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Biomedical subjects

M Woodford

Publications and source records attributed to M Woodford.

At least 19 recordsLinked to original sources
PubMed2000

Trends in trauma care in England and Wales 1989-97. UK Trauma Audit and Research Network.

BACKGROUND: In 1988, the Royal College of Surgeons reported major deficiencies in trauma care in UK hospitals. We investigated whether and how that care has changed in the last decade by use of data collected by the UK Trauma Audit and Research Network. METHODS: We analysed injury-severity, process, and outcome variables from 91602 patients' records on the database at the end of 1997, collected from 97 (49% of trauma-receiving) hospitals in England, Wales, and two in Ireland. We did longitudinal analyses of odds of death, process variables, and individual hospitals' performance. We took account of potential selection bias from missing data and recruitment of new hospitals. FINDINGS: The severity-adjusted odds of death after trauma declined gradually from 1989 (odds ratio 1997/1989 0.63 [95% CI [0.49-0.82]). In 1997, the reduction in odds of death was significant even after adjustment for missing data (ratio 1997/1989 0.72 [0.55-0.92]) and recruitment of new hospitals (0.64 [0.44-0.93]). There was significant variability in the proportion of survivors (adjusted for severity of injury and age) between the highest and lowest 10% of UK hospitals. The time between the call to the emergency services and arrival at hospital increased from 32 min in 1989 to 45 min in 1997, irrespective of injury severity. The proportion of severely injured patients seen first by senior doctors increased from 32% to 60%. INTERPRETATION: Hospital care has made a valuable but variable contribution to reductions in case fatality after injury in the UK in the past 10 years, though further improvement is possible.

Aged↗
PubMed1999

Unexpected contribution of moderate traumatic brain injury to death after major trauma.

BACKGROUND: The cardiovascular reflex responses to injury and simple hemorrhage are coordinated in the central nervous system. Coincidental brain injury, which is present in 64% of trauma patients who die, could impair these homeostatic responses. The occurrence of hemorrhagic shock in the patient with head injury is also known to increase mortality. Therefore, there is a potential bidirectional interaction between traumatic brain injury and peripheral injury, which would result in an increased mortality when these two injuries coexist. Our objective was to test the hypothesis that moderate traumatic brain injury is an independent predictor of outcome in patients with multisystem trauma. METHODS: We carried out an analysis of the UK Trauma Audit and Research Network Database. Moderate traumatic brain injury was defined as an Abbreviated Injury Scale score of 3. The study population included 2,717 patients with multisystem injury: 378 patients had a moderate brain injury with peripheral injury, and 2,339 patients had extracranial injury alone. Mortality rates for both groups were compared at increasing injury severity. RESULTS: Moderate brain injury alone was associated with a mortality rate of 4.2%. However, when combined with extracranial injury, the risk of death was double that attributable to extracranial injury alone (odds ratio, 2.08; 95% confidence interval, 1.57-2.77). CONCLUSION: This study confirms that the coexistence of moderate traumatic brain injury with extracranial injury is associated with a doubling of the predicted mortality rate throughout the injury severity ranges studied.

Adolescent↗
PubMed1998

Clostridium difficile-associated diarrhea in acute and long-term care facilities.

This report presents an overview of the epidemiology, diagnosis, complications, and treatment of Clostridium difficile-associated diarrhea in acute and long-term care facilities. More studies are needed to understand the epidemiology of this disease in long-term care facilities, to identify the risk factors for its recurrence, and to evaluate new treatment modalities.

Anti-Bacterial Agents↗
PubMed1996

Trauma care in China: challenge and development.

The People's Republic of China has significantly improved the general health of its people by a concerted effort in primary health care but trauma care and its prevention remains a problem. This paper provides an overview of the strengths and weaknesses of the trauma-care system in China and proposes a strategy for its future development. This includes public-health legislation, the integration of military and civilian practice to provide comprehensive care from the scene of the incident through to rehabilitation, medical audit, the introduction of postgraduate trauma-management training courses and international academic exchanges.

China↗
PubMed1995

Standardized comparison of performance indicators in trauma: a new approach to case-mix variation.

An institution's trauma survival rate can be compared with that predicted by TRISS using definitive outcome-based evaluation. This examines W, the difference between actual and predicted survival rates; Z, the statistical significance of this difference; and M, a measure of the similarity of injury severity mix to the prediction data base. However, it is possible for two institutions with the same survival rate within each band of injury severity to have very different W and Z scores whilst retaining a similar M score. Clearly this is unsatisfactory. A new statistic, Ws, is therefore proposed, which is standardized with respect to injury severity mix, producing more accurate comparisons between different institutions. Confidence intervals are used to graphically illustrate the magnitude of Ws, its direction, accuracy, and statistical significance. Data from the U.K. Major Trauma Outcome Study are used to demonstrate the calculations and presentation of Ws and its advantages.

Diagnosis-Related Groups↗
PubMed1994

Trauma audit--closing the loop.

The philosophy of medical audit and methods of data collection and statistical analysis have been extensively reviewed but less has been written about the effect of audit on medical practice. The measurement of performance is only valuable if it identifies areas of concern and stimulates appropriate change. This paper describes the work of the Salford Trauma Audit Group which has been developed at Hope Hospital, the problems that have been recognized, the strategies that have been introduced to effect change and their influence on management and outcome. Analysis of performance reveals an initial fall in adjusted mortality rate from severe injury after the introduction of resuscitation teams, the adherence to Advanced Trauma Life Support protocols and an integrated multidisciplinary approach to trauma care. Problems remain and there is continuing concern about trauma management in the hospital. This has been reinforced by performance feedback through the Trauma Audit Group which has attracted the interest of senior clinicians in several specialties.

Emergencies↗
PubMed1993

Trauma audit: clinical judgement or statistical analysis?

Comparisons have been made between two methods currently used to assess the effectiveness of management of major trauma. These are the review of fatal cases by senior clinicians and the use of statistical analysis of severity scores. The former was assessed by a re-examination of the Coroners' reports of 508 patients reviewed by senior clinicians at the request of The Royal College of Surgeons of England Working Party on the Management of Patients with Major Injuries. The latter was based on the 665 fatalities on the files of the UK Major Trauma Outcome Study. The two groups of patients had comparable age and sex profiles and broadly similar ranges of injury severity. There were major differences between and inconsistencies within the two assessments. Clinicians more frequently judged death avoidable in those with very severe injuries. In contrast, the statistical analysis suggested, paradoxically, that the proportion of avoidable deaths in those patients who had minor injuries was less than the proportion of avoidable deaths in those who had more serious injuries. These variations underline the limited values of retrospective peer review and will not encourage clinicians to adopt currently available statistical methods. Further refinements of anatomical and physiological scoring systems and their integration to provide a statistically valid and clinically acceptable measure of outcome are essential prerequisites to the wider introduction and success of trauma audit.

Adolescent↗
PubMed1992

Preliminary analysis of the care of injured patients in 33 British hospitals: first report of the United Kingdom major trauma outcome study.

OBJECTIVE: To measure the effectiveness of management of major trauma in the United Kingdom. DESIGN: Review of the care of all seriously injured patients seen over two years. SETTING: 33 hospitals which receive patients who have sustained major trauma. SUBJECTS: 14,648 injured patients admitted for more than three days, transferred or admitted into an intensive care bed, or dying from their injuries. MAIN OUTCOME MEASURE: Death or survival in hospital within three months of the injury. RESULTS: 21% of seriously injured patients (1299) took longer than one hour to reach hospital. Time before arrival at hospital was not related to severity of injury. A senior house officer was in charge of initial hospital resuscitation in 57% (826/1445) of patients with an injury severity score > or = 16. More senior staff were commonly responsible for definitive operations, but only 46% (165/355) of patients judged to require early operation arrived in theatre within two hours. Mortality for 6111 patients sustaining blunt trauma and treated in the 14 busiest hospitals was significantly higher (actual 408, predicted 295.6, p < 0.001) than in a comparable North American dataset. Large differences in the 14 hospitals assessed could not be explained by variations in case load or facilities. In contrast, the outcome of the 4.1% (597) of patients with penetrating injuries was better than that of a comparable group in the United States. Analysis of the 415 penetrating injuries with complete data showed that 15 patients died (19.3 predicted; p = 0.04). CONCLUSIONS: The initial management of major trauma in the United Kingdom remains unsatisfactory. There are delays in providing experienced staff and timely operations. Mortality varies inexplicably between hospitals and, for blunt trauma, is generally higher than in the United States.

Emergency Medical Services↗
PubMed1991

Histamine eye.

Explore the source record for details and available documents.

Bronchial Provocation Tests↗
PubMed1989

Preventability of death from penetrating injury in England and Wales.

A total of 1000 deaths from injury in England and Wales have been reviewed to establish the incidence and pattern of penetrating injury and the adequacy of its management. Of the 1000 deaths, 71 (7.1 per cent) were due to penetrating injury. There were 32 knife wounds and 30 firearm injuries. Most of the latter were suicides. Only 17 patients (24 per cent) reached hospital alive. Of these cases, 10 had extracranial injury and all 10 deaths were considered to have been potentially preventable when reviewed by four external assessors. One of seven patients with cranial injury was considered to have been a potentially preventable death. The median age of the 11 cases of potentially preventable death was 37 years (range: 7-61 years). Of these, three did not have any surgery for surgically treatable injuries. Seven patients underwent operation and difficulty was encountered in six of these. It appears from our figures that whilst penetrating injury is an uncommon cause of death, it is poorly managed. The implications of this finding for systems of injury care in the United Kingdom are discussed.

Adolescent↗
PubMed1989

An investigation of the role of possible neural mechanisms in cholera toxin-induced secretion in rabbit ileal mucosa in vitro.

1. Cholera toxin stimulates intestinal secretion in vitro by activation of mucosal adenylate cyclase. However, it has been proposed that cholera toxin promotes secretion in vivo mainly through an indirect mechanism involving enteric neural reflexes. 2. We examined this hypothesis further by studying the influence of neuronal blockade on cholera toxin-induced changes in fluid transport across rabbit ileum in vitro. Mucosa, stripped of muscle layers, was mounted in flux chambers and luminal application of crude cholera toxin (2 micrograms/ml) caused a delayed but sustained rise in the short-circuit current, electrical potential difference and Cl- secretion. Pretreatment with the nerve-blocking drug, tetrodotoxin (5 x 10(-6) mol/l serosal side), failed to influence the secretory response to cholera toxin, and addition of tetrodotoxin at the peak response to cholera toxin also had no effect. 3. That tetrodotoxin could block neurally mediated secretagogues was confirmed by the demonstration that the electrical responses to neurotensin (10(-7) mol/l and 10(-8) mol/l) were blocked by tetrodotoxin (5 x 10(-6) mol/l). Furthermore, the response to cholera toxin of segments of ileum, which included the myenteric, submucosal and mucosal nerve plexuses, was not inhibited by tetrodotoxin. 4. We conclude that cholera toxin-induced secretion in rabbit ileum in vitro is not mediated via a neurological mechanism.

Animals↗
PubMed1988

Retrospective study of 1000 deaths from injury in England and Wales.

One thousand consecutive deaths from injury in 11 coroner's districts in England and Wales were reviewed by four independent assessors, who studied necropsy reports to identify deaths in hospital that might have been preventable. Of 514 patients admitted to hospital alive, 102 deaths (20%) were judged by all four assessors to have been potentially preventable. When those cases in which three out of four assessors considered that the death was preventable were added the total rose to 170 (33%). Nearly two thirds of all non-central nervous system deaths were judged to have been preventable. The median age of the 170 patients whose deaths were preventable was 41, and the mean Injury Severity Score was 29. Further analysis suggested that the preventable deaths were principally the result of failure to stop bleeding and prevent hypoxia and the absence of, or delay in, surgical treatment. The results closely parallel those from similar studies from the United States and suggest that there are serious deficiencies in the services for managing severe injury in England and Wales. Debate is needed now on how to correct these deficiencies. In particular, the place of trauma centres must be considered.

Adolescent↗
PubMed1987

Inhibition of the effect of serotonin on rat ileal transport by cisapride: evidence in favour of the involvement of 5-HT2 receptors.

Cisapride is a synthetic drug which binds, in vitro, to type 2 serotonin receptors. We examined the influence of serotonin and cisapride on ion transport across intestinal mucosa in vitro and studied the effect of cisapride on the response to serotonin. Segments of ileum of male Sprague-Dawley rats were stripped of muscle layers and mounted in flux chambers. The addition of serotonin (10(-8) to 10(-4) M) to the serosal aspect of the mucosa caused a rapid, dose-dependent rise in short circuit current and transmural potential difference. Cisapride alone (5 X 10(-5) M), when added to the mucosal and serosal surfaces, had no effect on the short circuit current, transmural potential difference, resistance, or sodium and chloride fluxes across the mucosa. It did, however, inhibit the response of the mucosa to serotonin (10(-5) M) in a dose dependent manner and blocked it completely at a concentration of 5 X 10(-5) M. Serotonin (5 X 10(-5) M) increased serosal to mucosal flux of chloride from 12.6 +/- 0.8 to 15.2 +/- 0.6 mumol/cm2/h (p less than 0.025), thus reducing net chloride absorption from 4.65 +/- 0.81 to 1.49 +/- 1.04 mumol/cm2/h (p less than 0.05). This effect was completely blocked by cisapride (5 X 10(-5) M). In summary, cisapride inhibits the effect of serotonin on rat ileal ion transport, probably by blocking type 2 serotonin receptors.

Action Potentials↗
PubMed1987

In-line measurement of pulmonary metabolic function in the anesthetized rabbit.

Quantitative assessment of lung metabolic function is thought to provide biochemical information reflecting integrity of the pulmonary microcirculation. Although multiple indicator-dilution techniques are useful in such pharmacokinetic studies, the need for fractionation and subsequent processing of blood samples greatly prolongs data generation. Accordingly, we designed and tested an in-line system which rapidly can quantify single-pass disposition of photon-emitting substances in the pulmonary circulation of intact animals. The nuclear detection system consisted of a phoswich scintillation probe optically coupled to a photomultiplier tube. Pulses were discriminated for height and shape and counts recorded in a counter-timer, the output of which was interfaced with a personal computer. A mixture of an intravascular reference substance (99mTc-sulfur colloid) and an inhibitor of angiotensin-converting enzyme, N-[1(S)-carboxy-(4-OH-3-[125I]-phenyl) ethyl]-L-alanyl-L-proline (125I-CPAP), was injected as a bolus in the right heart of anesthetized ventilated rabbits and arterial blood was diverted through a flow-cell cuvette directly apposed to the phoswich detector. Single-pass extraction of 125I-CPAP was 39 +/- 3% (mean +/- SE; n = 20) and was depressed in a dose-dependent fashion by the addition of unlabeled CPAP (1-10 micrograms/kg) to the injection. These data indicate that we can now quantify, in the intact animal, saturable binding of an inhibitor to angiotensin-converting enzyme expressed on the surface of the pulmonary microvascular endothelium. Furthermore, such data can be obtained rapidly.

Animals↗
PubMed1979

The effect of intermittent compression of the calf on the fibrinolytic responses in the blood during a surgical operation.

The fibrinolytic responses in the blood during surgical operation have been studied in two groups of patients during intraoperative intermittent compression of the calf. Fibrinolytic activity did not differ significantly between the groups. The postoperative fibrinolytic shutdown was not prevented by intermittent compression of the calf. It is concluded that, whatever the mechanism by which venous thrombosis is prevented by intermittent compression of the calf, it is not by further stimulation of systemic fibrinolysis.

Dextrans↗
PubMed1977

Alteration in fibrinolytic capacity after operation.

The fibrinolytic response to 20 min of forearm venous occlusion was studied in patients undergoing major and minor operations. Fibrinolytic capacity, which is defined as the increase in fibrinolytic activity resulting from a period of venous occlusion, was significantly reduced on the first postoperative day after major operations, but not after minor operations. Since venous occlusion results in the release of plasminogen activator from the vascular endothelium into the blood, these findings suggest that the reduction in the level of spontaneous fibrinolytic activity after major operations is the result either of exhaustion of the vascular endothelium of plasminogen activator or defective synthesis and release of this enzyme from the endothelium.

Adult↗
PubMed1977

Plasma fibrinolytic inhibitors after operation.

The response of the fibrinolytic system to the stress of a surgical operation has been studied in a group of 39 patients. Fibrinolytic activity was stimulated during the operation but depressed during the early postoperative period. This was accompanied by an increase in the level of fibrinolytic inhibitors in the plasma after operation. This increase in fibrinolytic inhibitors was a result of a significant rise in alpha1 antitrypsin; the level of alpha2 macroglobulin fell both during and after the operation.

Adolescent↗