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Biomedical subjects

D Goodwin

Publications and source records attributed to D Goodwin.

At least 19 recordsLinked to original sources
PubMed2006

What defines expertise in regional anaesthesia? An observational analysis of practice.

BACKGROUND: Published work on knowledge in regional anaesthesia has focused on competence, for instance by identifying numbers of procedures required to achieve competence, or by defining criteria for successful performance of blocks. We aimed to define expertise in regional anaesthesia and examine how it is acquired. METHODS: We observed anaesthetists performing 15 regional anaesthetic blocks and analysed the resulting transcripts qualitatively and in detail. RESULTS: Expertise in regional anaesthesia encompasses technical fluency but also includes non-cognitive skills such as handling of the patient (communicating, anticipating and minimizing discomfort) and recognizing the limits of safe practice (particularly deciding when to stop trying to insert a block). Such elements may be underplayed by the experts who possess them. Focusing on a small number of regional anaesthetic procedures in detail (as is standard with such qualitative analytical approaches) has also allowed us to develop a model for the acquisition of expertise. In this model, trainees learn how to balance theoretical and practical knowledge by reflection on their clinical experiences, an iterative process which leads to the embedding of knowledge in the expert's personal repertoire of individual techniques. CONCLUSIONS: Expertise in regional anaesthesia extends beyond competence at technical performance; non-cognitive elements are also vital. Further work is needed to test our learning model, and the hypothesis that learning can be enhanced by deliberate promotion of the tacit elements of 'expertise' we have described.

Anesthesia, Conduction↗
PubMed2006

Adverse events in anaesthetic practice: qualitative study of definition, discussion and reporting.

BACKGROUND: This study aimed to explore how critical and acceptable practice are defined in anaesthesia and how this influences the discussion and reporting of adverse incidents. Method. We conducted workplace observations of, and interviews with, anaesthetists and anaesthetic staff. Transcripts were analysed qualitatively for recurrent themes and quantitatively for adverse events in anaesthetic process witnessed. We also observed departmental audit meetings and analysed meeting minutes and report forms. RESULTS: The educational value of discussing events was well-recognized; 28 events were discussed at departmental meetings, of which 5 (18%) were presented as 'critical incidents'. However, only one incident was reported formally. Our observations of anaesthetic practice revealed 103 minor events during the course of over 50 anaesthetic procedures, but none were acknowledged as offering the potential to improve safety, although some were direct violations of 'acceptable' practice. Formal reporting appears to be constrained by changing boundaries of what might be considered 'critical', by concerns of loss of control over formally reported incidents and by the perception that reporting schemes outside anaesthesia have purposes other than education. CONCLUSIONS: Despite clear official definitions of criticality in anaesthesia, there is ambiguity in how these are applied in practice. Many educationally useful events fall outside critical incident reporting schemes. Professional expertise in anaesthesia brings its own implicit safety culture but the reluctance to adopt a more explicit 'systems approach' to adverse events may impede further gains in patient safety in anaesthesia.

Anesthesia↗
PubMed2003

Making monitoring 'work': human-machine interaction and patient safety in anaesthesia.

This study aimed to explore the use of electronic monitoring within the context of anaesthetic practice. We conducted workplace observation of, and interviews with, anaesthetists and other anaesthetic staff in two UK hospitals. Transcripts were analysed inductively for recurrent themes. Whilst formal sources of knowledge in anaesthesia deal with the issue of monitoring in terms of theoretical principles and performance specifications of devices, anaesthetists in practice often 'disbelieve' monitoring information. They call on and integrate other sources of knowledge about the patient, especially from their clinical assessment. The ability to distinguish 'normal' and 'abnormal' findings is vital. Confidence in electronic information varies with experience, as does the degree to which electronic information may be considered 'redundant'. We conclude that electronic monitoring brings new dimensions of understanding but also the potential for new ways of misunderstanding. The tacit knowledge underlying the safe use of monitoring deserves greater acknowledgement in training and practice.

Anesthesia, General↗
PubMed2003

Expertise in practice: an ethnographic study exploring acquisition and use of knowledge in anaesthesia.

BACKGROUND: Expert professional practice in any field is known to rely on both explicit (formal) and tacit (personal) forms of knowledge. Current anaesthetic training programmes appear to favour explicit knowledge and measurable competencies. We aimed to describe and explore the way different types of knowledge are learned and used in anaesthetic practice. METHOD: Qualitative approach using non-participant observation of, and semi-structured interviews with, anaesthetic staff in two English hospitals. RESULTS: The development of expertise in anaesthesia rests on the ability to reconcile and interpret many sources of knowledge--clinical, social, electronic, and experiential--and formal theoretical learning. Experts have mastered technical skills but are also able to understand the dynamic and uncertain condition of the anaesthetized patient and respond to changes in it. This expertise is acquired by working with colleagues, and, importantly, by working independently, to develop personal routines. Routines mark the successful incorporation of new knowledge but also function as a defence against the inherent uncertainty of anaesthetic practice. The habits seen in experts' routines are preferred ways of working chosen from a larger repertoire of techniques which can also be mobilized as changing circumstances demand. CONCLUSIONS: Opportunities for developing expertise are linked to the independent development of personal routines. Evidence-based approaches to professional practice may obscure the role played by the interpretation of knowledge. We suggest that the restriction of apprenticeship-style training threatens the acquisition of anaesthetic expertise as defined in this paper.

Anesthesia↗
PubMed2002

Foraging enrichment for stabled horses: effects on behaviour and selection.

The restricted access to pasture experienced by many competition horses has been linked to the exhibition of stereotypic and redirected behaviour patterns. It has been suggested that racehorses provided with more than one source of forage are less likely to perform these patterns; however, the reasons for this are currently unclear. To investigate this in 4 replicated trials, up to 12 horses were introduced into each of 2 identical stables containing a single forage, or 6 forages for 5 min. To detect novelty effects, in the first and third trials the single forage was hay. In the second and fourth, it was the preferred forage from the preceding trial. Trials were videotaped and 12 mutually exclusive behaviour patterns compared. When hay was presented as the single forage (Trials 1 and 3), all recorded behaviour patterns were significantly different between stables; e.g. during Trial 3 in the 'Single' stable, horses looked over the stable door more frequently (P<0.001), moved for longer (P<0.001), foraged on straw bedding longer (P<0.001), and exhibited behaviour indicative of motivation to search for alternative resources (P<0.001) more frequently. When a previously preferred forage was presented as the single forage (Trials 2 and 4) behaviour was also significantly different between stables, e.g in Trial 4 horses looked out over the stable door more frequently (P<0.005) and foraged for longer in their straw bedding (P<0.005). Further study is required to determine whether these effects persist over longer periods. However, these trials indicate that enrichment of the stable environment through provision of multiple forages may have welfare benefits for horses, in reducing straw consumption and facilitating the expression of highly motivated foraging behaviour.

Animal Feed↗
PubMed2001

Effects of treatment intensification with hydroxyurea in HIV-infected patients with virologic suppression.

BACKGROUND: Virologic rebound can result from suboptimal antiviral potency in combination antiretroviral therapy. DESIGN: Multicenter, partially blinded, prospective, randomized study of 202 HIV-infected subjects to determine whether therapy intensification improves long-term rates of virologic suppression. METHODS: Subjects had plasma HIV RNA < 200 copies/ml, CD4 cell count of > 200 x 10(6) cells/l, and treatment with indinavir (IDV) + zidovudine (ZDV) + lamivudine (3TC) for at least 6 months before randomization to stay on this regimen or to receive IDV + didanosine (ddI) + stavudine (d4T) plus or minus hydroxyurea (HU) (600 mg twice daily). Treatment failure was defined as either confirmed rebound of HIV RNA level to > 200 copies/ml or a drug toxicity necessitating treatment discontinuation. RESULTS: Treatment failure occurred more frequently in subjects randomized to the HU-containing arm (32.4%), than in those taking IDV + ddI + d4T (17.6%) or IDV + ZDV + 3TC (7.6%). The time to treatment failure was shorter for the HU-containing arm compared with the IDV + ZDV + 3TC (P < 0.0001) or IDV + ddI + d4T arms (P = 0.032). Dose-limiting toxicities rather than virologic rebound accounted for the differences between treatment failure among the study arms. Pancreatitis led to treatment discontinuation in 4% of subjects in treatment arms containing ddI + d4T. Three subjects with pancreatitis died, all randomized to the HU-containing arm. CONCLUSIONS: Switching to IDV + ddI + d4T + HU in patients treated with IDV + ZDV + 3TC was associated with a worse outcome, principally because of drug toxicity.

Adolescent↗
PubMed2001

Management strategies and financial performance in rural and urban hospitals.

This study identifies the difference in financial performance between rural and urban hospitals and examines whether or not that difference may be attributed to the emphasis of revenue enhancement over cost management strategies. Hospitals in Virginia were included in this study except for the two state university medical centers. Rural and urban hospitals were compared on 10 performance indicators grouped into four categories: revenues, costs, profits, and productivity. The results suggest that rural hospital profitability is dependent on cost management. Since rural hospitals achieved lower cost, better efficiency and productivity level than urban hospitals in Virginia, they demonstrate a significant higher level of profit.

Analysis of Variance↗
PubMed2001

Functional magnetic stimulation facilitates colonic transit in rats.

OBJECTIVE: To investigate the effect of functional magnetic stimulation (FMS) on colonic transit in rats. DESIGN: Experimental. SETTING: Functional magnetic stimulation laboratory in a Veterans Administration health care system. ANIMALS: Twenty-four female Wistar rats, divided into an experimental group and a control group. INTERVENTIONS: All rats had technetium 99m (Tc 99m) infused through a cecal catheter to assess colonic transit times. FMS was performed over the cervical region; a figure of 8 magnetic coil was used in the experimental group. The colon was removed and sectioned into 10 segments, and a stool sample was taken in both groups. MAIN OUTCOME MEASURES: Distribution of radioactivity within the large intestine and stool were measured. RESULTS: Geometric center calculations showed significant differences (p <.001) between the control group and the experimental group when the distribution of radioactivity along the colon was measured. The percentage of Tc 99m recovered from the stool in the experimental group was significantly higher than the percentage recovered from the control group. CONCLUSION: FMS facilitates colonic transit in a rat model.

Animals↗
PubMed2000

Treatment of leg telangiectasia by using a long-pulse dye laser at 595 nm with and without dynamic cooling device.

BACKGROUND AND OBJECTIVE: The long-pulse dye laser (PDL) at 595 nm and pulse duration of 1.5 msec has been shown to improve clearance of larger vessels such as those seen in leg telangiectasia. The objectives of this study are twofold. First, to determine the effect of the dynamic cooling device (DCD) in clearance of leg telangiectasia by using a long-pulse PDL at 595 nm. Next, to determine the effect of the DCD in reducing transient discomfort associated with treatment and in reducing epidermal damage (blistering, hyper/hypopigmentation, scarring) caused by the laser. STUDY DESIGN/MATERIALS AND METHODS: Matched treatment sites were compared at energy densities of 20 and 24 J/cm(2) with and without the use of the cryogen spray in 18 patients. In areas treated without the DCD, the laser pulse was delivered through a single layer of Spenco Second Skin. Patients received two treatments 6 weeks apart. Discomfort ratings, clearance of leg telangiectasia, and complications were assessed at 6 weeks, 12 weeks, and 6 months. RESULTS: A reduction in discomfort ratings was found in most patients using the DCD. Six-month follow-up data revealed at the 20 J/cm(2) treatment sites, with or without the DCD, 76.9% showed greater than 50% clearance. At the 24 J/cm(2) treatment sites, with or without the DCD, 84.6% showed greater than 50% clearance. CONCLUSION: The long-pulse dye laser at 595 nm with a 1.5-msec pulse duration cleared leg telangiectasia an average of 67.5% with two treatments at 6 months. The major effect of the DCD was on pain reduction. There was no difference in clearance rates when using the DCD vs. cooled Second Skin. Further studies with longer cooling times with the DCD are needed to optimize treatment parameters.

Adult↗
PubMed1999

Determination of behavioural traits of pure-bred dogs using factor analysis and cluster analysis; a comparison of studies in the USA and UK.

The questionnaire survey of Hart and Hart (1985, Journal of the American Veterinary Medical Association 186, 1811-1815) ranked the 56 most popular breeds of dog in the USA on 13 behavioural traits and is compared here with results of a similar survey conducted on the 49 most popular breeds in the UK. Of the 36 breeds in common between the studies, 24 were similar for the traits aggressivity, reactivity and ease of housetraining between the two countries. However, the characteristics of nine breeds (Airedale Terrier, Old English Sheepdog, Welsh Corgi, Irish Setter, Standard Poodle, Beagle, Samoyed, Boxer, Dalmatian) differed markedly between the two countries, and a further three (Chihuahua, Scottish Terrier, Standard Dachshund) showed smaller, but probably meaningful, shifts. These differences should be recognised when giving advice to prospective owners, and when treating unwanted behaviour in these breeds.

Aggression↗
PubMed1999

The importance of ethology in understanding the behaviour of the horse.

Domestication has provided the horse with food, shelter, veterinary care and protection, allowing individuals an increased chance of survival. However, the restriction of movement, limited breeding opportunities and a requirement to expend energy, for the benefit of another species, conflict with the evolutionary processes which shaped the behaviour of its predecessors. The behaviour of the horse is defined by its niche as a social prey species but many of the traits which ensured the survival of its ancestors are difficult to accommodate in the domestic environment. There has been a long association between horses and man and many features of equine behaviour suggest a predisposition to interspecific cooperation. However, the importance of dominance in human understanding of social systems has tended to overemphasize its importance in the human-horse relationship. The evolving horse-human relationship from predation to companionship, has resulted in serial conflicts of interest for equine and human participants. Only by understanding the nature and origin of these conflicts can ethologists encourage equine management practices which minimise deleterious effects on the behaviour of the horse.

Animal Husbandry↗
PubMed1999

Posteromedial tibial plateau injury including avulsion fracture of the semimembranous tendon insertion site: ancillary sign of anterior cruciate ligament tear at MR imaging.

PURPOSE: To evaluate posteromedial tibial plateau injuries of or about the semimembranous tendon insertion site and their association with anterior cruciate ligament (ACL) tears on magnetic resonance (MR) images. MATERIALS AND METHODS: A retrospective study of MR images and conventional radiographs was performed in 10 patients with posteromedial tibial plateau injuries, including avulsion fractures of the semimembranous tendon insertion site. Associated abnormalities were analyzed, including ACL tears, medial meniscal tears, and other lateral femorotibial compartment injuries. Findings from the clinical history and physical examination were correlated with radiographic and MR imaging findings. Nine patients had arthroscopically or surgically documented ACL tears. RESULTS: All 10 patients had ACL tears at MR imaging. Five patients had posteromedial tibial plateau fractures: Four had avulsion fractures of the tendon insertion site, and one had a fracture lateral to the site. Five patients had posteromedial tibial plateau bruises: Two had bruises at the tendon insertion site. Five patients had tears of the posterior horn of the medial meniscus. Two patients had posterior meniscocapsular separations. Three patients showed evidence of the O'Donoghue triad. Six patients had bruises of the lateral tibial plateau and of the lateral femoral condyle. CONCLUSION: There appears to be an association between posteromedial tibial plateau injuries and ACL tears. Posteromedial tibial plateau injuries may be predictive of ACL status.

Adolescent↗
PubMed1996

A survey of the behavioural characteristics of pure-bred dogs in the United Kingdom.

One-hundred-and-twelve small animal veterinarians and 56 dog care professionals were asked to rate the behavioural characteristics of 49 breeds of dog, and to compare males and females by means of a 13-point questionnaire. From their replies, factor analysis was used to extract three underlying traits, labelled aggressivity, reactivity and immaturity. On the basis of these traits, eight groups of breeds were derived. Membership of these groups did not correspond exactly with any of the four existing breed classification systems (Mégnin, the Fédération Cynologique International, ancient breeds and Kennel Club of Great Britain), but significant differences between Kennel Club groups were found on all three traits. Male dogs were rated higher than females on both aggressivity and immaturity; the components of reactivity were also rated higher in males, apart from the demand for affection which was rated higher in females. Females were also considered easier to train than males.

Analysis of Variance↗
PubMed1996

Food selection by the domestic cat, an obligate carnivore.

The domestic cat Felis silvestris catus is the most accessible member of the family Felidae for the study of the relationship between food selection and nutrition. In contrast to pack-living animals such as the dog, and opportunistic omnivores such as the rat, the cat is generally able to maintain its normal body weight even when allowed ad libitum access to palatable food by taking small meals and adjusting intake according to the energy density of the food(s) available. The most extreme adaptations to carnivory discovered to date lie in the taste buds of the facial nerve, which are highly responsive to amino acids and unresponsive to many mono- and disaccharides. Preferences for particular foods can be modified by their relative abundance, their novelty, and by aversive consequences such as emesis: the mechanisms whereby these are brought about appear to be similar to those used by omnivorous mammals.

Animal Nutritional Physiological Phenomena↗
PubMed1996

Ventral sacroiliac ligament. Anatomic and pathologic considerations.

RATIONALE AND OBJECTIVES: The ventral sacroiliac ligament (VSL), which bridges the sacroiliac (SI) joint anteriorly, has been described as an important stabilizing structure of the joint, but no data exist regarding its assessment with routine and advanced imaging methods. The authors determine the imaging appearance of the normal and abnormal VSL using close anatomic-histologic-imaging correlation. METHODS: Eight and 10 cadaveric SI joints were examined with magnetic resonance imaging in axial and coronal planes, respectively; and in four computed tomography scanning in both planes was obtained. Anatomic sectioning with histologic correlation at levels corresponding to those of imaging planes was performed. Representative examples of diseases that produce abnormalities of the VSL and connective tissue about the SI joint were reviewed. RESULTS: Magnetic resonance images showed the VSL-anterior capsular complex as a hypointense, linear, or minimally curved structure of approximately 2 mm thickness traversing the SI joint anteriorly. The VSL could not be separated from the anterior joint capsule by imaging studies, but such differentiation by histology could be determined based upon the orientation of its collagen fibers. Any disease process that affects the ligament or the site of ligamentous attachment to bone produces characteristic imaging alterations.

Aged↗
PubMed1996

MR imaging of the tarsometatarsal joint: analysis of injuries in 11 patients.

OBJECTIVE: We evaluated how well MR imaging revealed ligamentous and bony abnormalities in patients with injuries of Lisfranc's joint. SUBJECTS AND METHODS: We evaluated the studies of 11 patients with plantar hyperflexion injuries of the foot who underwent MR imaging in all three planes using spinecho T1-weighted, fast spin-echo T2-weighted, and short inversion time inversion recovery sequences. In four of the 11 patients, a three-dimensional spoiled gradient-recalled acquisition in the steady-state volume sequence was performed in the coronal plane. For five of the 11 patients, radiographs were available for evaluation. RESULTS: Radiographs revealed tarsometatarsal joint malalignment in all five patients for whom plain films were available, metatarsal fractures in four of these patients, and tarsal fractures in the same four patients. MR imaging showed joint malalignment in all 11 patients and disruption of the Lisfranc's ligament in eight of the 11 patients. In the remaining three patients, normal Lisfranc's ligaments were associated with avulsion fractures of the second metatarsal bases or the medial cuneiform bones. On MR imaging, fractures of the metatarsal bases were evident in 10 of 11 patients. Fractures of the tarsal bones were seen in the same 10 patients. CONCLUSION: MR imaging allows the detection of disruption of the Lisfranc's ligament as well as tarsal and metatarsal fractures and therefore may be a valuable technique in assessing patients after trauma to the tarsometatarsal joints when results of routine radiographs are not conclusive.

Adult↗
PubMed1995

Complete dislocation of the knee: spectrum of associated soft-tissue injuries depicted by MR imaging.

OBJECTIVE: Complete knee dislocation is a rare injury. The purpose of this study was to evaluate the spectrum of injuries that are depicted by MR imaging in patients with a dislocation of the knee and to determine if there is any predictive factor that might indicate those patients who may be at risk for popliteal nerve injury. MATERIALS AND METHODS: A retrospective search for patients sustaining traumatic knee dislocations who had radiographs and an MR imaging examination of the knee as part of their initial evaluation was done at three level I trauma centers for the period between 1989 and 1993. Each MR examination was independently reviewed by three osteoradiologists for ligamentous, tendinous, meniscal, and osseous injuries. Equivocal diagnoses were decided by consensus. Only patients who underwent surgery were selected. MR imaging findings were confirmed at the time of surgery. Seventeen patients (15 men, two women; age range, 14-62 years; mean age, 29 years) were studied. Motor vehicle accident, fall from a height, a vehicle striking a pedestrian, and football injury were common mechanisms of injury. Posterior dislocation (seven patients) and anterior dislocation (five patients) were the most common injuries. RESULTS: At the time of surgery, all patients had complete tears of the anterior cruciate ligament, 15 had complete tears of the posterior cruciate ligament, nine had complete tears of the medial collateral ligament, and 12 had tears of the fibular collateral ligament (nine tore both the fibular collateral ligament and the biceps femoris tendon). Popliteal tendon tears occurred in eight patients (six complete, two partial). Of the six patients with complete tears of the popliteal tendon, five occurred at the musculotendinous junction; all were the result of either posterior or posterolateral dislocations. Four patients had injuries to the peroneal nerve; three of the four also had tears of the popliteal tendon. On MR imaging, the integrity of the anterior cruciate and lateral collateral ligaments was correctly depicted in all 17 patients; evaluation of the posterior cruciate ligament resulted in one false-positive and one false-negative diagnosis of a tear; evaluation of the medial collateral ligament resulted in one false-positive diagnosis of a tear; and one false-positive diagnosis of a tear occurred with evaluation of the popliteal tendon. CONCLUSION: Knee dislocations cause extensive disruption of the ligaments that stabilize the knee and the surrounding soft-tissue structures, including the popliteal artery. Nearly all will result in disruption of the cruciate ligments and, often, injury of the collateral ligaments. An injury to the popliteal tendon denotes a more severe injury. The mechanism of injury that results in a popliteal tendon tear may also increase the possibility of a peroneal nerve injury. Recognition of this pattern of injuries on MR imaging enables precautionary observation for ischemic changes of the foot to be instituted in patients that otherwise may not be considered at risk for acute vascular compromise.

Adolescent↗