PubMed Health⌕ Search

Biomedical subjects

N J Fothergill

Publications and source records attributed to N J Fothergill.

7 recordsLinked to original sources
PubMed1993

Audit of patients with chest pain presenting to an accident and emergency department over a 6-month period.

The results of a 6-month retrospective audit of patients presenting with chest pain to an accident and emergency (A&E) department to which 46,000 new patients per year present are discussed. The computer diagnostic code assigned to the patients by the A&E doctor, referral rates for second opinion and disposal after assessment in the A&E department are examined, with particular reference to patients who may have had serious cardiac pathology, such as acute myocardial infarction (AMI) or unstable angina. Audit showed that overall 61% of patients with chest pain of all causes were assessed and discharged home by A&E doctors without recourse to second opinion. Of patients thought by the A&E doctors to have chest pain of cardiac origin, who were referred to the duty medical registrar or cardiologist, 88% were admitted. As a result of these findings a policy of more open referral for second opinion was instituted to reduce the likelihood of discharging patients home with serious cardiac pathology. In addition, the clinical problems of AMI and unstable angina are emphasized to all senior house officers early in their educational programme after joining A&E. Published literature on the diagnosis and misdiagnosis of AMI and unstable angina in the A&E department is reviewed. These studies are almost exclusively from North America, and a need for similar work in the U.K. is discussed.

Adolescent↗
PubMed1992

The Purley train crash mechanism: injuries and prevention.

On the afternoon of Saturday 4th March 1989 two trains, both bound for London Victoria Station, collided. Part of the rear train rolled down a steep railway embankment and jack-knifed against a tree. The mechanism of the crash and the injuries sustained by the 55 victims who were seen in the A&E Department of the Mayday University Hospital are described. Improvements in signalling technology and design of rolling stock which may reduce both the risk of collision and severity of injury in future accidents are discussed.

Accident Prevention↗
PubMed1990

A prospective study of assault victims attending a suburban A&E department.

This prospective study was undertaken to assess demographic and social factors, assault characteristics and injuries sustained by assault victims attending a suburban A & E department. A total of 214 men and women who admitted to having been assaulted were entered into the study, information being obtained by patient questionnaire and from A&E records. The assault victims made up 3.3% of the total new patients seen in the study period. The majority of victims were employed, single young men (72%) who had been drinking alcohol prior to assault (66%). They were assailed late at night in the street, in pubs and clubs. Female domestic assault was two times more common in this population than in previous British studies, and women were more extensively injured than men. Injuries were mostly to the face, caused by punches and kicks. Overall, 72% of fractures were facial. Most patients were referred to their G. P. for follow up (41%). The available evidence suggests that personal violence is on the increase, and is not confined to inner-City areas. As victims seeking help will usually attend an A&E department, staff should be alerted to recognize and advise these patients on possible psychological sequelae, as well as treating their physical injuries.

Adolescent↗
PubMed1988

Abdominal pain as a presenting symptom of the Guillain-Barré syndrome.

Guillain-Barré syndrome (acute inflammatory polyneuropathy) is a rare disorder with an incidence of one to two per 100,000 per year (Kennedy et al., 1978) but it is the commonest cause of acute muscle weakness in patients under 40 years of age. The clinical diagnosis is made by finding a symmetrical motor and sensory peripheral neuropathy, commonly with cranial nerve involvement. Mechanical ventilation is required in 14% of patients because of paralysis of the respiratory muscles. Early treatment with plasma exchange leads to more rapid and complete recovery of neurological function, and reduces the time spent on the ventilator. Early diagnosis and referral for plasma exchange is therefore very important. The present authors report a case in which abdominal pain was the patient's initial symptom and her main complaint.

Abdomen↗
PubMed1987

The natural course of gold nephropathy: long term study of 21 patients.

To clarify the natural course of gold nephropathy and thereby facilitate its clinical management 21 patients with rheumatoid arthritis who developed proteinuria during treatment with intramuscular sodium aurothiomalate were studied in detail throughout their renal illnesses. Renal biopsies were performed, and creatinine clearance and proteinuria were measured serially for 60 months (range 16-130 months). Ten patients developed proteinuria after six months' treatment, 15 after 12 months, and 18 after 24 months. When treatment was stopped the proteinuria reached a median peak of 2.1 g/day (range 0.7-30.7 g/day) at two months (range 1-13 months) before resolving spontaneously, in eight patients by six months, in 13 by 12 months, and in 18 by 24 months. All patients were free of proteinuria by 39 months, the median duration being 11 months. The median first and last measurements of creatinine clearance showed no significant change (77 ml/minute and 59 ml/minute, respectively), and no patient died from or needed treatment for renal failure. HLA-B8 or DR3 alloantigens, or both, were identified in seven patients. Renal biopsy specimens showed membranous glomerulonephritis in 15 patients, a minimal change nephropathy in two, mesangial electron dense deposits in two, and no appreciable glomerular changes in two. In these 21 patients the proteinuria of gold nephropathy resolved completely when treatment was withdrawn. Renal function did not deteriorate, corticosteroids were unnecessary, and several different renal lesions were seen.

Adult↗
PubMedDate not supplied

Two hundred school injuries presenting to an accident and emergency department.

Two hundred children who had been injured at school and sought hospital treatment were studied. Younger children tended to be brought to the Accident and Emergency Department later after the injuries than the older children, and one in seven of those under 15 years attended alone or without a legally acceptable guardian. Sixteen per cent of the 204 injuries were fractures, of which 70% were to the upper limbs, and 18% facial. Eighteen per cent of the injuries were lacerations requiring sutures. Younger children sustained proportionately more lacerations and fewer minor injuries such as bruises, abrasions and sprains than older children. Over half of the injuries occurred in patients' free time at school, which had been unsupervised in 51% of cases.

Accidents↗