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Biomedical subjects

J McElligott

Publications and source records attributed to J McElligott.

6 recordsLinked to original sources
PubMed1999

Asymptomatic patients at high risk for deep venous thrombosis who receive inadequate prophylaxis should be screened.

BACKGROUND: Patients after stroke and major orthopedic surgery have increased factors for developing deep vein thrombosis. We sought to determine the implications of screening high-risk patients to detect proximal deep vein thrombosis. METHODS: We used decision analysis to determine the implications of screening vs not screening asymptomatic high risk patients with duplex ultrasonography to detect proximal deep venous thrombosis. The outcomes were bleeding, pulmonary embolism, death, and number of patients with true-positive, false-positive, and false-negative tests. RESULTS: Screening with ultrasonography, all asymptomatic patients who receive appropriate prophylaxis, prevalence 5%, would result in the treatment of 3.1% patients with proximal deep vein thrombosis (true positives); 2.9% without proximal deep vein thrombosis (false positives) and in the lack of diagnosis in 1.9% patients (false negatives). At a prevalence of 20%, no prophylaxis, screening would result in the treatment of 12.4% patients with proximal deep vein thrombosis (true positives), 2.4% without proximal deep vein thrombosis (false positives), and in the lack of diagnosis in 7.6% of patients (false negatives). CONCLUSIONS: Screening high-risk patients who receive prophylaxis is not warranted. Patients who receive no prophylaxis should be screened with ultrasonography.

Anticoagulants↗
PubMed1992

Identification of preventable trauma deaths: confounded inquiries?

The published evaluation of methods for identifying preventable trauma deaths contains many unstudied confounding factors. To investigate the reliability of methods for identifying such preventable deaths, we compared three consensus systems using separate five-member general review panels assessing 20 non-central nervous system fatalities: panel A, independent judgments; panel B, discussion of all cases preceding individual judgments; and panel C, independent judgments followed by discussion and equivocal case reassignment. The Kappa concordance index was low for all methods (method A, 0.20; methods B and C, 0.40). Of the 11 deaths judged preventable by at least one panel, only one death was judged preventable by all three panels. Consensus agreement (four of five assessors) was 20% for panel A, 45% for panel B, and 10% for panel C (difference between panels B and C, p less than 0.03). In panel C, discussion affected the rate of equivocal case designation from 30% to 5%. Thus different consensus methods yielded different results. We conclude that individual case review can be severely flawed and therefore should not be used to measure institutional quality of patient care. We recommend that assessment of institutional performance should be based on objective evaluation methods, which require the study of patient population outcomes, rather than on subjective methods in which individual cases are reviewed.

Confounding Factors, Epidemiologic↗
PubMed1991

Behavioral disturbances in children after trauma.

The psychological effects of nonneurologic trauma on children are poorly recognized. We hypothesized that physical trauma in children, with or without head injury, would result in substantial and persistent psychological and behavioral abnormalities. Using a short telephone survey followed by a detailed behavioral checklist, we studied psychobehavioral dysfunction in children who had experienced trauma either with or without minor head injury (n = 40 each) as well as in a comparative group of children after emergency appendectomy (n = 80). Substantial behavioral disability was identified by the detailed checklist in 35% and 28% of children without and with head injury, respectively, but in none after appendectomy. Dysfunctions included phobias, major scholastic difficulties, rage attacks, and episodic depression that continued for a long period. Even in the 67% of children who eventually fully recovered, the duration of symptoms after the time of injury was an average of 19 months. Demographics, socioeconomic status, severity of injury, and length of hospitalization did not correlate with dysfunction, and these traumatized children's siblings had no reported history of trauma or psychological difficulties. Thus, parental opinion about behavioral dysfunction appears sensitive and specific and is therefore a useful screening index. These results suggest that injured children, even after minor trauma, may suffer substantial and long-lasting behavioral changes to a degree hitherto unrecognized.

Appendectomy↗
PubMed1989

Low back injury in industry: the value of a recovery program.

Low back pain is the most frequent chronic disabling condition in the United States in patients younger than 45 years, and it is the second largest cause of employee absenteeism. In this retrospective study involving extreme working conditions at an industrial plant, we found that 20% of all employees incurred a back injury (occupational and nonoccupational) during the 12-month study period, costing more than 5,000 days of work lost, and approximately $920,000. Based on these findings a three-phased program of education/prevention, physical therapy, and an on-site rehabilitation workshop was implemented. After the first operational year, the net saving to the corporation was $255,000, and all employees who participated in the program returned to work within 60 days. We conclude that good job design, employee education on back injury prevention, and immediate on-site rehabilitation for injuries incurred can reduce employee disability and lost work time thus benefiting the employer and employee alike.

Absenteeism↗
PubMed1987

Splenic rupture at colonoscopy.

We report splenic rupture a few hours after a colonoscopy. Even though the patient had no previous history of splenic injury or symptoms attributable to splenocolonic adhesions, exploration revealed adhesions between the spleen and the colon at the level of the splenic flexure. Pathological examination revealed capsular thickening and fibrosis. Splenocolonic adhesions may lead to potentially lethal rupture of the spleen. A careful history prior to endoscopy should rule out pathological conditions that may lead to formation of adhesions between the spleen and the colon. In addition, the endoscopist should consider splenic rupture after colonoscopy in the patient who develops abdominal pain and acute anemia without evidence of intestinal perforation or external bleeding.

Colonoscopy↗