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Biomedical subjects

T M Cook

Publications and source records attributed to T M Cook.

At least 37 records · Page 2Linked to original sources
PubMed1997

An audit of hospital mortality after urgent and emergency surgery in the elderly.

An audit was carried out of 102 patients aged over 75 years undergoing urgent or emergency surgery in a district general hospital. The risk of death in hospital after general surgery (13 deaths in 49 patients) was greater than after orthopaedic surgery (two deaths in 53 patients) (P < 0.05). In particular, laparotomy carried a high in-hospital mortality: 12 of 25 patients undergoing laparotomy died. Risk of death after general surgery increased with increasing preoperative ASA class, increasing medical risk factors and duration of operation. Orthopaedic cases were fitter than the general surgical cases as determined by ASA class and the number of medical risk factors. NCEPOD has recommended increased involvement of senior medical staff in operations, reduced night-time operating and avoidance of futile surgery. A high proportion of cases were operated on and anaesthetised by higher specialist trainees and consultants. Death rate was not affected by the seniority of doctors involved, nor by the time of day the operation took place. General surgical deaths were predictable postoperatively in most cases, but preoperative prediction of outcome was not specific enough to alter management.

Aged↗
PubMed1997

Analgesia following thoracotomy: a survey of Australian practice.

This survey examines pain management after thoracotomy in Australian hospitals. Questionnaires were sent to senior thoracic anaesthetists at 27 hospitals (16 public and 11 private) with thoracic surgical units. Twenty-six anaesthetists replied and 24 responses were included in the analyses. Seventy-two percent of respondents were from hospitals with acute pain services (APS), and in 94% of these hospitals patients are reportedly visited by the APS. The most frequently used analgesic modalities are epidural analgesia, intravenous patient-controlled analgesia (IVPCA), and nurse-controlled intravenous opioid infusions. Over half of the anaesthetists reported using local anaesthetic intercostal nerve block, non-steroidal anti-inflammatory drugs (NSAIDs), or paracetamol. Combinations of analgesic techniques were cited frequently. Respondents reported that cryoanalgesia, interpleural blockade, paravertebral blockade, subarachnoid infusions, ketamine, and transcutaneous electrical nerve stimulation are used infrequently. Anaesthetists from public hospitals reported using epidural analgesia, IVPCA and NSAIDs more frequently than those from private hospitals. When epidural analgesia is used, most respondents place the catheter in the mid-thoracic region (91%), use a regimen of opioids plus local anaesthetic (96%), use a constant infusion technique (100%), and continue analgesia for up to three days (83%). Over half of the respondents reported that post-thoracotomy patients are nursed in a high-dependency area. Seventy-nine percent of respondents selected epidural analgesia as the best available analgesia technique, whereas 21% consider IVPCA to be the best. Only 75% of respondents reported that the type of analgesia they consider best is also the type which they use most frequently.

Acetaminophen↗
PubMed1996

Prevalence of abnormal median nerve conduction in applicants for industrial jobs.

There has been much debate regarding the work relatedness of carpal tunnel syndrome (CTS) and whether workers diagnosed with CTS had pre-existing disease at the time they were hired. To elucidate the latter issue, we examined the prevalence of abnormal median nerve conduction within the carpal tunnel in applicants for industrial jobs. Nerve conduction studies (NCS) were performed on both hands of 1,021 applicants following a conditional offer of employment. Each applicant completed a self-administered symptom survey specific to the upper extremity. Applicants had worked previously for an average of 4.4 (range 0-33) years and had a mean age of 30.1 (S.D. 8.9) years. Nerve conduction studies were performed in a private medical clinic. Sensory palmar latencies were determined over an 8 cm segment for the median and ulnar nerves. The difference between the median and ulnar sensory latencies was the primary electrophysiologic measurement used to determine median neuropathy. Using a very conservative criterion for abnormal median nerve conduction, 17.5% of the applicants were classified with neuropathy in at least one hand. Despite the relatively high prevalence of median neuropathy, relatively few (10%) with positive NCS acknowledged symptoms associated with CTS. Males had a higher percentage of median neuropathy than did females. We conclude that a large percentage of industrial workers have objective evidence of abnormal median nerve conduction within the carpal tunnel when hired. The high prevalence of abnormal median nerve conduction without corresponding symptoms may suggest a subclinical entity associated with CTS.

Adolescent↗
PubMed1996

Effectiveness of a physical therapy regimen in the treatment of tension-type headache.

Twenty patients with diagnosis of muscle contraction headache were treated for pain relief in a physical therapy clinic once a week for six visits. The previous 3-week period of no treatment served as a control period during which patients recorded by diary their headache frequency, duration, and intensity using a numeric pain scale. Activity level, as measured by the Sickness Impact Profile, and verbal reports of headache frequency, duration, and intensity were recorded at four points during a 1-year period. Measurements were recorded at precontrol, pretreatment, posttreatment, and 12-month follow-up. Treatment included education for posture at home and work place, isotonic home exercise, massage, and stretching to the cervical spine muscles. Results indicated frequency of headaches and Sickness Impact Profile scores were significantly improved (P < 0.001) over the course of treatment. These benefits were maintained after 12 months.

Adult↗
PubMed1996

Work-related musculoskeletal disorders among physical therapists.

BACKGROUND AND PURPOSE: Increasing evidence suggests that musculoskeletal disorders are common in workers in the United States health care industry. Physical therapists, who commonly treat patients with these disorders, are also at risk for work-related musculoskeletal disorders (WMD) in the upper limbs and low back. The purpose of this study was to determine the prevalence of WMD during a 12-month period and the job factors that may be associated with these disorders in physical therapists. SUBJECTS: A four-page questionnaire was mailed to physical therapists (N = 1,160) who attended The University of Iowa between 1943 and 1993. Nine hundred twenty-eight questionnaires were returned (80% response rate) from physical therapists in 46 states. METHODS: Based on a literature review and pilot study of physical therapists, a survey instrument was constructed consisting of a symptom survey, a job-factor survey, and various demographic information. RESULTS: The highest prevalences of WMD among physical therapists were in the following anatomical areas: low back (45%), wrist/hand (29.6%), upper back (28.7%), and neck (24.7%). The job factor rated most likely to contribute to job-related musculoskeletal disorders was "lifting or transferring dependent patients." The prevalence of WMD in physical therapists also was affected by work setting, practice specialty, age of patient, and gender of therapist. CONCLUSION AND DISCUSSION: Specific strategies should be developed to reduce WMD in the practice of physical therapy.

Adult↗
PubMed1996

Forum. An evaluation of the levering laryngoscope.

This study was undertaken to evaluate the effect of the levering laryngoscope on the view obtained at laryngoscopy. Two hundred and ten consecutive patients who required tracheal intubation were studied. The view at laryngoscopy with the levering laryngoscope blade in the neutral and elevated positions was recorded. In patients in whom there was a Cormack and Lehane grade 3 view of the larynx with the blade in the neutral position, elevation of the levered tip of the blade significantly improved the visualisation of the larynx. In patients where the view of the larynx was grade 1 or 2 with the blade in the neutral position, elevation of the levered tip often (23%) resulted in the view being impaired. This was not a clinical problem as the blade could simply be returned to the neutral position. The levering laryngoscope is a useful additional aid to laryngeal visualisation.

Adolescent↗
PubMed1996

Cricoid pressure: are two hands better than one?

One hundred and twenty patients were studied to compare the view of the larynx at laryngoscopy with one- or two-handed cricoid pressure applied. A blinded crossover technique was employed. When the grade of laryngeal view achieved with either type of cricoid pressure was compared using a 4-point scale there was no significant difference. However, when the views were compared with greater discrimination the laryngeal view achieved with one-handed cricoid pressure was significantly better than that seen with two-handed cricoid pressure. There was no significant difference between the groups in the need for a gum elastic bougie to facilitate intubation. A two-handed technique has been advocated to improve intubation conditions when cricoid pressure is required. It has several disadvantages, its efficacy has not been proven and this study suggests it does not improve the view at laryngoscopy. Two-handed cricoid pressure should no longer be advocated unless an advantage over one-handed cricoid pressure can be shown.

Adolescent↗
PubMed1996

Topical lignocaine and thiopentone for the insertion of a laryngeal mask airway; a comparison with propofol.

We assessed conditions for insertion of a laryngeal mask airway in 90 unpremedicated adult patients who received either thiopentone 5 mg.kg-1 preceded by 40 mg of topical lignocaine spray to the posterior pharyngeal wall or propofol 2.5 mg.kg-1 alone in a randomised, single-blinded trial. All patients received fentanyl 1 microgram.kg-1. Gagging, coughing and laryngospasm following laryngeal mask insertion were graded and haemodynamic data and apnoea times were recorded. There were no significant differences between the two groups with regard to the incidence of gagging, coughing and laryngospasm, but the apnoea time was significantly less in the thiopentone group (p < 0.005). The decrease in systolic and diastolic blood pressure, following induction and the insertion of a laryngeal mask with propofol was significantly greater than following thiopentone (p < 0.05--systolic, p < 0.01--diastolic). We conclude that thiopentone preceded by topical lignocaine spray provides conditions for insertion of a laryngeal mask equal to those of propofol, with more haemodynamic stability and a shorter period of apnoea.

Adolescent↗
PubMed1996

Lignocaine to aid the insertion of the laryngeal mask airway with thiopentone. A comparison between topical and intravenous administration.

Conditions for insertion of a laryngeal mask airway in 90 unpremedicated adult were patients were assessed in a randomised, single-blinded trial. Each patient received fentanyl 1 microgram.kg-1 and thiopentone 5 mg.kg-1, and this was preceded either by lignocaine 0.5 mg.kg-1 intravenously (group 1), lignocaine 1.5 mg.kg-1 intravenously (group 2) or 40 mg of topical lignocaine spray to the posterior pharyngeal wall (group 3). Conditions for laryngeal mask airway insertion were recorded. The group receiving topical lignocaine had a lower incidence of laryngospasm (p < 0.05), required fewer attempts for successful insertion of the laryngeal mask (p < 0.05) and coughed or gagged less frequently than either group receiving lignocaine intravenously (p > 0.05). Overall, the conditions for laryngeal mask airway insertion were better in the topical group (p < 0.05). There were no significant differences in haemodynamic response and apnoea between the three groups. Topical lignocaine spray prior to thiopentone provides conditions for insertion of a laryngeal mask that are superior to those provided by lignocaine and thiopentone intravenously.

Administration, Topical↗
PubMed1996

A comparison between the Macintosh and the McCoy laryngoscope blades.

The view of the larynx using the Macintosh laryngoscope and the McCoy levering laryngoscope was assessed in 177 adult patients. The view with the McCoy blade in the neutral position and in the position (neutral or elevated) that gave the 'best' view were recorded. The McCoy blade in the neutral position was associated with a lower incidence of grade 1 views and a higher incidence of grade 2 views than the Macintosh blade. There was no difference in the incidence of grade 3 views. When views for each patient using the different blades were compared, the McCoy blade in the neutral position produced a worse view than the Macintosh blade (p < 0.0001). The view obtained with the McCoy blade in its 'best' position and the Macintosh blade were similar. In the 152 patients in whom the vocal cords were seen using the Macintosh blade, the view was worse using the McCoy blade in its 'best' position more often than it was better (p = 0.06). In 25 patients, the vocal cords could not be seen with the Macintosh blade; in these patients the view was better with the McCoy blade (the cords were visible) on 14 occasions and worse in one (p = 0.001). We conclude that the McCoy blade in its neutral position does not behave identically to the Macintosh blade. The McCoy blade is a useful aid to difficult intubation but should not replace the Macintosh blade as the first choice laryngoscope.

Anesthesia, General↗
PubMed1996

Three-dimensional scapular orientation and muscle activity at selected positions of humeral elevation.

Abnormal scapular kinematics and associated muscle function presumably contribute to shoulder pain and pathology. An understanding of scapular kinematic and electromyographic profiles in asymptomatic individuals can provide a basis for evaluation of pathology. The purpose of this study was to describe normal three-dimensional scapular orientation and associated muscle activity during humeral elevation. Twenty-five asymptomatic subjects, 19-37 years old, were evaluated. Digitized coordinate data and surface electromyographic signals from the trapezius (upper and lower), levator scapulae, and serratus anterior were collected at static positions of 0, 90, and 140 degrees of humeral elevation in the scapular plane. The scapula demonstrated a pattern of progressive upward rotation, decreased internal rotation, and movement from an anteriorly to a posteriorly tipped position as humeral elevation angle increased. Electromyographic activity of all muscles studied increased with increased humeral elevation angles. Differences between mean values at all elevation angles for all variables were significant (p < .05), except for the lower trapezius between the 90 and 140 degrees humeral angles. The results of this study suggest assessment of scapular tipping and internal rotation as well as upward rotation may be necessary to understand pathologies of the shoulder that are related to abnormal scapular kinematics.

Adolescent↗