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Biomedical subjects

J R Staniland

Publications and source records attributed to J R Staniland.

At least 19 recordsLinked to original sources
PubMed1990

Acute renal failure: a study of elderly patients.

Two hundred and forty-six patients over the age of 65 years treated for acute renal failure (ARF) between 1960 and 1987 are reviewed. Although the fatality has apparently not changed over the duration of the study, it is possible to identify groups with a relatively good prognosis with renal replacement therapy. This particularly applies to patients with an underlying medical illness or with urological problems (excluding neoplasia). ARF following surgery with perioperative sepsis continues to carry a poor prognosis. We would recommend early referral of elderly patients with acute renal failure to a specialist unit, as a substantial proportion of survivors will regain normal renal function and quality of life.

Acute Kidney Injury↗
PubMed1981

Geographical variation in disease presentation. Does it constitute a problem and can information science help?

This paper assesses the extent and importance of geographical variation in disease presentation in relation to automated systems for clinical decision making. Reference is made to studies carried out by the World Organization of Gastroenterology involving 1,500 patients with inflammatory bowel disease, 6,000 patients with acute abdominal pain, and 1,300 patients with upper GI bleeding. These studies indicate that geographical variation in disease presentation (both regarding prior probability of disease and conditional probability of symptoms in each disease) is so great as to constitute a considerable potential threat to the widespread introduction of any automated decision-making system. It is suggested that there is an urgent need for the creation of large-scale multinational case series where diseases and symptoms are adequately and reproducibly defined in advance. Reference to studies previously mentioned is used to adduce evidence of the benefits of such large-scale data bases.

Abdomen↗
PubMed1980

Presentation of cancer to hospital as 'acute abdominal pain'.

In a survey of 5675 patients presenting to five hospitals in England, Scotland and Denmark with acute undiagnosed abdominal pain, 106 patients later proved to have intraabdominal cancer. The risk of cancer was age-dependent: amongst patients over 50 years with 'non-specific' pain the risk of cancer was 10 per cent. The commonest primary cancer site (in 57 cases, 53.8 per cent) was the large bowel. Most cancers neither perforated nor obstructed: 73 patients merely presented with a short history of unexplained abdominal pain. Of those patients with cancer presenting with 'unexplained' pain, half (37/73, 50.7 per cent) left hospital without a diagnosis of cancer having been made. Subsequently, a computer-aided system was constructed to discriminate (in patients over the age of 50) between those with unexplained acute abdominal pain who did and did not have cancer. Overall accuracy was 84.7 per cent in 138 cases. The most helpful clinical features in making this discrimination are listed. It is suggested (a) that cancer is now a relatively common cause of acute abdominal pain, (b) that the diagnosis is frequently difficult and (c) that urgent screening of all patients over 50 with non-specific acute abdominal pain may be warranted.

Abdomen, Acute↗
PubMed1980

Presentation and diagnosis of patients with acute abdominal pain: comparisons between Leeds, U.K. and Akershus county, Norway.

Geographical variation in clinical presentation may be a key obstacle to accurate diagnosis of patients with acute abdominal pain. This paper studies two series of patients presenting to hospital with an "acute abdomen"; 552 patients from Leeds, England and 398 patients from Akershus, Norway. The causative disease patterns and detailed clinical presentation are compared and contrasted (where appropriate) with a larger series of 6,097 patients under study by the World Organisation of Gastroenterology. Finally, the report outlines the results of implementing automated (computer-aided) diagnostic systems both in Leeds and Akershus, and the effects of adopting a structured case history form for data-recording when the patient is first seen.

Abdomen, Acute↗
PubMed1976

Clinical presentation of diseases of the large bowel. A detailed study of 642 patients.

This paper presents in detail the symptomatology and findings on examination of 642 patients suffering from a variety of lower gastrointestinal disorders, such as colonic and rectal cancer, diverticular disease, Crohn's disease, and ulcerative colitis. Location of precise sites of abdominal pain and tenderness was shown to carry a high level of diagnostic discrimination between the various disorders. Some surprising features emerged: almost half of patients with lower gastrointestinal tract disease complained of symptoms referable to the upper gastrointestinal tract, such as nausea/vomiting or anorexia. It is suggested that the provision on demand of such data to junior staff may benefit both diagnostic ability and decision making. As an incidental finding, just under 40% of patients with large bowel cancer had undergone previous (unrelated) abdominal surgery. The significance of this is unclear.

Adult↗
PubMed1975

Computer-aided diagnosis of lower gastrointestinal tract disorders.

This paper reports a survey of human and computer-aided diagnosis in a prospective consecutive series of 301 patients admitted to the hospital with lower gastrointestinal tract disease. At initial outpatient contact (at which time endoscopy was customarily performed), the clinicians' diagnostic accuracy was 64.5%. After biopsy, radiology, and other investigative procedures, the clinicians' preoperative diagnostic accuracy rose t0 82.7%. When data from the house surgeon's case notes were fed into the computer, its diagnostic prediction proved accurate in 77% of the 301 patients, and when details of the outpatient endoscopy were added to the house surgeon's case notes, the computer's diagnostic accuracy rose to 84.7%. It is suggested that computer-aided analysis may have a limited part to play in discriminating between the common causes of lower gastrointestinal disorders in routine clinical practice.

Adolescent↗
PubMed1974

Human and computer-aided diagnosis of abdominal pain: further report with emphasis on performance of clinicians.

This paper reports a controlled trial of human and computer-aided diagnosis in a series of 552 patients with acute abdominal pain. The overall diagnostic accuracy of the computer-aided system was 91.5% and that of the senior clinician to see each case was 81.2%. However, the clinician's diagnostic performance improved markedly during the period of the trial. The proportion of appendices which perforated before operation fell from 36% to 4% during the trial, and the negative laparotomy rate dropped sharply. After the trial closed in August 1972 these figures reverted towards their pretrial levels.It is suggested that while computer-aided diagnosis is a valuable direct adjunct to the clinician dealing with the "acute abdomen," he may also benefit in the short-term from the constant feedback he receives and from the disciplines and constraints involved in communicating with the computer.

Abdomen↗
PubMed1973

Clinical diagnostic process: an analysis.

An analysis of observations made during 1,307 diagnoses by a total of 28 clinicians (503 diagnoses in real life, and 804 on simulated patients) concerned primarily the interview of patients suffering from abdominal pain. Interviews ranged from 10 to 35 questions, and from "stereotyped" procedures, in which identical (and often irrelevant) questions were asked to each patient, to "adaptive" interviews, in which specific relevant questions were put to each patient. Senior clinicians tended to ask fewer, more relevant questions than their junior counterparts; and urgent cases were dealt with in a more adaptive fashion than routine cases in outpatients. Disappointingly, there was considerable difference between real-life and simulated situations. From these results it is suggested (a) that the "diagnostic process" does not exist, (b) that any automated diagnostic system must be flexible to accommodate the wishes of a variety of clinicians, and (c) that studies based on artificial clinical situations should be treated with extreme caution.

Abdomen↗
PubMed1972

Computer-assisted diagnosis of abdominal pain using "estimates" provided by clinicians.

This paper reports a comparison between two modes of computer-aided diagnosis in a real-time prospective trial involving 472 patients with acute abdominal pain. In the first mode the computer-aided system analysed each of the 472 patients by referring to data previously collated from a large series of 600 real-life patients. In the second mode the system used as a basis for its analysis "estimates" of probability provided by a group of six clinicians. The accuracy and reliability of both modes were compared with the performance of unaided clinicians.Using "real-life" data the computer system was significantly more effective than the unaided clinician. By contrast, when using the clinicians' own estimates the computer-aided system was often less effective than the unaided clinician-especially when diagnosing less common disorders. It seems, firstly, that future systems for computer-aided diagnosis should employ data from real-life and not clinicians' estimates, and, secondly, that clinicians themselves cannot analyse cases in a probabilistic fashion, since often they have little idea of what the "true" probabilities are.

Abdomen, Acute↗
PubMed1972

Clinical presentation of acute abdomen: study of 600 patients.

This paper presents the clinical features of 600 patients suffering from abdominal pain of acute onset and admitted to either the General Infirmary or St. James's Hospital, Leeds. The survey was initially retrospective, but later put on a prospective basis. Roughly two-thirds of these 600 patients presented a "typical" picture of the disease with which they presented, while the remaining third presented one or more atypical features. Since other prospective studies have indicated that the diagnostic accuracy of a group of clinicians in respect of the acute abdomen is roughly 65% it is tentatively suggested (a) that clinical diagnosis contains a large element of "pattern-matching," and (b) that such a policy can be expected to be ineffective in roughly one-third of all cases of acute abdominal pain.

Abdomen, Acute↗
PubMed1972

Computer-aided diagnosis: description of an adaptable system, and operational experience with 2,034 cases.

This paper describes a system of computer-aided diagnosis using an English Electric KDF9 computer linked to a terminal in a busy clinical department. Data from a series of patients were recorded, coded, and entered into the computer, which then performed a Bayesian analysis and displayed diagnostic probabilities in an adaptable format. Experience in this setting suggests that computer diagnosis may be a valuable aid to the clinician.

Abdomen↗