Evaluation of preoperative patient education and computer-assisted patient instruction.

Health care practitioners believe that patient education enhances patients' compliance with treatment, their medical outcomes, and their quality of life. This study evaluated an existing method of noncomputerized structured preoperative education delivered by a nurse specialist and implemented and evaluated a computer-assisted instruction (CAI) tool for nonsurgical patients in the Vanderbilt Orthopaedic Spine Service. These patient education modalities were assessed with regard to the patient health concepts measured in the Short Form-36 Health Survey and, in addition, for preoperative education, with regard to the length of patient hospital stay.

Do calendars enhance posttraumatic temporal orientation?: a pilot study.

The purpose of this study was to determine the effectiveness of an in-room calendar to correct temporal disorientation in a brain-injured population. Thirty consecutive brain injured patients (16 traumatic, 14 non-traumatic) admitted to a brain injury rehabilitation unit were randomly assigned to either a group with in-room calendars (n = 14) or a group without calendars (n = 16). A baseline Temporal Orientation Test (TOT) score was obtained.

Superior sagittal sinus thrombosis: a complication of gunshot wound injuries to the brain.

Superior sagittal sinus thrombosis (SSST) is a rare complication of non-penetrating brain injuries. However, this is not an uncommon event in those patients who have suffered a gun shot wound (GSW) to the head. Disturbances in blood flow, lead to development of SST, endothelial injury and clotting abnormalities.

Posttraumatic amnesia: its relation to functional outcome.

Objective: To investigate the relation between duration of posttraumatic amnesia (PTA) and functional outcome in a traumatically brain injured population.

Patients: Two hundred seventy-six patients with traumatic brain injury (TBI) who were admitted to a Level I university trauma center and required inpatient rehabilitation.

Measures: Duration of PTA was assessed by serial administrations of the Galveston Orientation Amnesia Test (GOAT).

Rural Hospital Transfer Patterns before and after Implementation of a Statewide Trauma System.

Objective: To evaluate trauma transfer practices in rural Oregon before and after implementation of a statewide trauma system.

Methods: A pre- vs post-system implementation (historical control) analysis of trauma transfer practices was performed using a sample of rural ED trauma patients from 4 Level-3 and 5 Level-4 trauma hospitals. Medical records of patients with specific index injury diagnoses in 4 anatomic regions (head, chest, liver/ spleen, and femur/open-tibia) were reviewed for a 3-year period before statewide trauma system implementation and 3 years after hospital trauma designation.

Rural hospital transfer patterns before and after implementation of a statewide trauma system. OHSU Rural Trauma Research Group.

Objective: To evaluate trauma transfer practices in rural Oregon before and after implementation of a statewide trauma system.

Methods: A pre- vs post-system implementation (historical control) analysis of trauma transfer practices was performed using a sample of rural ED trauma patients from 4 Level-3 and 5 Level-4 trauma hospitals. Medical records of patients with specific index injury diagnoses in 4 anatomic regions (head, chest, liver/ spleen, and femur/open-tibia) were reviewed for a 3-year period before statewide trauma system implementation and 3 years after hospital trauma designation.

Use of resuscitation skills by paramedics caring for critically injured children in Oregon.

Objectives: 1) To perform a statewide analysis of the frequency of major pediatric trauma cases and the use of resuscitation skills by paramedics (EMT-Ps). 2) To determine whether EMT-Ps use resuscitation skills less frequently for injured children than for older patients.

Study Design: Retrospective, database analysis of major trauma cases.

Pulmonary agenesis: a predictor of ipsilateral malformations.

Pulmonary agenesis is a rare malformation that can be isolated or associated with other anomalies. We became interested in pulmonary agenesis after evaluation of a child with right pulmonary agenesis, an unlobed left lung, bilateral cleft lip and palate, maxillary and mandibular hypoplasia, bilateral microtia, bilateral radial ray hypoplasia, horseshoe kidney, and complex congenital heart disease. A review of the occurrence of pulmonary agenesis with other congenital anomalies uncovered a striking association with ipsilateral radial ray defects and/or hemifacial microsomia.

Pediatric window-cord strangulations in the United States, 1981-1995.

Objective: To document the prevalence of pediatric asphyxial death from window-covering cords in the United States and identify associated risk factors.

Design: Retrospective analysis of existing death certificate and incident files compiled by the US Consumer Product Safety Commission.

Setting: United States, 1981 through 1995.

The effect of short-term diets rich in fish, red meat, or white meat on thromboxane and prostacyclin synthesis in humans.

Foods which increase tissue arachidonic acid levels have been proposed to increase thrombosis tendency, presumably through increased platelet aggregation. This study examined the effect of doubling the dietary arachidonic acid (20:4n-6) using meat- or fish-based diets on the systemic production of prostacyclin (PGI2) and thromboxane (TXA2) in 29 healthy, nonsmoking adults. There were three, 3-wk low-fat dietary periods (< 15% energy as fat) in which subjects consumed a vegetarian diet for 1 wk followed by 2 wk on diets containing meat or fish as sources of 20:4n-6.

An immunological approach to detect phosphate stress in populations and single cells of photosynthetic picoplankton.

In the marine cyanobacterium Synechococcus sp. strain WH7803, PstS is a 32-kDa cell wall-associated phosphate-binding protein specifically synthesized under conditions of restricted inorganic phosphate (P1) availability (D. J.

Functional outcome after violence related traumatic brain injury.

Violent injuries have become an increasingly prevalent cause of traumatic brain injury (TBI). These injuries can be classified as either penetrating or non-penetrating in nature. While much of the research on violence has been within a military population, there exists a marked difference between military and civilian injuries.

Psychogenic polydipsia after traumatic brain injury. A case report.

Electrolyte abnormalities are common medical complications of traumatic brain injury (TBI). Hyponatremia is the most common of these disorders. The syndrome of inappropriate antidiuretic hormone and cerebral salt-wasting are the most well known causes of hyponatremia following TBI.

Specifications for calculation of risk-adjusted odds of death using trauma registry data.

Background: Logistic regression models, with coefficients developed from normative populations, can be applied to a trauma registry cohort to predict the risk-adjusted frequency of death. Quality of care is judged based on differences between predicted and observed mortality frequency. The goal of these analyses was to determine if decedents who died in the emergency department had independent variables associated with risk of death identical to those who died after hospital admission.

Cerebral salt wasting syndrome in brain injury patients: a potential cause of hyponatremia.

Hyponatremia is a common neuromedical problem seen in survivors of central nervous system injury. The etiology of this hyponatremia is often diagnosed as syndrome of inappropriate diuretic hormone (SIADH). Fluid restriction is usually the first line of treatment.

Impact of a statewide trauma system on rural emergency department patient assessment documentation. OHSU Rural Trauma Research Group.

Objective: To determine the association of rural ED patient assessment documentation with state trauma system implementation, hospital trauma categorization level (i.e., Level-3 vs Level-4), injury diagnosis, and patient demographics.

Influence of a statewide trauma system on pediatric hospitalization and outcome.

Background: During the years 1987-1991, a statewide trauma system was implemented in Oregon (Ore) but not in Washington (Wash). Incidence of hospitalization, frequency of death and risk-adjusted odds of death for injured children (< 19 years) in the two adjacent states were compared for two time periods (1985-1987 and 1991-1993).

Methods: State populations of injured children (International Classification of Diseases, 9th Revision-Clinical Modification, code 800-959) were identified through a Hospital Discharge Index.

Web client and ODBC access to legacy database information: a low cost approach.

A new method has been developed for the Department of Orthopaedics of Vanderbilt University Medical Center to access departmental clinical data. Previously this data was stored only in the medical center's mainframe DB2 database, it is now additionally stored in a departmental SQL database. Access to this data is available via any ODBC compliant front-end or a web client.

Integrating and presenting clinical and treatment outcome data for cost-effective case management.

The broad objective was to develop an information system which integrates various sources of clinical data and facilities outcome assessment for patients evaluated in a lumbar spine service. During a patient encounter, the physician formulates a hypothesis regarding appropriate forms of treatment and he or she may then use this system to explore previous treatment outcomes for similar cases. The availability of a clinical tool that presents information in an outcome-oriented format may be highly relevant to the delivery of cost-efficient, high-quality health care and also create a formal mechanism for detecting practice variability.

Assessing rater performance without a "gold standard" using consensus theory.

This study illustrates the use of consensus theory to assess the diagnostic performances of raters and to estimate case diagnoses in the absence of a criterion or "gold" standard. A description is provided of how consensus theory "pools" information provided by raters, estimating rater competencies and differentially weighting their responses. Although the model assumes that raters respond without bias (i.

Revised trauma score: an additive predictor of disability following traumatic brain injury?

Recent studies have clarified the role of hypoxic-ischemic damage as a secondary factor in traumatic brain injury (TBI). Many trauma centers are now consistently using the Revised Trauma Score (Glasgow Coma Scale, systolic blood pressure, and respiratory rate) to assist with triage of multitrauma patients. This study investigated the predictive power of the Revised Trauma Score (RTS) instead of the Glasgow Coma Scale (GCS) in determination of disability as measured by the Disability Rating Scale (DRS).

Relationship between Glasgow coma scale and functional outcome.

The Glasgow Coma Scale (GCS) is routinely used in the acute care setting after traumatic brain injury (TBI) to guide decisions in triage, based on its ability to predict morbidity and mortality. Although the GCS has been previously demonstrated to predict mortality, efficacy in prediction of functional outcome has not been established. The purpose of this study was to assess the value of the acute GCS in predicting functional outcome in survivors of TBI.

Characterization of the genes encoding a phosphate-regulated two component sensory system in the marine cyanobacterium Synechococcus sp. WH7803.

An oligomer probe was designed to detect the presence of a putative phoB gene in the genome of the marine, phycoerythrin-containing cyanobacterium Synechococcus sp. WH7803. A 2.