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Biomedical subjects

N G Kirby

Publications and source records attributed to N G Kirby.

9 recordsLinked to original sources
PubMed1993

Use of an accident and emergency department observation ward in the management of head injury.

The management of 405 patients presenting with head injury to an accident and emergency department was assessed. Sixty-nine patients were admitted, although this number should have been 127 according to current guidelines on the management of head injury. Only three attenders were admitted inappropriately according to these guidelines. An accident and emergency observation ward was open on weekdays only; at weekends, patients with head injury were admitted to a general surgical ward. When the observation ward was open, 51 of the 76 patients (67 per cent) presenting with admission criteria were admitted. When closed, only 15 of the 51 patients (29 per cent) with these criteria were admitted. Guidelines were applied effectively to reduce the number of unnecessary admissions, but there was a significant number of patients with minor head injury who were discharged inappropriately. This number was much reduced when an observation ward was available.

Craniocerebral Trauma↗
PubMed1993

Skull X-ray after head injury: the recommendations of the Royal College of Surgeons Working Party report in practice.

In 1986 a Royal College of Surgeons Working Party published guidelines, based on over 15 years of clinical research both here and in the U.S.A., on when to perform skull X-rays on a head injury patient. In this retrospective study the recorded details of 405 patients who presented to an accident and emergency (A&E) department over a 3-month period in 1991 are analysed, and the Report criteria applied to each one to assess whether the guidelines are being followed in performing a skull X-ray. According to these guidelines, 191 of these patients (47.2%) should have been X-rayed, however, only 83 were. Only one patient was thought to have been X-rayed inappropriately. The Report criteria most commonly thought by the A&E doctors not to warrant skull X-ray, were loss of consciousness, amnesia, dizziness, blurred vision, headache, and alcohol intoxication. The reasons why these criteria are being ignored are examined, and together with reference to recent studies, slight alterations to the Working Party guidelines are suggested to make them more applicable to everyday situations of head injury encountered in a casualty department.

Adolescent↗
PubMed1993

The storage of tetanus vaccine in accident and emergency departments: a postal survey.

The aim of this study was to assess the quality of storage of tetanus vaccine in accident and emergency (A&E) departments and also of the awareness of Department of Health guidelines. A postal questionnaire was sent to 50 randomly selected major A&E departments in the British Isles, enquiring about awareness of Department of Health guidelines (Department of Health, 1990). Forty (80%) A&E departments responded. Only 14 were aware of the Department of Health guidelines and in only 18 was there a member of staff taking responsibility for vaccine storage. The study found that safe storage of vaccine, and therefore guarantee of efficacy, is not occurring in the majority of A&E departments. Unnoticed failure of refrigerators could be exposing patients to the risk of tetanus infection.

Drug Storage↗
PubMed1987

Synthaderm in the management of pre-tibial lacerations: a controlled clinical study.

A clinical study of patients with pre-tibial lacerations at King's College Hospital and Guy's Hospital, London, England, compared a non-adhesive dressing with Synthaderm. Treatment was randomly allocated. At King's College Hospital, deep and superficial lacerations were equally distributed, the median time to healing with Synthaderm was significantly (P less than 0.02) reduced; and the median rate of healing (mm/day) was significantly (P less than 0.01) better. At Guy's Hospital, larger and wider wounds were unequally distributed, with fewer in the control group; in the Synthaderm group, the median rate of healing was increased. In both centres, the clinical impression was that Synthaderm reduced nursing dressing time and a better scar resulted. Synthaderm improved the rate of healing in pre-tibial lacerations.

Adolescent↗