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PubMed1988

Effectiveness of teaching breast self examination during office visits.

In a randomized clinical trial a comparison was made of two BSE teaching interventions delivered by primary providers during office visits in a group nursing faculty practice. Patients who reported no regular BSE (n = 121) received either individualized teaching focused on reducing perceived barriers and reinforcing benefits of BSE, or routine teaching limited to usual instruction in BSE technique. Patients reporting frequent/monthly BSE during the past year were comparison subjects (n = 81). Self-reported data on BSE behavior were obtained in questionnaires administered before the interventions and via telephone interviews three months after the visit. Analysis using chi square showed that, contrary to expectation, individualized and routine teaching were equally effective: 61.4% of the individually taught and 63.5% of the routinely taught reported frequent or monthly practice at followup. Both groups were significantly more confident in technique and ability to detect change in the breast. The previously non-practicing women remained significantly less likely than comparison subjects to be performing BSE monthly at followup. The perceived benefit of BSE giving peace of mind predicted non-practicers most likely to change.

Adult↗
PubMed2006

Using initiative to achieve autonomy: a model for advanced practice in medical nutrition therapy.

The purpose of this research was to generate a model of advanced medical nutrition therapy (MNT) practice based on descriptions of their clinical activities provided by advanced-level MNT practitioners. A qualitative approach using grounded theory methodology was employed. The model of advanced MNT practice was based on interviews with 21 credentialed advanced practice registered dietitians from across the United States and Canada. Verbatim transcripts of the interviews were coded for aggregation into themes and subthemes. The resulting model included a single overarching theme: using initiative to achieve autonomy. The five subthemes are aptitude, attitude, expertise, context, and approach. The model provides a richer picture of advanced MNT practice than was previously available and is presented for discussion and debate. Validation of the model is required before incorporation into education or practice.

Attitude↗
PubMed2004

Disclosing a dementia diagnosis: a review of opinion and practice, and a proposed research agenda.

PURPOSE: The ethical and practical issues in disclosing a dementia diagnosis remain subjects of some debate. In this review of the literature we document previous opinion and practice in the area of diagnostic disclosure. DESIGN AND METHODS: We identified sources for this review with a MEDLINE and PsycINFO database search, followed by collection of additional articles from reference lists. RESULTS: Across sources we were able to identify a broad list of arguments both for and against diagnostic disclosure. We briefly discuss some of the ethical principles that undergird those reasons. IMPLICATIONS: Practice guidelines and professional opinion regarding disclosure appear to depart from the actual experience reported by clinicians, patients, and family members. At a more detailed level, process issues in disclosure, such as who is told, how and what they are told, and the impact of disclosure, are poorly understood. Sensitivity to individual differences may promote an optimal approach to disclosure. Research in this area is sparse and often contradictory, and throughout the review we propose research questions that, when answered, could clarify issues in disclosure that are essential to sound dementia care.

Attitude of Health Personnel↗
PubMed2005

SOGC clinical practice guidelines. Guidelines for vaginal birth after previous caesarean birth. Number 155 (Replaces guideline Number 147), February 2005.

OBJECTIVE: To provide evidence-based guidelines for the provision of a trial of labor (TOL) after Caesarean section. OUTCOME: Fetal and maternal morbidity and mortality associated with vaginal birth after Caesarean (VBAC) and repeat Caesarean section. EVIDENCE: MEDLINE database was searched for articles published from January 1, 1995, to February 28, 2004, using the key words "vaginal birth after Caesarean (Cesarean) section". The quality of evidence is described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam. RECOMMENDATIONS: 1. Provided there are no contraindications, a woman with 1 previous transverse low-segment Caesarean section should be offered a trial of labor (TOL) with appropriate discussion of maternal and perinatal risks and benefits. The process of informed consent with appropriate documentation should be an important part of the birth plan in a woman with a previous Caesarean section (II-2B). 2. The intention of a woman undergoing a TOL after Caesarean section should be clearly stated, and documentation of the previous uterine scar should be clearly marked on the prenatal record (II-2B). 3. For a safe labor after Caesarean section, a woman should deliver in a hospital where a timely Caesarean section is available. The woman and her health care provider must be aware of the hospital resources and the availability of obstetric, anesthetic, pediatric, and operating-room staff (II-2A). 4. Each hospital should have a written policy in place regarding the notification and (or) consultation for the physicians responsible for a possible timely Caesarean section (III-B). 5. In the case of a TOL after Caesarean, an approximate time frame of 30 min should be considered adequate in the set-up of an urgent laparotomy (IIIC). 6. Continuous electronic fetal monitoring of women attempting a TOL after Caesarean section is recommended (II-2A). 7. Suspected uterine rupture requires urgent attention and expedited laparotomy to attempt to decrease maternal and perinatal morbidity and mortality (II-2A). 8. Oxytocin augmentation is not contraindicated in women undergoing a TOL after Caesarean section (II-2A). 9. Medical induction of labor with oxytocin may be associated with an increased risk of uterine rupture and should be used carefully after appropriate counseling (II-2B). 10. Medical induction of labor with prostaglandin E2 (dinoprostone) is associated with an increased risk of uterine rupture and should not be used except in rare circumstances and after appropriate counseling (II-2B). 11. Prostaglandin E1 (misoprostol) is associated with a high risk of uterine rupture and should not be used as part of a TOL after Caesarean section (II-2A). 12. A foley catheter may be safely used to ripen the cervix in a woman planning a TOL after Caesarean section (II-2A). 13. The available data suggest that a trial of labor in women with more than 1 previous Caesarean section is likely to be successful but is associated with a higher risk of uterine rupture (II-2B). 14. Multiple gestation is not a contraindication to TOL after Caesarean section (II-2B). 15. Diabetes mellitus is not a contraindication to TOL after Caesarean section (II-2B). 16. Suspected fetal macrosomia is not a contraindication to TOL after Caesarean section (II-2B). 17. Women delivering within 18-24 months of a Caesarean section should be counseled about an increased risk of uterine rupture in labor (II-2B). 18. Postdatism is not a contraindication to a TOL after Caesarean section (II-2B). 19. Every effort should be made to obtain the previous Caesarean section operative report to determine the type of uterine incision used. In situations where the scar is unknown, information concerning the circumstances of the previous delivery is helpful in determining the likelihood of a low transverse incision. If the likelihood of a lower transverse incision is high, a TOL after Caesarean section can be offered (II-2B). VALIDATION: These guidelines were approved by the Clinical Practice Obstetrics and Executive Committees of the Society of Obstetricians and Gynaecologists of Canada.

Cervical Ripening↗
PubMed2002

Taking health care back: the physician's role in quality improvement.

Physicians now enjoy a moment of tactical advantage in the evolution of the struggle for control over health care in the United States. The most effective way to capitalize on this-perhaps fleeting-position and to more permanently alter the balance of power in their favor is for physicians to establish strong and visionary leadership in health care quality improvement. Such an undertaking, if successful, could place the very essence of health care-defining, measuring, and improving its quality-in the hands of physicians. To succeed requires understanding the relationships between the different kinds of quality problems that plague our health care system, the various kinds of errors that lead to them, and how amenable these different kinds of errors may be to different interventions. The authors delineate a conceptual framework that describes these relationships, as well as their implications for conducting effective and durable quality improvement. The authors then illustrate how physicians could engage in this activity in three different settings: a four-or-five-physician primary care practice, a 50-physician multispecialty group, and a 450-bed community hospital. Finally, the authors submit that now is an opportune time for physicians and the organizations they direct or guide to take the leadership role in conducting health care quality improvement. Realizing the opportunity will require dedicating significant resources and changing traditional approaches to quality, but in so doing, physicians can regain much of the autonomy over the practice of medicine previously lost to government and managed care.

Group Practice↗
PubMed2006

Effects of care pathways on stroke care practices at regional hospitals.

BACKGROUND: Our previous work identified deficiencies in stroke care practices at regional hospitals in comparison to standards suggested by published stroke care guidelines. These deficiencies might be improved by the implementation of clinical pathways. The aim of this study was to assess changes in acute stroke care practices following the implementation of stroke care pathways at four regional Queensland hospitals. METHODS: The medical records of two cohorts of 120 patients with a discharge diagnosis of stroke or transient ischaemic attack were retrospectively audited before and after implementation of stroke care pathways to identify differences in the use of acute interventions, investigations and secondary prevention strategies. RESULTS: Following pathway implementation there were clinically important, but not statistically significant, increases in the rates of swallow assessment, allied health assessment (significant for occupational therapy, P = 0.04) and use of deep vein thrombosis prevention strategies (also significant, P = 0.006). Fewer patients were discharged on no anti-thrombotic therapy (statistically significant in the subgroup of patients with atrial fibrillation, P = 0.02). Only 37% of the patients audited were actually enrolled on the pathway. Among this subgroup there were significant increases in the rates of swallow assessment (first 24 h, P = 0.01; any time during admission, P = 0.0001), allied health assessments (all P < 0.05), estimation of blood glucose level (P = 0.0015) and the use of deep vein thrombosis prevention strategies (P = 0.0003). CONCLUSION: Stroke care pathways appear to improve the process of care. Whether this influences outcomes such as mortality, functional and neurological recovery, the incidence of complications, length of stay or the cost of care was beyond the scope of this study and will require further examination.

Adult↗
PubMedDate not supplied

Outpatient consultations from a family practice residency program: nine years' experience.

Previous reports of consultation rates from family practice physicians have included small sample sizes and have suggested higher rates in residency training programs. This report summarizes 9 years of data involving 161 family practice physicians in a residency training program and shows an overall rate of 1.4 percent for outpatient consultations. Otolaryngology, orthopedics, obstetrics/gynecology, and general surgery were the most frequent disciplines consulted. These data are helpful in designing health care systems that include family practice residency programs.

Family Practice↗
PubMed2002

Intermanual transfer of procedural learning after extended practice of probabilistic sequences.

Previous studies using simple, repeating patterns have suggested that the knowledge gained in early sequence learning is not effector-specific in that it transfers to muscle groups other than those used during training. The current experiments extended these findings to transfer after extensive practice with probabilistic sequences using a task on which people fail to gain declarative knowledge of the regularity. Specifically, an alternating serial reaction time (ASRT) task was used in which predictable and unpredictable trials alternated. Participants responded for the first five sessions using their right hand, then switched to the left hand for the sixth session. Stimuli were spatial in the first experiment and nonspatial in the second. Significant near-perfect transfer of pattern knowledge was seen in both experiments, suggesting that muscle-specific information for either the fingers or the eyes cannot explain the observed learning.

Adult↗
PubMed1999

A national survey of practice patterns of gastroenterologists with comparison to the past two decades.

Previous surveys on the practice of gastroenterology collected limited data on practice demographics. Gastroenterology practices may have changed over the past decade as a result of changes in health care delivery. The authors sought to describe the practice composition and demographics of today's gastroenterologist, and also to make comparisons to prior studies to determine whether changes have occurred. A nationwide cross-sectional survey was performed in 1997 of 900 American Gastroenterological Association (AGA) members selected randomly from the AGA directory. A total of 767 AGA members were eligible for the study, and 376 responded (response rate, 49%). The mean age was 46 years old and the mean year training was completed was 1982. The majority of gastroenterologists were in solo or group practice (57%) and in an urban setting (55%). Respondents were fairly equally represented from different regions of the country. The most common diagnosis seen was irritable bowel syndrome ([IBS] 19%), followed by esophageal reflux (17%) and inflammatory bowel disease (14%). Functional disorders as a group (IBS, nonulcer dyspepsia, and other functional disorders) were, by far, the most common disorders (35%), which is similar to findings in prior studies of gastrointestinal practices. Only 3% of gastroenterologists believed that managed care has made it easier to deliver quality health care to patients with IBS. Despite changes that have occurred in health care over the past decade, the types of diagnoses seen in gastroenterology practices has remained the same. Most gastroenterologists feel that managed care has not made it easier to deliver quality health care.

Colonic Diseases, Functional↗
PubMed1996

Children's bicycle helmet attitudes and use. Association with parental rules. The Pediatric Practice Research Group.

BACKGROUND: Previous studies have assessed the attitudes of parents and children toward bicycle helmet ownership and use in various settings, but they have not addressed the role of parental rules in promoting bicycle helmet use by children. OBJECTIVES: To further explore the attitudes of parents and children at pediatric practices toward bicycle helmet ownership and use by children and to assess the role of parental rules in promoting bicycle helmet use by children. DESIGN: One hundred sixty-nine 5- to 14-year-old children who owned bicycles and their parents were surveyed during well-child visits at 5 general pediatric practices in the Chicago, Ill, area. One hundred twenty-nine families were represented. Of the children, 60% were aged 5 to 9 years, and 50% were girls. RESULTS: Forty-eight children (28%) reported helmet ownership. Of the helmet owners, 21 (45%) reported helmet use; thus, the overall percentage of helmet use was 12%. Helmet ownership by children was significantly (P < .05) related to parental characteristics: educational level, race, perceived effectiveness of bicycle helmets, seat belt use, and parental helmet ownership. The most common reasons parents gave for lack of helmet ownership by children were "never thought about purchasing" a helmet (35%), "never got around to purchasing" a helmet (29%), "child wouldn't wear it anyway" (26%), and the bicycle helmet was "too expensive" (16%). Only 33% of the parents reported hearing about helmets from their children's pediatrician, but 40% of these parents regarded pediatricians as their most important information source. Of the children who did not own helmets, 64% said they would wear a bicycle helmet if they had one, a more frequent comment for 5- to 9-year-old children than 10- to 14-year-old children (76% vs 49%, P < .01). The most common reasons for not wearing a helmet among owners were as follows: forgot or lost it and not needed. The most common reasons for not wearing a helmet among nonowners were as follows: uncomfortable and appearance or perception of others. Children who owned helmets and whose parents had a strict rule about wearing helmets were more likely to always wear their helmets than helmet owners whose parents had a partial rule or no rule (88% vs 19%, P < .001). CONCLUSIONS: Parental rules are associated with bicycle helmet use by children. Pediatricians may increase helmet use rates by promoting strict parental helmet rules as part of their anticipatory guidance regarding bicycle safety. More research about the effectiveness of this strategy is needed.

Adolescent↗
PubMed1967

The specific influence of carbon dioxide and carbamate compounds on the buffer power and Bohr effects in human haemoglobin solutions.

1. The difference of pH (DeltapH) between human deoxygenated haemoglobin (Hb) and oxygenated haemoglobin (O(2)Hb) solutions when equilibrated with physiological pressures of carbon dioxide is (experimentally) much less than previously supposed.2. This smaller DeltapH is in contradiction to Wyman's (1948) theoretical calculations, wherein no allowance was made for the specific effect of carbamino-compounds on the amount of base neutralized by haemoglobin. Other previous authorities have also neglected this factor, which when properly allowed for restores the role of carbamino-compounds in CO(2) transport practically to that previously estimated by Ferguson & Roughton (1934a, b).3. At a given pH and P(CO(2) ), more CO(2) is bound by Hb solutions than by O(2)Hb, the difference increasing with pH. This result provides further, and seemingly decisive, evidence that the bound-CO(2) in the blood other than HCO(3)- (i.e. x-bound CO(2)) is oxygen-linked.4. According to a modified form of the Henderson-Hasselbalch equation for haemoglobin solutions [Formula: see text]. The value of pK(1)' is the same in Hb as in O(2)Hb solution and from the data in 3 is found to have the value 6.15 at 37 degrees C.5. The difference between the titration curves of O(2)Hb and Hb (DeltaX), at a given pH had been hitherto supposed to be the same in presence of CO(2) as in its absence. Our experiments show, however, that DeltaX is less in presence of CO(2) and at pH > 7.5 may even change sign. This paradoxical effect is also explicable, at any rate semi-quantitatively, by the effect of carbamino compounds on the buffer power, according to the theory put forward in the paper.6. The results show that the buffer power (dB/dpH) of haemoglobin solution under physiological conditions is 20-30% greater than previously estimated, and this also is in line with the new theory.7. In graphs of total CO(2) versus P(CO(2) ) in haemoglobin solutions (or blood) it has been customary to suppose that points on straight lines radiating from the origin are points of equal pH. Our data, however, show that the iso-pH lines drawn through the experimental points in the pH range, 7.2-7.4 do not, when produced as straight lines, pass through the origin, but intercept the P(CO(2) ) axis significantly to the right thereof.8. Calculations indicate that most of the x-bound CO(2) in haemoglobin solutions at pH 7.2-7.4 and at 37 degrees C can be accounted for by carbaminobound CO(2) without the need of postulating the existence of appreciable amounts of yet other forms, i.e. y-bound CO(2), in this range.

Journal Article↗
PubMed2005

Correlates of reflective practice in medicine.

BACKGROUND: The ability of physicians to critically reflect on their professional practice has been increasingly valued. Previous research brought to light the multidimensional structure of reflective practice in medicine. It comprises at least five sets of behaviours in response to complex medical problems encountered in professional practice. Factors associated to reflective practice among physicians have, as far as we know, not yet been explored by empirical study. PURPOSE: To study factors correlated to reflective practice among physicians. METHODS: A questionnaire exploring characteristics of professional practice and educational experiences was administered to primary health care physicians. Measurements were related to scores on a reflective practice measuring instrument developed previously. Associations between variables were examined by statistical analysis with tests of correlation and analysis of variance. RESULTS: Reflective practice is negatively correlated to physician's age and number of years of clinical practice. Working mainly in hospitals and attendance to medical residency programmes in some specialties apparently have a positive effect on reflective practice. CONCLUSION: Reflective practice tends to decrease with experience. Findings are consistent with the literature on medical expertise that shows a decline of analytical reasoning in proportion to the increase in experience. Some specialty programmes seems to enhance concerns with the scientific basis to professional practice, thereby favouring reflective approaches. Local features of primary health care settings probably explain their negative effect on reflective practice. Strategies to develop reflective practice among physicians should be explored by further research.

Adult↗
PubMed2006

The health of people classified as lesbian, gay and bisexual attending family practitioners in London: a controlled study.

BACKGROUND: The morbidity of gay, lesbian or bisexual people attending family practice has not been previously assessed. We compared health measures of family practice attendees classified as lesbian, gay and bisexual. METHODS: We conducted a cross-sectional, controlled study conducted in 13 London family practices and compared the responses of 26 lesbian and 85 bisexual classified women, with that of 934 heterosexual classified women and 38 gay and 23 bisexual classified men with that of 373 heterosexual classified men. Our outcomes of interest were: General health questionnaire; CAGE questionnaire; short form12; smoking status; sexual experiences during childhood; number of sexual partners and sexual function and satisfaction. RESULTS: In comparison to people classified as heterosexuals: men classified as gay reported higher levels of psychological symptoms (OR 2.48, CI 1.05-5.90); women classified as bisexual were more likely to misuse alcohol (OR 2.73, 1.70-4.40); women classified as bisexual (OR 2.53, 1.60-4.00) and lesbian (OR 3.13, 1.41-6.97) and men classified as bisexual (OR 2.48, 1,04, 5.86) were more likely to be smokers and women classified as bisexual (OR 3.27, 1.97-5.43) and men classified as gay (OR 4.86, 2.28-10.34) were much more likely to report childhood sexual experiences in childhood. Psychological distress was associated with reporting sexual experiences in childhood in men classified as gay and bisexual and women classified as heterosexual. Men classified as bisexual (OR 5.00, 1.73-14.51) and women classified as bisexual (OR 2.88, 1.24- 6.56) were more likely than heterosexuals to report more than one sexual partner in the preceding four weeks. Lesbian, gay and bisexual classified people encountered no more sexual function problems than heterosexuals but men classified as bisexual (OR 2.74, 1.12-6.70) were more dissatisfied with their sex lives. CONCLUSION: Bisexual and lesbian classified people attending London general practices were more likely to be smokers and gay classified men were at increased risk of psychological distress in comparison to heterosexual classified people. Increased awareness of the sexuality of people seen in primary care can provide opportunities for health promotion.

Adult↗
PubMedDate not supplied

Factors associated with breast self-examination among jordanian women.

The purpose of this cross-sectional, correlational, descriptive study was to investigate factors and beliefs that may be related to the practice of breast self-examination (BSE) among a group of Jordanian women. The sample consisted of 519 women from two major universities in Jordan. About 36% of the sample were university employees and 64% were graduate and undergraduate students. Stratified random sampling was used to enroll the undergraduate students while graduate students and employees were selected by convenience sampling. The study instrument was an adapted version of Champion's Revised Health Belief Model Scale (CRHBMS). The results were analyzed using a chi-square test and a stepwise multiple regression. The main findings indicate that although the majority of the sample population (67%) had heard/read about BSE, only a quarter of them reported that they had ever practiced BSE in the previous 12 months, and only 7% had performed it on a regular monthly basis. Confidence, motivation, susceptibility, and fewer barriers were variables that showed a positive association with BSE practice in the previous year, while benefits, susceptibility, and motivation influenced the intention to perform BSE in the future. Women's age, level of education, having heard or read about breast tumors, and personal history of breast tumors were also found to be significant predictors of BSE practice.

Adolescent↗
PubMed1992

Implementing practice guidelines through a utilization management strategy: the potential and the challenges.

Although there is currently much enthusiasm for practice guidelines, far more energy and resources have been expended on their development than on their implementation. A prospective interventional trial was performed using a previously validated explicit practice guideline (decision aid) to decrease the hospital length of stay for selected "low-risk" patients with chest pain. Utilization management (UM) coordinators (RNs) and physicians were chosen to implement the guideline since these resource people are available in most hospitals, allowing for generalization of the experience. With explicit review criteria used for 624 patients, it was found that when the guideline was applied by UM coordinators, it had a sensitivity of 0.85, a specificity of 0.90, a positive predictive value of 0.76, and a negative predictive value of 0.94. The attending physicians failed to override falsely classified low-risk patient recommendations 51% of the time. Implicit review judged that outcome might have theoretically been worsened in two of these patients. Follow-up at 30 days after admission, however, revealed no untoward sequelae in falsely categorized patients discharged according to the guideline. Utilization management appears to be a promising mechanism for guideline implementation that is available in most institutions. However, the accuracy with which UM coordinators implement guidelines should be assessed rigorously. Guidelines should be implemented in an environment of checks and balances in which physicians have the ultimate responsibility for their patients' care.

Adult↗
PubMed1997

The University of Massachusetts Medical Center office-based continuity experience: are we preparing pediatrics residents for primary care practice?

OBJECTIVE: Surveys of residency graduates and employers have suggested that residency programs do not prepare residents well for practice. Since 1988, pediatric residents at the University of Massachusetts have been paired one-on-one with an office-based pediatrician for their 3-year continuity experience. This survey was conducted to determine if graduates of such a program are prepared to enter pediatric practice. METHODOLOGY: Graduates of the program from 1991 through 1995 who entered primary care practice were surveyed about their preparedness for practice. The questionnaire was also sent to the residents' first employers. The 32 questions were directed to overall sense of preparedness, ability to manage the pace of practice, common illnesses, common behavior problems, anticipatory guidance, office management, and subspecialty problems. RESULTS: Data from all 25 residents who entered practice and the employers of 20 of the 25 residents were obtained and analyzed. Both groups rated overall resident preparedness to be "well-prepared" or "very well-prepared" and gave high scores on working at the pace of practice, diagnosing and treating common illnesses, diagnosing and treating common behavior problems, and providing anticipatory guidance. Areas in which residents were considered to be less well-prepared included anticipatory guidance about nutrition, managing problems by telephone, office management, gynecology, and orthopedics. CONCLUSIONS: The results suggest that continuity experiences in office practices are associated with preparation for the pace and types of visits that occur commonly in primary care practice, abilities which previous surveys of residency alumni and employers have found lacking. Some areas may benefit from a formal curriculum which may be implemented in the office practice, at the medical center, or at both sites. Preceptors may benefit from faculty development and continuing medical education that is directed not only at teaching skills but also at content areas which were not addressed in their own residencies.

Academic Medical Centers↗
PubMed1987

Providing census data for general practice. 2. Usefulness.

Computerized census data are described in relation to a general practice population. The previously published methods for scoring deprivation - underprivileged areas score and material deprivation score - are applied to the data. Wards and enumeration districts within a single practice area are ranked by both methods and examples show the wide variation in deprivation scores for enumeration districts within single wards. The value of these data to a general practice is discussed with particular reference to developing a profile of the practice and to planning prevention and anticipatory care.

Catchment Area, Health↗
PubMed1996

Management of splenic injuries in a Canadian trauma centre.

OBJECTIVES: To document the current practice pattern for the treatment of splenic injuries in one Canadian trauma centre and to identify factors that determined which method was employed. DESIGN: A cohort study. SETTING: A Canadian lead trauma centre. PATIENTS: A cohort of 100 patients with splenic injury treated at one trauma hospital over 5 years was identified from a prospective trauma database. MAIN OUTCOME MEASURES: The success rate and failure rate for splenic salvage by splenectomy, splenorrhaphy or observation. Volume of blood transfused, injury severity score (ISS) and method of diagnosis. RESULTS: The median ISS for the cohort was 34 (36 for splenectomy, 38 for splenorrhaphy and 35 for observation). A blunt mechanism of injury was present in 96%. The diagnosis was made by computed tomography (CT) in 55%. Splenic salvage was accomplished in 51 patients; of these, 44 (86%) were in the observation group, and the success rate was 90% (within the range reported in the literature). Only seven patients underwent splenorrhaphy. CT was performed more frequently in the observation group than in the splenectomy group (82% v. 25%, p < 0.0001). The splenectomy group had more blood transfused than the successful observation group (mean units 15 v. 3, p = 0.0001) and had a higher median ISS (36 v. 29, p = 0.02). Multivariate analysis revealed that the method of diagnosis (CT v. diagnostic peritoneal lavage) was the strongest factor associated with how the splenic injury was treated. CONCLUSIONS: The finding in this report of an increase in observational treatment of splenic injuries represents a shift in practice from a previous Canadian report and is in keeping with recent published trends from the United States. Future studies are needed to assess whether any strong regional practice pattern variations in the management of blunt splenic injuries exists in other trauma centres across Canada.

Adult↗