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Job embeddedness considers job satisfaction while incorporating the concepts of environment and community. This exploratory, mixed methods study used the Job Embeddedness Instrument to examine factors that influence retention of acute care nurses. Qualitative methods informed the survey results. Increasing age, ties to community, and peer relationships were found to be most indicative of job embeddedness. Nursing professional development practitioners can impact retention by focusing on factors that encourage nurses to stay in their positions. [ABSTRACT FROM AUTHOR]

Background: Motor vehicle collisions (MVCs) are the leading cause of spine and spinal cord injuries in the United States. Traumatic cervical spine injuries (CSIs) result in significant morbidity and mortality. This study was designed to evaluate both the epidemiologic and biomechanical risk factors associated with CSI in MVCs by using a population-based database and to describe occupant and crashes characteristics for a subset of severe crashes in which a CSI was sustained as represented by the Crash Injury Research Engineering Network (CIREN) database., Methods: Prospectively collected CIREN data from the eight centers were used to identify all case occupants between 1996 and November 2009. Case occupants older than 14 years and case vehicles of the four most common vehicle types were included. The National Automotive Sampling System's Crashworthiness Data System, a probability sample of all police-reported MVCs in the United States, was queried using the same inclusion criteria between 1997 and 2008. Cervical spinal cord and spinal column injuries were identified using Abbreviated Injury Scale (AIS) score codes. Data were abstracted on all case occupants, biomechanical crash characteristics, and injuries sustained. Univariate analysis was performed using a χ analysis. Logistic regression was used to identify significant risk factors in a multivariate analysis to control for confounding associations., Results: CSIs were identified in 11.5% of CIREN case occupants. Case occupants aged 65 years or older and those occupants involved in rollover crashes were more likely to sustain a CSI. In univariate analysis of the subset of severe crashes represented by CIREN, the use of airbag and seat belt together (reference) were more protective than seat belt alone (odds ratio [OR]=1.73, 95% confidence interval [CI]=1.32-2.27) or the use of neither restraint system (OR=1.45, 95% CI=1.02-2.07). The most frequent injury sources in CIREN crashes were roof and its components (24.8%) and noncontact sources (15.5%). In multivariate analysis, age, rollover impact, and airbag-only restraint systems were associated with an increased odds of CSI. Using the population-based National Automotive Sampling System's Crashworthiness Data System data, 0.35% of occupants sustained a CSI. In univariate analysis, older age was noted to be a significant risk factor for CSI. Airbag-only restraint systems and both rollover and lateral crashes were also identified as risk factors for CSI. In addition, increasing delta v was highly associated with CSIs. In multivariate analysis, similar risk factors were noted. Of all the restraint systems, seat belt use without airbag deployment was found to be the most protective restraint system (OR=0.29, 95% CI=0.16-0.50), whereas airbag-only restraint was associated with the highest risk of CSI (OR=3.54, 95% CI=2.29-5.46)., Conclusions: Despite advances in automotive safety, CSIs sustained in MVC continue to occur too often. Older case occupants are at an increased risk of CSI. Rollover crashes and severe crashes led to a much higher risk of CSI than other types and severity of MVCs. Seat belt use is very effective in preventing CSI, whereas airbag deployment may increase the risk of occupants sustaining a CSI. More protection for older occupants is needed and protection in both rollover and lateral crashes should remain a focus of the automotive industry. The design of airbag restraint systems should be evaluated so that they are not causative of serious injury. In addition, engineers should continue to focus on improving automotive design to minimize the risk of spinal injury to occupants in high severity crashes.

Background: : To study whether trauma center patients with positive toxicology findings for cocaine-positive (COC+) are at a higher risk for suicide, homicide, and unintentional injury death after discharge than cocaine-negative (COC+) trauma patients., Methods: : Patients admitted between July 1983 and June 1995 and discharged alive from a level I trauma center were prospectively followed up for 1.5 years to 14.5 years. The occurrence of suicide, homicide, and unintentional injury death was explored in relation to COC+ status at admission using Cox proportional hazards methodology. Models included possible confounders. Interactions with each of the main effects were explored., Results: : Of the 27,399 admissions, 21,500 had urine COC toxicology testing performed and were included in the study. COC was positive in 11.4% of the studied population. COC+ patients were significantly younger, with 72% of COC+ versus 43% of COC- in the 25 to 44 years age group. COC+ patients were more likely to be men, positive for alcohol, and intentional injury victims. COC+ status was not associated with subsequent suicide. Furthermore, the COC+ status association with subsequent homicide became nonsignificant after adjusting for confounders. Unadjusted COC+ status was associated with unintentional injury death (odds ratio = 1.65 [1.14-2.40]). Interactions were found in the association with unintentional injury death such that COC+ status tripled the odds of injury death (odds ratio = 2.75 [1.58-4.78]) among the alcohol-negative patients within the 25 to 45 years age group., Conclusion: : COC+ trauma patients are at an increased risk of subsequent unintentional injury death after discharge from a trauma center. Suicide and homicide occurrence seems to be unaffected.

Objectives: Pulmonary contusions (PCs) are a common injury sustained in motor vehicle collisions. The crash and occupant characteristics of PC in motor vehicle collisions are currently unknown. Additionally, the clinical significance and the impact on mortality have not been determined., Methods: A retrospective review of the Crash Injury Research and Engineering Network database with inclusion criteria of frontal (F) and near-side lateral (L) crashes involving occupants older than 15 years, yielded 2,184 case occupants. Pearson's chi and multivariate logistic regression were used with a p < 0.05 conferring statistical significance., Results: Median age was 38 years, 80% were drivers and mortality was 16%. Forty-nine percent of case occupants were not wearing lap-shoulder belts. Chest trauma was sustained by 1,131 (52%), of whom 379 had PC. Crash characteristics included: 38 kph median change in velocity (delta V), 72% frontal deformation, and 35% struck a fixed object. Injury characteristics included median Injury Severity Score 17 with the following Abbreviated Injury Score (AIS) >2 injuries: thoracic 40%, abdominal 19%, and head 24%. Univariate predictors of PC included: age <25, male, higher Injury Severity Score, fatality, delta V >45 kph, L impacts, and collision with fixed object. PC was significantly associated with occupant compartment intrusion in F but not L crashes. In multivariate analysis, significant predictors of PC included: age <25 (odds ratios [OR] = 1.5), delta V >45 kph (OR = 1.9), and fixed object (frontal crash only) (OR = 1.8). Controlling for head, spine, abdominal, and extremity injuries AIS >2, PC was not a statistically significant risk factor for mortality. This was consistent whether or not another AIS >2 thoracic injury was present. The effectiveness of side-impact airbags was not evaluated due to the small sample size., Conclusions: Crash severity as demonstrated by higher delta V was strongly associated with PC in all crashes. Frontal crashes with a fixed object or intrusion are more likely to result in a PC. The risk of PC is greatly increased in near-side lateral impacts regardless of intrusion or object struck; suggesting occupant proximity may be the most important factor. Further investigations of the efficacy of side airbags as a counter measure should be considered and continued public education of the efficacy of lap-shoulder restrains should continue. Unexpectedly, although a marker for crash severity, PC is not an independent marker of mortality.

Background: The Occluded Artery Trial-Electrophysiological Mechanisms (OAT-EP) tested the hypothesis that opening a persistently occluded infarct-related artery by percutaneous coronary intervention and stenting (PCI) after the acute phase of myocardial infarction compared with optimal medical therapy alone reduces markers of vulnerability to ventricular arrhythmias., Methods and Results: Between April 2003 and December 2005, 300 patients with an occluded native infarct-related artery 3 to 28 days (median, 12 days) after myocardial infarction were randomized to PCI or optimal medical therapy. Ten-minute digital Holter recordings were obtained before randomization, at 30 days, and at 1 year. The primary end point was the change in alpha1, a nonlinear heart rate variability parameter, between baseline and 1 year. Major secondary end points were the changes in the filtered QRS duration on the signal-averaged ECG and variability in T-wave morphology (T-wave variability) between baseline and 1 year. There were no significant differences in the changes in alpha1 (-0.04; 95% CI, -0.12 to 0.04), filtered QRS (2.2 ms; 95% CI, -1.4 to 5.9 ms), or T-wave variability (3.0 microV; 95% CI, -4.8 to 10.7 microV) between the PCI and medical therapy groups (medical therapy change minus PCI change). Multivariable analysis revealed that the results were unchanged after adjustment for baseline clinical variables and medication treatments during the Holter recordings., Conclusions: PCI with stenting of a persistently occluded infarct-related artery during the subacute phase after myocardial infarction compared with medical therapy alone had no significant effect on changes in heart rate variability, the time-domain signal-averaged ECG, or T-wave variability during the first year after myocardial infarction. These findings are consistent with the lack of clinical benefit, including no reduction in sudden death, with PCI for stable patients with persistently occluded infarct-related arteries after myocardial infarction in the main OAT.

Purpose: The purpose of this analysis was to determine which of the initial symptoms after mild traumatic brain injury (MTBI) can best predict the development of persistent postconcussive syndrome (PCS)., Methods: One hundred eighty MTBI patients admitted to a level I trauma center were enrolled in a prospective study and 110 followed for 3 months. MTBI was defined as a Glasgow Coma Score of 13 to 15 with a transient loss of consciousness or report of being dazed or confused. PCS was defined as the persistence of four or more symptoms long term. Patients were screened at admission and at 3 days to 10 days and 3 months. Symptom checklists were administered to ascertain the presence of symptoms (cognitive, emotional, and physical) after concussion. For a subset of patients that were physically able, balance tests were also conducted. Stepwise logistic regression was used to identify which symptoms best predicted PCS., Results: The mean age of the subjects was 35 years, and 65% were men. Physical symptoms were the most prevalent in the 3 days to 10 days postinjury with most declining thereafter to baseline levels. Emotional and cognitive symptoms were less prevalent but more likely to remain elevated at 3 months; 41.8% of subjects reported PCS at 3 months. The strongest individual symptoms that predicted long-term PCS included anxiety, noise sensitivity (NS), and trouble thinking; reported by 49%, 27%, and 31% of the subjects at 3 days to 10 days, respectively. In multivariate regressions including age, gender, and early symptoms, only anxiety, NS and gender remained significant in the prediction of PCS. Interactions revealed that the effect of anxiety was seen primarily among women. NS had an odds ratio of 3.1 for PCS at 3 months., Conclusions: After MTBI, anxiety among women and NS are important predictors of PCS. Other physical symptoms, while more prevalent are poor predictors of PCS.

Objective: To compare injury patterns and outcomes of near- and far-side collisions., Methods: Near- and far-side occupants in the Crash Injury Research and Engineering Network (CIREN) were compared for mortality and the occurrence of severe injuries (maximum abbreviated injury scale [MAIS] 3+). Regression models, adjusting for confounders, examined death and MAIS 3+ injuries as outcomes and near- or far-side position as an independent variable. CIREN findings were compared with those of the Crash Outcome Data Evaluation System (CODES), and the Maryland Automated Accident Reporting System., Results: Of the 380 cases, 72% were in the near and 28% in the far position. Mortality was similar between groups within CIREN. Near-side occupants experienced a higher frequency of MAIS 3+ injuries for the thorax, abdomen, and lower extremities, and fewer MAIS 3+ head injuries than far-side occupants (35% vs. 46%, p = 0.06). Regression models revealed similar risk of MAIS 3+ head injuries among near- and far-side occupants. The most common structures contacting the head in far-side crashes (N = 62) were opposite side structures (52%) and other occupants (13%). Similar risks of head injuries among near- and far-side occupants were observed for the CODES data; however, lower risks of death were present among far-side drivers involved in crashes, based on CODES and Maryland Automated Accident Reporting System., Conclusions: Despite a lower incidence of thoracic, abdominal, and lower extremity injuries, far-side occupants experienced a similar risk of head injuries to that of near-side occupants. Contact patterns suggest that restraint systems fail to keep far-side occupants' heads from striking opposite side structures or other occupants.

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., Results: The annual proportion of directly admitted patients of age 65 or older increased by 44% from 1996 to 2000. Blood alcohol concentration (BAC) was measured for 66% of older patients; 9% were alcohol positive, and 81% had BAC > or = 80 mg/dL. Mean BAC was 165 mg/dL for all alcohol-positive patients. The highest mean BAC was noted in patients with fall-related injuries, followed by pedestrians struck, then by those in a motor vehicle crash. The most common cause of injury was motor vehicle crash (47%). Among all injury causes, patients with fall-related injuries had the greatest proportional increase from 28% in 1996 to 44% in 2000. Alcohol positive status was most frequent (13%) and mean BAC was highest among patients admitted because of fall-related injuries., Conclusion: Identifying and addressing alcohol use problems remains an important injury prevention measure for the older trauma population.

Objective: To measure the combined contribution of change in velocity (Deltav), principal direction of force (PDOF), and restraint use on mortality after vehicular trauma., Methods: The Crash Injury Research and Engineering Network population includes patients <8 years old with one injury with an Abbreviated Injury Scale score >or=3 or with two injuries with an Abbreviated Injury Scale score >or=2, who were occupants of a vehicle. Patients 15 years or younger; in rear collisions; back seat occupants; in crashes with Deltav >80 km/h, unknown Deltav, or unknown PDOF; or in vehicles without airbags were excluded. Mortality was analyzed in relation to Deltav (km/h), restraint use, and PDOF using chi2. Multiple logistic regression models were built, including possible confounders (body mass index, age, gender) and interactions were explored. An [alpha] = 0.05 was used for all statistics., Results: A total of 1,261 cases were included. Mortality was higher for unrestrained than for restrained patients (17% vs. 9%) and was higher for lateral than for frontal impact patients (17% vs. 11%). Higher mortality rates were also observed for Deltav 40-80 km/h than for Deltav <40 km/h (17% vs. 9%). Multiple logistic regression findings, after adjusting for age, gender, and body mass index, revealed significant effects of lateral PDOF (odds ratio [OR] 3.06 [2.03-4.61]), unrestrained status (OR 2.95 [2.01-4.38]), and Deltav 40-80 km/h (OR 3.65 [2.44-5.44]). Effect modification was found between PDOF and Deltav., Conclusions: A Deltav 40 km/h to 80 km/h, lack of restraint use, and lateral impact significantly affects mortality. A synergistic effect was found between Deltav 40-80 km/h and lateral PDOF.

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. Trauma patients defined as at-risk alcohol users (n=497) were randomized into two treatment options: a brief personalized motivational intervention (PMI), or brief information and advice (BIA). After a brief assessment, PMI subjects received a motivational session, feedback letter, and two postdischarge telephone contacts, whereas the BIA group received a brochure and one postdischarge telephone contact. Both groups were reassessed at 6 and 12 months postinjury., Results: Both the PMI and BIA groups had statistically significant reductions in drinking, binge episodes, and consequences related to drinking that persisted from the 6- to the 12-month follow-up. However, although not statistically significant, for those classified as lower-level drinkers (

Background: Suicide risk after discharge among trauma patients could be influenced by multiple factors. The aim of this study is to establish whether patients discharged from a trauma center experience an increased suicide rate and whether this can be explained by defined demographic, injury, or alcohol abuse risk factors., Methods: Patients admitted between July 1, 1983, and June 30, 1995, and discharged alive from a Level I trauma center (n = 27,399) were followed for 1.5 to 14.5 years to determine whether they had died. Death determination was made by an epidemiologic support service, which had created a repository of death certificates. Variables used in the analyses included age, gender, race, Injury Severity Score, discharge disposition, mechanism of injury, and alcohol toxicology. General and trauma populations were compared using standard mortality rates. Risk factors for suicide within the trauma population were explored using Pearson's chi2, Mantel-Haenszel chi2, Cox proportional hazards, and Mantel-Cox log-rank methodology., Results: Suicide was more common in the trauma than in the general population (standard mortality rate = 1.71). This difference may be attributed primarily to alcohol use problems. Suicide risk in the trauma population increased with age from 25 to 44 years, male gender, Caucasian race, and positive alcohol toxicology. Disability (as measured by discharge disposition), but not injury severity, also seemed to have an influence on suicide rates., Conclusion: Interventions that address modifiable risk factors for suicide (substance abuse, psychiatric disorders, hopelessness, and social isolation) could benefit trauma patients known to be at higher risk for suicide, particularly those abusing alcohol.

Background: Despite advances in automotive safety, pelvic fractures caused by motor vehicle collisions remain a significant cause of mortality, morbidity, and functional disability. This study was designed to evaluate epidemiologic and biomechanic risk factors associated with pelvic fractures resulting from motor vehicle collisions. We utilized the Crash Injury Research Engineering Network (CIREN) database to identify these risk factors in newer vehicles., Methods: Data were prospectively collected at the ten CIREN centers from 1996 to 2005. Specific data were then abstracted on all patients, biomechanic crash characteristics, and injuries sustained. Patients involved in a frontal or near-side lateral impact with pelvic fractures were compared with those without. Univariate analysis was performed using a chi2 analysis. Logistic regression was used to identify significant risk factors in a multivariate analysis to control for confounding associations., Results: Of the 1,851 patients studied, 511 (27.6%) had a pelvic fracture. The overall mortality was 17%. Injury specific factors associated with pelvic fracture were higher Injury Severity Score (ISS) and fatality of the patient. Biomechanic factors associated with the risk of pelvic fracture included; no airbag deployment (p < 0.001), smaller vehicle (p = 0.05), and lateral deformation location (p < 0.001). When stratified by vehicle deformation location, logistic regression models revealed statically significant variables in a frontal impact which included; higher body mass index, higher ISS, large patient vehicle, no seatbelt use, and higher deltaV. For near-side lateral impacts, multivariate analysis revealed statistically significant variables of lower body mass index, higher ISS, female sex, small vehicle size, and higher deltaV., Conclusions: Even in newer vehicles with federally mandated safety features, pelvic fractures remain a common injury. Pelvic fractures may serve as a marker of crash severity and specific crash characteristics are associated with pelvic fractures. Lateral crashes are significantly more likely to result in a pelvic fracture and, therefore, prevention of pelvic fractures should focus on improving occupant safety in near-side lateral impacts. Recognition of other associations should lead researchers to further investigate causative factors that will ultimately result in improved vehicle design.

Background: Lower extremity injuries (LEIs) sustained in vehicular crashes result in physical problems and unexpected psychosocial consequences. Their significance is diminished by low Abbreviated Injury Scale scores., Methods: Drivers who sustained LEIs were identified as part of the Crash Injury Research and Engineering Network (CIREN) and interviewed during hospitalization, at 6 months, and at 1 year. All were occupants of newer vehicles with seatbelts and airbags., Results: Sixty-five patients were followed for 1 year. Injuries included mild brain injury (43%), ankle/foot fractures (55%), and bilateral injuries (37%). One year post-injury, 46% reported limitations in walking and 22% with ankle/foot fractures were unable to return to work. Depression (39%), cognitive problems (32%), and post-traumatic stress disorder (18%) were significant in the mild brain injury group., Conclusions: Long-lasting physical and psychological burdens may impede recovery and alter the lifestyle of patients with LEI. These issues need to be addressed by trauma center personnel.