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Biomedical subjects

W M Castleden

Publications and source records attributed to W M Castleden.

At least 19 recordsLinked to original sources
PubMed1992

General practitioners' attitudes to computer-generated surgical discharge letters. Members of the Department of General Surgery, Fremantle Hospital.

OBJECTIVE: To assess general practitioners' attitudes to a computed-generated general surgical discharge letter. To identify the six most important items of information in an ideal discharge letter. DESIGN: One hundred and thirty general practitioners who had received at least six computer-generated surgical discharge letters in one year were circulated with a questionnaire. RESULTS: Most general practitioners approved of the computer-generated discharge letter which included all six of the most important items of information they requested. Eighty-four per cent wished to see a similar computer-generated discharge system extended into other areas of hospital practice.

Attitude of Health Personnel↗
PubMed1992

Detection of reversible platelet aggregates in the blood of smokers and ex-smokers with peripheral vascular disease.

OBJECTIVE: To demonstrate that smoking increases platelet aggregation in vivo, that smoking cessation reverses platelet aggregation and that this explains, in part, why smoking perpetuates the development of peripheral vascular disease. DESIGN: Prospective case-control study involving three groups of patients: smokers with peripheral vascular disease, ex-smokers with peripheral vascular disease and smokers with peripheral vascular disease who quit smoking during the study. SETTING/PARTICIPANTS: Fourteen smokers and seven ex-smokers, new patients with confirmed peripheral vascular disease, attending the vascular clinic at Fremantle Hospital between February and November, 1988. INTERVENTIONS: Blood samples taken weekly from all subjects for five weeks. Week 1 was taken as the baseline before smoking cessation in the six smokers who were assigned to stop smoking during the study. MAIN OUTCOME CRITERIA: Platelet aggregate ratio, an indicator of in-vivo platelet aggregability where an increase in platelet aggregate ratio suggests a decrease in platelet function. RESULTS: Only three of six smokers stopped smoking for the duration of the study. Median platelet aggregate ratios were: smokers = 0.85 (range, 0.79-0.92) v. non-smokers = 0.93 (range, 0.91-1.00). The difference was statistically significant P less than 0.0002. The difference in platelet aggregate ratios between smokers and quitters was not statistically significant. CONCLUSIONS: This study demonstrated an increase in platelet aggregability in smokers compared to ex-smokers but there was no clear evidence that platelet function was fully reversed after only four weeks cessation of smoking. The data suggested that platelet function of the ex-smokers had fully reversed to normal over a longer period. This could explain the decreased incidence of complications of peripheral vascular disease in ex-smokers. The small number of patients able to quit smoking impeded this study.

Adult↗
PubMed1992

How accurate is a computerized surgical audit when resident medical staff collect the data?

Since July 1988 all eight general surgeons at Fremantle Hospital have used a computer-based surgical audit and discharge system. At the time of writing (September 1991) 10,919 computer-generated discharge letters have been produced by the system. This paper describes the system and reports a series of quality control assessments carried out between 1 July 1988 and 30 June 1990 during which 30 pre-registration surgical residents completed 5,716 data collection forms. It was found that: (1) data collection for 23 of 24 monthly surgical audits was at least 95% complete; (2) outstanding surgical discharge summaries were reduced by 89%; (3) the residents recorded 17/19 wound infections and identified 15 (79%) of these as a surgical complication; and (4) the residents tended to under-record complications in patients who had more than one complication during their hospital stay. It was concluded that the system was robust, and that resident staff collected data in such a way that good quality computer-generated discharge letters were produced in a timely manner. Closer attention to aspects of data collection will be required before the optimum surgical audits of the QX system can be generated.

Abstracting and Indexing↗
PubMed1991

Prevalence of abdominal aortic aneurysm in Western Australia.

The prevalence of abdominal aortic aneurysm (AAA) in Western Australia was studied using health department mortality data. Age-standardized and age-specific mortality rates related to the disease were calculated for the period 1980-88. The mortality rate has risen by 36 per cent for men and 24 per cent for women. Most of this rise was due to an increase in non-hospital and emergency admission hospital deaths. The number of elective and emergency operations has also risen. Despite two decades of elective surgery, the mortality rate for AAA continues to rise. This rise is highly suggestive of an increasing prevalence. This contrasts with the decline in deaths from other manifestations of arteriosclerosis and provides support for a policy of screening for aneurysm.

Age Factors↗
PubMed1991

Synchronous combined oesophagectomy: a review of 20 cases.

Twenty patients with carcinoma of the oesophagus treated by a modification of the Ivor Lewis oesophagectomy using two surgeons working synchronously were reviewed. All the patients had carcinomas of the middle or lower thirds of the oesophagus. The median age was 68 years. There were 17 males and 3 females. Average total operating time was 3 h 40 min. There was one peri-operative death. The median length of stay was 15 days. The synchronous combined approach to oesophagectomy has advantages, which are discussed, similar to synchronous combined abdomino-perineal resection of the rectum.

Adenocarcinoma↗
PubMed1990

Acetylation phenotype is not associated with breast cancer.

In the present study, we have measured acetylation phenotype in 45 patients who had undergone surgical resection of a primary adenocarcinoma of the breast and in 48 patients or volunteer subjects with no breast disease. Phenotype was determined by measuring the ratio of N-acetylsulfamethazine to N-acetylsulfamethazine plus sulfamethazine in plasma 6 h after a p.o. dose of sulfamethazine. In the control group, there were 31 slow and 17 rapid acetylators, while in the breast patients, there were 25 slow and 20 rapid acetylators. The proportions of slow/rapid acetylators were not significantly different between the 2 groups (Pearson's chi 2 with Yates' correction = 0.45; P = 0.51). The data suggest that acetylation phenotype is not a useful risk prediction measurement in breast cancer.

Acetylation↗
PubMed1989

Biliary bile acids in cholelithiasis and colon cancer.

The role of biliary deoxycholate as an endogenous colon carcinogen and the possible association between cholelithiasis and/or cholecystectomy and the subsequent development of large bowel cancer is unclear. This paper describes biliary bile acids analysis performed on 13 patients undergoing cholecystectomy for gall stones, 10 patients undergoing colonic resection for colon cancer, and eight control patients. For all 31 patients the total bile acids concentration was highly variable (8.3 mg/ml-106.5 mg/ml). The median ratio of primary to secondary bile acids was 2.7:1. The biliary bile acid ratios were similar in both control patients (3.7:1) and those with colon cancer (3.1:1), whereas patients with gall stones had significantly higher secondary bile acid levels in their biliary bile (ratio 1.9:1, p = less than 0.05). This result indicates that raised biliary deoxycholate concentrations are not present in patients with colon cancer and are therefore unlikely to be a major predisposing factor in the aetiology of this disease. It is unlikely that cholelithiasis and/or cholecystectomy predispose to the subsequent development of colon tumours.

Bile↗
PubMed1988

The Hollywood surgical-audit programme: a computer-based discharge and data-collection system for surgical audit.

This article describes the development of a computer-based system for the prospective collection of data for surgical audit and peer review with the generation of a surgical discharge letter. The software has been developed for an IBM personal computer and is suitable for any compatible computer. The system has potential advantages for teaching hospitals as it enables patients to obtain a definitive discharge letter on their discharge from hospital. It is also of potential benefit to surgeons who wish to collect clinical data and to audit the quality of their surgical practice.

Computers↗
PubMed1988

An audit of clinical teaching: an approach to one performance indicator of educational competence.

This paper describes a simple, self-administered audit of the year-by-year clinical examination results of 149 students taught by the writer (Dr X) over a 9-year tenure (1977-1985) as a Senior Lecturer in Surgery at the University of Western Australia. The clinical examination results of these 149 students are compared with the clinical examination results of a total peer group cohort of 1567 students taught by the writer's colleagues in the same academic department over the same years. The limitations and applicability of this method of audit are discussed, and it is argued that this type of self-assessment might be of use, in conjunction with other evidence, in the documentation of teaching expertise. Such documentation might be of use in applications for clinical teaching appointments or promotions.

Clinical Clerkship↗
PubMed1979

Diet, liver function and dimethylhydrazine-induced gastrointestinal tumours in male Wistar rats.

Male Wistar rats fed a normal laboratory pelleted diet, when treated s.c. with 1,2-dimethylhydrazine (DMH) 10 mg/kg/wk survived the 24-week experiment, showed no signs of chemical toxicity or macroscopic liver damage, and developed mainly large-bowel tumours. Conversely, male Wistar rats treated with 20 mg/kg/wk DMH did not survive the full term of the experiment and developed ascites, pleural effusions and nodular livers. They also developed more small-bowel tumours than large-bowel tumours. The relationship between the predominant site of tumour development and dosage of DMH was highly significant.Male Wistar rats fed with an all-liquid diet (Vivonex) and treated with 20 mg/kg/wk DMH behaved quite differently both in terms of survival and site of tumour development. These rats survived the full term of the experiment, showed no signs of chemical toxicity, experienced minimal liver damage and developed predominantly large-bowel tumours. The protection afforded by the all-liquid diet against DMH toxicity and small-bowel tumour induction was statistically highly significant.A series of blood tests with special reference to liver function confirmed the highly significant degree of protection against liver damage afforded by the all-liquid diet.Sections of liver from treated rats were examined, and a simple pathological scoring system was devised which showed a highly significant difference in liver histology between standard diet and liquid-diet rats treated with 20 mg/kg/wk DMH.The results strongly suggest an association between severity of liver damage from DMH and the subsequent development of small-bowel tumours. The all-liquid diet protected rats from liver damage and these rats developed significantly fewer small-bowel tumours.

Animal Feed↗
PubMed1979

Diverticular disease of the colon and gallstones in New Zealand and England.

The clinical presentation and subsequent treatment of 160 consecutive patients with proven diverticular disease of the colon from the Auckland Hospital, New Zealand were compared with 182 consecutive patients admitted to St. Bartholomew's Hospital, London. There were significant differences in sex incidence, in the ages of the male patients at presentation, patient symptoms, extent of disease and methods of surgical treatment. These probably reflect differences in the types of National Health Services of the two countries, rather than differences in the natural history of diverticular disease of the colon. Overall, the 342 patients studied show a very good correlation with other large series published over the last 10 years. This study confirms the previously reported association between diverticular disease of the colon and gallstones. It confirms that gallstones are more common in female patients with or without diverticular disease. It suggests that Auckland patients with gallstones are more likely to have had a cholecystectomy than London patients. The possible role of dietary fiber in the aetiology of both gallstones and diverticular disease of the colon is discussed.

Adult↗