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Biomedical subjects

A G Pennycook

Publications and source records attributed to A G Pennycook.

12 recordsLinked to original sources
PubMed1995

Women attending an accident and emergency department after assaults.

Assaults on women are a distressing aspect of A&E work. In a combined prospective and retrospective study, covering a 6-month period, 282 female victims were identified (0.75% of attendances). Although most of the injuries were relatively minor the recording of historical and social factors was poor. Attempted follow up for counselling and support proved ineffective. Better education of the doctors regarding the documentation for such patients, assessment of the social dimensions of their needs and requirement for improving both their immediate care and long term follow-up are discussed.

Adolescent↗
PubMed1994

Relation between Glasgow coma score and cough reflex.

How unconscious does a patient need to be, to be intubated without drugs? In 76 comatose patients (Glasgow coma score [GCS] < or = 8) who were treated consecutively in an emergency department, the integrity of the cough reflex was not related to GCS. All comatose patients must be treated as if their airway is compromised but even at the lowest coma scores, there are many patients whose airway reflexes are sufficiently intact to make procedures such as endotracheal intubation difficult and dangerous without drugs. The state of the airway should be assessed independently of conscious level.

Coma↗
PubMed1993

Knee radiographs: a substitute for proper clinical examination within the accident and emergency department?

Over a 2-month period in an accident and emergency department, the clinical benefits and cost-effectiveness of radiology of the knee after trauma was audited. In all, 178 patients had radiographs as part of their initial assessment, the majority of which were subsequently reported by the radiologist as entirely normal (90.4 per cent of films after a twisting injury and 80.6 per cent after a direct blow). Early and appropriate clinical review by a senior doctor is proposed as a viable alternative to perhaps unneeded radiographs where the physical signs of injury are minimal. The clinical and financial benefits of such a policy are discussed.

Cost-Benefit Analysis↗
PubMed1992

Intravenous drug abusers attending an inner city accident and emergency department.

In a 3-month prospective study, intravenous drug abusers represented 1.14% of all new attendances at Glasgow Royal Infirmary. They generated a significant workload and were often difficult to identify. A very high proportion required surgery or other invasive procedures. The clinical and epidemiological characteristics of the patients were often unexpected. The risks to staff and other implications for the A&E department are discussed.

Adolescent↗
PubMed1992

Irregular discharge against medical advice from the accident and emergency department--a cause for concern.

An irregular discharge (ID) from the A&E department is an undesirable, but relatively common occurrence. A prospective study was undertaken to quantify the size of the problem and by arranging a subsequent review of the patient, to determine the clinical outcome. Over a 3-month period, 139 patients (0.73%) of attendances) took their own discharge against medical advice. A further 566 patients (3.03% of attendances) left prematurely prior to any medical assessment (DNW). Attenders irregularly discharged, often with serious untreated conditions. A high proportion were intoxicated with alcohol (65.5%). Attempted follow up proved difficult and incomplete. Patients with serious conditions appeared to return spontaneously for further care. Methods of minimizing the numbers of patients who take an ID or DNW are discussed. Taken together, the numbers of these attenders leaving prematurely, can be used as a valid performance indicator of the delivery of health care in the A/E department.

Adolescent↗
PubMed1991

Accidental golf club injuries.

Over a 2 month period, 33 patients with injuries caused by golf clubs were identified among attenders at the accident and emergency department at Glasgow Royal Infirmary. The vast majority of these were to the face and head, including three compound skull fractures. Attention is drawn to the average age of those injured (8.1 years) and to the fact that only one of the injuries occurred on a golf course. The dangers of unsupervised experimentation with golf clubs by young children are emphasized.

Accidents↗
PubMed1991

Unplanned re-attendance in the accident and emergency department.

The notes of patients who re-attended the Accident and Emergency Department with a problem for which they had already been seen and treated were reviewed over a five-week period. Such patients comprised 2.5% of total attendances. The commonest reason for re-attendance was persistent pain following an injury and of such patients, about a half required a significant change in management. It was estimated that two-thirds of re-attendances were unavoidable. Twenty patients were admitted following re-attendance, and of these, two had serious medical conditions which were missed on initial presentation. The role of senior Accident and Emergency doctors is discussed in the light of these findings.

Emergency Service, Hospital↗
PubMed1991

Use of the emergency ambulance service to an inner city accident and emergency department--a comparison of general practitioner and '999' calls.

Over a 2-week period a prospective study was undertaken of patients brought to an inner city accident and emergency department by the emergency ambulance service. Criteria for assessing the appropriateness of use of the emergency ambulance service are not well defined and at worst entirely subjective. The author's finding that, of patients attending after a '999' call, 49.8% were discharged with no follow-up suggests that many of these journeys represented inappropriate use of the emergency ambulance service. Close liaison between senior medical staff and the emergency ambulance service may allow more appropriate and effective use of the service, improving patient care in the pre-hospital setting.

Adolescent↗
PubMed1991

A study of the content of general practitioners' referral letters to an accident and emergency department.

A two-week prospective study was undertaken to assess the quality and content of referral letters from the primary care services to an inner city accident and emergency department. It was found that the majority of letters fell short of commonly accepted minimum standards. A comparison was also made between letters from general practice principals and deputising service doctors. Recommendations for improvement in written communication are discussed.

Correspondence as Topic↗
PubMed1990

The general practitioner's use and expectations of an accident and emergency department.

In an attempt to establish what the general practitioner expects from an accident and emergency department, and how closely the service provided correlates with that view, a 12-point questionnaire was sent to the general practitioners in the Glasgow Royal Infirmary catchment area. Out of the 61.2% of general practitioners who replied, the majority wish to have responsibility for their own patients for conditions which are neither accidents nor emergencies. There is less agreement as to how much should be done within an accident and emergency department and on the appropriate modes of referral and communication between the general practitioner and the hospital service. Further consultation and cooperation are necessary to interpret and resolve these differences.

Attitude of Health Personnel↗