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Biomedical subjects

C Fowler

Publications and source records attributed to C Fowler.

At least 19 recordsLinked to original sources
PubMed1999

Can nurses screen all outpatients? Performance of a nurse based model.

PURPOSE: This paper outlines and evaluates a nurse based model for screening outpatients that is utilized in our free standing Surgical Day Care Centre (SDCC). METHODS: For 668 outpatients presenting at our SDCC, the attending anesthesiologist completed a study survey that was designed to identify: completeness of history; important concerns as judged by the pre-admission nurse; whether the patient was seen in the anesthesia preadmission clinic (PAC) for a consultation; if there was a delay in SDCC, the duration and reasons for the delay; whether in the opinion of the attending anesthesiologist the patient should have had an anesthetic consultation; whether the patient was canceled and the reason for cancellation. RESULTS: A nurse based model for screening all outpatients in a university affiliated tertiary hospital day care unit had an accuracy of 81%, specificity of 86%, sensitivity of 46% and a negative predictive value of 92%. The cancellation rate with this model was 1.4%(8/551) and the case delay rate was 3.4%(19/551). The referral rate to anesthesiology staff was 17.5%(117/668) and the referral rate to the PAC for anesthetic consultation was 5.1%(34/668). CONCLUSIONS: The use of the nurse based model allowed for the efficient use of anesthesia and surgical day care centre resources. The model was better at 'ruling out' patients who do not need to be seen by anesthesiology ahead of the day of surgery rather than 'ruling in' patients who need to be seen by anesthesiology.

Adult↗
PubMed1999

Early and late reversal of rocuronium and vecuronium with neostigmine in adults and children.

UNLABELLED: We investigated the influence of the timing of neostigmine administration on recovery from rocuronium or vecuronium neuromuscular blockade. Eighty adults and 80 children were randomized to receive 0.45 mg/kg rocuronium or 0.075 mg/kg vecuronium during propofol/fentanyl/N2O anesthesia. Neuromuscular blockade was monitored by train-of-four (TOF) stimulation and adductor pollicis electromyography. Further randomization was made to control (no neostigmine) or reversal with 0.07 mg/kg neostigmine/0.01 mg/kg glycopyrrolate given 5 min after relaxant, or first twitch (T1) recovery of 1%, 10%, or 25%. Another eight adults and eight children received 1.5 mg/kg succinylcholine. At each age, spontaneous recovery of T1 and TOF was similar after rocuronium and vecuronium administration but was more rapid in children (P < 0.05). Spontaneous recovery to TOF0.7 after rocuronium and vecuronium administration in adults was 45.7 +/- 11.5 min and 52.5 +/- 15.6 min; in children, it was 28.8 +/- 7.8 min and 34.6 +/- 9.0 min. Neostigmine accelerated recovery in all reversal groups (P < 0.05) by approximately 40%, but the times from relaxant administration to TOF0.7 were similar and independent of the timing of neostigmine administration. Recovery to T1 90% after succinylcholine was similar in adults (9.4 +/- 5.0 min) and children (8.4 +/- 1.1 min) and was shorter than recovery to TOF0.7 in any reversal group after rocuronium or vecuronium administration. Recovery from rocuronium and vecuronium blockade after neostigmine administration was more rapid in children than in adults. Return of neuromuscular function after reversal was not influenced by the timing of neostigmine administration. These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated. IMPLICATIONS: These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated. Although spontaneous and neostigmine-assisted recovery is more rapid in children than in adults, in neither is return of function as rapid as after succinylcholine administration.

Adult↗
PubMed1999

Reflective meniscometry: a non-invasive method to measure tear meniscus curvature.

AIMS: To devise a method to measure tear meniscus curvature by a non-invasive specular technique. METHODS: A photographic system was devised. The system consisted of a camera and an illuminated target with a series of black and white stripes oriented parallel to the axis of the lower tear meniscus. The target was mounted on a flash gun close to the objective of a Brown macrocamera and calibrated using a graduated series of glass capillaries of known diameter, ground down to expose the inner wall. It was then applied to normal human eyes (n = 45) to measure the tear meniscus curvature. A video system was also assessed which provided qualitative online information about the tear meniscus. RESULTS: Using the photographic system, measured values for capillary radii were in excellent agreement with theoretical calculations (r2 = 0.996, p < 0.0001). The radii of curvature of lower tear menisci in normal human subjects (mean 0.365 (SD 0.153) mm, range 0.128-0.736; n = 45) were similar to those reported in the literature. Both systems demonstrated variations in meniscus shape. The video system provided stable images of human menisci over prolonged periods of time and promises to be useful for the analysis of dynamic changes in meniscus volume. CONCLUSIONS: Reflective meniscometry is a non-invasive technique providing quantitative information about tear meniscus shape and volume and of potential value in the study of ocular surface disease.

Calibration↗
PubMed1999

US probes: risk of cross infection and ways to reduce it--comparison of cleaning methods.

After their use at ultrasonography (US) in the intensive therapy unit, probes were used to directly inoculate blood agar plates before and after various cleaning procedures. The uncleaned probes transmitted large numbers of clinically important microbes. Simple cleaning methods were effective in reducing transmission among certain patients: fit patients, double paper wipe; patients at risk of contracting infection, single paper wipe followed by alcohol wipe; patients with a potential source of infection, single paper wipe followed by alcohol wipe.

Bacteria↗
PubMed1999

[Consensus on the diagnosis of multi-system atrophy].

We report the results of a consensus conference on the diagnosis of multiple system atrophy. We describe the clinical features of the disease, which include four domains: autonomic failure/urinary dysfunction, parkinsonism and cerebellar ataxia, and corticospinal dysfunction. We set criteria to define the relative importance of these features. The diagnosis of possible multiple system atrophy requires one criterion plus two features from separate domains. The diagnosis of probable multiple system atrophy requires the criterion for autonomic failure/urinary dysfunction plus poor levodopa responsive parkinsonism or cerebellar ataxia. The diagnosis of definite multiple system atrophy requires pathological confirmation.

Diagnosis, Differential↗
PubMed1998

Consensus statement on the diagnosis of multiple system atrophy. American Autonomic Society and American Academy of Neurology.

We report the results of a consensus conference on the diagnosis of multiple system atrophy (MSA). We describe the clinical features of the disease, which include four domains: autonomic failure/urinary dysfunction, parkinsonism and cerebellar ataxia, and corticospinal dysfunction. We set criteria to define the relative importance of these features. The diagnosis of possible MSA requires one criterion plus two features from separate domains. The diagnosis of probable MSA requires the criterion for autonomic failure/urinary dysfunction plus poor levodopa responsive parkinsonism or cerebellar ataxia. The diagnosis of definite MSA requires pathological confirmation.

Antiparkinson Agents↗
PubMed1998

A comparison of bone scintigraphy and MRI in the early diagnosis of the occult scaphoid waist fracture.

OBJECTIVE: To determine the accuracy of MRI in the assessment of the radiographically occult scaphoid fracture. DESIGN: This prospective study compared the sensitivity and specificity of MRI for detection of radiographically occult scaphoid fractures with bone scintigraphy (BS), the currently accepted imaging modality of choice. Consecutive patients with clinical signs of a scaphoid injury but no evidence of fracture on plain radiographs at presentation and after 7-10 days were evaluated by MRI and BS. All images were reported in masked fashion and the sensitivities and specificities of the imaging modalities determined. All patients with a scaphoid fracture demonstrated by MRI or BS were followed for at least a year after injury. PATIENTS: Forty-three subjects (aged 12-74 years) had both MRI and BS carried out on average 19 days from the injury date. RESULTS AND CONCLUSIONS: Six patients (14%) had scaphoid waist fractures. There were other bony injuries in a further six. In 40 patients there was agreement between the BS and MRI findings. In three cases there was discrepancy between the imaging modalities; in all three MRI was found to be the more sensitive and specific. MRI could become the investigation of choice for this injury.

Adolescent↗
PubMed1998

TBJ murine neuroblastoma resists dibutyryl cyclic AMP-induced differentiation and effects on metalloproteinase secretion.

BACKGROUND: Nonmetastatic C1300 murine neuroblastoma and TBJ, a metastatic variant, exhibit different mechanisms of metastasis and invasion. METHODS: In this study, they were examined for response to 1 mmol/L dibutyryl cyclic AMP in vitro. RESULTS: (1) dCAMP induced morphological differentiation in 20% to 40% of C1300 cells, whereas TBJ resisted differentiation. (2) Untreated TBJ expressed 92-kDa metalloproteinase, whereas C1300 expressed none. These results were not affected by dCAMP. (3) Growth curves of untreated C1300 and TBJ were exponential. Dibutyryl CAMP induced a plateau in C1300 growth that was confirmed by increased S-phase cells by cell cycle analysis. CONCLUSIONS: TBJ growth was unaffected by dCAMP. Apoptosis, as assayed by Hoechst-merocyanine staining test, was not involved in the growth plateau.

Animals↗
PubMed1998

Evaluation of the EyeSys model II computerized videokeratoscope. Part I: Clinical assessment.

PURPOSE: To compare the agreement and repeatability of keratometry measurements with simulated keratometry measurements from the EyeSys (model II) corneal analysis system (CAS). Furthermore, to establish any relationship between the repeatability of peripheral corneal measurements and the spatial location at the cornea. METHODS: Measurements using a Bausch & Lomb keratometer in 19 eyes (19 subjects) were compared with the simulated keratometry values using the EyeSys CAS. Repeatability of the keratometer (14 eyes, 14 subjects) and the EyeSys simulated keratometry values (10 eyes, 10 subjects) was assessed by comparing the difference of two measurements. Peripheral repeatability of the EyeSys CAS was compared in a similar manner in a sample of 10 eyes (10 subjects). RESULTS: The 95% confidence limits (-0.529 to +0.149 D) showed a lack of agreement between both instruments. With respect to the repeatability, both the keratometer (SD = +/- 0.103 D) and the EyeSys (SD = +/- 0.072 D) were found to exhibit approximately similar degrees of repeatability. The repeatability of peripheral corneal measurements using the EyeSys CAS showed changes in repeatability dependent on the corneal meridian and the distance from the point of alignment. Measurements along the superior and nasal meridians showed poorest repeatability. Repeatability was also found to deteriorate away from the point of alignment. CONCLUSIONS: EyeSys simulated keratometry values were not interchangeable with the keratometer. This could be due to differences in the method of alignment or measurements from different areas on the corneal surface. Repeatability of both the Bausch & Lomb keratometer and the EyeSys CAS was found to be similar. The spatial dependency of peripheral corneal radius repeatability measurements could be attributed to interference of the ocular adnexa in those areas of measurement.

Cornea↗
PubMed1998

Evaluation of the EyeSys model II computerized videokeratoscope. Part II: The repeatability and accuracy in measuring convex aspheric surfaces.

PURPOSE: To evaluate the precision and repeatability of a Placido disc-based computerized videokeratoscope, using convex surfaces of varying eccentricities and apical radii designed to simulate the range of topographical variations of the human cornea, rather than the purely spherical surfaces used in most previous studies. METHODS: Form Talysurf analysis was used to verify the exact form of 12 Perspex convex surfaces. The EyeSys model II videokeratoscope was used to measure the sagittal radii of curvature twice at known points on each surface. The raw data tables were analyzed to assess the repeatability and accuracy for both central and peripheral points on each surface. The relationship between these factors and the eccentricity was investigated. RESULTS: For central radii the instrument showed high correlation (r = 0.996) between actual and measured values. There was a small instrumental bias of +0.042 mm and the 95% limits of agreement were narrow (+0.121 to -0.037 mm), indicating clinically acceptable accuracy. The accuracy decreased slightly as the p-value decreased (greater peripheral flattening). For peripheral radii, the overall accuracy compared well to central radii, with an average bias of +0.022 mm and maximum error in 95% of cases 0.083 mm (bias +1.96 x SD). However, for surfaces where p = 0.50, the bias was +0.049 and maximum error in 95% of cases 0.110 mm. Repeatability for the aspheric surfaces was shown to be high (SD +/- 0.01 mm in all quadrants). CONCLUSIONS: The accuracy of the EyeSys corneal analysis system (CAS) in measuring central and peripheral radius of curvature was shown to be dependent on the shape of the surface to be measured. For more rapidly flattening surfaces, a decrease in accuracy was found for both central and peripheral radius of curvature, which in clinical terms is thought acceptable.

Cornea↗
PubMed1998

Recent trends in progressive power lenses.

Despite having been first marketed in the 1950s, new designs of progressive addition spectacle lens continue to appear. Some of the recent patent literature is reviewed on the design of such lenses. As well as a number of improvements to general purpose designs, specifically to include aspheric surfaces for the distance portion of progressive lenses, the literature includes a recent patent on an improved version of the Alvarez lateral translation lens system. The optimisation of single vision lens forms in order to extend the depth of field for early presbyopes is also discussed.

Aged↗
PubMed1998

Assessing transitional phenomena with the transitional object memory probe.

Winnicott's concept of transitional relatedness has captured the interest of psychoanalysts because it provides an understanding of the dialectical process occurring between inner and outer reality, and by extension, between analyst and analysand. Clinical observations related to transitional phenomena have led the authors to develop a projective early memory probe that assesses transitional phenomena. The transitional object early memory probe was tested both for its empirical validity and for its clinical utility in psychodynamic psychotherapy. Construct validity was assessed by comparing memory scores to the Rorschach Transitional Object Scale, as well as to therapist ratings of patient behaviors. Results demonstrated moderate correlations between early memory scores and Rorschach scale scores. Equally important was the finding that early memory scores were significantly correlated with therapist ratings of key behavioral patterns in therapy. A case vignette highlights the clinical application of the transitional object probe in assessing the capacity for transitional relatedness. In this case, the data gleaned from the patient's memories provided the therapist with a sharper focus on their role in the patient's growing capacity for more vital and creative contact with reality.

Adult↗
PubMed1997

Affect regulation and affective experience: individual differences, group differences, and measurement using a Q-sort procedure.

This article describes the development of, and preliminary findings with, the Affect Regulation and Experience Q-Sort (the AREQ), an observer-based assessment of affect regulation and experience. In Study 1, 31 clinicians provided Q-sort descriptions of 90 patients. Factor scores correlated in predicted ways with criteria such as suicide attempts and hospitalizations, as well as with clinicians' ratings of functioning in a variety of domains. Correlations between prototype Q-sorts and actual Q-sort profiles for patients sharing a diagnosis (dysthymia, borderline personality disorder, and narcissistic personality disorder) also provided evidence for convergent and discriminant validity. The data also suggested the importance of distinguishing 2 kinds of negative affect that have very different correlates. Study 2 showed that the AREQ can be applied reliably using an interview that avoids many of the problems of self-report.

Adult↗