D'Souza N.,Poole Hospital |
Sunthareswaran R.,Stoke Mandeville Hospital
International Journal of Surgery | Year: 2013
Introduction: Every investigation that can contribute towards a diagnosis of appendicitis is valuable to the emergency general surgeon. Previous research has suggested that hyperbilirubinaemia is a more specific marker for both simple and perforated appendicitis than WBC (white blood count) and CRP (C-reactive protein), but this investigation is not commonly used to help diagnose appendicitis. Aims: This study investigated whether there is an association between hyperbilirubinaemia and appendicitis. We also reviewed the diagnostic value of bilirubin in perforated vs simple appendicitis, and compared it with the serum C-reactive protein (CRP) and white blood cell count (WBC). Methods: This single centre, prospective observational study included all patients admitted with right iliac fossa (RIF) pain who had liver function tests performed. Statistical analysis was performed using Fisher's exact test to compare bilirubin, WBC and CRP levels for normal appendices, simple appendicitis, and perforated appendicitis. Results: 242 patients were included in this study, of whom 143 were managed operatively for RIF pain.Hyperbilirubinaemia was significantly associated with appendicitis vs RIF pain of other aetiologies (p<0.0001). Bilirubin had a higher specificity (0.96), than WBC (0.71) and CRP (0.62), but a lower sensitivity (0.27 vs 0.68 and 0.82 respectively).Hyperbilirubinaemia was associated with perforated appendicitis vs simple appendicitis with statistical significance (p<0.0001). Bilirubin had a higher specificity (0.82) than both WBC (0.34) and CRP (0.21), but a lower sensitivity (0.70 vs 0.80 and 0.95 respectively). Conclusion: Our findings confirm that hyperbilirubinaemia has a high specificity for distinguishing acute appendicitis, especially when perforated, from other causes of RIF pain, particularly those not requiring surgery. © 2013 Surgical Associates Ltd.
Gallagher S.,University of Memphis |
Gallagher S.,University of Hertfordshire |
Gallagher S.,University of Wollongong |
Hutto D.D.,University of Hertfordshire |
And 3 more authors.
Behavioral and Brain Sciences | Year: 2013
The notion of an enactive system requires thinking about the brain in a way that is different from the standard computational-representational models. In evolutionary terms, the brain does what it does and is the way that it is, across some scale of variations, because it is part of a living body with hands that can reach and grasp in certain limited ways, eyes structured to focus, an autonomic system, an upright posture, etc. coping with specific kinds of environments, and with other people. Changes to any of the bodily, environmental, or intersubjective conditions elicit responses from the system as a whole. On this view, rather than representing or computing information, the brain is better conceived as participating in the action. Copyright © 2013 Cambridge University Press.
Cole J.,Poole Hospital |
Cole J.,Bournemouth University
Topics in Stroke Rehabilitation | Year: 2011
This essay contrasts the responses of persons with stroke described by Kaufman with the refl ections of persons with spinal cord injury (SCI). It is suggested that, over the last decade or so, mainstream medicine has become less reductionist and more humane in focus. Many with SCI become reconciled to their new bodies, though this may take years. It is not clear whether this apparent difference in the responses of those with stroke, related by Kaufman, refl ects their older age or other factors. Perhaps it takes longer than 2 to 3 years for some people to become reconciled to profound alterations in their embodiment. Medical and social models of impairment are discussed. The effects of personal reductions in function may be lessened in signifi cance through appropriate environmental adaptations and changes in social attitudes. In agreement with Kaufman, the importance of an effective personal assistant/employer relationship is illustrated in relation to those with quadriplegia. Overall the perspective of persons with SCI is not as pessimistic as that of those with stroke, as related by Kaufman. However, her plea for a deeper and richer exploration of the lived experience of chronic impairment is supported for many reasons. © 2011 Thomas Land Publishers, Inc..
Natesh B.G.,Poole Hospital
Journal of Laryngology and Otology | Year: 2013
Introduction: It is important that patients have a good understanding of surgery-related risks, particularly for mastoid surgery, which exposes patients to the risk of very serious complications, despite addressing conditions which often have only minor symptoms. Materials and methods: A patient information leaflet describing the risks of mastoid surgery was prepared. However, the Hospital Patient Advice and Liaison Services team thought it was too long and complicated. It was introduced unchanged. Fifty-four consecutive mastoidectomy patients were given a questionnaire asking for their opinion of the leaflet. The leaflet was also assessed with readability formulae and the Ensuring Quality Information for Patients tool. Results and analysis: Ninety-eight per cent of respondents thought the leaflet's writing style was easy to understand. The majority (96 per cent) thought the length was 'just right'. The 7 readability formulae used established readability at a grade 9 level (i.e. appropriate for a reading age of 13-15 years). The Ensuring Quality Information for Patients score was 87.5 per cent. Discussion: Despite the drive to simplify patient information leaflets, quite detailed information is sometimes required. A style which is too simple may be perceived as patronising and may encourage patients to underestimate potential risks. It is important to ask patients their opinion. Copyright © JLO (1984) Limited 2013Â.
Green A.,Poole Hospital
BMJ case reports | Year: 2013
Rupture of a splenic artery aneurysm is a rare but life-threatening presentation to the emergency department. This case demonstrates the importance of swift resuscitation and the benefit of bedside imaging in a highly unstable patient. The definitive management of this condition in patients who are refractory to resuscitative attempts is immediate surgery with the diagnosis often only confirmed at laparotomy.