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Objective: To determine the relationship between emergent intubation (emergency department and field intubation cases combined) and mortality in patients with traumatic brain injury (TBI) while controlling for injury severity.Methods: Retrospective observational study of 981 (35.2% intubated, 64.8% not intubated) patients with TBI evaluating the association between intubation status and mortality. Logistic regression was used to analyze the data. Injury severity measures included Head/Neck Abbreviated Injury Scale (H-AIS), systolic blood pressure, type of head injury (blunt vs. penetrating), and a propensity score combining the effects of several other potential confounding variables. Age was also included in the model.Results: The simple association of emergent endotracheal intubation with death had an odds ratio (OR) of 14.3 (95% CI = 9.4 – 21.9). The logistic regression model including relevant covariates and a propensity score that adjusted for injury severity and age yielded an OR of 5.9 (95% CI = 3.2 – 10.9).Conclusions: This study indicates that emergent intubation is associated with increased risk of death after controlling for a number of injury severity indicators. We discuss the need for optimal paramedic training, and an understanding of the factors that guide patient selection and the decision to intubate in the field. [WestJEM.2008;9:184-189]

Background: Youth violence and related aggressive behaviors have become serious public health issues with physical, economic, social, and psychological impacts and consequences. This study identified and evaluated the characteristics of successful school-based violence prevention programs. Methods: Twenty-six randomized controlled trial (RCT), school-based studies that were designed to reduce externalizing, aggressive, and violent behavior between the 1st and 11th grades were analyzed for assessing the effects of 5 program characteristics by comparing results of intervention groups to control groups (no intervention) after intervention using a meta-analysis. Electronic databases and bibliographies were systematically searched, and a standardized mean difference was used for analysis. Results: There was no significant difference between interventions, although programs that used non-theory-based interventions, focused on at-risk and older children, and employed intervention specialists had slightly stronger effects in reducing aggression and violence. Interventions using a single approach had a mild positive effect on decreasing aggressive and violent behavior (effect size =-0.15, 95% CI =-0.29 to -0.02, p = 0.03). Conclusions: Unlike previous individual study findings, this meta-analysis did not find any differential effects for 4 of the 5 program characteristics. In addition, the significant effect noted was contrary to expectation, exemplifying the complexity of identifying effective program strategies. This study adds to the current literature by assessing the program characteristics of RCT studies in an effort to determine what factors may affect school-based violence prevention program success. (Contains 1 table and 1 figure.)

Objective: To determine the relationship between emergent intubation (emergency department and field intubation cases combined) and mortality in patients with traumatic brain injury (TBI) while controlling for injury severity.Methods: Retrospective observational study of 981 (35.2% intubated, 64.8% not intubated) patients with TBI evaluating the association between intubation status and mortality. Logistic regression was used to analyze the data. Injury severity measures included Head/Neck Abbreviated Injury Scale (H-AIS), systolic blood pressure, type of head injury (blunt vs. penetrating), and a propensity score combining the effects of several other potential confounding variables. Age was also included in the model.Results: The simple association of emergent endotracheal intubation with death had an odds ratio (OR) of 14.3 (95% CI = 9.4 – 21.9). The logistic regression model including relevant covariates and a propensity score that adjusted for injury severity and age yielded an OR of 5.9 (95% CI = 3.2 – 10.9).Conclusions: This study indicates that emergent intubation is associated with increased risk of death after controlling for a number of injury severity indicators. We discuss the need for optimal paramedic training, and an understanding of the factors that guide patient selection and the decision to intubate in the field. [WestJEM.2008;9:184-189]

BACKGROUND: Youth violence and related aggressive behaviors have become serious public health issues with physical, economic, social, and psychological impacts and consequences. This study identified and evaluated the characteristics of successful school-based violence prevention programs. METHODS: Twenty-six randomized controlled trial (RCT), school-based studies that were designed to reduce externalizing, aggressive, and violent behavior between the 1st and 11th grades were analyzed for assessing the effects of 5 program characteristics by comparing results of intervention groups to control groups (no intervention) after intervention using a meta-analysis. Electronic databases and bibliographies were systematically searched, and a standardized mean difference was used for analysis. RESULTS: There was no significant difference between interventions, although programs that used non--theory-based interventions, focused on at-risk and older children, and employed intervention specialists had slightly stronger effects in reducing aggression and violence. Interventions using a single approach had a mild positive effect on decreasing aggressive and violent behavior (effect size = -0.15, 95% CI = -0.29 to -0.02, p = .03). CONCLUSIONS: Unlike previous individual study findings, this meta-analysis did not find any differential effects for 4 of-the 5 program characteristics. In addition, the significant effect noted was contrary to expectation, exemplifying the complexity of identifying effective program strategies. This study adds to the current literature by assessing the program characteristics of- RCT studies in an effort to determine what factors may affect school-based violence prevention program success. Keywords: school-based violence prevention program; meta-analysis; randomized controlled trials (RCTs)., Youth violence and related aggressive behaviors have become serious public health issues with physical, economic, social, and psychological impacts and consequences. (1) According to the results from the 2005 national [...]

This study evaluated the relationship of general and diabetes-specific conflict with diabetes self-care in adolescents with Type 1 diabetes within the context of family structure and parental employment. The study [...]

Background. Currently, there is no instrument that provides an accurate and simple method of monitoring pressure ulcer healing in clinical practice. This article reports the two studies that were conducted to assess the validity of the Pressure Ulcer Scale for Healing (PUSH) as a tool to monitor healing of stage II-IV pressure ulcers. Methods. Subjects in both studies (N = 103 and N = 269) were elderly (mean Study 1, 75 years, mean Study 2, 80 years), and the majority were women (Study 1, 51%, Study 2, 70%). Study data were extracted from patients' permanent records. Results. Principal components analysis confirmed that the PUSH tool accounted for 58% to 74% of the wound healing variance over a 10-week period in Study 1 and 40% to 57% of the wound healing variance over a 12-week period in Study 2. In addition, multiple regression analysis, used to measure the sensitivity of the model to total healing, showed PUSH accounted for 39% of the variance in 6 weeks and 31% of the variance over 12 weeks (p < .001; Studies 1 and 2, respectively). Conclusions. Data from these two studies confirmed that the PUSH tool, with the components of length times width, exudate amount, and tissue type, is a valid and sensitive measure of pressure ulcer healing. It is a practical approach that provides clinically valid data regarding pressure ulcer healing. Further testing is needed to confirm these findings.

Objective To document catch-up growth in children in the first 18 months after gastrostomy surgery and characterize how weight and length growth differ according to medical and nutritional risks. Design Repeated measures study to evaluate weight and linear growth in gastrostomy-fed children. Subjects/setting Seventy-five subjects met the selection criteria: gastrostomy placement anytime from birth to age 6.5 years, diagnosis of failure to thrive before gastrostomy surgery, absence of nonmedical barriers to adequate nutrition. Children were seen in specialty outpatient clinics. Outcome measures Three measurements of weight and length: at the time of surgery and 12 and 18 months after surgery. Statistical analyses Paired t tests of z scores were used to determine catch-up growth. Analysis of variance used variables (age of placement, ambulatory status, prematurity, mode of feeding) to determine statistically significant predictors of growth. Results After gastronomy surgery, catch-up growth was observed in height and weight for children regardless of prematurity or age at the time of gastrostomy placement. Ambulatory children did not achieve catch-up growth, but nonambulatory children did. At 18 months after surgery, catch-up growth occurred in children whose sole source of nutrition was through the gastrostomy, as well as in those who were able to receive nutrition by mouth. Children with a diagnosis of cerebral palsy experienced better growth than children with other diagnoses. Conclusion/application Failure to thrive in children up to age 6.5 years can be corrected when adequate nutrition is provided. Benefits of gastrostomy surgery observed in catchup growth reinforce the importance of medical nutrition therapy., One of the most troubling problems experienced by many children with developmental disabilities is growth retardation, often called failure to thrive (FTT). This term is used to describe infants and [...]

Dry skin and decreased body weight appear to be associated with an increased risk of pressure ulcer development among older patients. Pressure ulcers are also known as bedsores. In severe cases they may cause the skin to break down and the underlying tissue, bone or muscle may be exposed. A total of 286 hospitalized patients aged 55 years or older were examined regularly for pressure ulcers. The patients were examined for a median of nine days. Almost 13% of the patients (37) developed pressure ulcers. Of these, 73% developed pressure ulcers during the first three weeks of hospitalization. Among patients confined to bed or a chair, immobility, dry lower back skin, decreased body weight, the presence of a low-grade (stage I) pressure ulcer and a condition known as lymphocytopenia were all significantly associated with an increased risk of pressure ulcer development., Objective. - To identify specific demographic, medical, functional status, and nutritional characteristics that predict the development of stage 2 or greater pressure ulcers among patients whose activity is limited to bed or chair. Design. - Prospective inception cohort study. Setting. - Tertiary care, urban, university teaching hospital. Patients. - A total of 286 patients fulfilling the following criteria: admitted to the hospital within the previous 3 days, age 55 years or more, expected to be confined to bed or chair for at least 5 days or had a hip fracture, and without a stage 2 or greater pressure ulcer. Main Outcome Measure. - Time to in-hospital development of a stage 2 or greater pressure ulcer. Results. - Total cumulative incidence of pressure ulcers was 12.9% (n=37) after a median time of 9 days from admission to final skin examination. Age of 75 years or more, dry skin, nonblanchable erythema (a stage 1 pressure ulcer), previous pressure ulcer history, immobility, fecal incontinence, depleted triceps skinfold, lymphopenia (lymphocyte count