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PubMed2002

Thrombolysis for acute stroke in routine clinical practice.

BACKGROUND: Studies have demonstrated that thrombolytic therapy for acute stroke can be given safely and effectively in study settings with experienced clinicians, but the patient outcomes associated with thrombolytic therapy in routine clinical practice require investigation. OBJECTIVES: To compare outcomes among patients given intravenous thrombolysis in routine clinical practice with the results of the National Institute of Neurological Disorders and Stroke rt-PA Study (NINDS cohort) and to examine whether protocol deviations are associated with adverse events. METHODS: Retrospective cohort of community-based patients given thrombolysis for acute stroke from May 1, 1996, through December 31, 1998, in 16 Connecticut hospitals (Connecticut cohort). RESULTS: Forty-two (67%) of 63 patients in the Connecticut cohort had at least 1 major protocol deviation, and 61 (97%) had major or minor protocol deviations. Overall, the in-hospital mortality was higher in the Connecticut cohort (16/63 [25%]) compared with the NINDS cohort (40/312 [13%]; P =.01). The serious extracranial hemorrhage rate was also higher for the Connecticut cohort (8/63 [13%] vs 5/312 [2%]; P =.001). Patients in the Connecticut cohort without major protocol deviations had outcomes similar to those in the NINDS cohort; however, patients in the Connecticut cohort with major protocol deviations had higher rates of in-hospital mortality (13/42 [31%] vs 40/312 [13%]; P =.002) and serious extracranial hemorrhage (7/42 [17%] vs 5/312 [2%]; P =.001). CONCLUSIONS: Protocol deviations occur commonly when thrombolytic therapy is given to stroke patients in routine clinical practice. Patients who receive thrombolysis with major protocol deviations have higher rates of in-hospital mortality and serious extracranial hemorrhage than patients in the NINDS cohort.

Adult↗
PubMed1992

Management preparedness criteria: a study of nursing home administrators.

The observations from this study seem to suggest that there are some correlations between education, experience, age, and sex on the level of preparedness in the practice domains identified. Specifically, this study finds that years of experience have a significant negative correlation with the practice domains of physical plant/building management, fiscal reimbursement, financial management, and overall preparedness in both Oklahoma and Connecticut respondents. Experience level further correlates negatively with all other practice domains (except licensing standards) in Oklahoma respondents. Education level, on the other hand, did not correlate with any practice domain (except licensing standards among Oklahoma respondents). Age correlated positively with financial management activities but only with Oklahoma respondents, while sex correlated positively with physical plant/building management (Oklahoma and Connecticut) and with financial management in Connecticut only. Sex, however, had a negative correlation with basic nursing activities among Connecticut respondents. This study suggests that the nursing home administrators from Connecticut in our study felt that they were more prepared in the practice domains identified as compared to those responding from Oklahoma. This can be attributed to the fact that Connecticut respondents had almost a 13 percent higher average of experience years. This was also demonstrated in the correlation table. Other factors such as sex, age at onset of administrator career, and educational level had no or very limited effect on the practice domains identified in the study (p greater than 0.05). This holds true for both Oklahoma and Connecticut respondents. Therefore, the hypothesis stating that education has a direct effect on job performance and preparedness of nursing home administrators does not hold true with this study. It is the years of experience that has a direct effect on performance and preparedness of nursing home administrators.

Adult↗
PubMed2002

Relationship between tick bites and the seroprevalence of Babesia microti and Anaplasma phagocytophila (previously Ehrlichia sp.) in blood donors.

BACKGROUND: Tick-borne diseases, particularly babesiosis and ehrlichiosis, represent recently emerging infections. Despite an increased recognition of the threat tick-borne agents pose to blood safety, our understanding of the prevalence and transmissibility of these agents in blood donors is limited. STUDY DESIGN AND METHODS: Babesia microti and Anaplasma phagocytophila (previously Ehrlichia sp.) seroprevalence was determined in random Connecticut and Wisconsin donors, and subsequently in Connecticut donors reporting tick bites. In the interim, a postcard survey regarding tick bites during the previous 6 months was sent to 6,000 random donors in six geographically distinct collection regions. RESULTS: In total, 3 of 999 Wisconsin donors (0.3%) and 6 of 1,007 Connecticut donors (0.6%) had antibodies to B. microti. Of 992 donors tested for A. phagocytophila, 5 Wisconsin donors (0.5%) and 35 Connecticut donors (3.5%) were seropositive. A total of 2,482 donors (41.4%) completed the survey; 103 (4.1%) reported a tick bite. Of 848 Connecticut donors (0.4%) reporting tick bites, 3 had B. microti antibodies, while 8 (0.9%) had A. phagocytophila antibodies. These rates were not significantly different from control donors. CONCLUSION: Blood donors seropositive for B. microti and A. phagocytophila are present in Connecticut and Wisconsin. Donors readily recall previous tick bites, but self-reported bites are not reliable indicators of serologic status. The exposure of blood donors to tick-borne pathogens does suggest a need to better understand the transfusion transmission potential of these agents.

Anaplasma phagocytophilum↗
PubMed2004

Survival of patients with metastatic breast cancer: twenty-year data from two SEER registries.

BACKGROUND: Many researchers are interested to know if there are any improvements in recent treatment results for metastatic breast cancer in the community, especially for 10- or 15-year survival. METHODS: Between 1981 and 1985, 782 and 580 female patients with metastatic breast cancer were extracted respectively from the Connecticut and San Francisco-Oakland registries of the Surveillance, Epidemiology, and End Results (SEER) database. The lognormal statistical method to estimate survival was retrospectively validated since the 15-year cause-specific survival rates could be calculated using the standard life-table actuarial method. Estimated rates were compared to the actuarial data available in 2000. Between 1991 and 1995, further 752 and 632 female patients with metastatic breast cancer were extracted respectively from the Connecticut and San Francisco-Oakland registries. The data were analyzed to estimate the 15-year cause-specific survival rates before the year 2005. RESULTS: The 5-year period (1981-1985) was chosen, and patients were followed as a cohort for an additional 3 years. The estimated 15-year cause-specific survival rates were 7.1% (95% confidence interval, CI, 1.8-12.4) and 9.1% (95% CI, 3.8-14.4) by the lognormal model for the two registries of Connecticut and San Francisco-Oakland respectively. Since the SEER database provides follow-up information to the end of the year 2000, actuarial calculation can be performed to confirm (validate) the estimation. The Kaplan-Meier calculation for the 15-year cause-specific survival rates were 8.3% (95% CI, 5.8-10.8) and 7.0% (95% CI, 4.3-9.7) respectively. Using the 1991-1995 5-year period cohort and followed for an additional 3 years, the 15-year cause-specific survival rates were estimated to be 9.1% (95% CI, 3.8-14.4) and 14.7% (95% CI, 9.8-19.6) for the two registries of Connecticut and San Francisco-Oakland respectively. CONCLUSIONS: For the period 1981-1985, the 15-year cause-specific survival for the Connecticut and the San Francisco-Oakland registries were comparable. For the period 1991-1995, there was not much change in survival for the Connecticut registry patients, but there was an improvement in survival for the San Francisco-Oakland registry patients.

Adult↗
PubMed2005

Guidelines for constructing a statewide hospital syndromic surveillance network.

INTRODUCTION: The process to initiate a comprehensive and inexpensive statewide hospital emergency department-based syndromic surveillance system (HEDSS) in Connecticut can serve as a template for others. OBJECTIVES: With limited financial resources, the Connecticut Department of Public Health (CDPH) determined the requirements necessary to establish and routinely conduct hospital emergency department (HED)-based syndromic surveillance. METHODS: A statewide survey assessed ability and willingness of Connecticut hospitals to participate in HED syndromic surveillance. The New York City HED-based system protocol and analysis programs, available without financial charge, were modified for use in Connecticut. This system is based on hospitals sending daily standardized files of chief complaint data through encrypted e-mail or an FTP protocol to CDPH with subsequent categorization into syndromes using a SAS program. Anticipating regional surveillance needs during the Republican National Convention in New York City (RNC), CDPH initiated HEDSS in August 2004. RESULTS: Most Connecticut HEDs were willing and able to participate on a voluntary basis. Beginning in July 2004, hospital recruitment began. By the time of the RNC, 11 of 32 Connecticut hospitals participated in HEDSS. Since then, an additional six HEDs have joined. CONCLUSION: Establishing a voluntary statewide HEDSS was possible using an existing, readily available protocol with minimum financial resources and consensus from a statewide workgroup over a several-month time period.

Connecticut↗
PubMed2001

Prevention of lead poisoning in construction workers: a new public health approach.

BACKGROUND: In 1990, Yale University, the Connecticut Departments of Health Services and of Transportation, the Connecticut Construction Industries Association, and the state's construction trade unions created the Connecticut Road Industry Surveillance Project (CRISP). METHODS: Data from 90 bridge projects from 1991 to 1995 and approximately 2,000 workers were evaluated. The distribution of peak lead concentrations in the blood for CRISP workers classified into five groups were compared to that from workers outside of Connecticut. RESULTS: This demonstration project was instrumental in lowering bridge worker blood lead levels. After 1992, only the painting contract employees experienced peak blood lead levels with < or = 2% exceeding 50 microg/dl. Compared to similar workers in other states, Connecticut workers had significantly lower peak blood lead levels. CONCLUSIONS: Two thousand workers and over 120 contractors benefited directly from CRISP. Two key features of the CRISP model differed from the 1993 OSHA standard: a contract-specified lead health protection program and a centralized system of medical monitoring. These differences may account for the improved protection observed between the CRISP and non-Connecticut cohorts.

Adult↗
PubMed1992

A population-based study of motorcycle injury and costs.

STUDY OBJECTIVE: To provide a population-based injury and cost profile for motorcycle injury in Connecticut. DESIGN: Population-based retrospective epidemiologic review of Connecticut death certificates, hospital discharge data, and police accident reports. RESULTS: Connecticut death certificates identified 112 deaths from motorcycle injuries for an annual death rate of 1.2 per 100,000 persons. Death rates were highest among 20- to 24-year-old men. Nonhelmeted motorcyclists were 3.4-fold more likely to die than were helmeted riders (P less than .05). An estimated 2,361 motorcycle-related hospital discharges resulted in an annual hospitalization rate of 24.7 per 100,000 persons. Head, neck, and spinal injuries accounted for 22% of all injuries. Total costs exceeded $29 million; 29% of hospitalized patients were uninsured, and 42% of the cost was not reimbursed to the hospitals. CONCLUSION: Motorcycle injuries contribute significantly to Connecticut's mortality, morbidity, and medical costs. Our study suggests that a uniform helmet law would save an estimated ten lives and prevent more than 90 nonfatal injuries in Connecticut each year at a cost savings to the state of $5.1 million. These data are crucial in advocating re-enactment of motorcycle helmet laws.

Abbreviated Injury Scale↗
PubMed1998

Physical therapists' opinions and practices regarding direct access.

BACKGROUND AND PURPOSE: This study examined whether differences exist about physical therapists' opinions and practices regarding the use of direct access between therapists practicing in Massachusetts, a direct-access state, and therapists practicing in Connecticut, a state that allows only evaluation without referral. A second purpose was to examine direct-access practices of therapists in Massachusetts. SUBJECTS: A sample of 329 therapists in Massachusetts and 179 therapists in Connecticut were surveyed. METHODS: A cover letter, questionnaire, and return-reply envelope were mailed to each therapist. Independent group t tests and chi-square analyses were used to determine whether therapists' opinions about direct access differed between states. Frequencies were calculated to examine direct-access practices of therapists in Massachusetts. RESULTS: Adjusted response rates were 65.5% in Massachusetts and 57.9% in Connecticut. Therapists in both states were equally supportive of direct access (74.9%). Therapists in Connecticut were more supportive of three stipulations regulating direct access than therapists in Massachusetts were. In Massachusetts, 34.0% of the respondents stated that they practiced using direct access, and 8.8% of the patients seen by the therapists sampled were treated without physicians' referrals. The therapists indicated that the most common reasons for limited use of direct access were employer policies and lack of insurance reimbursement. CONCLUSION AND DISCUSSION: Therapists in Connecticut favored more stipulation regulating direct access than therapists in Massachusetts did. Although therapists in both states appear to be supportive of direct access, the number of patients in Massachusetts seen through this mode of care appears to be limited because of practice and financial restraints.

Adult↗
PubMed1998

Temporal correlations between tick abundance and prevalence of ticks infected with Borrelia burgdorferi and increasing incidence of Lyme disease.

The abundance of host-seeking Ixodes scapularis nymphs, the principal vector for the Lyme disease agent, Borrelia burgdorferi, in Old Lyme, Lyme, and East Haddam, Connecticut, was compared with the incidence of reported human Lyme disease in the 12-town area around the Connecticut River and the State of Connecticut for the period 1989 to 1996. Ticks were sampled from lawns and woodlands by dragging flannel over the vegetation and examined for the presence of B. burgdorferi by indirect fluorescent antibody staining. The infection rate of the nymphal ticks by B. burgdorferi during the 9-year period was 14.3% (of 3,866), ranging from 8.6% (1993) to 24.4% (1996). The incidence of Lyme disease was positively correlated with tick abundance in the 12 town area (r = 0.828) and the State of Connecticut (r = 0.741). An entomological risk index based upon the number of I. scapularis ticks infected by B. burgdorferi was highest in 1992, 1994, and 1996 and was highly correlated with the incidence of Lyme disease in Connecticut (r = 0.944). The number of Lyme disease cases has been influenced, in part, by annual changes in population densities of I. scapularis and, presumably, a corresponding change in the risk of contact with infected ticks. Based upon tick activity and spirochetal infection rates, epidemiologically based Lyme disease case reports on a regional scale appear to reflect real trends in disease.

Animals↗
PubMed2005

Critical care physicians' practices and attitudes and applicable statutes regarding withdrawal of life-sustaining therapies.

OBJECTIVE: To describe intensivist-educators' practices and opinions regarding the withdrawal of life-sustaining therapies, and to juxtapose these with applicable end-of-life statutes. METHODS: A questionnaire was sent to critical care program directors in Connecticut, New York, Illinois, California, Florida and Texas (to examine regional variability). Statutes regarding end-of-life care were ascertained for these states. RESULTS: Sixty-eight of 128 queried intensivists responded to the questionnaire. They reported having withdrawn life-sustaining therapies to a median of 28 patients in the previous year. Overall, respondents answered that of patients in whom they had withdrawn life-sustaining therapies, 55% were terminal, 20.5% weren't necessarily terminal but advance directives were applied to the situation and 22% weren't necessarily terminal but families requested withdrawal. The ranges of responses were highly variable (ranging from 5%-100% patients deemed terminal). All respondents agreed that withdrawal should be allowed in non-terminal conditions in which the likelihood or quality of survival would be unacceptable to the patient. Forty-eight respondents answered that advanced Alzheimer's Disease qualifies as a terminal illness. Connecticut's end-of-life statutes were unlike those in the five other states that allowed withdrawal of life-sustaining therapies based on advance directives and/or surrogates' consent. Practices of Connecticut respondents were similar to other sampled states. CONCLUSIONS: These data suggest that Connecticut's statutes requiring that patients be deemed terminal (or permanently unconscious) before withdrawal of care are dissimilar from those in several other states. Connecticut intensivists who responded to our survey appear to practice end-of-life care that is similar to practices elsewhere.

Advance Directive Adherence↗
PubMed2002

Genetic analysis of floral anthocyanin pigmentation traits in Asiatic hybrid lily using molecular linkage maps.

To understand the genetic background of two floral anthocyanin pigmentation traits, anthocyanin pigmentation in the flower tepals and spot formation, in the Asiatic hybrid lily (2n = 24), segregation of the two traits among 96 F(1) plants derived from a cross between commercial cultivars 'Montreux' and 'Connecticut King' were investigated. 'Montreux' has anthocyanin pigmentation in the tepals with many spots, and 'Connecticut King' has flowers with carotenoid pigmentation without spots. The F(1) plants with or without anthocyanin pigment in the tepals segregated with a 1:1 segregation ratio, indicating that a single gene controls anthocyanin pigmentation in the tepals. The number of spots per square centimeter of all tepals showed continuous distribution in the F(1) plants. To map the loci for the two anthocyanin pigmentation traits, molecular linkage maps in the Asiatic hybrid lily were constructed using a double pseudo-testcross strategy, with the same F(1) plants used for phenotypic evaluation, and 212 PCR-based DNA markers. The trait for anthocyanin pigmentation in tepals was used as a trait marker. The map of 'Montreux' comprised 95 markers in 26 linkage groups, and the map of 'Connecticut King' used 119 markers in 24 linkage groups. The total map lengths were 867.5 and 1,114.8 cM, respectively. The trait locus for anthocyanin pigmentation in the tepals was between markers ASR35-180 and P506-40 in linkage group 1 of the 'Montreux' map with a map distance of 1.2 cM and 2.6 cM, respectively. A single-point analysis of quantitative trait loci (QTLs) for tepal spot number identified two putative QTLs in linkage groups 1 and 19 of the 'Connecticut King' map. One putative QTL in linkage group 19 explained 64% of the total phenotypic variation. Because both putative QTLs were mapped on the linkage map of 'Connecticut King' that has no spots, dominant alleles of them might suppress spot formation.

Journal Article↗
PubMed2004

Longer term effects of New York State's law on drivers' handheld cell phone use.

OBJECTIVE: To determine whether substantial short term declines in drivers' use of handheld cell phones, after a state ban, were sustained one year later. DESIGN: Drivers' daytime handheld cell phone use was observed in four New York communities and two Connecticut communities. Observations were conducted one month before the ban, shortly after, and 16 months after. Driver gender, estimated age, and vehicle type were recorded for phone users and a sample of motorists. INTERVENTION: Effective 1 November 2001, New York became the only state in the United States to ban drivers' handheld cell phone use. Connecticut is an adjacent state without such a law. SAMPLE: 50,033 drivers in New York, 28,307 drivers in Connecticut. OUTCOME MEASURES: Drivers' handheld cell phone use rates in New York and Connecticut and rates by driver characteristics. RESULTS: Overall use rates in Connecticut did not change. Overall use in New York declined from 2.3% pre-law to 1.1% shortly after (p<0.05). One year later, use was 2.1%, higher than immediately post-law (p<0.05) and not significantly different from pre-law. Initial declines in use followed by longer term increases were observed for males and females, drivers younger than 60, and car and van drivers; use patterns varied among the four communities. Publicity declined after the law's implementation. No targeted enforcement efforts were evident. Cell phone citations issued during the first 15 months represented 2% of all traffic citations. CONCLUSIONS: Vigorous enforcement campaigns accompanied by publicity appear necessary to achieve longer term compliance with bans on drivers' cell phone use.

Accidents, Traffic↗