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Biomedical subjects

A Sivakumar

Publications and source records attributed to A Sivakumar.

17 recordsLinked to original sources
PubMed2004

Ginkgo biloba does not benefit patients with tinnitus: a randomized placebo-controlled double-blind trial and meta-analysis of randomized trials.

The objective was to ascertain if Ginkgo biloba benefits patients with tinnitus. The study design was: 1. Randomized double blind trial of Ginkgo biloba versus placebo; 2. A meta-analysis of randomized placebo controlled double blind trials. Participants included 66 adult patients with tinnitus and six (including our study) randomized placebo controlled double blind trials were meta-analysed. The main outcome measures were the Tinnitus Handicap Inventory (THI), Glasgow Health Status Inventory (GHSI) and average of hearing threshold at 0.5, 1, 2, 4 kHz. In the meta-analysis the proportion of patients gaining benefit and an overall odds ratio were determined. The results showed the mean difference in change of the THI, GHSI and hearing between Ginkgo biloba (n = 31) and placebo group (n = 29) was 2.51 (CI -10.1, 5.1, P = 0.51), 0.58 (CI-4.8, 3.6, P = 0.38) and 0.68 db (CI -4.13, 2.8, P = 0.69). Meta-analysis revealed 21.6% of Ginkgo biloba treated patients (n = 107/552) gained benefit versus 18.4% (n = 87/504) of placebo treated patients with an odds ratio of 1.24 (CI 0.89, 1.71). In conclusion, Ginkgo biloba does not benefit patients with tinnitus.

Adult↗
PubMed2003

Tetanus prophylaxis in superficial corneal abrasions.

A short cut review was carried out to establish whether tetanus prophylaxis is indicated after non-penetrating corneal abrasion. Altogether 30 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

Adult↗
PubMed2000

Supervising trauma life support by telemedicine.

The resuscitation room in a community hospital was linked with a main hospital accident and emergency department using telemedicine equipment working at 384 kbit/s. Fifteen simulated casualties replicated the 'moulage' scenarios in the Advanced Trauma Life Support Course Manual of the American College of Surgeons. Each of the 15 scenarios was broken down into three main parts: the primary survey, resuscitation and the secondary survey. While a physician in the community hospital undertook each task, a senior doctor in the accident and emergency department recorded his degree of confidence in the supervision of the task on a five-point scale. There were features of the management which the supervisor found difficult, mainly related to the camera view and the use of a proxy examiner. However, supervising major trauma management by telemedicine was feasible. The average scores were mostly above 3 and often above 4 in the assessment of the primary survey and the resuscitation. The average scores were mostly above 3 for the secondary survey but were less often above 4 than for the primary survey and the resuscitation. Trials of remote trauma management with real patients appear to be justified.

Feasibility Studies↗
PubMed2000

How do teleconsultations for remote trauma management change over a period of time?

We obtained follow-up information about the new patients seen at a minor accident and treatment service (MATS) staffed by emergency nurse practitioners (ENPs). A previous study, of 150 teleconsultations in a six-month period starting in April 1996, was used for comparison. In the present series, 150 teleconsultations occurring in a four-month period starting in April 1999 were studied; the patients constituted 5.6% of the 2658 new attenders or 3.8% of the 3936 total attenders. In comparison with the study three years before, falling teleconsultation rates were partly offset by increasing numbers of attenders and an extension of the ENPs' roles and skills. Teleconsultation rates rose when the number of consultant-run clinics was curtailed and ENP-run clinics replaced some of them. Eligibility to request and report more radiographs reduced the need for teleconsultations, and subsequently teleconsultations for help with interpretation of radiographs fell as the ENPs became more experienced. Specialty residents trusted ENP judgement and accepted telephoned direct admission of cases to their wards. Fewer teleconsultations were required for soft-tissue injuries. Telemedicine is an excellent educational tool.

Emergency Nursing↗
PubMed2000

A comparison of telemedicine with face-to-face consultations for trauma management.

We compared the accuracy of teleconsultations for minor injuries with face-to-face consultations. Two hundred patients were studied. Colour change, swelling, decreased movement, tenderness, instability, radiological examination, severity of illness, treatment and diagnosis were recorded for both telemedicine and face-to-face consultations. Colour change showed an accuracy of 97%, presence of swelling or deformity of 98%, diminution of joint movement of 95%, presence of tenderness of 97%, weight bearing and gait of 99%, and radiological diagnosis of 98%. The severity of illness or injury was overestimated in one case and underestimated in five cases. Treatment was over-prescribed in one case and under-prescribed in three cases. The final diagnosis was correct in all but the two cases in which mistakes were made in the teleradiology. Overall, there was good accuracy using teleconsultations.

Female↗
PubMed1998

Evaluation of telemedical support to a free-standing minor accident and treatment service.

We studied all patients attending a free-standing minor accident and treatment service (MATS) run by emergency nurse practitioners (ENPs). In a six-month period, 5563 patients were seen in the MATS, of whom 2843 (51%) were new attenders. A teleconsultation was carried out with 150 of these patients (2.7% of all cases). The most common reason (39%) was to discuss a radiograph with an accident and emergency consultant. The accuracy of the telemedicine-assisted radiographic diagnosis was checked subsequently by a review panel. The ENPs' working diagnoses (made by viewing the films) had a sensitivity of 90% and a specificity of 96%; this was improved by telemedicine assistance to 97% and 99%, respectively. The telemedicine patients were also surveyed several months after being seen in the MATS; their replies indicated that the telemedicine diagnoses had been correct.

Accidents↗
PubMed1997

A protocol for telemedical consultation.

We have developed a protocol for telemedical consultations. This has been used by emergency nurse practitioners to consult doctors in a main hospital accident and emergency department, using videoconferencing at 384 kbit/s. A telemedical consultation should simulate a face-to-face one. The protocol starts with an explanation for the patient of what will happen, followed by the necessary introductions. After relaying the history, the generalist should show the abnormal part to the specialist. Attention should be paid to colour. Depth perception is often enhanced by rotating the camera through 180 degrees. The diagnosis and management, together with their implications, should be discussed with the patient by the specialist. Referral and follow-up should also be discussed. Proper clinical record-keeping is essential. In the first 15 months of using the protocol, we completed more than 300 teleconsultations. An analysis of the first 50 teleconsultations showed that about half were for discussing a radiograph and about half were for examining a patient.

Clinical Protocols↗
PubMed1996

Teleradiology or teleconsultation for emergency nurse practitioners?

Twenty radiographs showing subtle orthopaedic findings were transmitted to three emergency physicians. Fifty-seven of the 60 attempted diagnoses were correct. We found the primary radiographic film had to be well centred, exposed, true and penetrated for successful transmission. There is a considerable element of familiarization with the technology. The software should permit simultaneous annotation from the two sites and additional cameras are necessary to enable emergency nurse practitioners (ENPs) to show the injured part. The 20 radiographs took 120 min to interpret with teleradiology rather than 10 min of viewing conventional films. The extra time for teleradiology is due to readers asking for multiple areas of the radiographic image to be enlarged before making a decision. We feel that ENPs should not engage in teleradiology but rather telemedical consultation.

Confidence Intervals↗
PubMed1996

Remote trauma management--setting up a system.

A telemedicine link to enable nurse practitioners at a remote minor injuries unit to obtain advice from an emergency physician at a main accident and emergency department is feasible and worthwhile. However, it is fraught with difficulties. These include technical difficulties, training problems, familiarization with the technology and provision of enough emergency physician time for the much longer duration of a full consultation. When choosing the equipment, attention has to be paid to the cameras, lighting, echo cancellation, layout of rooms, privacy and ambience. It is useful to obtain the system from suppliers who know what they are doing and have adequate backup of appropriate technical expertise, because each installation is different and difficult. Our experience suggests that anyone wishing to use similar technology should be prepared to be doggedly determined to learn the system, iron out kinks and motivate all concerned. The project will need to be driven. The technology is still at a stage where frustration and delay are significant. However, it is rewarding and very useful if the staff overcome its shortcomings and in due course all are pleased that they participated.

Emergency Medical Services↗
PubMed1996

Confidentiality and ethics in telemedicine.

This paper reviews the results of a survey of 200 members of the public. The topics examined were ethical issues and patient confidentiality related to the use of telemedicine between an accident and emergency department and emergency nurse practitioners providing a minor accident treatment service (MATS) based in community hospitals. A discussion group of eight respondents was established and a resumé of their views is included.

Confidence Intervals↗