Search PubMed⌕ Search

Biomedical subjects

P Cummings

Publications and source records attributed to P Cummings.

At least 37 records · Page 2Linked to original sources
PubMed2001

Drowsiness, counter-measures to drowsiness, and the risk of a motor vehicle crash.

OBJECTIVES: Knowledge of how different indicators of drowsiness affect crash risk might be useful to drivers. This study sought to estimate how drowsiness related factors, and factors that might counteract drowsiness, are related to the risk of a crash. METHODS: Drivers on major highways in a rural Washington county were studied using a matched case-control design. Control (n=199) drivers were matched to drivers in crashes (n=200) on driving location, travel direction, hour, and day of the week. RESULTS: Crash risk was greater among drivers who felt they were falling asleep (adjusted relative risk (aRR) 14.2, 95% confidence interval (CI) 1.4 to 147) and those who drove longer distances (aRR 2.2 for each additional 100 miles, 95% CI 1.4 to 3.3). Risk was also greater among drivers who had slept nine or fewer hours in the previous 48 hours, compared with those who had slept 12 hours. Crash risk was less for drivers who used a highway rest stop (aRR 0.5, 95% CI 0.3 to 1.0), drank coffee within the last two hours (aRR 0.5, 95% CI 0.3 to 0.9), or played a radio while driving (aRR 0.6, 95% CI .4 to 1.0). CONCLUSION: Drivers may be able to decrease their risk of crashing if they: (1) stop driving if they feel they are falling asleep; (2) use highway rest stops; (3) drink coffee; (4) turn on a radio; (5) get at least nine hours sleep in the 48 hours before a trip; and (6) avoid driving long distances by sharing the driving or interrupting the trip.

Accidents, Traffic↗
PubMed2001

Accuracy of external cause of injury codes reported in Washington State hospital discharge records.

OBJECTIVE: To evaluate the accuracy of external cause of injury codes (E codes) reported in computerized hospital discharge records. METHODS: All civilian hospitals in Washington State submit computerized data for each hospital discharge to a file maintained by the Department of Health. In 1996, 32 hospitals accounted for 80% of the injury related discharges in this file; from these hospitals, we sampled 1,260 computerized records for injured patients in a stratified, but random, manner. An expert coder then visited the 32 study hospitals, reviewed the medical records that corresponded to each computerized record, and assigned an E code for that hospitalization. The computerized E code information was compared with codes provided by the expert reviewer. RESULTS: The incidence of hospitalization for injury based upon computerized hospital discharge data was very similar to that based upon chart review: incidence rate ratio 1.0 (95% confidence interval 1.00 to 1.02). Computerized hospital discharge data correctly ranked injuries in regard to both mechanism and intent. Overall agreement on coding was 87% for mechanism of injury, 95% for intent of injury, and 66% for the complete E code. The sensitivity of computerized hospital discharge data for identification of falls, motor vehicle traffic injuries, poisonings, and firearm injuries was 91% or better. The predictive value positive of coding for these four categories of injury ranged from 88% for motor vehicle traffic injuries to 94% for poisonings. The amount of agreement for intent coding ranged from 84% for firearm injuries to 99% for falls. Agreement on coding of the complete E code ranged from 57% for firearm injuries to 72% for poisonings. CONCLUSIONS: Computerized hospital discharge data can be used with confidence to determine how many injuries are treated in a hospital setting and the relative magnitude of various categories of injury. E codes reported in hospital discharge data are a reliable source of information on the types of information most often used for injury related analyses and priority setting. The detail codes (complete E codes) reported in hospital discharge codes are less reliable and must be used with caution.

Forms and Records Control↗
PubMed2001

Use of Washington State newspapers for submersion injury surveillance.

OBJECTIVES: To evaluate the usefulness of newspapers as a surveillance tool for submersion injury, the proportion of submersion events and important details reported in Washington State newspapers was determined. It was also determined whether a letter sent to newspaper editors to encourage reporting changed the proportion and content of reported submersion events. METHODS: Newspaper articles regarding submersion were collected from 225 Washington newspapers from June 1993 through September 1998. Newspaper articles were linked to computerized state death and hospital records. Reporting during periods before and after a letter was sent encouraging more newspaper articles on submersion injury and preventative factors was compared. RESULTS: A total of 1,874 submersion victims were identified in the three data sources. Of the 983 victims who had a death certificate, 52% were reported in at least one news article. Of the 471 persons in hospital discharge data, 25% were reported in a newspaper. Reporting of pediatric victims who died increased from 63% to 79% (p=0.008); reporting of hospitalized persons increased from 23% to 27% (p=0.3). There were increases in reporting of swimming ability (7% to 15%, p<0.001), supervision (82% to 91%, p<0.001), and alcohol use (7% to 24%, p<0.001). Reporting of life vest use decreased (35% to 23%, p<0.001). CONCLUSIONS: Newspapers failed to report about one half of fatal submersions and three quarters of submersions that resulted in a hospitalization. An effort to improve reporting was associated with an increase in the proportion of pediatric drownings that were reported, but a consistent improvement in content was found. The usefulness of newspaper articles as a surveillance tool may be limited.

Adolescent↗
PubMed2001

Do "whiplash" victims with neck pain differ from those with neck pain and other symptoms?

Studying 432 patients with "whiplash" neck pain after a low speed rear-end crash, we determined whether those who reported associated symptoms (arm or low back pain) differed from those with neck pain only. Exposure variables were: age, gender, height, weight, surprised by impact, rotated position of the head, and pre-existing cervical or lumbar spinal degeneration. Immediate symptoms were considered. Odds ratios (OR) were derived from logistic regression. Only pre-existing lumbar spinal degeneration was associated with having arm symptoms (OR = 9.6, CI = 1.1, 83.6) or low back pain (OR = 23.3, CI = 2.6, 206.7) along with neck pain.

Accidents, Traffic↗
PubMed2000

The effect of organized systems of trauma care on motor vehicle crash mortality.

CONTEXT: Despite calls for wider national implementation of an integrated approach to trauma care, the effectiveness of this approach at a regional or state level remains unproven. OBJECTIVE: To determine whether implementation of an organized system of trauma care reduces mortality due to motor vehicle crashes. DESIGN: Cross-sectional time-series analysis of crash mortality data collected for 1979 through 1995 from the Fatality Analysis Reporting System. SETTING: All 50 US states and the District of Columbia. SUBJECTS: All front-seat passenger vehicle occupants aged 15 to 74 years. MAIN OUTCOME MEASURES: Rates of death due to motor vehicle crashes compared before and after implementation of an organized trauma care system. Estimates are based on within-state comparisons adjusted for national trends in crash mortality. RESULTS: Ten years following initial trauma system implementation, mortality due to traffic crashes began to decline; about 15 years following trauma system implementation, mortality was reduced by 8% (95% confidence interval [CI], 3%-12%) after adjusting for secular trends in crash mortality, age, and the introduction of traffic safety laws. Implementation of primary enforcement of restraint laws and laws deterring drunk driving resulted in reductions in crash mortality of 13% (95% CI, 11%-16%) and 5% (95% CI, 3%-7%), respectively, while relaxation of state speed limits increased mortality by 7% (95% CI, 3%-10%). CONCLUSIONS: Our data indicate that implementation of an organized system of trauma care reduces crash mortality. The effect does not appear for 10 years, a finding consistent with the maturation and development of trauma triage protocols, interhospital transfer agreements, organization of trauma centers, and ongoing quality assurance.

Accidents, Traffic↗
PubMed2000

Effect of a ban on carrying firearms on homicide rates in 2 Colombian cities.

CONTEXT: Homicide is a leading cause of death in Colombia, with much of the fatal interpersonal violence concentrated in the country's largest cities. Firearms are involved in as much as 80% of homicides in Colombia. OBJECTIVE: To evaluate the effect of an intermittent police-enforced ban on carrying firearms on the incidence of homicide in urban Colombia. DESIGN: Interrupted time-series study with multiple replications. SETTING: Cali, Colombia, during 1993 and 1994 and Bogotá, Colombia, from 1995 through August 1997. PARTICIPANTS: The populations of Cali and Bogotá. INTERVENTION: Carrying of firearms was banned on weekends after paydays, on holidays, and on election days. Enforcement included establishment of police checkpoints and searching of individuals during traffic stops and other routine law enforcement activity. MAIN OUTCOME MEASURE: Homicide rates during intervention days were compared with rates during similar days without the intervention; estimates were based on comparisons within the same month, day of week, and time of day. RESULTS: There were 4078 homicides in Cali during 1993 and 1994 (114.6 per 100,000 person-years). In Bogotá, 9106 homicides occurred from 1995 through August 1997 (61 per 100,000 person-years). The incidence of homicide was lower during periods when the firearm-carrying ban was in effect compared with other periods (multivariate-adjusted rate ratio, 0.86 [95% confidence interval [CI], 0.76-0.97] for Cali, and 0.87 [95% CI, 0.77-0.98] for Bogotá). CONCLUSION: An intermittent citywide ban on the carrying of firearms in 2 Colombian cities was associated with a reduction in homicide rates for both cities.

Adolescent↗
PubMed2000

The shift to and from daylight savings time and motor vehicle crashes.

The objective of the study was to examine whether the shifts to and from daylight savings time in Sweden have short-term effects on the incidence of traffic crashes. A database maintained by the Swedish National Road Administration was used to examine crashes from 1984 through 1995, that occurred on state roads the Monday preceding, the Monday immediately after (index Monday), and the Monday 1 week after the change to daylight savings time in the spring and for the corresponding three Mondays in the autumn. The Mondays 1 week before and after the time changes were taken as representing the expected incidence of crashes. Crash incidence was calculated per 1000 person-years using population estimates for each year of the study. The association between 1 h of possible sleep loss and crash incidence was estimated by the incidence rate ratio from negative binomial regression. The incidence rate ratio was 1.04 (95% CI, 0.92-1.16) for a Monday on which drivers were expected to have had 1 h less sleep, compared with other Mondays. In the spring, the incidence rate ratio for crashes was 1.11 (95% CI, 0.93-1.31) for Mondays after the time change compared to other spring Mondays. The corresponding rate ratio for the fall was 0.98 (95% CI, 0.84-1.15) It was concluded that the shift to and from daylight savings time did not have measurable important immediate effects on crash incidence in Sweden.

Accidents, Traffic↗
PubMed2000

Identified spouse abuse as a risk factor for child abuse.

CONTEXT: There are limited data on the extent to which spouse abuse in a family is a risk factor for child abuse. OBJECTIVE: To estimate the subsequent relative risk of child abuse in families with a report of spouse abuse compared with other families. DESIGN: Cohort study. SETTING: Analysis of a centralized US Army database PARTICIPANTS: Married couples with children with at least one spouse on active duty in the US Army during 1989-95. MAIN OUTCOME MEASURES: The US Army Family Advocacy Program's Central Database was used to identify child and spouse abuse. The exposure was an episode of identified spouse abuse and the main outcome was a substantiated episode of subsequent child abuse. RESULTS: During the study period of an estimated 2,019,949 person years, 14,270 incident child abuse cases were substantiated. Families with an incident case of spouse abuse identified during the study period were twice as likely to have a substantiated report of child abuse compaired with other military families, rate ratio, 2.0, (95% confidence interval [CI] 1.9-2.1). Young parental age had the highest rate ratio, 4.9 (95% CI 4.5-5.3) in the subgroup analysis controlling for rank. Identified spouse abuse was associated with physical abuse of a child, rate ratio 2.4 (95% CI 2.2-2.5), and with sexual abuse of a child, rate ratio 1.5 (95% CI 1.3-1.7). Identified spouse abuse was not associated with child neglect or maltreatment, rate ratio, 1.0 95% CI 0.9-1.1) CONCLUSION: An identified episode of spouse abuse in a family appears to be associated with an increased risk of subsequent child abuse and serves as an independent risk factor. Therefore. care providers should consider the potential risk to children when dealing with spouse abuse.

Adult↗
PubMed2000

Attitudes toward limitation of support in a pediatric intensive care unit.

OBJECTIVE: To prospectively determine opinions of members of a pediatric intensive care unit (PICU) team regarding the appropriateness of aggressive care. The types of support that caregivers sought to limit and their reasons for wanting these limits were collected over time. DESIGN: Prospective survey of caregiver opinions. SETTING: PICU in an academic tertiary care children's hospital. SUBJECTS: A total of 68 intensive care nurses, 11 physicians attending in the PICU, 10 critical care and anesthesia fellows, and 24 anesthesia and pediatric residents. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During a 6-month period, 503 patients were admitted to the PICU. Within this time period, 52.4% of all deaths were preceded by limitation of support, with 100% of noncardiac surgical deaths preceded by limitation of medical interventions. At least one caregiver wished to limit care for 63 of these patients (12.5%). When caregivers wished to limit support they most frequently wished to limit invasive modes of support such as cardiopulmonary resuscitation (94%) and hemodialysis (83%). The ethical rationales identified most often for wishing to limit support were burden vs. benefit (88%) and qualitative futility (83%). Preadmission quality of life was cited less frequently (50%). Caregivers were less likely to limit care on the basis of quality of life. Nurses and physicians in the PICU were very similar to each other in the types of support they thought should be limited and their ethical rationales. CONCLUSIONS: When making decisions about whether or not to limit care for a patient, caregivers were more likely to rely on the perceived benefit to the patient than preadmission quality of life.

Caregivers↗
PubMed2000

Harborview assessment for risk of mortality: an improved measure of injury severity on the basis of ICD-9-CM.

BACKGROUND: There have been several attempts to develop a scoring system that can accurately reflect the severity of a trauma patient's injuries, particularly with respect to the effect of the injury on survival. Current methodologies require unreliable physiologic data for the assignment of a survival probability and fail to account for the potential synergism of different injury combinations. The purpose of this study was to develop a scoring system to better estimate probability of mortality on the basis of information that is readily available from the hospital discharge sheet and does not rely on physiologic data. METHODS: Records from the trauma registry from an urban Level I trauma center were analyzed using logistic regression. Included in the regression were Internation Classification of Diseases-9th Rev (ICD-9CM) codes for anatomic injury, mechanism, intent, and preexisting medical conditions, as well as age. Two-way interaction terms for several combinations of injuries were also included in the regression model. The resulting Harborview Assessment for Risk of Mortality (HARM) score was then applied to an independent test data set and compared with Trauma and Injury Severity Score (TRISS) probability of survival and ICD-9-CM Injury Severity Score (ICISS) for ability to predict mortality using the area under the receiver operator characteristic curve. RESULTS: The HARM score was based on analysis of 16,042 records (design set). When applied to an independent validation set of 15,957 records, the area under the receiver operator characteristic curve (AUC) for HARM was 0.9592. This represented significantly better discrimination than both TRISS probability of survival (AUC = 0.9473, p = 0.005) and ICISS (AUC = 0.9402, p = 0.001). HARM also had a better calibration (Hosmer-Lemeshow statistic [HL] = 19.74) than TRISS (HL = 55.71) and ICISS (HL = 709.19). Physiologic data were incomplete for 6,124 records (38%) of the validation set; TRISS could not be calculated at all for these records. CONCLUSION: The HARM score is an effective tool for predicting probability of in-hospital mortality for trauma patients. It outperforms both the TRISS and ICD9-CM Injury Severity Score (ICISS) methodologies with respect to both discrimination and calibration, using information that is readily available from hospital discharge coding, and without requiring emergency department physiologic data.

Adolescent↗
PubMed2000

Systemic corticosteroids in infant bronchiolitis: A meta-analysis.

OBJECTIVE: To determine whether corticosteroids are efficacious in treating bronchiolitis in hospitalized infants. METHODS: Online bibliographic databases (Medline, Embase, and Cochrane Clinical Trials Registry) were searched for: 1) bronchiolitis or respiratory syncytial virus, and 2) corticosteroid or glucocorticoid or steroidal antiinflammatory agents or adrenal cortex hormones. Reference lists from all selected articles were also examined. Randomized, placebo-controlled trials of systemic corticosteroids in treatment of infants hospitalized with bronchiolitis were selected by 2 investigators. Of 12 relevant publications identified in the literature search, 6 met the selection criteria and had relevant data available. Investigators independently extracted data for 3 outcomes: length of stay (LOS), duration of symptoms (DOS), and clinical scores. RESULTS: In the pooled analysis, infants who received corticosteroids had a mean LOS or DOS that was.43 days less than those who received the placebo treatment (95% confidence interval: -.81 to -.05 days). The effect size for mean clinical score was -1.60 (95% confidence interval: -1.92 to -1.28), favoring treatment. Secondary analyses of mean LOS or DOS were performed on 5 trials that had clearly identified methods of randomization, 5 trials that measured LOS, and 4 trials that clearly excluded infants with previous wheezing. The estimates of effect were similar to the primary analysis but were not statistically significant. CONCLUSIONS: Combined, published reports of the effect of systemic corticosteroids on the course of bronchiolitis suggest a statistically significant improvement in clinical symptoms, LOS, and DOS.

Anti-Inflammatory Agents↗
PubMed2000

Firearm safety counseling in primary care pediatrics: a randomized, controlled trial.

CONTEXT: Physicians have been encouraged to counsel families about risks associated with gun ownership, but the effectiveness of physician counseling regarding gun safety is unknown. OBJECTIVE: To determine the effectiveness of gun safety counseling during well-child care visits. DESIGN: Group randomized, controlled trial. Physicians, nurse practitioners, and physician assistants were randomized to either the intervention group or a control group. SETTING: Group Health Cooperative, a staff-model health maintenance organization. Patients. Consecutive sample of families (n = 1295) seen for a scheduled appointment for well-child care for a child <18 years of age. Of the families originally scheduled for a visit, 80. 3% were seen and completed the outcomes surveys. INTERVENTION: Each family in the intervention group was given a 60-second message by their practitioner that depended on the presence of guns in the home. Families without guns were informed of the health risks associated with gun ownership and given a standard information pamphlet. Families with guns were given the same information about risks and were told that if they chose to keep a gun, they should store it locked and unloaded. They were given instructions on storage and a folder with material, including the same pamphlet, a letter from the police department, written storage guidelines, and discount coupons for gun storage devices. MAIN OUTCOME MEASURE: Changes in the following self-reported events: 1) acquisition of a safe storage device; 2) removal of firearms from the home; and 3) acquisition of firearms. Results. There were no important differences between intervention and control groups in the rate of acquisition of new guns (intervention: 1.3% vs control:.9%) after the intervention. Among households with guns at baseline, there were also no differences between groups in the removal of guns (intervention: 6.7% vs control: 5.7%), but there was a fairly large nonsignificant difference in the proportion who purchased trigger locks (intervention: 8.0% vs control: 2.5%). CONCLUSIONS: A single firearm safety-counseling session during well-child care, combined with economic incentives to purchase safe storage devices, did not lead to changes in household gun ownership and did not lead to statistically significant overall changes in storage patterns.

Adolescent↗
PubMed2000

The feasibility of a porcine model of acute coronary occlusion and reperfusion using off-pump coronary artery bypass grafting.

We developed an open-chest porcine model of acute coronary occlusion and surgical reperfusion, and attempted to prevent intra-operative ischaemic ventricular fibrillation (VF) by a Retrograde Intracoronary Glyceryl trinitrate (RIG) infusion into the occluded vessel. Five Yorkshire pigs (weight 50 +/- 1.1 kg), randomized into 3 groups, underwent median sternotomy under general anaesthesia. One pig (Group 1, control) underwent sternotomy and pericardiotomy only. Four pigs underwent acute left anterior descending (LAD) coronary occlusion. Two pigs were not reperfused (Group 2). Two pigs underwent surgical reperfusion (Group 3) via left internal mammary artery (LIMA) grafting to the LAD using the Off-Pump Coronary Artery Bypass (OPCAB) technique. Ischaemic injury was assessed using 7-lead electrocardiography (ECG) and transthoracic/epimyocardial echocardiography (ECHO). Group 1: transient intraoperative hypotension and VF occurred. Successful resuscitation and 10-week survival (until sacrifice) with normal left ventricular (LV) function was achieved. Group 2: there were ECG and ECHO evidence of acute LV ischaemic dysfunction in both pigs. The surviving pig had persistent anterior hypokinesis at 8 1/2 months. The other died intra-operatively following progressive ischaemic LV dysfunction despite resuscitative attempts. Group 3: the surviving pig had normal LV function at 8 months. Initial anterior LV akinesis normalized within 7 days. The other developed post-occlusion haemodynamic instability and died intra-operatively despite reperfusion. In this porcine model, acute LAD artery occlusion modified by the novel RIG infusion technique, followed by surgical reperfusion (OPCAB) is feasible. This model would facilitate further development of OPCAB surgical expertise and understanding of the pathophysiology of ischaemia-reperfusion injury.

Animals↗
PubMed1999

Trends in unintentional drowning: the role of alcohol and medical care.

CONTEXT: During the last few decades, mortality from drowning has decreased in the United States for unknown reasons. It has been hypothesized that this decline may be due to decreased use of alcohol in and around water or improved medical treatment after a submersion. OBJECTIVES: To estimate changes in unintentional mortality due to submersion, estimate trends in drownings attributable to alcohol use, and assess the role of medical care in these mortality trends. DESIGN: A 21-year longitudinal study of case findings, from January 1, 1975, through December 31,1995. SETTING AND PARTICIPANTS: All residents of King County, Washington, who died unintentionally from submersion and 284 persons hospitalized for submersion who survived. MAIN OUTCOME MEASURES: Changes in submersion-related mortality incidence over time, proportion of this mortality that could be attributed to alcohol use, changes over time in the case-fatality rate of treated patients, and estimate of deaths prevented in 1995 compared with projected estimates had there been no change in incidence since 1975. RESULTS: There were 539 deaths due to drowning in King County during 21 years. Mortality rates during this period declined by 59% (95% confidence interval [CI], -70% to -46%). The incidence of death attributable to alcohol use decreased by 81% (95% CI, -91% to -57%); this could account for 51% of deaths prevented in 1995. Among 249 comatose patients who received prehospital care, 205 died; the odds of survival decreased 40% over 21 years (P = .40). Among 101 comatose patients who were hospitalized, 63 died; the odds of survival decreased 29% (P = .75). The incidence of survival of comatose hospital patients decreased by 29% from 1975 to 1995 (95% CI, -78% to +125%). We found no evidence that trends in medical treatment prevented any deaths due to drowning in 1995. CONCLUSIONS: Drowning incidence in King County, Washington, declined because of a decrease in severe submersion episodes rather than an increase in success of medical interventions. Our data support the theory that less use of alcohol around water prevents some deaths. About half of the decrease was unexplained.

Alcoholic Intoxication↗
PubMed1999

Effectiveness of primary and secondary enforced seat belt laws.

OBJECTIVE: The objective of this study was to determine the relative efficacy of primary and secondary enforced motor vehicle occupant restraint laws on the outcomes of restraint use, crash-related mortality, and crash-related injuries. SEARCH STRATEGY: We used the Cochrane Collaboration search strategy to search the following electronic databases: MEDLINE, EMBASE, National Technical Information Service (NTIS), Psyc-INFO, ERIC, Nursing and Allied Health (CINAHL), Transportation Research Information Service (TRIS), and EI Compendex. The reference lists from each potentially eligible study were checked, and knowledgeable people in the field were contacted, for additional leads to published reports. SELECTION CRITERIA: Studies had to include a comparison of primary enforcement law to no law, secondary enforcement law to no law, or a primary to a secondary law. Any study design was acceptable. Acceptable outcome measures included observed restraint use, and counts or rates of deaths or serious injuries. DATA COLLECTION: Data were collected using a standard abstract reporting from. Relative differences in outcomes and absolute differences were calculated when possible. MAIN RESULTS: We identified 48 studies for the review. When places or time periods with primary enforcement laws were compared to those without such laws, the relative prevalence of seat belt use ranged from 1.5 to 4.5; the prevalence differences ranged from 10 to 50 per 100 observed drivers. Secondary laws had smaller effects. Two studies evaluated a change in law from secondary to primary enforcement; this was associated with an increase in belt use 6 months later of 5.3 per 100 observed drivers in Louisiana and 18 per 100 drivers in California. Primary enforcement laws were associated with a relative risk of death in MV crashes of .54 to .97. The reduction in mortality associated with secondary enforcement laws was much more modest, with relative risks estimates of .81 to 1.025. Primary enforcement laws were associated with a relative risk of severe injuries of .20 to .89; the association of secondary enforcement laws with severe injuries was smaller. CONCLUSIONS: Our review of existing studies suggests that primary enforcement laws are likely to be more effective than secondary laws. However, few studies are of good quality, and quantitative estimates of the relative effect of primary compared with secondary laws are limited.

Accidents, Traffic↗