The impact of preinjury DSM-III-R anxiety, mood, and alcohol and substance abuse disorders, determined by using the Structured Clinical Interview for DSM-III-R, nonpatient version (SCID-NP), on postinjury adjustment was examined prospectively in a consecutive series of 98 adult patients admitted to a regional burn center and followed for 1 year. The subjects were grouped according to SCID diagnoses: 1) any preburn mood and/or anxiety diagnosis; 2) preburn alcohol abuse or dependence diagnosis; or 3) any preburn diagnosis (i.e., any of the above diagnoses). These groups showed greater impairment in many functional domains at discharge than the subjects who had no preburn disorder. By 4 months postinjury, the "no diagnosis" and the preburn diagnosis groups had comparable levels of adjustment, and this comparability was maintained at the 1-year follow-up. Similarly, trait neuroticism had an early negative impact on adjustment, while trait extroversion had both an early and late positive effect on adjustment.

Adaptation, Psychological↗

PubMedDate not supplied

Preburn psychiatric history affects posttrauma morbidity.

A sample of inpatient, burn-injured adults (N = 95) were assessed upon discharge, and 4 and 12 months later with a structured interview and DSM-III-R criteria. The prevalence of disorder in this sample was contrasted with published data on a representative national community-dwelling comparison group in the National Comorbidity Study. The prevalence of lifetime affective, alcohol, and substance use disorders was significantly higher, and lifetime anxiety disorders significantly lower, in the burn-injured sample. The 12-month postburn prevalences of alcohol, and substance use disorders were significantly greater in the burn-injured sample. The risk of postburn disorder was significantly greater for the subjects who had a preburn history of affective, alcohol, or substance use disorder. The risk for developing posttraumatic stress disorder (PTSD) was elevated in the subjects with a preburn affective disorder but not preburn anxiety disorder. Finally, postburn PTSD was associated with a greater length of stay, and greater preburn comorbidity predicted preburn employment status and tended to lengthen hospitalization.

Adolescent↗

PubMedDate not supplied

Importance of paraspinal muscle electromyography in cervical and lumbosacral radiculopathies.

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Adult↗

PubMedDate not supplied

Barriers to employment among working-aged patients with major burn injury.

The purpose of this study was to examine the prevalence of preexisting and burn-related impairments and to describe their association with preburn employment status. Data gathered during the acute hospitalization were analyzed on a consecutive series of burn patients aged 16 to 64 years (N = 770) enrolled in a prospective, longitudinal, multicenter study. Patients who were unemployed before the injury were more likely than those who were employed to report being alcohol-dependent (36 vs 18%), abusing other drugs (22 vs 10%), having received psychiatric treatment in the past year (21 vs 6%), and having preexisting physical disability (23 vs 3%); all were significant at P < .001). Of the unemployed patients who received toxicologic screening at admission, 49% tested positive for alcohol and 39% positive for other drugs, percentages that were significantly higher than 26 and 31%, respectively, for the employed. With adjustment for age, sex, race, and education, variables that were most predictive of preinjury unemployment status were preexisting physical disability (odds ratio, 51.0; 95% confidence interval, 7.7-336.9) and being alcohol-positive at admission (odds ratio, 2.8; 95% confidence interval, 1.2-6.8). Unemployed and employed patients also differed significantly in injury patterns and clinical outcomes, with inhalation injury and psychiatric distress being more prevalent among the unemployed and both hand burns and hand surgery among the employed. The greater prevalence of preexisting impairments among survivors who were unemployed before the injury helps explain why preburn employment status is such a powerful determinant of postburn work outcomes, and suggests the need to include psychosocial services in a program of comprehensive rehabilitation.

Adolescent↗

PubMedDate not supplied

Prospective evaluation of the Ottawa Ankle Rules in a university sports medicine center. With a modification to increase specificity for identifying malleolar fractures.

In a sports medicine center, we prospectively evaluated the Ottawa Ankle Rules over 1 year for their ability to identify clinically significant ankle and midfoot fractures and to reduce the need for radiography. We also developed a modification to improve specificity for malleolar fracture identification. Patients with acute ankle injuries (< or = 10 days old) had the rules applied and then had radiographs taken. Sensitivity, specificity, and the potential reduction in the use of radiography were calculated for the Ottawa Ankle Rules in 132 patients and for the new "Buffalo" rule in 78 of these patients. There were 11 clinically significant fractures (fracture rate, 8.3% per year). In these 132 patients, the Ottawa Ankle Rules would have reduced the need for radiography by 34%, without any fractures being missed (sensitivity 100%, specificity 37%). In 78 patients, the specificity for malleolar fracture for the new rule was significantly greater than that of the Ottawa Ankle Rules malleolar rule (59% versus 42%), sensitivity remained 100%, and the potential reduction in the need for radiography (54%) was significantly greater. The Ottawa Ankle Rules could significantly reduce the need for radiography in patients with acute ankle and midfoot injuries in this setting without missing clinically significant fractures. The Buffalo modification could improve specificity for malleolar fractures without sacrificing sensitivity and could significantly reduce the need for radiography.

Adolescent↗

PubMedDate not supplied

Simultaneous monitoring of central venous and Swan-Ganz pressures.

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Cardiac Catheterization↗

PubMedDate not supplied

Exploring language about families.

When we work with families in health care settings, it is important to be aware of the way we communicate. Often overlooked is how the language we use to describe and understand families affects how we work with them. The language we use in thinking about a family can shape our perceptions of the family and may affect how we approach working with them. The language we use in describing a family to another health care provider can affect how that person will perceive and approach the family. The language families hear us use can affect families' perceptions of themselves, their perceptions of us, and, consequently, how they relate to us. In Project Copernicus' Family Centered Communication Skills: Facilitator's Guide (Edelman, Greenland, & Mills, 1993), an activity entitled "Watch Our Language" explores commonly used negative terminology about families and guidelines for better language. This exercise has been used with groups of nurses and other health care providers at several conferences and has generated thoughtful brainstorming about negative language related to families, its impact on families, and its impact on the nurses working with them. Those participating in the workshops explored better terminology about families and brainstormed a list of selected family strengths which are shared here.

Adult↗