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Biomedical subjects

C Broome

Publications and source records attributed to C Broome.

10 recordsLinked to original sources
PubMed2005

What gets missed when deploying new technologies in A&E?

This paper presents a longitudinal study (over 4 months) of an A&E department where the existing whiteboards were replaced with PC-based computer systems. The study was conducted in two parts - an observation of the physical whiteboard usage and in-depth interviews with all users of both the traditional whiteboard usage and the replacement technology. The research was conducted with the systems manager and all whiteboard users (i.e. nursing management, nurses, doctors, porters, and agency staff) across a spread of time frames. Although the technology supported simple information requirements, complex co-ordination, collaboration, and awareness issues were left unsupported. The important role of a pen-holder (information co-ordinator) was poorly supported by the replacement technology as was the task of annotating information with changing situations and needs. Specific deployment issues are derived from these findings that should guide designers when implementing technology replacements for current physical information formats (e.g. whiteboards, notice boards, shared paper notes).

Diffusion of Innovation↗
PubMed2001

Facial fractures in children.

OBJECTIVE: To determine the pattern of injury of facial fractures in children, the relative contribution of plain radiography and CT scanning in the diagnosis of these injuries, and factors leading to delayed diagnosis. DESIGN: Retrospective case note review. PARTICIPANTS: All children with facial fractures identified using the trauma and medical record databases at our institution. RESULTS: Forty-six children with 59 facial fractures presented over a 4-year, 2-month period from November 1995 to December 1999. The median age was 10 years, with a range from 1 to 14. There was a 2-to-1 male-to-female sex ratio. A motor vehicle accident (MVA) involving a child as passenger, pedestrian, or cyclist accounted for 63% of cases. In seven of these, the child was either a front seat passenger or inappropriately restrained for their age and size. In all but one case, the presence of a fracture was associated with an overlying laceration, abrasion, or significant soft tissue edema. Initial examination and plain radiologic assessment by a pediatric clinician led to diagnostic delay in nine children. Facial CT was performed in 38 children, and all results were positive. Twenty-six patients required operative intervention for their facial fracture. Associated injuries, particularly of the head and limbs, were present in all but six patients. CONCLUSIONS: Facial fractures were uncommon overall but occurred more frequently in children with major trauma. Plain facial radiographs provided limited additional diagnostic information to careful clinical examination and often fail to detect or clearly define a facial fracture in children. In the correct clinical setting, a facial CT scan allows accurate diagnosis of the injury and can reveal previously unsuspected additional fractures.

Accidents, Traffic↗
PubMed2000

Prevalence of laryngeal paresis in dogs undergoing general anaesthesia.

OBJECTIVE: To estimate the prevalence of laryngeal paresis within a selected population of dogs and identify some of the distinguishing characteristics of affected dogs. DESIGN: A prospective study involving laryngoscopic examination of 250 dogs. PROCEDURE: The laryngeal movements of 250 dogs undergoing general anaesthesia were observed. The severity of laryngeal paresis in these dogs was graded (0 = normal laryngeal movements, 4 = bilateral laryngeal paralysis). The following information was also recorded for each dog: age, sex, weight, breed, condition score, anaesthetic protocol, clinical suspicion of disease and observer. RESULTS: Twenty five percent of the dogs examined had some degree of laryngeal paresis. Affected dogs were significantly older than unaffected dogs (P < 0.001). There was a trend for the severity of laryngeal paresis to increase with age. There was no difference between the sexes. Dogs with laryngeal paresis were significantly heavier than normal animals (P < 0.02). Overweight animals had a significantly higher laryngeal grade than those with a normal condition score (P < 0.05). Labrador Retrievers and Rottweilers had a significantly higher risk of having laryngeal paresis (P < 0.05). Clinical suspicion was found to have high diagnostic value. An intra-class correlation coefficient for inter-rater reliability between the two observers was 0.95. CONCLUSIONS: Laryngeal paresis had a high prevalence in the animals surveyed and was strongly associated with age and breed. The results of this study are consistent with the concept of a progressive degenerative disease with a breed susceptibility. Clinical suspicion for the presence of the disease was a reliable indicator. The grading system used had a high degree of inter-observer agreement.

Anesthesia, General↗
PubMed2000

Site and mechanics of spontaneous, sleep-associated obstructive apnea in infants.

To examine the mechanics of infantile obstructive sleep apnea (OSA), airway pressures were measured using a triple-lumen catheter in 19 infants (age 1-36 wk), with concurrent overnight polysomnography. Catheter placement was guided by correlations between measurements of magnetic resonance images and body weight of 70 infants. The level of spontaneous obstruction was palatal in 52% and retroglossal in 48% of all events. Palatal obstruction predominated in infants treated for OSA (80% of events), compared with 38.6% from infants with infrequent events (P = 0.02). During obstructive events, successive respiratory efforts increased in amplitude (mean intrathoracic pressures -11.4, -15.0, and -20.4 cmH(2)O; ANOVA, P < 0.05), with arousal after only 29% of the obstructive and mixed apneas. The soft palate is commonly involved in the upper airway obstruction of infants suffering OSA. Postterm, infant responses to upper airway obstruction are intermediate between those of preterm infants and older children, with infrequent termination by arousal but no persisting "upper airway resistance" and respiratory efforts exceeding baseline during the event.

Airway Obstruction↗
PubMed1998

Multiple digital tumours in a rottweiler.

An eight-and-a-half-year-old rottweiler bitch was examined on four separate occasions over a period of 32 months for lameness caused by a mass on a digit. On each occasion the mass and affected digit were amputated. Three different neoplasms were diagnosed: two squamous cell carcinomas, a melanocytoma and an intracutaneous cornifying epithelioma. There was no recurrence following surgical excision.

Amputation, Surgical↗
PubMed1990

Interpretation of IgG subclass values: a comparison of two assays.

Because we have noted discordant results in the measurement of IgG subclass concentrations by means of a widely available commercial radial immunodiffusion (RID) kit in comparison with an enzyme-linked immunosorbent assay (ELISA) developed at the Centers for Disease Control (CDC), we conducted in a blinded manner a comparison of the two assays, using sera from 48 healthy children. The correlation coefficients between the assays were 0.92, 0.82, 0.93, and 0.86 for the IgG1, IgG2, IgG3, and IgG4 assays, respectively. However, the RID assay assigned lower values for IgG1 and IgG4 determinations than the ELISA did. Furthermore, the "normal lower range values" provided by the RID assay were higher for each IgG subclass. When the sera from the healthy control subjects were analyzed with the RID assay, 12 (25%) of 48 subjects had values below the normal range for at least one subclass measurement. In contrast, with the CDC ELISA, all values were within the 95% confidence limits determined for the CDC ELISA. We suggest that age-specific normal limits be established with the use of sera from many healthy subjects for any assay measuring IgG subclass concentrations. As new groups of immunodeficiencies are defined and potential therapies are advocated, careful attention to assay standardization will result in a clearer delineation of these disease groups and of their response to treatment.

Child↗