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At least 1,045 records · Page 58Linked to original sources
PubMed2002

In-house trauma surgeons do not decrease mortality in a level I trauma center.

BACKGROUND: The value of an in-house trauma surgeon is debated. Previous studies focus on comparing in-house and on-call surgeons at different institutions or different periods in time. The purpose of this study was to simultaneously evaluate in-house and on-call trauma surgeons in a single Level I trauma center and to determine the impact of in-house trauma surgeons on the mortality of severely injured patients. METHODS: All records were reviewed for patients classified as major resuscitations from July 1997 through November 1999. Multiple logistic regression was performed to determine predictors of mortality on the basis of trauma surgeon status (in-house vs. on-call) and response time, while controlling for Injury Severity Score (ISS) and Revised Trauma Score. RESULTS: Of the 4,278 admissions, 537 were trauma codes. Mean ISS was 20.16 +/- 11.59. There was no difference between groups admitted by in-house surgeons versus on-call surgeons with respect to ISS or Revised Trauma Score. Mortality for the group was 24.8% (133 of 537); no statistical difference existed between observed and expected mortality by TRISS. The average response time was 3.96 minutes for the in-house group and 14.70 minutes for the on-call group (p < 0.001). Neither the call status nor the response time of the trauma surgeon significantly decreased emergency department or hospital mortality. There was a trend for improved outcome in those patients cared for by an in-house surgeon who were upgraded to a code, transferred into the institution, admitted during the night, or neurologically impaired. This trend did not reach statistical significance. CONCLUSION: When the trauma surgeon was rapidly available (< 15 minutes), there was no difference in emergency department or hospital mortality between in-house and on-call trauma surgeons. Selected subgroups of severely injured patients may benefit from an in-house trauma surgeon. If trauma surgeons are not readily available in an institution, an in-house call policy may be necessary for the prompt resuscitation of critically ill patients.

Adult↗
PubMed1979

An interpersonal-effectiveness approach to consumer health education: rationale and case study.

The development and implementation of a program for teaching prospective consumers of medical care services interpersonal-effectiveness advocacy skills are described. Parents of developmentally disabled children attended one of two six-hour workshops to learn self-management, communication and social influence skills for dealing more effectively with health consultants. Consumer satisfaction evaluations indicated that the workshops were successful, and directions for future research and development are discussed.

Child↗
PubMedDate not supplied

Post-graduation factors predicting NCLEX-RN success.

The academic and nonacademic factors that influence nursing students' success on the licensure exam have been widely reported. However, many questions remain as to why certain candidates fail the exam. This pilot study explores postgraduation influences on the NCLEX-RN.(R) Factors such as length and type of study, work hours, review course participation, sleep, and stress were recorded using the newly developed NCLEX Preparation Survey. Results suggest both expected and unexpected relationships between these factors and NCLEX-RN mastery.

Adult↗
PubMed1990

Cancer mortality in the South, 1950 to 1980.

The overall cancer mortality for white and nonwhite men rose twice as rapidly in the South as in the rest of the nation, largely influenced by the rapid growth in lung cancer mortality among southern men in both race groups, and by the significant increase in prostate cancer mortality among southern, nonwhite men. Although the overall cancer mortality rate among white and nonwhite women in the South remained stable, the relative contributions of cervical and lung cancer changed considerably with time. The proportion of cancer deaths in southern women attributed to cervical cancer decreased by 50% while the proportion ascribed to lung cancer tripled. The South's cancer mortality experience differed substantially from that of the rest of the United States, which suggests that southerners diverge from residents of other parts of the United States in their risk of cancer, and in their access to and use of services for cancer prevention, diagnosis, and treatment. This study provides information for planning strategies for the reduction of cancer mortality in the South.

Adult↗
PubMed1994

Southern adolescents: a survey of attitudes and beliefs about smoking.

Using data collected by the National Center for Health Statistics, we examined the relationships between smoking-related beliefs and attitudes and smoking status for a sample of adolescents (N = 3,198) from southern states. Stepwise logistic regression was used to identify the best predictors of smoking prevalence. Results indicated that 8 of 13 variables in the logistic model significantly differentiated between smokers and nonsmokers. Smokers were more likely to believe that it is safe to smoke for only a year or 2 and that smoking helps reduce stress and boredom while promoting relaxation. Smokers also reported a higher tolerance than nonsmokers for being around other smokers, and reported their parents would not mind their smoking. The logistic model attained a predictive accuracy of 93.2%. The implication of these findings is that if smoking interventions targeted at adolescents address smoking-related beliefs and attitudes, there is an enhanced likelihood that such interventions will positively influence the smoking behavior of southern adolescents.

Adolescent↗
PubMed1998

Systems coherence: a method for evolving relationships and measuring system change.

To see the world systematically through the practice of systems thinking means to see the relationship in the phenomena we experience. The systems view is not just another way of improving an object, a process, or even services. It should not be viewed as a method that is focused only on "quality." The intrinsic value of systems thinking is in the movement of relationships.

Delaware↗
PubMed1981

A retrospective cohort study of mortality and cancer incidence among chemist.

This retrospective cohort study examines mortality and cancer incidence among 3,686 men and 75 women who were employed as chemists in 1959. During the period 1964 to 1977, the male chemists experienced lower overall mortality than other salaried employees of the chemical company (198 deaths observed, 241.0 expected, SMR = 82). Large deficits are seen in lung cancer and arteriosclerotic heart disease death. The chemist appear to be at slightly higher risk for death from malignancies of the colon (12 observed, 6.7 expected, SMR = 178) and from cerebrovascular disease (15 observed, 10.8 expected, SMR = 138). The low overall mortality resulted in a larger than expected proportion of deaths due to cancer. Fewer than expected cases were diagnosed of cancer of all sited combined (61 observed, 86.5 expected, SIR = 71) and of the lung (8 observed, 20.0 expected, SIR = 40). The incidence rates of melanoma and of cancer of the prostate are slightly higher than expected, relative to the Third National Cancer Survey and the experience of nonchemists, respectively. Among female chemists, deaths due to all causes and suicide occurred more frequently than expected. Possible explanations for the lack of anticipated excess risks and for the observed deficits are presented.

Adult↗
PubMed1981

A retrospective cohort study of disability among chemists.

This retrospective cohort study examines disability among 3,686 men and 75 women who were employed as chemists in 1959 and who were followed through 1977. Overall, the chemists experienced fewer absences of eight or more consecutive days than expected on the basis of the experience of other salaried employees of the chemical company. Among the men, fewer claims than expected were observed for absences due to benign and unspecified neoplasia, heart disease, and peptic ulcer, and to diseases of the urinary system, bones and joints, and skin. Also, the chemist had lower than expected incidence rates of first myocardial infarction (90 observed, 149.8 expected). The deficits may be attributable to exposure misclassification or to confounding by smoking or socioeconomic status. A slight excess was seen of absences due to mental disorders.

Absenteeism↗
PubMed1992

A survey of the prevalence of epididymitis in an industrial setting.

In response to concerns about the occurrence of epididymitis among employees at a Du Pont textile fibers plant, information was obtained from 1342 (94.8%) active male employees on history of epididymitis and/or orchitis (6.8%), prostatitis (11.5%), other genitourinary conditions, and vasectomy. Vasectomy was associated with an odds ratio of 3.26 (90% confidence interval (CI) = 1.96, 5.43) for subsequent development of epididymitis. History of prostatitis was also a risk factor for epididymitis (odds ratio = 5.02, 90% CI = 2.94, 8.58).

Delaware↗
PubMedDate not supplied

Creation of a stepdown nurse internship program.

Within Christiana Care Health System, an opportunity evolved to develop a nurse recruitment strategy for our stepdown units. Being a large teaching system, there was specific need for nursing education at this entry level. Through collaboration of nursing colleagues, the Stepdown Nurse Internship Program was created. The program encompassed clinical orientation and didactic classes. Of notable significance at the completion of the program were the Basic Knowledge Assessment Test score improvement and the nurse retention rate.

Curriculum↗
PubMedDate not supplied

Meeting bariatric patient care needs: procedures and protocol development.

Regardless of whether your facility has an existing surgical bariatric program, ongoing attention to staff education and the organization's physical environment is key in identifying potential areas of risk and need for improvements in meeting the needs of this special patient population. Development of an organization-wide protocol specifically designed to meet the needs of all bariatric patients will facilitate the provision of safe and dignified care for both patient and caregiver. Protocol parameters to include are assessment for body mass index, abdominal-hip girth, mobility level, and skin complications. Assessment findings trigger care planning for optimal patient outcomes.

Aftercare↗
PubMed2005

Labor progression and risk of cesarean delivery in electively induced nulliparas.

OBJECTIVE: To describe the pattern of labor progression and risk of cesarean delivery in women whose labor was electively induced. METHODS: We analyzed data on all low-risk, nulliparous women with an elective induction or spontaneous onset of labor between 37 + 0 and 40 + 6 weeks from January 2002 to March 2004 at a single institution. The median duration of labor by each centimeter of cervical dilation and the risk of cesarean delivery were computed for 143 women with preinduction cervical ripening and oxytocin induction, 286 women with oxytocin induction, and 1,771 women with a spontaneous onset of labor. An intracervical Foley catheter was used to ripen the cervix. RESULTS: Electively induced labor with cervical ripening had substantially slower latent and early active phases. After controlling for potential confounders, women who had an elective induction with cervical ripening had 3.5 times the risk of cesarean delivery during the first stage of labor (95% confidence interval 2.7-4.5), compared with those admitted in spontaneous labor. Elective induction without cervical ripening, on the other hand, was associated with a faster labor progression from 4 to 10 cm (266 compared with 358 minutes, P < .01) and did not increase the risk of cesarean delivery, compared with those in spontaneous labor. CONCLUSION: The pattern of labor progression differs substantially for women with an electively induced labor compared with those with spontaneous onset of labor. Furthermore, elective induction in nulliparous women with an unfavorable cervix has a high rate of labor arrest and a substantially increased risk of cesarean delivery. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMedDate not supplied

The role of the acetabulum in Perthes disease.

The purpose of this study is to evaluate the changes in the shape of acetabulum from the onset of the disease to the skeletal maturity in Legg-Calvé-Perthes disease. The study population consisted of 243 patients with unilateral involvement who had reached skeletal maturity at last follow-up. All hips were treated by containment methods (which included bed rest and traction in abduction, Petri cast, brace, varus osteotomy, Salter osteotomy, and shelf acetabuloplasty). Necrosis of the femoral head was estimated according to the lateral pillar classification and late results according to the Stulberg classification. Changes in the shape of the acetabulum were divided into 3 groups: type I-normal, concave lateral acetabulum margin; type II-flat, horizontal lateral acetabulum margin; and type III-convex, sloping acetabular margin. Roentgenograms performed during the fragmentation stage revealed type I changes in 78 (32.1%) hips, type II in 136 (55.7%), and type III in 29 (12.2%). At the last follow-up, there were type I changes in 124 (51.2%) hips, type II in 81 (33.5%), and type III in 38 (15.3%). The statistical analysis revealed no significant statistical difference between the age at the onset and gender with regard to acetabular changes. There was significant statistical correlation between the lateral pillar classification, subluxation of the femoral head, the range of hip abduction, and the Stulberg classification with regard to acetabular changes. A type III was statistically associated with lateral pillar classification group C, major subluxation of the femoral head, limited hip abduction, and in Stulberg group 3, 4, or 5. Only surgical methods of treatment improved the acetabular shape at the last follow-up (P<0.05). In our opinion, the lateral acetabulum shape plays a very important role during the remodeling of the deformed proximal femoral epiphysis.

Acetabulum↗
PubMed2003

The association of backpack use and back pain in adolescents.

STUDY DESIGN: A cross-sectional study comprising the first phase of an ongoing, longitudinal prospective study was conducted. OBJECTIVE: To investigate the relation between backpack use and back pain in adolescents. SUMMARY OF BACKGROUND DATA: The prevalence of nonspecific back pain increases dramatically during adolescence from less than 10% in the pre-teen-age years up to 50% in 15- to 16-year-olds. There is widespread concern that heavy backpacks carried by adolescents contribute to the development of back pain. METHODS: A total of 1126 children, ages 12 to 18 years, participated by completing a questionnaire about their health, activities, and backpack use. Each child's body weight, height, and backpack weight were measured. A child was classified as having back pain if one or more of the following were reported during the preceding month: neck or back pain that had interfered with school or leisure, neck or back pain with a severity rating of 2 or more on a scale 0 to 10, a visit to a physician or therapist for neck or back pain, or exemption from physical education or sports because of neck or back pain. RESULTS: Of 1122 backpack users, 74.4% were classified as having back pain, validated by significantly poorer general health, more limited physical functioning, and more bodily pain. As compared with no or low use of backpacks at school, heavy use (odds ratio, 1.98; P < 0.0001) was independently associated with back pain. Female gender and larger body mass index also were significantly associated with back pain. As compared with adolescents who had no back pain, adolescents with back pain carried significantly heavier backpacks that represented a significantly greater percentage of their body weights. CONCLUSION: The use of backpacks during the school day and backpack weights are independently associated with back pain.

Adolescent↗