Biomedical subjects

Gerald McGwin

Publications and source records attributed to Gerald McGwin.

At least 37 records · Page 2Linked to original sources

PubMed2006

Bovine polymerized hemoglobin versus Hextend resuscitation in a swine model of severe controlled hemorrhagic shock with delay to definitive care.

To compare the efficacy of low-volume resuscitation with bovine polymerized hemoglobin (HBOC-201) versus hetastarch (HEX) in an intermediate severity combat-relevant hemorrhagic shock swine model with a simulated delay to hospital care. Twenty-four anesthetized pigs were hemorrhaged 55% estimated blood volume in conjunction with a 5-min rectus abdominus crush. At 20 min, pigs were resuscitated with 10 mL/kg of HBOC-201 or HEX or nothing (NON); resuscitated pigs received additional infusions (5 mL/kg) at 30, 60, 120, or 180 min if hypotension or tachycardia persisted. Pigs were monitored for a 4-h "prehospital" period. At 4-h, hospital arrival was simulated: surgical sites were repaired, blood, or saline provided, and pigs were recovered from anesthesia. Pigs were monitored for 72 h and then killed for histological evaluation. One hundred percent (8/8) of HBOC-201-, 75% (6/8) of HEX-, and 25% (2/8) of NON-resuscitated pigs survived to 72 h (P = 0.007 overall, HBOC vs. HEX P > 0.05). Mean arterial pressure and mean pulmonary arterial pressure were highest in the HBOC-201 group (P < 0.001), and HR was lowest (P < 0.001). HBOC-201- and HEX-resuscitated pigs had comparable cardiac index and prehospital fluid requirements. HBOC-201 pigs had higher transcutaneous tissue oxygen tension, P < 0.001) and lower urine output (P < 0.001). At simulated hospital arrival, no HBOC-201 pigs required additional fluids or blood transfusion. In contrast, 100% of HEX pigs required blood transfusions (P < 0.01). In this swine model of controlled hemorrhage with low-volume resuscitation and delayed definitive care, HBOC-201 pigs had improved hemodynamics, transcutaneous tissue oxygen tension, and transfusion avoidance compared with HEX.

Animals↗

PubMed2006

Negative pressure wound therapy to treat hematomas and surgical incisions following high-energy trauma.

PURPOSE: To evaluate the use of negative pressure wound therapy (NPWT) to augment healing of surgical incisions and hematomas after high-energy trauma. MATERIALS: This study is a prospective randomized evaluation of NPWT in trauma patients, randomizing patients with draining hematomas to either a pressure dressing (group A) or a VAC (group B). Additionally, patients with calcaneus, pilon, and high-energy tibial plateau fractures were randomized to either a standard postoperative dressing or a VAC over the sutures. RESULTS: There were 44 patients randomized into the hematoma study. Group A drained a mean of 3.1 days, compared with only 1.6 days for group B. This difference was significant (p=0.03). The infection rate for group A was 16%, compared with 8% in group B. An additional 44 patients have been randomized into the fracture study. Again, a significant difference (p=0.02) was present when comparing drainage in group A (4.8 days) and group B (1.8 days). No significant difference was present at current enrollment for infection or wound breakdown. DISCUSSION: NPWT has been used on many complex traumatic wounds. Potential mechanisms of action include angiogenesis, increased blood flow, and decreased interstitial fluid. This ongoing randomized study has demonstrated decreased drainage and improved wound healing following both hematomas and severe fractures.

Adult↗

PubMed2006

Vasoactivity of bovine polymerized hemoglobin (HBOC-201) in swine with traumatic hemorrhagic shock with and without brain injury.

BACKGROUND: We previously reported that bovine polymerized hemoglobin (HBOC- 201) improved outcome in swine with hemorrhagic shock (HS) with and without traumatic brain injury (TBI). Herein, we add analyses of blood pressure (BP) responses, associated physiologic data, and HS fluid infusion guidelines. METHODS: HBOC-201 versus standard fluid resuscitation was compared in four anesthetized invasively monitored swine models: moderate controlled HS, severe controlled HS, severe uncontrolled HS (liver injury), and severe uncontrolled HS/TBI (liver/parietal brain injuries). Pigs received fluid for hypotension and tachycardia, and were followed up to 6 (HS alone) or 72 hours (HS/TBI). The change in mean arterial pressure (DeltaMAP) response severity was stratified and analyzed based on infusion number and HS severity, using Student's t and Fisher's exact tests. RESULTS: HBOC-201 vasoactivity resulted in higher MAP in all studies. Among HBOC-201 pigs, DeltaMAP responses were significant for the first two infusions and inversely related to HS severity. Among controls, DeltaMAP responses remained significant through the fourth infusion in controlled HS models, and through the first in severe uncontrolled HS/TBI; none were significant in severe uncontrolled HS. DeltaMAP was higher with HBOC-201 through the first infusion in moderate controlled HS, the fifth in severe uncontrolled HS, and the second in severe uncontrolled HS/TBI; there were no group differences in severe controlled HS. No severe MAP responses occurred. Higher DeltaMAP severity did not impact outcome. Hypotension satisfied fluid reinfusion criteria less consistently than tachycardia. Overall, HBOC-201 improved physiologic parameters and survival without causing hypoperfusion; in severe HS, perfusion improved. CONCLUSIONS: In swine with HS +/- TBI, HBOC-201 had mild to moderate vasoactivity, resulting in significant DeltaMAP responses mainly after initial infusions, no severe/adverse responses, and improved outcome. Our data suggest that use of physiologic parameters (e.g., tachycardia), in addition to hypotension to guide fluid reinfusion during HS resuscitation with HBOC-201, will minimize hypoperfusion risk and maximize potential benefit.

Animals↗

PubMed2006

Can high-risk older drivers be identified through performance-based measures in a Department of Motor Vehicles setting?

OBJECTIVES: To evaluate the relationship between performance-based risk factors and subsequent at-fault motor vehicle collision (MVC) involvement in a cohort of older drivers. DESIGN: Prospective cohort study. SETTING: Motor Vehicle Administration (MVA) field sites in Maryland. PARTICIPANTS: Of the 4,173 older drivers invited to participate in the study, 2,114 individuals aged 55 to 96 agreed to do so. These analyses focus on 1,910 individuals recruited through MVA field sites. MEASUREMENTS: Gross Impairment Screening Battery, which included Rapid Pace Walk, Head/Neck Rotation, Foot Tap, Arm Reach, Cued Recall, Symbol Scan, Visual Closure subtest of the Motor Free Visual Perception Test (MVPT), Delayed Recall, and Trail Making Test with an Abbreviated Part A and standard Part B; Useful Field of View (UFOV) subtest 2; a Mobility Questionnaire; and MVC occurrence. RESULTS: In drivers aged 55 and older with intact vision (20/70 far visual acuity and 140 degrees visual field), age, sex, history of falls, and poorer cognitive performance, as measured using Trails B, MVPT, and UFOV subtest 2, were predictive of future at-fault MVC involvement. After adjusting for annual mileage, participants aged 78 and older were 2.11 as more likely to be involved in an at-fault MVC, those who made four or more errors on the MVPT were 2.10 times as likely to crash, those who took 147 seconds or longer to complete Trails B were 2.01 times as likely to crash, and those who took 353 ms or longer on subtest 2 of the UFOV were 2.02 times as likely to incur an at-fault MVC. Older adults, men, and individuals with a history of falls were more likely to be involved in subsequent at-fault MVCs. CONCLUSION: Performance-based cognitive measures are predictive of future at-fault MVCs in older adults. Cognitive performance, in particular, is a salient predictor of subsequent crash involvement in older adults. High-risk older drivers can be identified through brief, performance-based measures administered in a MVA setting.

Accidents, Traffic↗

PubMed2006

Effect of cataract surgery on falls and mobility in independently living older adults.

OBJECTIVES: To determine the effect of cataract surgery on the occurrence of falls and mobility and balance problems in older adults with cataract. DESIGN: Longitudinal follow-up study. SETTING: Clinical Research Unit, University of Alabama at Birmingham. PARTICIPANTS: Persons aged 55 and older with a cataract were recruited from 12 eye clinics in Alabama from October 1994 through March 1996. Participants were classified into two groups: those who had cataract surgery (surgery group, n=122) and those who had not (no-surgery group, n=92). MEASUREMENTS: At baseline and 1-year follow-up visits, information on the occurrence of falls and mobility and balance problems was collected based on subjects' recall of events during the prior 12 months. RESULTS: After adjusting for demographic, behavioral, medical, and visual characteristics, there was no difference between the two groups in the likelihood of falling (risk ratio (RR)=0.96, 95% confidence interval (CI)=0.64-1.42) or in having mobility (RR=0.81, 95% CI=0.55-1.18) or balance difficulties (RR=0.71, 95% CI=0.37-1.39). CONCLUSION: Cataract surgery had no association with the occurrence of falls or mobility or balance problems in independently living older adults with a cataract.

Accidental Falls↗

PubMed2006

Trends in eye injury in the United States, 1992-2001.

PURPOSE: To report the trends of eye injury in the United States from 1992 through 2001. METHODS: The National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, and the National Hospital Discharge Survey were used to collect information on eye injuries from 1992 to 2001. Rates of eye injury per 1000 population were calculated according to age, gender, and race. RESULTS: From 1992 through 2001, the overall estimated rate of eye injury ranged from 8.2 to 13.0 per 1000 population. During this period the incidence of eye injury significantly declined overall, in persons aged 39 years and younger, in both genders, and in the black and white populations (all P <0.05). CONCLUSIONS: From 1992 through 2002, the incidence of eye injury in the United States declined overall, in persons aged 39 and younger, in both genders, and in both racial groups. Certain segments of the population, however, continued to be at high risk (i.e., males and persons aged 39 and younger) of eye injury and represent those groups toward whom prevention resources should be directed.

Adolescent↗

PubMed2006

Development of a questionnaire to assess vision problems under low luminance in age-related maculopathy.

PURPOSE: To develop a questionnaire for assessing self-reported visual problems under low luminance and at night for use in studies on age-related maculopathy (ARM). METHODS: The questionnaire was developed in three steps: (1) Content for questionnaire items was identified through focus groups of older adults with ARM and those exhibiting normal retinal aging. The topic for discussion was "vision at night and under low lighting." Discussion was audiotaped, transcribed, and subjected to content analysis to identify problem categories expressed by patients. (2) This content was used to develop a preliminary questionnaire administered by telephone to persons with ARM or normal retinal aging. Principal-components analysis identified groups of items that formed the questionnaire's subscales that were evaluated for internal consistency, and an item-reduction strategy was implemented to generate a briefer questionnaire. (3) Psychometric properties of the shortened Low-Luminance Questionnaire (LLQ) were determined, including construct validity, criterion validity, and test-retest reliability. RESULTS: The 32-item LLQ has six subscales (driving, extreme lighting, mobility, emotional distress, general dim lighting, and peripheral vision), all with good internal consistency (Cronbach alpha > or = 0.82). Scores on LLQ subscales correlated moderately with nearly all National Eye Institute Visual Function Questionnaire (NEI VFQ)-25 subscales and decreased in value (indicating more disability) for patients with increasing ARM disease severity. Whereas rod-mediated parameters of dark adaptation were significantly associated with LLQ subscale scores (r = 0.19-0.43, all P < 0.03), cone-mediated parameters were not. Test-retest reliability ranged from 0.74 to 0.88 for all subscales (P < 0.0001), except for peripheral vision (0.46; P = 0.0003), which also exhibited a ceiling effect in almost half of the respondents. CONCLUSIONS: The 32-item LLQ, derived from the content of focus group comments by persons with ARM, has good construct validity, subscale scores related to rod-mediated visual function, and good test-retest reliability for five of six subscales. The LLQ may ultimately be useful in patient-centered evaluation of the outcome of interventions to prevent ARM or to arrest progression of early disease.

Aged↗

PubMed2006

Discrimination between glaucomatous and nonglaucomatous eyes using quantitative imaging devices and subjective optic nerve head assessment.

PURPOSE: To compare the diagnostic ability of the confocal scanning laser ophthalmoscope (HRT-II; Heidelberg Engineering, Heidelberg, Germany), scanning laser polarimeter (GDx-VCC; Carl Zeiss Meditec, Inc., Dublin, CA), and optical coherence tomographer (StratusOCT, Carl Zeiss Meditec, Inc.) with subjective assessment of optic nerve head (ONH) stereophotographs in discriminating glaucomatous from nonglaucomatous eyes. METHODS: Data from 79 glaucomatous and 149 normal eyes of 228 subjects were included in the analysis. Three independent graders evaluated ONH stereophotographs. Receiver operating characteristic curves were constructed for each technique and sensitivity was estimated at 80% of specificity. Comparisons of areas under these curves (aROC) and agreement (kappa) were determined between stereophoto grading and best parameter from each technique. RESULTS: Stereophotograph grading had the largest aROC and sensitivity (0.903, 77.22%) in comparison with the best parameter from each technique: HRT-II global cup-to-disc area ratio (0.861, 75.95%); GDx-VCC Nerve Fiber Indicator (NFI; 0.836, 68.35%); and StratusOCT retinal nerve fiber layer (RNFL) thickness (0.844, 69.62%), ONH vertical integrated rim area (VIRA; 0.854, 73.42%), and macular thickness (0.815, 67.09%). The kappa between photograph grading and imaging parameters was 0.71 for StratusOCT-VIRA, 0.57 for HRT-II cup-to-disc area ratio, 0.51 for GDX-VCC NFI, 0.33 for StratusOCT RNFL, and 0.28 for StratusOCT macular thickness. CONCLUSIONS: Similar diagnostic ability was found for all imaging techniques, but none demonstrated superiority to subjective assessment of the ONH. Agreement between disease classification with subjective assessment of ONH and imaging techniques was greater for techniques that evaluate ONH topography than with techniques that evaluate RNFL parameters. A combination of subjective ONH evaluation with RNFL parameters provides additive information, may have clinical impact, and deserves to be considered in the design of future studies comparing objective techniques with subjective evaluation by general eye care providers.

Adult↗

PubMed2006

Effect of short-term, high-dose retinol on dark adaptation in aging and early age-related maculopathy.

PURPOSE: To examine the effect of a short course of high-dose retinol (preformed vitamin A) on dark adaptation in older adults with normal retinal health or early age-related maculopathy (ARM). METHODS: The study design was a randomized, double-masked, placebo-controlled experiment. Adults > or = 50 years of age whose fundus photographs for the eye to be tested psychophysically fell within steps 1 to 9 of the Age-Related Eye Disease Study (AREDS) Grading System were randomly assigned to a 30-day course of 50,000 IU oral retinol or a placebo. At baseline and 30-day follow-up, dark adaptation was tested and the Low Luminance Questionnaire (LLQ), an instrument for assessing difficulty with vision in reduced lighting, was administered. Primary outcomes of interest were rod- and cone-mediated parameters of dark adaptation, with scores on the LLQ's six subscales as secondary outcomes. RESULTS: The sample consisted of 104 participants with 52 each in the intervention and placebo groups. There were no group differences in baseline variables. At 30-days, the dark-adaptation parameters of cone time-constant, cone threshold, rod-cone break, and rod threshold did not differ. The retinol intervention group had significantly larger (i.e., steeper) rod slopes, indicating faster sensitivity recovery, than did the placebo group (P = 0.0419). There were no group differences in scores on the LLQ subscales driving, extreme lighting, emotional distress, general lighting, or peripheral vision. The retinol group had a higher score by five points on the mobility subscale compared with the placebo group (P = 0.0141). Those who had the most self-reported change on the mobility subscale at day 30 were more likely to have greater change in the speed of dark adaptation, as indicated by the rod slope parameter (r = 0.24, P = 0.0141). CONCLUSIONS: A short-term, high-dose course of retinol increased the rate of rod-mediated dark adaptation in older adults who were in the early phases of ARM or were exhibiting normal retinal aging. These results are consistent with the hypothesis that depositions and other structural changes in the retinal pigment epithelium and Bruch's membrane in aging and early ARM cause a localized retinoid deficiency.

Aged↗

PubMed2006

Perceived barriers to care and attitudes about vision and eye care: focus groups with older African Americans and eye care providers.

PURPOSE: To identify by using focus group methods the perceived barriers to eye care and attitudes about vision and eye care among older African Americans as well as among ophthalmologists and optometrists serving their communities. METHODS: Seventeen focus groups of older African Americans residing in the Birmingham or Montgomery, Alabama, areas were led by an experienced facilitator. Discussion was stimulated by a semistructured script focused on their perceived barriers to eye care and attitudes about vision and eye care. Six focus groups of ophthalmologists and optometrists who practiced in this geographic region addressed the same topics. Discussion was audiotaped and transcribed. Comments were coded using a multistep content analysis protocol. RESULTS: One hundred nineteen African Americans (age range, 59-97 years) and 35 eye care providers (51% ophthalmologists, 49% optometrists) participated. The barrier-to-care problem most frequently cited by both African Americans and eye care providers was transportation. The next most common problems mentioned by African Americans were trusting the doctor, communicating with the doctor, and the cost of eye care; and for eye care providers, the next most common problems were cost, trust, and insurance. With respect to older African Americans' comments on their attitudes about vision and eye care, these comments were predominantly positive (69%), highlighting the importance of eye care and behavior in their lives and attitudes that facilitated care. However, when eye care providers relayed their impressions of African Americans' attitudes about vision and eye care, their comments were largely negative (74%) centering on concerns and frustrations that older African Americans did not have attitudes or engage in behavior that facilitate eye care. CONCLUSIONS: These results provide some guidance for the design of interventions to increase the use of routine eye care in this population. At a societal level, there is a need for affordable and accessible transportation services for older African Americans seeking eye care. For ophthalmologists, optometrists, and their staffs, there is a need for continuing education that imparts culturally sensitive and age-appropriate communication and trust-building skills for interactions with this population. In addition to reinforcing the generally positive attitudes of older African Americans toward the importance of eye care, community-based educational programs should be focused on strategies for overcoming the common barriers to care.

Black or African American↗

PubMed2006

Time to renal disease and end-stage renal disease in PROFILE: a multiethnic lupus cohort.

BACKGROUND: Renal involvement is a serious manifestation of systemic lupus erythematosus (SLE); it may portend a poor prognosis as it may lead to end-stage renal disease (ESRD). The purpose of this study was to determine the factors predicting the development of renal involvement and its progression to ESRD in a multi-ethnic SLE cohort (PROFILE). METHODS AND FINDINGS: PROFILE includes SLE patients from five different United States institutions. We examined at baseline the socioeconomic-demographic, clinical, and genetic variables associated with the development of renal involvement and its progression to ESRD by univariable and multivariable Cox proportional hazards regression analyses. Analyses of onset of renal involvement included only patients with renal involvement after SLE diagnosis (n = 229). Analyses of ESRD included all patients, regardless of whether renal involvement occurred before, at, or after SLE diagnosis (34 of 438 patients). In addition, we performed a multivariable logistic regression analysis of the variables associated with the development of renal involvement at any time during the course of SLE. In the time-dependent multivariable analysis, patients developing renal involvement were more likely to have more American College of Rheumatology criteria for SLE, and to be younger, hypertensive, and of African-American or Hispanic (from Texas) ethnicity. Alternative regression models were consistent with these results. In addition to greater accrued disease damage (renal damage excluded), younger age, and Hispanic ethnicity (from Texas), homozygosity for the valine allele of FcgammaRIIIa (FCGR3A*GG) was a significant predictor of ESRD. Results from the multivariable logistic regression model that included all cases of renal involvement were consistent with those from the Cox model. CONCLUSIONS: Fcgamma receptor genotype is a risk factor for progression of renal disease to ESRD. Since the frequency distribution of FCGR3A alleles does not vary significantly among the ethnic groups studied, the additional factors underlying the ethnic disparities in renal disease progression remain to be elucidated.

Adult↗

PubMed2005

Impact of aging and age-related maculopathy on inactivation of the a-wave of the rod-mediated electroretinogram.

This study examined the impact of aging and age-related maculopathy (ARM) on the inactivation of phototransduction in rod photoreceptors by measuring the recovery of the a-wave using a paired flash electroretinogram technique. Measurements were made on 32 older adults in normal retinal health, 25 with early ARM, 7 with late ARM, and 20 young adults for comparison purposes. ARM presence and severity were defined by the Wisconsin Age-Related Maculopathy Grading System based on grading of fundus photographs. The inactivation of rod phototransduction exhibited an aging-related slowing. Those with early ARM did not exhibit inactivation slowing over and above what would be expected based on normal retinal aging. Persons in the late stages of ARM exhibited dramatic slowing in inactivation kinetics.

Adult↗

PubMed2005

Genetic deficiency of C3 as well as CNS-targeted expression of the complement inhibitor sCrry ameliorates experimental autoimmune uveoretinitis.

In this report, we describe the effect of complement deficiency and inhibition on experimental autoimmune uveoretinitis (EAU). C57BL/6 mice genetically deficient in C3 (C3-/-) or expressing a soluble complement activation inhibitor (soluble complement receptor related protein Y or sCrry) in a CNS-targeted fashion, (sCrry/GFAP) were induced for EAU via peripheral immunisation with a peptide of amino acids 1-20 of human interphotoreceptor retinoid binding protein in complete Freund's adjuvant with concurrent intraperitoneal pertussis toxin. The incidence and severity of EAU in the mutant mice was compared with that in simultaneously induced C57BL/6 wild type mice. The sCrry protein was detected in retinal extracts from transgenic but not wild type mice by western blot. C3-/- mice had a significant reduction in the incidence of EAU compared with wild type mice (incidence 44 versus 89%, respectively, p=0.0417) and a significant reduction in the severity of EAU (median disease score values 0 versus 1.3, respectively, p=0.0253). Similarly, sCrry mice had a significant reduction in the incidence of EAU compared with wild type mice (incidence 57 versus 100% respectively, p=0.0033) and a significant reduction in the severity of EAU (median disease score values 0.18 versus 1.85, respectively, p=0.0054). A genetic deficiency of C3 and production of a soluble complement inhibitor targeted to the CNS and eye are protective against EAU.

Animals↗

PubMed2005

The posterolateral corner of the knee: repair versus reconstruction.

BACKGROUND: Injuries to the posterolateral corner of the knee are disabling. Despite improved understanding of this group of tendons and ligaments, the best surgical treatment of an unstable corner is not clear. HYPOTHESIS: Surgical repair of acute tears of the posterolateral corner has outcomes that are as good as those from reconstruction combined with an early motion rehabilitation protocol. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Sixty-three patients with 64 posterolateral corner tears were included in this study, with 39 posterolateral corner repairs and 25 reconstructions using the modified 2-tailed technique. Patients were evaluated with clinical and KT-2000 arthrometer examinations, as well as with Lysholm, International Knee Documentation Committee, and Short Form-36 scores. RESULTS: Fifty-six patients with 57 corner tears had minimum clinical follow-up of 24 months (range, 24-59 months). Acute primary repairs were performed on 35 patients, with 22 successful outcomes and 13 (37%) failures. Primary reconstructions were performed on 22 patients, with 20 successful outcomes and 2 (9%) failures. The difference in stability on clinical examination between repairs and reconstructions was significant (P < .05). Fourteen of 15 patients with failures of the primary posterolateral corner repair or reconstruction underwent successful revision reconstruction. The final patient with failure of the primary repair elected not to have a revision reconstruction. The final mean Lysholm knee score for both repair and reconstruction patients was 88.7 (range, 53-100). Final International Knee Documentation Committee objective scores yielded 14 (26%) normal, 28 (52%) near-normal, 9 (17%) abnormal, and 3 (6%) severely abnormal knees; the mean score was 60 at the most recent clinical evaluation. CONCLUSION: Results with repair followed by early motion rehabilitation have been significantly inferior when compared with results from reconstruction using the modified 2-tailed technique. The authors now use reconstruction rather than repair in the majority of patients who sustain posterolateral corner tears after high-energy injuries.

Adolescent↗

PubMed2005

Risk factors for motor vehicle collision-related eye injuries.

OBJECTIVE: To evaluate the association between specific occupant, collision, and vehicle characteristics and the risk of motor vehicle collision (MVC)-related eye injury. METHODS: The 1988-2001 National Automotive Sampling System Crashworthiness Data System files were used. The Crashworthiness Data System is a national probability sample of passenger vehicles involved in police-reported tow-away MVCs. The risk of eye injury was calculated according to specific occupant (eg, age, seat belt use) and collision (eg, DeltaV [estimated change in velocity], vehicular intrusion) characteristics. The association between eye injury and these characteristics was calculated using risk ratios and associated 95% confidence intervals. RESULTS: The incidence of eye injuries in MVCs has progressively increased since 1998. Frontal air bag deployment was associated with a statistically significant, 2-fold (risk ratio, 2.13 [95% confidence interval, 1.56-2.91]) increased risk of eye injury, whereas seat belt use was associated with a 2-fold (risk ratio, 2.17 [95% confidence interval, 1.89-2.44]) reduced eye injury risk. In late-model vehicles, frontal air bags are the most common cause of MVC-related eye injury. Older age, female sex, seat position, vehicle weight, and collision severity were also associated with eye injury risk. CONCLUSIONS: Seat belt use is the most effective means of occupant protection against MVC-related eye injury. For front-seated occupants in frontal collisions, the adverse effect of frontal air bags on the risk of eye injury should be considered against their protective effect for fatal injury.

Accidents, Traffic↗

PubMed2005

Patient expectations regarding eye care: development and results of the Eye Care Expectations Survey (ECES).

OBJECTIVE: To develop an instrument (the Eye Care Expectations Survey [ECES]) that can identify and quantify the expectations of patients visiting eye care providers. METHODS: A total of 202 patients attending 4 ophthalmology practices affiliated with Duke University Eye Center enrolled in the study. All participants completed the pilot version of the ECES, which was developed through a review of the expectations literature and a multicondition focus group process. Factor analysis of patients' responses was used to identify the performance characteristics of the ECES. RESULTS: Factor analysis yielded factors that describe 4 distinct types of expectations: patient involvement in eye care, interpersonal manner, information about diagnosis and prognosis, and communication and clinical competence. These 4 factors explained 89% of the total variance. The factor analysis identified a subset of 27 questions (of the original 37) to represent the 4 factors. Estimates of internal consistency and test-retest reproducibility indicate that the ECES is reliable. In addition, tests of association with clinical variables support the construct validity of the survey. The psychometric properties of the ECES were influenced by the severity of the underlying eye condition as well as other demographic and clinical variables, including the patient's rating of his or her own vision, best corrected visual acuity, sex, education, race, and household income. CONCLUSIONS: Based on this cross-sectional study, the 27-item ECES appears to be a useful tool for better understanding patients' expectations regarding eye care.

Attitude to Health↗

PubMed2005

Incidence of emergency department-treated eye injury in the United States.

OBJECTIVE: To present the descriptive epidemiology of emergency department-treated eye injury in the United States. METHODS: Data from the Consumer Product Safety Commission's National Electronic Injury Surveillance System All Injury Program was used to estimate the number of patients treated in US emergency departments for eye injuries. Eye injury rates were calculated according to age, sex, and race, and characteristics of the injury event were determined. RESULTS: The rate of emergency department-treated eye injury in the United States is 3.15 per 1000 population (95% confidence interval, 2.66-3.63). Rates were highest among those in their 20s and 30s, among males, and among American Indians and African Americans. The majority of injuries occurred in the home, and contusions and abrasions were the most common types of injury. CONCLUSION: This study documents the burden of eye injury in the United States and identifies areas wherein future research activities should be directed.

Adolescent↗

PubMed2005

Rate of eye injury in the United States.

OBJECTIVE: To provide a comprehensive estimate of the rate of eye injury in the United States. METHODS: Data from the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the National Hospital Discharge Survey for 2001 were combined and used to provide estimates of eye injuries treated in emergency departments, inpatient and outpatient facilities, and private physicians' offices, as well as their causes and characteristics [corrected] RESULTS: In the United States in 2001, an estimated 1 990 872 (6.98 per 1000 population) individuals experienced an eye injury requiring treatment in an emergency department, inpatient or outpatient facility, or private physician's office. Most eye injuries are treated in emergency departments (50.7%), followed by private physicians' offices (38.7%), and outpatient (8.1%) and inpatient (2.5%) facilities. Eye injury rates were highest among individuals in their 20s, males, and whites. Injury rates were highest for superficial injuries, foreign bodies, contusions, and open wounds. CONCLUSIONS: This study provides a comprehensive estimate of the rate of eye injury in the United States. Private physicians represent an important source of care for eye injury in the United States.

Adolescent↗