Alcoholism at the time of injury among trauma center patients: Vehicular crash victims compared with other patients

A structured in-depth interview employing standardized criteria was used to determine the prevalence of lifetime and current alcohol dependence (alcoholism) in unselected consecutive patients admitted to a regional Level I trauma center. Of 629 patients, 157 (25.0%) were current alcoholics at the time of injury. An additional 87 (13.8%) were diagnosed as lifetime non-current alcoholics. There was no significant difference in the rates of current alcohol dependence among patients injured in vehicular crashes (23.5%), other unintentional trauma victims (29.3%), and those injured as a result of violence (24.6%). Of BAC + (blood alcohol concentration positive) patients, 54.5% were current alcoholics. However, 14.4% of alcohol-negative patients were also diagnosed as alcohol dependent.     

Factors affecting the ambulance response times of trauma incidents in Singapore

ObjectivesTime to definitive care is important for trauma outcomes, thus many emergency medical services (EMS) systems in the world adopt response times of ambulances as a key performance indicator. The objective of this study is to examine the underlying risk factors that can affect ambulance response times (ART) for trauma incidents, so as to derive interventional measures that can improve the ART.Material and methodsThis was a retrospective study based on two years of trauma data obtained from the national EMS operations centre of Singapore. Trauma patients served by the national EMS provider over the period from 1 January 2011 till 31 December 2012 were included. ART was categorized into “Short” (<4 min), “Intermediate” (4–8 min) and “Long” (>8 min) response times. A modelling framework which leveraged on both multinomial logistic (MNL) regression models and Bayesian networks was proposed for the identification of main and interaction effects.ResultsAmongst the process-related risk factors, weather, traffic and place of incident were found to be significant. The traffic conditions on the roads were found to have the largest effect—the odds ratio (OR) of “Long” ART in heavy traffic condition was 12.98 (95% CI: 10.66–15.79) times higher than that under light traffic conditions. In addition, the ORs of “Long ART” under “Heavy Rain” condition were significantly higher (OR 1.58, 95% CI: 1.26–1.97) than calls responded under “Fine” weather. After accounting for confounders, the ORs of “Long” ART for trauma incidents at “Home” or “Commercial” locations were also significantly higher than that for “Road” incidents.ConclusionTraffic, weather and the place of incident were found to be significant in affecting the ART. The evaluation of factors affecting the ART enables the development of effective interventions for reducing the ART.     

A decision support tool for allocating hospital bed resources and determining required acuity of care

Limitations in health care funding require physicians and hospitals to find effective ways to utilize resources. Neural networks provide a method for predicting resource utilization of costly resources used for prolonged periods of time. Injury severity knowledge is used to determine the acuity of care required for each patient and length of stay is used to determine duration of inpatient hospitalization. Neural networks perform well on these medical domain problems, predicting total length of stay within 3 days for pediatric trauma (population mean and S.D. 4.37±45.12) and within 4 days for acute pancreatitis patients (7.75±79.19).     

Wrist motion in computer keyboard typing

The purpose of this study is to define how wrist motion is affected by different postures and supporting devices and to discover functional range of wrist motion for keyboard typing. The range of wrist motion (ROM) needed for fourteen experienced typists to type on a computer keyboard was measured by flexible and biaxial electrogoniometers. The most frequent wrist motion during typing was in extended and ulnarly deviated positions in both wrists. Range of wrist motion was similar in both wrists. The average ROM for keyboard typing with the typists’ own posture was about 39° in flexion/extension (FEM) and 29° in radial/ulnar deviation (RUD) in both wrists. The range of wrist motion was significantly reduced to 30° in FEM and 27° in RUD with use of either wrist or forearm supporting devices, which suggests that these devices might help to relieve fatigue, discomfort, or pain during and/or after typing. Results of this study will be of interest to clinicians and helpful to those who are professionally or nonprofessionally involved in typing.     

Thermal trauma resulting from motor vehicle operation or maintenance

Burn injury may result from the operation or maintenance of motor vehicles. We reviewed the experience of one burn center with injuries related to motor vehicle use over the 6 year period 1987–1992. One hundred and fifty patients with motor vehicle related burns were identified comprising 11.3% of all admissions for this period. The mean extent of burn injury was 22.8% total body surface area with a mean full thickness (third degree) burn size of 11.7%. The average hospital length of stay was 42.41 days. The most common mechanisms of injury were collisions resulting in fire (n = 48), carburetor priming (n = 37) and scalding from radiator fluid contact (n = 27). Burns resulting from vehicle operation or maintenance are costly and potentially preventable.     

Drug and alcohol use among drivers admitted to a Level-1 trauma center

The purpose of this research was to determine the incidence and prevalence of drug use, alcohol use, and the combination of drug and alcohol use among motor vehicle crash (MVC) victims admitted to a Level-1 trauma center. In a 90-day study, nearly two-thirds of trauma center admissions were victims of motor vehicle crashes. Blood and urine was collected from 168 MVC victims of whom 108 were identified as the driver in the crash. Toxicology results indicated that 65.7% of drivers tested positive for either commonly abused drugs or alcohol. More than half of the drivers tested positive for drugs (50.9%) other than alcohol, with one in four drivers testing positive for marijuana use. About one-third of those using drugs had also been drinking, but alcohol was detected in only 30.6% of all injured drivers. Within the total MVC patient pool, passenger drug/alcohol use was equivalent to the driver population; however, injured pedestrians had higher rates of alcohol only than other MVC victims. There were no significant differences in drug and alcohol use between MVCs and trauma admissions of other causes. Of the patients with positive toxicology results, less than half (42%) were referred for evaluation for substance abuse disorders.     

关于生物固体力学

本文综述了20年来生物固体力学的研究与发展,包括肌肉骨骼系统,创伤,感觉系统,视觉系统,泌尿和生殖系统的生物力学。本文是应国家自然科学基金委员会生命科学部要求撰写的。     

The utility and comparative incremental validity of the MMPI-2 and Trauma symptom Inventory validity scales in the detection of feigned PTSD.

The authors examined the comparative predictive capacity of the Trauma Symptom Inventory (TSI) Atypical Response Scale (ATR) and the standard set of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) fake-bad validity scales (i.e., F, FB, Fp, FBS) to detect feigned posttraumatic stress disorder (PTSD). Remitted trauma victims (n = 60) completed the TSI and MMPI-2 under standard (honest) instructions and then were randomly assigned to 1 of 2 experimental conditions (noncoached/validity scale coached) in which they were administered these instruments again with instruction to fake PTSD. These test protocols were compared with TSI and MMPI-2 results from workplace injury claimants with PTSD (n = 84). The ATR and FBS were able to distinguish only the noncoached participants instructed to fake from the PTSD claimants; in contrast, the F, FB, and Fp scales were able to distinguish both the noncoached and the validity-scale-coached participants from the PTSD claimants. F, FB, and Fp always outperformed the ATR and FBS; neither the ATR nor the FBS was able to add incremental predictive variance to that of F, FB, or Fp. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adaptation and validation of the Spanish-language Trauma Symptom Inventory in Puerto Rico.

Objective: This research was conducted to assess the Spanish-language Trauma Symptom Inventory's (Briere, 1995) suitability for use with a Puerto Rican sample. Minor revisions were made to the original instrument following a comprehensive appraisal involving a bilingual committee and pilot focus group. The present study outlines the review and adaptation process and examines the psychometric properties of the revised instrument, the Inventario de Síntomas de Trauma-Revisado (IST–R). Method: A sample of 225 students (155 women, 70 men) at the University of Puerto Rico, age 20 to 59 (M = 23.24, SD = 4.69), participated in the validation study. Participants completed a demographic questionnaire; a self-report trauma exposure instrument; and measures of psychological distress, including Spanish-language versions of the Beck Depression Inventory, Symptom Checklist—36, and the Dissociative Experiences Scale. Results: Reliability coefficients for the IST–R clinical scales ranged from .69 to .91 (mean α = .84), and correlation coefficients were strongest for scales measuring the same constructs. Factor loadings obtained were consistent with those reported in the literature. Results support the internal consistency and construct validity of the IST–R. Conclusions: Culturally and linguistically appropriate assessment instruments are needed to address the mental health needs of diverse populations. Results from this study provide evidence for the clinical and research promise of the IST–R as a screening tool for trauma-related symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)