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Biomedical subjects

K T Taylor

Publications and source records attributed to K T Taylor.

25 records · Page 2Linked to original sources

Can a nurse trained in coronary care expedite emergency department management of patients with acute coronary syndromes?

OBJECTIVE: The goal of this study was to determine the effect of a coronary care-trained nurse (CCTN) on transfer times of patients presenting with acute coronary syndromes (ACS) from the emergency department (ED) to the coronary care unit (CCU) for definitive cardiac treatment (DCT). DESIGN: This was a prospective randomized controlled study. SETTING: The study took place in the ED of a metropolitan public teaching hospital in South Australia. PATIENTS: The study sample was comprised of 893 patients who presented to the ED with a complaint of chest pain. INTERVENTION: An experienced senior CCTN was randomly assigned to work in an ED for 16 randomly selected hours per week; comparable hours over the same period without a CCTN in attendance were used as control data. The major endpoint was time to CCU transfer where DCT was completed for patients with ACS. RESULTS: Out of 893 patients assessed as having possible ACS, 91 (10%) were admitted to the CCU, 47 with a diagnosis of unstable angina pectoris (UAP) and 44 with a diagnosis of acute myocardial infarction. Nineteen patients required thrombolysis and/or percutaneous coronary angioplasty. Mean times (in minutes) to transfer for DCT (95% CI) were 102 (70-134) and 117 (95-139) in the presence and absence of a CCTN, respectively, for all ACS, and 33 (10-55) and 54 (25-82), respectively, for acute myocardial infarction requiring thrombolysis and/or percutaneous coronary angioplasty. CONCLUSIONS: These pilot data show a nonsignificant trend suggesting that DCT is expedited by assignment of senior CCTNs to EDs and provides direction for further study.

Acute Disease↗

An in vitro biomechanical investigation of an interlocking nail for fixation of diaphyseal tibial fractures in adult horses.

The compressive, bending and torsional mechanical properties of osteotomized adult equine tibiae stabilized with an interlocking intramedullary nail (nail-tibia composite) were compared with those of intact tibiae to determine the clinical applicability of the the nail for repair of tibial fractures in adult horses. The mean yield load, failure load, and stiffness for the nail-tibia composites were significantly less (P < .05) than those for the intact tibiae in all loading configurations. The mean compressive yield load for the nail-tibia composites was greater than the compressive load calculated from previously reported in vivo data for walking and trotting, and was equal to the load calculated for recovery from anesthesia. The mean yield bending moment for the nail-tibia composites was greater than the bending moment previously calculated for standing, walking, and recovery from anesthesia. The mean torsional yield load for the nail-tibia composites was less than the torsional load determined for the walk from another in vivo study. The design of the interlocking nail evaluated in the present study should be modified to increase torsional and compressive yield strengths and torsional stiffness before reasonable success could be expected for the treatment of adult equine tibial fractures.

Animals↗

The effect of hole diameter on the torsional mechanical properties of the equine third metacarpal bone.

The torsional monotonic structural material properties of equine metacarpi with or without, either a 5/16 inch or 3/8 inch diameter bicortical lateromedial middiaphyseal hole were assessed to determine the effect of a hole on metacarpal strength. Torsional stiffness was not significantly effected by the presence of a bicortical hole, whereas yield and failure angles, torques and energies of metacarpi with a hole were 51% to 97% of those of intact bones. Significant differences were not apparent for yield and failure mechanical properties between metacarpi with a 5/16 inch diameter hole and metacarpi with a 3/8 inch diameter hole; however, postyield mechanical properties were lower for metacarpi with a 3/8 inch hole. Whereas some metacarpi with a 5/16 inch hole were capable of plastic deformation before failure, metacarpi with a 3/8 inch diameter hole appeared to have sufficient stress concentration to propagate complete fracture on structural yield.

Animals↗

An in vitro biomechanical investigation of the mechanical properties of dynamic compression plated osteotomized adult equine tibiae.

OBJECTIVE: To determine the monotonic mechanical properties of osteotomized adult equine tibiae stabilized with two dynamic compression plates (DCP) and to compare the mechanical properties with those of intact tibiae and in vivo loads. STUDY DESIGN: The compressive, bending, and torsional mechanical properties of plated and intact tibiae were assessed in vitro. ANIMALS OR SAMPLE POPULATION: Twelve pairs of adult equine tibiae. METHODS: Tibiae were loaded in axial compression, craniocaudal 3-point bending, or torsion in external rotation in a single cycle to failure. Mechanical properties were determined from load-displacement data. RESULTS: Compared to intact tibiae, the mean yield load, failure load and stiffness of plated tibiae were significantly lower (P < .05) (compression and torsion); and the mean yield and failure bending moments, and bending stiffness, of the plated tibiae were lower (P < .075 for yield), or significantly lower, respectively. The mean compression and bending yield loads for plated tibiae were greater than in vivo loads. The mean torsional yield load for plated tibiae approximated the torsional load determined for the adult horse at a walk. CONCLUSIONS: Simple, anatomically reduced, DCP plated tibiae should have adequate strength to withstand immediate, postoperative in vivo compressive loads and bending moments placed on the tibia in vivo during immediate postoperative activities, however, may not have adequate torsional strength during immediate postoperative weight-bearing at a walk. CLINICAL RELEVANCE: Additional supportive methods, to decrease torsional loads, may be beneficial in maintaining stability of plate repaired tibiae during recovery from anesthesia and postoperative healing.

Animals↗

An in vitro biomechanical investigation of an equine interlocking nail.

OBJECTIVE: To determine the mechanical properties of Equine Interlocking Nail (EIN; JD Wheat Veterinary Orthopedic Research Laboratory, University of California, Davis) stabilized osteotomized tibiae and compare these variables with estimated in vivo loads. STUDY DESIGN: In vitro biomechanical investigation. ANIMALS: Twelve adult equine cadaveric tibiae. SAMPLE POPULATION: EIN-stabilized tibiae were tested monotonically under compression, 3- and 4-point bending, and torsion. Mechanical properties were compared with estimated in vivo loads. RESULTS: EIN-tibial composite mean compressive yield load (11 kN) and bending moment (216 Nm) were greater than loads expected postoperatively in vivo; however, the mean torsional yield load (156 Nm) was less than that expected in vivo. CONCLUSIONS: EIN-stabilized tibiae had compressive and bending strengths greater than those expected to maintain stability during walking in adult horses. Torsional yield strength did not appear sufficient to provide stability during walking in vivo. CLINICAL RELEVANCE: The EIN is not a feasible method of fracture repair for adult equine tibial fractures at this time, because its mechanical properties appear inadequate to withstand the postoperative torsional loads encountered during walking. Because this method of fracture repair may offer biological advantages, further modification of an interlocking nail for adult horses appears warranted.

Animals↗

In vitro cyclic biomechanical properties of an interlocking equine tibial nail.

OBJECTIVE: To determine cyclic biomechanical properties of gap osteotomized adult equine tibiae stabilized with an equine interlocking nail (EIN). STUDY DESIGN: In vitro experimental biomechanical investigation. SAMPLE POPULATION: Thirteen adult equine cadaveric tibiae. METHODS: Adult equine tibiae with transverse, midshaft, 1-cm gap osteotomies, stabilized with an equine interlocking nail, underwent cyclic biomechanical testing in vitro under axial compression, 4-point bending, and torsion. Different specimens were subjected to different load levels that represented estimated in vivo loads at 2 Hz for 740,000 cycles. Fatigue life and gap strain were calculated. RESULTS: Compression and bending, but not torsional, fatigue life were longer than time necessary for bone healing. Compressive, but not bending or torsional, gap strains were small enough to be compatible with fracture healing by primary bone formation. Gap strains for compressive, bending, and torsional loads were compatible with indirect, or secondary, bone formation. CONCLUSIONS: Further modification should be made to the equine interlocking nail to increase bending stiffness and torsional fatigue life. CLINICAL RELEVANCE: The stainless steel equine intramedullary interlocking nail is unlikely to provide appropriate long-term stability for fracture healing in adult equine tibiae without modifications in the nail design and material.

Animals↗