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Biomedical subjects

J P Campbell

Publications and source records attributed to J P Campbell.

At least 19 recordsLinked to original sources
PubMed1999

Malar augmentation: a 5-year retrospective review of the silastic midfacial malar implant.

OBJECTIVES: To determine the effectiveness and safety of the Silastic midfacial malar implant and to review indications, patient selection, technique, and complications of malar augmentation. DESIGN: Five-year retrospective review of clinical cases with at least 2-year follow-up. PATIENTS: A cohort of 60 consecutive private patients with complaints of malar hypoplasia or facial asymmetry. SETTING: A plastic surgery clinic. INTERVENTION: Silastic midfacial malar implants were fitted in each patient. Most underwent implantation via the canine fossa approach and in conjunction with another facial plastic procedure. MAIN OUTCOME MEASURES: Subjective patient satisfaction, photographic grading using a visual analog scale, and complications. RESULTS: Of the 60 patients, 51 (85.0%) reported an excellent result after at least a 2-year follow-up. Ten patients (16.7%) had some form of undesirable sequelae; however, only 4 (3.4%) of 118 implants had to be revised. Photographically, all 60 patients graded postoperative improvement. CONCLUSIONS: Findings support the contention that the Silastic midfacial malar implant is a safe and effective alloplastic alternative to treat malar hypoplasia and facial asymmetry. The complication and revision rates are acceptable. Relative technical ease of insertion makes malar augmentation an excellent adjunct for rhytidectomy and rhinoplasty.

Adolescent↗
PubMed1999

Bridging the emergency medical services for children information gap.

OBJECTIVE: To determine the epidemiological features of pediatric usage of prehospital emergency medical services (EMS) in a defined urban population. METHODS: Residents of Kansas City, Mo, younger than 15 years who used EMS during the calendar years 1993-1995 were included. In this geographic area there is a single provider of prehospital care; all numerator data were taken from this single source. Denominator data were provided by 1995 intercensal estimates based on the 1990 US Census. Rates were calculated as an annual average and reported as the number of children transported per 1 000 persons per year. RESULTS: There were a total of 7296 pediatric EMS transports during the study period, for an annual rate of 21.9. Infants younger than 1 year had the highest rate (47.4), followed by those aged 1 to 4 years (26.2), 10 to 14 years (17.5), and 5 to 9 years (17.3). Medicaid was the insurer for half and 27% were uninsured. One quarter of the patients used EMS more than once. Children living in ZIP codes in the lowest median income tertile were 5.8 times more likely to use EMS than those in the upper income tertile (95% confidence interval, 5.4-6.3). One third of all transports occurred between the hours of 4 and 8 PM. CONCLUSIONS: Children using the Kansas City EMS were more likely to be infants, insured by Medicaid or uninsured, and live in low-income ZIP codes. Further study is needed to determine if this increased usage is due to greater incidence and severity of illness and injury, lack of transportation, lack of education, or other factors.

Adolescent↗
PubMed1998

An ultrastructural comparison of mechanical dermabrasion and carbon dioxide laser resurfacing in the minipig model.

OBJECTIVE: To compare the histological and ultrastructural changes in skin collagen with mechanical dermabrasion and pulsed carbon dioxide laser resurfacing in the minipig model. SETTING: Academic medical center. SUBJECTS: Yucatan minipig animal skin model. MAIN OUTCOME MEASURES: Comparison of light microscopic and ultrastructural (electron microscopic) changes in the skin following the 2 resurfacing modalities. RESULTS: No significant difference in collagen histological characteristics or ultrastructure was detected between the 2 comparison groups. CONCLUSIONS: When mechanical dermabrasion or pulsed carbon dioxide laser resurfacing is used with similar-depth injury to the dermis in this model, the histological changes seen via light microscopy and ultrastructural changes seen via electron microscopy are similar between the 2 treatment modalities.

Animals↗
PubMed1998

Swine and dynamic ultrasound models for trauma ultrasound testing of surgical residents.

BACKGROUND: Trauma ultrasound workshops have been recommended for training surgical residents. We assessed the teaching effectiveness of the workshop, comparing swine and dynamic patient ultrasound models. MATERIALS AND METHODS: MCQ exams on ultrasound physics and practical skills tests with and without pericardial or peritoneal fluid using four swines and eight dynamic patient ultrasound videos were used to compare pre- and postworkshop performance in 18 surgical residents (Group I) and a matched control group of 18 (Group II). Paired t tests and unpaired t tests for paired and unpaired data, respectively, were used for analysis with a P < 0.05 being considered statistically significant. RESULTS: Mean scores (% correct response) +/- SD were as follows (*P < 0.05 vs Group I). [table: see text] For the swine model, the best scores were with pericardial fluid (25.0% pre vs 69.4% post in Group I) and the worst scores were with RUQ fluid (5.6% pre vs 22.2% post in Group I). Postworkshop dynamic video scores were always higher than the swine model scores in Group I (100% correct video scores for pericardial fluid). CONCLUSIONS: This study confirms the trauma ultrasound workshop teaching effectiveness. For testing, the swine model (especially RUQ) was more difficult. In postcourse evaluation, the dynamic human video was considered more relevant, realistic, and less costly for repeated testing of the residents.

Animals↗
PubMed1998

Corneal injury from explosion of microwaved eggs.

PURPOSE: To report two patients with ocular burns from explosion of microwaved eggs that caused direct vision-threatening corneal damage. METHODS: The initial examination and treatment of both patients are described. RESULTS: Both patients were initially examined with severe decrease in the visual acuity of both eyes. The first patient required limbal conjunctival transplantation and a subsequent penetrating keratoplasty in the right eye and prolonged treatment of superficial keratitis in the left eye. The second patient sustained bilateral corneal epithelial defects and unilateral intrastromal hemorrhage. CONCLUSIONS: Exploding microwaved eggs can cause notable thermal injury to the eyes. The public should be educated about the dangers of cooking eggs in the microwave oven.

Adult↗
PubMed1997

Posterior cervical rhytidectomy: a valuable adjunct in facial rejuvenation surgery.

OBJECTIVE: To describe the aesthetic indications and operative technique of posterior cervical rhytidectomy as a staged procedure after extended cervical-facial rhytidectomy. DESIGN: The senior author's series of patients requiring posterior cervical rhytidectomy is reviewed, including preoperative and postoperative aesthetic results. SETTING: A private practice plastic surgery clinic. PATIENTS: Eleven patients who underwent staged posterior cervical rhytidectomy after extensive cervical-facial rhytidectomy are presented, with follow-up ranging from 3 months to 8 years. During this same duration, 941 primary and 256 secondary cervical-facial rhytidectomies were performed. INTERVENTIONS: The preoperative and postoperative results are presented along with a description of the pertinent anatomy and the senior author's operative technique. Potential complications are reviewed. A discussion is included on ways to minimize these untoward sequelae. OUTCOME MEASURE: The aesthetic postoperative results are reviewed, and representative clinical photographs are presented. RESULTS: Staged posterior cervical rhytidectomy is a safe and effective means of improving certain stigmata of previous cervical-facial rhytidectomy in patients requiring extensive facial rejuvenation. CONCLUSIONS: Posterior cervical rhytidectomy is a valuable surgical adjunct in selective patients who demonstrate redundant skin and soft tissue in the posterior cervical region.

Adult↗
PubMed1997

Measuring response intervals in a system with a 911 primary and an emergency medical services secondary public safety answering point.

STUDY OBJECTIVE: Measurement of interval data is important in the accurate recording of events that occur in an emergency medical services system. Measurement of intervals should be a simple task. However, when two separate clocks are needed to record the beginning and end of an interval, accurate measurement may be difficult. We sought to accurately measure the 911 call receipt-to-vehicle departure and 911 calls receipt-to-patient access intervals in a system with primary and secondary public safety answering points (PSAPs). METHODS: We conducted a descriptive study between January 1 and July 31, 1993. All 911 calls beginning at the primary PSAP, transferred to the EMS secondary PSAP, and ending with patient access times were eligible. Clock-synchronization errors and unavailability of 911 time logs were the criteria for exclusion. We measured the 911 call receipt-to-vehicle departure interval by adding the primary-PSAP and the EMS secondary-PSAP call-processing intervals. The 911 call receipt-to-patient access interval was the absolute difference between the time when the 911 primary-PSAP phone range and the time of patient access recorded by EMS personnel. RESULTS: The data were best described with median and interquartile ranges (IQRs). We found 1,945 calls that met inclusion criteria. Of these, 270 were deleted because of clock errors and 616 for time log unavailability, yielding 1,059 calls for interval determinations. The median 911 call receipt-to-vehicle departure interval was 1.7 minutes (IQR, 1.2 to 2.2 minutes). The median 911 call receipt-to-patient access interval was 8.2 minutes (IQR, 6.4 to 10.5 minutes). CONCLUSION: The 911 call receipt-to-vehicle departure and 911 call receipt-to-patient access intervals can be accurately measured in a system with two separate PSAP computer-aided dispatch clocks. These intervals are variable and often lengthy.

Ambulances↗
PubMed1996

Trauma ultrasound workshop improves physician detection of peritoneal and pericardial fluid.

Hemoperitoneum represents a major indication for surgical intervention after trauma. To improve the ability of surgical residents and trauma physicians to detect intraperitoneal and pericardial fluid using ultrasound as a diagnostic modality, we conducted a focused trauma ultrasound workshop consisting of discussion of ultrasound physics, demonstration of instrumentation, review of pertinent literature, videotaped demonstration, and "hands-on" teaching of the skills utilizing live patient models. The ultrasound probes were placed in four standard locations--right and left upper quadrants, epigastrium, and Pouch of Douglas. Skills acquisition was tested by pre- and postworkshop performance on 12 sonograms (3 for each location, 6 were positive for fluid). Thirty physicians (21 residents and 9 staff: Group I) who attended the workshop were compared to 30 matched controls (Group II). The results (means +/- SD) were as follows (R = number right, I = number of "indeterminate," W = number of wrong responses out of 12, *P < 0.05 compared to Group II): [Table: see text] False positive (%) and false negative (%) decreased from 12.9 +/- 1.5 to 8.9 +/- 5.3 and 15.0 +/- 10.4 to 5.0 +/- 5.2, respectively, in Group I but did not change in Group II. Postworkshop ability to detect fluid was significantly (P < 0.05) improved, with no major differences between residents and staff. Our data suggest that these workshops can significantly improve the skills of nonradiologists in sonographic identification of pericardial and intraperitoneal fluid and should therefore be considered an essential component of ultrasound training for trauma physicians.

Ascitic Fluid↗
PubMed1995

Hawthorne effect: implications for prehospital research.

STUDY OBJECTIVE: The phenomenon of altered behavior or performance resulting from awareness of being a part of an experimental study has been termed the "Hawthorne effect." Prehospital studies generally involve paramedics or are designed to use data collected by paramedics. Our objective was to determine whether paramedic performance, as measured by frequency of documentation, can be modified by (1) written notification of the importance of documentation, (2) written notification of a research project involving paramedic documentation, or (3) written notification of a quality-improvement audit of paramedic documentation. DESIGN: Prospective, sequential intervention study with five study phases. SETTING: Urban, all-advanced life support public utility model emergency medical services system with 55,000 emergency calls per year. PARTICIPANTS: One hundred forty-five paramedics who completed all ambulance run reports from August 1992 to May 1993. RESULTS: A total of 30,828 run reports was entered into the study. Baseline undocumented parameters ranged from 3.7% to 6.5%. Compared with baseline, a memo to heighten awareness (phase 2) did not alter documentation (P > or = .08). A medication study memo (phase 3) improved medication documentation (P = .0005) and allergies documentation (P = .037). A quality-improvement audit memo (phase 4) improved documentation of all parameters (P < or = .001). CONCLUSION: The Hawthorne effect occurs in prehospital research. It does not require direct observation, nor does it require direct feedback. However, it may require a perceived demand for performance. The Hawthorne effect must be considered in the design of prehospital studies and interpretation of data collected by paramedics.

Data Collection↗
PubMed1995

Measuring the call-receipt-to-defibrillation interval: evaluation of prehospital methods.

STUDY OBJECTIVE: Successful resuscitation of cardiac arrest depends partly on the time of first defibrillation. An accurate, practical method of measuring this time has not been devised. We attempted to determine the interval from receipt of a call by emergency medical services personnel to first defibrillation (total defibrillation interval) with synchronized clocks between computer-aided dispatch operations and an event-recording defibrillator. DESIGN: A 7-month prospective study measuring the total defibrillation interval. An automated code summary was to be submitted for each participant. SETTING: An urban, all-advanced life support, public utility model system. PARTICIPANTS: All primary ventricular fibrillation patients seen during the study period. RESULTS: Ninety-two patients met study criteria. Data are presented as median (interquartile range). The total defibrillation interval was 9.8 minutes (7.9 to 11.8 minutes). The call-receipt-to-vehicle-at-scene interval was 5.98 minutes (4.4 to 7.3 minutes). The vehicle-at-scene-to-defibrillation interval was 3.6 minutes (2.5 to 4.6 minutes). CONCLUSION: The use of synchronized clocks in automated event-recording systems may provide a method of accurately measuring the time elapsed before defibrillation.

Electric Countershock↗
PubMed1995

Vehicle-at-scene-to-patient-access interval measured with computer-aided dispatch.

STUDY OBJECTIVE: To determine whether the vehicle-at-scene-to-patient-access (VSPA) interval could be measured by means of crew reporting to a computer-aided dispatch operation. DESIGN: A prospective demonstration-proof-methodology pilot study using crew reporting of access time on emergency calls. SETTING: An urban, public utility model (a type of EMS system), all-ALS system. PARTICIPANTS: Six ambulance crews (four day and two night). INTERVENTIONS: Times were collected by radio reporting. A survey was to be completed for each call. RESULTS: Two hundred ninety-two calls met study criteria; 181 had corresponding surveys. Crew reporting compliance ranged from 52.8% to 94%. Poor radio transmission was cited infrequently as a reason for noncompliance. The median VSPA interval for all calls was 1.3 minutes (interquartile range, .8 to 2.6 minutes). Twenty-five percent of calls had intervals of more than 2.5 minutes, and 10% had an interval of more than 5 minutes. CONCLUSION: Our study suggests that it is feasible for ambulance crews to report patient access times. Methods to improve the consistency and frequency of crew reporting should be considered. The VSPA access interval varies in length and is not normally distributed.

Ambulances↗
PubMed1995

Sensitivity and specificity of ultrasound in the diagnosis of foreign bodies in the hand.

High-resolution ultrasound is capable of detecting foreign bodies of practically any composition. The purpose of this study was to determine in a controlled manner the sensitivity and specificity of ultrasound in the diagnosis of foreign bodies in the hand. Each of 15 fresh-frozen cadaver hands was divided into 21 standardized sites for potential foreign body insertion. Foreign bodies consisted of two sizes of three different materials (wood, glass, and metal). Foreign bodies were randomly assigned to 50% of the available sites. The empty sites served as controls. All hands were scanned by a single radiologist using high-resolution ultrasound at a frequency of 10 MHz. The radiologist was unaware of which specimens contained foreign bodies. Of the 166 foreign bodies inserted in total, 156 were detected by ultrasound. Ten sites were falsely analyzed as negative, for a sensitivity of 94%. There was one false positive result and 148 true negatives. The specificity was therefore 99%. The high specificity of ultrasound allows foreign body presence to be confirmed given a positive result. A combination of ultrasound and x-ray films should allow for diagnosis and localization of virtually all foreign bodies in the hand.

Cadaver↗
PubMed1995

Orbital osteology: a study of the surgical landmarks.

This study was conducted to re-examine the osteological anatomy of the orbit. Previous studies examined dried human skulls; this study looks at cadaveric specimens in a population that more closely resembles the population in the United States. Measurements were made of the bony orbit to define safe distances for surgical intervention and to identify distances to intraorbital fissures, canals, and foramina. Safe distances to the optic nerve were identified by subtracting 5 mm from the shortest measured specimen. The safe distances were as follows: medial quadrant, 29 mm; inferior quadrant, 39 mm; superior quadrant, 38 mm; and lateral quadrant, 36 mm. Staying close to the bony wall, not exceeding these parameters, and careful identification of anatomical structures should keep the surgeon from inadvertent damage to the intraorbital structures.

Cadaver↗