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Biomedical subjects

B H Rowe

Publications and source records attributed to B H Rowe.

102 records · Page 6Linked to original sources
PubMedDate not supplied

Knowledge of periconceptional folic acid for the prevention of neural tube defects. The missing links. Northeastern Ontario Primary Care Research Group.

BACKGROUND: Periconceptional folic acid supplementation is effective in preventing primary and secondary neural tube defects (NTDs) and other congenital defects. However, debate exists regarding the effectiveness of public and physician education on patient knowledge and compliance. OBJECTIVE: To examine the level of knowledge about the usefulness of periconceptional folic acid supplementation in a sample of patients from primary care practices. DESIGN: Cross-sectional survey. A confidential, anonymous questionnaire was completed by patients before physician encounters. A maximum of 20 consecutive female patients from each of 3 age groups (16-24, 25-32, and 33-40 years) were recruited from each primary care practice. SETTINGS: Twenty-two Canadian teaching practices affiliated with the Northeastern Ontario Primary Care Research Group. OUTCOME: Women's knowledge of periconceptional folic acid supplementation for the prevention of NTDs. RESULTS: Of 1125 eligible female patients between the ages of 16 and 40 years visiting their family physician in 1996, 1124 (99.9%) completed the questionnaire. General awareness of NTDs was high (62.7%); however, knowledge that these defects were preventable was lower (22.5%). Only 7.8% of the women made the association between folic acid intake and NTDs. The specific knowledge that NTDs could be prevented with folic acid supplementation before conception was identified by 1.8% of the sample. Pregnant participants were at least twice as likely to be informed about the link. Interpractice variability existed with respect to knowledge of folic acid supplementation. CONCLUSION: Knowledge of periconceptional folic acid supplementation for the prevention of NTDs was low in this sample and is likely to be reflected in missed opportunities to prevent an important class of congenital malformations.

Adolescent↗
PubMedDate not supplied

Continuous monitoring of oxygen saturation in prehospital patients with severe illness: the problem of unrecognized hypoxemia.

The continuous measurement of arterial oxygen saturation using pulse oximetry (SpO2) has become popular for critically ill hospitalized patients. Its use in the ambulance transfer of similarly ill patients has been infrequently documented. This study examines the use of prehospital pulse oximetry, with special reference to the ability of ambulance attendants to recognize hypoxemia. Using a prospective single-blind case series method, a convenience sample of adult patients transferred by ambulance designated Code 3 (serious but not life threatening) or Code 4 (serious and life threatening) to a regional base hospital were examined for the presence of hypoxemia. An Ohmeda finger pulse oximeter probe was attached to all patients. Prior to the study, oxygen treatment was reviewed and ambulance personnel were instructed on the use of the instrument. The continuous oxygen saturation record was not revealed to the attendant(s) during the cell. Administration of oxygen was monitored, and a study form was completed by the attendant at the completion of the call. Overall, 50 patients were included in the study. The most common complaints were chest pain 21 (37%) and shortness of breath 15 (27%). The average age was 64 years, with a range of 32-82. Hypoxemia, defined as SpO2 of less than 90% for more than 1 minute, was detected in 14 patients. Attendants recognized hypoxemia on clinical grounds in only 4 patients (sensitivity = 28%). Forty-one (82%) patients received various amounts of supplemental oxygen; many patients remained hypoxemic despite therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Life-threatening luminal obstruction due to mucous plugging in chronic tracheostomies: three case reports and a review of the literature.

Tracheotomy is a common treatment option for a number of acute and chronic medical conditions. Emergency personnel may be required to deal with one or more of the complications associated with tracheostomy tubes. One of the more common, and potentially serious, problems involves luminal obstruction. These case reports describe three patients with luminal obstruction of long standing tracheostomy tubes. We propose that emergency medical personnel must act swiftly to eliminate the possibility of respiratory difficulties due to the result of tracheostomy tube obstruction. Prompt removal of the tracheostomy tube in cases of subtotal and total obstruction may prevent rapid deterioration or cardiopulmonary arrest.

Aged↗
PubMedDate not supplied

Problems associated with the Z-fold region of defibrillation electrodes.

To examine performance failures of automatic external defibrillator (AED) self-adhesive electrodes, a retrospective analysis of patient reports and electrodes was conducted in a suburban emergency medical service (EMS) system. In all cases, only records from out-of-hospital cardiac arrests (OHCA) were used if the EMS was activated and an AED was used. Electrode failures were assessed as follows: 1) EMS staff returned defibrillation electrodes when they were unable to resolve repeated "Check Electrode" messages, and 2) an audit of selected records was used to determine the frequency of electrode problems during calls. Of 302 OHCA calls during the study period, 22 (7%) resulted in returned electrodes. Defects (cracks or faults) in the internal conductor were present in 37 (86%) of the 43 returned electrodes; 2 (5%) possessed dehydrated conductive gel, and in 4 (9%) electrodes no faults could be identified. Of the 21 complete sets of defective electrodes, 16 (76%) had faults in both electrodes. Chart review revealed at least one "check electrode" message occurring in 21 (60%) of 35 OHCA reports. The electrode checks were present for a total of over 83 min, representing 11% of the call times. Paramedics were required to change electrodes in 9 (26%) of the 35 cases, resolving the malfunction in all instances. Electrode malfunction appears to be a common prehospital problem; the conductor is responsible for the majority of electrode problems and is probably subjected to the most stress during storage and handling. More reliable, durable defibrillation electrodes are required for OHCA treatment. Other strategies for electrode storage and quality control are also discussed.

Electric Countershock↗
PubMedDate not supplied

Readiness to perform cardiopulmonary resuscitation: an emerging strategy against sudden cardiac death.

OBJECTIVES: This investigation assessed motivational factors and psychosocial barriers that affect individual readiness to perform cardiopulmonary resuscitation (CPR). This is the first study to use the Transtheoretical model in assessing readiness to perform CPR. METHODS: A sample of 786 subjects, > or = 45 years of age and who resided in a private residence, were randomly selected to participate in a structured telephone interview. Data on motivational readiness, emotional state, perceived psychosocial barriers, and perceived efficacy in performing CPR were collected using dichotomous and Likert-type ratings. RESULTS: Subjects with greater motivational readiness expected to experience significantly fewer symptoms of emotional distress during a cardiac emergency and to encounter fewer psychosocial barriers. This group also reported greater efficacy in their ability to perform CPR. These findings were independent of gender, medical history, age, and educational level. CONCLUSIONS: Meaningful differences are apparent in individual readiness to perform CPR. These findings provide additional support for the need to tailor CPR training strategies using behavioral methods that enhance motivational readiness and decrease apprehension about anticipated emotional distress and psychosocial barriers.

Adaptation, Psychological↗
PubMedDate not supplied

Relationship between battery capacity and the delivery of shocks in prehospital defibrillators.

STUDY OBJECTIVE: Automatic external defibrillators (AED) have enabled the medical act of defibrillation to be performed in the community by a number of non-physician providers. However, these portable, battery-powered units are costly to maintain and service. This study examines the life of AED batteries and provides a battery replacement protocol. DESIGN: Prospective diagnostic testing of 191 field batteries to determine their ability to deliver shocks at 360 joule. SETTING: Ottawa General Hospital Paramedic Program. OUTCOMES: Using a battery analyzer, battery capacity and the number of shocks delivered were determined for each battery (at room temperature and in a controlled, refrigerated setting). In addition, the reliability of the testing method was assessed using the interclass correlation coefficient (ICC). RESULTS: High reliability of blinded technical assessment of the batteries was achieved (ICC = 0.85). A strong correlation between the battery's capacity and the number of shocks it can deliver was obtained. For example, a battery with a measured capacity of 75% is capable of delivering more than 30 consecutive 360 joule shocks. This compares to a battery with a capacity of 20%, which is capable of delivering only 12 consecutive 360 joule shocks. CONCLUSIONS: While manufacturers' recommendations on battery replacement always have been based on an assumed technical threshold, these recommendations are not based on individual battery performance. The system for testing batteries described in this paper, should provide significant cost savings and improve quality assurance within a prehospital AED program.

Electric Countershock↗
PubMedDate not supplied

Bronchopulmonary hygiene physical therapy in bronchiectasis and chronic obstructive pulmonary disease: a systematic review.

OBJECTIVES: This study had two objectives: (1) to examine the effects of bronchopulmonary hygiene physical therapy on patients with chronic obstructive pulmonary disease and bronchiectasis; (2) to determine any differences between manual and mechanical techniques for bronchopulmonary hygiene physical therapy. DESIGN: The study design was a systematic review of the literature that used an exhaustive search for trials and review methods prescribed by the Cochrane Collaboration. INCLUSION CRITERIA: Randomized controlled trials examined patient groups, interventions, and dependent variables. PATIENTS: Patients included those with chronic obstructive pulmonary diseases (emphysema or chronic bronchitis) or bronchiectasis. INTERVENTIONS: Any of the following interventions or combinations thereof were included: manual interventions, such as postural drainage, chest percussion, vibration, chest shaking, directed coughing, or forced exhalation technique. CONTROLS: Controls of the study were as follows: no intervention; placebo; coughing; and mechanical interventions, such as mechanical vibration. RESULTS: The search identified 99 potential trials; inclusion or exclusion analysis left 7, which examined a total of 126 patients. Mean score on trial quality was 1.4 (5 = greatest). Three separate trials (N = 51) found statistically significant effects for bronchopulmonary hygiene physical therapy on sputum production and radioaerosol clearance. No trials (N = 126) found statistically significant effects on pulmonary function variables or differences between manual and mechanical techniques. CONCLUSIONS: Considering the small sizes, low quality, and mixed results from the trials, the research on bronchopulmonary hygiene physical therapy is inconclusive. There is a need for adequately sized, high-quality, randomized controlled trials with uniform patient populations to examine the effects of bronchopulmonary hygiene physical therapy.

Breathing Exercises↗
PubMedDate not supplied

Regional variations of northern health: the epidemic of fatal trauma in northeastern Ontario.

OBJECTIVE: To examine the causes of traumatic death in a northern region of Ontario. METHODS: Prevalence study of trauma deaths occurring within the region of Northeastern Ontario over the years 1989-1991; regional data were compared with provincial data. RESULTS: 1,027 patient records were identified over the study period (51.4 deaths per 100,000 population/year). Non-intentional trauma accounted for 70% of all trauma deaths in the region; suicide (25%; 12.8/100,000) and homicide (5%; 2.4/100,000) were less common. Motorized vehicle trauma accounted for most of the non-intentional traumatic death (39%; 20.4/100,000). Age-standardized mortality ratios were 67% above the provincial average for non-intentional trauma, 71% above the provincial average for suicides, 55% above the provincial average for homicides, and 68% higher for all forms of traumatic death. CONCLUSIONS: Traumatic death is a major health problem in northern areas; reduction of these rates depends on the development of an effective injury prevention strategy.

Accidents, Traffic↗
PubMedDate not supplied

Bicycle helmet use and compliance: a northeastern Ontario roadside survey.

OBJECTIVE: To determine the prevalence of helmet use, compliance with helmet-wearing recommendations and attitudes to bicycle helmet legislation in a northern Ontario community. DESIGN: Prospective roadside survey of pedal cyclists. PARTICIPANTS: Cyclists riding in the city of Sudbury completed a survey and trained interviewers examined helmet fit. RESULTS: Of 1134 cyclists encountered at 28 locations; 472 (42%) completed surveys. Males predominated and the mean age was 19.7 years. Overall, helmet use was 20% but helmet ownership was higher (32%). Only 49% of helmets were worn correctly. Support for legislation for those under the age of 16 (81%) and for all ages (57%) was high. CONCLUSIONS: Helmet use in this community is low; one third of helmet owners were found not to be using helmets regularly. Efficacy was reduced by nonadherence to helmet-wearing standards. Education aimed at correcting these findings should be included in safety campaigns.

Adolescent↗
PubMedDate not supplied

The effect of a community-based police surveillance program on snowmobile injuries and deaths.

Serious snowmobile injuries are preventable and associated with late-night travel, alcohol use, and speed. We studied the effectiveness of a community-based policing (STOP) program in the prevention of serious injuries related to snowmobile trauma in Sudbury, Ontario. Volunteers were trained in police protocol and were appointed special constables to increase policing on snowmobile trails from 1993-95. Snowmobile admissions and deaths in Sudbury were examined; the pre- (1990-1992) and post- (1993-1995) STOP seasons were compared. In the pre-STOP period, 102 injuries, 87 admissions, and 15 deaths occurred compared to 57 injuries (p = 0.0004), 53 admissions (p = 0.00001) and 4 deaths (p = 0.13) in the post-STOP period. All other event and demographic features of the crashes remained similar. Significant economic savings were realized from this intervention; acute care costs savings exceeded $70,000/year and costs from death decreased by $5 million. An intervention involving enforcement on snowmobile trails can reduce the incidence of injuries from snowmobile-related trauma.

Accident Prevention↗
PubMedDate not supplied

Factors associated with seat belt use: an evaluation from the Ontario Health Survey.

This study examines the factors associated with seat belt use for drivers and passengers in Ontario. Using the 1990 Ontario Health Survey, a population-based survey of non-institutionalized Ontario residents, factors associated with seat belt use among drivers and passengers were identified and are reported as unadjusted and adjusted odds ratios (OR; 95% CI). Seat belt non-use in Ontario drivers was most strongly associated with younger age (p < 0.0001), high risk health behaviours (drinking and driving (OR: 2.43), speeding (OR: 2.04), smoking (OR: 1.66)), being male (OR: 1.87), living in northern (OR: 1.80) or rural (OR: 1.69) regions, and achieving lower education (OR: 1.46). Seat belt non-use in passengers was associated with younger age (p < 0.0001), smoking (OR: 1.62), being male (OR: 1.68), living in northern (OR: 1.63) or rural (OR: 1.46) regions, and low education (OR: 1.31). Vehicular trauma is a major public health problem and seat belt use has been shown to reduce injuries in the event of a crash. Any strategy to increase seat belt use in Ontario should be targeted to involve both drivers and passengers. Attention should be paid to increasing seat belt usage by younger adults, males, and especially those living in northern and rural regions.

Adolescent↗