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Biomedical subjects

P Cummings

Publications and source records attributed to P Cummings.

At least 55 records · Page 3Linked to original sources
PubMed1999

Predictors of physician compliance with a published guideline on management of febrile infants.

BACKGROUND: Previous studies have demonstrated clinicians' poor compliance with published management strategies and protocols, but the reasons why physicians often choose to vary their management of the febrile infant from published guidelines are poorly understood. OBJECTIVE: We conducted a study of physicians to learn more about the issues that influence their decisions in the management of febrile infants. METHODS: A survey study of pediatricians, emergency physicians and family physicians randomly selected from a list of licensed physicians in the United States. Chi square and Kruskal-Wallis tests were used to measure differences in responses by specialty. Odds ratios from logistic regression were used to measure differences in compliance with a recently published guideline. RESULTS: We received 193 completed surveys from pediatricians, 177 from emergency physicians and 104 from family physicians. After controlling for other variables, odds for compliance with a recently published guideline were higher for pediatricians [odds ratio (OR) = 9.13] and emergency physicians (OR = 2.5) than for family physicians (P < 0.001). Factors associated with decreased odds of compliance included more years since graduation from medical school (OR = 0.93), a higher proportion of office visits by children < 1 year of age (OR = 0.97) and increased comfort diagnosing serious bacterial illness (OR = 0.35). Factors associated with increased odds of compliance included a higher perceived likelihood of serious bacterial illness in febrile infants (OR = 1.01) and better reported knowledge of the recently published guideline (OR = 2.01). CONCLUSIONS: We found that specialty as well as other factors were associated with physician compliance with a recently published guideline. This information may facilitate guideline development and implementation by providing a better understanding of what motivates physicians in their clinical decision making.

Adult↗
PubMed1999

Pediatric practice based evaluation of the Steps to Prevent Firearm Injury program.

OBJECTIVE: To estimate the prevalence of gun ownership and methods of gun storage in homes of pediatric patients before and after an educational intervention. DESIGN: Before and after trial. SETTING: Hospital based, inner city, pediatric primary care practice. PARTICIPANTS: Consecutive sample of parents of patients with appointments August to November 1994. INTERVENTION: Before the intervention, participants completed an anonymous questionnaire regarding ownership and storage of guns in their home. The intervention followed the Steps to Prevent Firearm Injury program of the American Academy of Pediatrics. It began after the parent completed the questionnaire and was reinforced at subsequent visits until July 1995. Families completing a baseline questionnaire and returning to the office July to October 1995 were resurveyed. MAIN OUTCOME MEASURE: Reported change in gun ownership and methods of storage. RESULTS: A gun(s) in the home was reported by 8.7% of respondents. Matched baseline and follow up questionnaires were available for 23.6% of families. In these, gun ownership reportedly decreased after intervention from 9.4% to 7.0%, handgun ownership fell from 5.4% to 3.0%, and long gun ownership fell from 6.1% to 5.5%. Storing guns outside of a locked container did not change from the baseline prevalence of 2.7%, but keeping any gun loaded fell from 1.6% to 0.5%. All p values were >0.05. CONCLUSION: This study was unable to demonstrate a statistically significant decline in gun ownership or improvement in gun storage after a practice based intervention designed to encourage these behaviors.

Adult↗
PubMed1999

Evaluation of a drowning prevention campaign in King County, Washington.

OBJECTIVES: A three year drowning prevention campaign focused on increasing the use of life vests among children 1-14 years old. An evaluation was conducted to determine campaign awareness, change in ownership and use of life vests by children, and predictors of life vest use. SETTING: King County, Washington. METHODS: Four telephone surveys were conducted with parents before, during, and after the campaign. RESULTS: The campaign was recalled by 50% of families surveyed. From before to after the campaign, reported life vest use by children on docks, beaches, or at pools increased from 20% to 29% (p < 0.01) and life vest ownership for children increased from 69% to 75% (p = 0.06). Among parents aware of the campaign, reported child life vest use increased from 20% to 34% (p < 0.001) and ownership increased from 69% to 80% (p < 0.01). Among families unaware of the campaign, neither life vest use nor ownership changed significantly. Children were more often reported to wear life vests if a parent knew of the campaign, was confident fitting the vest, was younger than 40 years, felt the child could not swim well, and owned a life vest for the child. CONCLUSIONS: A community-wide drowning prevention campaign resulted in a significant, although modest, increase in reported life vest use and ownership among children.

Accident Prevention↗
PubMed1999

Incidence and outcome of injury in Ghana: a community-based survey.

Injury is an increasingly significant health problem in most low-income countries. However, strategies for preventing injury have not been well addressed. The present study was carried out to measure the incidence and outcome of various mechanisms of injury in Ghana in order to provide data for use in developing priorities for injury prevention efforts. For this purpose, using two-stage cluster sampling and household interviews, we surveyed 21,105 persons living in 431 urban and rural sites. During the preceding year, 1609 injuries resulting in one or more days of loss of normal activity were reported. Injury-related mortality was slightly higher in the urban (83 per 100,000) than in the rural area (53 per 100,000). However, the burden of disability from nonfatal injuries, as assessed by disability days, was higher in the rural (4697 disability days per 1000 person-years) than in the urban area (2671 days per 1000 person-years). Based on incidence rates and disability times, the major types of injury in the urban area were transport-related injury and falls. In the rural area, agricultural injuries predominated, followed by falls and transport-related injury. In rural and urban areas combined, 73% of motor vehicle-related injuries involved commercial vehicles. In this and other similar developing-country settings, injury prevention efforts should focus on falls and on transport safety in both urban and rural areas, with special attention being paid to commercial vehicles. In rural areas, agricultural injuries contributed the largest burden of morbidity, and should be a priority for prevention efforts.

Adolescent↗
PubMed1998

Risk factors for pilot fatalities in general aviation airplane crash landings.

CONTEXT: Most pilots survive airplane crash landings in small airplanes. Factors associated with pilot death have not been well studied. OBJECTIVE: To identify factors associated with fatalities in general aviation airplane crash landings. DESIGN: Case-control study. SETTING: The United States. SUBJECTS: All pilots in general aviation crash landings of airplanes with 10 seats or fewer, from 1983 through 1992. MAIN OUTCOME MEASURE: Pilot death. RESULTS: Pilots died in 437 (5.2%) of 8411 crash landings. A fire or explosion on the ground was strongly associated with pilot death (relative risk [RR], 20.4; 95% confidence interval [CI], 15.5-26.9), adjusted for pilot age, pilot flight hours, type of landing gear, and the filing of an instrument flight plan. Pilots who failed to use both lap belt and shoulder harness were more likely to die (adjusted RR, 6.8; 95% CI, 1.8-25.5), as were those who used only the lap belt (adjusted RR, 1.7; 95% CI, 1.3-2.2), compared with pilots who used both restraints. CONCLUSION: Pilots may be able to reduce their risk of death in a crash landing by using lap and shoulder restraints.

Accidents, Aviation↗
PubMed1998

Trends in firearm-related injuries in Washington State, 1989-1995.

STUDY OBJECTIVES: To describe the incidence and outcome of firearm-related injuries and to describe trends over time. DESIGN: Information about firearm-related injuries in Washington state was extracted from computerized death certificate and hospital discharge files for the period 1989 through 1995. Cases seen only in emergency departments were estimated using initial results from a statewide firearm injury surveillance system. RESULTS: An estimated 9,995 persons were shot during the 7-year period (incidence 28.0/100,000 person-years); 2,944 persons (29%) required ED care only, 2,864 persons (29%) were hospitalized and survived, and 4,187 persons (42%) died. Survival was lowest for suicide attempts (11%), intermediate for assaults (68%), and greatest for unintentional shootings (96%). Most deaths (91%) occurred before hospital admission. From 1989 to 1995, the incidence of firearm-related injuries showed little change: an increase of 4.5%. However, suicidal shootings among persons younger than 35 years increased by 31.3%, and the incidence of firearm-related assaults rose by 53.7% among persons of all ages. Survival among all persons who were shot and among hospitalized shooting victims showed little change over time. CONCLUSION: Firearm-related suicides among the young and assault-related shootings among all persons increased. The estimated proportion of shooting victims who survived did not change over time.

Adolescent↗
PubMed1998

Handgun purchase trends, Washington state: differences by age of buyer.

STUDY OBJECTIVES: To examine trends in legal handgun purchases from federally licensed dealers and specifically to describe recent changes in age and gender of purchaser and caliber of handguns purchased. METHODS: A cohort study was performed of the adult population of Washington state from 1950 through 1992 using a state dealer record of handgun sales database. The purchase of handguns from licensed dealers was expressed as the number purchased per 100,000 population per year. RESULTS: The handgun purchase rate increased for the total population between 1950 and 1992, from 169 to 2,076 per 100,000 persons. Between 1983 and 1992, the purchase rate among men aged 21 to 24 years increased 184%; among women of this age group, the rate increased 127%. Among men aged 21 to 24 years, the rate of 9 mm handgun purchases increased 1,682% between 1983 and 1992, the greatest increase for any age-caliber category. CONCLUSION: The greatest increase in rate of legal handgun purchases in Washington state from 1983 through 1992 was among the youngest purchasers. Sales of 9 mm handguns increased most rapidly, especially among the youngest buyers.

Adult↗
PubMed1998

Studying injuries with case-control methods in the emergency department.

To study factors that cause or prevent injuries, it can be efficient to use a case-control study design and select both cases and controls from patients seen in the ED. Bias in case ascertainment can be reduced by studying exposures that, aside from their influence on the risk of injury, are unrelated to the use of emergency care. The ideal control group often includes persons generally not seen in an ED: for example, those who experience the injury-producing event, such as a bicycle crash, but who do not sustain serious injury. However, the exposure experience of the underlying population at risk sometimes can be closely approximated with information from selected persons seeking emergency care. With careful attention to the selection of study subjects, valid case-control studies of the causes of some injuries can be conducted in the ED.

Bias↗
PubMed1998

Washington State Gunshot-Wound Surveillance System.

CONTEXT: Gunshot is the second leading mechanism of injury death in Washington State, but data on nonfatal gun-related injuries are limited. OBJECTIVE: Develop and evaluate a system for surveillance of fatal and nonfatal gunshot injuries. DESIGN: A gunshot wound surveillance system was pilot-tested. Reports from emergency departments were compared with emergency department logs and reports from medical examiners and coroners were compared with death certificates. SETTING: Six Washington counties, with 57% of the state's population. PARTICIPANTS: Hospital emergency departments, coroners, medical examiners, and local law enforcement agencies. MAIN OUTCOME MEASURES: Surveillance system simplicity, acceptability, sensitivity, and predictive value positive. RESULTS: The pilot system was found to be simple and acceptable to data providers. The predictive value positive was 99% for reports from hospital emergency departments and 100% for reports from medical examiners and coroners. The sensitivity of hospital emergency department reporting was 76%; the sensitivity of reporting by medical examiners and coroners was 81%. CONCLUSIONS: States interested in developing gunshot-wound surveillance systems should: (1) verify the existence of a statewide gunshot-wound reporting requirement, (2) consider establishing such a requirement if one does not exist, (3) include hospital emergency departments as a data source, (4) establish the capacity to link records if multiple data sources are used, (5) limit the data reporting requirements to fit on a one-page form, preferably one-side only, (6) periodically review the data and the reporting practices of data providers, and be prepared to make changes if things are not working as planned, and (7) disseminate surveillance data and system evaluation findings on a regular basis.

Cause of Death↗
PubMed1998

Cancer and a fatiguing illness in Northern Nevada--a causal hypothesis.

PURPOSE: We investigated the possibility that chronic fatigue syndrome (CFS) predisposes to cancer by comparing the cancer pattern in an area in northern Nevada, where an outbreak of a fatiguing illness, which included cases of CFS, was reported, to an area in southern Nevada, where no such illness was reported. METHODS: Data from the computerized Nevada Cancer Registry were utilized to compare incidence rates of four malignancies--brain cancer, non-Hodgkin lymphoma (NHL), lung cancer, and breast cancer--in Washoe and Lyon Counties, where an unexplained fatiguing illness was reported during 1984-86, with comparably sized Clark County, where no such illness was reported. RESULTS: Higher incidences of NHL and primary brain tumors were noted in the two northern Nevada counties (Washoe and Lyon) in 1986 and 1987 respectively, compared to the southern Nevada (Clark) county. Similar patterns were not seen for breast or lung cancer. CONCLUSIONS: This study provides a model for investigating the possible predisposition of CFS patients to develop cancer using other cohorts, but it is currently premature to accept such a link at this time.

Adult↗
PubMed1998

Blood-brain barrier disruption for the treatment of malignant brain tumors: The National Program.

Chemotherapy delivery for the treatment of malignant brain tumors is markedly enhanced when given in conjunction with osmotic opening of the blood-brain barrier. Osmotic opening or disruption of the blood-brain barrier is achieved while the patient is under general anesthesia, by the infusion of mannitol into the internal carotid or vertebral artery circulation. The mannitol infusion is followed by administration of intraarterial chemotherapy. A National Blood-Brain Barrier Program now exists and includes six universities. Within the National Program over 4200 blood-brain barrier disruption procedures have been performed in over 400 patients. Patients with primary central nervous system (CNS) lymphoma, glioma, primitive neuroectodermal tumor (PNET), germ cell and metastatic cancer are eligible for treatment. Results in patients with primary CNS lymphoma, recently reported in the Cancer Journal, include the first example of a durable response in a primary brain tumor without loss of cognitive function and without use of radiotherapy. Results with PNET and germ cell tumors are also very encouraging. Advanced practice nurses coordinate the care of blood-brain barrier disruption patients. Care includes patients selection, education, close neurological observation, maintenance of fluid and electrolyte balance and managing effects of high-dose chemotherapy. Both acute and long-term medical and psychological follow-up are an essential component of the program, as well as patient and family support.

Antineoplastic Agents↗
PubMed1998

Case series and exposure series: the role of studies without controls in providing information about the etiology of injury or disease.

Descriptions of exposure histories in persons with the same injury or illness ("case series"), and descriptions of outcomes in persons with the same exposure ("exposure series"), have the potential to contribute knowledge relevant to disease etiology in some special situations. The case series can be thought of as a primitive form of case-control study--one in which the controls are only implied. Similarly, the exposure series is a rudimentary type of cohort study. By keeping these analogies in mind, those who author or read studies without controls can assess the design or results for selection bias, confounding, or information bias. While studies without controls cannot supplant true case-control or cohort studies, they are relatively cheap and easy to perform, and there are circumstances in which they provide valuable information. Attention to design is needed to strengthen the results they provide.

Case-Control Studies↗
PubMed1998

Are life vests worn? A multiregional observational study of personal flotation device use in small boats.

OBJECTIVE: Although life vest use is thought to prevent drowning, their use by boaters has not been described. This study sought to determine the use of personal flotation devices (PFDs) in small boats. METHODS: Boaters were observed between April and June 1995 in Washington and Oregon and classified by their age, gender, PFD use, and boat type. RESULTS: Among 4181 boaters, 25% wore a PFD. Use was highest in < 5 year olds (91%) and lowest in those over 14 years (13%). Those in kayaks were most likely (78%) and those in motor boats (19%) were least likely to wear a PFD. Females were more likely to wear a PFD than males (relative prevalence 1.5, 95% confidence interval 1.3 to 1.6). When a child less than 15 years was in a boat with an adult, PFD use was 65% if no adult wore a PFD and 95% if at least one accompanying adult wore a PFD (p = 0.001). CONCLUSIONS: Generally, PFD use by boaters was low in the Northwestern US. Efforts to increase PFD use should target adolescents, adults and specific boating populations, especially those in motor boats.

Adolescent↗
PubMed1997

State gun safe storage laws and child mortality due to firearms.

CONTEXT: Since 1989, several states have passed laws that make gun owners criminally liable if someone is injured because a child gains unsupervised access to a gun. These laws are controversial, and their effect on firearm-related injuries is unknown. OBJECTIVE: To determine if state laws that require safe storage of firearms are associated with a reduction in child mortality due to firearms. DESIGN: An ecological study of firearm mortality from 1979 through 1994. SETTING: All 50 states and the District of Columbia. PARTICIPANTS: All children younger than 15 years. MAIN OUTCOME MEASURES: Unintentional deaths, suicides, and homicides due to firearms. RESULTS: Laws that make gun owners responsible for storing firearms in a manner that makes them inaccessible to children were in effect for at least 1 year in 12 states from 1990 through 1994. Among children younger than 15 years, unintentional shooting deaths were reduced by 23% (95% confidence interval, 6%-37%) during the years covered by these laws. This estimate was based on within-state comparisons adjusted for national trends in unintentional firearm-related mortality. Gun-related homicide and suicide showed modest declines, but these were not statistically significant. CONCLUSIONS: State safe storage laws intended to make firearms less accessible to children appear to prevent unintentional shooting deaths among children younger than 15 years.

Accidents, Home↗