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R S Thompson

Publications and source records attributed to R S Thompson.

At least 19 recordsLinked to original sources

Measurement of severity for nonhospitalized injuries in the pediatric age group.

To better classify minor injuries in the pediatric outpatient population, we empirically developed a scale to predict functional impairment, one week and one month postinjury, based on data available at the time of care. A sample of 857 injured children aged five to 19 years was randomly split into two subsamples. Using logistic regression techniques, predictive models were developed and confirmed on the subsamples and then applied to the full sample. Age, location of injury, and type of injury were predictive of impairment one week post-injury; however, type of injury was the only consistently significant predictor. Type of injury, specifically fracture, dislocation, and sprain, and location of injury (lower extremity) were significant predictors of functional impairment one month postinjury; however, once again, the type of injury was the only variable consistently significant across all models. Other than the type of injury, the variables available at the time of care were too uniform between disabled and nondisabled patients to be useful in developing a severity scale for minor injuries. We conclude that other outcome measurements or scale development techniques should be explored to develop a useful classification scheme for minor injuries.

Adolescent

Calculation of Doppler spectral power density functions.

A volume integral method for the calculation of Doppler ultrasound spectral power density (spd) functions is described. Axisymmetric flow in a circular tube with a power law velocity profile is assumed. The spd function is regarded as a probability density function for scatterer velocity, and the assumptions under which this is justified are considered. It is shown that the spd function is independent of Doppler angle except in the presence of wall reflection effects. A coordinate system centered on the beam is used and this enables the integrals to be easily formulated for arbitrary beams. Irregularly shaped and nonuniform beams can be treated. For the common flow and beam patterns, which exhibit symmetry, the volume integrals can often be reduced to a single integral and evaluated directly. The method is applied and the spectra are calculated for various different cases. Results are obtained for uniform rectangular and circular insonating beams, and for nonuniform beams with Gaussian, jinc, and sinc profiles. The effects of narrow beams and wall reflection are shown. The method may be readily applied to other beam and flow patterns, and extension to more complicated situations is also discussed.

Blood Flow Velocity

Development of an immunization tracking system in a large health maintenance organization. Group Health Cooperative of Puget Sound.

We have successfully developed a mainframe system for tracking all immunizations administered to enrollees in a large HMO. This system will provide comprehensive immunization records on a population of over 350,000 patients. Data required by the National Childhood Vaccine Injury Act of 1986 are locally entered into terminals, and records of immunization are stored in a database. Preliminary results show that data entry times are practical, but that improvement in data quality is needed. This immunization tracking system will be used for research, and as the foundation of an immunization reminder system under development.

Health Maintenance Organizations

Injuries to children and adolescents: impact on physical health.

Disability resulting from injuries was examined in a health maintenance organization population of children and adolescents 0 through 19 years of age. The physical health status instrument from the Rand Health Insurance Study was used to evaluate functional outcome of patients seen in the emergency room and outpatient clinic. Overall, 55.1% of individuals had limitations in their usual activities during the week following injury; 16.4% and 3.8% were not yet back to full activities after 1 week and 1 month, respectively. Individuals 10 years of age and older had more functional impairment than did younger children. Restrictions were greatest for fractures/dislocations and sprains and for injuries due to sports, play/recreational activities, and falls.

Activities of Daily Living

Revisions in the risk-based Breast Cancer Screening Program at Group Health Cooperative.

To pursue the goal of achieving regular use of mammography in women 40 years of age and older, a risk-based selective approach to screening was implemented at a 400,000-member managed health care system in the Northwest in 1985. This article describes the context for this approach to selective screening and reviews revisions in the algorithm used to determine when and how a woman should be screened. Changes made in 1988 with respect to age criteria, intervals for mammography, and which risk factors to include are discussed. The result of these changes is that 83% of women 40 years of age and older are now eligible for regular mammography compared with 57% under the former system. The total use of mammography in any given year remains unchanged. The results of this analysis have implications for other organizations attempting to promote the use of mammography.

Adult

Feasibility of a randomized trial of a low-fat diet for the prevention of breast cancer: dietary compliance in the Women's Health Trial Vanguard Study.

The Women's Health Trial Vanguard Study was conducted to examine the feasibility of a nationwide, randomized multicenter intervention trial to test the hypothesis that a low-fat diet followed for a period of 10 years will reduce breast cancer risk. Women ages 45-69 years at increased risk of breast cancer were randomized into intervention (low-fat diet, n = 184) and control (usual diet, n = 119) groups. On the basis of 4-day food records, baseline fat intakes were comparable in the two groups, averaging 1,718 kcal with 39% of energy as fat. Intervention women reported substantially lower fat intake at 6 (20.9% kcal), 12 (21.6%), and 24 months (22.6% kcal). In contrast, control women reported only slight reductions in fat intake (37.3% kcal at 12 months and 36.8% kcal at 24 months). Evidence that these women were indeed complying with the low-fat dietary intervention comes from (a) the reasonable nature of reported nutrient changes within food groups in the intervention women and (b) agreement between observed and expected differences in plasma total cholesterol between the control and the intervention groups. At 12 months, the observed control - intervention plasma cholesterol difference was 13.1 +/- 4.6 mg/dl while the expected difference based on the Keys equation was 15.1 +/- 1.1 mg/dl; at 24 months, the observed difference was 15.5 +/- 4.3 mg/dl and the expected difference was 12.0 +/- 1.2 mg/dl. These analyses indicate that the intervention women made substantial dietary changes and have successfully maintained these changes over a 2-year period. This study thus demonstrates the feasibility of a randomized trial with an intensive low-fat dietary intervention.

Aged

Doppler waveform pulsatility index and resistance, pressure and flow in the umbilical placental circulation: an investigation using a mathematical model.

A mathematical model of the umbilical placental circulation was used to examine the effect of different physiological variables on the pulsatility index (PI) of the umbilical artery Doppler waveform. The variables include the umbilical and placental resistances, the volume flow rate and the pressure. In the model the branching structure of the placental villous tree is considered in detail, while each arterial branch is itself represented simply using a resistor and a capacitor. Placental vascular disease is modelled as obliteration of a fraction of the terminal branches of the tree. The model umbilical artery PI depends on the ratio of the placental resistance to the umbilical artery resistance. The PI increases with vascular disease, but the rate of increase is not uniform. Initially, the placental resistance and the PI increase very slowly with vessel obliteration. Once the level of vessel obliteration has reached a large enough value--typically between 60% and 90% obliteration--the PI begins to rise sharply. A larger placental vascular bed can accommodate a greater level of vessel obliteration before this rapid PI rise begins. The umbilical artery PI also depends on the pulsatility of the input (aortic bifurcation) pressure waveform, but blood pressure variations in the physically attainable range cannot account for the very high PI values associated with fetal compromise. Physically attainable pressure waveform changes would, however, enable the fetus with substantial placental vascular disease to maintain umbilical volume flow rate, and at the same time exhibit a raised umbilical artery PI value.

Blood Flow Velocity

Incidence of bicycle-related injuries in a defined population.

Population-based incidence rates for head injuries and total injuries resulting from bicycle crashes were calculated in a Seattle, Washington health maintenance organization population. Overall rates were 163 per 100,000 for all injuries and 42/100,000 for head injuries. Individuals between 5 and 14 years of age are at highest risk for bicycle-related injuries. The data are presented for their potential utility in program planning.

Age Factors

A case-control study of the effectiveness of bicycle safety helmets in preventing facial injury.

In a case-control study we sought to assess the potential effectiveness of helmets in preventing facial injuries. Our study included 212 bicyclists with facial injuries and 319 controls with injuries to other body areas, who were treated in emergency rooms of five Seattle area hospitals over a one-year period. Using regression analyses to control for age, sex, education and income, accident severity, and cycling experience we found no definite effect of helmets on the risk of serious facial injury (odds ratio 0.81; 95 percent confidence interval = 0.45, 1.5), but protection against serious injuries to the upper face (odds ratio 0.27; 95% CI = 0.1, 0.8). No protection was found against serious injuries to the lower face. The independent effect of helmet use on facial injury was difficult to isolate due to the association of head and facial injuries. Our results suggest that bicycle helmets as presently designed may have some protective effect against serious upper facial injuries.

Adolescent

Cost issues.

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Breast Neoplasms

A case-control study of the effectiveness of bicycle safety helmets.

Bicycling accidents cause many serious injuries and, in the United States, about 1300 deaths per year, mainly from head injuries. Safety helmets are widely recommended for cyclists, but convincing evidence of their effectiveness is lacking. Over one year we conducted a case-control study in which the case patients were 235 persons with head injuries received while bicycling, who sought emergency care at one of five hospitals. One control group consisted of 433 persons who received emergency care at the same hospitals for bicycling injuries not involving the head. A second control group consisted of 558 members of a large health maintenance organization who had had bicycling accidents during the previous year. Seven percent of the case patients were wearing helmets at the time of their head injuries, as compared with 24 percent of the emergency room controls and 23 percent of the second control group. Of the 99 cyclists with serious brain injury only 4 percent wore helmets. In regression analyses to control for age, sex, income, education, cycling experience, and the severity of the accident, we found that riders with helmets had an 85 percent reduction in their risk of head injury (odds ratio, 0.15; 95 percent confidence interval, 0.07 to 0.29) and an 88 percent reduction in their risk of brain injury (odds ratio, 0.12; 95 percent confidence interval, 0.04 to 0.40). We conclude that bicycle safety helmets are highly effective in preventing head injury. Helmets are particularly important for children, since they suffer the majority of serious head injuries from bicycling accidents.

Accidents, Traffic

Mathematical model for interpretation of Doppler velocity waveform indices.

Various empirical indices such as the pulsatility index (PI) are widely used for quantitative analysis of Doppler ultrasound velocity waveforms. The physical interpretation of these indices was studied using a mathematical model. Although the method has more general applicability, this particular study was concerned with the umbilical-placental circulation. A lumped element electrical circuit equivalent was used, with each arterial branch represented by a resistor and a capacitor. The placental villous bed was modelled by a two-step parallel branching structure. Placental vascular disease was modelled either as obliteration of a fraction of the terminal branches, or as a fractional decrease in the radius of the vessels. The main features of both normal and abnormal umbilical artery waveforms can be reproduced by this simple model. Theoretical relationships between the velocity waveform indices and the lumped resistances and capacitance of the system were obtained for different input pressure functions. Over a wide range of physically reasonable conditions, the umbilical artery PI is approximately proportional to the ratio of the placental resistance to the umbilical artery resistance. The PI also depends on the pulsatility of the input pressure waveform. The Fourier pulsatility index was evaluated for an arbitrary pressure function, and shown to behave like (PI)2 for the umbilical artery waveform.

Biomedical Engineering