ABO blood groups do not predict progression of traumatic intracranial hemorrhage

ABO blood groups are associated with genetically predisposed variations in von Willebrand factor (VWF) resulting in higher risks of thrombotic events in non-O blood types and bleeding complications in blood type O. The role of ABO blood groups in progression of traumatic intracranial hemorrhage (TICH) is unknown. Given statistically lower VWF levels in blood type O in the general population, we hypothesized that blood type O patients have a higher risk of such progression. A retrospective review of adult trauma patients with isolated TICH admitted to a Level 1 trauma center over eight years was conducted. Patients were categorized with blood type O and non-O (types A, B, AB) delineation. The primary outcome was radiological progression of TICH during the first 24 h. Secondary outcomes included surgical intervention after follow-up computed tomography (CT), complications, days on mechanical ventilation (DMV), intensive care unit (ICU) length of stay (LOS), hospital LOS, and mortality. Of 949 patients, 432 (45.5%) had blood type O. When comparing O and non-O groups, no significant differences were found in gender, age, race, admission vital signs, Glasgow Coma Scale, coagulation profile, TICH type, or Injury Severity Score. No difference in TICH progression was found between O and non-O groups: 73 (17%) vs 80 (15%), respectively, p = 0.55. Blood type O mortality was 12 (3% vs. 23 (4%), p = 0.174). Rate of TICH surgical intervention after follow-up CT, DMV, complications, and ICU and hospital LOS did not differ. No association between ABO blood types and radiological progression of TICH was identified.

Evidence-Based Considerations and Recommendations for Athletic Trainers Caring for Patients With Attention-Deficit/Hyperactivity Disorder

CONTEXT

Patients with attention-deficit/hyperactivity disorder (ADHD) can be noncompliant, impulsive, and disruptive in an athletic training or physical rehabilitation facility. Athletic trainers (ATs) are valuable and essential health care providers for active patients with ADHD. However, for a patient with ADHD to have a successful outcome in a busy athletic training environment, the AT or health care provider must tailor the treatment setting to the patient's needs.

OBJECTIVE

To educate and raise awareness among ATs about patients with ADHD and to provide ATs with strategies and tools that will allow them to treat patients with ADHD more effectively.

DATA SOURCES

We retrieved and reviewed articles from PubMed, PsychINFO, and Ovid without date restrictions. Search words were attention deficit hyperactivity disorder plus 1 of the following topics or search words: athletic training, athletics, coaching, sport, or sport psychology.

STUDY SELECTION

Any ADHD articles that were not applicable or translatable in good faith to athletic training, physical rehabilitation, or sport and exercise were excluded.

DATA EXTRACTION

Nonpharmacologic interventions were reviewed and amassed into categories from which the recommendations were created. No statistical analyses were conducted for this review.

DATA SYNTHESIS

We identified 1241 articles, and 86 met the inclusion criteria. Five groups of evidence were observed: (1) goal setting and coaching, (2) reinforcements and outcomes, (3) routines and treatment timing, (4) simplified feedback and instructions, and (5) environmental control. Reliable evidence suggests that these techniques can be translated and applied within an athletic training and physical rehabilitation setting.

CONCLUSIONS

Athletic trainers are a vital component in providing health care for patients with ADHD. Using goal contagion creates a structured environment and positive reinforcements that accommodate patients with ADHD. Furthermore, ATs may use the evidence-based recommendations in this review to create a treatment and physical rehabilitation program and space that are tailored to the needs of the ADHD patient to increase the chance of a successful outcome.

Discussion of the controversies associated with prostate cancer screening

Early detection of prostate cancer through screening seems to provide the best hope of control or possibly cure of the disease. Unfortunately, controversy and confusion surround the screening guidelines. Specifically, the controversy involves whether the screening of asymptomatic men, particularly those under age 50, should be recommended. To date, there have been no randomised clinical trials which have demonstrated that screening for prostate cancer reduces mortality or increases life expectancy. The lack of evidence regarding the benefits of prostate screening and the risk of adverse effects make it important for clinicians to provide information to interested patients regarding the possible consequences before they take part in screening endeavours. Other health care professionals must be proactive in becoming informed about the entire prostate screening issue.

Problems experienced by residents in internal medicine training

A review of the literature and the experience of a residency program in internal medicine indicate that house officers have special problems during training. Some are shared by all residents, whereas others are unique to certain groups. These problems are caused by historical and cultural factors that have led to the current structure of many residency programs and often interfere with the parallel development of professional, personal and family growth. Program directors and chiefs of service need to be flexible and humane and should negotiate clear expectations with house staff to allow efficient functioning of the residency program and insightful personal growth.

Graduate medical education in an HMO: an internal medicine residency program

Graduate medical education in the setting of a large health maintenance organization (HMO) is a challenging enterprise with surmountable problems and tangible rewards. Ten years ago an independent residency program in internal medicine was begun at one of the largest medical centers in the Kaiser-Permanente Medical Care Program in Northern California. The residency program, at the Kaiser-Permanente Medical Center in Santa Clara, is described and compared with other graduate medical programs. Included are discussions of curriculum development, faculty, funding, medical school affiliation, and the role of HMOs in graduate training.