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Biomedical subjects

B H Rowe

Publications and source records attributed to B H Rowe.

At least 91 records · Page 5Linked to original sources
PubMed1997

Head, neck, and facial injuries in ice hockey: the effect of protective equipment.

OBJECTIVES: To determine the factors and behaviors associated with facial, head, and/or neck injuries to those engaged in ice hockey; the use of protective equipment was also examined. DESIGN: Prospective case series. SETTING: Emergency Department of Sudbury General Hospital. PATIENTS: All patients presenting to the emergency department with a head, neck, or facial injury while playing hockey between the months of October and March 1993-94 and 1994-95 were included in the study. Physicians completed data forms on each patient. Information was validated by review of the emergency-room records; further information was obtained by telephone. RESULTS: A total of 226 patients were identified with ice-hockey-related head, neck, or facial injuries. Most injuries involved males (99%), and the mean age of patients was 23.9 (range, 4-63). Injuries occurred most frequently to the face [192 (85%)]. Many of the injuries were minor, with a mean injury severity score of 1.5 (range, 1-25). However, three patients (1%) required hospital admission, and one teenager suffered a serious spinal fracture. Protective facial hockey equipment use was low in our sample, except among younger injured players. Most of the facial injuries occurred in mature athletes playing recreational hockey. Full facial protection reduced the chance of upper facial injury (p = 0.0001), but the risk of such injury while wearing a half-visor was the same as while wearing no facial protection at all (p > 0.05). From the current study, we estimate that these hockey injuries result in approximately 2.7-3.0 million dollars of direct acute-care medical expenditure per year in emergency departments throughout Ontario. CONCLUSIONS: Head, neck, and facial injuries suffered during ice hockey participation are common problems presented to emergency departments. Moreover, serious injuries can occur while playing this sport. Most injuries appear to be preventable, and facial protection appears to be less frequently used, especially by older men, than is currently recommended. Prevention strategies are discussed.

Adolescent↗
PubMed1997

A truncated E-code system for injury surveillance in the emergency department: description and clinometric testing.

OBJECTIVES: ED injury surveillance requires accurate information about mechanism. This study explored the clinometric properties of an E-code system specifically designed to track ED injuries. METHODS: All patients assessed in the ED had cause-of-injury information documented using a truncated E-code system. Patient records were hand-searched to determine coding compliance. A selection of 98 charts (50 injury/48 noninjury) were coded by 7 physicians, 2 nurses, and 2 nosologists. Agreements (interrater and intrarater) on the diagnosis of trauma and exact E-codes were determined (using kappa; kappa). RESULTS: E-coding compliance was high (overall 90%: 95% CI: 85-93%), and accuracy of injury classification was 99%. Compared with an expert's coding, agreement on injury classification was excellent for physicians (kappa = 0.91; 95% CI: 0.80-1.0), nurses (kappa = 0.88; 95% CI: 0.75-1.0), and nosologists (kappa = 0.92; 95% CI: 0.81-1.0). Agreement was substantial for the exact E-codes between physicians (kappa = 0.77; 95% CI: 0.60-0.94) and nurses (kappa = 0.72; 95% CI: 0.54-0.90). Recode reliability was also excellent for physicians (kappa = 0.88; 95% CI: 0.75-1.0) and nurses (kappa = 0.96; 95% CI: 0.88-1.0). CONCLUSIONS: Injury coding using a truncated E-code system can provide valid and reliable data from the ED. Differences between nurses, physicians, and nosologists in the ability to accurately code using this system were minimal, thus eliminating the need for additional staff and resources.

Confidence Intervals↗
PubMed1997

Knowledge of medical-legal issues. Survey of Ontario family medicine residents.

OBJECTIVE: To ascertain how much family medicine residents know about medical-legal issues and what their attitudes toward medical-legal training are. DESIGN: Survey using multiple-choice questions to assess knowledge of typical legal scenarios and attitudes to training. Responses to questions were assessed using a Likert scale. SETTING: University of Ottawa's Family Medicine Program, including the Northeastern Ontario Family Medicine Program and the Melrose and Elizabeth Bruyere Family Medicine Centres. PARTICIPANTS: Forty-five family medicine residents in the University of Ottawa's Family Medicine Program. MAIN OUTCOME MEASURES: Demographic information and answers to questions assessing respondents' knowledge of and attitudes toward medical-legal issues. RESULTS: Mean score for correct responses was 8.6 out of 16 possible correct responses. Resident's knowledge about certain issues was excellent, such as knowing that comments can be constructed as sexual abuse and that they should report patients whose medical conditions make it dangerous for them to operate motor vehicles. On other issues, such as how to treat incompetent individuals and how to treat minors when parents refuse consent for treatment, residents' knowledge seemed poor. Although residents thought knowledge of medical-legal issues was important for providing good-quality care to patients and avoiding litigation, they felt inadequately trained in and uncomfortable about dealing with these issues. CONCLUSIONS: Residents are somewhat confused about medical-legal issues. They seem very interested in learning medical-legal principles. These findings should encourage educators to provide opportunity for residents to gain knowledge in these areas.

Adult↗
PubMed1995

The successful application of a heparin nomogram in a community hospital.

BACKGROUND: Heparin administration by physicians can vary greatly, and this variance can result in ineffective anticoagulation and reduced effectiveness of treatment. OBJECTIVE: To examine the use of a heparin nomogram in two community hospitals to validate its effect on anticoagulation parameters and to determine its influence on length of hospital stay. METHODS: Prenomogram and postnomogram intervention in two community hospitals in Sudbury, Ontario. All patients who presented and were admitted to the hospitals between 1991 and 1994 with a confirmed primary diagnosis of deep vein thrombosis and/or pulmonary embolism were eligible for the study. A heparin nomogram was instituted in April 1993 for treatment of deep vein thrombophlebitis and pulmonary embolism in hospitalized patients. The study patients were designated as prenomogram or postnomogram. Anticoagulation parameters (time to therapeutic activated partial thromboplastin time), number of diagnostic tests, percentage of times within the therapeutic range, and length of hospital stay were recorded for both groups. RESULTS: A total of 326 patients were identified from the database; 163 (50%) met the inclusion criteria. Patients in both groups appeared to be similar. Adequate anticoagulation was achieved faster (17.9 hours postnomogram vs 48.8 hours prenomogram; P < .001) and remained subtherapeutic less frequently in the postnomogram group (number of activated partial thromboplastin time tests below the therapeutic window; 56% prenomogram vs 28% postnomogram; P < .001). There were no differences between the groups with respect to length of stay (11.3 days prenomogram vs 10.9 days postnomogram; P = .60). More activated partial thromboplastin time tests were ordered in the postnomogram group (15.6 postnomogram vs 12.7 prenomogram; P = .001); however, fewer prothrombin time tests were ordered in the postnomogram group. CONCLUSIONS: A heparin nomogram was successfully used in a community hospital without a structured hematology-thrombosis service. Therapeutic anticoagulation was achieved faster and maintained more frequently, with less logistical problems, with this protocol. However, additional measures may be required to reduce the length of hospital stay.

Adult↗
PubMed1995

First-year family medicine residents' use of computers: knowledge, skills and attitudes.

OBJECTIVE: To identify the computer knowledge, skills and attitudes of first-year family medicine residents. DESIGN: Cross-sectional survey of family medicine residents during the academic year 1993-94; sampling began in July 1993 and ended in October 1993. SETTING: Canada. PARTICIPANTS: All 727 first-year family medicine residents, of whom 433 (60%) responded. OUTCOME MEASURES: Previous computer experience or training, current use, barriers to use, and comfort with and attitudes regarding computers. RESULTS: There was no difference in age or sex between the respondents and all first-year family medicine residents in Canada. French-speaking respondents from Quebec were underrepresented (p < 0.001). Only 56 respondents (13%) felt extremely or very comfortable with computer use. The most commonly cited barriers to obtaining computer training were lack of time (243 respondents [56%]) and the high cost of computers (214 [49%]) but not lack of interest (69 [16%]). Most residents wanted more computer training (367 [85%]) and felt that computer training should be a mandatory component of family medicine training programs (308 [71%]). CONCLUSIONS: Computer knowledge and skills and comfort with computer use appear low among first-year family medicine residents in Canada, and barriers to acquisition of computer knowledge are impressive. Computer training should become an integral part of family medicine training in Canada, and user-friendly applicable computer systems are needed.

Attitude to Computers↗
PubMed1995

Bicyclist and environmental factors associated with fatal bicycle-related trauma in Ontario.

OBJECTIVE: To identify bicyclist and environmental factors associated with fatal bicycle-related trauma in Ontario. DESIGN: Retrospective study. SETTING: Ontario. PARTICIPANTS: Information was extracted from the provincial coroner's reports on 212 people who had died of bicycle-related injuries in Ontario between 1986 and 1991. OUTCOME MEASURES: Age, sex and helmet use of the bicyclist, time and place of the event, type of bicyclist or motorist error(s) and use of alcohol by bicyclist or motorist. RESULTS: Only 32% of the deaths involved bicyclists under 15 years of age. The male-female ratio was 3.5. Over 75% of the cases involved head injury; however, only 8 (4%) of the bicyclists had been wearing a helmet. In 91% of the cases death occurred as the result of a bicycle-motor vehicle collision. Most (65%) of the deaths for which the time was known occurred between 4 pm and 8 am. Bicyclist error was the main cause of crash for 26 (79%) of the children less than 10 years old; it was also the main cause of crash among the bicyclists aged 10 to 19 years (43 [55%]) and those aged 45 years or more (15 [44%]). However, motorist error was the most common cause of collision in the group of cyclists 20 to 44 years of age (42 [63%]). Alcohol was detected in the blood of 7% of the bicyclists killed; alcohol had been consumed by 30% of the motorists who claimed not to have seen the cyclist. CONCLUSIONS: Bicycle-related deaths result from factors that are generally avoidable. Identifiable risk factors other than lack of helmet use suggest that additional research is required to determine the benefits of preventive interventions aimed at reducing the number of such deaths. Age-specific strategies appear warranted.

Adolescent↗
PubMed1995

Evaluation of a computer tracking program for resident-patient encounters.

OBJECTIVE: To examine the effectiveness of a formal tracking system for residents' clinical experiences. DESIGN: We examined three shifts, selected at random, for each resident (without residents' knowledge) during emergency rotations. Information from patient charts was compared with residents' computerized records for rotation (location and preceptor) and patient (age, sex, diagnosis, and procedure) information. SETTING: The Northeastern Ontario Family Medicine Program, a program designed to provide remote, rural, and northern resident experience. PARTICIPANTS: First-, second-, and third-year residents on emergency rotations in the academic years 1992 to 1994. MAIN OUTCOME MEASURES: Compliance, reliability, and validity of tracking records. RESULTS: Residents recorded patient encounters 88% of the time. Compliance with rotation information was high (100% rotation, 94% preceptor). Agreement on patient age and sex was high. Procedure compliance was somewhat lower (83%). Intrarater reliability (91%) and inter-rater reliability (78%) are acceptably high, as is validity when compared with a gold standard entry (88%). CONCLUSIONS: Regular entry of reliable and valid data is facilitated by the computerized resident-patient encounter tracking program. This computer tool should prove useful for multilevel program evaluation in the future.

Cooperative Behavior↗
PubMed1995

Computer-based patient encounter tracking. Development of a system for family medicine residents.

Tracking residents' experiences in clinical settings is difficult. We describe a computerized tracking program that can be used to catalogue and evaluate clinical experience. Using the program, learners can evaluate and validate their experiences, and educators can identify setting and preceptor strengths and weaknesses. The program is adaptable to other settings, inexpensive, and easy to use.

Computer-Assisted Instruction↗
PubMed1994

Sledding trauma in a northeastern Ontario community.

GOALS AND OBJECTIVES: To determine the incidence of sledding trauma in a northeastern Ontario community. Factors and behaviors associated with these events were also examined. DESIGN: Prospective case series. SETTING: Emergency departments of the Sudbury General and Memorial Hospitals. PATIENTS: All patients arriving at the two emergency departments in Sudbury with an injury sustained while sledding were included in the study. Physicians completed data forms on each patient. Information was validated by review of the ER records. Follow-up was completed by telephone in one to two weeks to determine residual disability. RESULTS: A total of 101 patients were identified with sledding-related injuries. There was a higher incidence of injuries among males (59%); the mean age of injured patients was 16 years (range, 16-46 years). Injuries occurred most frequently on weekends (51%). GT-racers were the most common device used by injured sledders (44%). Most injuries occurred on non-designated sledding hills in the community (71%). Many of the injuries were mild with a mean Injury Severity Score of 2.3 (range, 1-16). However, 7 (7%) patients required hospital admission, while 58% required follow-up by either their family physician or a specialist. Patients injured while sledding missed an average of 3.7 days of work or school. CONCLUSIONS: Sledding injuries are uncommon emergency department problems in this community; however, serious injury and absenteeism from work or school may result. Most injuries appear to be preventable and strategies of prevention are discussed.

Adolescent↗
PubMed1994

Sledding deaths in Ontario.

Traumatic injury from sledding and tobogganing can be reduced. The objective of this study was to determine the incidence of sledding and tobogganing deaths in Ontario. Operator, vehicle (sled), and environmental factors associated with these events were also examined. A retrospective series of cases from the Provincial Chief Coroner's Office identified all patients fatally injured while sledding or tobogganing in Ontario between 1986 and 1991. Communities should pay careful attention to injury prevention when planning organized sledding areas.

Adult↗
PubMed1993

Reliability of prehospital rating scales for case severity and status change.

The purpose of this report is to determine the reliability and sensibility of the currently available prehospital rating scales by a prospective evaluation of ambulance call reports using generalizability methodology. Sequential samples of emergency call data from the Hamilton Base Hospital Paramedic program database were used to sample calls randomly for a two-phase study. Phase I and II used blinded ambulance call report forms presented to six rates during three sessions in each phase. Generalizability (reliability) coefficients were then generated to determine the degree of reliability for the scales in both phases of the study. The generalizability coefficients for all scales are substantial or excellent using the standards commonly applied to agreement statistics. The conclusion of the study is that all ambulance officers can use the prehospital scales reliably. The reliability of these general measures is one of the parameters that will allow us to evaluate where basic and advanced prehospital care have an impact on overall patient outcome.

Emergency Medical Technicians↗
PubMed1993

An assessment of the sensibility of a quality-of-life instrument.

The objective of this study was to assess the sensibility of an asthma quality-of-life questionnaire (AQLQ); therefore, a structured survey of asthma patients seen in Hamilton, Ontario, emergency departments and physicians involved in asthma management was performed. Twenty-five consecutive patients who had completed the AQLQ questionnaire twice during a 7- to 10-day pilot study assessed sensibility using a 12-item questionnaire. The same number of practicing physicians from four centers in Ontario were sent the asthma AQLQ questionnaire and were asked to complete a 13-item sensibility form. All patients who were approached successfully completed the sensibility assessment; 80% (20 of 25) of the practicing physicians completed the assessment. Mean response scores were more than 5 of a possible 7 points in all questions for both groups. Patients had more mean responses greater than 6 (7 of 12) than did physicians (2 of 13). The AQLQ seems acceptable and sensible to both patients and physicians. A formal assessment of the sensibility of an outcome measurement can provide valuable information regarding it's use. Both research and clinical outcomes should be subjected to this form of evaluation.

Asthma↗
PubMed1993

Performance of an asthma quality of life questionnaire in an outpatient setting.

The objectives of this study were to assess the validity, reliability, and responsiveness of a disease-specific quality of life questionnaire (AQLQ) in asthma patients presenting for assessment and treatment in an emergency department (ED). Fifty-two patients 18 to 64 yrs of age were surveyed in three EDs. Admitted and discharged patients with stable and unstable asthma were included. Patients were interviewed prior to discharge from the ED. They completed a self-report asthma questionnaire, the self-administered Sickness Impact Profile (SIP) and AQLQ, a global assessment of asthma severity, a symptom questionnaire, and pulmonary function testing. Forty-three (83%) patients were available for follow-up at 7 to 10 days, and they completed a similar series of tests. Moderate correlations were found between total SIP and AQLQ measurements (r = 0.49; p < 0.001). Correlations were high between physical domain scores of the SIP and AQLQ symptoms (r = 0.58; p < 0.0001) and activity limitations (r = 0.50; p < 0.0001). Low correlations were found between pulmonary function results and AQLQ domains, except activity limitations (r = 0.44; p < 0.001). High correlations were found between symptoms or global assessments and AQLQ (r > 0.6; p < 0.0001). The instrument is highly responsive to small changes in patient status and outperforms pulmonary function tests and symptom scores in this setting. Test-retest reliability in patients who were stable was substantial (intraclass correlation coefficients > 0.9) on all aspects of the AQLQ.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1992

Cardiac arrest in Ontario: circumstances, community response, role of prehospital defibrillation and predictors of survival.

OBJECTIVES: To describe the patient characteristics, circumstances and community response in cases of out-of-hospital cardiac arrest; to evaluate the effect on survival of the introduction of prehospital defibrillation; and to identify factors that predict survival. DESIGN: Population-based before-and-after clinical trial. SETTING: Five Ontario communities: London, Sudbury, the Greater Niagara region, Kingston and Ottawa. PATIENTS: A consecutive sample of 1510 primary cardiac arrest patients who were transported to hospital by ambulance over 2 years. INTERVENTION: The use of defibrillators by ambulance attendants. MAIN OUTCOME MEASURES: Patient characteristics (sex and age), circumstances of arrest (place, whether arrest was witnessed and cardiac rhythm), citizen response (whether cardiopulmonary resuscitation [CPR] was started by a bystander, time to access to emergency medical services and time to initiation of CPR), emergency medical services response (ambulance response time, time to initiation of CPR and time to rhythm analysis with defibrillator) and survival rates. MAIN RESULTS: A total of 92.1% of the patients were 50 years of age or older, and 68.3% were men. Overall, 79.6% of the arrests occurred in the home. The average ambulance response time for witnessed cases was 7.8 minutes. The overall survival rate was 2.5%. The survival rates before and after defibrillators were introduced were similar, and the general functional outcome of the survivors did not differ significantly between the two phases. Factors predicting survival included patient's age, ambulance response time and whether CPR was started before the ambulance arrived. CONCLUSIONS: The survival rate was lower than expected. The availability of prehospital defibrillation did not affect survival. To improve survival rates after cardiac arrest ambulance response times must be reduced and the frequency of bystander-initiated CPR increased. Once these changes are in place a beneficial effect from advanced manoeuvres such as prehospital defibrillation may be seen.

Adult↗
PubMed1992

An overview of interventions to improve compliance with appointment keeping for medical services.

OBJECTIVE: To determine, by a quantitative meta-analysis of randomized trials, the effectiveness of strategies to improve patient compliance with screening, referral, and clinic appointments for health services that are provided at the time of the visit. DATA SOURCES: Computerized searches of MEDLINE (1966 through 1990) were done using two search strategies: (1) (Patient Compliance OR Adhere* OR Dropout*) AND (Appointment*) AND (Screen* OR Follow* OR Refer*); and (2) (Patient Compliance OR Adhere* OR Dropout*) AND (Attend* OR Screen*) OR (Appointment*). A computerized search of PSYCHLIT was done with the terms Compliance AND Appointment*. In addition, the reference list of each retrieved article was reviewed and relevant citations retrieved. STUDY SELECTION: Only randomized trials with quantitative data concerning the effect of interventions to improve attendance at appointments for supervised administration of care were considered for detailed review. Studies of appointment keeping for self-administered treatments or tests were excluded. Two independent reviewers assessed each article for inclusion (kappa, for agreement, 0.66 for MEDLINE; 0.95 for PSYCHLIT) and validity (kappa, 0.62) using a priori criteria. Twenty-three (26%) of 88 relevant articles met all criteria. DATA EXTRACTION: Data on study populations, interventions, and outcomes were extracted and analyzed using pooled odds ratios (ORs). DATA SYNTHESIS: The average rate of compliance with appointments was 58%. Mailed reminders and telephone prompts were consistently useful in reducing broken appointments (OR, 2.2; 95% confidence interval [CI], 1.7 to 2.9; and OR, 2.9, CI, 1.9 to 4.3, respectively). An "orientation statement" (OR, 2.9; CI, 1.5 to 5.6), "contracting" with patients (OR, 1.9; CI, 1.04 to 3.5), and prompts from physicians (OR, 1.6; CI, 1.4 to 2.0) showed positive effects as well. CONCLUSIONS: In clinic settings where kept appointments can be an accurate measure of patient compliance with health care interventions, broken appointments can be reduced by mail, telephone, or physician reminders; orienting patients to the clinic; or contracting with patients.

Appointments and Schedules↗
PubMed1992

Effectiveness of steroid therapy in acute exacerbations of asthma: a meta-analysis.

The objective of this study was to determine the effect of steroid therapy on pulmonary function, admission rates, and relapse rates in patients presenting with acute exacerbations of asthma. Computerized MEDLINE and SCIENCE CITATION searches were combined with review of reference lists from book chapters and articles to identify published randomized trials on steroid interventions. Over 700 articles were reviewed by two independent reviewers who identified 30 relevant randomized controlled trials for analysis. Study validity was independently assessed by two reviewers and information regarding populations, interventions, and outcomes was abstracted. Binary outcomes were combined and reported as odds ratios (OR), using the Mantel-Haenszel method. Individual and pooled effect sizes (ES) were determined for pulmonary function data. The authors found that the use of steroids early in the treatment of asthmatic exacerbations reduces admissions in adults (common OR 0.47; 95% confidence interval (CI) 0.27, 0.79) and children (OR 0.06-0.42). They found steroids effective in preventing relapse in the outpatient treatment of asthmatic exacerbations (OR 0.15; CI 0.05, 0.44). Oral and intravenous steroids appear to have equivalent effects on pulmonary function in acute exacerbations (ES -0.07; CI -0.39, 0.25). The authors conclude that overall, steroid therapy provides important benefits to patients presenting to emergency departments with acute exacerbations of asthma. Further research into dosage, alternative routes of administration, and alternative outcome measures is needed.

Asthma↗
PubMed1990

Characteristics of children presenting with chest pain to a pediatric emergency department.

Chest pain among children is a common complaint in primary care practice. However, the demographic features and treatment of such patients are controversial. We distributed a questionnaire to 336 consecutive patients with a complaint of chest pain seen during 1 year at an urban pediatric emergency department. Such visits represented 0.6% of all emergency encounters; the male:female ratio was 1.0. Physical examination was done in 325 patients. Chest-wall pain was the most common diagnosis (in 28% of cases). Other causes included pulmonary (in 19%), minor traumatic (in 15%), idiopathic (in 12%) and psychogenic (in 5%); miscellaneous causes (in 21%) most often indicated pain referred from the upper respiratory tract and the abdomen. The most common physical finding was chest tenderness (in 41% of cases). Investigations included chest radiography (in 50% of cases), electrocardiography (in 18%) and determination of the hemoglobin concentration and of the leukocyte count (in 13%); the results were rarely positive. Only eight patients (2%) required admission to hospital, and there were no cases of myocardial ischemia. The findings suggest that health care costs may be reduced by more judicious use of investigations. We conclude that chest pain is an uncommon and usually benign complaint in the pediatric emergency department. Most causes are evident on careful physical examination.

Adolescent↗