Bernard Foëx - Academia.edu (original) (raw)

Papers by Bernard Foëx

Journal of Accident & Emergency Medicine, 1999

Emergency Medicine Journal, 1999

Emergency Medicine Journal, 2015

A shortcut review was carried out to establish whether dousing areas of contact with vinegar coul... more A shortcut review was carried out to establish whether dousing areas of contact with vinegar could relieve the symptoms of Irukandji syndrome. Four studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is there is a lack of evidence for effectiveness and the latest local guidelines should be followed.

QJM, 2010

Suicide by self-poisoning is a major cause of death worldwide. Few studies have investigated the ... more Suicide by self-poisoning is a major cause of death worldwide. Few studies have investigated the medical management of fatal self-poisoning. To describe the characteristics and management of a national sample of individuals who died by intentional self-poisoning in hospital and assess the quality of care that they received. National population-based descriptive study and confidential inquiry. Adults (aged ≥ 16 years) who had died by self-poisoning in English hospitals in 2005 and received a coroner's verdict of suicide or undetermined death at inquest were included. Socio-demographic and clinical data were collected through detailed questionnaires sent to clinicians at the treating hospitals. A panel of three expert assessors rated each case with respect to quality of care and likely contribution to the fatal outcome. We obtained information on 121 cases (response rate for questionnaires 77%). Expert assessors rated 41/104 cases [39% (95% CI 30-49%)] as having received inadequate care; in the majority (38/41-93%) of these, this poor care was felt to have potentially contributed to the patient's death. The most common reason for a rating of inadequate care was poor airway management (recorded in over half of inadequate care cases). In three cases, the receipt of inadequate care was associated with the presence of some form of advance directive. In as many as 39% of in-hospital self-poisoning fatalities, the care received may be in some way sub-optimal. The challenge for clinical services is to ensure that optimal management strategies are implemented in practice.

Injury, 1993

Serial measurements of the inflammatory cytokines interleukin 6 (IL-6) and tumour necrosis factor... more Serial measurements of the inflammatory cytokines interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF alpha) were made in four patients with multiple injuries to characterize secretion patterns and to relate them to severity of injury and degree of haemorrhage. IL-6 and TNF alpha were assayed using a sandwich ELISA. Injury scores varied from 9 to 50, and transfusion requirements varied from 7 to 14 units. All patients showed an increase in IL-6 but only one a rise in TNF alpha. There was no consistent pattern in the elevation of IL-6 and there was no relation between cytokine levels, severity of injury, transfusion requirement or ultimate outcome. From this preliminary study it would seem that measurement of IL-6 and TNF alpha is not of value in directing therapeutic decisions or as a predictor of outcome.

Heart, 2004

... BA Foëx. Correspondence to: Dr Bernard A Foëx Department of Emergency Medicine, Manchester Ro... more ... BA Foëx. Correspondence to: Dr Bernard A Foëx Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester ... Informed consent in acute myocardial infarction is possible: Anne Gammelgaard,; Ole S. Mortensen, and Peter Rossel. Heart published ...

Emergency Medicine Journal, 2008

Emergency Medicine Journal, 2012

In recent years there has been a commendable focus on patient-centred medicine, with increasing a... more In recent years there has been a commendable focus on patient-centred medicine, with increasing attention being paid to the timely assessment and management of acute pain. 78% of patients who attend the emergency

Emergency Medicine Journal, 2001

The CRASH Trial (Corticosteroid Randomisation After Significant Head injury), which started in Ap... more The CRASH Trial (Corticosteroid Randomisation After Significant Head injury), which started in April 1999 hopes to answer the question of whether or not there is any benefit to giving high dose corticosteroids after significant head injuries. To do this patients are randomised to receive either the standard care for head injuries, as defined by the receiving hospital, or standard care plus a 48 hour infusion of corticosteroids. This is to be started within eight hours of injury, preferably as soon as possible. As all eligible patients will have a reduced level of consciousness informed consent has been deemed unnecessary. In this review the issue of consent in human experimentation is presented with a special emphasis on the problems faced in emergency medicine research, and the way these have been tackled.

Emergency Medicine Journal, 2000

One of the many problems in the resuscitation of the shocked patient is how to gain access to the... more One of the many problems in the resuscitation of the shocked patient is how to gain access to the circulation to provide fluids or drugs. Since the 1830s fluids have been administered intravenously. Intravenous access is not always possible in the very shocked patient. An alternative, used in the first world war, was the rectal route. This has rarely been used on a large scale since. Just before the outbreak of the second world war a chance discovery resulted in the development of intraosseous infusions of fluid and drugs. From its discovery it was used in adults and children. For many years it seemed to be ignored in adult resuscitation, but there are now signs of renewed interest in the technique. This brief review traces the discovery of the intraosseous route to put the current developments into a historical context.

Emergency Medicine Journal, 2007

Emergency Medicine Journal, 2010

Critical Care Medicine, 2007

British Medical Bulletin, 1999

The systemic responses to trauma can be divided into cardiovascular, immunological, and metabolic... more The systemic responses to trauma can be divided into cardiovascular, immunological, and metabolic. The cardiovascular responses are seen immediately after a traumatic insult. The pattern of response depends on whether the insult is mainly haemorrhagic, tissue damage, or a combination of the two. The response may be quite different for penetrating vascular trauma, compared with a crush injury to a limb. The immunological, or inflammatory, consequences of trauma usually become apparent several hours or days after the initial insult, although it is increasingly clear that they may be triggered by the very early cardiovascular changes. These have been implicated in the development of multiple organ failure. The metabolic responses are of greatest importance in the longer term: after successful resuscitation and after the definitive treatment of the patient's injuries. The metabolic responses need to be taken into account during the recovery from treatment and during the rehabilitation of the patient.

British Journal of Surgery, 2000

Statistical analyses were done with Student's t test for independent samples. Results: In the sys... more Statistical analyses were done with Student's t test for independent samples. Results: In the systemic chemotherapy group phagocytic activity (36 versus 52 per cent in control) and bactericidal activity (decreased in seven versus two in control) were signi®cantly decreased. Peripheral and peritoneal leucocyte numbers were also decreased in the systemic chemotherapy group. Peritoneal cell morphology was not affected. Bacterial translocation occurred in mesenteric lymph nodes of ®ve rats in this group. Intraperitoneal chemotherapy signi®cantly decreased the phagocytic activity (33 versus 56 per cent in control). Peripheral and peritoneal leucocyte numbers were also decreased but the bactericidal activity and peritoneal cell morphology were not affected. In contrast to the systemic chemotherapy group, bacterial translocation was not detected. Conclusion: Systemic chemotherapy caused bacterial translocation. Both systemic and intraperitoneal chemotherapy have detrimental effects on peritoneal defence mechanisms under experimental conditions. Transforming growth factor b-mediated inhibition of src kinases is regulated by SHP-1 O È . Sir, M. A. Choudhry and M. M. Sayeed

BMJ, 2008

Warfare in ancient Greece and modern emergency departments have much in common, says Bernard A Foëx

Anaesthesia, 2001

Tracheal gas insufflation is a technique in which gas is injected intratracheally during positive... more Tracheal gas insufflation is a technique in which gas is injected intratracheally during positive pressure ventilation. The fresh gas rinses expired gas from the tracheal tube and anatomical dead space, aiding carbon dioxide elimination. This reduces ventilatory volume and pressure, helping to reduce ventilator-induced lung damage. Complications of tracheal gas insufflation include interference with ventilator function, tracheal damage and barotrauma. Expiratory washout is a variation of tracheal gas insufflation. We designed and constructed an original expiratory washout system and evaluated its safety and performance in lung and animal models. We found that expiratory limb and tracheal tube occlusion tests caused the device to disable itself at acceptable intratracheal pressures. We also demonstrated up to 31% reduction in tidal volume compared with conventional ventilation, supporting the possibility of using this device clinically to lessen volutrauma. We concluded that aspects of this design might alleviate many of the safety concerns of using tracheal gas insufflation.