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Michaels AJ, Michaels CE, Smith JS, Moon CH, Peterson C, Long WB. Outcome from injury: general health, work status, and satisfaction 12 months after trauma. THE JOURNAL OF TRAUMA 2000; 48:841-8; discussion 848-50. [PMID: 10823527 DOI: 10.1097/00005373-200005000-00007] [Citation(s) in RCA: 256] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We evaluated outcomes 12 months after trauma in terms of general health, satisfaction, and work status. METHODS Two hundred forty-seven patients without severe neurotrauma were evaluated by interview during admission and by mailed self-report 6 and 12 months after trauma. Data were obtained from the Trauma Registry, interviews, and survey instruments. Baseline assessment was obtained with the Short Form 36 (SF36) and the Sickness Impact Profile (SIP) work scale. Outcome measures were the SF36, SIP work scale, Brief Symptom Inventory (BSI) depression scale, the Civilian Mississippi Scale for Posttraumatic Stress Disorder (PTSD), and a satisfaction questionnaire. Three regressions were determined for outcome. The dependent variables were general health and work status (linear) and satisfaction (logistic). Each regression controlled for baseline status and mental health, Injury Severity Score (ISS), and 12-month SF36 physical function before evaluating the effect of outcome mental health. RESULTS Follow-up data were available for 75% of the patients at 6 months and 51% at 12 months. The mean age of patients was 37.2 +/- 0.9 years (+/-SEM), and 73% were male. Their average ISS was 13.9 +/- 0.6. Seventy percent of injuries were blunt force, 13.5 % were penetrating, and 16.5 % were burn injuries (mean total body surface area, 13.3 +/- 1.5%). Sixty-four percent of the patients had returned to work at 12 months. Follow-up SF36 mental health was associated with the dependent outcome in each regression. After controlling for baseline status and mental health, ISS, and outcome SF36 physical function, outcome mental health was associated with outcome SF36 general health (p < 0.001), SIP work status (p = 0.017), and satisfaction with recovery (p = 0.005). Outcome SF36 mental health was related to baseline mental health, 12-month PTSD and BSI depression scores, and increased drug and alcohol use. CONCLUSIONS Twelve months after trauma, patients' work status, general health, and overall satisfaction with recovery are dependent on outcome mental health. This dependency persists despite measured baseline status, ISS, or physical recovery. The mental disease after trauma is attributable to poor mental health, the development of symptoms of PTSD and depression, and increased substance abuse. Trauma centers that fail to recognize, assess, and treat these injury-related mental health outcomes are not fully assisting their patients to return to optimal function.
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Lichtenstein GR, Park PD, Long WB, Ginsberg GG, Kochman ML. Use of a push enteroscope improves ability to perform total colonoscopy in previously unsuccessful attempts at colonoscopy in adult patients. Am J Gastroenterol 1999; 94:187-90. [PMID: 9934753 DOI: 10.1111/j.1572-0241.1999.00794.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Total colonoscopy with use of a standard adult colonoscope can be difficult in the presence of a redundant or angulated colon. It is often possible to traverse these areas with the use of a thinner, more flexible endoscope. The objective of this study was to evaluate the efficacy of completing total colonoscopy using a push enteroscope when a standard colonoscope was unsuccessful. METHODS A prospective analysis was performed for 721 consecutive colonoscopies attempted by two gastroenterologists. Those patients in whom complete colonoscopy was unsuccessful using the standard colonoscope (Olympus CF-100L) had attempts to complete colonoscopy using the enteroscope (Olympus SIF-100). The extent of each exam was recorded. Additional pathologic findings discovered by the use of the enteroscope and therapeutic interventions performed were additionally noted. RESULTS Colonoscopy using an enteroscope was performed in 32 patients with successful total colonoscopy in 22 patients (68.7%). Additional pathology was noted in nine patients who had successful complete colonoscopy using the enteroscope; adenomatous polyp (n = 5), adenocarcinoma (n = 1), bleeding source (n = 2), and extent of colitis (n = 1). Total colonoscopy rate using standard adult colonoscope was 93.2% (630 of 676) when cases with poor bowel preparation (n = 23) and obstructing lesions (n = 14) were excluded. When the results of successful colonoscopies with the enteroscope were included, the overall completion rate of total colonoscopy improved to 96.4% (652 of 676). CONCLUSION The use of the enteroscope to help evaluate patients who have had incomplete colonoscopies with the standard colonoscope increases the diagnostic yield of colonic examination.
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Riddick L, Long WB, Copes WS, Dove DM, Sacco WJ. Automated coding of injuries from autopsy reports. Am J Forensic Med Pathol 1998; 19:269-74. [PMID: 9760096 DOI: 10.1097/00000433-199809000-00015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Medical examiners have a unique database about trauma victims, many, if not most, of whom died at the scene or in transit to a hospital and who, thus, never had their injuries documented by trauma surgeons and so never entered into a local or regional trauma registry. These trauma registries have assisted in assessing the magnitude of traumatic injuries in the community and in evaluating the community's emergency medical systems. Without information about those who are dead at the scene or who die in transit, these trauma registries are incomplete and the evaluations based on them inaccurate. The data about the 50% of trauma victims who never enter the medical system are lacking in these registries. Such information is present in the death investigation and autopsy reports in the various medical examiner/coroner offices in the country. To access this important information more easily in trauma registries, an expert computer system was developed. This pilot study presents the results of using that system to gather medical examiner data. Injury descriptions were abstracted from autopsy reports of 50 consecutive nonhospitalized persons fatally injured in Mobile County, Alabama and its environs. Injury descriptions for all cases were successfully coded in International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) and the Abbreviated Injury Scale (AIS-90) by an expert system. For some cases the expert system "requested" and received clarifying information, all of which was present in the medical records. This research demonstrates the feasibility of gathering accurate and consistent information on the estimated 50% of trauma deaths who do not reach a hospital and who are not included in acute care registries. Without data on such patients, our evaluation of trauma systems is incomplete and resources directed at prevention and treatment may be misapplied.
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Lipson DA, Berlin JA, Palevsky HI, Kotloff RM, Tino G, Bavaria J, Kaiser L, Long WB, Metz DC, Lichtenstein GR. Giant gastric ulcers and risk factors for gastroduodenal mucosal disease in orthotopic lung transplant patients. Dig Dis Sci 1998; 43:1177-85. [PMID: 9635604 DOI: 10.1023/a:1018835219474] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Giant gastric ulcers are defined as ulcers with a diameter greater than 3 cm. Previously they have not been described in lung transplant recipients. We report a high incidence of symptomatic giant gastric ulcers and identify the risk factors for ulcer development in these patients. We examined the records of all 95 patients who had undergone lung transplantation at our institution from November 1991 to July 1995. Fourteen of the patients who underwent lung transplantation developed symptoms that required esophagogastroduodenoscopy. Three of these patients (21%) were found to have giant gastric ulcers. The relative risk of giant gastric ulcer in symptomatic patients undergoing endoscopy after lung transplantation is over 40 times that of population controls. The patients who developed giant gastric ulcers, despite H2 antagonist use, had all received bilateral lung transplantation and had received nonsteroidal antiinflammatory drugs, cyclosporine, and high-dose intravenous corticosteroids. The risk of developing giant gastric ulcers is significantly increased in patients who have undergone bilateral orthotopic lung transplantation. Clinicians should be made aware of this complication in order to avoid use of ulcerogenic medications in this population. Avoidance of these medications could potentially minimize the risk of this complication.
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Abstract
The "golden hour" of trauma is based on the principle that severely injured patients are more likely to survive with rapid, appropriate resuscitation and treatment. An inequality exists between sophisticated urban trauma centers and rural/community hospitals in their efforts and abilities to treat severely injured patients. A level I trauma center developed a unique program in an attempt to equalize this inequality--a mobile surgical transport team (MSTT). This article explains the origin of the MSTT, how and why the MSTT is activated, and the roles and responsibility of MSTT members. To further explain the MSTT, two contrasting case studies on trauma patients are presented.
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Faigel DO, Stotland BR, Kochman ML, Hoops T, Judge T, Kroser J, Lewis J, Long WB, Metz DC, O'Brien C, Smith DB, Ginsberg GG. Device choice and experience level in endoscopic foreign object retrieval: an in vivo study. Gastrointest Endosc 1997; 45:490-2. [PMID: 9199906 DOI: 10.1016/s0016-5107(97)70179-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Successful foreign object retrieval may depend on device choice and the experience level of the endoscopist, although these factors have not been systematically evaluated. METHODS In anesthetized pigs, the ability to retrieve foreign objects (metal tack, button disc battery, wooden toothpick) placed endoscopically into the stomach was assessed. Seven university medical center gastroenterology attending physicians (5 clinical and 2 basic science research [BSR]), and 4 fellows-in-training participated. The devices used were the Roth retrieval net, rat tooth forceps, Dormia basket, polypectomy snare, and radial jaw forceps. The time to retrieve each object into an esophageal overtube within a 5 minute maximum was measured. RESULTS Only the Roth net and Dormia basket were successful in retrieving the button disc battery, although the Roth net was superior (100% vs 27%, Fisher p < 0.025). All devices were equally successful at retrieving the tack (82% to 100%, p = NS). The snare was significantly faster than the Roth net (p < 0.05). For the tack, there was significantly fewer difficulties encountered with the snare than the Roth net (Fisher p < 0.03). The Roth net was incapable of retrieving the toothpick; the other devices were equally successful (91% to 100%). The clinical attendings had a significantly higher success rate (95%) than the fellows (82%, chi squared p < 0.05) or combined fellows/BSR attendings (80%, p < 0.02), and were significantly faster than the fellows (p < 0.0002) or the fellows/BSR attendings (p < 0.0003). CONCLUSIONS The Roth net is the best device for retrieving smooth objects such as the button disc battery. For sharp objects, such as the tack and toothpick, best results were achieved with the snare, although the forceps were also effective. More experienced endoscopists had higher success rates and faster retrieval times. Both device choice and the experience level of the endoscopists have an impact on successful foreign object retrieval.
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Faigel DO, Veloso KM, Long WB, Kochman ML. Endosonography-guided celiac plexus injection for abdominal pain due to chronic pancreatitis. Am J Gastroenterol 1996; 91:1675. [PMID: 8759702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kadish SL, Faigel DO, Long WB. Safe duodenoscopic intubation in a patient with a large Zenker's diverticulum. Gastrointest Endosc 1996; 44:101-2. [PMID: 8836732 DOI: 10.1016/s0016-5107(96)70246-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Lemmer JH, Metzdorff MT, Krause AH, Okies JE, Molloy TA, Hill JG, Long WB, Winkler TR, Page US. Aprotinin use in patients with dialysis-dependent renal failure undergoing cardiac operations. J Thorac Cardiovasc Surg 1996; 112:192-4. [PMID: 8691870 DOI: 10.1016/s0022-5223(96)70199-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Perchinsky MJ, Long WB, Hill JG, Parsons JA, Bennett JB. Extracorporeal cardiopulmonary life support with heparinbonded circuitry in the resuscitation of massively injured trauma patients. Resuscitation 1996. [DOI: 10.1016/0300-9572(96)83771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Amygdalos MA, Haskal ZJ, Cope C, Kadish SL, Long WB. Transjugular insertion of biliary stents (TIBS) in two patients with malignant obstruction, ascites, and coagulopathy. Cardiovasc Intervent Radiol 1996; 19:107-9. [PMID: 8662168 DOI: 10.1007/bf02563903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Two patients with pancreatic malignancies presented with biliary obstruction which could not be treated from an endoscopic approach. Standard transhepatic biliary drainage was relatively contraindicated because of moderate ascites and coagulopathy related to underlying liver disease. In one patient, a transjugular, transvenous approach was used to deliver a Wallstent endoprosthesis across the distal common bile duct obstruction in a single step procedure. In the second case, a previously placed biliary Wallstent was revised with an additional stent from a similar approach. Transjugular biliary catheterization offers a valuable alternative approach for primary stent placement or revision in patients with contraindication to standard transhepatic drainage.
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Perchinsky MJ, Long WB, Hill JG. Blunt cardiac rupture. The Emanuel Trauma Center experience. ARCHIVES OF SURGERY (CHICAGO, ILL. : 1960) 1995; 130:852-6; discussion 856-7. [PMID: 7632145 DOI: 10.1001/archsurg.1995.01430080054008] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To analyze the factors affecting outcome in patients with blunt cardiac rupture, including anatomical cardiac injury, associated injury, clinical presentation, age, mechanism of injury, diagnostic method, surgical intervention, and presence of vital signs in the field and on arrival. DESIGN Retrospective review. SETTING A community-based level I trauma center. PATIENTS A consecutive series of 27 patients seen between 1984 and 1993. MAIN OUTCOME MEASURE Survival with return to preinjury activity. RESULTS Eleven patients (41%) survived resuscitation, surgery, and initial hospital care. Survivors had a lower mean Injury Severity Score (38) than nonsurvivors (62) (P < .05). Three (33%) of nine patients who arrived with no blood pressure or viable electrical heart rhythm survived. No patient survived rupture of two cardiac chambers. CONCLUSIONS Patients with blunt cardiac rupture who present with cardiac arrest can survive. Nonsurvivors tend to have more associated injuries, as indicated by higher Injury Severity Scores. Our institution's overall survival rate of 41% (11/27) compares favorably with rates at other trauma centers.
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Herman JB, Levine MS, Long WB. Portal venous gas as a complication of ERCP and endoscopic sphincterotomy. Am J Gastroenterol 1995; 90:828-9. [PMID: 7733099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report a patient in whom portal venous gas occurred as a complication of endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy, presumably because of bleeding at the papilla that allowed gas to enter the duodenal wall and portal venous system. To our knowledge, four similar cases have been reported previously. Although these patients have had a benign clinical course with rapid resolution of the gas, they should be observed carefully for signs of duodenal bleeding or perforation.
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Perchinsky MJ, Long WB, Hill JG, Parsons JA, Bennett JB. Extracorporeal cardiopulmonary life support with heparin-bonded circuitry in the resuscitation of massively injured trauma patients. Am J Surg 1995; 169:488-91. [PMID: 7747825 DOI: 10.1016/s0002-9610(99)80201-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Patients who have massive but potentially survivable injuries frequently die from complications of hypovolemia, hypoxemia, hypothermia, metabolic acidosis, and coagulopathy. Emergency cardiopulmonary bypass has been unsuccessful in preventing such deaths because it involves systemic anticoagulation that exacerbates coagulopathy. PATIENTS AND METHODS A simplified extracorporeal cardiopulmonary life support (ECLS) system was assembled consisting of a centrifugal pump head, heat exchanger, membranous oxygenator, percutaneous cannulas, and heparin-bonded circuitry. The entire system has heparin-bonded surfaces. Patients were resuscitated with the system after femoral vein-femoral artery cannulation. ECLS was used to resuscitate massively injured patients who were deteriorating despite maximal conventional therapy. RESULTS While receiving maximal conventional therapy, 6 patients developed hypothermia, metabolic acidosis, and coagulopathy causing pulmonary hemorrhaging and hypoxemia from severe underlying lung injuries. ECLS with heparin-bonded circuitry provided cardiopulmonary support and rewarming while physicians addressed coagulopathies and surgical bleeding and assessed survivability. Three patients survived. CONCLUSIONS ECLS with heparin-bonded circuitry offers supplemental capability in the resuscitation and cardiopulmonary support of selected massively injured patients while their primary injuries are being evaluated and treated.
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Khandelwal M, Lichtenstein GR, Morris JB, Furth EE, Long WB. Abdominal lymphangioma masquerading as a pancreatic cystic neoplasm. J Clin Gastroenterol 1995; 20:142-4. [PMID: 7769196 DOI: 10.1097/00004836-199503000-00015] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Lymphangiomas are congenital abnormalities of the lymphatics that occur predominantly in the head and neck, most often in children. We present an unusual case of a middle-aged man who had a large septated cystic lesion adherent to the pancreas that could not be differentiated from a pancreatic cystic neoplasm despite analysis by ultrasound, computed tomography, magnetic resonance imaging, or percutaneous needle aspiration. The correct diagnosis was established only via laparotomy and subsequent pathologic interpretation. Although lymphangiomas are rare, they should be included in the differential diagnosis of pancreatic cystic neoplasms.
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Perchinsky MJ, Long WB, Urman S, Borzotta A. 'The broken halo sign': a fractured calcified ring as an unusual sign of traumatic rupture of the thoracic aorta. Injury 1994; 25:649-52. [PMID: 7829186 DOI: 10.1016/0020-1383(94)90005-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Two elderly patients, involved in separate motor vehicle accidents, sustained blunt chest injury resulting in rupture of their thoracic aortas. The initial chest radiographs showed the presence of a calcified ring fractured in two places with lateral displacement of a calcified fragment by haematoma. This 'broken halo sign' is a radiographic sign not previously well described in the literature. The presence of a disrupted aortic ring in the elderly patient, associated with the appropriate mechanism of injury, should alert the clinician to the potential diagnosis of traumatic rupture of the thoracic aorta (TRTA).
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Long WB, Sacco WJ, Copes WS, Lawnick MM, Proctor SM, Sacco JB. An evaluation of expert human and automated Abbreviated Injury Scale and ICD-9-CM injury coding. THE JOURNAL OF TRAUMA 1994; 36:499-503. [PMID: 8158710 DOI: 10.1097/00005373-199404000-00007] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Two hundred ninety-five injury descriptions from 135 consecutive patients treated at a level-I trauma center were coded by three human coders (H1, H2, H3) and by TRI-CODE (T), a PC-based artificial intelligence software program. Two study coders are nationally recognized experts who teach AIS coding for its developers (the Association for the Advancement of Automotive Medicine); the third has 5 years experience in ICD and AIS coding. A "correct coding" (CC) was established for the study injury descriptions. Coding results were obtained for each coder relative to the CC. The correct ICD codes were selected in 96% of cases for H2, 92% for H1, 91% for T, and 86% for H3. The three human coders agreed on 222 (75%) injuries. The correct 7 digit AIS codes (six identifying digits and the severity digit) were selected in 93% of cases for H2, 87% for T, 77% for H3, and 73% for H1. The correct AIS severity codes (seventh digit only) were selected in 98.3% of cases for H2, 96.3% for T, 93.9% for H3, and 90.8% for H1. On the basis of the weighted kappa statistic TRI-CODE had excellent agreement with the correct coding (CC) of AIS severities. Each human coder had excellent agreement with CC and with TRI-CODE. Coders H1 and H2 were in excellent agreement. Coder H3 was in good agreement with H1 and H2. However, errors among the human coders often occur for different codes, accentuating the variability.(ABSTRACT TRUNCATED AT 250 WORDS)
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Long WB, Sacco WJ, Coombes SS, Copes WS, Bullock A, Melville JK. Determining normative standards for functional independence measure transitions in rehabilitation. Arch Phys Med Rehabil 1994. [DOI: 10.1016/0003-9993(94)90386-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Long WB, Sacco WJ, Coombes SS, Copes WS, Bullock A, Melville JK. Determining normative standards for functional independence measure transitions in rehabilitation. Arch Phys Med Rehabil 1994; 75:144-8. [PMID: 8311669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We present a method for determination of normative standards for Functional Independence Measure (FIM) transitions in rehabilitation. Data from 230 consecutive brain-injured patients treated before 1991 were used to characterize transitions in patient FIM values between admission and discharge. The pre-1991 average and standard deviation FIM transitions, computed as a function of admission values, are used as standards ("norms") for comparing rehabilitation transitions among institutions or in one institution over time (say, yearly) and for identifying patients with striking transitions, believed worthy of audit. The evaluation method requires the computation of two statistics, z and W, which compare the actual transitions for patients of one time period (in this instance the 1991 patients) to the expected transitions as computed from the pre-1991 norms. The z and W values indicated that 1991 transitions were neither statistically nor clinically different from pre-1991 ones. Also introduced in the paper are the concepts of Mean Gain, Ideal Gain, and the ratio Mean Gain/Ideal Gain. Ideal Gain is the greatest possible "aggregated" transitions score for a study patient set and the ratio Mean Gain/Ideal Gain may be interpreted as "the degree of ideal rehabilitation transitions achieved."
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Bennett JB, Hill JG, Long WB, Bruhn PS, Haun MM, Parsons JA. Interhospital transport of the patient on extracorporeal cardiopulmonary support. Ann Thorac Surg 1994; 57:107-11. [PMID: 8279874 DOI: 10.1016/0003-4975(94)90375-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Portable extracorporeal cardiopulmonary support systems have enhanced the resuscitation and support of moribund patients outside of the operating room environment. The literature documents the successful application of emergency cardiopulmonary support within the hospital setting. Clinicians have reported the use of helicopter and ground ambulance to transport patients requiring intraaortic balloon counterpulsation and fixed-wing transport of neonates requiring extracorporeal membrane oxygenation. As medical transport capabilities extend the sphere of tertiary care to outlying medical facilities, there is a role for extracorporeal cardiopulmonary support in the initial stabilization and safe transport of critically ill patients, via air or ground ambulance. Potentially, the early application of life-sustaining technology can lower mortality and morbidity in patients with a survivable pathology. This is a report on the experience with the resuscitation and interhospital transport of patients on extracorporeal cardiopulmonary support.
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Bennett JB, Hill JG, Long WB. Considerations for inter-hospital extracorporeal cardiopulmonary support resuscitation and transport. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 1993; 26:79-86. [PMID: 10147373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The availability of commercial, pre-packaged extracorporeal cardiopulmonary support (ECPS) circuits, which are simplified for rapid set-up and priming, has made the intra-hospital resuscitation of moribund patients routine. The successful utilization of this technology in the emergent setting requires planning and the coordination of personnel familiar with the technology. Many issues must be addressed when a patient requiring life-sustaining support utilizing this technology at an outlying hospital, must be transported while on ECPS. After reducing the size and weight of the ECPS cart and obtaining Federal Aviation Administration approval for use during aeromedical transport, the Emanuel Hospital Mobile Surgical Transport Team (MSTT) was able to extend the use of emergency cardiopulmonary bypass to outlying medical facilities. The patients selected for transport, using ECPS, are a group of patients with a potentially survivable pathology unlikely to survive inter-hospital transport without such measures. This report describes our experience with inter-hospital transport of patients on ECPS with special emphasis on transport considerations.
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Kiesow LA, Simons CT, Long WB. Quantitative determination and comparison of ethanol in saliva samples of unknown volumes with blood ethanol levels in human test subjects following ethanol ingestion. Ann N Y Acad Sci 1993; 694:293-5. [PMID: 8215070 DOI: 10.1111/j.1749-6632.1993.tb18368.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Auteri AG, O'Brien CB, Long WB, Malet PF. Submucosal gastric hemorrhage following extracorporeal shock wave lithotripsy of bile duct stones. Gastrointest Endosc 1991; 37:486-7. [PMID: 1916178 DOI: 10.1016/s0016-5107(91)70790-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Silfen D, Long WB, Alavi A. The role of hepatobiliary imaging in the evaluation and management of patients with common bile duct gallstones. J Nucl Med 1991; 32:1261-5. [PMID: 2045944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Baggott BB, Long WB. Annular pancreas as a cause of extrahepatic biliary obstruction. Am J Gastroenterol 1991; 86:224-6. [PMID: 1992639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Annular pancreas is a rare congenital abnormality that is increasingly diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) in the adult. In this population, it can present with duodenal or gastric ulceration, duodenal obstruction, pancreatitis, and, rarely, with associated congenital abnormalities. Although it has been suggested that biliary obstruction may result from associated pancreatitis, such cases have not been reported; primary extrahepatic biliary obstruction from a constricting annulus also has not been reported. We report such a case, and describe resolution of symptoms and a return to normal biochemical tests in a patient. The literature and embryology of annular pancreas are reviewed. We suggest that this entity be added to the differential diagnosis of extrahepatic biliary obstruction.
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