Papers by James Rowbottom
The Spine Journal, 2003
The quadriceps receives it innervation from the L3 and L4 nerve roots, therefore quadriceps weakn... more The quadriceps receives it innervation from the L3 and L4 nerve roots, therefore quadriceps weakness may be a consequence of L3 or L4 radiculopathies. To date, there are no standardized and validated methods to evaluate quadriceps strength in the clinical office setting. This may lead to inconsistent detection of quadriceps weakness caused by an L3 or L4 radiculopathy. This study evaluated four office tests of quadriceps strength in symptomatic adults with radiographic evidence of L3 or L4 nerve root compression. Each test was evaluated for its ability to detect weakness (when compared to the asymptomatic side), as well as inter-rater reliability. In addition, to determine the potential influence of radicular pain on the performance of the four tests, a control group of patients over the age of 40 with clinical and radiographic L5 or S1 radiculopathies underwent identical testing of quadriceps strength. METHODS: Thirty-three consecutive patients with L3 or L4 radiculopathies and 19 patients with L5 or S1 radiculopathies (controls) were studied. The L3 and L4 subjects consisted of 17 males and 16 females with a mean age of 59, duration of symptoms of 2.8 months, back pain VAS score of 3.7, leg pain of 5.5, and Oswestry score of 34%. The L5 and S1 control subjects consisted of 9 males and 10 females with a mean age of 51, duration of symptoms of 2.7 months, back pain VAS score of 3.7, leg pain of 5.5 and Oswestry score of 38%. The four tests of quadriceps strength included: single leg sit-to-stand test; step-up test, knee-flexed manual muscle testing (MMT); and knee-extended MMT. The above four tests were performed by two examiners to measure inter-rater reliability. RESULTS: Quadriceps weakness as detected by one or more tests was noted for 22 (67%) of the subjects with L3 or L4 radiculopathies, and in only 1 (5%) of the control subjects with L5 or S1 radiculopathies. The single leg sit-to-stand test detected all but two cases of unilateral quadriceps weakness, with those cases detected by knee-flexed MMT . DISCUSSION: In L3 and L4 radiculopathies, unilateral quadriceps weakness was best detected by a single leg sit-to-stand test. As the results of this test are based on successful performance of this maneuver, inter-rater reliability was high. Subjects of similar age with radicular pain caused by L5 or S1 radiculopathies could perform this test, suggesting that pain inhibition was not a major factor affecting the test's results. CONCLUSIONS: Clinicians should consider utilizing the single leg sitto-stand test for assessing quadriceps strength in cases of L3 and L4 radiculopathies.
Journal of the Association for Vascular Access, 2014
ABSTRACT Background Current peripheral intravenous catheter (PIV) first attempt success averages ... more ABSTRACT Background Current peripheral intravenous catheter (PIV) first attempt success averages 47%, complications 47%, and dwell time 44 hours. Multiple intravenous (IV) access lines requiring replacement during each admission result in poor satisfaction and unnecessary costs. With 2011 Infusion Nursing Society standards allowing IV lines to dwell until complication, there is incentive to explore improvement opportunities. Purpose A new, proprietary coiled tip guidewire PIV was compared with conventional IV catheters in adult patients. The experimental IV catheter was projected to have a higher rate of successful placement on first attempt, fewer complications, longer dwell times, higher completion of therapy, higher user satisfaction, and lower overall costs than conventional catheters. Methods Adult patients requiring nonemergent IV catheters provided consent and were enrolled and randomized. The study, conducted over 4 months, included 248 patients (experimental IV group n = 123, conventional IV group n = 125). Results Experimental IV first attempt success was 89% compared with 47% for the conventional catheter. Fifty percent of conventional IV placements required a second attempt. Experimental IV complications occurred 8% of the time and complications occurred with the conventional catheter 52% of the time. Completion of therapy was 89% with the experimental IV versus 34% with the conventional IV (P < .001). Dwell time improved with the experimental IV (mean 4.4 days [105 hours] vs conventional IV at 1.5 days [35 hours]) (P < .001). Overall patient satisfaction using a 5-point Likert scale scored an average of 4.5 with the experimental IV compared with the conventional IV, which scored 3. Conclusions A new, proprietary coiled tip guidewire-delivered PIV demonstrated clear superiority over the conventional catheter in our study. Clinical outcome results showed statistically significant improvements in first attempt success, complications, completion of therapy, dwell time, and overall patient satisfaction.
Seminars in Arthroplasty, 2012
The cemented all-polyethylene acetabular component has almost completely been replaced by the cem... more The cemented all-polyethylene acetabular component has almost completely been replaced by the cementless porous-coated acetabular component. A variety of different designs, incorporating several types of porous coatings, have proven to be reliable and durable. The ability to reposition a cementless cup to optimize component orientation allows the joint replacement surgeon to minimize impingement and maximize component stability. This is essential to prevent dislocation and damage to bearing surface of the acetabular component. Insertion of a hemispherical cementless cup with 1 mm of underreaming typically allows for secure interference fit, good apposition of the implant to the underlying bone, an insignificant risk of pelvic fracture, and a rare risk of ingrowth failure. Semin Arthro 23:163-166
Spine, 2009
Prospective, randomized, double-blind study. To evaluate intravenous corticosteroids in preventin... more Prospective, randomized, double-blind study. To evaluate intravenous corticosteroids in preventing delayed extubation after multilevel corpectomy and strut graft reconstructive procedures and to identify risk factors for delayed extubation in these patients. We performed a prospective, randomized double-blind study in patients undergoing multilevel cervical corpectomy procedures. Our hypothesis was that high-dose perioperative steroids would decrease edema and thus decrease the incidence of delayed extubation. We studied patients undergoing 2- or 3-level anterior cervical corpectomy procedures with anterior strut graft reconstruction. Sixty-six patients were randomized to receive 3 doses of either intravenous dexamethasone (n = 35) or saline (n = 31). The first dose was given before the incision, with subsequent doses given 8 and 16 hours later. Patients remained intubated until postoperative day 1, at which time a cuff leak test was performed by the anesthesiology attending. If a leak was present, the patient was extubated. If not, the test was repeated each postoperative day until a leak was present, indicating a patent airway. Five of 35 (14%) in the steroid group and 6 of 31 (19%) in the saline group required delayed extubation (P = 0.22). There were no statistical differences in preoperative parameters of age, gender, diagnosis, smoking history, BMI, number of operative levels, or preoperative American Society of Anesthesiologists rating between the 2 groups. Similarly there were no differences between the groups for duration of anesthesia, intraoperative colloids or crystalloids, intraoperative blood loss, or intraoperative urine output. The data for both groups were pooled to evaluate risk factors for delayed extubation. The only statistically significant risk factor for delayed extubation in this study was female gender (P = 0.0001). Based on our data, we cannot recommend intravenous dexamethasone for prevention of delayed extubation after multilevel anterior cervical corpectomy and strut grafting procedures.
Anesthesiology Clinics, 2012
The clinician caring for patients in the immediate postoperative period must maintain a high inde... more The clinician caring for patients in the immediate postoperative period must maintain a high index of suspicion for the development of complications. Evolving illness manifests itself throughout the continuum of care and must be recognized and aggressively managed to ensure optimal outcome. This article discusses common hemodynamic problems encountered in the postanesthesia care unit. These problems are presented in a clinical framework that is familiar to experienced practitioners and recognizable to trainees. This article reviews of these common problems including relevant physiologic principles; effects on hemodynamics; and a logical approach to evaluation, monitoring, and management of a complex postoperative patient.
Plastic and Reconstructive Surgery, 2012
Patients undergoing abdominal wall reconstruction are at risk of developing major postoperative r... more Patients undergoing abdominal wall reconstruction are at risk of developing major postoperative respiratory complications. The authors attempted to identify factors predictive of respiratory complications following abdominal wall reconstruction. All patients who underwent complex abdominal wall reconstruction over a 2-year period were reviewed. The primary endpoint studied was severe respiratory complication, defined as respiratory insufficiency requiring intubation or transfer to a higher level of care. Sixty patients underwent complex abdominal wall reconstruction during the study period. The incidence of respiratory complications was 20 percent. Factors predictive of postoperative respiratory complication included age (p = 0.05), American Society of Anesthesiologists score (p = 0.04), and hernia defect size (p = 0.01). In addition, patients who developed respiratory complications were more likely to have had a greater change in plateau pressure (5.8 versus 2.3 cmH(2)O; p = 0.01). The greater the change in plateau pressure, the greater the risk of developing a respiratory complication: for a change in plateau pressure greater than or equal to 6 cmH(2)O, the odds ratio was 8.67; for a change in plateau pressure greater than or equal to 9 cmH(2)O, the odds ratio was 11.5. Respiratory complications following abdominal wall reconstruction can be serious and are associated with prolonged hospitalizations. Patients with an increase in their plateau pressure of greater than 6 cmH(2)O are at an increased risk of severe postoperative respiratory complications.
Military Medicine, 2013
Information access at the point of care presents a different set of requirements than those for t... more Information access at the point of care presents a different set of requirements than those for traditional search engines. Critical care in remote (e.g., battle field) and rural settings not only requires access to clinical guidelines and medical libraries with surgical precision but also with minimal user effort and time. Our development of a graphical, anatomy-driven navigator called Visual Navigator for Surgical Information Access (VINSIA) fulfills the goal for providing evidence-based clinical decision support, specifically in perioperative and critical care settings, to allow rapid and precise information access through a portable stand-alone system. It comes with a set of unique characteristics: (a) a high precision, interactive visual interface driven by human anatomy; (b) direct linkage of anatomical structures to associated content such as clinical guidelines, literature, and medical libraries; and (c) an administrative content management interface allowing only an accredited, expert-level curator to edit and update the clinical content to ensure accuracy and currency. We believe that the deployment of VINSIA will improve quality, safety, and evidence-based standardization of patient care.
Journal of the American College of Surgeons, 2010
Journal of Spinal Disorders & Techniques, 2006
Airway difficulties after single-stage, multilevel anterior and posterior cervical surgery are po... more Airway difficulties after single-stage, multilevel anterior and posterior cervical surgery are potentially life-threatening complications. Although extubation delays can occur, overnight intubation can reduce the risk of postoperative airway emergencies. Our protocol was as follows: all patients were kept intubated overnight in an intensive care unit and examined by the intensive care unit staff each morning. Readiness for extubation was based on the cuff-leak test, and extubation done on patients beyond the first postoperative day was considered delayed. Eleven patients were extubated on the first postoperative day (group 1), and 11 extubated beyond day 1 (group 2). No airway emergencies occurred. Patient factors-age, weight, smoking, medical comorbidities, American Society of Anesthesiologist class-were not significantly related to extubation delay. There were no differences between groups in the number of anterior and posterior levels or anterior and posterior operative times. Delayed extubation was significantly related to total operative time (8.2 hours vs. 10.6 hours), volume of crystalloid replacement (3,627 cm3 vs. 6,218 cm3) and intraoperative blood transfused (0.7 units vs. 3.1 units); approaching significance was increased blood loss (1,238 mL vs. 2,820 mL). We have found intraoperative factors-operative time, crystalloid volume, blood loss and replacement-rather than patient characteristics, to be risk factors for delayed extubation. Good communication with anesthesia staff and careful attention to postoperative airway management is essential after single-stage, multilevel anterior cervical decompression and posterior fusion.
Intensive and Critical Care Nursing, 2012
Background: Determining the optimal timing and progression of mobility exercise has the potential... more Background: Determining the optimal timing and progression of mobility exercise has the potential to affect functional recovery of critically ill adults. This study compared standard care with care delivered using a mobility protocol. We examined the effects of exercise on vital signs and inflammatory biomarkers and the effects of the nurse-initiated mobility protocol on outcomes.
CHEST Journal, 2010
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Plastic and reconstructive surgery, Jan 8, 2016
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Papers by James Rowbottom