PubMed Health⌕ Search

Biomedical subjects

R J Earlam

Publications and source records attributed to R J Earlam.

At least 19 recordsLinked to original sources
PubMed1995

Ceiling-mounted radiographic equipment for trauma management in the emergency room.

Use of ceiling-mounted radiographic equipment in an emergency room for management of the multiply injured patient is described. The protocol of the Advanced Trauma and Life Support manual is followed and three plain radiographs (lateral cervical spine, anteroposterior views of the chest and pelvis) are obtained by the radiographers, who are members of the trauma team. Abnormalities were diagnosed on 7 per cent of the cervical radiographs, 31 per cent of the chest and 28 per cent of the pelvis in 108 patients during the first year of use. With full integration of the radiographers into the trauma team these three initial films are obtained within 10 min. Subsequent films can be taken of skeletal injuries found clinically or incidentally on the first three plain radiographs. It is recommended that all emergency rooms should have a ceiling-mounted radiographic unit with an automatic daylight processor to provide the best service for patients with major trauma.

Cervical Vertebrae↗
PubMed1995

The disability status of injured patients measured by the functional independence measure (FIM) and their use of rehabilitation services.

The type and severity of disability following major trauma was evaluated using the Functional Independence Measurement (FIM) in 93 patients brought to the Royal London Hospital (RLH) by helicopter. The range of values for FIM is from 18 (dependent) to 126 (fully independent) in the six sections of self-care, sphincter control, mobility, locomotion, communication and social cognition. The sections are divided into 18 separate items and graded 1-7. Forty-eight patients were discharged directly to home with a median FIM score of 124; 11 were transferred to another acute hospital with a median FIM of 63 and seven went to rehabilitation unit with a median FIM of 58. At six months, 79 per cent of the patients reported no disability and 89 per cent of the original 93 patients were at home with a median FIM of 126. The mean amount of rehabilitation provided at the RLH for all patients was 11 h 20 min with a mean in-patient length of stay of 14 days. The actual and optimal amount of therapy for rehabilitation worked out at less than 1 h per day in the acute hospital. FIM is a useful, practical and simple methodology for recording disability in the acute hospital. It provides a measure for assessing the original disability, its progress and residual limitations. Nurses, doctors and therapists can use it for establishing care plans and goals as well as deciding the transfer of the patient to the most appropriate place for future care.

Activities of Daily Living↗
PubMed1995

Measurement of disability after multiple injuries: the functional independence measure. Clinical review.

Collection of data about injured patients must include a description of the injuries using the International Classification of Disease (ICD9) and their severity using the Anatomical Injury Scale (AIS) from which the Injury Severity Score (ISS) is calculated. This method was developed for assessing the risk of mortality and is a good way of defining the extent of injury or impairment. Morbidity after injury is equally important. The terms "disability", (relating to the individual person's behaviour and performance of activities) and "handicap" (relating more to the disadvantage for a given patient in society) are accepted as the two main sub headings of long term morbidity. There are limitations to total overall health measurements and a functional disability approach is necessary for patients with multiple injuries. Of the different assessment tools the Functional Independence Measure, originally developed in Buffalo, USA, has been chosen as the most reliable and valid as it has the additional advantage of a large database containing the records of 200,000 patients throughout the world. This has been introduced at the Royal London Hospital to measure the disability outcome of patients brought there by the Helicopter Emergency Medical Service.

Disability Evaluation↗
PubMed1994

Rehabilitation after injury and the need for coordination.

The outcome of treatment after injury can be measured using the general terms of mortality and morbidity. Mortality is an all-or-none phenomenon, but morbidity is a graded response to injury and its medical treatment, varying from complete return to normality at one end of the scale to total dependence on other people requiring residence in an institution at the other end. The words disability (the individual's response) and handicap (society's reaction) specify the morbidity. Rehabilitation affects these two outcomes of disability and handicap and is a complex process involving the patient, carers and a team of specialists. The rehabilitation team is comprised of professionals each with specialist skills who aim to rehabilitate the individual as far as possible back to his former health and independence. All aspects of an individual's life are treated, including the physical, functional, psychological and social. The team operates in a number of ways according to the setting and treatment approaches used. The rehabilitation process should remain consistent throughout and focus on the patient's strengths and deficits. The key to effective rehabilitation is good organization with a comprehensive team approach working towards common goals and aims. Whether the patient is located in an acute hospital, rehabilitation unit, nursing home or in his own house, rehabilitation must be continuous. It is a mistake to believe that the rehabilitation process can only exist in a special centre; it must start in the acute hospital and be maintained even when at home, although its intensity may vary at different stages.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed1993

Helicopter Emergency Medical Service operating from the Royal London Hospital: the first year.

The additional workload on the support hospital created by using a helicopter for emergency trauma has been assessed in the first year of operation. A total of 135 patients were brought to the Royal London Hospital, of whom 30 died, 34 were transferred for convalescence or rehabilitation to another hospital, and 71 discharged home. The median Injury Severity Score was 17 (range 0-75) and 82 patients (60.7 per cent) had a reduced Revised Trauma Score at the scene. Blunt injury greatly outnumbered penetrating trauma (117 versus 15 patients). Accidental injuries accounted for 77.0 per cent of the total, self-inflicted wounds 14.1 per cent and assaults 8.9 per cent. Parameters employed to assess workload were hospital bed-days used (total 2361), operations (118, occupying 287 h of theatre time) and blood transfusion (total 702 units used). The second 6-month study period showed a considerable increase in the number of patients admitted (102 versus 33) because of increased efficiency in call-out procedures.

Adolescent↗
PubMed1992

The Royal London Hospital Helicopter Emergency Medical Service: first phase 1990.

A Helicopter Emergency Medical Service (HEMS) has been introduced to improve trauma care in the Southeast of England. The majority of the workload comes from the area bounded by the M25 ring road. In 1989 a Dauphin 365N helicopter equipped for pre-hospital primary rescue and emergency inter-hospital secondary transfer was certified by the Civil Aviation Authority. The helicopter commenced carrying patients with a paramedic and a doctor on board early in 1990. In September 1990 this service was further improved by the opening of a helipad at the Royal London Hospital and a designated HEMS desk at London Ambulance Service central control. Eighty-four patients were transported in primary rescue missions and 107 as emergency transfers in 1990.

Aircraft↗
PubMed1992

Mammography in hospital patients: use and misuse.

Of 1433 consecutive patients who underwent mammography, 90 were subsequently found to have histologically confirmed carcinoma of the breast (85 invasive carcinoma, three lobular carcinoma in situ, two intraduct carcinoma). Sixty (67%) of the mammograms of the patients with cancer were reported correctly as carcinoma. There were 27 (30%) false negative reports and three (3%) equivocal reports. In 14 (16%) patients with false negative reports the biopsy was delayed by between 2 and 24 months. The false reassurance of the mammogram report was responsible for the delay in diagnosis in nine and may have contributed in the remainder. The mammogram was most likely to be misleading when used as an investigation for a palpable lump in the breast. The mean age of patients with a false negative mammogram (44 years) was significantly less than that of patients with a true positive mammogram (57 years). In 23 of the 60 patients with positive mammograms management was changed as a result of the investigation. The mammogram was most helpful when no breast lump was palpable and there was either some other clinical evidence of local malignancy (ten patients, 11%) or metastatic disease (three patients, 3%), or the mammogram had been performed to screen a high-risk patient (three patients, 3%). The positive mammogram was also useful in two patients with residual or recurrent disease following local excision of a breast cancer. There were 15 patients with bilateral breast cancer (17%). Three (3%) were diagnosed within 2 months of the first tumour but mammography did not contribute to the diagnosis of any of these.

Breast Neoplasms↗
PubMed1991

Breast cancer data collection for surgical audit.

Data are available about the mortality, the incidence, the stage, the survival, and the treatment of breast cancer. In this country mortality data are published by the OPCS and HIPE and evidence exists to show that there is a considerable shortfall in both these sources. The incidence of breast cancer is recorded by the Regional Cancer Registries and published by OPCS. The registries supply OPCS with a minimum data set which does not include the stage of the disease, which is important, and does include the quadrant, which is not. Audit shows marked regional variations in completeness of registration. International comparisons with Scandinavia are unfavourable and show what can be achieved. Patients who develop breast cancer but do not die from it may be cured. The discrepancy between incidence and mortality, which varies both geographically and historically, should therefore provide a valuable insight into changing survival, but does not do so because the data are unreliable. Wide variations in survival figures in the medical literature are probably due to variations in staging conventions rather than different treatments. It is clear that cancer stages carry a more favourable prognosis, but it still cannot be proved that earlier diagnosis in a particular individual prolongs the life of that individual. This unproven hypothesis is the rationale for mammographic screening. Data on treatment in hospitals do not link diagnosis to operation, so that it is impossible to separate operations for benign breast disease from those for cancer. The OPCS classification of operations is complex with many open-ended choices. Doctors do not participate in the coding process and clerks cannot make up for this. Radiotherapy and chemotherapy data are not collected nationally and the four regional registries who do collect it also rely on their clerks' interpretation of medical notes. Data on the use of tamoxifen are consistent and of high quality.An extensive data gathering mechanism is in place for breast cancer. A huge body of information exists about the disease which should form a valuable database. The poor quality of this information reduces its usefulness. It is the responsibility of doctors to agree on a data set and to ensure its collection. They do it in Scandinavia.

Breast Neoplasms↗
PubMed1990

Esophageal pain.

Explore the source record for details and available documents.

Gastroesophageal Reflux↗
PubMed1990

101 oesophageal cancers: a surgeon uses radiotherapy.

One hundred and one consecutive patients with oesophageal cancer, cancer of the cardia and gastric cancer extending upwards from the stomach to the oesophagus were treated from 1979 to 1985 with a policy that included radiotherapy treatment for 58. This heterogeneous group, which was considered together as oesophageal cancer, was subdivided according to anatomical location, histology and pretreatment staging. Those patients who could be treated surgically by a resection and anastomosis performed below the diaphragm were excluded. Thirty-five had surgery which was either an oesophagogastrectomy or oesophagojejunostomy with an intrathoracic anastomosis, except for two who were nonresectable. Eight patients were to ill or refused treatment. The role of radiotherapy was assessed in three groups: i. Operable squamous cell carcinoma of the oesophagus was treated by radical radiotherapy (22) with a 46% 1-year and 14% 5-year survival. ii. Inoperable squamous cell carcinoma of the oesophagus was given radical or palliative radiotherapy (25) with a 16% 1-year and 4% 5-year survival. iii. Non-resectable adenocarcinoma of the stomach or oesophagus was treated palliatively by radiotherapy to debulk the intraluminal tumour (11), all of whom had symptomatic relief of dysphagia. The results of radical radiotherapy for operable squamous cell carcinoma of the oesophagus were similar to the best results achieved by surgical resection in other series in which there is comparable staging. Radiotherapy should be included in the treatment options for oesophageal cancer.

Adenocarcinoma↗
PubMed1989

Motor responses of the upper esophageal sphincter and body to intraluminal acid.

1. It is known that contraction of the upper esophageal sphincter (UES) and secondary peristalsis protect the airway and clear the esophagus of refluxed gastric contents. However, the exact nature of the stimulus and the role of acid remain controversial. 2. Secondary peristalsis and UES responses were measured following the intraluminal infusion of 0.1 N hydrochloric acid and equiosmolar NaCl solutions in seven normal volunteers. The protocol consisted of three phases: infusion of increasing volumes (1, 3, 5 and 7 ml per min), infusion of a given volume (7 ml per min) at different stimulation sites and balloon distension. 3. At the proximal esophagus the UES response to both solutions was similar, rising from a basal resting pressure of 30 mmHg to 70 mmHg for both HCl (range 60-85 mmHg) and NaCl (55-85 mmHg). The magnitude of the response decreased as the distance from the UES increased. The level of response decreased to 40 mmHg for both NaCl and HCl (range 30-60 mmHg) at the distal esophagus. These responses were also volume dependent. When the solutions were infused at 7 ml/min into either the proximal or distal esophagus, the sphincter pressure increased with increased volume to 65 mmHg for HCl (range 50-85 mmHg) and 60 mmHg for NaCl (range 50-80 mmHg). Secondary peristalsis was also induced by the two solutions. The level of response again decreased as the distance from the UES increased. This response was also volume dependent. Esophageal distension by a balloon positioned 10 cm below the sphincter induced secondary peristalsis and sphincter response identical to those induced by the infusion of fluid. 4. These results indicate that the principal stimulus for recruitment of the esophageal motor clearance mechanism is intraluminal distension and not necessarily the pressure of intraluminal acid.

Adult↗
PubMed1988

Functional relationships between cricopharyngeal sphincter and oesophageal body in response to graded intraluminal distension.

Responses of the cricopharyngeal sphincter to graded intraluminal distension were studied in order to determine its response threshold and to define the functional relationship between the sphincter and oesophageal body. Nine normal subjects underwent manometric study using a multilumen tube with an attached inflatable balloon sited 10 cm below the sphincter. Sphincteric and oesophageal motor responses to six graded balloon inflations were recorded in each subject. The sphincter responded to distension with increasing rise in pressure, from a median value of 42.5 mmHg at lowest levels of distension to 95 mmHg at maximal tolerated distension. Non-swallow related contractile activity was stimulated in the oesophageal body proximal to the distension and increased in quantity as inflation progressed. Distal propagation of this secondary activity was progressively inhibited with increasing distension. These interrelated changes thus show the normal upper oesophageal clearance responses to intraluminal distension. It is suggested that their more widespread application, in addition to standard manometric techniques, might provide a more rational evaluation of those patients suspected to have impaired oesophageal clearance, but in whom standard manometry is non-diagnostic.

Adult↗
PubMed1988

Studies of the oesophageal clearance responses to intraluminal acid.

Contraction of the upper oesophageal sphincter combined with secondary peristalsis clears the oesophagus of refluxed gastric contents and protects the trachea, but the nature of these reflex stimuli remains controversial. Secondary peristaltic and sphincteric responses were measured during intraluminal infusion of 0.1 N hydrochloric acid and equiosmolar saline solutions in seven normal volunteers. Responses to a single volume infused at varying sites in the oesophagus and to progressively increasing volumes of test solution were measured. In addition oesophageal responses to similar degrees of distension induced by inflation of an intraluminal balloon were also recorded. The sphincteric responses to both stimuli were similar, decreasing in value with distance from the sphincter from values of 70 (68-85) mmHg (median (range] for HCl; and 70 (55-85) mmHg for NaCl at 5 cm below the sphincter to 40 (30-60) mmHg for both HCl and NaCl at 20 cm. As the volume of the solution infused into the proximal oesophagus was increased, the sphincter pressure also rose from a median basal value of 30 (25-50) mmHg to 40 (30-50) mmHg for HCl and NaCl after 1 ml, while after 7 ml infusion, the responses were greater, 65 (45-85) mmHg for HCl, and 60 (45-80) mmHg for NaCl. In the more distal oesophagus, responses were qualitatively similar but quantitatively smaller than proximally, being 30 (25-40) mmHg for HCl and 30 (25-50) mmHg for NaCl following 1 ml and 45 (40-55) mmHg for HCl and NaCl after 7 ml. Secondary peristalsis was also induced equally by both solutions and varied with volumes infused and site of infusion in a manner similar to the sphincter responses. After a 7 ml/min acid infusion 14 (1- 40) secondary contractions/three min were recorded at 5 cm and eight (2 - 18)/three min were recorded at 20 cm. Values for saline were similar, 13 (1- 38)/three min at 5 cm and eight (4 - 25)/three min at 20 cm. Oesophageal distension by a balloon positioned 10 cm below the sphincter induced identical clearance responses to those seen after similar volumes of either acid or saline infused at the same site. These results suggest that the principal stimulus for upper oesophageal clearance is intraluminal distension and do not support the idea that the oesophagus is pH sensitive.

Adult↗
PubMed1987

Heller's myotomy for achalasia: is an added anti-reflux procedure necessary?

Literature review (1970-85) indicates excellent or good results following Heller's operation in 89 per cent of 5002 patients. The overall mortality was 2.8 per cent with a reoperation rate of 2.8 per cent. When the operation was done through an abdominal incision, gastro-oesophageal reflux was almost twice as common as when it was done through a thoracic incision, regardless of whether an anti-reflux procedure was performed.

Adult↗
PubMed1987

Responses of the upper esophageal sphincter and esophageal body to graded intraluminal distension.

1. The responses of the upper esophageal sphincter (UES) to graded intraluminal distension of the esophagus were examined to determine response thresholds and to define the functional relationship between the sphincter and the esophageal body. 2. Nine normal subjects underwent manometric examination using a multiluminal tube with an attached inflatable balloon located 10 cm below the UES. Sphincter and esophageal motor responses to six balloon inflation volumes (1, 2, 4, 6, 8, and 10 ml) were recorded in each subject. 3. The UES responded to distension by increasing pressure, from a median value of 42.5 mmHg with a threshold distension of 1.0 cm, to 95 mmHg at 2.2 cm. Non-swallow-related, secondary contractile waves were stimulated in the esophageal body proximal to the distension and increased in number as inflation increased. Distal propagation of this secondary activity was inhibited with increasing distension. The amplitude of the primary peristalsis increased significantly to 61.7 mmHg at 2.2 cm. 4. These data demonstrate the normal upper esophageal motor responses to distension and provide a reference for future investigations of patients showing evidence of impaired esophageal clearance and in whom standard manometry may be unhelpful.

Adult↗
PubMed1986

Pancreatic cancer in England and Wales: surgeons look at epidemiology.

Five thousand eight hundred and eighty one cases of pancreatic cancer and 126 cases of ampullary carcinoma were registered in England and Wales in 1979. Fourty four per cent of men and 59% of women were aged 70 or over at the time of presentation. Sixty six per cent did not undergo a surgical operation. One thousand seven hundred had a bypass operation for relief of jaundice (34%) and 470 underwent gastrojejunostomy for pyloric obstruction (8%). Only 200 pancreatic resections were performed (3%). Ten per cent of all the patients survived for one year and less than 3% for five years. Most of the long term survivors at five years after pancreatic resection had carcinoma of the ampulla of Vater.

Adult↗
PubMed1985

Histological appearances of oesophagus, antrum and duodenum and their correlation with symptoms in patients with a duodenal ulcer.

Clinical data and histology from the oesophagus, gastric antrum, and duodenum were collected from 36 patients undergoing surgery for duodenal ulcer. Gastritis was present in 94% of the patients (25% of atrophic type), oesophagitis in 72% and duodenitis in 39%. Abnormal biopsies were present from all three sites in 33% of the patients. Only one patient showed three normal biopsies. The low incidence of duodenitis does not support the theory that duodenitis is part of the same spectrum as duodenal ulcer. Heartburn was related to the presence of gastritis (100%) and oesophagitis (76%) but not to duodenitis (52%). No relationship was found between the length of history, severity of pain, and histological abnormalities.

Adult↗