Deep venous thrombosis and pulmonary embolism in trauma patients: an overstatement of the problem?

Deep venous thrombosis (DVT) and pulmonary embolism (PE) affect high-risk trauma patients (HRTP). Accurate incidence and clinical importance of DVT and PE in HRPT may be overstated. We performed a ten-year retrospective analysis of HRTP of the Pennsylvania Trauma Outcome Study.

A proposed algorithm for managing the open abdomen.

Delayed abdominal closure has gained acceptance in managing a variety of surgical conditions. Multiple techniques were devised to promote safe, uncomplicated, expeditious fascial closure. We retrospectively reviewed patient records between September 22, 2001 and June 30, 2004.

Human immunodeficiency virus infection in trauma patients: where do we stand?

Objective: The human immunodeficiency virus (HIV) epidemic is a growing health care problem. The purpose of this study was to examine the relationship between HIV infection and trauma patient treatment, complications, and mortality.

Methods: The Pennsylvania Trauma Outcome Study database was used to identify trauma patients with known HIV-positive status (HP) and randomly selected age-matched controls (CL).

Adjusted chi-square statistics: application to clustered binary data in primary care.

The frequency of randomized cluster trials is increasing in primary care research. These trials are differentiated by the randomization method, in which a group of individuals is randomly assigned to an intervention as a cluster rather than as individuals. Characteristically, individuals within a cluster tend to be more alike than individuals selected at random.

Metastatic renal cell carcinoma-associated pleural effusion after coronary artery bypass grafting.

Pleural effusions after coronary artery bypass grafting (CABG) occur in up to 89% of patients undergoing the procedure. Effusions present days to months after surgery, and fluid characteristics relate to timing factors. Most of the effusions are left-sided and resolve spontaneously.

Tympanic membrane vs. pulmonary artery thermometry.

Studies that compare tympanic membrane thermometry with other thermometry methods conflict. Research at this facility suggests clinically significant discrepancies, which preclude expanding its tympanic thermometer use.

A potential complication of bi-level positive airway pressure after gastric bypass surgery.

Background: Bi-level positive airway pressure (BIPAP) is a common treatment modality for patients with obstructive sleep apnea (OSA), especially in the morbidly obese population. To our knowledge, there have been no reports of any adverse effects of BIPAP on patients who undergo weight loss surgical procedures.

Methods: We report 2 patients who were treated with BIPAP in the postoperative period following open Roux-en-Y gastric bypass (RYGBP).

Analysis of two-treatment, two-period crossover trials in emergency medicine.

In an AB/BA crossover trial, patients are randomly assigned to receive either treastment A in the first period followed by treatment B in the second period or treatment B in the first period followed by treatment A in the second period. The crossover trial allows for a within-patient comparison between treatments because each patient serves as his or her own control subject, removes the interpatient variability from the comparison between treatments, and can provide unbiased estimates for the differences between treatments. When applied inappropriately, crossover designs have serious problems that might adversely influence and invalidate their results.

Functional outcomes in octogenarian trauma.

Background: Outcome data on geriatric trauma patients (GTPs) (age >or= 65) focus on mortality and resource use. We examined mortality and outcome in GTPs and octogenarian trauma patients (OTPs) (age >or= 80). We hypothesized that OTPs would have worse functional outcomes than GTPs as defined by functional independence measurement (FIM) scales.

Hepatic portal vein gas: clinical features and outcomes.

Hepatic portal vein gas (HPVG) is found as branching gas extending to near the periphery of the liver. Increased utilization of CT may identify HPVG in more patients. In the past HPVG was associated with acute abdomen and high mortality.

Sharpen customer service skills with PCRAFT Pursuit.

Traditional approaches to teaching customer service skills do not involve participant interaction, nor do they provide a fun and relaxed atmosphere for learning. This article describes the development of PCRAFT Pursuit, an innovative game used to teach customer service skills. The development process began with concerns identified through patient satisfaction surveys.

Splenic injury after intraoperative transesophageal echocardiography.

A 55-year-old woman underwent coronary artery bypass grafting and mitral valve repair using intraoperative transesophageal echocardiography (TEE). Postoperatively she had hemodynamic instability associated with an increase in abdominal size and a drop in hemoglobin. At laparotomy, a splenic hilar laceration was discovered, which was presumed to be associated with intraoperative TEE.

The role of sentinel lymph node mapping in staging of colon and rectal cancer.

Purpose: Nodal metastasis is the best predictor of survival for patients with colon cancer. Statistical models based on random distribution of positive lymph nodes suggest that to correctly classify nodal status with 95 percent confidence, 20 nodes are needed for T1 lesions, 17 nodes for T2, and 15 nodes for T3. The mean number of nodes identified in American patients is 8, suggesting that they might not be accurately staged.

A two-hour intervention using START improves prehospital triage of mass casualty incidents.

Objective: There are few data concerning the ability of prehospital providers to triage patients in a mass casualty incident (MCI). The authors evaluated the effectiveness of a brief educational intervention on MCI triage with a written scenario and test. The START method (simple triage and rapid treatment) was used.

Comparing tympanic membrane and pulmonary artery catheter temperatures.

Studies comparing tympanic membrane thermometry with other thermometry methods have had conflicting results. Our hospital's nursing practice council sponsored this tympanic thermometry study in our cardiac surgical intensive care unit to assess the feasibility of increasing tympanic thermometer use in our hospital. Our results suggest clinically significant discrepancies between tympanic membrane and pulmonary artery catheter temperatures.

Long-term outcomes of stereotactic breast biopsies.

Stereotactic core needle biopsies (SCNBs) are accurate and relatively convenient for the patient; however, the long-term follow-up of benign results has not been reported. All patients between 1993 and 1998 undergoing SCNB at a community-based hospital were entered into a registry. Follow-up was obtained by a retrospective analysis of the charts.

Analysis of cathepsin D in human breast cancer: usefulness of the processed 31 kDa active form of the enzyme as a prognostic indicator in node-negative and node-positive patients.

The relative amounts of the precursor (52 kDa) and processed (31,27 kDa) forms of cathepsin D have been analyzed by Western blotting in biopsied breast tissue cytosols from 134 lesions from invasive breast cancer patients, 24 lesions from patients with ductal carcinoma in situ (DCIS), 227 lesions from benign breast disease patients, and 28 lesions from normal control subjects. The mean relative percentage amount of the 31 kDa form was significantly increased (p < 0.001) in the invasive breast cancer group compared to the other three groups.