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Biomedical subjects

H Champion

Publications and source records attributed to H Champion.

14 recordsLinked to original sources
PubMed1999

Realist errors in children's responses to pictures and words as representations.

In three experiments we examined the judgments made by 3- to 4- year-old children about out-of-date physical representations which no longer matched their referents. The referent was a doll wearing a sticker, and the sticker was swapped for a different one after a picture had been drawn of the initial state of affairs (Experiments 1 and 2) or after the name of the doll and its original sticker had been written down (Experiment 3). We confirmed previous findings of realist errors in identity judgments for pictures and showed also that children tended to misidentify the name of a sticker in a written list to match a change to its referent. Thus, realist errors are not confined to representations which are iconically similar to their referents. Furthermore, children also judged incorrectly that the pictures and words had actually been changed, indicating that realist errors to external representations extend to operations performed on their referents as well as to their identities.

Child Language↗
PubMed1999

Children's ability to infer utterance veracity from speaker informedness.

Children between the ages of 3 years 7 months and 6 years 5 months experienced a contradiction between what they knew or guessed to be inside a box and what they were told by an adult. The authors investigated whether children believed what they were told by asking them to make a final judgment about the box's content. Children tended to believe utterances from speakers who were better informed than they themselves were and to disbelieve those from less well-informed speakers, with no age-related differences. This behavior implies an understanding of the speaker's knowledge and suggests that children can learn from oral input while being appropriately skeptical of its truth. Children also gave explicit knowledge judgments on trials on which no utterances were given. Performance on knowledge trials was less accurate than, and unrelated to, performance on utterance trials. Research on children's developing explicit theory of mind needs to be broadened to include behavioral indexes of understanding the mind.

Adult↗
PubMed1997

The use of TRISS methodology to validate prehospital intubation by urban EMS providers.

The purpose of this study was to determine the impact of field orotracheal intubation (OI) by urban emergency medical technician-paramedics (EMT-Ps) on outcome compared with trauma score and injury severity score (TRISS) expectations. The records of all trauma patients intubated by EMT-Ps or hospital personnel were abstracted for OI attempts/ successes, use of neuromuscular blockade (NMB), scene time, discharge neurological status, and hospital survival compared with TRISS. EMT-Ps attempted 43% of all intubations; 81% were successful versus 98% by hospital staff (P < .05). NMB was used by 76% of hospital intubations versus none by EMS (P < .05). Scene time was 10.3 +/- 3.2 minutes versus 11.6 +/- 2.1 for patients intubated by emergency medical services (EMS) and hospital staff (P < .05). Sixty percent of patients intubated by EMS versus 68% by hospital staff had good/moderate discharge neurological status. Survival for patients intubated by EMS versus hospital staff was 11% and 40%, respectively, compared with 2% and 45% expected by TRISS. Field OI by urban EMT-Ps has a favorable impact on survival with good neurological outcome (P < .05).

Adult↗
PubMed1996

Subcutaneous tissue oxygen pressure: a reliable index of peripheral perfusion in humans after injury.

The usual initial life-threatening effect of injury is hypovolemic shock. In the hierarchical physiologic response to hypovolemia, perfusion of peripheral tissues is sacrificed early and restored late. But the usual hemodynamic and metabolic measurements of blood pressure, urine output, and base deficit are not reliable indices of peripheral perfusion. Although the Clark electrode can quantitate tissue oxygen pressure and thereby serve as an index of perfusion, its use is compromised by several technical deficiencies. Recently, an optical method (optode) using fluorescent technology has been developed for measurement of oxygen tension in subcutaneous tissue (P sgO2). Our studies compared this device with the Clark electrode in the laboratory and tested its value in both animal and clinical studies of hypovolemic shock. The results of these several studies demonstrated that: (1) the new oximeter tracked a rapid fall or rapid rise of oxygen tension between room air (150 mm Hg) and 0 mm Hg ( a glucose oxidase/catalase solution) as well as the Clark electrode without encountering its technical problems; (2) with an acute hemorrhage to 20% of base line, the PsgO2 was found to decline rapidly in parallel with the decline of mean arterial pressure (MAP). Although the MAP rapidly returned to normal after immediate complete return of all shed blood, the PsgO2 did not reach normal levels for at least 2 hours, suggesting persistent peripheral vasoconstriction. (3) Studies in progress suggest that between 35 and 78% of trauma patients (n = 18) adequately resuscitated for hypovolemia b customary criteria have a decreased level of PsgO2 for as long as 60 hours after resuscitation for injury. If care is taken to prevent other causes of catecholamine induced vasoconstriction such as pain, fear, cold, and arterial hypoxia, these several results suggest that a certain number of injured patients are inadequately resuscitated despite the return to normal of conventional hemodynamic measurements. The serial analysis of PsgO2 may assist in managing patients and promote better understanding of the responses to injury.

Animals↗
PubMed1996

The impact of implementation of neuromuscular blockade monitoring standards in a surgical intensive care unit.

The purpose was to determine whether implementation of standards for peripheral nerve monitoring could decrease the incidence of neuromuscular dysfunction related to the administration of paralytic agents. Over a 2-year period, consecutive patients admitted to a surgical intensive care unit who received continuously-infused or >6 daily doses of neuromuscular blocking agents were subjected to train-of-four (TOF) monitoring of the adductor pollicis. Therapy was titrated to the maintenance of one to two twitches at all times. The incidence of prolonged (>12 h) paralysis after drug discontinuation was documented in these patients and compared to that in patients treated in the previous 12 months. The presence of electrolyte abnormalities, organ dysfunction, and concomitant medications was also recorded. Chi-square analysis with Yates correction was employed. Before implementation of routine TOF monitoring, there were five instances of paralytic-associated neuromuscular dysfunction (5/43). After implementation of the TOF protocol, no instances of paralytic-associated neuromuscular dysfunction occurred (0/90), despite the same incidence of risk factors (100%) (P < 0.05). A protocol for neuromuscular blockade monitoring is efficacious in preventing paralytic-associated neuromuscular dysfunction. This can be a cost-effective measure, minimizing the prolonged mechanical ventilation and intensive rehabilitation required secondary to unmonitored use of neuromuscular blocking agents.

Aged↗
PubMed1995

Complete denture problem solving: a survey.

An investigation was carried out into the problems experienced by 114 referred patients with complete dentures who were considered to be difficult or to have difficult prosthodontic problems. The commonest problems were those of pain and lack of retention, due mainly to occlusal discrepancies and excessive VDO. Treatment was carried out on an individual basis with a large proportion of dentures being remade. However, a small number was satisfied by counselling alone without procedural treatment. A diagnostic denture technique was used for particularly difficult cases. This technique showed that, in two cases, technical prosthodontic inadequacies could definitively be excluded as the problem. The overall success rate for treatment was 80 per cent. Further studies on a larger patient sample are needed so that specific problems can be linked to cause and outcome in a meaningful manner.

Counseling↗
PubMed1988

Intra-abdominal vascular injury secondary to penetrating trauma.

There were 85 patients in this series. The overall mortality was 17.6%. Gunshot wounds were responsible for 51 injuries, with a 21% mortality. There were three stabbings and three shotgun blasts, with a mortality of 10% and 33%, respectively. There were 127 intra-abdominal vascular injuries. The majority were to the SMA and its branches: 34. The highest mortality occurred with protal vein and combined aortic and vena caval injuries (80%). Fatalities averaged twice as many vascular injuries as survivors. There were 194 organ injuries. A liver injury predicted the highest mortality as did injuries to the spleen, lung, and pancreas. The presence of shock and the ability to rapidly control the source were the major predictors of survival. Fatalities averaged a Trauma Score of 7.5; survivors averaged a score of 14.0. There were 12 deaths which occurred intra-operatively and three postoperatively, for a total of 15 deaths. Once the patients made their way from surgery, their survival was 96% assured. Early suspicion of an intra-abdominal vascular injury followed by rapid exposure and control of hemorrhage are the keys to successful management.

Abdominal Injuries↗
PubMed1985

Application of the trauma score in the prehospital setting.

The Trauma Score (TS) is a physiologic measure of injury severity that correlates with patient outcome. Application of the TS has shown that it is useful for patient triage, for predicting patient outcome, and as a means of normalizing for case mix when comparing prehospital care and transport modalities. Our study explored the interrater reliability of assessments of TS variables that were made by emergency medical technicians and paramedics during the prehospital phase. Results showed that 95.3% of the assessments made by prehospital personnel agreed with those made by a highly-trained nurse observer, despite slight variations in assessment techniques. The results have implications for prehospital field use of the TS.

Diagnosis-Related Groups↗