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Biomedical subjects

C A Brooks

Publications and source records attributed to C A Brooks.

At least 19 recordsLinked to original sources
PubMed2001

The use of proxies in community integration research.

OBJECTIVE: To assess the level of agreement between persons with various disabilities and their proxies in reporting community integration outcomes using the Craig Handicap Assessment and Reporting Technique (CHART). DESIGN: Reliability study. SETTING: Participants living in the community for a minimum of 6 months after onset of disability or completion of inpatient rehabilitation. PARTICIPANTS: Persons (n = 983) with disability resulting from amputation, burn, multiple sclerosis, spinal cord injury (SCI), stroke, or traumatic brain injury and their self-selected proxies. INTERVENTIONS: Telephone interview of subjects (FIM instrument, CHART); proxies (CHART). FIM instrument assesses the degree of assistance with physical and cognitive subscales; CHART measures community integration in 6 subscales: physical, cognitive, and economic independence, and mobility, social integration, and occupation. MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICCs) were used to assess participant-proxy agreement, and stepwise multiple regressions were used to identify patterns of difference in agreement based on disability type and demographic variables. RESULTS: Thirty-seven of the 38 items examined for the entire sample yielded moderate to strong ICCs. Multiple regression analyses indicated that proxies overrated participants with severe functional cognitive disabilities on the mobility subscale (p < .001), overrated participants with less than a high school education on the total CHART score (p < .01), and underrated participants with SCIs on the occupation subscale (p < .01). Differences in all cases, however, were less than 6 points out of a possible score of 100 per subscale. CONCLUSIONS: Participant-proxy agreement across the 6 disability groups provided evidence in support of the inclusion of proxy data for persons with various types of disabilities in community integration research.

Adult↗
PubMed2001

Religion in the clinic: the role of physician beliefs.

BACKGROUND: Although studies have identified physician beliefs that may cause them to avoid spiritual topics in the clinic (eg, lack of time), it is unknown to what extent these beliefs predict behavior. The purpose of the present study was to identify physician beliefs about religion and medicine that predict attention to religious issues in the clinic. METHODS: The study was cross-sectional and correlational. Seventy-eight physicians completed a self-report survey of religious behavior in the clinic and beliefs about religion and medicine. RESULTS: Most physicians do not initiate religious discussions with patients, though a majority accept a link between religion and health. Physician personal discomfort with addressing religious topics was the sole multivariate predictor of clinical religious behavior. Time, role definition, health relevance of religion, and physician religiousness were not significant predictors. CONCLUSIONS: Avoidance of religion in the clinic may be primarily belief-based. Future research is needed to examine the role of medical education in creating and/or maintaining these beliefs.

Ambulatory Care↗
PubMed2000

Time for an overhaul.

Explore the source record for details and available documents.

Health Services Needs and Demand↗
PubMed1999

The effect of tidal volumes on the time to wean persons with high tetraplegia from ventilators.

STUDY DESIGN: Retrospective review of patient medical records comparing the outcomes of two groups of individuals with high-level (C3-4) tetraplegia- those with high-volume and those with low-volume mechanical ventilation. OBJECTIVES: To determine if higher volume mechanical ventilation contributes to faster weaning from the ventilator with fewer complications in individuals with ventilator dependent high-level tetraplegia. SETTING: A Model Spinal Injury Center, located in Colorado, USA, which treats patients referred from throughout the Rocky Mountain region as well as other states. METHODS: The medical records of 42 individuals with ventilator dependent C3-4 tetraplegia, admitted consecutively to the Rocky Mountain Regional Spinal Injury System between 1983 and 1993, were reviewed. All had required full-time mechanical ventilation upon admission, but had successfully weaned by discharge. They were divided into two groups that differed with respect to the ventilator tidal volumes used during their treatment and weaning: a large volume group (> 20 mls/kg of body weight) and a smaller volume group (< 20 mls/kg of body weight). RESULTS: Though the two groups were equivalent in neurological level and completeness, muscular function, initial spontaneous vital capacity, the weaning method used (T-piece), and final spontaneous vital capacity, those in the large tidal volume group successfully weaned an average of 21 days faster than the lower tidal volume group (37.6 days vs 58.7 days, P=0.02). They also had significantly less atelectasis (P=0.01) than the lower tidal volume group. CONCLUSION: This research suggests that the use of higher ventilator tidal volumes may speed up the weaning process and lessen respiratory complications. Because of the potential for this to decrease the length and cost of the rehabilitation programs for persons with high-level tetraplegia, further large-scale research is needed to verify these single-center findings.

Adolescent↗
PubMed1997

Traumatic brain injury: designing and implementing a population-based follow-up system.

Craig Hospital and the Colorado Department of Public Health and Environment began designing a population-based follow-up system for persons with traumatic brain injury (TBI) in 1994. With funding from the Centers for Disease Control and Prevention, the Colorado TBI Follow-up System addresses the issue, "What happens to persons with TBI after they are discharged from the hospital?" Two methods of data collection are used, medical record review and annual telephone surveys to gather long-term outcomes. The design calls for following all persons hospitalized with severe TBI (defined as any person with inpatient rehabilitation and/or with an Abbreviated Injury Scale [AIS] score for the head of 3 or greater) and a 20% random sample of persons hospitalized with less severe TBI. An expert panel was used to select variables for retrospective abstracting and prospective interviewing. Information obtained from medical records includes data verifying eligibility, diagnoses, radiological results, circumstances of injury, and severity of injury, as well as demographic data. The interview instrument includes questions and scales related to health status, disability, handicap, quality of life, and service utilization. Both methods of data collection have been pilot-tested and are now used routinely in the Colorado TBI Follow-up System.

Brain Injuries↗
PubMed1997

A call to action. Violent deaths are preventable when information is available.

Collecting these variables, along with routine EMS data, will enhance analysis of the interpersonal violence problem. To assume that this information will be obtained further along in the health-care delivery chain jeopardizes its validity, since there is a likelihood that the story may change. Surveillance or ongoing data collection allow for better estimates and enhanced knowledge about the cost of violence to the health-care system. Timely data are needed to identify important shifts in injury patterns, as well as newly emerging problems. For example, a community may observe an increase in the use of baseball bats as weapons. That information could become vital to prevention. As EMS providers, you are in a unique position to augment public-health surveillance of interpersonal violence by virtue of the fact that you are often the first on scene and can collect data that may not be routinely collected. Without this type of information, planning, implementation and evaluation of successful violence prevention reduction efforts continue to present a major challenge to public health systems.

Adolescent↗
PubMed1996

Cost of traumatic spinal cord injury in a population-based registry.

This prospective study examines a population based cohort of 115 Coloradans identified as having an acute traumatic spinal cord injury by the Spinal Cord Injury Early Notification System in 1989. Comprehensive medical cost and complication data were collected for the first 2 years of survival. Unlike previous cost studies, this group represents the broad spectrum of spinal cord injured persons, reflected in a truly population based sample. Nearly 22 million dollars were spent during the first 2 years post injury on behalf of these Coloradans. Care provided to the 27 persons with Frankel A, B or C tetraplegia accounted for $10.9 million (50%); $7.6 million (35%) was spent providing care for the 36 people with Frankel A, B or C paraplegia; and the remaining $3.3 million (15%) was required for services provided to the 52 persons who had resolved to either Frankel D or E at acute care discharge. Of the $6.3 million that was spent post hospital discharge, $2.5 million (39%) is directly attributable to in-home care, and another $2.0 million (32%) is directly attributable to secondary medical complications. The most expensive complications occurred in the neurological, skin, respiratory and orthopedic body systems.

Colorado↗
PubMed1993

Supporting operational decision making.

The collection and processing of information is a source of power. This fact is true especially in the health care industry. The apparent lack of information related to operational decisions in the health care industry is cause for concern. Data envelopment analysis (DEA) provides information regarding efficiency of resource utilization. This article reports on the use of DEA to measure relative technical efficiency of nursing units and the level of association between efficiency scores and the presence of selected operational characteristics. We found a statistically significant association between efficiency and two of the selected characteristics. Although nursing units are used to illustrate the application of the technique, DEA can be applied to any operational unit of a health care organization. However, we conclude that information systems and a minimum data set are essential to optimizing utilization of a such techniques.

Data Collection↗
PubMed1993

Preparative chromatographic purification of cyclosporine metabolites.

Polar and primary metabolites of cyclosporin A (CsA) have successfully been isolated by a novel separation protocol. An efficient, easy-to-scale-up chromatographic adsorption/desorption operation recovers polar and primary CsA metabolite pools from large volumes of urine; purified CsA metabolites are subsequently obtained by high-resolution preparative elution chromatography of the semipurified metabolite pools. Separations performed on a semipreparative scale [with a 250 x 9.4 mm (i.d.) reversed-phase HPLC column] yielded microgram quantities of CsA metabolites at > 97% purity, as determined by fast atom bombardment mass spectrometry. These separations also yielded two previously unreported CsA metabolites, similar to AM1A but with an additional hydroxylation. The yield of metabolites was increased to several milligrams by performing the separations with a preparative-scale [250 x 21.2 mm (i.d.)] reversed-phase column. The production rate of purified primary CsA metabolites was greatly increased by performing the separation with the preparative-scale column under conditions of severe mass overloading. In a single chromatographic run, we successfully isolated 11.0 and 5.0 mg of AM1 and AM1c, respectively, at a purity of > 97%. As expected, this increase in the yield of purified metabolites was accompanied by a decrease in the overall recovery. This separation scheme enables the rapid processing of large volumes of urine for isolation of the milligram quantities of CsA metabolites necessary to assess their biological activity. The procedure is applicable to small- or large-scale metabolite isolation and provides a ready source of purified metabolites for in vitro and whole-animal studies.

Amino Acid Sequence↗
PubMed1992

Assessment of the in vivo immunosuppressive activity of the major cyclosporine metabolite by leukemia allograft rejection.

AM1 (M17) is the major metabolite of cyclosporine found in the blood of human transplant recipients, and trough levels of this derivative exceed those of the parent compound approximately two-fold. Studies performed in vitro indicate that AM1 retains only 10-20% of the biological activity of the parent compound, but very little is known about its in vivo immunosuppressive effects. We therefore developed a rapid and sensitive method, based on the rejection of allogeneic L1210 (H-2d) leukemia cells by C57BL/6 (H-2b) mice, to assess the immunosuppressive activity of AM1 in vivo. Rejection of the leukemia allograft was determined by analyzing the spleens from mice injected intravenously with 10(5) L1210 cells for the presence of H-2Kd-positive cells by flow cytometry using an FITC-conjugated monoclonal anti-H-2Kd antibody. Nonimmunosuppressed mice rejected the allogeneic cells and survived indefinitely. Spleens from these mice were virtually free of H-2Kd-positive cells (0.51 +/- 0.21%) by day 7. In contrast, C57BL/6 mice treated with 10 mg/kg/day s.c. of CsA all died from the L1210 challenge (mean survival time of 9 +/- 1 days). Spleens from mice treated in this manner contained 11.02 +/- 3.31% H-2Kd-positive cells on day 7. There was a direct correlation between the dose of CsA administered (7.5-50 mg/kg/day) and the percentage of H-2Kd-positive cells in the spleen. We then compared the immunosuppressive activity of AM1 and CsA in this model. AM1 was purified from the urine of CsA-treated renal allograft recipients by a combination of preparative adsorption-desorption chromatography and preparative elution high-performance liquid chromatography. AM1 at a dose of 10 mg/kg/day exhibited no demonstrable immunosuppressive effect, and trough levels of AM1 on day 7 were only 36 +/- 4 ng/ml. Increasing the dose of AM1 to 50 mg/kg/day resulted in only 1.05 +/- 0.16% H-2Kd-positive cells in the spleens (P = NS) and a mean trough level of 221 +/- 27 ng/ml. In contrast, mice treated with 50 mg/kg/day of CsA exhibited 17.7 +/- 2.9% H-2Kd-positive cells in their spleens and a mean trough CsA level of 3036 +/- 277 ng/ml. The half-life of a single subcutaneous dose of 10 mg/kg of AM1 (4.6 hr) was significantly shorter than that of CsA (9.7 hr) in mice. Compared with CsA, the lack of immunosuppressive effect of AM1 in vivo therefore appears to be due to a combination of decreased immunosuppressive activity and increased rate of clearance in mice.

Animals↗
PubMed1991

Impairment, disability, handicap and medical expenses of persons aging with spinal cord injury.

Data from 205 Craig Hospital patients with spinal cord injuries (SCI) were analysed with regard to level of injury, age, length of time since SCI, disability (as measured by the Functional Independence Measure), handicap (as measured by the Craig Handicap Assessment and Reporting Technique), and average annual costs for services relating to the SCI. Differences in disability, handicap, and costs of care were analysed by chronological age and length of time since injury. Older individuals showed significant increases in disability and handicap. When chronological age was added to the number of years post-injury, significant increases in disability, handicap, and costs of care were noted at all neurological levels.

Adolescent↗
PubMed1989

A seroepidemiologic survey of the prevalence of herpes simplex virus type 2 infection in the United States.

The prevalence of infection with the genital herpes simplex virus type 2 (HSV-2) has been difficult to ascertain, primarily because of the large percentage of subclinical cases and the limitations in specificity of serologic assays for antibody to HSV-2. To obtain an improved estimate of the distribution of HSV-2 infection in the United States, we used an HSV type-specific antibody assay to test serum samples from 4201 participants in the second National Health and Nutrition Examination Survey. The results in our sample indicate that in the period from 1976 to 1980, 16.4 percent of the U.S. population 15 to 74 years of age (approximately 25 million persons) was infected with HSV-2 (95 percent confidence interval, 14.2 to 18.6 percent). Age and race were the demographic factors associated most strongly with the presence of HSV-2 antibody. The prevalence of the antibody increased from less than 1 percent in the group under 15 years old to 20.2 percent in the group 30 to 44 years old; it increased only slightly thereafter. In the oldest group, 60 to 74 years of age, the prevalence was 19.7 percent in whites and 64.7 percent in blacks. Among blacks of all age groups, but not whites, higher rates were observed in women than in men. The associations were weaker with respect to marital status, income, education, urban residence, and region of the country. After control for age, sex, and race, only the association with marital status remained significant; the rate was increased in persons previously married--i.e., divorced, separated, or widowed. We conclude that the prevalence of HSV-2 infection in the United States is higher than has previously been recognized and that many infections with this sexually transmitted virus may be subclinical.

Adolescent↗