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Biomedical subjects

P Leman

Publications and source records attributed to P Leman.

At least 19 recordsLinked to original sources
PubMed2002

Validity of urinalysis and microscopy for detecting urinary tract infection in the emergency department.

This study assessed the validity of standard urinalysis, urinalysis for leucocyte esterase and nitrites, and urgent microscopy in the diagnosis of urinary tract infection (UTI) in 60 female patients with a triage diagnosis of UTI. There were 24 (40%) proven UTIs after culture. Simple urinalysis was sensitive for UTI (95.8%) but the positive predictive value was only 45.1%. The addition of leucocyte esterase and nitrite urinalysis testing did not improve the sensitivity, but if both of these were positive the positive predictive value improved to 100%. Urgent microscopy alone was sensitive (100%) but non-specific (38.9%). The specificity of the diagnosis improved to 94.4% for organism counts of >or=10/microl and to 88.9% for leucocyte counts of >or=50/microl. The negative predictive value of no detectable leucocytes on microscopy was 94.7%. Screening for UTI in the emergency department (ED) population is improved by the addition of leucocyte esterase and nitrite test. A positive urinalysis test for leucocytes and nitrites, or urinalysis positive at levels of >or=500 leucocytes or >or=5 g/l protein should confirm a clinical diagnosis of UTI. Urgent urine microscopy should be performed only if the above criteria are not met yet a minimum of one urinalysis result is positive.

Adult↗
PubMed2001

A case-control study of food poisoning seen at an accident and emergency department.

We investigated the hypothesis that sporadic food poisoning is a result of the consumption of food cooked or prepared outside the home. We did a case-control study, set in an urban emergency department, to find out the odds ratios for the risk of food poisoning associated with various patterns of consumption. We found that recent eating out (exposure on the day of or day before presentation) was associated with an odds ratio of 2.41 (95% CI 1.29-4.50) for presenting with food poisoning.

Adult↗
PubMed2001

Pain management.

Explore the source record for details and available documents.

Analgesics↗
PubMed2001

Clinical and microbiological features of suspect sporadic food poisoning cases presenting to an accident and emergency department.

During a five-month period all patients presenting to an inner-city accident and emergency department with suspected food poisoning were assessed for relevant clinical and microbiological features. There were 102 patients in the study period (0.3% of all attendances). Fifty-two stool samples were processed and 11 were culture positive (21% of those sampled, 11% of all cases). The two commonest organisms were Campylobacter (6) and Salmonella (4). A logistic regression analysis showed that, of the continuous variables, a higher temperature (odds ratio [OR] 2.72, 95% confidence interval [CI] 1.36 to 5.46) was predictive of stool culture positivity, and age was negatively predictive (OR 0.88, 95% CI 0.78 to 0.98). Of the dichotomous variables only a history of fever (OR 3.94, 95% CI 1.07 to 14.5) was predictive of stool culture positivity. The presence of nausea (OR 0.11, 95% CI 0.03 to 0.43) or vomiting (OR 0.22, 95% CI 0.06 to 0.80), and the absence of abdominal tenderness, had a negative predictive value for stool culture positivity. No patient without a history of abdominal pain and diarrhoea had a positive stool culture.

Abdominal Pain↗
PubMed1999

Questionnaire survey of interpreter use in accident and emergency departments in the UK.

OBJECTIVE: To determine the support for a national telephone interpreter service from accident and emergency (A&E) departments across the UK, and the factors that may influence that support. To determine the nature of interpreter needs for these departments. METHODS: Postal questionnaire survey of 255 A&E departments in the UK. RESULTS: A total of 197 replies were received, a response rate of 77.3%. Altogether 186 respondents answered the question on support for a national telephone interpreter service and 124 (66.7%) would support one. Those departments in favour were no more likely to have required an interpreter in the last seven days (chi 2 = 0.16, df = 1, p = 0.69), be in the inner city (Fisher's exact test, two sided probability, p = 1), have predominantly local population needs compared with tourist needs (chi 2 = 0.65, df = 1, p = 0.42), or be current users of a telephone interpreter service (chi 2 = 0.01, df = 1, p = 0.93). Seventy-nine of 180 (42.9%) departments had used some form of interpreter in the seven days preceding completion of the survey. Seventy-six of 86 (88.4%) of those departments using face to face interpreters had experienced difficulty obtaining an interpreter out of hours. Nationally, the following proportion of all A&E departments listed the named language as occurring among the three most common languages requiring interpretation: French 0.46 (95% confidence interval 0.42 to 0.50), Urdu 0.30 (0.26 to 0.34), and German 0.24 (0.21 to 0.27). CONCLUSIONS: There is widespread need and support for a national telephone interpreter service that would match the requirements of 24 hour emergency health care provision.

Communication Barriers↗
PubMed1999

Malaria in inner London.

This retrospective analysis was performed to describe the malarial cases treated in an inner London hospital during a single year (1996). A total of 44 case records were available for review, 40 (90.9%) were due to Plasmodium falciparum. Thirty-seven patients were admitted to hospital, there were no deaths. Only two (4.5%) patients had taken adequate malarial prophylaxis. A total of 119 inpatient bed-days were utilized in the treatment of malaria in 1 year. In 75 (63%) of these bed-days, observation was the only reason for continued inpatient treatment. The commonest laboratory findings are mild elevation of serum bilirubin to a mean of 28 micromol/l, and a low platelet count to a mean of 124x10(12)/l. A bilirubin greater than 20 micromol/l was found in 72.9% of patients (95% CI; 58.7-87.3%). The platelet count was less than 150x10(12)/l in 77.3% of patients (95%, CI; 64.9-89.7%). We found that malaria is not uncommon in inner London. Whilst most cases are admitted few complications are usually seen. Many cases may well be able to be treated with a brief hospital admission, possibly to an accident and emergency observation ward.

Adolescent↗
PubMed1997

Interpreter use in an inner city accident and emergency department.

OBJECTIVE: To determine the extent of communication problems that arose from patients whose primary language was non-English presenting to an inner city accident and emergency (A&E) department. METHODS: A prospective survey over seven consecutive days during September 1995. All adult patients other than those directly referred by their general practitioner to an inpatient team had a questionnaire completed by the A&E doctor first seeing the patient. The doctor recorded language ability and form of interpreter used, and estimated any prolongation of the consultation and ability to improve communication by the use of additional services. RESULTS: 103 patients (17%) did not speak English as their primary language; 55 patients (9.1% of the study population) had an English language ability rated as other than good, and 16 (29%) of these consultations could have been improved by the use of additional interpreter services; 28 patients overall (4.6% of the study population) required the use of an interpreter, who was usually a relative. CONCLUSIONS: A significant number of patients presenting to A&E have difficulty in communicating in English. These consultations could often have been improved by the use of additional interpreter services. Telephone interpreter services may provide the answer for use in A&E departments because of their instant and 24 hour availability.

Communication Barriers↗
PubMed1996

Toxicity following accidental ingestion of Aconitum containing Chinese remedy.

Various species of Aconitum are commonly used in traditional Chinese medicine. These plants are known to contain highly potent cardiotoxins. A 22 year old Chinese male accidentally ingested a herbal liniment prepared from Aconitum with near fatal results. His ventricular tachyarrhythmias responded to standard treatment including the use of i.v. magnesium.

Aconitine↗
PubMed1985

[Cerebral lesions in a case of Degos' disease].

The central nervous system may be involved in Degos disease, but neuropathologic observations are still few. We report a typical case with cerebral involvement. The diagnosis was suggested by the characteristic skin lesions and vascular damage. In the central nervous system, occlusive changes of small arteries were responsible for areas of ischaemic necrosis. These foci of infarction were of varying size, age and distribution. Intestinal lesions were discrete and death was due to several cerebral infarcts.

Adult↗
PubMed1985

[Spontaneous subarachnoid hemorrhage. Plea for a standard evaluation system].

There is no univocal grading of subarachnoid hemorrhage by ruptured intra-cranial aneurysms. Three systems are commonly used: Botterell's, Hunt's and Hess's, Nischioka's. Besides, many surgical teams use modified or derived systems. It is this very difficult to compare series of patients whose grading has not been made, using the same criteria. The authors propose to make a unique system of grading with new criteria of clinical evaluation.

Humans↗