20-year mortality after discharge in a cohort of 1,099 former trauma inpatients with and without substance use disorders.

Introduction: Psychoactive substance use disorders (SUDs) are common in trauma patients and substance use has become a leading cause of death in the United States. The purpose of this study is to examine the impact of a lifetime SUD and SUD characteristics (substance used, current SUD versus in remission from dependence, etc.) on the long-term survival of trauma patients.

Social Support Moderates the Negative Association Between Reduced Driving and Life Satisfaction in Older Adults.

When older adults reduce their driving, there can be subsequent decreases in life satisfaction. In this cross-sectional study, we used baseline data from the multi-site Longitudinal Research on Aging Drivers (LongROAD) study to examine whether social support moderates the negative association between reduced driving and life satisfaction. The outcome variable was life satisfaction, and the main predictor variable was past-year reduced driving (yes/no).

Resistance towards nondepolarising muscle relaxants: prolonged onset time: A systematic review.

Background: Nondepolarising muscle relaxants (NDMRs) provide optimal conditions for tracheal intubation and improve surgical conditions. Several clinical conditions, diseases and pharmacological interactions have been suggested to cause resistance towards NDMRs that may translate into difficult intubation or inadequate operating conditions during surgery.

Objective: The aim of this study was to evaluate the current evidence of patient groups with resistance towards NDMRs.

Reversal of mivacurium-induced neuromuscular blockade with a cholinesterase inhibitor: A systematic review.

Background: Mivacurium is a short-acting non-depolarizing muscle relaxant, which is hydrolyzed by butyrylcholinesterase. The neuromuscular block (NMB) can be antagonized with cholinesterase inhibitors (CHEI), but the short duration of action of mivacurium questions the need. This systematic review evaluated if the use of CHEIs (neostigmine, pyridostigmine or edrophonium) facilitates reversal of mivacurium-induced NMB.

Test characteristics of a drug CAGE questionnaire for the detection of non-alcohol substance use disorders in trauma inpatients.

Background: Non-alcohol substance use disorders (drug use disorders [DUDs]) are common in trauma patients.

Objective: To determine the test characteristics of a 4-item drug CAGE questionnaire to detect DUDs in a cohort of adult trauma inpatients.

Methods: Observational cross-sectional cohort of 1,115 adult patients admitted directly to a level-one trauma center between September, 1994 and November, 1996.

Deep neuromuscular blockade and surgical conditions during laparoscopic ventral hernia repair: A randomised, blinded study.

Background: Laparoscopic ventral hernia repair is a common surgical procedure. However, muscle contractions and general muscle tension may impair the surgical view and cause difficulties suturing the hernial defect. Deep neuromuscular blockade (NMB) paralyses the abdominal wall muscles and may help to create better surgical conditions.

Regulating drivers with epilepsy in Maryland: Results of the application of a United States consensus guideline.

Objective: Driving regulations for people with seizures vary widely throughout the United States and the world. Maryland updated their guidelines in 2003 to reflect those of a U.S.

Loop Diuretics Diminish Hemolysis Induced by α-Hemolysin from Escherichia coli.

Uropathogenic Escherichia coli often produce the virulence factor α-hemolysin (HlyA), and the more severe the infection, the likelier it is to isolate HlyA-producing E. coli from patients. HlyA forms pores upon receptor-independent insertion of the toxin into biological membranes and it has been substantiated that HlyA-induced hemolysis is amplified by toxin-induced ATP release and activation of P2X receptors.

Leukotoxin from Aggregatibacter actinomycetemcomitans causes shrinkage and P2X receptor-dependent lysis of human erythrocytes.

Leukotoxin (LtxA) is a virulence factor secreted by the bacterium Aggregatibacter actinomycetemcomitans, which can cause localized aggressive periodontitis and endocarditis. LtxA belongs to the repeat-in-toxin (RTX) family of exotoxins of which other members inflict lysis by formation of membrane pores. Recently, we documented that the haemolytic process induced by another RTX toxin [α-haemolysin (HlyA) from Escherichia coli] requires P2X receptor activation and consists of sequential cell shrinkage and swelling.

Impulsive or depressive personality traits do not impede behavioral change after brief alcohol interventions.

The authors investigated whether impulsivity and depression affect the success of interventions to reduce alcohol use. Unadjusted and adjusted regression models were constructed to analyze the effect of impulsivity and depression on 12-month outcomes of participants of a trauma center based randomized trial of brief personalized motivational interventions versus information and advice. Of 497 problem drinkers enrolled in the program, 248 completed the 12-month follow-up.

Pursuit of Licensure by Senior Drivers Referred by Police to a State Licensing Agency's Medical Advisory Board.

In all fifty United States and the District of Columbia, police Requests for Re-examination (RRE) concerning fitness to driver are accepted by licensing agencies. This study assessed licensing outcomes of senior drivers, ≥75 years of age, who had RREs submitted to the Medical Advisory Board (MAB) of a Maryland Motor Vehicle Administration from March 2005 through April 2007. RRE traffic event information (including crashed, did not crash), driver demographic information, initial MAB recommendations (suspension vs no suspension), driving occupational therapists assessments, and drivers' pursuit of continued licensure were entered into a database.

Police referral of drivers to the Maryland Motor Vehicle Administration's Medical Advisory Board.

In the 50 United States and the District of Columbia law enforcement medical referrals are accepted by licensing agencies. This study assessed driving actions, medical concerns, and medical conditions in 486 police referrals to the Medical Advisory Board of the Maryland Motor Vehicle Administration during a 25-month period. Driving actions, medical concerns, and medical conditions were grouped into categories and entered into a database.

Applying research to licensing agency screening of seniors for fitness to drive.

The aging process is associated with medical conditions that can negatively affect medical fitness to drive. Traditional licensing agency methods to identify at-risk drivers have significant limitations. These include testing of visual acuity and driving tests.

Adult correlates of early behavioral maladjustment: a study of injured drivers.

Objective: To establish whether a history of school suspension (HSS) predicts adult driver behavior.

Methods: 323 injured drivers were interviewed as part of a study of psychoactive substance use disorders (PSUD) and injury. Drivers with a HSS were compared to those without HSS in relation to demographics, SES, PSUD, risky behaviors, trauma history and driving history using student's t test and chi-square.

School suspensions, injury-prone behaviors, and injury history.

Purpose: To investigate the association of history of school suspension (HSS) to risky behaviors and injury history.

Methods: Adult patients admitted to a Level I trauma center (n = 774) were assessed for demographics, socioeconomic status, educational history, risky behaviors (infrequent seat belt use, drinking and driving, binge drinking, and speeding for a thrill), substance abuse disorders, and prior injury history. Student's t test and chi statistics were used to compare subjects with and without a HSS in relation to risky behaviors and injury history (alpha = 0.

Medical review of fitness to drive in older drivers: the Maryland experience.

Background: Over the next several decades, both the number and percentage of older drivers will increase dramatically. Older age is inherently associated with medical conditions, particularly those involving cognition and vision, that can affect medical fitness to drive. Over a 60-year period, the Maryland Motor Vehicle Administration (MVA) in conjunction with its medical advisory board (MAB) has matured a comprehensive system to identify at-risk older drivers and to assess their medical fitness to drive.

Alcohol use and testing among older trauma victims in Maryland.

Background: Few studies have examined alcohol use in the older trauma population. The purpose of the present study was to examine blood alcohol level testing and results among older trauma patients.

Methods: All patients aged 65 years or older directly admitted from the injury scene and entered into the Maryland Trauma Registry during a 6-year period were reviewed.

Smoking is a marker of risky behaviors independent of substance abuse in injured drivers.

Objective: Smoking has been linked to disease and injury. The purpose of this study is to investigate the smoking habits of motor vehicular driver trauma center patients and their association with previous injury history and risky behaviors.

Methods: The studied population included 323 motor vehicular driver injury patients (123 smokers and 200 non-smokers) interviewed as part of a larger study of psychoactive substance use disorders at an adult Level I trauma center.

Sociodemographic characteristics associated with substance use status in a trauma inpatient population.

Substance use is significantly associated with physical injury, yet relatively little is known about the prevalence of specific substance use disorders among trauma patients, or their associated sociodemographic characteristics. We evaluated these issues in an unselected sample of 1,118 adult inpatients at the University of Maryland Shock Trauma Center, Baltimore, MD, who were interviewed with the psychoactive substance use disorder section of the Structured Clinical Interview for DSM-III-R. Among trauma inpatients, lifetime alcohol users (71.

A controlled trial of brief intervention versus brief advice for at-risk drinking trauma center patients.

Background: Numerous reports document that preinjury alcohol use is associated with all modes of injury requiring treatment in a trauma center, with 25% to 50% or more of patients testing positive for alcohol at the time of admission. There is evidence that in trauma patients unaddressed alcohol use problems result in recurrent injury requiring readmission to a trauma center and/or death.

Methods: A randomized clinical trial was conducted to assess the effectiveness of two types of brief interventions to reduce drinking and the consequences of drinking.

Risk of psychoactive substance dependence among substance users in a trauma inpatient population.

One measure of a substance's addictive risk is the proportion of users who become dependent. This study evaluates the lifetime and current risk of substance dependence among lifetime substance users' among trauma inpatients and provides a relative ranking of addictive risk among the substances. Data on use of 8 substance groups (alcohol, opiates, marijuana, cocaine, other stimulants, sedative-hypnotics, hallucinogens, other drugs) were obtained by interview (Structured Clinical Interview for the DSM-III-R) from 1,118 adult trauma inpatients.

Social, behavioral and driving characteristics of injured pedestrians: a comparison with other unintentional trauma patients.

Pedestrian injuries represent 11% of all motor vehicle related injuries in the USA. This study attempts to define the epidemiology of the pedestrian victim. Patients admitted to a regional adult trauma center were interviewed and evaluated for substance abuse.