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Biomedical subjects

S E Clamp

Publications and source records attributed to S E Clamp.

32 records · Page 2Linked to original sources
PubMed1982

A comparison of barium sulphate preparations used for the double contrast barium meal.

Radiologists' opinions of the properties of six barium suspensions with their recommended gas-producing agents designed for upper gastrointestinal use were assessed, using a linear analogue scale. Five radiologists independently assessed mucosal coating of stomach and duodenum, areae gastricae, gaseous distension and bubble formation in a total of 258 patient examinations. Preparation 1 (EZHD) was judged to give best overall results, coating stomach and duodenum particularly well. Preparation 2 (X-Opaque) gave good distension and also coated mucosa fairly well, as did preparations 3 and 4 (Medebar XAC and Field 2C). The latter two preparations produced good distension at the expense of bubble formation. Preparations 5 and 6 (Micropaque DC and Baritop G) were judged, by comparison, to have performed poorly as regards mucosal coating. None of the preparations delineated areae gastricae well, even in the presence of good, bubble-free gastric distension.

Barium Sulfate↗
PubMed1982

Diagnosis of inflammatory bowel disease: an international multicentre scoring system.

Inflammatory bowel disease is being studied by the World Organisation of Gastroenterology (OMGE) Research Committee in a survey (currently) affecting 1696 patients presenting to 30 hospitals in 16 countries. A computer-aided diagnostic prediction system (when tested in 1056 patients) showed an accuracy of match between computer prediction and clinical diagnosis in 94% of these patients. Most centres, however, do not possess appropriate computing facilities. A simple diagnostic "scoring system", based on likelihood ratios, has therefore been developed, using a series of numbers set out on a single sheet of paper. The overall accuracy of the simple scoring system in the same 1056 patients was equivalent (93%) to the computer-aided system. In a further series of 510 "new" patients from eight fresh centres the diagnostic scoring system made a firm prediction in 490 cases (96%). Where made, the accuracy of match between the scoring system prediction and clinical diagnosis was 96%. It is suggested that this simple system, which requires no analytical resource and could be used by any gastroenterologist, might be of some value in clinical research and clinical practice.

Adult↗
PubMed1981

Geographical variation in disease presentation. Does it constitute a problem and can information science help?

This paper assesses the extent and importance of geographical variation in disease presentation in relation to automated systems for clinical decision making. Reference is made to studies carried out by the World Organization of Gastroenterology involving 1,500 patients with inflammatory bowel disease, 6,000 patients with acute abdominal pain, and 1,300 patients with upper GI bleeding. These studies indicate that geographical variation in disease presentation (both regarding prior probability of disease and conditional probability of symptoms in each disease) is so great as to constitute a considerable potential threat to the widespread introduction of any automated decision-making system. It is suggested that there is an urgent need for the creation of large-scale multinational case series where diseases and symptoms are adequately and reproducibly defined in advance. Reference to studies previously mentioned is used to adduce evidence of the benefits of such large-scale data bases.

Abdomen↗
PubMed1980

Presentation and diagnosis of patients with acute abdominal pain: comparisons between Leeds, U.K. and Akershus county, Norway.

Geographical variation in clinical presentation may be a key obstacle to accurate diagnosis of patients with acute abdominal pain. This paper studies two series of patients presenting to hospital with an "acute abdomen"; 552 patients from Leeds, England and 398 patients from Akershus, Norway. The causative disease patterns and detailed clinical presentation are compared and contrasted (where appropriate) with a larger series of 6,097 patients under study by the World Organisation of Gastroenterology. Finally, the report outlines the results of implementing automated (computer-aided) diagnostic systems both in Leeds and Akershus, and the effects of adopting a structured case history form for data-recording when the patient is first seen.

Abdomen, Acute↗
PubMed1979

Sampling gastro-enterologists' opinions--an OMGE study.

This study describes a pilot project to sample gastroenterologists' opinions on a variety of interesting and controversial topics. At the Madrid World Congress, a sample of delegates were asked to respond to a questionnaire distributed at the meeting itself. A total of 224, representative of those attending by discipline and by geographical area, did so. The results were analysed in two days and presented to the Congress within 72 hours. Amongst the findings were several of interest. Vagotomy is now the most common operation for (elective) duodenal ulcer surgery. Three-quarters of those responding prescribe high-fibre diet for chronic diverticular disease. Over 80% routinely prescribe sulphazalazine for patients with ulcerative colitis--even in remission. The most useful mode of detection of gastro-intestinal cancer is now felt to be endoscopy, even ahead of double contrast radiology. The results should be interpreted with caution, although the survey represents findings in over 200 hospitals. The principle of an on-the-spot rapid attitude survey has been established as feasible. It is proposed to repeat the exercise on a wider scale at the next World Congress in Stockholm in 1982.

Attitude of Health Personnel↗
PubMed1975

Computer-aided diagnosis of lower gastrointestinal tract disorders.

This paper reports a survey of human and computer-aided diagnosis in a prospective consecutive series of 301 patients admitted to the hospital with lower gastrointestinal tract disease. At initial outpatient contact (at which time endoscopy was customarily performed), the clinicians' diagnostic accuracy was 64.5%. After biopsy, radiology, and other investigative procedures, the clinicians' preoperative diagnostic accuracy rose t0 82.7%. When data from the house surgeon's case notes were fed into the computer, its diagnostic prediction proved accurate in 77% of the 301 patients, and when details of the outpatient endoscopy were added to the house surgeon's case notes, the computer's diagnostic accuracy rose to 84.7%. It is suggested that computer-aided analysis may have a limited part to play in discriminating between the common causes of lower gastrointestinal disorders in routine clinical practice.

Adolescent↗
PubMed1974

Short-term course and prognosis of Crohn's disease.

An analysis is presented of the course and outcome of the initial referred attack in a group of 332 patients with Crohn's disease treated at the General Infirmary at Leeds from 1939 to 1968 inclusive. A further 50 cases were excluded on the basis of insufficient diagnostic evidence: usually such patients had acute terminal ileitis. Only 5% of patients achieved full remission on conservative management, and most eventually came to surgery. The overall fatality rate was some 3.3% and this was affected chiefly by the severity of attack and the age of the patient. The severity of attack was classified as mild, moderate, or severe according to a system which took into account factors such as bowel habit, rectal bleeding, abdominal pain, pulse rate, temperature, haemoglobin, and weight. In attacks graded as ;mild', no deaths occurred; in those graded ;severe' the fatality rate was 8.8%. Similarly, whilst no patient under 20 years of age died, the fatality rate in the over 60s was some 14.8%. Further comparison between the present group of 332 patients and an earlier series of 204 patients suffering from ulcerative colitis (Watts, de Dombal, Watkinson, and Goligher, 1966a) shows considerable differences in the course and prognosis of the two diseases. In particular 70% of patients with ulcerative colitis achieved remission on conservative management alone whereas only 5% of Crohn's disease patients did so. These differences, and in particular the poor response to conservative therapy, are discussed, together with their implications for management.

Age Factors↗
PubMedDate not supplied

Reliability and reproducibility of clinical findings in low-back pain.

The data obtained from the history and examination of patients with low-back pain and sciatica have been subjected to an observer variation analysis. Redesign of the proformata resulted in a reduction of the observer error from 33% to 18% for the history, but no improvement in the finding of a 30% observer error in the examination. The clinician has a simple choice: if he wishes to obtain a large amount of detailed information he must realize that much of it will be unreliable; if he is prepared to limit the information then he will increase its reliability.

Back Pain↗
PubMedDate not supplied

Prediction of individual patient prognosis: value of computer-aided systems.

Physicians take both diagnosis and prognosis into account when allocating treatment. However, by "prognosis" physicians usually imply a somewhat vague impression concerning large groups of patients. One possible task for decision support studies is to design and construct systems that accurately predict individual patient prognoses. The authors constructed and tested such systems in three areas of medicine (inflammatory bowel disease, upper gastrointestinal tract hemorrhage, and acute chest pain). In each area, the individual patient's symptoms were compared with a computer-held database of information via a Bayesian analysis, prior and conditional probabilities being derived from large-scale real-life surveys. Prospective trials designed to test these predictive systems by reference to test series comprising over 4,000 patients indicate that a firm prognostic prediction can generally be made; where made, the accuracy of prediction is over 90%. Ways in which this type of prediction may be of clinical value are discussed.

Adult↗