A study of productivity and participation at IADR and AADR annual meetings from 1970 to 1981.

An analysis was conducted of the scientific research productivity and participation in the International Association for Dental Research and the American Association for Dental Research annual meetings between 1970 and 1981. The study was designed to describe the overall level of participation, most productive institutions by year, and percent change in total research productivity of participating institutions and countries from 1970 to 1981. The results indicate that a total of approximately 687 different institutions representing 49 countries participated during the 12-year period. The total number of presentations increased by 77%, while the total number of participating institutions increased by 63%. The top 20 most productive institutions in any given year accounted for between 38 and 51% of all research presented. Of these top 20 participating institutions, approximately 83% were universities. An analysis by year and most productive institutions from 1980 to 1981 is presented.

Intravenous chlorpromazine vs intravenous metoclopramide in acute migraine headache.

OBJECTIVE: To compare the efficacy of IV chlorpromazine with that of IV metoclopramide in the treatment for acute migraine headache in the ED. METHODS: A prospective randomized double-blind trial was undertaken at two university-affiliated urban EDs with a combined annual census of more than 85,000 patients. Included in the study were patients presenting to the ED with a diagnosis of migraine headache. The subjects were randomized to receive 0.1 mg/kg/dose IV of either chlorpromazine (CPZ) or metoclopramide (MC), up to a total of three doses. RESULTS: Ninety-one patients completed the protocol; 44 received MC and 47 received CPZ. The demographics of the two groups were similar. Both drugs provided, for the majority of patients, adequate pain relief as measured on a visual analog scale (VAS) completed every 15 minutes from T = 0 minutes to T = 45 minutes. The average pain relief over 45 minutes (delta VAS) for CPZ was 4.87 cm, vs 4.34 cm for MC (p = 0.35). There also was no statistically significant difference in blood pressure (BP) changes (delta BP < 2 mm Hg for both systolic and diastolic BPs, p = 0.47 and 0.33) or numbers of patients reporting adverse effects (AEs) (CPZ: 16 of 35; MC: 13 of 29, p = 0.43). There was no severe AE with either study drug. CONCLUSIONS: Metoclopramide and chlorpromazine administered IV are both effective in the management of acute migraine headache. They are associated with similar minor side-effect profiles.

Trauma outcome analysis and the development of regional norms.

Early attempts to assess patient outcomes in trauma hospitals included morality reviews and expert panel chart audits. More recently, a statistical methodology combining the Revised Trauma Score and Injury Severity Score has been developed (TRISS). A modification of this methodology--TRISS-like analysis--allows the inclusion of patients who have required endotracheal intubation prior to the time of arrival at the trauma hospital. This study was undertaken to further improve this TRISS-like methodology by developing statistical coefficients based on regional data. It was hypothesized that his would allow the analysis to better identify those hospitals with significantly better worse outcomes than their peers. The Comprehensive Data Set of the Ontario Trauma Registry was accessed, which contains data on severely injured patients from all 11 lead trauma hospitals in the province. Three years' data were obtained, and checked for accuracy and completeness. Analysis was performed using the previously published coefficients. New coefficients were then derived, using regression analysis on the Ontario patient data. 5,258 of 6,389 files were complete and eligible for analysis. TRISS-like analysis resulted in an expected mortality of 21.2% (1115.6/5258) with a z score for the entire province of -14.102. Individual hospital scores were all negative (fewer deaths than expected), and 9/11 hospital scores were < -1.96 (statistically significant). The new coefficients were markedly different from those previously published, and their application resulted in an overall z score of 0.000. Institutional scores ranged from -3.309 to +4.686, with two hospitals < -1.96 and one > +1.96. The old coefficients predicted many more deaths than occurred in all of the hospitals. The new coefficients proved quite accurate overall in predicting outcomes, and identified one institution with significantly more deaths than would have been predicted for other hospitals in the province. Subsequently, a fourth year's data files were obtained, and used as a validation data set. The new coefficients again proved more useful than the original ones.

A study of injury-producing crashes on median divided highways in southwestern Ontario.

The University of Western Ontario Accident Research Team investigates every fatal crash, and approximately one out of every 50 personal-injury crash, within a defined geographic area of three counties. Over a seven-year period, the team investigated 107 collisions (62 fatal and 45 personal injury) that occurred on median-divided highways. These crashes were representative of over 2,300 collisions on the highways involving 81 fatalities and injury to over 3,200 vehicle occupants. Vehicle loss of directional control prior to any impact occurred in 55 of the 62 fatal cases and in 36 of the 45 personal-injury cases. In 36 fatal cases and 17 personal-injury cases loss of control was initiated after a vehicle travelled from the roadway onto the gravel shoulder. Rollover collisions were the most frequent collision type investigated and comprised 25 fatal and 25 personal-injury cases. Unrestrained occupants made up 24 of the 29 rollover fatalities with 96% of these unrestrained occupants being ejected from the vehicle. Collision with an oncoming vehicle after median-crossover occurred in 26 fatal cases. These crashes were usually frontal or side impacts characterized by extensive vehicle damage and massive intrusion into the occupant compartment. Severe head injury (AIS 5 or greater) predominated as the cause of death in all collision types.

An evaluation of a hospital-based drinking and driving prevention program.

For the past four years, Victoria Hospital has provided a drinking and driving prevention program: IMPACT - Impaired Minds Produced by Alcohol Cause Trauma. The program provides information to Grade 11 students about the potential "impact" of alcohol-related trauma on themselves, their family and their future. At the end of the program, students were asked to complete a short evaluative questionnaire; 74.2% completed the questionnaire. Of those responding, 97.5% agreed that the program increased their awareness of drinking and driving, and 79.4% agreed that the program would cause them to change their own behaviour. Determining whether or not increased knowledge and changed attitude in fact results in changed behaviour is beyond the scope of this study. Further longitudinal, quantitative evaluation of program effectiveness, based on traffic safety indices, is being undertaken.

Traumatic fetal deaths.

This study was undertaken to characterize traumatic third trimester fetal deaths in terms of maternal injuries, seat belt use, and clinical course. All traumatic fetal deaths reported to the Chief Coroner's Office in Ontario (population approximately 9 million) over the five year period 1982-1986 (incl) were reviewed. A total of 13 cases were reported. All of these were third trimester deaths, 5 being of 36 weeks gestations or more. In 8 of 13 cases, maternal injuries were either very minor or limited solely to the uterus and placenta. In 4 of these cases, the mother was examined in hospital and discharged having sustained only trivial injuries. In the remaining 5 cases, the mothers sustained serious injuries. The causes of fetal demise were placental abruption, infarction, laceration, or uterine rupture. In 5 of 13 cases, the fetus also suffered significant injuries usually to the head. In only 4 of 13 cases was the mother wearing restraints. Traumatic fetal death is a rare but important consequence of motor vehicle crashes and may occur despite relatively trivial maternal injuries.

Trauma triage criteria system compliance for victims of motor vehicle crashes.

The objective of this study was to determine the proportion of EMS (Emergency Medical Services) Motor Vehicle Collision cases within a large state meeting Trauma Triage Criteria (TTC) who are ultimately cared for in trauma centers (TC). This cross-sectional observational study utilized EMS records linked with hospital discharge records for the year 1997. Using ICDMAP-90 AIS and ISS scores were computed. ICD-9-CM and E-codes were used to define acute trauma cases resulting from motor vehicle collisions. This population-based system evaluation demonstrated effective TTC implementation in urban areas. However, in rural areas, many severely injured patients were transported to non-trauma centers.

Crutch walking.

This article provides nurses with information on crutch walking which is helpful for patient teaching in a variety of settings. Two nursing diagnoses are discussed: knowledge deficit and potential for injury related to crutch walking. Preparatory exercises and measurement of the patient for crutches are explained, as well as types of weight bearing and point and swing gaits for crutch walking. Crutch maneuvers in and out of a chair or bed, and on stairs are also included. A discharge instruction sheet with tips on crutch walking is provided for use with patients.

Perioperative uncertainty and state anxiety of orthopaedic surgical patients.

PURPOSES: The purposes of this study were to determine (a) the relationship between preoperative uncertainty and anxiety of orthopaedic surgical patients in three adult developmental stages (young, middle, older) and (b) the differences in uncertainty and anxiety among the adult developmental stages, gender, and acuity levels of the disorder. DESIGN: Correlational and comparative with descriptive survey. SAMPLE: 106 adult orthopaedic surgical patients. METHODS: Subjects were contacted 1 to 2 weeks preoperatively during their preadmission visit or upon early admission the day of surgery. FINDINGS: All patients responded similarly in terms of having moderate levels of preoperative uncertainty and anxiety. There were no statistically significant differences among developmental stages, gender, or acuity levels for these orthopaedic patients. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to be aware that adult orthopaedic patients such as these subjects may have moderate levels of uncertainty and anxiety prior to surgery. In addition to physical preparation for surgery, nurses need to help patients with their emotional concerns. The incorporation of preoperative psychoeducational interventions and improved communication into plans of care for all orthopaedic surgical patients is recommended.

Nurse-client perceptions: the double standard of touch.

Because nurses have been cited as being unaware of clients' nonverbal communication as well as their own (Blondis, 1977; Murphy, 1984), the purpose of this descriptive study was to determine if 80 adult surgical clients' and 80 female registered nurses' perceptions about intrusions of hospital territory and personal space differed. Differences according to gender of client were specifically examined. The investigator administered the Territorial Intrusion-Personal Space (TIPS) Scale questionnaire to measure various feelings in response to intrusions. T-tests revealed that male clients generally had higher scores on the personal space subscale than nurses anticipated, whereas female clients had lower scores than nurses anticipated. These results revealed a double standard of touch: Male clients interpreted touch from a female nurse more positively than did female clients; however, female nurses interpreted female clients' behavior as being more receptive to touch and therefore appeared to be more comfortable touching female than male clients.

New Prescriptions for Migraine in the Emergency Department: Treating a common affliction and presenting symptom.

Migraine headache is a common affliction and presenting symptom in the emergency department. Its diagnosis is entirely clinical, and the treating physician should ensure precise diagnosis before commencing therapy. General non-pharmacological measures and oral medications are usually effective in relieving the symptoms. Occasionally, patients with fixed migraines require parenteral therapy. Some medications used for migraine are antiemetic agents, ergot preparations, narcotic agents, phenothiazines (particularly chlorpromazine), and newer selective serotonin agonists.

Metaanalysis in clinical chemistry: validation of cardiac troponin T as a marker for ischemic heart diseases.

Metaanalysis is a method that incorporates the pooling of previously published results to produce more statistically significant results. We used metaanalysis to examine the role of a new cardiac marker, cardiac troponin T (cTnT), in patients with ischemic heart disease. Metaanalysis of six articles and one abstract on cTnT showed that this marker was just as sensitive as creatine kinase MB isoenzyme (CK-MB) for the retrospective diagnosis of acute myocardial infarction (AMI) 12-48 h after onset but less specific. Most of these articles showed that cTnT was increased in non-AMI patients with unstable angina pectoris. In a metaanalysis of four papers, two abstracts, a letter, and an unpublished manuscript, we examined the prognostic role of cTnT in non-AMI cardiac patients. For an unfavorable endpoint defined as cardiac death, AMI, or the need for coronary artery revascularization, the results demonstrated that abnormal concentrations of cTnT were associated with a higher risk for a poor outcome than were normal concentrations of cTnT. We also compared cTnT with CK-MB for risk stratification. Metaanalysis will become an increasingly important tool for evaluating new tests as they become available.

The lived experiences of homeless men.

To investigate the phenomenon of social disaffiliation in homeless men, a qualitative study was conducted that used a framework of Bahr's (1973) social disaffiliation theory. Ten homeless men were interviewed to determine their reasons for becoming homeless, their feelings about being homeless, and the specific resources they used for maintaining life on the streets. Using a semistructured interview, audiotapes were made of the responses of the 10 men, 20 to 61 years old, who were using a shelter for the homeless in a U.S. southern city. For data analysis, Giorgi's phenomenological approach (cited in Omery, 1983) was used. Activities and resources that the men used to meet their social, economic, and other needs were described. The following three major themes were identified: rejection, uncertainty, and social isolation. Recommendations include changing nursing curricula and conducting staff development programs, testing interventions to alleviate social isolation, and assisting the homeless to return to the societal mainstream.

Massive blood transfusion causing hypomagnesemia.

A case report and short retrospective study are presented which describe the clinical occurrence of hypomagnesemia in the setting of massive blood transfusion. Hypomagnesemia is an important electrolyte imbalance and in the massively transfused patient is most likely secondary to citrate toxicity.

An evaluation of patient outcomes before and after trauma center designation using Trauma and Injury Severity Score analysis.

In June 1990, the Ministry of Health designated 11 hospitals throughout Ontario to be lead hospitals in trauma care. An integral part of a trauma system is the evaluation of care, in particular, outcome of the trauma patients. The Trauma and Injury Severity Score (TRISS) methodology, which offers a standard approach for evaluating outcomes for different populations of trauma patients, was used to determine if there was an improvement in outcomes after the designation of trauma centers of patients involved in motor vehicle crashes (ICD-9-CM, E810.0-825.9), with an Injury Severity Score > 12 for two 12-month periods: one predesignation (1989/1990) and one postdesignation (1992/1993). The Revised Trauma Score, Injury Severity Score, age, and outcome were calculated or abstracted from the hospital chart of each patient at the trauma center. The probability of survival of each patient, the z- and W-statistics of both years were calculated. A measurable improvement was shown in z-statistics between the 2 years from z = -0.40 predesignation to z = +0.72 postdesignation. When the bias introduced by patients intubated before arrival at the trauma center being excluded from TRISS analysis was removed, using a TRISS-like (as per Offner et al: J. Trauma 32:32, 1992) logistic regression equation that allows analysis of intubated patients, the improvement was even greater, with z = +1.34 predesignation and z = +2.97 postdesignation. Only the statistically significant z-score of the postdesignated year required the W-score to be calculated, W = +5.60.(ABSTRACT TRUNCATED AT 250 WORDS)

Etiology of shock in blunt trauma.

Patients who have suffered blunt trauma and present in shock of uncertain cause represent a problem frequently encountered by emergency physicians. A retrospective review of the charts of 879 patients who had suffered blunt trauma and presented to a regional trauma unit over a 44-month period revealed that 154 of the patients had presented to either a hospital or the trauma unit in shock. The most common causes of shock when a single source of hemorrhage was identified were, in order of decreasing frequency, intraperitoneal hemorrhage, pelvic or other musculoskeletal fractures, thoracic hemorrhage, severe head injury and spinal cord injury. Severe head injuries accounted for only 8% of the single-source cases and contributed to shock in only seven of the remaining cases.

Comparative efficacy of chlorpromazine and meperidine with dimenhydrinate in migraine headache.

Approximately 20% of the population suffers from migraine headache, and a significant number develop "fixed" migraines, refractory to oral medications. Of this group, many become habitual narcotic users. A previously published case series using IV chlorpromazine suggested efficacy, so a randomized, double-blind, controlled trial was conducted. The study compared IV chlorpromazine against IV meperidine with dimenhydrinate. Entry criteria were emergency department patients from 18 to 60 years of age with a clinical diagnosis of common or classic migraine headache. After informed consent was obtained, an IV line with normal saline was established, and a bolus of 5 mL/kg was administered. Patients were randomized into two groups: chlorpromazine and meperidine with dimenhydrinate. The chlorpromazine group received a bolus injection of 5 mL normal saline placebo followed by 0.4 mL/kg chlorpromazine solution (0.1 mg/kg). The chlorpromazine was repeated every 15 minutes as needed up to a total of three doses. The meperidine with dimenhydrinate group received 5 mL dimenhydrinate solution (25 mg) followed by 0.04 mL/kg meperidine (0.4 mg/kg). Again, the meperidine solution was repeated in the same dosage every 15 minutes as needed up to a total of three doses. If response was inadequate 15 minutes after the third dose, the sequence was broken, and the other medication given. Blood pressure and response were assessed at 15-minute intervals for one hour. Pain was assessed by both visual and verbal analogue scales every 15 minutes. In all, 46 patients were entered in the study (24 chlorpromazine and 22 meperidine with dimenhydrinate).(ABSTRACT TRUNCATED AT 250 WORDS)

Pedestrians in real world collisions.

The University of Western Ontario Accident Research Team investigated motor vehicle collisions resulting in a personal injury (PI) or fatality (F). Injury and collision data were analyzed for 198 injury-producing passenger car or light truck/van collisions with pedestrians (96 F; 102 PI). The majority of the fatal collisions occurred on roadways, often when pedestrians were crossing or walking along the travel lanes. In contrast, the majority of the personal injury cases occurred at intersections. Elderly pedestrians were found to be over-represented in the fatal cases in comparison with the personal injury cases. Fatal pedestrian collisions at night were found to be over-represented in comparison with the representative PI cases. In more than 90% of the fatal cases pedestrians were struck by the front of the vehicles and they had either wrapped around the front end onto the hood or projected forward and struck the ground. The wrap trajectory was more frequent in the passenger car collisions, and the forward projection was more frequent in the light truck/van collisions. If there was vehicle damage resulting from the impact it almost always meant serious injury or fatality. Body contacts causing injury were typically to the hood or hood edge, roof rail, A-pillar, windshield, bumper, and ground. The head was the body region most often seriously injured, with more than 80% of all fatally injured pedestrians suffering a head injury of AIS score 2 or greater. In the PI cases, the injured pedestrians most frequently sustained integumentary injuries of AIS score 1 with injuries to the lower extremities or head typically being AIS score 2 or greater.

An evaluation of Ontario trauma outcomes and the development of regional norms for Trauma and Injury Severity Score (TRISS) analysis.

Outcomes analysis of patient care programs has become increasingly necessary for a variety of reasons in recent years. This has been particularly true for trauma programs. The Trauma and Injury Severity Score (TRISS) methodology was developed for this purpose in the context of the Major Trauma Outcome Study (MTOS). It provides an estimate of the probability of survival for individual patients, based on anatomic, physiologic, and etiologic factors. In addition, it allows hospitals and groups of hospitals to compare survival rates with other hospitals submitting data to the data base. However, the published coefficients for TRISS analysis have been derived from the MTOS data base. Patterns of practice, time to treatment, and other variables may be significantly different in other jurisdictions. To compare outcomes among similar hospitals within the province of Ontario, Canada, a regression analysis was performed to develop TRISS coefficients specific to the province. Data were obtained from the 12 trauma centers in the province treating the most severely injured patients (Injury Severity Score > 12). A total of 3,880 cases were eligible for TRISS analysis, over a 3-year period. Of these, 3,672 were patients with blunt trauma, and 208 were victims of penetrating injury. Standard TRISS analysis of the patients with blunt trauma revealed z scores ranging from -10.260 to +1.849, with a mean of -6.648. Four centers had negative z scores that were significant (an absolute value of > 1.96 is considered statistically significant). Using Ontario TRISS coefficients, z scores ranged from -4.125 to +2.782, with a mean of 0.000. Four scores were significant with the Ontario coefficients, only one of which had been significant using the MTOS norms. The other three z scores were all positive, indicating more deaths than would have been predicted, but they were not significant when compared to the MTOS norms. The mean was also, of course, no longer significant. The area under the receiver operating characteristic curve analysis was strongly positive, and the Hosmer-Lemeshow Goodness-of-Fit analysis indicated good calibration. The new coefficients were subsequently validated by applying them to a subsequent year's data from patient records that did not form part of the original data set. This resulted in slightly improved z scores overall, and in most of the hospitals. This use of regional norms allows comparison with outcomes of patients cared for in hospitals within the same jurisdiction that are more similar to one another than to those in the MTOS, and helps to identify unexpected outcomes and outliers.

Intracranial pressure monitoring and outcomes after traumatic brain injury.

OBJECTIVE: Uncontrolled intracranial hypertension after traumatic brain injury (TBI) contributes significantly to the death rate and to poor functional outcome. There is no evidence that intracranial pressure (ICP) monitoring alters the outcome of TBI. The objective of this study was to test the hypothesis that insertion of ICP monitors in patients who have TBI is not associated with a decrease in the death rate. DESIGN: Study of case records. METHODS: The data files from the Ontario Trauma Registry from 1989 to 1995 were examined. Included were all cases with an Injury Severity Score (ISS) greater than 12 from the 14 trauma centres in Ontario. Cases identifying a Maximum Abbreviated Injury Scale score in the head region (MAIS head) greater than 3 were selected for further analysis. Logistic regression analyses were conducted to investigate the relationship between ICP and death. RESULTS: Of 9001 registered cases of TBI, an MAIS head greater than 3 was recorded in 5507. Of these patients, 541 (66.8% male, mean age 34.1 years) had an ICP monitor inserted. Their average ISS was 33.4 and 71.7% survived. There was wide variation among the institutions in the rate of insertion of ICP monitors in these patients (ranging from 0.4% to over 20%). Univariate logistic regression indicated that increased MAIS head, ISS, penetrating trauma and the insertion of an ICP monitor were each associated with an increased death rate. However, multivariate analyses controlling for MAIS head, ISS and injury mechanism indicated that ICP monitoring was associated with significantly improved survival (p < 0.015). CONCLUSIONS: ICP monitor insertion rates vary widely in Ontario's trauma hospitals. The insertion of an ICP monitor is associated with a statistically significant decrease in death rate among patients with severe TBI. This finding strongly supports the need for a prospective randomized trial of management protocols, including ICP monitoring, in patients with severe TBI.