Biomedical subjects

Anand Pillai

Publications and source records attributed to Anand Pillai.

5 recordsLinked to original sources

PubMed2007

Scaphoid fractures: variation in radiographic views - a survey of current practice in the West of Scotland region.

BACKGROUND: A variation seems to exist between hospitals with regard to the initial radiographic assessment of suspected scaphoid fractures. MATERIALS AND METHODS: A survey of all acute hospitals in the West of Scotland was carried out to ascertain the current practice in the assessment of acute scaphoid fractures. Consultant radiologists and consultant orthopaedic surgeons from the same hospitals were requested to suggest the minimum number and type of views to be ideally performed for a routine scaphoid series. RESULTS: Fourteen hospitals, 85 consultant orthopaedic surgeons and 60 consultant radiologists were contacted. Among the hospitals, 64.3% performed four views and 28.5% performed three views for a suspected scaphoid fracture. The commonly performed radiographs were lateral with the wrist neutral (85.7%) and postero-anterior oblique in ulnar deviation (78.5%). Of the consultant orthopaedic surgeons, 57.5% suggested four views, while 33.3% suggested three views. A lateral view with the wrist neutral (87.8%) and a postero-anterior view in ulnar deviation (51.5%) were considered most useful. Of the consultant radiologists, 68.4% suggested four views and 15.8% suggested three views. A lateral view with the wrist neutral (84.2%) and a postero-anterior view in ulnar deviation (52.6%) were considered most useful. DISCUSSION: A lack of uniformity is found among orthopaedic consultants who request scaphoid views, radiographers who perform the views and radiology consultants who report on these. We feel a uniform system of radiographic evaluation of scaphoid fractures should be introduced, with a standardized number and type of views, in all hospitals to increase the familiarity of both terminology and visualization.

Data Collection↗

PubMed2006

Fluroscopy in paediatric fractures--setting a local diagnostic reference level.

BACKGROUND: The ionizing radiations (Medical Exposure) Regulation 2000 has made it mandatory to establish diagnostic reference levels (DRLs) for all typical radiological examinations. OBJECTIVES: We attempt to provide dose data for some common fluoroscopic procedures used in orthopaedic trauma that may be used as the basis for setting DRLs for paediatric patients. MATERIALS AND METHODS: The dose area product (DAP) in 865 paediatric trauma examinations was analysed. Median DAP values and screening times for each procedure type along with quartile values for each range are presented. RESULTS: In the upper limb, elbow examinations had maximum exposure with a median DAP value of 1.21 cGy cm2. Median DAP values for forearm and wrist examinations were 0.708 and 0.538 cGy cm2, respectively. In lower limb, tibia and fibula examinations had a median DAP value of 3.23 cGy cm2 followed by ankle examinations with a median DAP of 3.10 cGy cm2. The rounded third quartile DAP value for each distribution can be used as a provisional DRL for the specific procedure type.

Child↗

PubMed2006

Bacillus cereus: the forgotten pathogen.

BACKGROUND: Infection with Bacillus cereus is generally associated with gastrointestinal effects of food poisoning linked to infected rice. Isolates of B. cereus in hospital and clinical settings from any material other than vomitus or feces are commonly dismissed as contaminants. CASE REPORT: We report a case of B. cereus surgical site infection after fasciotomy in a healthy 31 year-old man admitted to the orthopedic ward with a comminuted fracture of the tibia. No source was identified. CONCLUSIONS: This report highlights the risk of surgical site infection with an unlikely bacterium known to contaminate surgical materials. It stresses the importance of vigilance against this infrequent but potentially serious non-gastrointestinal bacillary infection, as organisms dismissed initially as contaminants may lead to rapid clinical deterioration. The use of antimicrobial agents with nosocomial coverage, even of non-nosocomial pathogens, is considered in the treatment of postoperative surgical site infections.

Adult↗

PubMed2005

Management of clinical fractures of the scaphoid: results of an audit and literature review.

OBJECTIVES: Two to 5% of scaphoid fractures are missed on initial presentation. The failure of early recognition and treatment are considered to contribute to delayed union and non-union. Despite advances in diagnostic imaging, a dogmatic approach has persisted in the management of patients with clinical suspicion but no radiographic evidence of scaphoid fracture. A critical analysis of the current treatment protocol of indiscriminate cast immobilization and serial clinical and radiographic follow-up is presented. METHODS: A prospective study involving 90 patients with clinical signs suggestive of scaphoid injury, followed up until a definite boney injury was demonstrated or the patient was discharged. A review of the literature was conducted to question the need for immobilization in these patients and the potential use of other forms of diagnostic imaging in screening for occult scaphoid fractures. RESULTS: The incidence of true fractures of the scaphoid was 6.66% (5/75). Ten patients (13.33%) had other injuries around the wrist unrelated to the scaphoid. Eighty per cent of the patients had no definite boney injury and were needlessly immobilized, and followed up. A total of 128 scaphoid casts, 135 sets of scaphoid X-rays, 135 clinic appointments and a cumulative 148 weeks of cast immobilization involved patients with normal wrists. CONCLUSION: The incidence of radiologically inapparent fractures of the scaphoid is low. The use of a tender anatomical snuff box as the only clinical sign in the diagnosis of scaphoid injury is unsatisfactory. Other injuries around the wrist must be carefully excluded. There is insufficient evidence to support immobilizing all patients with clinical scaphoid fractures. For suspected fractures with no radiological evidence, symptomatic treatment is probably sufficient. Most occult fractures are visible at 2 weeks. Both magnetic resonance imaging and bone scintigraphy are accurate and cost effective and should be performed earlier rather than later.

Adolescent↗

PubMed2004

The electronic immediate discharge document: experience from the South West of Scotland.

BACKGROUND: Communication and transfer of information between healthcare professionals are essential to a seamless healthcare process, and are vital for ensuring that there is smooth transition of care for patients. Throughout the National Health Service (NHS) Scotland, there is a wide variability in the quality and quantity of information provided in the immediate discharge document (IDD). AIMS: To analyse general practitioner (GP) attitudes and responses on the quality and efficacy of an electronic IDD (e-IDD). SETTING: All GPs in Dumfries and Galloway. METHODS: GPs communicating electronically with the hospital were sent a survey questionnaire at the end of an 18-month pilot. An amended questionnaire surveying potential interest was sent to the remaining GPs in the region. RESULTS: The overall response rate was 70%. Eighty-one percent of practices connected received the e-IDD regularly, but the majority still used it in conjunction with its postal equivalent. Seventy percent complained of inadequacies in content relating to medication and follow-up information. Eighty percent agreed that it was faster and 68% felt significant cost savings could be made. Eighty-eight percent wanted a multidisciplinary input. Concerns were raised about funding, need for adequate training and back-up systems. Ninety-six percent were optimistic that in future other forms of clinical communications could be sent electronically. CONCLUSION: Discharge content is more important than delivery method. Emphasis should be placed on ensuring standards are met on the quality and quantity of current e-discharge documents. Further clarification is required on patient confidentiality issues and legal validity of electronic patient records. E-health is to play a larger and ever-increasing role in the NHS in Scotland.

Attitude to Computers↗