only four patients placed under the scheme suffered deterioration in their sores (all immediately prior to death). Over the three years before the scheme began, 14 patients per year were admitted from private nursing homes to an acute hospital with a primary diagnosis of pressure sore. Since the introduction of the scheme this figure has been reduced to nil.

Aged↗
PubMed1993

Elective ventilation for transplant purposes.

There is a shortfall in organ donations, particularly with regard to an increasing dialysis population. Some patients who now die on general wards would be suitable donors if they were nursed on Intensive Care Units (ICUs) and ventilated until brain-stem death is confirmed. This study examines the concept of elective ventilation in relation to ethical, economic and resource considerations and examines the role and philosophy of ICU nursing care. A suitable nursing model is discussed, including caring for relatives. In conclusion, it is submitted that the concept of elective ventilation for transplant purposes is not incompatible with the philosophy and aims of ICUs and nursing.

Brain Death↗
PubMed1995

Elective ventilation of potential organ donors.

Elective ventilation describes the procedure of transferring selected patients dying from rapidly progressive intracranial haemorrhage from general medical wards to intensive care units for a brief period of ventilation before confirmation of brain stem death and harvesting of organs. This approach in Exeter has led to a rate of kidney retrieval and transplant higher than has been achieved elsewhere in the United Kingdom, with a stabilisation of numbers on patients on dialysis. Recently doubt has been cast on the legality of our practice of elective ventilation on the grounds that relatives are not permitted to consent to treatment of an incompetent person when that treatment is not in the patient's best interests. We are thus faced with the dilemma of a protocol that is ethical, practical, and operates for the greater good but which may be illegal. This article explores various objections to the protocol and calls for public, medical, and legal debate on the issues.

Brain Death↗