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K M Martin

Publications and source records attributed to K M Martin.

35 records · Page 2Linked to original sources
PubMed1994

Comparison of indices of traumatic brain injury severity as predictors of neurobehavioral outcome in children.

This study examined the ability of early measures of traumatic brain injury (TBI) severity to predict neurobehavioral and functional skill outcomes shortly after injury and at 1 year postinjury. Ninety-eight children aged 6 to 15 years with TBI were consecutively identified on presentation to two regional medical centers. Ten measures of TBI severity were subsequently administered: initial Glasgow Coma Scale (motor, eye, verbal, and total GCS), duration of loss of consciousness, Abbreviated Injury Scale Head score, GCS motor score at 3 days postinjury, days to reach a total GCS score of 15, days to reach a GCS motor score of six, and duration of posttraumatic amnesia (days to reach a 75% performance on the Children's Orientation and Amnesia Test [COAT]). Cases were matched individually with controls on the basis of age, gender, school grade, the classroom teacher's assessment of pre-morbid level of academic performance in reading and arithmetic, and pre-morbid behavior. Both groups received intellectual, neuropsychologic, academic, and functional skill assessments three weeks after the case achieved full orientation and 1 year later. The indices of injury severity that were most predictive of both early and 1-year outcome across all neurobehavioral and functional measures were (1) days to an age-adjusted 75% performance on the COAT, (2) days to a GCS score of 15, and (3) initial total GCS score. For most outcome areas, a single measure of severity predicted outcome almost as well as multiple measures. However, early and 1-year academic performance and 1-year memory performance were best predicted by considering multiple indices of brain injury severity. The GCS verbal and motor scores were better predictors of outcome than the GCS eye score. However, consideration of individual GCS subscores did not improve upon prediction of outcome versus the GCS total score. These results provide strong validation for the use of duration of posttraumatic amnesia, measured by the COAT, as a measure of TBI severity and a significant indicator of neurobehavioral and functional outcome in children.

Activities of Daily Living↗
PubMed1994

Family functioning and children's academic performance and behavior problems in the year following traumatic brain injury.

This study examined the roles of preinjury family and child functioning and injury severity in predicting 1-year outcomes and changes in academic performance and behavioral problems following childhood traumatic brain injury (TBI). Families of 94 children (ages 6 to 15) with TBI (mild = 50, moderate = 25, severe = 19) were consecutively enrolled from emergency departments of two regional medical centers. Standardized measures of family and child functioning and interviewer ratings were completed within 3 weeks of injury (measuring preinjury status), at 3 months, and 1 year. Mean ratings of preinjury child functioning were within normal range. Whereas injury severity was associated with substantial declines in academic functioning, there was no association of injury severity with change in behavior problems. Interview ratings showed declines at all severity levels, however. Poor academic and cognitive outcomes at 1 year were associated with injury severity and, to a lesser degree, poor preinjury family and child functioning. In contrast, most of the variation in behavioral outcomes was explained by preinjury child or family factors. Preinjury functioning must be assessed and support services provided for optimal academic and behavioral outcomes following childhood TBI.

Achievement↗
PubMed1994

Modeling the growth of Yersinia enterocolitica in donated blood.

BACKGROUND: Sepsis and death subsequent to the transfusion of blood containing Yersinia enterocolitica is an increasing problem. The organisms probably originate from bacteremia in the donor and can subsequently multiply at low temperature. STUDY DESIGN AND METHODS: Reported here are experiments with a strain of Y. enterocolitica associated with a case of transfusion-associated bacteremia. RESULTS: It was found that the rapid early killing of Y. enterocolitica injected into donated blood does not require viable phagocytes and can be explained by complement-mediated killing. Complement resistance in Y. enterocolitica is known to be plasmid-coded. It is expressed at 37 degrees C, but not at 20 degrees C, and is favored by calcium-deficient culture media. Y. enterocolitica organisms induced to express complement resistance were still killed in donated blood, though the initial rate was slower. Such organisms multiplied in plasma at 37 degrees C, but were killed after 6 hours of incubation at 20 degrees C, presumably because complement resistance genes are switched off at this temperature. CONCLUSION: This experiment is thought to reflect the natural history of Y. enterocolitica contamination of blood, in which complement-resistant organisms in the donor blood encounter lower temperatures after donation. These observations suggest that the practice of plasma depletion may have contributed to the increased incidence of mortality due to Y. enterocolitica contamination of donated blood.

Blood↗
PubMed1994

Coordinating multidisciplinary, collaborative research: a formula for success.

Nursing continues to move toward the goal of providing care that is grounded in theory and research. As such, the CNS may perform the role of research nurse coordinator for collaborative research projects. In this article, three nursing principles that were successfully applied to the planning and conduct of multidisciplinary, collaborative research resulting in a high degree of participant satisfaction and subject retention are described. These three nursing principles are: (1) using the nursing process as an organizing framework for nursing practice, (2) delivering nursing care through a process of interpersonal relationships, and (3) allowing a humanistic philosophy to guide nursing actions. Knowledge and application of this "formula for success" will assist the CNS who is a novice at research to achieve a positive outcome in his or her endeavors.

Clinical Nursing Research↗
PubMed1994

Loss without death: a dilemma for the head-injured patient's family.

Family members of a person suffering head injury are confronted with permanent alterations in the person they love. The change in the individual is experienced as a loss which must be grieved. This grieving process can be difficult since the presence of the head injury survivor serves as a constant reminder to the family of what they have lost. With an understanding of the concept of loss without death, nurses caring for the families of head-injured individuals may be better equipped to assist them through this difficult process.

Adaptation, Psychological↗
PubMed1994

When the nurse says "he's just not right": patient cues used by expert nurses to identify mild head injury.

Many patients with mild head injury are discharged from the hospital without recognition of their true rehabilitative needs. This qualitative study was designed to describe what patient cues the expert nurse uses when making an assessment of mild head injury. Although the majority of cues the participants identified are supported in the head injury literature, several other cues, not previously linked with the assessment of mild head injury, were found. The identification of these aspects of the nursing assessment provides new insight into the art of neuroscience nursing.

Behavior↗
PubMed1994

Mild pediatric traumatic brain injury: adjusting significance levels for multiple comparisons.

The outcome following mild traumatic brain injury (TBI) is controversial. We addressed this topic in a study of neurobehavioural and 'real-world' functioning among 53 children with mild TBI and their matched controls, using statistical methods recently developed for multiple comparisons. Because the study involved calculation of 414 p-values, four methods of adjustment for multiple comparisons, including the Bonferroni method, were used to avoid 'false-positive' statistical significance. The additional three methods allowed greater insight into the data than provided by the standard Bonferroni adjustment. Results showed that at initial testing, three areas of 'real-world' functioning (eating, domestic and home/community living skills) had weak but statistically significant associations with mild injury. No other specific areas of neuro-behavioural or 'real-world' functioning had plausible associations with the injury either initially, at 1 year, or when changes over the year were considered. However, the adjustment for multiple comparisons provided additional results. There were statistical significant associations of the injury with the entire domain of neurobehavioural variables both initially and at 1 year. These results suggest that the injury affects a spectrum of neurobehavioural skills weakly, rather than a single area substantially. The gain from using multiple comparison methods is discussed.

Activities of Daily Living↗
PubMed1994

Outcome of pediatric traumatic brain injury at three years: a cohort study.

This cohort study examined the neurobehavioral, academic, and "real world" consequences of mild, moderate, and severe traumatic brain injury in children at 3 years following the resolution of posttraumatic amnesia. Seventy-two children, aged 6 to 15 years at time of injury, were individually matched with controls on the basis of age, gender, school grade, and the classroom teacher's assessment of premorbid academic achievement and behavior. Both groups were assessed using the same standardized neuropsychological test battery and parent and teacher report measures as were used initially and at 1-year follow-up covering 10 cognitive, behavioral, and functional domains. The performance of both moderately and severely injured children was worse than their controls on 40 out of 53 variables. The association of outcome variables with injury severity was validated using school achievement tests and grades. Analyses of the impact of preinjury variables and study dropouts on outcome showed no threat to the validity of study findings. These results provide strong validation for the persisting and comprehensive nature of neuropsychological deficits in children and adolescents with moderate and severe traumatic brain injury.

Adolescent↗
PubMed1993

Pediatric traumatic brain injury: acute and rehabilitation costs.

Pediatric traumatic brain injury constitutes an enormous public health problem, but little is known about the economic costs of such injury. Using charges as a proxy for cost, we prospectively collected data on initial hospital charges and professional fees for emergency department services, acute inpatient care, and acute inpatient rehabilitation for 96 patients with mild, moderate, and severe traumatic brain injuries. We also examined the relationship between these costs and injury severity and etiology. Acute care and rehabilitation median costs were $5,233 per child, $11,478 for hospitalized children, and $230 for those only seen in the emergency department. Median costs for injuries due to motor vehicles, bicycles, and falls were $15,213, $6,311, and $792, respectively. Using Glasgow Coma Scale criteria, median cost of mild, moderate, and severe traumatic brain injuries were $598, $12,022, and $53,332, respectively. Injury etiology added modestly but significantly to the prediction of cost over and above that predicted by injury severity alone. Rehabilitation costs accounted for 37% of the total for all children, but 45% of those with the most severe injuries.

Adolescent↗
PubMed1993

Family functioning and injury severity as predictors of child functioning one year following traumatic brain injury.

This study examined changes in children's functioning in the year following traumatic brain injury (TBI) and the preinjury family and injury factors most predictive of children's overall adaptive functioning and social competence at 1 year. Ninety-four children with TBI (mild = 50, moderate = 25, severe = 19) and their families were consecutively enrolled from two regional medical centers. The age range was from 6 years to 15 years. Interviewer ratings and standard measures of family and child functioning were completed within 3 weeks of injury (measuring preinjury status), at 3 months and 1 year. Mean preinjury parent and teacher ratings of child functioning were within normal range. Older children (> or = 12 years) had worse preinjury functioning than younger children. Declines in child functioning were significantly associated with injury severity. Mild and moderately injured children had few declines in overall functioning. Severely injured children had the most dramatic early declines and improved only slightly between 3 months and 1 year; however, older children from poorly functioning families deteriorated in the same period. Injury severity and preinjury family functioning explained from 25% to 39% of the variation in child functioning at 1 year and up to 57% when the child's preinjury status was included. Children at risk for poorer adaptation following TBI can be identified and for optimal recovery should receive appropriate support services for optimal recovery.

Adaptation, Psychological↗
PubMed1993

Severity of pediatric traumatic brain injury and neurobehavioral recovery at one year--a cohort study.

As part of an ongoing longitudinal cohort study of children with mild, moderate, and severe traumatic brain injury and their matched controls, the neurobehavioral status of 94 case-control pairs was assessed one year after initial postinjury testing. There was a statistically significant dose-response association of severity with performance in all six domains of neurobehavioral functioning (intelligence, adaptive problem solving, memory, academic performance, motor performance, and psychomotor problem solving) with Spearman correlation coefficients of up to -.35, p < .001. The strongest correlations between severity and outcome were in the domains of intelligence, academic performance, and motor performance. Recovery over the year was also dependent on the severity of brain injury. Because mildly injured cases had negligible initial deficits, recovery was not at issue. However, for moderately and severely injured children, the degree of initial impairment was related to the magnitude of both recovery and residual deficit. Results showed that the use of population normative values to evaluate impairment was misleading. Although the mean scores of all severity groups fell within the normal range of standardized tests, the means for the moderately and severely injured were substantially below those of their matched controls on many tests.

Adolescent↗
PubMed1993

Mild pediatric traumatic brain injury: a cohort study.

Using a prospective, cohort design, we investigated whether children with mild traumatic brain injury (TBI) differed from individually matched controls on measures of intellectual, neuropsychological, academic, and "real world" functioning. Subjects included children between the ages of 6 and 15 years who sustained mild, moderate, and severe closed head injuries and were consecutively identified on presentation to the emergency departments of two regional, university medical centers. One hundred twenty-nine children were eligible for enrollment. Seventeen refused enrollment. Fifty-nine of the 112 enrolled children were classified as mildly injured. Six of these children dropped out, leaving 53 mildly injured cases for analysis. Individually matched controls from the classroom of the injured cases were identified based on age, gender, and premorbid academic achievement and behavior. Assessment measures included standardized intellectual, neuropsychological, and academic measures. Also, parent and teacher questionnaires, measuring social, educational, domestic, and community living skills were used. Among 51 outcome variables only five were significantly associated with injury at initial or 1-year testing after adjusting for multiple comparisons. However, these five associations were either very weak or implausible. Results from this study suggest that mild TBI produces virtually no clinically significant long-term deficits in intellectual, neuropsychological, academic, or "real world" functioning.

Activities of Daily Living↗
PubMed1992

Predictors of family functioning one year following traumatic brain injury in children.

This study examined changes in family functioning and predictors of family outcome during the year following traumatic brain injury (TBI). The families of 94 children with TBI (mild = 50, moderate = 25, severe = 19), ages six to 15, were consecutively enrolled from two regional medical centers. Family interview ratings and standard measures of family and child functioning were completed three weeks after injury (measuring preinjury status), as well as three and 12 months. Two-thirds of families had moderate to good preinjury global functioning and coping resources, but more than half exhibited high levels of stress and at-risk family relationships. No significant preinjury differences by injury severity were seen on any measure. Whereas few changes in family functioning were observed over the year in the mild or moderate groups, greater deterioration occurred in the severe group. From one third to one half noted moderate to severe strain in 13 problem areas often seen in individuals with TBI. Preinjury family global functioning, however, was more strongly predictive of 12-month family functioning (R2 = .38 to .68) than was injury severity (R2 = .05 to .09). In four out of five outcome areas assessed at 12 months, preinjury status in each area was the strongest single predictor. Preinjury coping was the best predictor of stress. Families at risk can be identified and need ongoing support for optimal functioning.

Adaptation, Psychological↗
PubMed1992

Severity of pediatric traumatic brain injury and early neurobehavioral outcome: a cohort study.

Traumatic brain injury (TBI) is a major cause of pediatric disability. Its neurobehavioral sequelae can often be difficult to distinguish from premorbid problems. To establish the early neurobehavioral consequences of TBI, we compared a cohort of brain injured children with controls, individually matched on premorbid characteristics. Ninety-eight children, aged 6 to 15 years, with mild, moderate, and severe closed head injuries, were consecutively identified on presentation to two regional medical centers. Individually selected controls were matched for age, gender, school grade, behavior, and academic performance. Intellectual, neuropsychologic, and academic assessments were undertaken 3 weeks after full orientation was achieved. No significant case-control differences were found on 20 variables measuring premorbid status. The pattern of decline in performance with increasing severity of brain injury was consistent for measures assessing intelligence, memory, speeded motor performance, adaptive problem solving, and academic performance. Moderately and severely injured patients performed at normal levels in reference to standardized intellectual norms, but they showed impairment when compared with their matched controls. The impairments uncovered in this study place moderately and severely brain injured children at risk for problems in the acquisition of academic skills and higher-order cognitive abilities.

Achievement↗
PubMed1987

Predicting short-term outcome in comatose head-injured children.

While planning patient care strategies for the critically head-injured child, anticipation of complications and expected outcomes are important nursing considerations. This research study followed 30 comatose children retrospectively during their hospitalization for severe head injury. Ten prognostic indicators (age, sex, type of injury, Glasgow Coma Scale total, motor response, pupillary response, oculocephalic reflex, corneal reflex, gag reflex, and ventilatory status) were analyzed for their relationship to the subsequent development of diffuse cerebral swelling, duration of coma, and mortality. Only the corneal reflex was significantly related to all three of the short-term complications (p greater than 0.05). Age category was shown to be related to both diffuse cerebral swelling and duration of coma (p greater than 0.05), identifying children between 11 and 15 years of age at greatest risk for these life-threatening complications. Knowledge of the probable clinical course of a head-injured child aids the nurse in developing care plans and supporting family members.

Adolescent↗
PubMedDate not supplied

The protein content of dental rubber dams.

OBJECTIVES: The purpose of this study was to analyse the protein content of 17 commonly used rubber dams and to determine if they contained known allergenic proteins. METHODS: Proteins were eluted with buffer from 17 brands of commercially available rubber dams. The quantity of eluted protein was measured and expressed in micrograms in every gram of rubber. The molecular weights of the individual proteins eluted were then measured after resolution on sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and compared with those of known allergens. RESULTS: The rubber dams were shown to contain significant amounts of protein (950-5850 micrograms). The subsequent analysis of these proteins using SDS-PAGE confirmed that some of these proteins were of the same molecular weight as known allergens. CONCLUSIONS: The results of this study confirm that all the rubber dams tested contained significant amounts of protein. The molecular weights of these proteins correspond with those of known allergens, and they could, therefore, be a cause of hypersensitivity reactions to dental rubber dams.

Allergens↗