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Biomedical subjects

S Norwood

Publications and source records attributed to S Norwood.

At least 19 recordsLinked to original sources
PubMed2001

Percutaneous dilatational tracheostomy in a community hospital setting.

BACKGROUND: Over the past 15 years, many large university hospitals have reported their experience with percutaneous dilatational tracheostomy (PDT). The purposes of this study are to evaluate the safety of PDT in a non-university hospital setting and to compare our results with those published in the literature. METHODS: The study was done by retrospective chart review. RESULTS: Over a 6-year period, 300 PDTs were done in two community hospitals in Tyler, Texas. There was one death and 12 complications. Comparison of our results and those reported in five recently published articles in the literature showed no significant difference in mortality rate, pneumothorax, bleeding, paratracheal placement, dislodgement, or cellulitis. There was a trend toward a significantly lower incidence of paratracheal placement using bronchoscopic guidance. CONCLUSION: Bedside PDT with bronchoscopic guidance can be safely done in a community hospital setting.

Adult↗
PubMed2000

The quality of forensic psychological assessments, reports, and testimony: acknowledging the gap between promise and practice.

During the past decade, the field of forensic psychological assessment entered a period of standard setting, reflected in the publication of specialty guidelines for practice and in the proliferation of educational opportunities, training programs, and credentialing and certification procedures for forensic examiners. Representing significant efforts to advance the quality of psychological assessments in legal contexts, these developments foreshadow the promise of forensic assessment. During this same time period, new evidence emerged regarding the quality of forensic practice. This article reviews this evidence and evaluates current practice against the promise of forensic assessment. Forensic reports appear to be of higher quality than those described by commentators in the 1970s and early 1980s; nevertheless, the level of practice falls far short of professional aspirations for the field. The review identifies significant areas of weakness that demand the attention of professional organizations, accrediting agencies, educators, lawmakers, practitioners, and consumers.

Child↗
PubMed2000

Incidence of tracheal stenosis and other late complications after percutaneous tracheostomy.

OBJECTIVE: To determine the incidence of tracheal stenosis, voice and breathing changes, and stomal complications after percutaneous dilatational tracheostomy (PDT). METHODS: From December 1992 through June 1999, 420 critically ill patients underwent 422 PDTs. There were 340 (81%) long-term survivors, 100 (29%) of whom were interviewed and offered further evaluation by fiberoptic laryngotracheoscopy (FOL) and tracheal computed tomography (CT). Tracheal stenosis was defined as more than 10% tracheal narrowing on transaxial sections or coronal and sagittal reconstruction views. Forty-eight patients agreed to CT evaluation; 38 patients also underwent FOL. CT and FOL evaluations occurred at 30 +/- 25 (mean +/- standard deviation) months after PDT. RESULTS: Twenty-seven (27%) patients reported voice changes and 2 (2%) reported persistent severe hoarseness. Vocal cord abnormalities occurred in 4/38 (11%) patients, laryngeal granuloma in 1 (3%) patient, focal tracheal mucosal erythema in 2 (5%) patients, and severe tracheomalacia/stenosis in 1 (2.6%) patient. CT identified mild (11-25%) stenosis in 10 (21%) asymptomatic patients, moderate (26-50%) stenosis in 4 (8.3%) patients, 2 who were symptomatic, and severe (>50%) stenosis in 1 (2%) symptomatic patient. Ten patients (10%) reported persistent respiratory problems after tracheal decannulation, but only four agreed to be studied. Two patients had moderate stenosis, and one had severe stenosis. One patient's CT scan was normal. No long-term stomal complications were identified or reported. CONCLUSIONS: Subjective voice changes and tracheal abnormalities are common after endotracheal intubation followed by PDT. Long-term follow-up of critically ill patients identified a 31% rate of more than 10% tracheal stenosis after PDT. Symptomatic stenosis manifested by subjective respiratory symptoms after decannulation was found in 3 of 48 (6%) patients.

Adolescent↗
PubMed2000

The safety of prolonging the use of central venous catheters: a prospective analysis of the effects of using antiseptic-bonded catheters with daily site care.

OBJECTIVE: To determine rates of catheter colonization and catheter-related bloodstream infection (CRBSI) when antiseptic-bonded central venous catheters (CVCs) and standardized daily site care are used with no predetermined interval for removal. DESIGN: Prospective observational study. SETTING: Two major trauma centers. PATIENTS: All trauma patients admitted to two major trauma centers that received a CVC from May 1996 through May 1998. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Catheters were semiquantitatively cultured to identify bacterial colonization and CRBSI. Monitored variables included total catheter days, anatomical site of catheter insertion, and area in hospital of catheter insertion. CVC tips and intracutaneous segments were semiquantitatively cultured. A total of 460 (92%) of 501 catheters placed in 324 trauma patients were evaluable, representing 95.5% of all catheter days during the study period. Rates of catheter colonization and CRBSI were 5% (5/1000 catheter days) and 1.5% (1.511000 catheter days), respectively. Subclavian catheters were in place longer than femoral or internal jugular catheters (p < .0001), but the colonization rate was significantly lower (p = .03; relative risk, 0.34; 95% confidence interval, 0.15-0.77). No differences in CRBSI rates among anatomical sites or between catheters used < or =14 days and those used >14 days were identified. CONCLUSION: Femoral and internal jugular antiseptic-bonded CVCs develop bacterial colonization earlier than subclavian CVCs. Subclavian antiseptic-bonded CVCs combined with standardized daily site care may be safely used >14 days in trauma patients.

Adolescent↗
PubMed2000

Mechanisms and patterns of injuries related to large animals.

BACKGROUND: Injuries from encounters with large animals represent a significant health risk for rural communities. We evaluated our regional trauma centers' experience with large-animal injuries to determine whether certain mechanisms and patterns of injury predicted either major head/craniofacial or torso (chest/abdomen/pelvis) trauma. METHODS: The hospital courses of 145 patients with injuries related to large animals were reviewed retrospectively to determine patterns of injury, specific injury mechanisms, species-specific injuries, and predictors of multiple body region trauma. RESULTS: Seventy-nine patients (55%) were injured by horses, 47 patients (32%) by bulls, 16 patients (11%) by cows, and 3 patients (2%) by wild animal attacks. The predominant species-specific mechanisms of injury were falls (horses), tramplings (bulls), and kicks (cows). Brain/craniofacial injuries were most common from horse-related encounters (32%), whereas bull and cow encounters usually resulted in torso injuries (45% and 56%, respectively). Multiple body region injuries occurred in 32% of patients. Fractures of the upper extremities were more often associated with torso and head/craniofacial injuries (48%) than lower extremity injuries (17%) (p = 0.02). CONCLUSION: Large animal injuries frequently involve multiple body regions with species-specific mechanisms. Upper extremity injuries are associated with a significantly higher percentage of torso and head/craniofacial injuries, which may have implications for field triage.

Adult↗
PubMed1996

Bedside percutaneous tracheostomy with bronchoscopic guidance in critically ill patients.

BACKGROUND: Bedside percutaneous dilational tracheostomy, a relatively new method of tracheal cannulation, provides safe and ready access to the trachea to relieve airway obstruction and tracheopulmonary secretions. The dilational technique has undergone various modifications during the past decade. Complications of this procedure are primarily related to the lack of direct visualization during tracheostomy tube placement and to poor patient selection. OBJECTIVE: To report the utility of percutaneous dilational tracheostomy with bronchoscopic guidance in 162 critically ill patients. MAIN OUTCOME MEASURES: Mortality rates and complications associated with this technique. RESULTS: Twenty-five patients (15.4%) died while hospitalized. No deaths were related to tracheostomy. There were four (2.5%) major complications: one pneumothorax and three posterior tracheal tears, which healed spontaneously. There were five (3.1%) minor complications: one posterior mucosal disruption, one minor bleeding episode, and three minor episodes of cellulitis. One hundred thirty-seven patients (84.6%) were discharged. Twenty-nine patients (21.2%) were available for follow-up and were experiencing no significant problems or complications following the procedure. Compared with standard open tracheostomy, charges were reduced by $1628.20 per patient ($263,768.40 total savings). CONCLUSIONS: Bedside percutaneous tracheostomy with bronchoscopic guidance is safe and cost-effective. Complications compare favorably with that of open tracheostomy. Major complications should be avoided with continuous bronchoscopic observation during the procedure.

Adult↗
PubMed1996

Temporary intravenous bag silo closure in severe abdominal trauma.

Several temporary abdominal wall closure techniques have been described in the literature. We present our experience with an inexpensive and efficient method of temporary abdominal closure when bowel edema and distension preclude safe primary closure. Our technique is a variation of the silon (silo) closure used in the repair of gastroschisis and omphalocele, using a pre-gas-sterilized, soft 3-L plastic cystoscopy fluid irrigation bag cut to an oval shape and stapled or sutured to the skin edges of the wound.

Abdominal Injuries↗
PubMed1995

The early effects of implementing American College of Surgeons level II criteria on transfer and survival rates at a rurally based community hospital.

We conducted a retrospective review to determine the early effects of implementing the American College of Surgeons (ACS) level II criteria on the number of transferrals and survival rates of trauma patients in a rurally based hospital. Data were collected from time period "B" (13 months before) and time period "A" (14 months after) implementing ACS criteria. Patient data parameters included age, sex, Revised Trauma Score, Glasgow Coma Scale score, Injury Severity Score, number of days hospitalized, diagnoses, place of injury (i.e., local county or transfer from another county), outcome, and probability of survival. There was a significant increase in the number of patients with Injury Severity Score > or = 15 from period B to period A (189 vs. 297, p = 0.002). A much higher percentage of these patients were transfers from out of county (period B = 33% vs. period A = 59.5%, p = 0.0001). Despite a higher percentage of transferred patients with probability of survival < or = 25% (period B = 25% vs. period A = 58%, p = 0.002), the survival rate in this group improved from 7.5% during time period B to 25.5% after implementing level II criteria (p = 0.0303). This data suggest that implementing level II ACS guidelines has the early beneficial effects of increasing transfers of seriously injured patients and improving survival in the most critically injured group.

Adolescent↗
PubMed1994

Outcomes following injury in a predominantly rural-population-based trauma center.

OBJECTIVE: To determine the incidence, severity, and outcomes of injury in patients treated in a rural-based level I trauma center and to compare the outcomes with a nationally indexed patient population--the Major Trauma Outcome Study. DESIGN: Retrospective evaluation of trauma registry data. SETTING: State of Illinois designated level I trauma center located in Urbana. PATIENTS: A total of 2246 trauma patients admitted from August 1989 through August 1992, with a mortality cohort of 158 patients. There were 1735 patients (77%) with Injury Severity Scores less than or equal to 19 and 511 patients (23%) with more severe injuries (Injury Severity Scores > or = 20). MAIN OUTCOME MEASURES: Mortality rates using the TRISS method, the Major Trauma Outcome Study, and final patient dispositions. RESULTS: The overall mortality rate, excluding those patients who were pronounced dead on arrival, was 125/2213 (5.6%). Eighty-six (69%) of these 125 patients had neurological Abbreviated Injury Scores of 3 or greater, with neurotrauma being a major contributor to their deaths. The m-statistic was 0.99 and the z-statistic was -3.30 for the entire group. The observed probability of survival met or exceeded the expected probability of survival when compared with the Major Trauma Outcome Study in all categories. CONCLUSION: Acceptable mortality rates compared with the Major Trauma Outcome Study can be achieved in a rural-community-based level I trauma center despite relatively small numbers of critically injured patients. Such outcomes may assist in justifying resource allocation for trauma centers in rural areas.

Abbreviated Injury Scale↗
PubMed1994

The safety of emergency neuromuscular blockade and orotracheal intubation in the acutely injured trauma patient.

BACKGROUND: This study was done to determine the safety and success of orotracheal intubation with planned neuromuscular blockade in patients who are severely injured. The study was performed at Carle Foundation Hospital, designated Level I trauma center located in east central Illinois. STUDY DESIGN: A retrospective review of the trauma registry and medical records of all patients requiring emergency airway control from September 1, 1987 to September 30, 1991 was performed. Two hundred twenty-nine patients who were critically injured were reviewed, the mean injury severity score was 29 (range of 3 to 75), the mean revised trauma score was 9 (range of 3 to 12), the mean Glasgow Coma Scale was 9 (range of 3 to 15), and the mean age was 31 years (range of one to 94 years). RESULTS: Indications for intubation included hemodynamic instability or altered level of consciousness (66.4 percent), or both, combative or uncooperative behavior (33.2 percent), and need to secure airway for transport (0.4 percent). Two hundred twenty-three (97.4 percent) patients were successfully intubated. Six (2.6 percent) patients required cricothyroidotomy and one (0.4 percent) patient was aspirated during intubation. Eight (3.5 percent) patients had cervical spine injuries but had no complications from orotracheal intubation. In the combative group, 32 (42 percent) patients had significant head injuries and 17 (22 percent) had other potentially life-threatening injuries. CONCLUSIONS: Orotracheal intubation with planned neuromuscular blockade and in-line cervical traction is a safe, effective method for airway control in patients who are severely injured. This technique is also indicated to expedite therapy in combative, uncooperative patients because of the high incidence of significant life-threatening injuries to the brain and other organs.

Adolescent↗
PubMed1994

Postoperative pain management in preverbal children: the prescription and administration of analgesics with and without caudal analgesia.

A retrospective chart review was conducted to examine the prescription and administration of analgesics with and without caudal analgesia to inpatient preverbal children within the first 48 hours after surgery. The 75 subjects were between birth and 24 months of age and had undergone various operative procedures. Seventy (93%) of these subjects were prescribed analgesics, but 8 of them had only acetaminophen prescribed. Of the 70 subjects who had a medication prescribed, 64 (91%) patients received analgesics. Morphine was the most frequently administered analgesic. The prescribed and administered mean dosages were less than the minimum recommended dosage for morphine. The mean prescribed and administered dosage for other analgesics exceeded the minimum recommended dosage. Preverbal children who had caudal analgesia during surgery were more likely to receive fewer dosages of analgesics and to receive lower dosages of narcotics even after 24 hours postoperatively than children who had not had caudal analgesia.

Acetaminophen↗
PubMed1992

The influence of an attachable subcutaneous cuff for preventing triple lumen catheter infections in critically ill surgical and trauma patients.

One hundred and ninety-one triple lumen central venous catheters were placed into 107 sites in 81 surgical and trauma patients who were prospectively studied to determine the rate of catheter related infection using a subcutaneous cuff of biodegradable collagen containing bactericidal silver and a guide wire exchange protocol. Thirty-seven sites in 36 nonseptic patients (group 1) were compared with 70 sites in 45 septic patients (group 2). The data were also compared with data consecutively collected one year earlier, using the same exchange protocol without the cuff. Fourteen of 70 sites in group 2 had catheter related infections, with seven causing bloodstream infection. Five of 14 were the result of fungus, with three causing fungemia. Two of 37 sites in group 1 had catheter related infections (p = 0.044), with no associated bacteremia. The number of triple lumen catheter related infections and associated bacteremia or fungemia are higher in septic patients compared with nonseptic critically ill surgical and trauma patients. The cuff significantly prolongs time of catheter site use in patients who are nonseptic, but may be of no benefit in reducing infection rates or prolonging site use time in patients who are septic and may predispose to fungal colonization.

Adolescent↗
PubMed1991

Characteristics and outcomes of insanity acquittees in Oklahoma.

The insanity defense is perhaps the most vigorously debated topic at the interface of the legal and mental health systems. This article addresses the need for empirical evidence by providing data on insanity acquittees and their later outcomes in Oklahoma, a jurisdiction not previously studied. Information was obtained on the demographic, legal, psychiatric, hospitalization, and post-hospitalization characteristics of all 61 defendants acquitted not guilty by reason of insanity (NGRI) and treated on the state forensic unit during a 5-year period. Insanity acquittees had few resources, significant psychopathology, and extensive involvement with the legal and mental health systems prior to the NGRI offense. Follow-up of three groups of discharged patients--those released at an initial court review, those who completed the NGRI treatment program, and those who absconded from the forensic unit--revealed that those who escaped from the unit had significantly more arrests and subsequent legal charges than regularly discharged patients.

Adolescent↗
PubMed1991

Psychosocial concerns of the ventilator-dependent child in the pediatric intensive care unit.

An increasing number of infants and children suffer from respiratory and neuromuscular diseases that render them ventilator-dependent. These patients spend months in pediatric intensive care units (PICUs) until they are either extubated or are stable enough to tolerate home ventilation. The critical nature of the PICU and its emphasis on meeting short-term goals is not readily compatible with the long-term and dynamic needs of developing children. In order to prevent the delays in growth and development that often occur during prolonged hospitalizations, this article addresses the impediments to normal growth and development in the PICU and offers specific suggestions on how the environment and nursing care can be changed to support the development of ventilator-dependent children and their families.

Adolescent↗
PubMed1990

An evaluation of triple-lumen catheter infections using a guidewire exchange technique.

One hundred fifty-six triple-lumen central venous catheters placed into 65 different sites in 52 surgical or trauma patients were prospectively evaluated to determine the frequency of catheter-related infection and the efficacy of multiple guidewire exchanges. Thirty-four anatomic sites in 33 patients without clinical signs of sepsis were compared to 31 anatomic sites in 19 patients with a clinical diagnosis of sepsis based on clinical, microbiologic, and radiologic evaluation. Anatomic sites were used indefinitely unless a positive semiquantitative catheter culture (greater than or equal to 15 cfu) or catheter-associated bacteremia developed. Seven catheter-related infections developed in five septic patients (26.3%) while no infections developed in the nonseptic group (p = 0.004). Three of 31 anatomic sites (9.6%) were associated with bacteremia. The number of hospital days to initial catheter insertion and the length of catheter site use were considerably higher in the septic patients compared to the nonseptic group. We conclude that triple-lumen catheter-related infections are uncommon in patients with no evidence of infection and can be safely guidewire-exchanged to prolong site use. Catheter-related infections in septic patients are much more frequent and unpredictable. Although guidewire exchange has a role in septic patients, multiple exchanges cannot routinely be recommended.

Adolescent↗