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Biomedical subjects

B Holroyd

Publications and source records attributed to B Holroyd.

10 recordsLinked to original sources
PubMed2001

Osteoporosis follow-up after wrist fractures following minor trauma.

BACKGROUND: Patients presenting with low-trauma wrist fractures are an ideal target population for early case finding of osteoporosis. We decided to investigate whether this early detection occurred in practice. METHODS: This study was conducted at a single center in Edmonton, Alberta. A structured interview format was used to contact 112 (72%) of 156 patients older than 40 years who were diagnosed as having an atraumatic fracture of the distal radius/ulna from April 1997 to March 1998 and from January 1999 to February 1999. Information on osteoporosis follow-up and drug therapy was obtained from the patient. RESULTS: The time between fracture and telephone interview ranged from 6 months to 3 years, with the majority of the sample being interviewed at least 1 year after fracture. Of the 112 patients in this study, 44 had sustained previous fractures, 17 of which had occurred at the wrist, vertebrae, or hip. Sixteen patients in the sample had already sustained a subsequent clinical fracture before our telephone contact. Thirty-two patients had received treatment for osteoporosis before fracture. A further 24 patients (21%) had undergone osteoporosis follow-up after fracture. After fracture, 42 (38%) of all patients were receiving either hormone replacement therapy or using a bisphosphonate. CONCLUSIONS: Only 50% of the study population had received osteoporosis follow-up after fracture. Few patients had any change in their medication use after fracture. The findings in this study population suggest that recognition of the potential for osteoporosis in such patients is inadequate. Given the magnitude of this public health care problem, it is clear that attention to case finding and treatment of osteoporosis should be increased.

Age Distribution↗
PubMed2001

Canadian CT head rule study for patients with minor head injury: methodology for phase II (validation and economic analysis).

Prospective validation on a new set of patients is an essential test of a new decision rule. However, many clinical decision rules are not prospectively assessed to determine their accuracy, reliability, clinical sensibility, or potential impact on practice. This validation process is important because many statistically derived rules or guidelines do not perform well when tested in a new population. The methodologic standards for a validation study are similar to those described in the article on phase I for derivation studies in the August 2001 issue of Annals of Emergency Medicine. The goal of phase II is to prospectively assess the accuracy, reliability, and acceptability of the decision rule in a new set of patients with minor head injury. This will determine the clinical utility of the rule and is essential if such a rule is to be widely adopted into clinical practice.

Canada↗
PubMed2001

The Canadian CT Head Rule Study for patients with minor head injury: rationale, objectives, and methodology for phase I (derivation).

Head injuries are among the most common types of trauma seen in North American emergency departments, with an estimated 1 million cases seen annually. "Minor" head injury (sometimes known as "mild") is defined by a history of loss of consciousness, amnesia, or disorientation in a patient who is conscious and talking, that is, with a Glasgow Coma Scale score of 13 to 15. Although most patients with minor head injury can be discharged without sequelae after a period of observation, in a small proportion, their neurologic condition deteriorates and requires neurosurgical intervention for intracranial hematoma. The objective of the Canadian CT Head Rule Study is to develop an accurate and reliable decision rule for the use of computed tomography (CT) in patients with minor head injury. Such a decision rule would allow physicians to be more selective in their use of CT without compromising care of patients with minor head injury. This paper describes in detail the rationale, objectives, and methodology for Phase I of the study in which the decision rule was derived. [Stiell IG, Lesiuk H, Wells GA, McKnight RD, Brison R, Clement C, Eisenhauer MA, Greenberg GH, MacPhail I, Reardon M, Worthington J, Verbeek R, Rowe B, Cass D, Dreyer J, Holroyd B, Morrison L, Schull M, Laupacis A, for the Canadian CT Head and C-Spine Study Group. The Canadian CT Head Rule Study for patients with minor head injury: rationale, objectives, and methodology for phase I (derivation). Ann Emerg Med. August 2001;38:160-169.]

Adolescent↗
PubMed1999

Comparison of microvascular filtration in human arms with and without postmastectomy oedema.

Oedema is caused by impaired lymphatic drainage and/or increased microvascular filtration. To assess a postulated role for the latter in postmastectomy oedema, filtration was studied in the forearms of 14 healthy subjects and 22 patients with chronic, unilateral arm oedema caused by surgical and radiological treatment for breast cancer. A new non-contact optical device (the Perometer) and a conventional mercury strain gauge were used simultaneously to record forearm swelling rates caused by microvascular filtration during applied venous congestion. Filtration rate (FR) per 100 ml tissue was measured over 10-15 min at a venous pressure of 30 cmH2O, a pressure reached in the dependent forearm (FR30), and then at 60 cmH2O (FR60). Apparent filtration capacity of 100 ml soft tissue (CFCa) was calculated from FR60 - FR30/30, after adjustment for bone volume. The Perometer and strain gauge gave similar results in normal and oedematous arms. Mean CFCa in healthy subjects was (3.8+/-0.4) x 10(-3) ml (100 ml)-1 cmH2O-1 min-1, close to literature values. In the patients, FR30 was 47 % lower in the oedematous forearm than in the opposite, unaffected forearm (P = 0.04). FR60 showed a similar trend but did not reach significance (P = 0.15). The values of CFCa of (2.2+/-0.5) x 10(-3) ml (100 ml)-1 cmH2O-1 min-1 in the oedematous arm and (2.8+/-0.5) x 10(-3) ml (100 ml)-1 cmH2O-1 min-1 in the unaffected arm were not significantly different (P = 0.47). When differences in arm volume on the two sides were taken into account, the total fluid load on the lymphatic system of the oedematous forearm was (411.0+/-82.2) x 10(-3) ml min-1 at 30 cmH2O and (1168+/-235.6) x 10(-3) ml min-1 at 60 cmH2O, similar to the normal side, namely (503.7+/-109.3) 10(-3) ml min-1 and (1063+/-152.0) x 10(-3) ml min-1, respectively (P >/= 0.50). The filtration capacity of the entire oedematous forearm (CFCa scaled up by total soft tissue volume), (25.4+/-6.2) x 10(-3) ml cmH2O-1 min-1, was not significantly greater than that of the normal forearm, (18.3+/-2.6) x 10(-3) ml cmH2O-1 min-1 (P = 0.40). The results indicate that no major change occurs in the microvascular hydraulic permeability-area product of the forearm, or in the total filtration load on the lymph drainage system during dependency, in the arm with postmastectomy oedema compared with the normal arm. This argues against a significant haemodynamic contribution to postmastectomy oedema.

Aged↗
PubMed1998

Forearm blood flow measured by venous occlusion plethysmography in healthy subjects and in women with postmastectomy oedema.

A chronic swelling of the arm may develop following damage to axillary lymph vessels during breast cancer treatment. Certain unusual pathophysiological features of postmastectomy oedema indicate that factors additional to lymphatic damage are important. One factor postulated previously is a haemodynamic abnormality. Forearm blood flow was therefore measured by venous occlusion plethysmography using both a conventional mercury strain gauge and a newer optical volumeter (Perometer). The latter was initially assessed in healthy subjects. When forearm blood flow was measured using the two methods simultaneously, the strain gauge and Perometer did not differ significantly for healthy or oedematous arms. Dominant and non-dominant arm blood flow in healthy subjects was similar but with greater variation between sides with the Perometer. Using the strain gauge, blood flow in the oedematous arm (2.51 +/- 1.33 ml/100 ml per min) was significantly lower than in the opposite unaffected arm (3.77 +/- 2.29 ml/100 ml per min; p = 0.026). The Perometer results showed a similar but nonsignificant trend (p = 0.105). Taking into account the greater limb volume on the affected side, total forearm blood flow was essentially the same in each arm (unaffected: 40.72 +/- 28.70 micromilligrams/min; oedematous: 41.78 +/- 22.11 ml/min). The reduced blood flow per unit volume of arm was therefore likely to be due to a simple 'dilution' effect of the increase in volume. The results indicate that it is unlikely that raised blood flow contributes to oedema formation, contrary to the haemodynamic concept.

Adult↗
PubMed1997

Validation of an optoelectronic limb volumeter (Perometer).

The Perometer, a device designed for the measurement of limb volume, has been rigorously assessed by comparison with other methods. Differences in the volume of geometric shapes and limbs determined by the Perometer and a tape measure/meter rule (i.e., Perometer minus direct measurement) were -0.8 to 2.4% (cylinders), -4.6% (truncated cone), -3.3% (mannequin limbs), 6.1% (normal human arms) and 6.8% (lymphedema arms). The larger differences were likely to be due to deviation from circular or elliptical cross-section (Perometer or tape method) and compression of the arm (tape method). Errors arising from incorrect positioning within the measuring frame were generally small, but large errors occurred when a cylinder was partially rotated within the frame (i.e., no longer perpendicular to the light beams). The Perometer was highly reproducible, each measurement taking only a few seconds. When recording the change in volume with time of a segment of arm during venous occlusion (blood flow measurement by venous occlusion plethysmography) using the Perometer plus a mercury strain gauge, between-method differences for individual blood flow recordings were apparent. The source of these differences is discussed. However, using the average of a number of blood flow recordings the Perometer and the strain gauge agreed fairly closely for both the normal and lymphedema arms. The Perometer is thus a reliable and convenient tool for the measurement of limb volume, and may also be used to measure the rate of swelling during venous occlusion plethysmography.

Adult↗
PubMed1988

Prehospital patients refusing care.

In summary, many of the complex medicolegal and ethical issues surrounding the prehospital patient who refuses all or part of the care offered by the EMS system have been reviewed. The best outcome can be achieved using a sliding scale of capacity and a conservative approach to treatment rather than releasing the patient at the scene. Finally, the roles of collateral history, inquiries as to the origin of the patient's refusal of care, direct physician interaction with the patient, a spirit of creativity and compromise in dealing with the patient, meticulous documentation, and policy issues have been discussed.

Adult↗
PubMedDate not supplied

Guidelines for the use of imaging techniques for the investigation of venous thromboembolic disease.

The diagnosis of venous thromboembolic disease remains a difficult challenge. Chest radiography, ventilation/perfusion lung scanning, noninvasive leg testing, and pulmonary angiography were evaluated with regard to sensitivity, specificity, positive and negative predictive values. The need for treatment, observation, or serial testing with respect to risks and benefits of treatment and likelihood of serious outcomes was evaluated. The evidence for conclusions was based on the methodology and values of the Canadian Task Force on the Periodic Health Examination. The Diagnostic Imaging Advisory Group of the Canadian Association of Emergency Physicians developed eight recommendations.

Diagnostic Imaging↗