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Biomedical subjects

M J Bowman

Publications and source records attributed to M J Bowman.

11 recordsLinked to original sources
PubMed2001

Accuracy of visual determination of neutral position of the immobilized pediatric cervical spine.

BACKGROUND: The definition of neutral position for the immobilized pediatric cervical spine is not well standardized. In this study, we attempted to determine whether 1) physicians and/or paramedics could accurately assess visually if the cervical spine was in a neutral position, 2) the visual assessments of the observers were in agreement, and 3) a radiographic Cobb angle would correlate with the visual determination. METHODS: Children presenting to a pediatric emergency department (ED) in full spinal immobilization were randomly selected (convenience sample) for this prospective study. The emergency physician and transporting paramedic independently determined positioning of the cervical spine. A radiologist, blinded to clinical information, determined Cobb angles from radiographs of the immobilized cervical spines. RESULTS: Of the 59 children studied, the evaluation of cervical spine position by the physician and paramedic correlated in 88% of the cases. For the 22 children with non-neutral Cobb angles (definition of neutral: between 5 degrees flexion and 5 degrees extension), observers agreed in 100% of the cases. However, in 21 of these cases (95%) the position was observed as neutral. CONCLUSIONS: Although visual determinations of neutral position of the cervical spine by two observers may correlate, radiographic studies demonstrate that neutral position was not achieved in 37% of the cases.

Accidental Falls↗
PubMed1997

Babywalker-related injuries continue despite warning labels and public education.

OBJECTIVE: To describe the epidemiology of babywalker-related injuries to children treated in a pediatric emergency department despite current prevention efforts, and to investigate the beliefs of parents regarding babywalker use. DESIGN: A descriptive study of a consecutive series of patients. SETTING: The emergency department of a large, academic children's hospital. PARTICIPANTS: Children treated for babywalker-related injuries during the 3-year period of March 1993 through February 1996. RESULTS: There were 271 children treated for babywalker-related injuries. The mean age was 9.2 months, and 62% of patients were boys. Ninety-six percent of children were injured when they fell down stairs in their babywalker. The number of stairs that a child fell down was significantly associated with skull fracture and admission to the hospital, and a fall down more than 10 stairs had a relative risk (RR) of skull fracture = 3.28 (95% confidence interval, 1.35 < RR < 7.98). There were 159 children with contusions/abrasions (58.6%), 35 concussions/head injuries (12. 9%), 33 lacerations (12.2%), 26 skull fractures (9.6%), 9 epistaxis (3.3%), 4 nonskull fractures (1.5%), 4 avulsed teeth (1.5%), and 1 burn (0.4%). Three of the skull fractures were depressed, and three also had accompanying intracranial hemorrhage. Ten patients (3.7%) were admitted to the hospital, and all had skull fractures resulting from falls down stairs. Supervision was present in 78% of cases, including supervision by an adult in 69% of cases. Forty-five percent of families kept the walker, and 32% used the walker again for the study patient or another child after the injury episode. Fifty-nine percent of parents acknowledged that they were aware of the potential dangers of babywalkers before the injury event. Fifty-six percent of parents favored a national ban on the sale of walkers, and 20% were opposed. CONCLUSION: Despite the currently used prevention strategies, including adult supervision, warning labels, care giver education programs, and stairway gates, serious injuries associated with babywalkers continue to occur to young children. The US Consumer Product Safety Commission should promulgate a rule, similar to the voluntary standard adopted in Canada, regarding design requirements for babywalkers that will prevent their passage through household doorways at the head of stairs. The manufacture and sale of mobile babywalkers that do not meet this new standard should be banned in the US. A recall or trade-in campaign should be conducted nationally to decrease the number of existing babywalkers.

Accident Prevention↗
PubMed1996

Utility of blood cultures in pediatric patients found to have pneumonia in the emergency department.

STUDY OBJECTIVE: To determine the prevalence of bacteremia in pediatric patients with radiographic evidence of pneumonia in whom blood cultures were obtained. METHODS: We carried out a retrospective review of the radiology log of a tertiary care children's hospital to identify patients with radiographic evidence of pneumonia seen between August 1991 and July 1992. These patients were cross-referenced with the hospital laboratory information system, yielding results of any CBC or blood cultures. RESULTS: We found 939 patients with chest radiography findings consistent with pneumonia. Blood culturing was performed in 409 (44%). Eleven of these cultures (2.7%) grew pathogenic bacteria. Review of the medical records revealed no changes in clinical management made on the basis of the results of the blood cultures. CONCLUSION: Blood cultures are uncommonly positive in outpatients diagnosed with pneumonia.

Adolescent↗
PubMed1995

Pediatric cervical-spine immobilization: achieving neutral position?

This study was designed to evaluate prospectively the ability of current spine-immobilization devices to achieve radiographic-neutral positioning of the cervical spine in pediatric trauma patients. All trauma patients who required spinal immobilization and a lateral cervical spine radiograph were included in the study. A lateral cervical spine radiograph was obtained while the child was immobilized. The Cobb angle (C2-C6) was measured using a handheld goniometer. The method of immobilization, age at injury, and Cobb angle were compared. One hundred and eighteen patients with an average age of 7.9 years were enrolled. The majority were males (71%). The most frequent mechanisms of injury included motor vehicle accidents (35%) and falls (32%). The average Glascow Coma Scale score was 14. Although 31% of the children complained of neck pain, 92% were without neurologic deficits. The Cobb angles ranged from 27 degree kyphosis to 27 degree lordosis, and only 12 of the patients presented in a neutral position (0 degrees). Greater than 5 degrees of kyphosis or lordosis was observed in 60% of the children. Thirty-seven percent of the patients had 10 degrees or greater angulation. The most frequent methods of immobilization included a collar, backboard, and towels (40%), and a collar, backboard, and blocks (20%), but these techniques provided < 5 degrees kyphosis or lordosis in only 45% and 26% of the children respectively. No single method or combination of methods of immobilization consistently placed the children in the neutral position.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1993

Pediatric head injuries: can clinical factors reliably predict an abnormality on computed tomography?

STUDY OBJECTIVE: To assess clinical features that might reliably predict the need for computed tomography (CT) imaging in pediatric head trauma. DESIGN/SETTING/TYPE OF PARTICIPANT: Prospective cohort of 324 head CT scans performed on 322 consecutive trauma patients at an urban children's hospital. RESULTS: Sixty-two percent of patients were male. The mean age was 7.1 years (10 days to 20.6 years); half were less than 5 years of age. The two most frequent mechanisms of injury were falls (32%) and motor vehicle accidents (25%). Abnormalities were detected in 74 scans. Intracranial injuries were apparent in 39 patients (12%); 16 had a concomitant fracture. An isolated cranial abnormality was observed on 35 scans (11%). Loss of consciousness, amnesia for the event, a Glasgow Coma Scale (GCS) of less than 15, and the presence of a neurologic deficit were more common in children with intracranial injury (P < .05). Vomiting, seizures, and headache were not discriminating clinical features. No single characteristic consistently identified the children with an intracranial injury. Of the 195 children who were neurologically intact (GCS, 15) at the time of presentation, 11 (5%) had evidence of intracranial pathology on CT scan. CONCLUSION: This study demonstrates a poor correlation between the clinical symptoms of significant traumatic brain injury and findings on CT.

Adolescent↗
PubMed1984

Thyroid hormone-induced precocious growth and maturation of the embryonic chicken liver.

The effects of thyroid hormones thyroxine (T4) or triiodothyronine (T3) on the ontogeny of chicken embryonic liver were studied. Two micrograms of T4 administered to chicken embryos, prior to day 11 of incubation, was found to be least toxic and effective in increasing liver weights, total protein and DNA and RNA, over those of controls. A non-toxic dose of T4 (0.1 microgram) had no effect on embryonic chicken liver. Injection of 125I-labelled T4 or T3 into chick embryos showed that T4 was taken up in greater amounts by the liver than was T3. Uptake of both hormones by the liver increased dramatically around day 9 of incubation. Induction of hypothyroidism by methimazole (a goitrogen) suppressed the natural increase in liver weight.

Animals↗
PubMed1978

Age disorientation in schizophrenia: a constant prevalence of 25 per cent in a chronic mental hospital population?

The prevalence of age disorientation was estimated in the population of patients with a diagnosis of schizophrenia in a large mental hospital. Of these 357 patients 25 per cent demonstrated age disorientation, defined as a five-year discrepancy between true and subjective age, and 11 per cent of the population believed themselves to be within five years of the age they were at admission, although they were a mean 28.9 years older. Age-disorientated patients differed from the age-orientated in being significantly older. However, when age-matched, they were younger at first admission and had a longer duration of stay than patients with a diagnosis of schizophrenia without age-disorientation. Age-disorientation may thus be a feature of a type of schizophrenic illness of early onset and poor prognosis.

Adult↗
PubMed1977

A clinic within a general hospital for the assessment of urgent psychiatric problems.

Of 100 consecutive referrals to a clinic for urgent psychiatric assessment only a third (34 patients) were considered to warrant such urgent attention. In 29 of the 34 cases the patient's behaviour--either intent to harm himself or unpredictable behaviour that alarmed the referring agent--was the most important consideration for urgent assessment.

Emergency Service, Hospital↗