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Biomedical subjects

J D Thompson

Publications and source records attributed to J D Thompson.

193 records · Page 11Linked to original sources
PubMedDate not supplied

Severe (type III) open fractures of the tibia in children.

Twenty children with acute type III open fractures of the tibial metaphyses or diaphysis were retrospectively studied. The average age was 9 years, 1 month (range, 2 years, 11 months to 16 years, 2 months). There were seven type IIIA fractures, 10 type IIIB fractures, and 3 type IIIC fractures. All fractures were irrigated and debrided, and prophylactic antibiotics were given for a minimum of 48 h. Fifteen fractures were initially treated with external fixation, three with casts, one with internal fixation, and one with a combination of external fixation and limited internal fixation. Free muscle flaps were used for soft-tissue coverage in six patients, and a local muscle flap in one patient. The average time to fracture healing was 29 weeks, and the median time to fracture healing was 20 weeks (range, 8-104). Four patients had delayed union, and two additional patients had nonunion. Both patients with nonunion were successfully treated with autologous bone grafting. The time to fracture union was related to the severity of soft-tissue injury, fracture configuration, segmental bone loss, and infection. Osteomyelitis developed in three patients. All were successfully treated. Two patients treated with external fixation had leg-length discrepancies of > 1 cm, with the injured extremity longer in both cases. There were no late amputations. Children with severe open fractures of the tibia have a good prognosis for limb salvage with aggressive wound care and fracture management.

Adolescent↗
PubMedDate not supplied

A prospective study of early spica casting outcomes in the treatment of femoral shaft fractures in children.

We analyzed the early spica casting outcomes of 50 children age 2 to 10 years with uncomplicated femoral shaft fractures treated at Johns Hopkins Hospital between October 1987 and October 1990. Our objective was to develop criteria for the prospective identification of patients who can be safely and dependably treated with early spica casting without excessive shortening of the fracture fragments. Forty-one (82%) children had an acceptable outcome and nine (18%) had an unacceptable outcome according to our definition of > 25 mm of fracture fragment overlap at 3 to 4 weeks follow-up. A new clinical test, the telescope test, was statistically significant (p < 0.001) for association with spica casting outcome. Age, sex, fracture location, mechanism of injury, fracture type, and resting roentgenogram fracture fragment overlap were not statistically significant (p > 0.10). The telescope test had a sensitivity of 78%, a specificity of 85%, and a negative predictive value of 95% for predicting spica casting outcome. The relative risk of failing spica casting after a positive telescope test was 20.4 (95% CI, 2.74-225.10). We conclude that children 2 to 10 years of age with uncomplicated femoral shaft fractures and a negative telescope test can be safely treated with early spica casting and have a 95% change of having a successful outcome with this treatment.

Casts, Surgical↗
PubMedDate not supplied

Pediatric femur fractures: effects of spica cast treatment on family and community.

Twenty-three consecutive children with isolated closed femur fractures treated with early spica casts were studied to determine the impact of this treatment on family, school, and other support systems. Mobility was identified by families as the major problem. In families with two working parents, a mean of 3 weeks time off work was needed. None of the children was accepted into school in cast. Home tutoring for a mean of 8 weeks was used, with 48 tutor-hours per child. Despite this, none of the children fell permanently behind their class, and only two temporarily. No child required physical therapy beyond instruction in walking, and 12 had no physical therapy at all. Mean time to independent walking was 5 days and to running, 25 days; skills returned faster in younger children. All aspects of spica treatment were easier for preschool children. This study highlights some of the adaptations necessary with this treatment method and aids in advance planning.

Activities of Daily Living↗
PubMedDate not supplied

Nutritional and metabolic response to acute spinal-cord injury.

The metabolic response to complete spinal cord injury was prospectively studied in 10 patients with Frankel class A spinal cord injury. Weekly excretory and balance studies profile the changes in nitrogen, calcium, and 3-methylhistidine excretion in relation to body weight and metabolic rate. The initial resting energy expenditures were 10% below what was predicted, and body weight decreased by 10%. Nitrogen excretion paralleled the changes in body weight. Calcium excretion increased for 3 weeks and reached a plateau 150% above baseline. Our results chronicle the magnitude of metabolic response to spinal shock. Comparison with reported values shows this response exceeds that seen in immobilized patients. Nitrogen excretion rose to levels seen in highly stressed patients and must be considered in the management of patients with acute spinal-cord injury.

Acute Disease↗
PubMedDate not supplied

Hospital matrix management and DRG-based prospective payment.

If hospitals are to succeed in their efforts in cost control, they must segregate the influence of efficiency and effectiveness and integrate the medical staff into the management structure. One management model that facilitates such integration is Clinical Matrix Management. Using such a model, the distinct responsibilities in patient care can be segregated between the administration and the medical staff and appropriate accountability and responsibility allocated. Without the explicit integration of the medical staff into the organizational structure, the attempt to control patient care costs is unlikely to succeed.

Ancillary Services, Hospital↗
PubMedDate not supplied

The Great Stench or the fool's argument.

The eight weeks of the "Great Stench" in London in June-July 1858 had a lasting effect on the city. Today's embankments were planned then, and the huge oval brick sewers of London were designed and constructed as a direct result of the stench. The event occurred before the bacteriological era, when fear of cholera caused by a miasma gripped the city. This article, through quotations from The Times, Punch, and the medical press, traces the various reactions to the stink and explores the reasons why there wasn't more of a public reaction to the plague threat.

History, 19th Century↗
PubMedDate not supplied

Characteristics of Connecticut patients receiving services for end-stage uremia.

Data are presented on the characteristics of all patients with end-stage uremia who were treated in Connecticut hemodialysis programs over a 7-year period. Of the total of 353 patients, 103 patients died, 37 had successful transplants and discontinued dialysis, no information was available for one patient, and the remaining 212 patients continued to receive treatment in 1 of the 12 hemodialysis programs. The mean age of active chronic hemodialysis patients was 43.6 years; about 83 percent of all active patients were under age 55. Twenty-two percent were nonwhite; the nonwhite caseload appeared high in relation to the percent of nonwhite population. Of the 212 active patients, 78 percent were dialyzed at in-center programs and 22 percent at home; one patient obtained dialysis from a new limited-care program. The largest group (28 percent) of active patients had been in dialysis less than 7 months, about one-fourth had been dialyzing for 7-12 months, and about 13 percent of the total active population had been in dialysis between 19 and 24 months. The average period for active patients to be in dialysis was 17 months. The advent of Federal reimbursement for hemodialysis, as well as changes in the criteria for the selection of patients and increased physician awareness, can result in significant increases in the future population of patients receiving dialysis. To prevent overburdening of existing in center programs, expansion of training facilities statewide for home care dialysis is suggested.

Adolescent↗