Publications
255 results found
Davies CWH, Bell D, Wimperis J, et al., 2003, Early discharge of patients with pulmonary embolism: Feasibility of outpatient treatment, Winter Meeting of the British Thoracic-Society, Publisher: B M J PUBLISHING GROUP, Pages: 82-82, ISSN: 0040-6376
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- Citations: 1
Davies CWH, Bell D, Wimperis J, et al., 2003, Validation of pretest probability(PTP) scoring to predict pulmonary embolism in routine practice, Winter Meeting of the British Thoracic-Society, Publisher: B M J PUBLISHING GROUP, Pages: 82-83, ISSN: 0040-6376
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- Citations: 1
Bell DR, 2003, Rawls and research on cognitively impaired patients: A reply to Maio, THEORETICAL MEDICINE AND BIOETHICS, Vol: 24, Pages: 381-393, ISSN: 1386-7415
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- Citations: 1
Bell D, 2002, Acute medicine - A new era?, CPD Journal Acute Medicine, Vol: 1, ISSN: 1476-5063
Bell D, Nimmo GR, 2002, The future of acute (general) medicine?, SCOTTISH MEDICAL JOURNAL, Vol: 47, Pages: 99-99, ISSN: 0036-9330
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- Citations: 1
Crosswaite A, Bell D, 2002, General practitioners with special clinical interests, CLINICAL MEDICINE, Vol: 2, Pages: 168-168, ISSN: 1470-2118
Rose P, Bell D, Green ES, et al., 2001, The outcome of ambulatory DVT management using a multidisciplinary approach, CLINICAL AND LABORATORY HAEMATOLOGY, Vol: 23, Pages: 301-306, ISSN: 0141-9854
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- Citations: 8
Morrison LG, Lam S, Sutherland M, et al., 2001, A unitary patient record improves admission documentation in a medical assessment unit in a major teaching hospital., Health Bull (Edinb), Vol: 59, Pages: 218-223, ISSN: 0374-8014
OBJECTIVE: To ascertain the impact of the introduction of a unitary patient record (UPR) on clerking documentation of emergency medical admissions. DESIGN: Retrospective casenote audit. SUBJECTS AND SETTING: Random sample of 100 unselected admissions to the medical assessment unit of a major teaching hospital, comprising two groups pre- and post-introduction of the UPR. RESULTS: Statistically significant improvements in the documentation of several items were achieved; function before episode, ethnic origin, chest pain, breathlessness, ankle oedema, cough, bowel habit and locomotor symptoms and recording of blood pressure and peripheral pulses. There were trends towards improvement in other areas and there were no areas in which the UPR performed less well than standard documentation. CONCLUSIONS: Introduction of the UPR represents the successful application of multidisciplinary principles to over 10,000 acute general medical admissions. It has improved some, but not all, aspects of documentation. Revision of the design of the UPR should lead to further progress, as part of an ongoing process of development and re-audit.
Bell D, Dodds R, Park L, 2001, A prospective non-interventional audit of outcomes for medical patients who meet the criterion for high dependency care., CPD Journal Internal Medicine, Vol: 2, Pages: 77-81, ISSN: 1466-2914
Objective: This was a U.K. based study which aimed to identify medical patients who met criteria for high dependency care and to compare outcomes for patients managed in medical HDU with those managed in a general ward environment. Design: Over a 12 week period, all medical wards and medical HDU were visited daily. All patients who met criteria for admission to HDU in the U.K., irrespective of ward area, were included in the study. Setting: 1019 bedded teaching hospital. Patients and participants: A total of 201 patients were suitable for inclusion. The HDU group included 112 patients (64 male; 48 female) and the ward group included 89 patients (48 male; 41 female). Main outcome measures: The effect of high dependency care on patient's hospital length of stay hospital mortality and three-month mortality. Results: The median hospital length of stay (LOS) for the HDU group was 5.5 days and for the ward group 14 days (p=0.00008). Hospital mortality for the HDU group was 25%, increasing to 31% at three months while hospital mortality for the ward group was 33%, rising to 35% at three months. Of the 106 ward based high dependency episodes 38 were referred to medical HDU, five to CCU (Coronary Care Unit), four to ITU (Intensive Therapy Unit) and one to surgical HDU. In 58 high dependency ward based episodes no referral to a high dependency unit was made. Conclusion: These results suggests that patients who are cared for in HDU have an average hospital LOS 8.5 days shorter and a hospital and three month mortality rate eight percent and four percent lower than the ward based patients.
Carson AJ, Crichton J, Bell D, et al., 1999, When medicine meets the law--guidelines for decision making in acute medical admissions., Health Bull (Edinb), Vol: 57, Pages: 267-275, ISSN: 0374-8014
Watson ML, Bell D, 1998, The future of general medicine, Journal of the Royal College of Physicians London, Vol: 32, Pages: 489-489, ISSN: 0035-8819
Janes SM, Barker KF, Mak V, et al., 1998, Invasive pulmonary aspergillosis in an insulin-dependent diabetic, RESPIRATORY MEDICINE, Vol: 92, Pages: 972-975, ISSN: 0954-6111
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- Citations: 9
Bell D, 1998, Using NIPPV on a general respiratory ward., J R Coll Physicians Lond, Vol: 32, Pages: 489-490, ISSN: 0035-8819
Bell D, 1997, 0-19262584-5, Critical Care Cases, Editors: Armstrong, Salmon, Publisher: Oxford University press
Hyponatraemia
Mathur R, Mak V, Bell D, 1996, A survey of sleep service provision in North Thames Region, UK, Thorax, Vol: 51, ISSN: 0040-6376
Following the Royal College of Physicians recommendations (1993) a postal questionnaire survey of the current sleep service provision in North Thames region was undertaken. 31 of 34 hospitals replied, serving >8.3 million population with average district size of 287,000. 21 provide an in-house service (mean 176 studies/hospital/year) while 14 (9 not providing in-house service) referred a total of 170 patients annually to another hospital. 8 had sleep nurses (night service in 4), 8 had sleep technicians and 10 had electronics technicians. 17 had at least 1 bedroom (soundproofed in 3) while 4 performed studies on open wards. 7 classified themselves as Specialist Respiratory Sleep Centres (SRSC) and 14 District General Hospital (DGH) level providers. Overall 30% of all studies were overnight oximetries (annual total 1569, median per hospital 70), 56% limited studies (annual total 2831, median per hospital 125) and 14% polysomnographies (annual total 695, median per hospital 60). At the SRSC level, 15% of all studies were oximetries, 66% limited studies and 19% polysomnographies. At the DGH level 72% were oximetries and 28% limited steep studies. 13 had CPAP titration facilities (automatic in 9). There were multiple sources of funding for running costs. The population of North Thames has access to sleep services and the number of studies exceeds recommendations for the population. However, many centres perform overnight oximetry alone and few have the recommended level of support in terms of facilities or staff. The number of SRSC is higher than recommended. However some provide a tertiary referral service outside North Thames. There is no consistent purchasing policy. A review of services with identified funding would help to ensure adequate provision for the population.
Mathur R, Bell D, 1996, Asthma management in police study., J Clin Forensic Med, Vol: 3, Pages: 133-140, ISSN: 1353-1131
Asthma is a common condition and, therefore, may be seen by the clinical forensic physician and police in widely different circumstances ranging from the autopsy room to roadside breath alcohol testing. This paper concentrates on the assessment and treatment of asthmatics detained in custody and does not refer to the Road Traffic Act provisions. A careful history and objective recording of simple severity markers and peak expiratory flow rate should identify patients who may require hospitalization or urgent treatment. Asthma mortality may be reduced by better understanding of the disease and its treatment and by greater use of prophylactic rather than reliance on relief therapy for bronchospasm.
Bell D, 1996, Pulmonary Embolism and venous thromboembolism, Angiology in Practice, Editors: Strano, Publisher: Kluwer Academic Pub
Arterial and venous diseases are major causes of morbidity and mortality in most of the world, especially in the western hemisphere.
MIFSUD AJ, BELL D, SHAFI MS, 1994, RESPIRATORY CRYPTOSPORIDIOSIS AS A PRESENTING FEATURE OF AIDS, JOURNAL OF INFECTION, Vol: 28, Pages: 227-229, ISSN: 0163-4453
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- Citations: 8
Bell D, Turpin K, 1994, Quality of life at three months following admission to intensive and coronary care units., Clin Intensive Care, Vol: 5, Pages: 276-281, ISSN: 0956-3075
OBJECTIVE: Measurement of quality of life three months following critical illness, to assess impact on health expectations. DESIGN: Continuous quantitative study of patients admitted to a combined intensive and coronary care unit during a nine-month period. Questionnaires giving baseline information were completed soon after admission, and postal questionnaires incorporating the Nottingham Health Profile were sent to surviving patients three months following discharge from the unit. SETTING: District General Hospital. SUBJECTS: ICU sample included 60 patients, male n = 31, female n = 29. Twenty-nine patients received surgical treatment, 31 patients received medical treatment. Coronary Care Unit (CCU) sample included 112 patients, male n = 74, female n = 38. Fifty-four patients admitted following acute myocardial infarction (MI), 58 patients non-MI admission. MEASUREMENTS AND MAIN RESULTS: Hospital mortality for ICU patients was 31%, increasing to 34% at three months. Hospital mortality for CCU patients was 14%, increasing to 19% at three months. Significant differences in mean NHP scores between ICU and CCU patients were noted with higher CCU scores in the areas of sleep (p = 0.04), and social isolation (p = 0.01). Within the ICU group surgical patients had a higher mean NHP score in the area of pain (p = 0.02). There were no significant differences in the scores of male and female ICU patients. Within the CCU group non-MI patients had significantly higher mean scores than MI patients in the areas of energy (p = 0.007), pain (p = 0.04), emotion (p = 0.05), social isolation (p = 0.01) and physical ability (p = 0.003). Female CCU patients had higher mean NHP scores than male patients with significant differences in the areas of pain (p = 0.04), sleep (p = 0.009) and physical ability (p = 0.006). CONCLUSION: ICU patient quality of life three months after admission compares favourably with a corresponding group of CCU patients, particularly in areas of sleep and social
Parnaby RM, Eaton SE, Shafi MS, et al., 1994, The value of serum C-reactive protein levels as a marker of sepsis in intensive care unit patients., Clin Intensive Care, Vol: 5, Pages: 106-113, ISSN: 0956-3075
A one-year prospective study was carried out to assess the value of routine serum C-reactive protein (CRP) measurement in the early diagnosis of infection in ICU patients of a District General Hospital. Ninety-one patients were included in the study. Sixty-eight patients yielded 28 proved and 77 suspected episodes of infection. Control data were drawn from 23 uninfected ICU patients. Both absolute values and percentage rates of change were examined for the following variables: serum CRP, maximum daily temperature and peripheral white blood cell count. Neither absolute CRP levels nor rates of change in CRP were found to relate significantly to proved infection. In the group in whom infection was suspected but not proved, absolute CRP levels were higher than controls on the day before the suspected infection (p = 0.019), but were not significantly raised on the day of infection nor the day after. The only significant rises in CRP (> 25%) were found in the suspected infection group from the day before to the day of infection, when compared with controls (p = 0.04). Traditional markers of infection--maximum temperature and peripheral white blood cell count--were significantly associated with infection. Maximum temperature was significantly higher in both proved and suspected infection on the day before infection (p = 0.000 and 0.001), and on the day of infection (p = 0.025 and 0.03), compared with controls.(ABSTRACT TRUNCATED AT 250 WORDS)
GLEDHILL JA, MOORE DF, BELL D, et al., 1993, SUBARACHNOID HEMORRHAGE ASSOCIATED WITH MDMA ABUSE, JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, Vol: 56, Pages: 1036-1037, ISSN: 0022-3050
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- Citations: 48
DOWNIE A, ALI A, BELL D, 1993, SEVERE METABOLIC-ACIDOSIS COMPLICATING MASSIVE IBUPROFEN OVERDOSE, POSTGRADUATE MEDICAL JOURNAL, Vol: 69, Pages: 575-577, ISSN: 0032-5473
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- Citations: 15
MacKay T, Layton A, Sebire N, et al., 1993, Management of acute asthma - Audit of practice in a general-hospital 1988-1992, American Review of Respiratory Disease, Vol: 147, Pages: A376-A376, ISSN: 0003-0805
Jackson MH, Collier A, Nicoll JJ, et al., 1992, Neutrophil count and activation in vascular disease, Scottish Medical Journal, Vol: 37, Pages: 41-43, ISSN: 0036-9330
An elevated peripheral leucocyte count is associated with an increased risk of myocardial infarction and progression of coronary artery disease. The aim of this study was to determine neutrophil count and activation, measured as an increase in plasma neutrophil elastase, in patients with stable ischaemic heart disease, insulin-dependent diabetes mellitus and essential hypertension compared with a comparable group of control subjects. Neutrophil count and neutrophil elastase were raised significantly for patients with ischaemic heart disease (p less than 0.005; p less than 0.002), diabetes mellitus (p less than 0.001; p less than 0.01) and hypertension (p less than 0.05; p less than 0.0001) respectively compared to the control subjects. Neutrophil elastase did not correlate with subject age or leucocyte count. This study confirms the association between leucocyte count and vascular disease, and is consistent with neutrophil activation contributing to the progression of vascular disease.
Coker RJ, Bell D, Peters BS, et al., 1992, Cavitating pulmonary cryptococcosis developing in an HIV antibody patient despite prior treatment with fluconazole, Genitourin Med, Vol: 68, Pages: 42-44, ISSN: 0266-4348
Disseminated cryptococcosis developed in an HIV antibody positive patient who was taking fluconazole for oral candidiasis. This case highlights the poor response to therapy that may be seen, and the severe pulmonary complications that may ensue. The use of fluconazole prior to the development of cryptococcosis did not confer protection.
Bell D, Parnaby R, 1992, Pulmonary tuberculosis and HIV infection, Br J Hosp Med, Vol: 47, ISSN: 0007-1064
Turnbull LW, Ridgway JP, Nicoll JJ, et al., 1991, Estimating the size of myocardial infarction by magnetic resonance imaging, Br Heart J, Vol: 66, Pages: 359-363, ISSN: 0007-0769
To develop a method to measure myocardial infarct size by magnetic resonance imaging and to compare the results with pyrophosphate scanning by single photon emission computed tomography.
Bell D, Layton AJ, Gabbay J, 1991, Use of a guideline based questionnaire to audit hospital care of acute asthma, BMJ, Vol: 302, Pages: 1440-1443, ISSN: 0959-8138
To design an audit questionnaire and pilot its use by an audit assistant to monitor inpatient management of acute asthma and to compare the care given by chest physicians and general physicians.
Horner PJ, Bell D, Murphy S, et al., 1990, Mycobacterial infection in patients infected with the human-immunodeficiency virus, Thorax, Vol: 45, Pages: 907-907, ISSN: 0040-6376
Muir AL, Bell D, 1990, The role of the neutrophil in acute myocardial infarction, Saudi Medical Journal, Vol: 11, Pages: 257-260, ISSN: 0379-5284
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