Search PubMed⌕ Search

Biomedical subjects

D W Byrne

Publications and source records attributed to D W Byrne.

17 recordsLinked to original sources
PubMed1996

Major risk factors for pressure ulcers in the spinal cord disabled: a literature review.

Pressure ulcers remain a dominant health problem for persons with spinal cord injury despite abundant published research describing risk factors. Although information on these factors is plentiful, its usefulness to the spinal cord disabled is limited by three problems. First, the sheer volume is overwhelming; more than 200 risk factors for pressure ulcers have been described in the published literature. For most health care professionals, finding, no less reading and evaluating, the hundreds of articles published on this topic would be difficult. Second, most studies focused on elderly patients in nursing homes. Pressure ulcer risk factors for the spinal cord disabled are often different from those for the elderly; yet many findings from studies of the elderly provide valuable information. Third, inadequate sample sizes often hamper the usefulness of research on the spinal cord disabled. Drawing valid conclusions from these small studies, especially concerning potential risk factors is difficult. To address these three problems, we critically evaluated the medical, nursing, and nutritional research literature that pertained to risk factors for pressure ulcer development. The purpose of this paper is to provide a review of published reports on the principal risk factors for pressure ulcers in persons with spinal cord injuries.

Humans↗
PubMed1996

Preoperative nutritional status and outcome of elective total hip replacement.

Preoperative malnutrition increases the morbidity rate and length of hospitalization for various types of surgical patients. However, among patients who undergo elective total hip replacement, it is unclear how preoperative nutritional data can be used to detect a high risk subgroup. The purpose of this study was to identify preoperative nutritional factors that could be used to define a subgroup of patients who have undergone elective total hip replacement who are at high risk for poor post-operative outcome. Preoperative nutritional factors were evaluated in 89 consecutive patients who underwent elective total hip replacement. An inverse relationship was found between serum albumin and length of stay. Patients with an albumin level less than 3.9 were twice as likely to require prolonged hospitalization ( > 15 days) when compared with those in whom the albumin level was 3.9 or greater. Complications were related to the preoperative orthopaedic diagnosis of avascular necrosis of the hip. A subgroup of the patients undergoing elective total hip replacement who are at risk for prolonged recovery can be identified preoperatively by using a serum albumin level of less than 3.9 g/dL. The traditional normal range for albumin may be inappropriate for these patients.

Adult↗
PubMed1996

Effect of gender on perinatal outcome in pregnancies complicated by diabetes.

The aim of this study was to determine whether there is a gender-related difference in the morbidity and mortality of infants of diabetic mothers. We also wanted to identify risk factors associated with adverse pregnancy outcome, and create a perinatal morbidity index. We performed a retrospective review of 107 women whose pregnancies were singleton and complicated by diabetes. The subjects were divided according to the gender of the infant. The morbidity, mortality and confounding variables between the two groups were compared. Logistic regression analysis was used to identify the independent factors associated with an adverse pregnancy outcome. The male group (n = 62) had higher morbidity than the female group (n = 45). This was due to a higher incidence of hypoglycemia (relative risk = 3.9, 95% CI 1.2-12.5, p = 0.011) and need to stay in the neonatal intensive care unit 2 or more days (relative risk = 1.8, 95% CI 1.1-2.9, p = 0.015). There was one female stillbirth due to an episode of ketoacidosis in the mother. Male gender (relative risk = 1.8, 95% CI 1.2-2.7, p = 0.002) was one of three independent predictors of poor outcome. There is a male disadvantage in infants of diabetic mothers with regards to perinatal morbidity. Advanced White's classification, male gender, and third trimester mean glucose > or = 110 mg% identify the pregnancies at risk for diabetes-related morbidity.

Female↗
PubMed1996

Comparison of umbilical Doppler velocimetry, nonstress testing, and biophysical profile in pregnancies complicated by diabetes.

The purpose of this study was to determine which test is best for predicting adverse outcomes in pregnancies complicated by diabetes: the nonstress test, biophysical profile, or umbilical artery velocimetry. We evaluated 207 singleton pregnancies complicated by diabetes within 1 week of delivery using the afore-mentioned pregnancy surveillance tests. Adverse pregnancy outcome was defined as delivery before 37 weeks of gestation or the occurrence of fetal growth restriction, hypocalcemia, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, or fetal risk requiring cesarean delivery. The prognostic value of each of the three tests was assessed, after controlling for the mothers' White classification and third trimester glycosylated hemoglobin value. Among the 207 pregnancies, 75 (36.2%) had an adverse outcome. In pregnancies in which the umbilical artery systolic to diastolic ratio was > or = 3.0, the relative risk of adverse outcome was 2.6 (95% confidence interval: 1.9-3.5, P < 0.001). For those with a biophysical profile < or = 6 the relative risk was 1.7 (95% confidence interval: 0.9-2.9, P = 0.109). Patients with a nonreactive nonstress test had a relative risk of 1.7 (95% confidence interval: 1.2-2.5, P = 0.009). Umbilical artery Doppler velocimetry was superior to either the nonstress test or the biophysical profile in identifying the subgroup of pregnancies complicated by diabetes that resulted in an adverse outcome.

Female↗
PubMed1995

Incidence of acute care complications in vertebral column fracture patients with and without spinal cord injury.

STUDY DESIGN: This study retrospectively analyzed vertebral column fractures in trauma patients during a 2-year period. Data from a multicenter trauma registry were used. OBJECTIVES: The purpose of this study was to ascertain and describe the initial in-hospital morbidity and mortality rates for patients with vertebral column fractures with and without spinal cord injury. SUMMARY OF BACKGROUND DATA: Patients with vertebral fractures and associated spinal cord injuries experience more medical complications than those without spinal cord injuries. However, the precise incidence and relative risk of complications during acute care hospitalization for these two groups are not well documented. METHODS: Vertebral column fractures in 419 adolescent and adult trauma patients hospitalized during a 2-year period were retrospectively analyzed using data from a multicenter trauma registry. RESULTS: Of the 419 patients, 104 (24.8%) had an associated spinal cord injury. More than half of the spinal cord injury patients (52.9%) and 20.6% of those without spinal cord injury had one or more complications during their hospitalization. Complications resulted in an average of 33.1 extra hospital days, which extrapolates nationally into 1.5 million additional days annually. The four complications differing most significantly in incidence between the spinal cord injury group and the non-spinal cord injury group were: urinary tract infections (24.0% vs. 8.6%), respiratory (23.1% vs. 8.6%), cardiac (11.5% vs. 3.2%), and decubitus ulcer (7.7% vs. 1.0%). Pneumonia, although not statistically different, was high in both groups (13.5% vs. 7.3%). CONCLUSIONS: The incidence of the 25 types of medical complications reported here provides specific and relevant information to assist health professionals in treating patients during their acute care. We estimate that complications during initial hospitalization add $1.5 billion annually to the cost of caring for patients with vertebral fractures in the United States.

Adolescent↗
PubMed1995

The effects of non-thermal pulsed electromagnetic energy on wound healing of pressure ulcers in spinal cord-injured patients: a randomized, double-blind study.

The objective of this randomized, double-blind study was to determine if non-thermal pulsed electromagnetic energy treatment significantly increases the healing rate of pressure ulcers in patients with spinal cord injuries. Subjects included volunteers admitted to a Veteran's Administration Hospital in New York over a 2 year period and consisted of 30 male spinal cord-injured patients, 20 with Stage II and 10 with Stage III pressure ulcers. Subjects were given non-thermal pulsed high-frequency electromagnetic energy treatment for 30 minutes twice daily for 12 weeks or until healed. The percentage of pressure ulcers healed was measured at one week. Of the 20 patients with Stage II pressure ulcers, the active group had a significantly increased rate of healing with a greater percentage of the ulcer healed at one week than the control group. After controlling for the baseline status of the pressure ulcer, active treatment was independently associated with a significantly shorter median time to complete healing of the ulcer. Stage III pressure ulcers healed faster in the treatment group but the sample size was limited. For spinal cord-injured men with Stage II pressure ulcers, active non-thermal pulsed electromagnetic energy treatment significantly improved healing.

Adult↗
PubMed1994

Laparoscopic cholecystectomy. The early experience of surgical attendings compared with that of residents trained by apprenticeship.

During our first year of laparoscopic surgery, all cases were performed by attending surgeons; resident involvement was confined to camera work and occasionally to acting as first assistant. These residents were PGY3 or -4. During our second year, these same residents, who had learned the craft in the traditional apprenticeship method, on promotion to senior resident functioned as the primary surgeon in laparoscopic cholecystectomy cases, but under very close guidance by the credentialed attending. Ninety-two cases were attempted in the first year and 100 in the second. There were no differences in age, gender, or preoperative symptoms. More than half the patients had at least one co-morbidity in addition to their gallbladder disease. More women had laparoscopic cholecystectomy soon after pregnancy in the second year, but the percent of the patients with previous surgery declined from 21.4% to 5%. There was a threefold increase in the percent of cases performed in less than two hours and there was a significant reduction in hospital length of stay in the second year. Complication rates were similar in the first and second years. Training residents to do laparoscopic cholecystectomy can be done in a traditional residency program provided the attendings are adequately trained. However, the residents need a higher level of skill at this time than was necessary for open cholecystectomy and have to be further advanced in their training in order to perform this operation laparoscopically.

Adult↗
PubMed1994

Middle cerebral to umbilical artery Doppler ratio in post-date pregnancies.

OBJECTIVE: To determine which antepartum test is the best predictor of post-date-related adverse outcome among the amniotic fluid index (AFI), nonstress test (NST), biophysical profile, or middle cerebral artery to umbilical artery Doppler ratio. METHODS: Pregnant women of 41 or more weeks' gestation with singleton fetuses and vertex presentations underwent antepartum testing twice a week. Pulsed Doppler ultrasound was used to obtain the flow velocity waveforms from the umbilical and middle cerebral arteries. Adverse post-date-related outcome was defined as the occurrence of meconium aspiration syndrome, cesarean delivery for fetal distress, or fetal acidosis. The predictive values of an AFI equal to or less than 5 cm, a biophysical profile score equal to or greater than 6, a nonreactive NST, and a middle cerebral artery to umbilical artery ratio less than 1.05 in identifying adverse outcome were compared. RESULTS: Forty-nine women met the inclusion criteria; ten (20.4%) had an adverse outcome. A middle cerebral artery to umbilical artery ratio of less than 1.05 was found to be the best predictor of adverse outcome, with a sensitivity of 80%, specificity of 95%, positive predictive value of 80%, and negative predictive value of 95%. The other three diagnostic tests had sensitivities equal to or less than 40%. The middle cerebral artery to umbilical artery ratio was also a better discriminator of adverse outcome than either the umbilical artery systolic-diastolic (S/D) ratio or the middle cerebral artery S/D ratio. CONCLUSION: Although the sample size of our study was small, the results suggest that a middle cerebral artery to umbilical artery ratio of less than 1.05 is an accurate method of predicting post-date-related adverse outcome.

Adolescent↗
PubMed1993

A study of pneumatic antishock garments in severely hypotensive trauma patients.

The effectiveness of a pneumatic antishock garment (PASG) on severely hypotensive trauma patients (BP < or = 50 mm Hg) was studied using two data sets. The first included data from eight hospitals collected over 4 1/2 years; the second included 2 years of data from an additional eight hospitals. Data were collected by trained nurse abstractors whose interrater reliability was extremely high for AIS and ISS scoring. One hundred forty-two patients had blood pressures < 50 mm Hg. The PASG patients had a higher survival rate than non-PASG patients (Pr = 0.055). The PASG appeared to have the most effect on patients with abdominal injuries since no patient with such an injury survived unless a PASG was applied. Controlling for severity using the TRISS method, z scores indicated that the survival rate in the PASG group was significantly higher than expected whereas that in the non-PASG group was similar to that predicted; the same pattern was found when blunt injury and penetrating injury patients were analyzed separately. Improvement in survival among PASG patients occurred despite an average scene time that was 4.7 minutes longer than that for non-PASG patients. No improvement in survival among PASG versus non-PASG patients with blood pressures of 50-70 mm Hg or in those with blood pressures of 90 mm Hg or less was found. We conclude that the use of PASG in severely hypotensive patients (BP < or = 50) should be considered medically acceptable pending randomized controlled studies.

Abdominal Injuries↗
PubMed1992

Comparison between TRISS and ASCOT methods in controlling for injury severity.

ASCOT was developed by Champion et al. to address known limitations to TRISS. The present research attempted to validate ASCOT using an independent trauma registry. Data were collected by the Institute for Trauma and Emergency Care (ITEC), New York Medical College, between July 1, 1987 and June 30, 1989; 5685 trauma patients admitted to three level I trauma centers or five non-trauma center hospitals were included. Information was gathered by trained nurse-abstractors using all available prehospital and hospital records. ASCOT and TRISS were compared using sensitivity, disparity, misclassification rates, and the Hosmer-Lemeshow goodness-of-fit statistics. Disparity and sensitivity rates were relatively low for both indexes, particularly among blunt injury patients. Total numbers of patients misclassified by TRISS and by ASCOT were similar; most misclassifications were made by both TRISS and ASCOT and involved nonsurvivors. Each method had advantages in predicting the outcomes of particular subgroups of patients; ASCOT with regard to predicting outcomes among patients with head injuries and in correctly classifying blunt injured patients; TRISS in correctly classifying survivors. We conclude (1) the relatively small gain in predictive accuracy by ASCOT over TRISS is largely offset by its complexity and increased computer processing requirements; (2) Hosmer-Lemeshow tests indicate that neither index provides good statistical agreement between predicted and actual outcomes among either blunt or penetrating injury patients. Future models should include additional variables, stratify patients by several injury causes, and use decision rules to select variables and variable weights.

Adult↗
PubMed1992

Association of skull base and facial fractures.

A retrospective analysis of 268 trauma patients with facial fractures who received computed tomography of the head was undertaken to assess an association with skull base fractures. The incidence of skull base fracture was compared to facial fractures of various anatomic locations. Skull base fractures were significantly increased in orbital wall/rim fractures (36.0%, P = .0823). In contrast, skull base fractures related to orbital floor (27.3%, P = .6191) and maxillary/zygomatic (29.4%, P = .1148) fractures were not significantly greater and were infrequently seen with mandible (4.0%, P = .0454) and nasal (7.7%, P = .0345) fractures. The incidence of skull base fracture was directly associated with the number of facial fractures per patient; one facial fracture (21.0%), two facial fractures (30.4%), and three or more facial fractures (33.3%) (P < .05). The incidence of skull base fractures was related to the location of facial fractures and the number of facial fractures per patient. The results provide additional clinical information to facilitate the prompt detection and diagnoses of skull base fracture.

Adult↗
PubMed1991

Survival after resection of carcinoma of the splenic flexure.

Nine hundred ten patients undergoing colectomy for colon cancer were studied retrospectively. Seventy-four cancers (8 percent) were located at the splenic flexure. The stage at presentation was no different between splenic flexure cancers and colon carcinomas at other sites. Although splenic flexure cancers had twice the incidence of obstruction as did other colon cancers and obstruction in the overall series adversely affected survival, there was no difference in survival between splenic flexure cancer patients and patients with other colon cancers.

Aged↗
PubMed1991

Limitations of the TRISS method for interhospital comparisons: a multihospital study.

The value of the TRISS method for interhospital comparisons of trauma care was studied using data for 5,616 consecutive patients from three trauma centers and five community hospitals. Z-scores were used to compare mortality rates. Three limitations of the method were documented: 1) the lack of homogeneity within the patient subcategory of penetrating injuries, specifically between patients with gunshot versus stab wounds; 2) the inability of the TRISS method to predict the survival rate of patients suffering low falls; and 3) the inability of the TRISS method to account for multiple severe injuries to a single body part. Remedies to the first two of these limitations can be addressed within the present TRISS method. A remedy for the third requires a new method.

Abbreviated Injury Scale↗
PubMed1990

Development of a computerized data base to evaluate pressure ulcers.

A computerized data base for collecting information on patients with pressure ulcers was developed following a review of selected literature including Allman (1986), Bergstrom (1987), Barbenel (1977), Reichert (1986), Black (1987) and others. The data base was piloted, revised, and used for data collection on 103 patients admitted to two hospitals. Standardized data allowed for correlations of spinal cord injury (SCI) and location of pressure ulcers. Sacral ulcers were more prevalent with patients who had SCI at C4-T1 while ischial ulcers were more common with SCI at T11-L1. Some of the other correlations differ from prior research and warrant further investigation with a larger sample size from multiple institutions.

Adult↗
PubMedDate not supplied

A new pressure ulcer risk assessment scale for individuals with spinal cord injury.

Each year, one-fourth of the 200,000 individuals with spinal cord injury in the United States develop pressure ulcers. No method currently exists, however, to accurately identify which of these individuals are at increased risk for development of pressure ulcers. We studied 219 spinal cord-injured patients, seen at a Veterans Affairs Medical Center, during a 6-yr period. Our goal was to develop a pressure ulcer risk assessment scale, specifically for persons with SCI. Each risk factor had to meet four criteria: (1) statistical association with pressure ulcer development; (2) biologically plausible mechanism; (3) literature support; (4) improved prediction. Among the 219 spinal cord-injured patients evaluated, 176 (80.4 percent) had a history of one or more pressure ulcers. Fifteen risk factors met the four criteria for inclusion into the risk assessment scale. They were as follows: restricted activity level, degree of immobility, complete spinal cord injury, urinary disease, impaired cognitive function, diabetes, cigarette smoking, residence in a nursing home or hospital, hypoalbuminemia, and anemia. Compared with the more general scales available, for quantifying the risk of pressure ulcer development, preliminary results suggest that this new scale is a significant improvement for the spinal cord-disabled.

Adolescent↗
PubMedDate not supplied

Central catheter-related infections: comparison of pulmonary artery catheters and triple lumen catheters for the delivery of hyperalimentation in a critical care setting.

We prospectively studied the risk of catheter-related sepsis (CRS) in 75 critically ill patients who received total parenteral nutrition (TPN) through 158 pulmonary artery catheters (PACs) and 214 triple-lumen catheters (TLCs). We relied on semiquantitative cultures of the catheter tips, peripheral blood cultures in febrile patients and clinical response to catheter removal to diagnose catheter-related sepsis. The infection rate was 2.5% (4/158) of PACs and 6.5% (14/214) of TLCs (p = 0.124). Colonization rates were 29.1% for PACs and 32% for TLCs. PACs were left in place a significantly shorter length of time than TLCs, 3.1 vs 5.1 days (p less than 0.005). Guidewire exchanges and subclavian vein insertions were associated with a decreased rate of CRS when compared to new insertions and internal jugular vein insertions, respectively. We conclude that pulmonary artery catheters can be used safely for the delivery of hyperalimentation in critically ill patients with no increased risk for catheter-related sepsis compared to triple-lumen catheters. The use of the PAC in this manner allows for the use of a single central venous catheter for the delivery of hyperalimentation and hemodynamic monitoring.

Adult↗