PubMed Health⌕ Search

Biomedical subjects

H R Guly

Publications and source records attributed to H R Guly.

At least 37 records · Page 2Linked to original sources
PubMed1997

The misdiagnosis severity score and doctors' perception of the severity of diagnostic errors.

OBJECTIVE: To test the previously described misdiagnosis severity score (MSS) by comparing it with doctors' perceptions of the severity of diagnostic errors. METHODS: 14 scenarios of diagnostic errors were described on a questionnaire. These were given to 12 accident and emergency (A&E) consultants who were asked to indicate their assessment of the severity of the errors on a scale of 1 to 10. RESULTS: There was a highly significant concordance between doctors' rankings of the diagnostic errors, and between the MSS and the mean severity as assessed by the A&E consultants. CONCLUSIONS: It is reasonable to use the MSS as a measure of the severity of diagnostic errors.

Attitude of Health Personnel↗
PubMed1997

Interpretation of trauma radiographs by junior doctors in accident and emergency departments: a cause for concern?

OBJECTIVES: To investigate how well junior doctors in accident and emergency (A&E) were able to diagnose significant x ray abnormalities after trauma and to compare their results with those of more senior doctors. METHODS: 49 junior doctors (senior house officers) in A&E were tested with an x ray quiz in a standard way. Their results were compared with 34 consultants and senior registrars in A&E and radiology, who were tested in the same way. The quiz included 30 x rays (including 10 normal films) that had been taken after trauma. The abnormal films all had clinically significant, if sometimes uncommon, diagnoses. The results were compared and analysed statistically. RESULTS: The mean score for the abnormal x rays for all the junior doctors was only 32% correct. The 10 junior doctors were more experience scored significantly better (P < 0.001) but their mean score was only 48%. The mean score of the senior doctors was 80%, which was significantly higher than the juniors (P < 0.0001). CONCLUSIONS: The majority of junior doctors misdiagnosed significant trauma abnormalities on x ray. Senior doctors scored well, but were not infallible. This suggests that junior doctors are not safe to work on their own in A&E departments. There are implications for training, supervision, and staffing in A&E departments, as well as a need for fail-safe mechanisms to ensure adequate patient care and to improve risk management.

Clinical Competence↗
PubMed1997

Risk management.

Explore the source record for details and available documents.

Emergency Service, Hospital↗
PubMed1996

Medical aspects of the work of a moorland rescue team.

OBJECTIVE: To describe the work of a moorland rescue team and, in particular, the medical aspects of this work. METHODS: A retrospective study of 25 years of callouts of the Dartmoor Rescue Group (DRG)-the mountain rescue team (MRT) for Dartmoor. These were analysed by cause, year, month, day of the week, and time of day. Injuries and other medical problems in casualties are described. RESULTS: 276 callouts are described. The most common cause was searching for missing persons, but 62 callouts were to known casualties. The most common medical problem was cold exhaustion. The most common injuries were to the lower leg. However, a wide variety of other medical problems including heat exhaustion was also seen. CONCLUSIONS: The Mountain Rescue Council represents MRTs in mountainous regions and those covering lower hills and moorland. It produces an annual report containing details of the incidents attended by its affiliated teams. The work of the DRG is very different from that of the Mountain Rescue Council as a whole. Medical problems other than cold exhaustion and lower leg injuries are uncommon and moorland rescue teams do not need to equip themselves to treat other medical problems but in view of the wide variety of medical problems encountered a long way from a road, good first aid training of team members is essential.

Cause of Death↗
PubMed1996

Near hanging presenting to an accident and emergency department.

Victims of near hanging are being increasingly seen in accident and emergency (A&E) department. This paper reports on seven cases of near hanging seen over four years in a district general hospital. The mechanism of injury is ligature strangulation rather than cervical spinal cord injury. All cases of near hanging should be actively and vigorously resuscitated, as initial presenting features bear a poor correlation to eventual outcome.

Adolescent↗
PubMed1995

The effect of pre-hospital administration of intravenous nalbuphine on on-scene times.

The use of intravenous nalbuphine in pre-hospital settings by paramedics has been demonstrated to be safe and effective. We assessed the effect of this additional intervention by comparing the time spent on-scene by ambulance crews treating patients with fractures of the tibia and fibula who received intravenous nalbuphine with those who had placement of an intravenous cannula alone and those who had neither cannula nor nalbuphine. The mean on-scene times were 17.1 min without cannulation, 29.9 min for cannulation without nalbuphine and 37.5 min for cannulation and administration of nalbuphine. The benefits of effective pre-hospital analgesia thus have a cost in terms of time. Continued audit of interventions and on-scene times is important to prevent inappropriate delays in pre-hospital care which may cause clinical and operational problems.

Adolescent↗
PubMed1994

Prehospital intravenous nalbuphine administered by paramedics.

One-hundred sixteen patients were given nalbuphine by 10 specifically trained ambulance paramedics over a 9-month period. Forty-seven had suspected myocardial infarction and 69 had sustained trauma or burns. The mean pain score measured by a 10-cm visual analogue scale fell from 8 before analgesia to 3. This was highly significant. There were no serious side effects. We conclude that nalbuphine can be safely administered by trained paramedics to provide effective analgesia to those in pain in a prehospital setting.

Allied Health Personnel↗
PubMed1994

Acute calcific periarthritis outside the shoulder: a frequently misdiagnosed condition.

Thirteen patients presented to an accident and emergency (A&E) department with acute calcific periarthritis of joints other than the shoulder. In only three patients was the correct diagnosis made on the initial attendance with inappropriate treatment and delay in recovery as a result. The specific features and guidelines for management of this condition are reviewed.

Acute Disease↗
PubMed1994

Patients who attend two accident and emergency departments.

Forty-six patients were identified who attended an accident and emergency (A&E) department having previously attended a different A&E department in the same city for the same problem. Of these patients, 20% had been referred to the second department by the general practitioner (GP) or practice nurse. A diagnostic error had been made in 17.5% of patients at their first visit and some management errors were discovered. Eleven per cent of patients had an unnecessary second set of radiographs taken. A review of unplanned reattenders to an A&E department is an important opportunity for audit and normally an error will not be discovered if a patient attends a different department. We recommend that in cities where there is more than one A&E department a system should be set up whereby if a patient attends one department having previously attended another, the first department should be informed of the patients reattendance, especially if any diagnostic or management error has been discovered. Patients should be educated that if they have sought medical help for any problem and the condition does not improve, then they should return to see the same doctor or A&E department for continuity of care and avoidance of unnecessary duplication of investigations including exposure to X-rays.

Diagnostic Errors↗
PubMed1993

The need for better pre-hospital analgesia.

Many patients arrive at the accident and emergency (A&E) department in pain. To quantify this problem a retrospective analysis was performed of the clinical records of 502 consecutive patients arriving by ambulance at the A&E department over a 20-day period. A total of 273 (54%) of the patients had pain as a symptom on arrival and 69 (14%) were given opioid analgesia in the A&E department. Sixty of those given opioids had a single limb fracture. A survey of all ambulance services in the U.K. was conducted by means of a postal questionnaire sent to chief ambulance officers. Only five out of 65 services give any analgesia other than Entonox (B.O.C.). There were wide variations in the attitudes of services around the country to future developments. The authors suggest that paramedics should be trained to administer intravenous opioid analgesia.

Ambulances↗
PubMed1993

Fractures of the terminal phalanx presenting as a paronychia.

Three fractures at the base of the terminal phalanx of the finger and one at the base of the terminal phalanx of the tow were initially misdiagnosed as paronychias. If a 'paronychia' follows trauma, the possibility of a fracture should be considered and radiographs taken of the digit.

Adolescent↗
PubMed1985

Do accident and emergency patients collect their prescribed medication?

One month's prescriptions from an accident and emergency department were examined. Of these 16% were found not to have been dispensed by the chemist. The commonest drugs prescribed were antibiotics (60%) and analgesics (22%). Most age groups were guilty of failing to collect drugs--primary non-compliance.

Adolescent↗
PubMed1984

Missed diagnoses in an accident & emergency department.

The diagnoses which were missed at patients' first attendance at an A & E Department over a 6-month period were noted and investigated. The most common cause of missed diagnosis was failure to interpret X-ray findings correctly; this and other causes are discussed. Recommendations as to how this can be improved are made.

Diagnostic Errors↗