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Biomedical subjects

C Bulstrode

Publications and source records attributed to C Bulstrode.

34 records · Page 2Linked to original sources
PubMed1994

Why do doctors find some patients difficult to help?

Almost all doctors encounter difficulties in managing some patients. Previous studies have examined the characteristics of such patients: we have additionally studied the reasons why hospital doctors find these patients 'difficult to help'. Three clinics (two medical and one surgical) were studied. The consultants rated 60 (22%) of 293 attenders s severely or extremely difficult to help. Difficulty was associated with greater patient distress (odds ratio 3.9; 95% CI 2.0-7.7), less patient satisfaction (2.6; 1.3-5.0) and chronic attendance (5.0; 1.4-17.3). An interview study of 40 'difficult' patients indicated that doctors considered psycho-social factors more important in difficult patients (3.2; 1.3-7.7). Objective differences between the doctor's and the patient's aims for care also occurred more frequently for difficult patients (2.8; 1.1-7.2). Three common types of difficulty were identified; medically unexplained symptoms; co-existing social problems; and severe untreatable illness. A review of the management aims for patients whom doctors find 'difficult to help', combined with improved access to psycho-social care, could improve both the quality and the cost-effectiveness of hospital out-patient services.

Adolescent↗
PubMed1993

Survival analysis of joint replacements.

Survival analysis is a powerful tool for analysing the results of total joint replacement, but it has major drawbacks when the failure rates are very low. We have reviewed 35 recent survival analyses of joint replacements to assess the magnitude of these problems and make recommendations as to how they may be avoided.

Confidence Intervals↗
PubMed1991

Elective total hip replacement: incidence, emergency readmission rate, and postoperative mortality.

OBJECTIVES: To report the incidence of elective total hip replacement and postoperative mortality, emergency readmission rates, and the demographic factors associated with these rates in a large defined population. DESIGN: Analysis of linked, routine abstracts of hospital inpatient records and death certificates. SETTING: 10 hospitals in six districts in Oxford Regional Health Authority covered by the Oxford record linkage study. SUBJECTS: Records for 11,607 total hip replacements performed electively in 1976-85. MAIN OUTCOME MEASURES: Incidence of operation, postoperative mortality, relative mortality ratios, and incidence of emergency readmission. RESULTS: NHS operation rates increased over time from 43 to 58 operations/100,000 population. Variation in operation rates between districts reduced over time. Operation rates were on average 25% higher in women than men. There were 93 deaths (11/1000 operations) within 90 days of the operation and 208 emergency readmissions (28/1000 operations) within 28 days of discharge. Postoperative mortality and emergency readmission rates increased with age. No significant trend with time was found. Mortality in the 90 days after the operation was 2.5-fold higher (1.9 to 3.0) than in the rest of the first postoperative year. This represented an estimated excess of 6.5 (4.2 to 8.8) early postoperative deaths/1000 operations. Most deaths were ascribed to cardiovascular events. Thromboembolic disease was the commonest reason for emergency readmission. CONCLUSIONS: The pronounced increase in operations in districts with initially low rates suggests a trend towards greater equity in the local provision of NHS hip arthroplasty. The early postoperative clusters of deaths attributed to cardiovascular disease and of readmissions for thromboembolic disease suggest that there is scope for investigating ways of reducing the incidence of major adverse postoperative events.

Adult↗
PubMed1991

Avoidable causes of cancellation in elective orthopaedic surgery.

As part of an audit of clinical practice in an orthopaedic unit for elective surgery, a study was made of the causes of cancellation of operations. Despite careful liaison with general practitioners, and a booked admission policy, over 6% of patients were cancelled as unsuitable. The results of this study suggest that the number of cancellations on medical grounds would be reduced by closer liaison with general practitioners, and the establishment of preadmission clinics. Ensuring that only consultants book patients for surgery would also reduce the number of cancellations due to incorrect indications for surgery.

Appointments and Schedules↗
PubMed1991

Percutaneous nucleotomy. An anatomic study of the risks of root injury.

Fifteen cadaveric dissections have been performed to determine the anatomic relationships of nucleotomy guide wires. All the 44 guide wires inserted were found to be in contact with at least one nerve root (eight transfixed a root). Guide wires passing anterior to the nerve roots always passed anterior to the center of the disc. Lateral displacement of the skin entry point made safe entry to the center of the disc impossible. Nerve root transfixion is likely to be a significant complication in percutaneous nucleotomy. Entry to the center of the disc avoiding the nerve roots is simplest if the skin entry is as near to the midline as possible.

Cadaver↗
PubMed1990

Osteotomy for osteoarthritis of the hip. A survivorship analysis.

We have reviewed 368 osteotomies carried out for osteoarthritis of the hip at the Nuffield Orthopaedic Centre. Survivorship analysis showed that 10 years after osteotomy 47% had required no further surgery, and even after 20 years 23% had still not had a hip replacement. Hips with moderate arthritic change showed significantly better results than those with more severe degeneration. Osteotomies with varus angulation as well as medial displacement showed longer survival.

England↗
PubMed1986

What happens to wild animals with broken bones?

Orthopaedic teaching suggests that long-bone fractures in wild animals are not uncommon and that they can heal naturally. This paper investigates this statement. The unsystematic collection of specimens for museums has perpetuated the idea that these fractures are not uncommon. Many fractures in adult skeletons seem to have occurred while the animal was still young. A review of the original skeletons in two museums does not support the view that major long-bone fractures in adult wild animals heal well. Contemporary observations on primates in the wild over long periods show that fractures of long bones in adult wild primates are rare and usually fatal, while falls which might be associated with juvenile fractures are much more common and may well be the source of the many well-healed fractures found in museum collections.

Age Factors↗
PubMed1985

Polylactate-coated carbon fiber in extra-articular reconstruction of the unstable knee.

Fascia lata and carbon fiber were used in identical operations for the correction of a clearly defined knee instability in cases with a follow-up period of about one year. The early results suggest an improvement of the results in the carbon group, but free carbon has been found within the joint despite careful extra-articular implantation. The long-term consequences of this await evaluation.

Adult↗
PubMed1984

Pseudo-malignant osseous tumour of soft tissue.

A case of pseudo-malignant osseous tumour of soft tissue in the hand is described. The history was over two years with intractable pain becoming the dominant symptom. There was no history of trauma or infection initiating the condition. Local amputation provided complete relief of symptoms and there has been no recurrence in two years.

Adult↗