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At least 433 records · Page 24Linked to original sources
PubMed2006

Emergency nurse practitioner care and emergency department patient flow: case-control study.

OBJECTIVE: The present study aimed to compare ED waiting times (for medical assessment and treatment), treatment times and length of stay (LOS) for patients managed by an emergency nurse practitioner candidate (ENPC) with patients managed via traditional ED care. METHODS: A case-control design was used. Patients were selected using the three most common ED discharge diagnoses for ENPC managed patients: hand/wrist wounds, hand/wrist fractures and removal of plaster of Paris. The ENPC group (n = 102) consisted of patients managed by the ENPC who had ED discharge diagnoses as mentioned above. The control group (n = 623) consisted of patients with the same ED discharge diagnoses who were managed via traditional ED care. RESULTS: There were no significant differences in median waiting times, treatment times and ED LOS between ENPC managed patients and patients managed via traditional ED processes. There appeared to be some variability between diagnostic subgroups in terms of treatment times and ED LOS. CONCLUSION: Patient flow outcomes for ENPC managed patients are comparable with those of patients managed via usual ED processes.

Adolescent↗
PubMed1978

Electrophysiology of the afferent innervation of the penis of the domestic ram.

1. The discharge of impulses in afferent fibres dissected from the dorsal nerve of the penis of chloralose-anaesthetized rams was recorded electrophysiologically during controlled natural stimulation of the surgically exposed penis maintained at body temperature and mechanically stabilized in a plaster of Paris mould. 2. Fifty-eight slowly adapting mechanorecptor units were examined and their pressure, velocity and displacement thresholds were determined. Units often responded best to integumental stretch. Few had resting discharges. During a sustained perpendicularly applied displacement most units adapted to silence within 1.5 min. The units were classified into types from an analysis of their adapted impulse trains in response to a sustained mechanical stimulus. 3. Twenty-five mechanoreceptive units had rapidly adapting responses. Most units had typical rapid adapting characteristics and discharged impulses only during the dynamic phase of the application of the displacement. A subgroup had intermediate adapting characteristics, and discharged intermittently during steady displacement of the integument. 4. The mechanical sensitivity of most receptors altered when the temperature of the receptive field was changed with a positive correlation in eleven units, a negative correlation in six. Six slowly adapting units were thermally insensitive. Twelve rapidly adapting units were tested. Six had a positive thermal correlation and four a negative correlation. 5. The conduction velocities of axons of mechanoreceptor units in the dorsal nerve of the penis were in the Aalpha range (12--77 msec-1). 6. Two specific warm and five specific cold units were found. The conduction velocities of the axons supplying warm receptors were 45.4 msec-1 (one unit) and those for cold receptors were 7.5, 7.8, 30, 45.5, 48.7 msec-1. 7. No correlation could be found between the receptor submodality and the profuse receptor end bulb population demonstrated histologically.

Action Potentials↗
PubMed2004

Dependence of calculus retropulsion dynamics on fiber size and radiant exposure during Ho:YAG lithotripsy.

During pulsed laser lithotripsy, the calculus is subject to a strong recoil momentum which moves the calculus away from laser delivery and prolongs the operation. This study was designed to quantify the recoil momentum during Ho:YAG laser lithotripsy. The correlation among crater shape, debris trajectory, laser-induced bubble and recoil momentum was investigated. Calculus phantoms made from plaster of Paris were ablated with free running Ho:YAG lasers. The dynamics of recoil action of a calculus phantom was monitored by a high-speed video camera and the laser ablation craters were examined with Optical Coherent Tomography (OCT). Higher radiant exposure resulted in larger ablation volume (mass) which increased the recoil momentum. Smaller fibers produced narrow craters with a steep contoured geometry and decreased recoil momentum compared to larger fibers. In the presence of water, recoil motion of the phantom deviated from that of phantom in air. Under certain conditions, we observed the phantom rocking towards the fiber after the laser pulse. The shape of the crater is one of the major contributing factors to the diminished recoil momentum of smaller fibers. The re-entrance flow of water induced by the bubble collapse is considered to be the cause of the rocking of the phantom.

Calculi↗
PubMed2001

Dynamic photoelastic study of the transient stress field in solids during shock wave lithotripsy.

Photoelastic and shadowgraph imaging techniques were used to visualize the propagation and evolution of stress waves, and the resultant transient stress fields in solids during shock wave lithotripsy. In parallel, theoretical analysis of the wavefront evolution inside the solids was performed using a ray-tracing method. Excellent agreement between the theoretical prediction and experimental results was observed. Both the sample size and geometry were found to have a significant influence on the wave evolution and associated stress field produced inside the solid. In particular, characteristic patterns of spalling damage (i.e., transverse and longitudinal crack formation) were observed using plaster-of-Paris cylindrical phantoms of rectangular and circular cross sections. It was found that the leading tensile pulse of the reflected longitudinal wave is responsible for the initiation of microcracks in regions inside the phantom where high tensile stresses are produced. In addition, the transmitted shear wave was found to play a critical role in facilitating the extension and propagation of the microcrack.

High-Energy Shock Waves↗
PubMed1981

Feasibility of outpatient management after intra-articular yttrium-90: comparison of two regimens.

In a study comparing two regimens of treatment after intra-articular irradiation of the knee with yttrium-90 one group of patients was allocated to bed rest for 48 hours in hospital and the other to mobilisation at home. Initially a Robert-Jones orthopaedic bandage was applied to the knee in all patients, serving as a semi-rigid splint, but as loss of isotope from the knee was appreciable in the mobilised patients, subsequent patients were sent home with the knee in a plaster-of-Paris cylinder. No difference in extra-articular spread or chromosomal damage was found between the patients sent home with their knee in a rigid splint and those treated by bed rest. Clinical outcome at three months was satisfactory in all three groups. These results show that rigid splinting is essential in reducing extra-articular spread of the isotope but that bed rest is not necessary. Increases in intra-articular pressure associated with quadriceps muscle activity combined with flexion of the knee may be the most important factor affecting extra-articular spread of isotope.

Ambulatory Care↗
PubMed2002

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Plaster or functional splint in gamekeepers thumb.

A short cut review was carried out to establish whether a plaster of Paris or functional splint was better for treatment of ulnar collateral ligament rupture. Altogether 50 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are tabulated. A clinical bottom line is stated.

Adult↗
PubMed1986

Bone scintigraphy in the management of X-ray-negative potential scaphoid fractures.

One hundred and eleven patients with signs and symptoms of carpal scaphoid injury, but with no fracture visible on X-ray, underwent bone scintigraphy of the wrists. The first 42 patients were re-X-rayed 10 days after injury: bone scanning had identified all fractures confirmed on this X-ray; there were no false negative bone scans. Sixty-seven patients (60%) did not have increased focal uptake over the scaphoid or distal radius, and were mobilised immediately. None of these had a fracture at follow up. Twenty-nine patients with increased uptake over the scaphoid area (26%) remained in plaster of Paris for 6 weeks. All of these had clinical signs of a scaphoid injury. Bone scanning is a practical investigation for all X-ray-negative potential scaphoid injuries, and is acceptable to patient and clinician. In the presence of a normal scan, the practice of re-X-raying patients 10 days after injury may be abandoned.

Adult↗
PubMed1993

An improved instrument for the in vivo detection of lead in bone.

An improved instrument for the fluorescence excitation measurement of concentrations of lead in bone has been developed. This is based on a large area high purity germanium detector and a point source of 109Cd. The source is positioned in a tungsten shield at the centre of the detector face such that 88keV photons cannot enter the detector directly. In vivo measurements are calibrated with plaster of Paris phantoms. Occupationally non-exposed men show a minimum detectable concentration of about 6 micrograms/g bone mineral. Measurements of tibia lead concentrations in 30 non-occupationally exposed men between the ages of 23 and 73 showed an annual increment of 0.46 microgram/g bone mineral/year. The mean deviation from the regression of tibia lead upon age was 3.5 micrograms/g bone mineral. Tibia lead concentration in one subject with a history of exposure to lead was 69.6 (SD 3.5) micrograms/g bone mineral. The improved precision of the point source large detector system means that greater confidence can be placed on the results of in vivo measurements of lead concentration. This will allow studies of the natural history of non-occupational lead accumulation in normal subjects and should permit investigations of the efficacy of therapeutic interventions in subjects poisoned with lead.

Adult↗
PubMed1985

A comparison of some casting materials.

The physical and mechanical properties of four casting materials are compared with two plaster of Paris preparations. Properties evaluated include working and specific strengths, resistance to abrasion and radiolucency. Ease of application, conformability and rate of strength development are discussed and the clinical relevance of these properties is considered.

Acrylic Resins↗
PubMed1975

A drop-in treatment shell support.

An easily made, inexpensive drop-in support for the use with treatment shells fabricated by the direct (plaster of paris bandage) method is used to immobilize the patient and reproduce the treatment position. Its quick and easy method of attachment and removal requires a minimum of patient cooperation.

Head↗
PubMed1975

A microindentation technique to measure rheological properties of the vascular intima.

A microindentor was developed to measure the depth of indentation of the intimal surface of arterial tissue loaded by flat-ended, cylindrical probes. The depth of indentation depended on the initial stretch of the tissue which required a rigid support (plaster of Paris) beneath the adventitial surface. Probe tips used ranged from 550-mum down to 65-mum diameter while loads ranged from 800 to 15 mg. The depth of indentation was markedly time dependent; that obtained 30 s after loading (variation of 30) was reproducible and served as a useful parameter of viscoelasticity of the aortic intima and supporting tissues of dog and man. The mean variation of 30 (0.19-mm diam tip, 120-mg load), obtained from longitudinal series of indentations of nine dog aortas, ranged from 40.8 to 68.8 mum while coefficient of variation in these series ranged from 4.8 to 15.9%. Intimal pads were found to have greater resistance to identation than adjacent tissue; likewise the tissue on the dorsal, intimal surface of the aorta had lower variation of 30 values compared with the rest of the intima. Lipid-filled intimal regions were about twice as complaint as macroscopically spared areas. The technique should prove useful in understanding the microrheological response of the blood vascular interface to hydrodynamic stresses.

Animals↗
PubMed2000

Excision of a remarkable tumour of the upper jaw in 1834 by Robert Liston.

A series of pre-operative casts of the head, one of plaster of Paris and the other of wax, have recently been discovered in the Department of Anatomy, Edinburgh, of a patient with an immense tumour of the left maxillary antrum which produced an enormous degree of facial distortion. These casts complement a series of engravings published in the contemporary literature. This lady's tumour was successfully excised by Robert Liston in 1834 in the Royal Infirmary of Edinburgh, only a month before he left Edinburgh for London. The tumour was believed to be benign, and was removed without the benefit of anaesthesia. The patient returned the following summer to have a gold palate fitted, and while her voice was initially indistinct, it subsequently recovered.

History, 19th Century↗
PubMed1982

Suggested method for closed treatment of fractures of the carpal scaphoid: hypothesis supported by dissection and clinical practice.

The anatomy and kinetics of the carpus with special reference to the fractured scaphoid are described. Clinical, radiological and post-mortem studies of the wrist show that the scaphoid can be immobilized and compressed in its long axis, with the wrist held in full supination, mid-dorsiflexion and full ulnar deviation. Immobilization of the upper limb in this position for four weeks has achieved union of those fractures of the scaphoid which are often problematical, i.e. the displaced fracture, fractures of the proximal pole, and those exhibiting delay in union of many months. The method of manipulation and immobilization in a plaster of Paris cast is described, and some clinical examples are presented. The indications for the complications of the method of treatment are discussed and briefly compared with other methods of treatment.

Adolescent↗
PubMed1989

The oxygen delivery characteristics of the Hudson Oxy-one face mask.

The inspired oxygen fraction (FIO2) delivered by the Hudson Oxy-one face mask was measured under changing conditions of ventilation, oxygen flow rate to mask, and mask fit. A single trained subject sat in a body plethysmograph to measure ventilation and breathed at a constant rate of 15 per minute at three different tidal volumes, of approximately 0.3, 0.6, and 1.2 litres, from the mouthpiece in the plethysmograph. The Oxy-one face mask was fitted to a plaster-of-Paris face model on the outside of the plethysmograph in a loose and then in a tight fashion. Oxygen concentration was continuously monitored from a point in the metal tube connecting the face model to the mouthpiece. The tightly fitting mask demonstrated an orderly reduction in FIO2 as ventilation increased and oxygen flow rate to the mask decreased. The mean FIO2 at a ventilation of 4.5 l.min-1 and 8 l.min-1 oxygen flow was 78% and this fell to 27% at a ventilation of 16 l.min-1 and oxygen flow of 2 l.min-1. The loosely fitting mask demonstrated larger SD of measurements and lower mean maximum FIO2 values of 46 to 49% and these fell in an irregular fashion to similar minimum values as ventilation increased and oxygen flow decreased. Although the precise definition of the FIO2 for each breath from the changing concentration during each inspiration was not possible, these results indicate that FIO2 changes in a predictable way as a function of ventilation and oxygen flow, if the mask is close fitting. This method could be conveniently used to study other oxygen delivery systems.

Evaluation Studies as Topic↗
PubMed2001

Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot.

We evaluated the ability of seven devices to immobilize a prosthetic ankle-foot complex against plantarflexion, dorsiflexion, inversion, and eversion forces: two casts (plaster of Paris and Fiberglas) and five removable braces (molded ankle/foot orthosis, composite boot brace, pneumatic boot walker, nonarticulating fracture boot, and ankle stirrup). Each device was applied to a prosthetic ankle-foot complex and evaluated on a test frame for resistance to sagittal motion and coronal torque. Results showed that casts offered significantly (P < or = 0.05) more resistance to motion in all directions tested than did the braces. The resistance offered by the devices tested depends on the conformity of the device to the shape of the foot in that plane and the material properties of the device. Braces offer the advantage of being easily removed and reapplied. Different braces offer specific advantages and disadvantages in different planes tested, and immobilization selection should be individualized based on this information.

Ankle↗
PubMed1980

Early and late repair of lateral ligament of the ankle.

Utilizing an apparatus for separately testing the status of the anterior talofibular and the calaneofibular ligaments of the ankle in 25 healthy, 15- to 30-year-old adults, it became apparent that the stability of the ankle depends primarily upon the integrity of the anterior talofibular ligament. When the "fore n' aft" stress measurement exceeds 4 mm, a positive anterior drawer test is elicited, and the ankle ligament needs surgical repair. Tibial talar tilt normals ranged up to 18 degrees. Repair (early and late) is accomplished by suturing what one finds (there is always some ligament present) and reinforcing the anterior talofibular ligament repair with overlap of the nearby lateral talocalcaneal ligament plus the marginal ankle retinaculum. Four weeks in a plaster of paris walking cast are followed by use of Ace bandages of 2 weeks. Light activity is begun 6 weeks after repair, and activity of choice is begun 8 weeks after repair. Repeat stress testing is performed at 3 months postsurgery, and a questionnaire is completed at the same time. On a point system (1 to 10) reviewing pain, stability, and swelling, the results in 50 cases rate from 8 to 10, with a lower rating improving with more time. Surgical time is approximately 30 minutes. There seems to be no need for more radical surgery utilizing other muscles. The senior author has employed this surgery for the past 19 years with approximately 165 cases. Only 50 patients with proper 3-month postoperative stress testing and questionnaire follow-up, who were operated upon 1 or more years ago, area recorded here.

Adolescent↗
PubMed2006

Biocompatability of hydroxyapatite composite as a local drug delivery system.

PURPOSE: To investigate the biocompatibility of hydroxyapatite composite (hydroxyapatite, plaster of Paris, and chitosan) impregnated with gentamicin, fosfomycin, imipenem, or amphotericin B. METHODS: The interactions of the extract from each drug against osteoblast were tested using the methylthiotetrazole test. RESULTS: Extracts from all drugs showed good biocompatibility at concentrations varying from 10 microgram/ml to 1000 microgram/ml. Imipenem and amphotericin B at a concentration of 1000 microgram/ml had a significantly higher percentage of cell viability than the control group. No morphological change of osteoblast was observed in all drug tests at any concentrations. CONCLUSION: The hydroxyapatite composite had a good biocompatibility for carrying gentamicin, fosfomycin, imipenem, or amphotericin B.

Amphotericin B↗
PubMed1993

Controlled trial of a semi-rigid bandage ('Scotchrap') in patients with ankle ligament lesions.

A randomized, controlled, parallel-group study was performed to compare the clinical efficacy of a semi-rigid bandage ('Scotchrap') with the standard adhesive tape treatment for ankle ligament injuries. The semi-rigid bandage support wrap consists of a knitted fibreglass fabric impregnated with a polyurethane resin. The cotton stockinet and the synthetic cast padding are used for protection of pressure points and any bony prominences. Prior to application, the 'Scotchrap' must be soaked in water after which it is applied in a way similar to that used for a plaster of paris bandage. The finished bandage remains elastic, allowing normal dorsal and plantar flexion of the foot, but preventing inversion and eversion, and pronation and supination. At rest, the bandage always redresses the immobilized ankle into the neutral position. One hundred and thirty-six patients were included in the study. The semi-rigid bandage group comprised 59 patients and the tape group had 57 patients. These two groups were statistically comparable. The intake questionnaire included a general and a specific anamnesis form as well as a physical examination form. Follow-up data were recorded every 2 weeks. After termination of the treatment, the patients evaluated treatment efficacy. Statistical analysis of 126 items per patient with chi 2-tests (p < or = 0.05) and Fisher's exact tests (p < or = 0.05) revealed no statistical significant differences in treatment result. The patient assessments of treatment efficacy of both types of bandage were also comparable. Both types of bandage gave sufficient stability (98%; p < 0.005) and were equally effective.(ABSTRACT TRUNCATED AT 250 WORDS)

Adhesives↗