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Biomedical subjects

M W Ardagh

Publications and source records attributed to M W Ardagh.

7 recordsLinked to original sources
PubMed2002

Effect of a rapid assessment clinic on the waiting time to be seen by a doctor and the time spent in the department, for patients presenting to an urban emergency department: a controlled prospective trial.

AIMS: To test the hypothesis that triaging certain emergency department (ED) patients through a rapid assessment clinic (RAC) improves the waiting times, and times in the department, for all patients presenting to the emergency department. METHODS: For ten weeks an additional nurse and doctor were rostered. On the odd weeks, these two staff ran a RAC and on even weeks, they did not, but simply joined the other medical and nursing staff, managing patients in the traditional way. Patients suitable for triage to the RAC were those for whom disposal was readily apparent, interventions required were quickly undertaken, and lengthy investigations or assessment were not required. After the ten-week period data from the five weeks of the RAC and the five weeks with no RAC, but the same staffing level, were analysed and compared. RESULTS: During the five weeks of the RAC clinic a total of 2263 patients attended the ED, and 361 of these were referred to the RAC clinic. During the five control weeks a total of 2204 patients attended the ED. There was no significant difference in the distribution across triage categories between the RAC and non-RAC periods. The waiting times to be seen by a doctor show no difference at Triage 2 and 3 and a difference of several minutes for Triage 4 and 5 categories. The times patients spent in the ED also show no difference for Triage 2 and 3 and about 20 to 25 minutes advantage for RAC-week patients in Triage categories 4 and 5. CONCLUSIONS: The rapid management of patients with problems which do not require prolonged assessment or decision making, is beneficial not only to those patients, but also to other patients sharing the same, limited resources.

Adolescent↗
PubMed2001

Frequent attenders at Christchurch Hospital's emergency department.

AIM: To describe the characteristics of adult frequent attenders presenting to a major urban emergency department during a twelve month period. METHODS: A retrospective study was performed of all frequent attenders (presenting ten of more times during twelve months) to the Emergency Department (ED) at Christchurch Hospital. RESULTS: The proportion of visits to the ED by frequent attenders increased from 1.38% to 2.08% of all visits between 1996 to 2000. A computer search identified 86 frequent attenders between 1 November 1998 and 31 October 1999: 1,395 visits were made by these patients. The median age was 35 years, both sexes were equally represented and most frequent attenders were single. The most common presenting problem was medical (40%) or psychological (36%), and (86%) had secondary problems related to each attendance. CONCLUSION: This study's findings are generally consistent with those from two previous descriptions of frequent attenders. Evidence from overseas trials suggests that case management may provide the best outcomes for these patients, but further research is needed.

Adolescent↗
PubMed2001

Pulse rate over pressure evaluation (ROPE) is useful in the assessment of compensated haemorrhagic shock.

OBJECTIVE: To evaluate a calculation of pulse rate over pulse pressure as a method of predicting decompensation in patients with compensated haemorrhagic shock. METHODS: A retrospective cohort study was undertaken enrolling 184 adult victims of major road trauma who were not shocked on presentation to the emergency department. A pulse rate over pressure evaluation was calculated at presentation and vital signs were observed during the first 2 h of emergency department management. RESULTS: Thirty-one patients became shocked during their first 2 h. A ROPE value of greater than 3.0 had a positive predictive value of 53% and a value less than 3.0 had a negative predictive value of 86% for the development of decompensated shock. CONCLUSIONS: ROPE is an easily applied and useful clinical tool with a ROPE of less than 3.0 being predictive of a patient remaining well and a ROPE of above 3.0 being predictive of the patient developing decompensated shock.

Adolescent↗
PubMed2000

Methanol poisoning.

AIMS: This study examines clinical experience with methanol poisoning during a one-year period. METHODS: All admissions with the diagnosis of suspected methanol toxicity were analysed and the current guidelines for the management of this problem were reviewed. RESULTS: Twenty-four subjects were identified. Most had a history of chronic use of methylated spirits. Four died before admission to hospital and the other 20 patients had 26 admissions to hospital and form the basis for this report. Four patients died in the Intensive Care Unit. In total 11 patients were admitted to the Intensive Care Unit. Seven patients received haemodialysis. There was no correlation between the methanol level and the outcome. The strongest predictor of death or a poor outcome was a blood pH < 7.0. Some patients, in spite of potentially lethal methanol levels of up to 160 mmol/L, did not develop signs of toxicity. CONCLUSIONS: The overall mortality was high and ethanol was given to most of the patients for up to several days. Some patients did not show any toxicity and some of those were not given ethanol. It is recommended that chronic meths drinkers, who are not acidaemic and are generally well, do not require ethanol treatment. Only the complete removal of methanol from methylated spirits will reduce the morbidity of this condition.

Adult↗
PubMed1994

Does learning emergency medicine equip medical students for ward emergencies?

The aim of this study was to assess the competence of senior medical students in recognizing and managing life-threatening ward emergencies and to compare the competence of a group that had received emergency medicine teaching with one that had not. This was achieved by asking 60 final year medical students to complete a structured written clinical examination designed to test these skills. Comparisons were made between the group that had received emergency medicine teaching (the 'taught' group) and that which had not (the 'untaught' group) with respect to numerical scores on the examination and the number of fatal management errors committed. The 'taught' group had an average total score of 285/400 compared with an average score of 223/400 for the 'untaught' group (P < 0.001). The 'untaught' group committed 0.25 fatal errors per student per case compared with the 'taught' group that committed 0.06 fatal errors per student per case (P < 0.001). There is considerable scope to improve the competence of senior medical students for dealing with life-threatening ward emergencies. Students who had received emergency medicine teaching scored significantly better than those who had not suggesting that emergency medicine teaching is a suitable tool to help equip medical students to deal with life threatening ward emergencies.

Clinical Competence↗