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Biomedical subjects

B T Collopy

Publications and source records attributed to B T Collopy.

13 recordsLinked to original sources
PubMed1992

Correlation between injury severity scores and subjective ratings of injury severity: a basis for trauma audit.

A retrospective review of 1900 road accident victims attending the emergency departments of two Melbourne hospitals was undertaken to identify Injury Severity Score levels which could distinguish between minor, moderate, severe and critical injury. Injuries scoring ISS 6 or below were designated 'minor' because they were associated with a low risk of requiring admission to hospital. Case notes of patients scoring above ISS 6 were then reviewed by a panel of clinicians, who independently rated each patient's overall injury severity as moderate, severe or critical according to what was recorded in the notes and their 'clinical' judgement. ISS values were compared with clinicians' ratings. Measures of each clinician's individual rating consistency, and correlation between pairs of clinicians with respect to inter-rater consistency, were made. By combining data from both hospitals it emerged that 'moderate' injury corresponded to ISS 8-13, 'severe' to ISS 14-20 and 'critical' to ISS 21 and above. These ISS breakpoints will be useful in selecting groups of injured patients for future trauma audit studies.

Accidents, Traffic↗
PubMed1992

Use of the Injury Severity Score to monitor diagnostic accuracy in the early assessment of road trauma.

A retrospective review of 279 hospital admissions at two Melbourne hospitals was conducted to develop a method for identifying diagnostic error using the Injury Severity Score (ISS) as a model for clinical audit. Two scores were calculated for each patient, the first according to injuries diagnosed on initial assessment in the Emergency Department and the second according to final, confirmed diagnoses upon discharge from hospital. Diagnostic errors were identified as discrepancies between the initial and final scores. ISS discrepancies were found in 48 cases (17.2%). Some were clinically significant errors of diagnosis while others reflected inaccurate injury description or record keeping. Abdominal injuries were the most frequently missed, followed in decreasing order by spinal, thoracic, extremities (limbs), head/face and external injuries (skin and subcutaneous tissues). The frequency and pattern of injury misdiagnosis concurs with the findings of other studies. The diagnostic error rate was found to increase with injury severity and with the number of anatomic body regions involved. The authors suggest that comparing initial and final ISS provides a convenient mechanism for the audit of early diagnosis in trauma cases.

Accidents, Traffic↗
PubMed1992

Colonoscopy in a private hospital: continuous quality improvement in practice.

This paper documents serial audits on technical aspects of the performance of fibre-optic examination of the large intestine by a number of proceduralists, in one institution, over 7 years. The completeness of the procedure and the associated morbidity are recorded and compared with results reported in the world literature. The study provides a clear demonstration of continuous quality improvement in practice.

Clinical Competence↗
PubMed1991

Improving appropriate use of surgical services.

The aspects of surgical services being addressed from the point of view of appropriateness in Australia at the present time are the use of the surgical bed, the maintenance of standards by the surgeon and the need for and outcome of the surgical procedures performed. There are growing waiting lists now for the 70% of acute hospital beds which are public. Whilst these waiting lists are inaccurate and require regular review their existence has led to a greater interest in reducing length of stay. This has hitherto not been of concern, with hernia patients for example staying five days or more. With regard to the surgeon it has been felt that the long training period (six years) guaranteed a high standard which was maintained. The Royal Australasian College of Surgeons is however, now to introduce a system of re-certification which will involve a demonstration of continuing education, the maintenance of an audit and a periodic physical examination. Delineation of privileges has until now only been in the broad traditional categories but consideration is being given to delineation of privileges for sophisticated surgery and particularly for new procedures (e.g. percutaneous cholecystectomy). Systems for assessing the quality of the surgery itself have been slow to develop, particularly in the smaller and private hospitals. Government bodies have been concerned in the private sphere with over servicing and a number of studies have been done showing regional variations in numbers of operations performed. Over servicing is, however, difficult to detect.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMed1991

Comparison of length of stay after hernia repair in two Victorian hospitals. Standards Sub-committee of the Victorian State Committee of the Royal Australasian College of Surgeons.

The objective of this study was to ascertain factors which determine the length of stay in relation to adult patients admitted for hernia surgery in two different hospitals. It was conducted prospectively on a total of 141 patients, 82 in a central hospital and 59 in a district hospital. There were no significant differences with regard to age, sex, type of hernia, pre-existing disease and postoperative complications. There was a significant difference between the average length of stay in the two hospitals (6.7 days in the central hospital and 3.9 days in the district hospital). There was a longer pre-operative stay in the central hospital through administrative problems, availability of operating time and admission for pre-operative investigations. In the postoperative period there was a significant difference between the day of operation and the time the surgeon stated that the patient could be discharged (i.e. the surgically advised discharge (SAD) date). This period was 4 days at the central hospital, as against 2 days at the district hospital. Once the SAD date was determined, there was no difference between the two hospitals with regard to placement. Consideration should be given to improving admission practices, including patient 'work-up' in the preadmission phase and to shortening the postoperative stay after hernia surgery.

Adolescent↗
PubMed1978

Experimental replacement of the cervical oesophagus with a free transverse colon autograft using microvascular anastomoses.

Microsurgical revascularization in the neck has improved the survival rate of free small-bowel grafts used to replace the cervical oesophagus. Colon vessels are larger than those in the jejunum, and even with naked-eye technique good results have been reported following free colon grafting of the oesophagus. The authors thought it might be possible to achieve even better results using microvascular anastomoses in the neck, and in this way replaced the cervical oesophagus in each of 15 dogs with a free transverse colon autotransplant. Four dogs died during operation and four within three days, two of the latter with graft necrosis. The next seven dogs survived eight days or more, and all their colon grafts were viable. Where patent arteries were demonstrated (three cases) the mucosa and myenteric plexuses of the graft survived. In all four dogs where the arteries were thrombosed or not demonstrated, the mucosa was absent, myenteric plexuses were absent in three, and one graft was grossly stenosed. Among these seven dogs there were three fistulae, one where graft arteries were patent and two where they were not; immediate anastomotic healing was not guaranteed by graft survival or arterial patency.

Animals↗
PubMed1976

Lincomycin-clindamycin-associated psuedomembranous colitis.

Five cases of lincomycin-clindamycin-associated acute pseudomembranous colitis, demonstrating a spectrum of clinical, histological and radiological severity, were encountered over a five-months period. All patients presented with watery diarrhoea without the passage of macroscopic blood or pus. Two patients were seriously ill with fulminant colitis, but responded rapidly to corticosteroids given parenterally and supportive therapy. The diagnosis of acute colitis should be considered in all patients developing diarrhoea during or up to three weeks after beginning therapy with lincomycin or clindamycin and can be confirmed by sigmoidoscopic examination. Withdrawal of the antibiotic and symptomatic treatment is appropriate for mild cases of colitis, but our experience suggests that corticosteroid therapy is safe and effective in severe cases. Indiscriminate use of these antibiotics should be avoided.

Acute Disease↗